I get in tonight and the place is hopping. My partner that is to leave shift has one person to tell me about that will be staying extra long. 26 year old teacher with ongoing diarrhea for last few weeks. Seen by her primary care doc about a week ago and supposedly no sick contacts at that time. She does work in a primary school and there are sniffles going round but no stomach bugs. She actually did ok with that episode and it cooled down in few days. She remembers that didnt bother her much after that until hubby took her to Olive Garden. Soon after the whole thing started again. Diarrhea, few times a day with mostly water. Last few days it seems it got worse and was associated with nausea and fatigue. Patient admits to alot of issues with "her stomach". No alcohol, only occasional coffee, no tobacco. Mother was in room and she stated she herself has a consitpation issue and patients sister is bad with stomach issues.
Her primary care doc wanted to rule out parasites and C. difficile ( a special bacterial that usually follows antibiotic treatment and leave the patient with bloody stool) He even wanted to check for norwalk virus in addition to the 20 other lab tests he wanted done in the ER. Girl was tired with bags under the eyes, pale, cracked lips and thick saliva on the toungue. Couldnt get up from lying down. Obviously dehydrated with orthostatic changes during standing.
I gave her 2 liters of fluid and a tagamet pill. I had talked to mom about using "slippery elm" and once the gut was a little stronger to consider resupplying the colon with acidophyllus. We started to talk about how the 36 feet of tubing from mouth to anus secreates, digestes and moves. When a small infection occurs....this is one of the only body systems that can protect itself. Just let it do its thing and the toxin, agent, chemical, bacterial or virus will usually be pooped or vomited out in minutes. Even with something as harsh as Salmonella, no need for antibiotics with gut just finds the closest door and pushes everything through it. Well, her gut was probably doing just fine and healing up. No doubt the Olive garden has two things that are bound to have alot of acid....vinegar and tomatoe. (salad dressing and pasta, there goes your whole meal right there.....and dont forget the dairy dessert to follow). I explained when the gut has to move fast to protect itself, that delicate lining of little finger like projections in the small intestine get sloughed off and pooped out. Like an abrasion on a knee, it takes about a week to get things healed. You throw food like that mentioned on a roughened lining and it wont like it....thus the return of the diarrea. Just think of the colon as a separate living thing trying to protect itself from further irritation. Its gonna move just like it did when it started 2 weeks ago. ALthough the initial thing that caused all this to start isnt there anymore, the bowl movements will seem exactly the same. Thus the reason the doc is looking for a white elephant instead of concentrating on the regular elephants that are right in front of him.
After the water she was acutally seen standing up walking to the toilet, not dizzy, red lips, moist tongue and smiling. I told her no need for fancy tests at this point. Need to just go home and stick to fluids over the next 24 hours. Also suggested the slippery elm as stated above. No dairy, No acidic foods, no caffeine. Further evaluation reveals she is a full time teacher, going for a night degree, taking care of her own child, and helping her husband with his line of work. I discussed with her the need to carve out 10-15 minutes a day of medication. Told her to consider ginger root in addition to slippery elm. May consider kavakava or valerian in near future for stress reduction. Told them no need for the fancy tesing esecially if she feels better. Also told them that many times, we in conventional medicine will not know the exact diagnosis but while sick we'll get alot of tests to look for something....anything. Gut doesnt need a fancy name or treatment plan, just needs some healing time before being battered with the next bout of being unhealthy and eating poorly. Girl walked out with mom, smiling and looking forward to visiting the herbal shop in town tommorrow. Mom then preceded to ask me about other "remedies" for her ailments............but that for another day.
