Another WIN for Therapeutic Modalities

Hello everyone! Sorry I haven't posted in approximately ten years. I have either been out of town, nothing to say/write, or just trying to find seconds to spare just to breathe. But there's no excuse! So look for a lot of upcoming posts. Many weeks of no posts= a lot of pent up thoughts waiting to escape into blog posts! Yay!


So this post stemmed from last night at work. Here's the situation:

My patient had a total abdominal hysterectomy approximately 2 days before she was under my care.  Under report I learned that she had not had a bowel movement since surgery (but this is common with recent abdominal surgery), and that she has having a lot of bloating and pent up gas cramps/pain.  When I first saw her, she was having some intense nausea. However she had just received a one time dose of morphine, which can very often cause some intense nausea, especially depending on how its given. She also received a PO (by mouth) dose of percocet (she was in a lot of pain). Percocet can also cause nausea. So I decided to give it a little while and told her I would come back.

Well, not ten minutes later is she throwing up, but not much. I still attributed it to the recent doses of narcotics and helped her clean up and decided just to keep an eye on it. However about thirty minutes later she was in intense nausea again, so much so that she couldn't stand up, and was vomiting. My mind started reeling....is there an obstruction? As with any abdominal tampering, its possible to get an unfortunate bowel obstruction. If severe enough, this would then cause anything that's in your intestines above the blockage to come out upwards because it has no where else to go. Keep in mind that she was promoted to a regular diet, just as of the previous day.

So keeping in mind the very real possibility that we were facing an obstruction and may be putting in an NG tube (this would drain out the contents from your intestines above the obstruction), I didn't want to scare her so I didn't even mention it yet. She was already having enough anxiety from her pain and nausea.


Then a thought occurred to me....I always try and put myself in patients shoes. I have had my own very extensive share of gastrointestinal problems and have a lot of experience with different therapeutic techniques, both with western and alternative therapy. 

So despite the fact that I've been blessed enough to have never had abdominal surgery, I have had my fair share of "gas issues", especially thanks to my ever so lovely lactose intolerance. So I thought, what do I do for gas cramps/pain?

I went in the room and asked if anyone had taught her the "Left side trick". She looked at me strange because I pretty much made up that phrase on my own, but what else do you really call it in a quick bundle?  She obviously said no and I then proceeded to have her lay on her left side and massage her entire abdominal wall in a clockwise motion, slowly and rather firmly (but not enough that it hurts). This follows the natural pathway of your intestines and helps guide the gas out the exit door, so to speak.  If you're super lucky, it may even promote the probability of having a bowel movement, in addition to the gas passage increasing the then probability of a bowel movement.

So I had her concentrate on this technique, as I so often do when I'm in gas pain. I also encouraged her to take some deep breaths, and to remain on left side, while also in the fetal position. I find that in the fetal position, the pressure of your knees against your abdomen also helps guide things out the exit door, and....well, it "opens up" the exit door completely, making it that much easier to pass gas.

Now for the epic result?? I checked back in about thirty minutes after that education time, and I honestly didn't have much faith in my alternative non-medication therapies. I came  in offering a powerful anti-emetic that she was now eligible to receive, but turns out? She was feeling much better already. Her nausea had receded slightly and the gas cramps were improving. Win!

Even more win, when I went to go to check on her in the middle of the night, I heard some unexpected news that she actually passed gas! Woot! She even managed to pass a very tiny (but one all the same!) bowel movement. Woo hoo! A + for non-medication therapies, for the win!


I couldn't believe it worked. I mean, I thought everyone knew that trick. I thought it was an old age wive's tale, or whatever they call it. I learned the trick in a mother-baby class in college, when we were taught how to alleviate gas in babies. I assumed it would work for adults, and its always worked for me and now for my patients too! :)


So, thanks for reading through a rather gaseous post.....it can be helpful if you also suffer at times! Who the heck doesn't??!  Admit it. You probably just farted.  Yeah, I just said fart.



Anyway, like I said, I'll try to post more upcoming! Stay tuned....

With Love, WNB




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You've Got a Point

So I have this 93 year old gentleman, who is 100% "with it", aka he's still got it all up there. These are the patients I truly cherish as they are fascinating to talk to. The stories they can tell can blow you away and sometimes you feel like you're working with a truly honorable person, even for just making it this far in life. Anyone that climbs past 90 gets a special medal in my book.

Anyway, this poor gentleman had an NG tube in his nose, which travels down to the stomach. Patients may get these for different reasons, but in this case its purpose was to drain out contents that was impeding a potential small bowel obstruction.

Patients generally hate these tubes, as it is a tube that goes into a nose nostril, travels down the back of your throat. Patients hate it. I would, too. Everytime you swallow, a tube is there and you have to walk around with a tube coming out of nose, on top of totally feeling like crap.

So this one patients tube was giving me a little trouble and I was resultingly in there more working with it, which unfortunately causes him more discomfort. So this is how our conversation went during this whole ordeal:

Patient: "I don't like this tube, it's stuck in my throat."

Me: " mr patient I can imagine this is very uncomfortable and I am very sorry for that. I'm going to do the best I can to make it a little more comfortable for you."

Patient: "what you CAN do is take it out! That will make it all better."

Me: "I know that would make you feel less discomfort but Right now your doctor thinks its best to leave it in, at least for tonight."

Patient: "yeah, he's not the one with a tube down his nose!"


Me, thinking: "touché."



WNB.