Friday, September 3, 2010

SEPTEMBER 3, 2010 BEHAVIORIAL DIARRHEA





"WE CANNOT CONTROL WHAT OTHERS DO, BUT WE CAN CHOOSE OUR OWN BEHAVIORS AND OUR OWN COURSE OF ACTION."

This is a great reminder for me. It is so true I cannot control what others do. Everyone deals with the beginning of this quote at least once a day. Whether it is someone you work with, a friend, or a family member. I have come to the realization that I cannot control what others do. On this day, there is nothing I can do about people's behaviors. At the end of a 12 step meeting the serenity prayer is recited. At some meetings we take a moment of silence for those in and out of the rooms before reciting the serenity prayer. You may wonder why do that. I have found out that just because you are sober---are you truly sober. I pray for those who have insulted, disappointed or even taken advantage of me.

Some individuals have an illness- the illness of addiction. As a volunteer physician on an island I see more problems with alcohol and sex addictions than I would normally see in my private practice. I see other people's addictions when they might not even recognize it. I have seen friends, which in reality are just acquintances come out of a bar staggering back to their home, or being held up by their significant other. I often wonder what the 'significant other' is thinking when they see me. I behave soberly. I must learn even though I am angry not to stoop to others level when he/she has delibertly hurt me. I object even more when he/she is representing a community and board of directors. Again I cannot control what others do. I cannot stop them from drinking nor speaking their mind. I cannot control their actions. Their actions are not sober, but should everyone be sober? Absolutely not. I would like people to act with kindness, compassion and love, more so when they represent a community.

What I can do is control my behaviors and my own course of action. MY BEHAVIOR and MY COURSE OF ACTOION can be controlled by me, and only me. It has been difficult. I can admit this without hesitation. It is progress, but more importantly it is a process which I am in constant flux with on a daily basis. The good news--I am getting better at it! Have you controlled your own behaviors and course of action? Think about it and write down in what way can you change.

What can also be changed are your bowel movements. I want to briefly discuss diarrhea.
Diarrhea is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant death worldwide. The loss of fluids through diarrhea can cause dehydration and electrolyte imbalances. In 2009 diarrhea was estimated to have caused 1.1 million deaths in people aged 5 and over and 1.5 million deaths in children under the age of 5. In the United States, diarrhea is not discussed as it is in developing countries. Diarrhea is an uncomfortable condition that can have many causes. Most cases of diarrhea will go away on their own. However, in some cases, diarrhea can lead to dehydration or be a sign of a more serious problem.

The most common cause of diarrhea is viral gastroenteritisviral gastroenteritis, a mild viral infection that goes away on its own within a few days. This condition is often called the stomach flu. Viral gastroenteritis often occurs in mini-epidemics in schools, neighborhoods, or families. A common cause is after a trip to a foreign country. Rememeber Montezuma's revenge when returning from Mexico. This occurs as a result of eating food or drinking water contaminated with bacteria or parasites.

I commonly see diarrhea in patients who have finished a course of antibiotics. You forgot to take your probiotics, or 'good bacteria' or you didn't eat Activa. I prefer Colibani or Sheep/Goat yogurt. Other medications such as laxatives containing magnesium, and chemotherapy for cancer treatment, can also cause diarrhea.

Other medical conditions can also lead to diarrhea. Some of these such as Celiac disease, Inflammatory bowel diseases (Crohn's disease, Ulcerative colitis, Irritable bowel syndrome), Lactose intolerance, and malabsorption syndromes have been discussed in previous blogs. Some other less common causes of diarrhea are partial removal of the stomach, carconoid syndrome and diabetic complications. Drink plenty of fluid to avoid becoming dehydrated. Start with sips of any fluid other than caffeinated beverages. Milk may prolong loose stools, but also provides needed fluids and nourishment. Drinking milk may be fine for mild diarrhea. For moderate and severe diarrhea, electrolyte solutions available in drugstores are usually best.

Let's talk about a home remedy if you cannot get to the store and get Pedialyte (electrolyte replacement). A simple remedy is mixing one quart of water, 3 teaspoons of sugar and 1 teaspoon of salt. PLEASE do not use honey.

PLEASE take probiotics. Another supplement to help the absorption is taking L-glutamine, an amino acid that builds up the villi of the small intestines.

Foods like rice, dry toast, and bananas can sometimes help with diarrhea.

Avoid over-the-counter antidiarrhea medications unless specifically instructed to use one by your doctor. Certain infections can be made worse by these drugs. When you have diarrhea, your body is trying to get rid of whatever is causing it (contaminated food, virus, etc.). The medicine can interfere with this process.

Get plenty of rest. For chronic disease, please consult a health care professional. Try adding bulk to your diet to thicken your stool and regulate bowel movements. Such foods include fiber from whole-wheat grains and bran. Psyllium-containing products such as Metamucil or similar products can also add bulk to stools.

When should you seek medical advice? I there is blood or pus in your stools, your stools are black, you have any abdominal pain, lightheadedness, fever, foul smelling or oily stools, recent foreign travel, have eaten with someone who has acute diarrhea, you are starting a new medication or if you have diarrhea lasting more than 5 days.

One herbal remedy would be slippery elm,Ulmus rubra. It is a species of elm native to eastern North America (from southeast North Dakota, east to southern Quebec, south to northernmost Florida, and west to eastern Texas). It is similar to American Elm in general appearance, but more closely related to the European Wych Elm, which has a very similar flower structure. Other common names include Red Elm, Gray Elm, Soft Elm, Moose Elm and Indian Elm. It has a great history in America. During the Revolutionary War, surgeons used bark poultice as a treatment for gunshot wounds. If you like mucilaginous tea, use three tablespoons of the inner bark in a hot cup of water. This has been traditionally used for sore throats, upset stomach, and diarrhea. I would prefer using elderberry or ginger for my sore throat. I use Aloe vera for gastric irritation because I have difficulty swallowing this gelatinous herb. The FDA approved slippery elm as a non prescriptive demulcent in throat lozenges. I find this interesting since there are very few studies.

Until tomorrow...

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