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Sunday, January 11, 2009

Gum ,Your Bowels and Society

I once had a patient with severe constipation. Passing flatus, normoactive bowel sounds. But just couldn't go. One of the M.D's at that particular facility told me that he had recently read a study that linked gum chewing to bowel motility, and he even gave me a copy. Apparently it's not exactly novel research because several journals, especially surgical, onco, and GU focused journals have published similar findings.

Because of that I still sometimes write, "encourage gum chewing as appropriate to stimulate bowel motility" in the A/P section of applicable SOAP notes, especially for new post- op patients.

Then I sit and wonder why anyone lets me have a grown-up job.

In all seriousness though, it has been really helpful to several of my patients, and it is evidence based practice, so it's a legitimate plan. I mean, especially in conjunction with something like, "push fluids p.o and encourage prn laxatives as needed." But I just really, really love non pharmacological interventions that have measurable physiological responses. Hot packs and ice, ambulation, pursed lip breathing, weight bearing activity, elevation, relaxation techniques, massage, acupuncture, incentive spirometer use ... I love it all. Medications are very important. And nothing can take the place of getting the proper dose at the correct times (via the correct route!) But when you can add behaviors or actions to create a definable and qualitative increase in quality of health, I think it's even better.

So much can be done just by altering one's lifestyle. Changing diet. Changing exercise habits. In mild cases diabetes can be almost completely managed that way. So can hypertension.

So much can be prevented with life style modifications. But as a society not only are we all about pharmaceuticals but we're also not so much into primary intervention. We'd rather do the damage now and pay for it later.
The exception seem to be middle class 20 somethings who are into being non smokers, doing yoga, shopping at Trader Joe's and going to the gym. (So... Cambridge, MA.) But for the majority of Americans either lack of education or lack of resources or just plain laziness stand in the way of life styles that could prevent major problems down the road. Meanwhile our current health care system is mainly controlled by the Pharm Industry which means that no one at the top has any major incentive to change that.

And so I will continue to include things in my care plans like ginger ale for nausea, elevation for edema, and ambulating ad lib to prevent pneumonia post op. And finding the research to back it up. At least now you know that if you're having trouble with your bowel movements you can go grab a stick of gum. It tastes better than cod liver oil and is cheaper anyway.

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