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Introduction Our Story Surgery Options Management Links Update Making Contact
Management Drug Treatments Role of Specialists Diet Hyperbaric Oxygen News
With “rapid transit” a major everyday problem, her GP prescribed Codeine Phosphate, utilising its constipating side effect. This relatively simple action fairly early in 1995, made a tremendous difference increasing confidence etc, for which she was very grateful. If an obstruction attack is indicated (by tell-tale pain initially), she stops the Codeine Phosphate until the obstruction has passed, then recommences only when confident it is safe to do so.

However, attacks of pain and vomiting (obstructions) were increasingly frequent by the later 1990's. So she felt that every avenue had to be explored, and with surgery ruled out, felt the time had come to draw a line under it and concentrate on management of the condition. 

She continues to see her consultant oncologist who treated her initially, and who has been so willing to suggest and prescribe medication to help manage the attacks and refer on as necessary. Dextromoramide was used for severe pain. Unfortunately this became unavailable, so Buprenorphine sublingual (Temgesic) was tried in Oct 2005. Buphenorphine is easy to take as it dissolves under the tongue, so no need for water when vomiting is likely or going on. But it was not nearly as good as Dextromoramide.

In 2001 Janice was referred by her oncologist to a gastroenterologist with a special interest in fibrosis resulting from radiotherapy. He carried out a series of tests and scans initially, so he knew exactly what he was dealing with. His suggestions included some interesting ideas, such as Hyperbaric Oxygen Treatment (HBO). Both HBO and a drug called Pentoxifylline can help to reduce fibrosis.

This Consultant was very keen for Janice to try these, but starting with antibiotics. If this was unsuccessful, Pentoxifylline, which is designed to improve blood flow to damaged areas and licensed for peripheral vascular disease and venous ulceration would be tried.

She did not opt for the Hyperbaric Oxygen Treatment for various reasons.

Drug Treatments Drug Treatments Role of Specialists Diet Hyperbaric Oxygen
Codeine Phosphate has been mentioned already and is very effective at slowing "rapid transit". It is purely for symptomatic relief and does nothing to reverse the damage of course. People might find other medications for diarrhoea, like Imodium, better. Bile acid malabsorbtion might be diagnosed as the reason, and if so there are bile acid sequestrants that can be prescribed by a gastroenterologist.

Pentoxifylline (PTX) and alpha-tocopherol (vit-E) is different. It has been trialled and used in various centres. The links below give some more information on this regime.
This link suggests beneficial effects of the above regime and is a Phase II double blind, placebo controlled, randomised trial for bowel symptoms after radiotherapy. Janice was not able to take part in the trial, but was permitted the drug regime (Pentoxifylline and Alpha-Tocopherol), so at least she knew it was not the placebo.

Click here for the full text of an article describing the striking regression of radiotherapy damage in a clinical trial using PTX and vit-E from a source in Paris in 1999.
Pentoxifylline/vitamin E
As the antibiotic treatment was ineffective, Janice started PTX + vit-E in February 2002. This had been shown to have a reversing effect on fibrosis following radiotherapy for breast cancer according to trials carried out by the Royal Marsden Hospital and others, though the effect on the bowel was unknown at this time. Initially it appeared to have no effect on Janice, indeed she was hospitalised with a series of attacks in July 2002 requiring rehydration, morphine and a gastric nasal tube.

Undeterred, she continued with PTX + vit-E, as she had been advised that the process of fibrosis reversal, if it was going to work at all, would be very slow. Until recently it had been thought that fibrosis was irreversible, but this is not the case, as these drug trials, and other therapies such as hyperbaric oxygen have indicated. Janice had been free of these major attacks since July 2002, but unfortunately, Christmas 2002 was ruined by a prolonged attack, though not hospitalised.

Optimism remained, however, as the attacks had formerly been so frequent, so maybe the drugs were having the intended effect. There seemed to be no other reason for it. See Update page for history and to date.

Role of Specialist Drug Treatments Role of Specialists Diet Hyperbaric Oxygen
It is very important that people suspected of having radiation damage, with substantial problems such as faecal or urinary leakage, bowel blockages that occur regularly, bleeding, inability to retain weight, or anything unusual, should be referred to a specialist who has a special interest in radiotherapy injuries. For damage to the bowel as a result of radiotherapy to the pelvic area, this will usually be a gastroenterologist, but does need to be someone with a specialist interest in radiation diseases. If the problems are principally bone related such as osteoradionecrosis then perhaps a different specialist is appropriate.

The more that people come forward with these problems, rather than suffer in silence, the more widely this will be acknowledged by GPs and other disciplines within the medical profession, thus enabling more resources to be directed to this area. Despite the fact that survival rate has much improved, currently  there are few doctors, even worldwide, dedicated to this speciality.

An abstract of an article gives an indication of how gastrointestinal symptoms should be diagnosed and treated. It is to be noted that symptoms can easily be incorrectly attributed to other disorders and therefore any treatments given are likely to be ineffective.

Please go to our
Links page for many more links to articles on work being done.

Your specialist will be able to refer you to a specialist dietician who can help with eating problems that people encounter with pelvic damage, and prescribe supplements to replace vitamins and minerals.

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Introduction Our Story Surgery Options Management Links Update Making Contact Updated 26 May 2014 Document made with KompoZer

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