I recently treated a lovely 45 year old female patient who had arrived in the ambulatory care department.
As I flicked through her triage notes in preparation for our consultation, it was apparent she had a “high stoma output”.
A stoma is a bag that attaches to the skin to act as a continuation of the gut – as the gut contents progress through the body, it reaches the stoma bag and is stored.
People have stomas when they have had operations on their digestive system, which may have occurred for a number of reasons including damage, infections, cancer and inflammatory bowel diseases.
Part 1: Admission
She knew what was wrong.
She had experienced tingling and cramping of the muscles in her feet – she told me that her ‘magnesium and salts are low”.
She had a racing heart that had strong forceful beats – “I only get these when I know I’m dehydrated”.
We decided to top her up with fluid to bring her back to full hydration and to keep her in the department for an hour to monitor her recovery.
WorkupThis lady had her entire large colon removed, which is a segment of the gut that helps absorb the water contained in the foods and drinks we consume.
This means that, unlike other people who are able to drink water to stay hydrated, normal oral intake is not adequate for this lady. Although she can absorb some liquid, it seems that she gradually becomes more and more depleted until she returns to be fixed at the hospital.
People with stomas are commonly recommended to avoid foods high in fibre and chewy foods such as red meat, to prevent obstruction of their gut, an essential organ made even more precious after its surgical shortening.
Compare this scenario to the outcome of eating these foods in a normal digestive system – fibre acts in the small bowel to slow down the digestion and absorption of food, while feeding the helpful bacteria found in the microbiome of the large bowel.
The ability to eat meat makes an adequate protein intake easy – maintaining nitrogen balance and providing the building blocks for muscle and immunity.
Moreso, these plant and animal foods are nutritious, providing us with the minerals, vitamins and other micronutrients needed for enzymatic processes and hormone production. A healthy gut is the best way to fuel our bodies for health; for my patient, these options are off the menu.
Soft, fibreless foods. No fibrous vegetables, which removes many options. Limited meats. White bread. White pasta. What can she eat that fits the bill? She eats chips and crisps to get calories and salts, and drinks lucozade to maintain her electrolytes. This is not a balanced nor good diet for long term health.
But why did the stoma happen?
Why did the clot happen?
What causes clots?
Inflammation: A heightened state of the immune system to deal with insults and infection.
Hemodynamic changes – stasis or turbulence.
At medical school, we are taught that common examples of stasis are sedentary behaviour, dehydration and smoking.
One cause of disruption is secondary to a clot, a product made more likely if the blood is hypercoaguable