Sunday, June 22, 2014
Transverse Myelitis and getting your Bowels into shape
We are all different; we all have different family traditions in daily living and our dietary patterns. Different shaped bodies have different intake needs, and different bowel habits. There are those of us who have exercised regularly all our lives and try to keep our bodies in shape – whatever our physical problems, and there are many people who have never needed to seek out exercise – their bodies are just in a natural balance.
There is one truth I know, and that is we all feel more comfortable when we have emptied our bowels. Doesn’t matter if we are once a day types, or once a week types. For those of us with Transverse Myelitis, there is another truth, and that is that from time to time we all have problems keeping regular. Some of us have naturally sluggish bowels apparently made worse by TM, some of us have erratic bowels, or recurrent diarrhoea. Either way we are likely from time to time to get ourselves in a mess and maybe embarrass ourselves in public. I am not necessarily talking about the first few days and weeks after we are attacked by this damned disease, as I described (chapter 3 in my book on recovery: ‘Taking Charge; a journey of recovery’ now available on Amazon Kindle (you need the whole title to find it !!). Rather my focus is on after we have reached a steady state of some sort of recovery.
I thought I might share some things I have discovered. My hope is that it will help those of you who are a bit shy, or intensely private, to discuss your own experience to help others. The basis of this article is to make changes as ‘naturally’ as we can, and avoid having to take artificial laxatives from the pharmacy. In fact I will not be talking about those at all.
So, my natural habit, all my life, is to go twice a week. Now I have reached a steady state, I am sort of back to this pattern. The problem is that (in semi-retirement) I work in a private practice 2 days a week (Wednesdays and Thursdays), and that is fairly intense, with back to back clients – not much time for personal needs. But what seems to have happened is that the ‘twice a week’ happens on the days I work! All very awkward... I want to change the pattern, and have been struggling to work out how.
The first thing to say is that, despite body shape and lifelong habits, my bowel habit (like everyone else’s) depends on my intake. If I go with my childhood preferences of high calorie, low residue foods, then I get ‘blocked up’. Being married to a dietitian, I have learned that, (in order to avoid later diabetes) it is advisable to eat what are called low glycaemic index foods. That is foods that release their sugars into the body slowly over time. As an example, if I eat potato in a meal, then the starch is broken down into some sugars slowly over time. Conversely, if I drink a can of high sugar fizzy soft drink, then I get a sugar hit – a rapid rise in my blood sugars, which challenges my pancreas to produce insulin, to reduce the blood sugar rapidly. Then I feel I need another sugar hit.
OK, the interesting thing is that the can of soft drink does not contribute much (if anything) to my bowel regularity. Potatoes, on the other hand, like many starchy vegetables, provide the bulk to my stool that we all need. A wide range of other foods help to keep us regular. Fruits and vegetables are never totally digested, and leave behind cellulose and other things that provide bulk. Meat fibres tend not to be totally digested, and meat also contains fats that may pass through to the large bowel.
If your bowel is a bit slow, look at your own diet, and see whether the addition of foods that leave residue could be part of the answer. My own diet includes two serves of bread with lots of salad (lettuce, celery, tomatoes, etc) and some tasty filler (cheese, ham, sardines or paté, etc) for lunch most days, with a piece of fruit (a pear or apple). Our evening meal always has at least three vegetables in season, in addition to a main item.
There are some other things I have found by trial and error. Dried fruits (apricots, figs, cranberries), are tasty, and leave a residue which can induce a bit of bowel movement. I have practiced enough now to know exactly how much I can eat of these on a regular basis to avoid looseness and diarrhoea.
Kellog’s make a cereal which is known as ‘Guardian’ in Australia (no, I don’t have any shares or other conflict of interest). It contains a fibre called ‘psyllium’, which stays in the bowel, provides bulk and provokes some bowel movement; very useful. Several members of my family have a habit of using this as part of their cereal serve every morning, and swear it keeps them regular. I think it tastes a bit like cardboard, but when I am a bit glued up, I succumb and have some over several mornings, and it does help. Each of you will be different, and will use something like this on a more or less regular basis, to suit your own bowel pattern. My preference is to have a bowl of porridge with honey and some cooked dried fruits on a couple of strategic mornings each week to provoke a bowel movement over the weekend or on a Monday (to avoid the problem of my clinical practice days).
There are some foods almost guaranteed to provoke a bowel movement if you are a bit blocked. One well known one is a good curry. Very much your choice... Baked Beans have a reputation for provoking a bowel movement. Again, very much your own choice...
I am somewhat lactose intolerant. Part of my story from hospital is that I love yoghurt. I never gave it a second thought, just ordered yoghurt each morning for breakfast. In retrospect, that was stupid, because I could have ordered lactose free yoghurt, and not had such a glorious story to tell. LOL. However, I use lactose free milk on morning cereal, and that avoids a problem. If I am glued up, I can have a bowl of ice cream on one or two nights after dinner. Ice cream contains lactose, so 36-48 hours later, I usually get a result.
Many people are using so-called probiotics to provide them with a regular ‘natural’ bowel rhythm. I know it works for many. Personally, I get a similar result to when I use ice cream, so I have not found it helpful.
The bottom line here, is that whatever your level of damage from TM, I want you to think through your diet, and look to make some deliberate changes to improve bowel function, and thence your sense of wellbeing.
I don’t want you guys to think I am obsessed with my bowels. However, it is crucial to work out how many times a week you want to go to the toilet to feel comfortable, well, and happy with your body. My personal obsession is to ensure I go to the toilet on any other days than a Wednesday and Thursday. We seem to be managing fairly well.