Medical Procedures and Hospital Stays

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Purpose

The purpose of this section is to assist persons who are following the Specific Carbohydrate Diet as delineated in the book, Breaking the Vicious Cycle by Elaine Gottschall, B.A., M.Sc. to maintain SCD while undergoing various medical procedures. It is not intended to be medical advice nor is it a substitute for consulting medical professionals.

Stool Tests

The stool test is a standard procedure for making a diagnosis about the gut. A stool test takes a sample of feces and examines it for a variety of things that could be causing digestive problems such as parasites and giardia. The patient is presented with a handful of little bottles and then told to go home, put poop samples in the bottles, put the caps on, date and label them, and return the package to the medical office to be send to the laboratory. Seems simple enough until the patient learns that they have to give them a "clean sample" of poop. The nurse explains that they want the patient to capture only the poop, without having the poop becoming immersed in urine. Now things have become pretty tricky.

Wendy posted - Here is what I did for my stool test and it worked out well (considering that the whole subject is unpleasant).

Preparation:

I was told that I needed to give them a clean sample catch of poop only, without having the poop landing in urine. To do that, I prepared as follows: I put the bottles for the samples on the back ledge of the bathroom sink with a pair of disposable plastic gloves, a plastic teaspoon and a few paper towels. I took a medium size, plastic, rectangular waist basket that I could physically sit or lean on (and therefore be able to poop in). I took a new, heavy duty trash bag and lined that waste basket with the plastic trash bag. I put the now lined wastebasket next to the toilet. The plastic bag too long so it flowed well over the sides.

Capturing the Sample

Then, I went and did other things and waited for nature to signal me to let the games begin. when the call came, first, I urinated in the toilet. Then I shifted to the adjacent, lined waste basket to poop. Since I had a tendency to diarrhea, no problem. Then I cleaned my bottom with toilet paper I threw into the toilet, washed my hands, turned on the bathroom fan, opened the bathroom window, and put on my plastic gloves.

Filling the bottles

I put the lid down on the toilet and put the lined wastebasket up on the toilet lid. This made it higher up and easy to reach inside without bending over too much. I pulled down on the plastic on the outside of the wastebasket so that the bottom of the bag moved up and the poop was easy to access. (I did not want to have to fish around in the dark plastic.) One bottle at a time, I did what each bottle said to do. I used my plastic teaspoon because the little plastic tiny shovels attached to the insides of the sample bottle tops were so hard to use that I would have been there all night. While I was filling the bottles as directed, I held the bottles over the wastebasket so if any bit of poop slipped off the spoon, it just went back into my plastic wastebasket latrine.

If the outside of the bottle got a little dirty, I rinsed the bottle (after I had sealed it shut) at the bathroom sink. If some poop got on my gloves, I washed my hands (with the gloves still on) in the bathroom sink. If I needed to dry the outside of the bottles or my gloved hands, I used the paper towels. Some of the bottles had to be shaken and I also did that over the plastic bag.

Finishing Up

When all the bottles were full, tightly sealed, dry outside, etc. I labeled them as directed, put them in the re-sealable plastic bag provided and set them aside. At the very end, I threw the spoon, the used gloves, the paper towels and any other debris into the plastic bag i had pooped in. I pulled up the plastic bag from the top edge of the bag which was on the outside of the wastebasket, sealed it up and put it in a another trash bag to go out. As an extra precaution, I put on new disposable gloves then cleaned the sink and the wastebasket. I washed my hands again after everything was done and took the samples to the doctor's office.

It sounds like a big deal because I put in all the details but it really was not hard if you set out what you need in advance. As you can guess, I was not in a hurry to close the window or turn off the fan.

Antibiotics

Before World War II, infectious diseases were the major killers of mankind and stopping infectious diseases was a major focus of medical research. In almost any war in history, more people died of infectious diseases than from wounds on the battlefield. The discovery and development the sulfa drugs, penicillin and antibiotics finally gave doctors adequate weapons to fight infectious diseases. The availability of antibiotics has changed our attitudes about medical outcomes and enabled all manner of elective surgery. Today, we take it for granted that in all likelihood, we will get better and that medical care is generally beneficial. Lives are saved and quality of life is better because of antibiotics.

Unfortunately, over the years, like any good thing, antibiotics have been over used and abused. Prescribed too often, used in places that they were never intended, such as when raising animals in crowded conditions, as with any misused substance, there are unfortunate consequences.

Antibiotics represent a special challenge to persons with digestive diseases. Persons on the SCD diet are carefully working on maintaining a healthy population and a good balance of their digestive bacteria. We eat yogurt and/or take probiotic supplements probiotics. Antibiotic means using bacteria to fight bacteria. Unfortunately, not only does the antibiotic fight or prevent the infectious bacteria, it kills off the beneficial bacteria in the gut as well.

Obviously, persons on SCD want to avoid taking antibiotics as much as possible; however, there are times when antibiotics are medically necessary to treat or to prevent infection. For example with surgery, not to take antibiotics would be life threatening and no doctor would agree to it.

The SCD dieter now a patient should plan to continue and even increase the regular course of probiotics (including SCD yogurt if allowed). Kim has posted a useful probiotic strategy when antibiotics are necessary. Timing when probiotics are taken is the key. She suggests that it is better to wait at least 2 hours after taking the antibiotic dose before taking the probiotic (whether supplement or yogurt). Otherwise, the probiotics will be killed off fairly rapidly by the antibiotic. It takes 2 or 3 hours for the antibiotics to be absorbed into the bloodstream or be eliminated.

In addition, she suggests to continue taking an extra boost of probiotics for a few weeks following the end of the antibiotic treatment and then taper off to the normal maintenance dose was. She normally takes the extra probiotics once a day when she is on antibiotics, even thought her normal maintenance dose is just once every 4 days. Most people normally take probiotics at least once a day. These folks should take probiotics twice a day during antibiotics, perhaps even more often.

The other thing to anticipate is that while taking antibiotics, the SCD patient's digestion will be more sensitive. Kim suggests falling back to soft, easy-to-digest, bland foods during the antibiotics and for a few weeks afterwards.

Colonoscopys

The following is not intended to be medical advice nor is it a substitute for consulting medical professionals. Colonoscopys are never pleasant but they are an important cancer screening tool and a diagnostic fact of life for people with bowel diseases. Colonoscopy is a day procedure in the hospital and from entry to discharge is over in a few hours. There is no food allowed before and during the process so maintaining the diet is not a problem.

Preparation

Almost everyone agrees that the colonoscopy preparation process is worse than the actual procedure. The particular problem with colonoscopys for persons on SCD is that the usual preparation materials GoLYTely, NyLYTely, etc. are full of unpermitted ingredients, especially in the flavor packet. Persons on SCD do not want to upset and re-inflame their guts while undergoing a diagnostic procedure to monitor their digestive progress.

Discuss the problem with your doctor and see there is a method that he will accept that will not compromise your diet. Part of preparation involves drinking a gallon (64 ounces) of fluid) to prevent dehydration. There are generally three basic types of colonoscopy preparations:

1.Bisacodyl - brand name Dulcolax. As of this writing, the Walgreen's brand has the same active ingredient but appears to have fewer impermissible SCD inactive ingredients. For those on SCD, the advantage here is that you can pick your fluid.
2.Polyethylene glycol 3350 - brand names: GoLYTely, NyLYTely, Movi Prep and Miralax. The fluids are mixed in with the preparatory medicine. MoviPrep has aspertame in the inactive ingredients but otherwise appears to be okay. It may be the least worse choice of this type.
3.Sodium biphosphate and sodium phosphate - brand name OsmoPrep. This method also may be a good choice for the person on SCD. The preparation formula is taken by swallowing tablets and there are no inactive ingredients that would be problematic for those on SCD. The patient can choose a clear liquid so water or SCD lemonade or an allowable brand of clear white grape juice can be used for the 64 ounces of fluid that one takes with the pills. No red or purple juices are allowed for the preparation as it affects the color of the tissue being examined.

At some point in the process, one is restricted to clear fluids. E-lyte and ELETE electrolytes, chicken or beef broth, lemonade, an allowable brand of white grape juice, water, weak tea and weak coffee are examples of SCD permitted fluids. Some find it easier if on the day before the colonoscopy preparation, they modify their diet and stay with soft foods or even eliminate solid foods.

After the procedure

You will come home with a very empty gut so it is best to restart foods gradually. Fluids are very important. Before the test, make and freeze lots of chicken stock and bone broth in small containers so you will have a supply ready for you when you come home. The person who picks you up could bring a small container of broth ready to drink. Have some electrolytic drinks on hand (E-lyte or ELETE concentrate). Have cooked bland, safe foods ready for you when you come home. Add unflavored gelatin whenever you can to help your gut heal. Take it easy food wise for a few days.

Hopefully, you will have good results. Those on SCD have a reputation of amazing their doctors with their gut healing progress.

Hospital Stays

Hospital stays are perhaps the most challenging experience for patient on SCD. One is not feeling well which is the reason for the hospital stay in the first place. The patient has no access to a kitchen and hospital food is notoriously limited even before considering all foods that are not allowed on SCD. Do not expect help from the professional dietitians as they usually do not understand the difference between nutritional composition and the importance of the ease of digestibility vital to the SCD person. In the hospital, the SCD patient is typically surrounded by health experts but there are none who are knowledgeable about SCD or even care about it. The patient's expertise is usually dismissed. Of course, there will usually be antibiotics (see above).

Hospitals are not known for their flexibility and some get their food from outside vendors under contract. The one thing that you have going for you is that they are supposed to follow physician's orders. Have your doctor specify on your chart that you are on a special diet. Try to find out before hand if the hospital can accommodate your food needs by looking at a food selection chart. Do not be surprised that there is nothing that you can eat. Have the doctor specify that your relatives will be bringing your food. There is usually a refrigerator on the floor for medicines where your food could be kept.

What you can eat will also depend on the type of surgery. Find out before hand if you will need a liquid diet for a while after the surgery. Preparation beforehand is key so get into your kitchen and prepare. If relatives want to know what they can do, train them Give them some SCD recipes. Have a supply of unflavored gelatin, E-lyte or ELETE electrolytic drinks, a allowable juice and probiotic capsules. Make and freeze small plastic containers of things like: chicken broth, bone broth, pieces of cooked chicken, easy to eat (pureed) cooked vegetables from your safe list. Have a supply on hand of bananas, SCD cheeses and SCD yogurt ready at home to be brought in daily portions. Be sure you have an insulated carry pack with reusable blue ice for transportation of perishables.

Packets of gelatin, tea bags, and other things that do not need refrigeration can be kept in a drawer by your bed. A squeeze jar or individual packets of honey may also be handy at bedside. With your family supplying you with SCD allowable food, and your stash in the nurse's refrigerator, you should be okay. You can get the SCD nutritional equivalent of jello by using unflavored gelatin, warm water, honey and a little fruit juice. You can even make your own SCD jello in small plastic cups before you go into the hospital. Fortunately, hospital stays are usually short.

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