Funny Constipation Story. It Involves Manual Disimpaction!

Funny constipation stories don't come around too often, so put your lunch down for a second and pay attention.  I was talking to an old medical school friend of mine that asked his hospitalist  to admit an 88 year old female with abdominal pain and severe constipation.  She hadn't pooped in two weeks.  She had already received an oral laxative,  a suppository, an enema and a manual disimpaction "up to the elbows"  in the ER without success.

I'm not generally in the business of admitting patients with a single diagnosis of constipation.  There's just no reason for it. I'd be admitting every 88 year old in the city every other month.   In this case, the hospitalist told my ER doctor friend  to please give one 12 mg dose of methylnaltrexone (Relistor).  It has been marketed for a couple of years as an antidote to optiate induced constipation without causing central narcotic withdrawal. 

The  May 29th, 2008  NEJM methylnaltrexone study indicated about half of the people who took methylnaltrexone had a bowel movement induced within four hours, compared with a placebo response of  15%.  Not only did I find the response to this drug remarkable, I also found the response to placebo even more remarkable.  Not in a million years would I think I could induce a bowel movement in 15 out of 100 opiate bowels just by telling the colon they were going to get a shot of relief, even if it just turned out to be a saline injection.  Well, she apparently got her shot, but it didn't work.  So the hospitalist came to do an observation  admission.  He tells me this is how the conversation went. 
Hospitalist:  When the patient gets to the floor, can you have the floor nurse give her a brown cow enema.
Nurse:  I've already done that.  That's my favorite enema.  It ALWAYS works!
Hospitalist:  Dang it.  What am I going to do now?  That was my secret weapon.  Is doing manual disimpaction part of the nursing scope of practice.
Nurse:  Absolutely.  
Hospitalist:  I might have to have the floor nurse try a manual disimpaction again.    They're going to hate me.
My ER Doctor Friend:  You might want to write an order for a nurse with Marfan syndrome to do it. 
My friend reports,  about six hours after admission, she had her blow out bowel movement without any further bowel assault.    The stuff works.  It really works as advertised.  In fact, if I was a primary care doctor, I would stock it in my office.   Now I'm sure his office staff will hate him forever when he opens up his FAC  FoS Medicare clinic.  And you thought Methadone clinics where a money maker.  These days, it's methylnaltrexone clinics.  That's where the action is at.

This post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk.

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