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OK so here goes nothing…


My dad is currently being seen by a myriad of specialists. He has a pulmonologist, neurologist, ENT, geriatrics and as of yesterday a G.I. doctor. He’s a multiple stroke victim who has COPD and is still smoking. He’s got major issues with his appetite and hunger but he is still eating, although not as regularly as we’d like. He was just seen by a nutritionist/dietitian. This man is 5‘11“ and over the past year went from 160 pounds to 117 pounds. We cannot seem to target exactly where the weight-loss is coming from. He has been given just about every single blood test there is and he has been scoped by the ENT and had a brain scan for the neurologist. Everything comes back clear. He also has a small amount of fluid in the pleura around his lung that was just drained, sent out and came back and it was negative of any suspicious or cancerous cells. The other thing that we are concerned about. Very concerned about! Is that it could be colon cancer. His dad had colon cancer at age 73 and he is age 71. The thing is that the doctor was very upset that he is just now seeing him. That we waited this long before going to a GI specialist. The thing is we were going to so many specialists that this is the very first time we were ever even referred to them or thought about going to a GI Doctor. I think we just felt like we were covering every base we could and apparently we weren’t. The scary part about all of this is that if we don’t find anything after the colonoscopy or endoscopy where does that leave us? He still wants to know why he’s not gaining weight. Does anyone have any other suggestions or doctors in mind? We are completely baffled as to why he is losing so much weight and so quickly. More weight he loses the harder it makes for him to get up and do anything. And so it’s a catch 22 for sure! Please if anyone has any suggestions or ideas on what we might be missing we would really appreciate it. Time is of the essence. Thank you!!

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They don’t want to do the whole Warfarin/Lovenox thing. This isn’t Coumadin that he’s on, it’s Plavix. Which makes things a bit more difficult because the studies about Plavix when it comes to this aren’t as in depth as something like Coumadin. At the same time he seems to want to go through with it. However, after talking with my best friend who is a nurse that cares for geriatrics she is very concerned that this will be extremely difficult on him. I had no idea how hard the prep was until I talked with her. When she described it to me I was shocked. I had. I idea it liquifies everything. He can’t get up and run to a bathroom like a normal person. We now know we’ll have to at least get a bedside commode, diapers and wipes. His G.I. doctor never described the prep to us as much at all. He basically said, you drink a bunch of stuff at 10 and then again at 2 am. It will clean you out and then you’ll come in for the procedure. I asked for other alternatives like admitting him to a hospital the night before prep and he said they don’t do that for insurance won’t cover it. So I asked him how we’re supposed to handle this and they said, “Do the best you can.” I’m terrified of how that night is going to go. Wondering if we’ll end up having to call an ambulance if my dad were to pass out from exhaustion or something. And then it will be all for nothing. I know this is more like a rant, but if anyone has any ideas please let me know. He doesn’t sound sure of what he would do if they found cancer. I don’t think he even knows. I at least want them to do the endoscopy. A lot of this with hunger is that he gets nauseous and says his stomach hurts. An endoscopy wouldn’t involve any prep. But I understand they want to do the colonoscopy because there is a family history with his dad dying of colon cancer around the same age.
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Mandolina, the blood thinning medication wouldn't be stopped entirely; it would be substituted. Warfarin/coumadin would be substituted with either Heparin or Lovenox, both of which are faster acting than Warfarin, so he could still get the benefit of an anticoagulant. Heparin might be given for a few days and Lovenox on the last few days.

Raise this issue with whoever is prescribing the Warfarin. In my experience Lovenox is expected to be self administered. It's just an injection but either your father or you might have to do it. I couldn't do it for my father; I'm just not good at that sort of thing.

JoAnn raises good points about the challenges of a colonoscopy on someone who's frail. And Shad also raises the issue of cancer and weight loss. I think these are both factors to consider in going forward with a colonoscopy.

It will be hard on your father; he'll be very weak by the time he goes through the partial fast and prep.

I think the other issue to consider is that if he does have cancer, does he want to go through chemo and/or radiation?
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My dad is 71. Although his pulmonologist says he’s a 71 year old in the body of a 91 year old. So that’s what scares me. My dad is also on blood thinner and they would have to stop the blood thinner for five days prior to the procedure therefore increasing the risk of stroke. That is what scares me the most next to prep. I’m not sure what to do. Ultimately it’s my dad’s call. But he’s acting like he wants me to make the decision for him. I told him to please not make me do that. He told me I’m the “smarts of the operation” and so he needs help deciding what to do. Of course I’ll help him make the most educated decision, but ultimately I feel it’s up to him.
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Unfortunately he may have cancer. Unexplained weight loss could be a cause as well as if he is fatigued since the cells drain the body's energy. 
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How old is Dad? I ask because I wouldn't do a colonoscopy on an elderly person. There are tests (the advertisement is a little box in a bathroom) that can be done to see if cancer cells are present. With Dads weight lost, I would not put him thru the day before stuff that has to be done. They have to be able to drink a lot of this liquid that they are given. Then they go all day. They r only allowed Gatorade and jello to eat. And if you find cancer I doubt if he can go thru the surgery. If the GI doctor insists on a colonoscopy then I would talk to his other doctors for their opinion. With his lung problems not sure if he can go under. And please do not feel guilty about not getting him there in time. Colon cancer is a quiet cancer. Healthcare is like a car. The mechanic fixes what he thinks is wrong and thats not it. So he tries something else, thats not it. Its trial and error.
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