Welcome to Fight Colorectal Cancer’s

Webinar:Stomach Stuffers: How to eat well and avoid

a bowel obstruction this holiday seasonMake Sure You Know the Latest News

About CRC Research and Treatment visit fightcrc.org

Our webinar will begin shortly.

Today’s Webinar:1. Today’s Speakers: Margaret Martin, RD, MS, LDN, CDE &

James D. Waller, Jr., MD

2. Archived Webinars: FightColorectalCancer.org/Webinars

3. AFTER THE WEBINAR: expect an email with links to the

material. Also a survey on how we did, receive a Blue Star pin

when completed

4. Ask a question in the panel on the RIGHT SIDE of your screen

5. Follow along via Twitter – use the hashtag #CRCWebinar

Introducing our much acclaimed:

Patient Resource Guide

Funding Science

Established in 2006, our Lisa Fund has

raised hundreds of thousands of dollars

to directly support the innovative research

in treating late-stage colorectal cancer.

100% of the funds donated go

directly to Late-stage colorectal

cancer research.

Learn more or donate:

FightColorectalCancer.org/LisaFund

DisclaimerThe information and services provided by Fight Colorectal

Cancer are for general informational purposes only. The

information and services are not intended to be

substitutes for professional medical advice, diagnoses, or

treatment.

If you are ill, or suspect that you are ill, see a doctor

immediately. In an emergency, call 911 or go to the

nearest emergency room.

Fight Colorectal Cancer never recommends or endorses

any specific physicians, products or treatments for any

condition.

SpeakerMargaret Martin, RD, MS, LDN, CDE is a Licensed Dietitian and Nutritionist in the

State of Tennessee as well as a Certified

Diabetes Educator. Margaret graduated from

the University of Alabama with a Bachelor of

Science in Dietetics and received her

Master’s Degree in Nutrition Science & Public Health from the

University of Tennessee. With more than 10 years of experience in

Clinical Nutrition, Margaret has also worked in the insurance

industry with WellPoint Inc. and Blue Cross Blue Shield providing

telephonic nutrition consultations, service assistance, and web-

based nutrition education. In her free time Margaret volunteers

with the American Lung Association’s annual “Lung Force Walk" in

Middle Tennessee.

PearlPoint Cancer Support• Our Mission: To create a more

confident cancer journey for adults

anytime, anywhere

• Provide personalized guidance,

education, and support through My

PearlPoint (mypearlpoint.org)

• Focus on patients and family

members dealing a cancer

diagnosis and subsequent

treatment

• Personalized services from the

moment of diagnosis, free of

charge

12/9/2014 7

Nutrition Tips for Colorectal Surgery

Objectives

• The Colon’s Job

• Nutrition Steps to Know

• Holiday Tips to Avoid obstruction

8

Nutrition & The Healthy Colon

The colon is your body’s food & nutrition workhorse. What does the colon do?

• Finishes the final step of digestion

• Absorbs nutrients and fluids

• Balances nutrition for life and immunity

• Prepares waste for elimination

9

Nutrition and Colorectal Cancer

• Colorectal cancer & surgery may trigger digestive issues.

• Digestive issues such as diarrhea, constipation, gas, & bowel obstruction can trigger malnutrition.

• Digestive issues are treatable! – Start the conversation with your healthcare

team– Share your “Side Effects Log”

10

Fortify Before Surgery

• Grab nutrient-rich foods

• Stir in extra protein sources

• Sip on supplemental liquids

• Follow your surgeon’s pre-op instructions

11

Fortify Before Surgery

• Choose nutrient-richfoods with iron, protein, vitamins, etc.

• Look on Nutrition Facts labels for % Daily Values

5% or less=LOW20% or more=HIGH

12

Fortify Before Surgery

• Stir extra nutrition into hot

cereals, gelatins, beverages,

soups, creamy items,

or casseroles.

• For example:

– egg whites powder

– dry milk powder

– commercial protein powders

– liquid daily multivitamin

13

Nutrition after Surgery

• Give your colon time to heal

• There is not just ONE post-op meal plan

• Surgeon or registered dietitian will prescribe your nutrition plan

• Nutrition plan progresses over time from ice chips to solid foods

14

Nutrition After Surgery

Tips to Avoid Obstruction:

• Ask for printed meal plan

• Meet with registered dietitian

• Drink fluids as prescribed– Ice chips

– Clear liquids such as apple, cranberry, or cherry juices

– Gelatins, decaf tea, soft drinks, coffee

– Full liquids such as milk, soup, ice cream, or yogurt

15

Nutrition After Surgery

Eat small, frequent mini-meals

• Go small

– Small meals give your colon an easier job

• Choose fuel

– Frequent nutrition fights fatigue & mood swings

• Drink up

– Aim for 10-12 ounces every 3-4hrs

16

Nutrition After Surgery

Types of Fiber• Soluble Fiber thickens the stool

• Insoluble Fiber gives bulk

• Spread fiber intake throughout the day

17

Nutrition After Surgery

Watch Fiber Intake • Know which foods and drinks contain fiber

• Low-fiber means less than 0.5 to 2 grams per serving and less than 13 grams daily

• Low fiber = low-stress digestion which helps speed healing

• High-fiber sources include nuts, seeds, pulp, peels. Avoid these.

18

Nutrition After Surgery

Good Low-fiber foods • Juices with no pulp or seeds• Cooked veggies with no strings, peels, seeds• White bread, plain bagels, crackers with < 2 grams fiber• Cooked and cold cereals <3grams fiber• Plain noodles, pasta, white rice• Skinless potatoes • Bananas• Canned fruits, seedless in light syrup• Cooked meat, fish, and eggs• Broths and soups made with OK items• Angel food cake, frozen yogurt, pudding, ices

19

Holiday Tips To Avoid Obstruction

• Choose low fiber

• Hydrate thru the day with 64 ounces +

• Eat every 3-4 hours

• Enjoy what you eat

• Review your food intake log for any issues

• Seek help for meal plan, cooking & shopping

20

Holiday Tips to Avoid Obstruction

• Take good posture

• Off the high risk foods—nuts, strings,

peels, seeds, stalks, whole grains, etc.

• Avoid spicy foods, gassy foods, gum, & straws

• Set goals to get active-start 5 minute walk

• Trim alcoholic and caffeinated beverages

21

For more resources to help you navigate your cancer journey, sign up for a free dashboard on My PearlPoint at mypearlpoint.org.

22

For more tips managing nutrition side effects, download our free Cancer Side Effects Helper mobile app from Google Play or iTunes.

23

Additional Resources

• www.MyPearlPoint.org

• www.FightColorectalCancer.org

• www.cancer.gov

• www.cancer.org/Low-FiberFoods

• www.OncologyNutrition.org

• www.AICR.org

24

SpeakerJames D. Waller, Jr., MD is a

native of Evansville, Indiana. He

attended medical school at Indiana

University and completed his internship

at Methodist Hospital in Indianapolis.

His residencies in general surgery and

colorectal surgery were in Michigan at Butterworth Hospital

and Ferguson Hospital respectively. Dr. Waller is board-

certified by the American Board of Surgery and the American

Board of Colon and Rectal Surgery. In 1986, Dr. Waller

joined Dr. Krystosek in practice at Ohio Valley Colon and

Rectal Surgeons. Outside the office, he enjoys playing ice

hockey and softball.

12/9/2014 26

James D. Waller, M.D.

Ohio ValleyColon &Rectal Surgeons

801 St. Mary’s Drive, 200 WestEvansville, IN 47714(812) 477-6103 ● (800) 371-1169www.colonsurgeons.com

DIGESTIVE CARE CENTER

12/9/2014 28

Bowel Obstruction

Small bowel

Colon

Obstruction

Small bowel obstruction more common

Colon cancer most common cause of colonoic

obstruction

Colon cancer obstructing in only 2-3% of cases

Small Bowel Obstruction

Complete or partial occlusion of the intestinal

lumen

Adhesions in 60%

Cancer in 20%

Hernia in 10%

Inflammation 5%, Crohn’s, diverticulitis, abcess

Adhesions

Can occur after any surgery

More common with extensive or multiple

surgeries

Worse with pelvic or colon surgeries

Obstruction occurs with torsion/twisting of

bowel (garden hose)

This reults in kinking of the bowel and possible

compromise of the blood supply

Tumors

Metastatic cancers are most common

Small bowel cancers are rare

Intra-abdominal:

ovaries/pancreatic/stomach/colon

Extra abdominal: lung/breast/melanoma

Obstruction caused by direct

compression/invasion or twisting

Hernia

Entrapment of bowel within the hernia

Compression/twisting and possible restriction

of blood flow

Inflammation

Crohn’s disease

Ulcerative colitis

Diverticulitis

Majority of Obstructions

Adhesions with twisting or entrapment of the

bowel

Involving the small bowel

Even in patients with a history of colon cancer!!

Clinical presentation

Crampy abdominal pain

Abdominal distension

Nausea and vomitting

Obstipation (no stool or gas )

Loose frequent stool/diarrhea with partial

obstruction!

Evaluation

Exam

-abdominal distension

-pain

-hyperactive bowel sounds

-scars

-herniae

Evaluation

Plain abdominal Xray- Upright KUB

CT scan

Barium study when intermittent or partial

CBC, CMP, EKG, UA

Treatment

IV fluid support

Tube ( NG ) decompression

Surgery when indicated

Medical Tx

Monitor closely… vitals, urine output, exam

Over 50% will resolve with medical treatment

Surgery

If no improvement in 24-48 hours

Deterioration

Any sign of acute abdomen

Negative exploration is sometimes better than

waiting!

Surgery

Laparoscopic approach sometimes possible

Simple lysis of adhesion in most cases

Reduction repair of herniae

Bowel resection if not viable

Bypass or resection if cancer or radiation

Resection or stricturoplasty in Crohn’s

Resection of sigmoid if diverticular

Special cases

Early post op

History of multiple surgeries for obstruction

Metastatic disease

Radiation

Colon Cancer Patients

15% or greater lifetime risk of obstruction

? Less risk with laparoscopic resection

Partial obstruction can occur with anastomotic

strictures

Radiation induced strictures

Ostomy can represent an area of partial

obstruction

Prevention

No proven method of prevention

Minimize ‘injury’ of surgery

Not caused by diet or activities

Summary

Most obstructions caused by adhesions

At least a 15% risk after colon resection

Most respond to conservative treatment

Surgery for those who do not improve or

present with incarcerated hernia or acute

abdomen

Question & Answer Time . . .

DONATE $10 NOW on your mobile.

Text “FCRC” to 501501

(A $10 donation to Fight Colorectal Cancer will be deducted from your cell phone bill. Message rates apply.)

BECOME AN ADVOCATE.Learn more at FightColorectalCancer.org/Advocacy

How can YOU help? Join us.

Contact UsFight Colorectal Cancer

1414 Prince Street, Suite 204

Alexandria, VA 22314

(703) 548-1225

Resource Line: 1-877-427-2111

www.FightColorectalCancer.org

facebook.com/FightCRC

twitter.com/FightCRC

youtube.com/FightCRC

pinterest.com/FightCRC