Topic: Drainage of ascites/low blood pressure

Hello all.  As I said in my previous post, my husband is not doing very well but we are trying to make him as comfortable as possible.  I'd appreciate any advice you might have on a couple of issues.
First, he had ascites drained twice and the decision was made to insert a permanent drain.  Unfortunately, due to high amonia, the effects of anesthesia, and pain medication, he tore the drain out the same night and the doctor doesn't want to try it again.  However, the liquid in the abdomen is currently draining through the hole where the drain was into an ostomy bag and this seems to solving the problem for the moment.  Has anyone else experienced anything like this? 
Second, he is experiencing low blood pressure which drops when he stands, making him dizzy.  The doctor says this is due to the compression caused by the tumors and there is nothing that can be done about it.  Has anyone else had this problem and were they able to address it in any way?
As always, thanks for any help you can provide.

Re: Drainage of ascites/low blood pressure

Linda,
This is a difficult situation and I'm sure you are just putting one step in front if the other to get through it.  I can't help with medical advice but do know that when fluid drains too fast from ascites it can cause low BP and other issues. Sounds like comfort and his safety (from falling) are the biggest concerns at this stage. When my father was passing last year from a Alzheimers he kept pulling out his urinary catheter over and over, causing himself pain and trauma. They surgically placed a suprapubic catheter through his lower abdomen as an alternative but he eventually pulled that out too. Once hospice was on board, it took a few days to get meds dialed in so that he was not agitated. Simply ask if you don't feel he is getting all he needs and on schedule.
May God Bless you with strength and surround you with love,
Willow

Willow

Re: Drainage of ascites/low blood pressure

Linda -
We have experienced similar with the drain but not the biliary drain. Mark has his surgical drain pulled at DC because they thought it was done draining. Instead it was plugged and when  they pulled it out, all his surgical drainage and ascites drained out through that hole then eventually started draining through a small surgical site. It was ugly for awhile. I too used a ostomy bag, we used a urostomy bag which is designed to urine rather than bowel so the drain is better and easier to deal with you. We utilize a Home supply place called Byram Healthcare. They are very easy to work with and will contact doctors for orders and bill your insurance....if you aren't already hooked up with the a supplier.

His low blood pressure may be related to a variety of things. I would make sure that he is drinking plenty of fluids, ascites and draining ascites can cause some dehydration. Sometimes Gatorade or other sports drink can help too. He may be losing sodium and potassium which can aggravate the low blood pressure. The sports drink will help.

There are lots of things to assist with the confusion, agitation and the elevated ammonia levels. If you are not using lactulose then I would ask for that. It will help pull the ammonia out in the bowels. Also you may ask doctors for some sort of anti-psychotic medications - something like risperidal, Haldol or Seroquel. They sound scare but they really well help.

Hope this helps.

KrisV

Any advice given is based on my experiences and should not be substituted for any medical recommendations. Please speak with your provider before making any changes.

Re: Drainage of ascites/low blood pressure

Thank you Willow and Kris for the helpful responses.  They have put him on Lactulose and it is helping a great deal.  His amonia has decreased from 115 to 49 and his memory and lucidity are greatly improved.  At my request they have taken him off Dilaudid as it seemed to cause very vivid dreams that resulted in confusion.  Fortunately he has only mild pain at this point that is easily controlled by milder forms of pain relief.  I hadn't thought about the possible relationship between draining the ascites and the lower blood pressure but that may be part of the problem.

Re: Drainage of ascites/low blood pressure

Linda,

Can't add much to what has already been said, but am glad things have been done to improve things for your husband.   Take care & know I am thinking of you.

Love & Hugs,
Darla

"One Day At A Time"

All of my comments and suggestions are just my opinions and are not a substitute for professional medical advice.   You should always seek the advice of your physician or other qualified health care providers.