Or..Diarrhea (you know the song)

My job has a lot of interesting facets besides midnight admissions. There are also those situations where a patient needs a new medication, or there’s a change of condition in the middle of the night. It’s an important part of my job because as I’ve said in the past if there’s going to be a problem, it usually happens on the night shift. Last night is what I would call a series of stupid calls, and I mean that in the nicest way possible. One of the things about nurses, and when I talk about nurses, I mean floor nurses, is they’re trained how to assess the patient very well. Although, sometimes their judgment of what to report to a provider at 3 o’clock in the morning is lacking. I’ll give you an example; the phone rings at 3 AM with Karen on the other end telling me that Mr. Smith took medication last night and has diarrhea this morning. So, I asked Karen how many times has he had it? Karen reports to me that this is his first occurrence, but he would like something for it. Fighting the urge to throw the phone across the room, I tell Karen that I’m going to decline prescribing anything at this point.

Now, I know it sounds mean to deprive someone of a medication, at least on the surface. I want to play through the options because honestly, I feel like more and more if something is wrong with our bodies, we just want to take a pill and be done with it. Diarrhea is a really good example of this and a really bad reason to take anything to slow or stop it. Remember a couple of days ago when I wrote that the body has a great ability to cleanse itself and the colon is no exception to this ability. The typical reason that the body develops diarrhea is an irritation to the digestive tract. Whether this irritation is a bug, foodborne, or some type of diet irregularity, the body knows what it wants and needs. Of course, it’s very common to want to rush out and get some Imodium with diarrhea. Imodium is a wonderful drug, and it does a great job of slowing down or even stopping diarrhea, but it also continues to slow your intestine after the diarrhea has stopped. The slowed intestine leaves us with constipation, and we can all see the vicious cycle we can develop by taking medications. So, the natural urge to stop diarrhea, especially with medications, may send our body into a cycle of yo-yoing back-and-forth that isn’t fun to deal with.

So what’s the solution? Well, unfortunately, it’s diet and good self-care. I know everyone’s thinking, “but Nursie poo there has to be an easier way.” The reality of all this is diet and self-care are the easier way because it gives your body the tools to regulate itself in an effective and long-term manner and without the harshness of chemical stimulation or retardation. The truth in all this is a high fiber diet with around 30 g of fiber a day, plenty of water, and avoiding intestinal irritants. Intestinal irritants vary between people. What bothers me may not bother others. Although, I’ve eaten Army food, so I’m pretty sure I’ve got a leg up on most people. In all this, everyone will find some pretty good self-regulation without a lot of effort. It’s pretty simple, safe, and effective.

With these patients I find myself caught between my crabbiness for being bothered at 3 AM and my need to educate. This is one of the most important things I can do in my role as a nurse practitioner is educate, even at 3 o’clock in the morning — the need to explain that a little diarrhea is not the end of the world and that there are some things to fix that problem. So, the one natural questions that comes up in this is well, what if I have diarrhea for three days? This ranges into a little bit of a different scenario. Something more serious may be going on, and it might be a good idea to swing by primary care and have it looked at. The treatment may be the same as an acute bout of diarrhea, or it may be at that point that we choose to use medications. One of the biggest problems that a patient needs to deal with when it comes to diarrhea is staying hydrated. Loose or wet stool (what a lovely description it is, isn’t it?) Is draining water from your body. It is very easy to become dehydrated, and it could prolong the ill effects on your intestinal tract.

The take away from all of this is, of course, a healthy diet. I know, everyone is sick of hearing this, however, it is, unfortunately, the answer. The other take away is every time your body changes just a smidge; there isn’t a need to shove a pill in it. Yes, they make tons of good pills that do lots of good things for people, and some of those pills are regularly necessary. That doesn’t mean you need to take every one of them.

Well my warm coffin and my hounds await