Monday, August 1, 2005
"I think I'll stop taking pills for awhile."
These were the first words out of my mother's mouth this morning. She's felt this way before; maybe once every two years. It always surprises me, but I know how to handle it.
"Well," I began, "that's pretty much not possible, but why do you want to stop taking your pills?"
"I'm constipated and I think the pills are doing it."
Mind you, she had a bowel movement yesterday and a clean-out movement two days before that. However, considering the only fair volume she eliminated yesterday and the fact that I had to "help" that clean-out movement along with a laxative, I was willing to consider that she is, indeed, regularly building up shit that doesn't get eliminated on schedule, even when some of it does. "Are you feeling constipated right now."
"Yes," she said, her brow wrinkling.
"Okay, well, you may be right that the pills are contributing to this." I explained about the recent 'only fair' elimination volume, reminded her of the stool softener induced clean-out movement and reviewed which medications might be causing this. "Your antibiotic mentions constipation as a side effect."
"And," she added, much to my surprise, "the iron."
"Well, yes and no. Iron salts do indeed contribute to constipation. The type you're taking isn't supposed to do that nearly as often and all the fiber and olives you're eating have mitigated any possibility of constipation up to a couple of weeks ago. The furosemide you've been taking lately, even though it hasn't been much, doesn't help your colon, either, because it pulls fluid off you. So, I, too, think that your colon isn't eliminating quite as well as it should. I think you're right. I have some suggestions. First, I'll give you a stool softener (ducosate sodium [Colace], 1 tablet) this morning. You have to drink liquids today, more than you usually do, to get it to work, though, and I'll be reminding you. Second, Mom, I'm telling you, exercise of any kind and moving around, even simple moving around, promote regular bowel movements. It doesn't matter which muscles you exercise, almost everything helps to keep those muscles involved in elimination up to snuff. Third, although you're already eating a good amount of fiber we'll up it. How about adding an apple a day? You like apples, right?"
"Oh, yes! That sounds good."
"And," I continued, "I'll work on getting more fiber in your diet. Maybe wheat germ in your yoghurt, for instance. You've been refusing it but I'll remind you, now, that you need it."
"Good. Do that."
"But, Mom, we've got to get you moving a little more. When you start to fight me on exercising and walking around, before it escalates to the point where I give up, I'm going to remind you that you're constipating yourself."
"I understand. I think you should do that."
"Good. The only other thing I could do is get some of that soluble fiber to mix with liquids. When we tried those back in 2002 when you were on iron salts, even low doses caused you to have diarrhea, which is why I've not used those again on you. But, if the other strategies don't work, we'll try that. I'll pick some up the next time I'm at Costco. One other thing we'll try, I'll pick up a bottle of caffeinated instant coffee. Caffeine often promotes regularity. I'll just give you one cup a day, when necessary, in the middle of the day, but that might help, too."
"Okay."
This afternoon, although she hasn't had a bowel movement, I've asked her a couple of times if she feels constipated. Each time I ask she looks at me as though I picked the question out of thin air and denies feeling constipated. She hasn't had a bowel movement yet, even with the stool softener underneath her belt. According to her regular schedule, tomorrow is her target day. But I would like to see her eliminatory volume upped, a bit. I've been concerned that over the last month or so she's been having only fair volume movements, followed, after three or four of those, with a clean-out movement which usually causes her some minor discomfort. I'd like us to get back to where we were. This may take some experimenting, especially since the antibiotic will be a daily affair from now on, probably, and it looks as though our use of furosemide, although very light, once or twice a week, will probably continue for the rest of her life.
Time to make some adjustments.
I like discussing her care with her in detail. So does she. I know that she won't remember much, if anything, although sometimes her memory kicks in when I least expect it. But just taking her seriously when she wants information or suggests changes in her care and discussing in detail the possibility of making the changes she suggests keeps her feeling as though her life is under her control. Today, for instance, I carefully explained what each medication and supplement was for, what might or would happen if she discontinued its use and gave her choices where choices were appropriate: With her supplements, for instance. Since her supplements are mostly substances that she's chosen on her own and taken for years (even though I've found personally specific reasons for all these supplements), she decided, supplement by supplement, to continue taking everything. She wavered on the iron until I explained to her that the alternate to taking iron was for her hemoglobin to drop month by month, as well as her energy level and sense of well-being, and enduring transfusions when it dropped low enough. She doesn't want to do that. Once she understood, again, what the lisinopril, glipizide, Protonix and Macrodantin do she decided to continue taking those, too. I assured her, more than once, that, all things told, she's actually on very little medication and I continue to work to look for ways to keep her medications from being increased or for ways to reduce them. She knows this and trusts me to make sure she isn't over medicated or dangerously cross-medicated.
Test results came through today. I've posted them here. I was wrong about a draw for TIBC and Ferritin, which is fine. A reading for iron was taken as a part of the CMP chemistry section. She reads in the normal range. The only out of range reading that concerned me was her unusually low Anion Gap, which can be noted in the CMP section. I talked to MCS about this and we both looked it up in our medical texts. Anion Gap is a measurement of "all other electrolytes" beyond Potassium, Sodium, Chloride and CO2. We both discovered that a low Anion Gap reading often occurs as a result of taking, among other substances, diuretics, some antibiotics and, get this, licorice. Interestingly, although one wouldn't think her low intake of furosemide would qualify, both her Detox teas, of which she ingests one cup daily (usually strong, since she prefers to keep the bag in the cup as she drinks her tea) contain licorice root. The aroma of the teas, in fact, are strong with licorice. So this not only explains her low reading (she's been minorly low before) but also explains, in part, why the doctor was not concerned about this. As well, MCS's text mentioned that this reading should be considered in conjunction with the other four electrolyte readings. Her other readings are fine.
All's well that tests well.
Later.
"Well," I began, "that's pretty much not possible, but why do you want to stop taking your pills?"
"I'm constipated and I think the pills are doing it."
Mind you, she had a bowel movement yesterday and a clean-out movement two days before that. However, considering the only fair volume she eliminated yesterday and the fact that I had to "help" that clean-out movement along with a laxative, I was willing to consider that she is, indeed, regularly building up shit that doesn't get eliminated on schedule, even when some of it does. "Are you feeling constipated right now."
"Yes," she said, her brow wrinkling.
"Okay, well, you may be right that the pills are contributing to this." I explained about the recent 'only fair' elimination volume, reminded her of the stool softener induced clean-out movement and reviewed which medications might be causing this. "Your antibiotic mentions constipation as a side effect."
"And," she added, much to my surprise, "the iron."
"Well, yes and no. Iron salts do indeed contribute to constipation. The type you're taking isn't supposed to do that nearly as often and all the fiber and olives you're eating have mitigated any possibility of constipation up to a couple of weeks ago. The furosemide you've been taking lately, even though it hasn't been much, doesn't help your colon, either, because it pulls fluid off you. So, I, too, think that your colon isn't eliminating quite as well as it should. I think you're right. I have some suggestions. First, I'll give you a stool softener (ducosate sodium [Colace], 1 tablet) this morning. You have to drink liquids today, more than you usually do, to get it to work, though, and I'll be reminding you. Second, Mom, I'm telling you, exercise of any kind and moving around, even simple moving around, promote regular bowel movements. It doesn't matter which muscles you exercise, almost everything helps to keep those muscles involved in elimination up to snuff. Third, although you're already eating a good amount of fiber we'll up it. How about adding an apple a day? You like apples, right?"
"Oh, yes! That sounds good."
"And," I continued, "I'll work on getting more fiber in your diet. Maybe wheat germ in your yoghurt, for instance. You've been refusing it but I'll remind you, now, that you need it."
"Good. Do that."
"But, Mom, we've got to get you moving a little more. When you start to fight me on exercising and walking around, before it escalates to the point where I give up, I'm going to remind you that you're constipating yourself."
"I understand. I think you should do that."
"Good. The only other thing I could do is get some of that soluble fiber to mix with liquids. When we tried those back in 2002 when you were on iron salts, even low doses caused you to have diarrhea, which is why I've not used those again on you. But, if the other strategies don't work, we'll try that. I'll pick some up the next time I'm at Costco. One other thing we'll try, I'll pick up a bottle of caffeinated instant coffee. Caffeine often promotes regularity. I'll just give you one cup a day, when necessary, in the middle of the day, but that might help, too."
"Okay."
This afternoon, although she hasn't had a bowel movement, I've asked her a couple of times if she feels constipated. Each time I ask she looks at me as though I picked the question out of thin air and denies feeling constipated. She hasn't had a bowel movement yet, even with the stool softener underneath her belt. According to her regular schedule, tomorrow is her target day. But I would like to see her eliminatory volume upped, a bit. I've been concerned that over the last month or so she's been having only fair volume movements, followed, after three or four of those, with a clean-out movement which usually causes her some minor discomfort. I'd like us to get back to where we were. This may take some experimenting, especially since the antibiotic will be a daily affair from now on, probably, and it looks as though our use of furosemide, although very light, once or twice a week, will probably continue for the rest of her life.
Time to make some adjustments.
I like discussing her care with her in detail. So does she. I know that she won't remember much, if anything, although sometimes her memory kicks in when I least expect it. But just taking her seriously when she wants information or suggests changes in her care and discussing in detail the possibility of making the changes she suggests keeps her feeling as though her life is under her control. Today, for instance, I carefully explained what each medication and supplement was for, what might or would happen if she discontinued its use and gave her choices where choices were appropriate: With her supplements, for instance. Since her supplements are mostly substances that she's chosen on her own and taken for years (even though I've found personally specific reasons for all these supplements), she decided, supplement by supplement, to continue taking everything. She wavered on the iron until I explained to her that the alternate to taking iron was for her hemoglobin to drop month by month, as well as her energy level and sense of well-being, and enduring transfusions when it dropped low enough. She doesn't want to do that. Once she understood, again, what the lisinopril, glipizide, Protonix and Macrodantin do she decided to continue taking those, too. I assured her, more than once, that, all things told, she's actually on very little medication and I continue to work to look for ways to keep her medications from being increased or for ways to reduce them. She knows this and trusts me to make sure she isn't over medicated or dangerously cross-medicated.
Test results came through today. I've posted them here. I was wrong about a draw for TIBC and Ferritin, which is fine. A reading for iron was taken as a part of the CMP chemistry section. She reads in the normal range. The only out of range reading that concerned me was her unusually low Anion Gap, which can be noted in the CMP section. I talked to MCS about this and we both looked it up in our medical texts. Anion Gap is a measurement of "all other electrolytes" beyond Potassium, Sodium, Chloride and CO2. We both discovered that a low Anion Gap reading often occurs as a result of taking, among other substances, diuretics, some antibiotics and, get this, licorice. Interestingly, although one wouldn't think her low intake of furosemide would qualify, both her Detox teas, of which she ingests one cup daily (usually strong, since she prefers to keep the bag in the cup as she drinks her tea) contain licorice root. The aroma of the teas, in fact, are strong with licorice. So this not only explains her low reading (she's been minorly low before) but also explains, in part, why the doctor was not concerned about this. As well, MCS's text mentioned that this reading should be considered in conjunction with the other four electrolyte readings. Her other readings are fine.
All's well that tests well.
Later.
