In July, I had a bad cold that wouldn’t go away. I was congested and coughing. I had a slight fever that came and went, and I alternated between chills and sweats. I also had a weird occasional pain in my right temple. It wasn’t a normal headache but it was bothersome and I wanted to take something for it. I don’t take pain relief medication very often, so I forget what I’m supposed to take. I remember being told after gastrectomy that I should take either Ibuprofen or Tylenol, but I can never remember which. I reached out to Dr. Mansfield’s staff at MD Anderson to confirm and want to document it here so I always have it: “It is best to take Tylenol only. The Ibuprofen, Advil and Aspirin can irritate your intestines and not recommended.”
One issue I have when I have a bad cold I think is related to the total gastrectomy. When I cough a lot and especially when I cough really hard and deep, I cough up whatever is there. Sometimes it’s just liquid, but if I’ve recently eaten, it’s whatever I’ve eaten. It’s not like vomit, it’s just whatever I ate, that’s why I call it “coughing up” instead of “throwing up.” Being so sick, I didn’t feel like eating to start with, and then when I did eat, it would trigger the coughing, which would have me coughing up the food I did eat, which would make me want to eat even less. It was an endless cycle. Because I have put on more weight post-TG than I would prefer, I actually did like the 10 pounds I lost in the first 10 days of being sick, but it’s not a way I recommend for losing weight. However, I am happy that so far, I have been able to keep most of the weight off.
After 10 days of being sick, I decided it was time to see a doctor. I don’t like to go to urgent care because I don’t like explaining the no stomach thing to new health care professionals. Unfortunately, my primary care provider didn’t have any openings for several days and originally they tried to schedule me with someone at a different office within the same healthcare system. When I explained my situation, they transferred me to someone at my PCP’s office and I still couldn’t get in with my doctor but was able to get in with another doctor in the same practice, so I felt a little better. I figured even though she didn’t know me, at least she could consult with my doctor if she wanted to.
The doctor hadn’t read anything on my chart, so she knew nothing of my history. She decided to put me on antibiotics to clear out the sinuses. We talked about the no stomach and that therefore, I couldn’t take any time release meds such as capsules or coated tablets. She decided the regular amoxicillin tablets should be fine and prescribed them. This was on Wednesday. She told me I should feel better my Friday. When I picked up the prescription, I found that the tablets were "film-coated". I wasn’t sure exactly what that meant and wasn’t sure if they worked for me or not. I was also still coughing stuff up, so was also afraid I was sometimes coughing up the medication.
By Friday, I had only seen slight improvement, rather than the significant feeling better that she had predicted, so I called back the office to express my concerns of the film coating and coughing up the medicine and asked for a chewable or liquid form of the antibiotic. I was apparently convincing as even though I never talked to the doctor, she did prescribe the liquid amoxicillin. I was frustrated because I felt like I was two days behind where I should have been at this point.
I did get a chuckle reading the patient portal notes from when I called and asked for the chewable form. It included “Pt stated she ‘do not have a stomach’ Believe pt is referring to having gastrectomy.” Yeah, duh!
The good news is that I’m not sick very often. The bad news is that since I’ve had very little experience with being sick post-TG, I’m not good about knowing what I need. I also have no idea if it would have been different if I had seen my normal doctor. I know none of this no stomach thing is common and we’re learning together.
I did also ask MD Anderson about the film-coated tablets. I appreciate their explanation and again, I want to repeat it here for my own use and anyone else who might find it helpful:
It would be a good idea if you can get liquid medication. Please see below on how film coated medication is processed once it is swallowed. Please take care!
Once a film-coated medication is swallowed, it begins a journey through the digestive system where its coating and the active drug are processed for absorption and eventual action in the body.
Here's how it generally works:
Stomach Entry: Upon swallowing, the film-coated tablet enters the stomach, which is a highly acidic environment.
Coating Breakdown: Unlike enteric coatings, which are designed to resist stomach acid, film coatings typically dissolve readily in the stomach's acidic environment. This dissolution allows the active drug ingredient to be released from the tablet.
Drug Release and Dissolution: Once the film coating dissolves, the tablet or capsule (if it's a film-coated capsule) begins to break down, releasing the active medication into the stomach.
Absorption in the Gastrointestinal Tract: The released medication then passes through the stomach and enters the small intestine, where the majority of drug absorption takes place.
I appreciate that even though I haven’t been to MD Anderson or communicated with Dr. Mansfield’s office for over 5 years, they are still there and still willing to answer my questions.
Getting on the right meds helped, but symptoms still lingered on. As I reached the end of the antibiotic, I called the office again and they suggested I come back in since I was continuing to have symptoms. 3 weeks into this, I still had some congestion and especially the cough. Sometimes the cough was dry, sometimes productive, coughing up mucus. The doctor said my lungs and everything looked clean. Even though my time period for the antibiotic was finished, with the liquid form, I had a few days remaining so we agreed to finish it out. I was to call back in a week if I didn’t continue to improve or if symptoms got worse. She also said coughs can linger for up to 13 weeks.
I did continue to improve, but slowly. It took about 6 weeks before I began to get my stamina back. Before that, I found myself leaving work early, especially if I had something in the evening. I needed to take a break after work to rest before I was good for the evening. Now at 8 weeks, I’m still not sure I would consider myself 100%, but I’m so much better than I was! I hope I’m done being sick for awhile!
