DEHYDRATION
by Bill Hayles

This is meant as a salutory warning to all those who, like me, think they know all there is to know about stomas and their management.  I'm writing it and posting it while the memory is still fresh in my mind.

DIARRHOEA AND DEHYDRATION.

Vesuvius and I have been together now for nearly seven years.  Like most panproctocolectomates, I know more about managing my condition than the vast majority of doctors.  That's no reflection on them. I have become expert on one condition, and how it affects one person - me.  They have to know a bit about everything.  That's why I've always insisted on managing my own condition.  Problems don't occur very often, but when they do, I can handle them.  I've cleared a couple of blockages without resort to anything more high tec than grape juice and a warm bath.

Dehydration is an ever-present danger for anybody with an ileostomy, and the less small bowel there is remaining, the more of a problem it can be. But I had the problem licked.  Drink lots of liquid, including ORT (Oral Rehydration Therapy) supplements and, if the output increases, drink more, not less. OK, I had those occasional dull headaches due to temporary dehydration, but they always went after some ORT.

Until, that is, the last week.

On Sunday afternoon, 15th December, my wife had a stomach upset and some diarrhoea, which was attributed (wrongly) to a meal we'd had earlier.  A day or so later, I had similar symptoms, and took the usual precautions.  By the Tuesday afternoon, I was feeling unwell, but didn't take much notice, just putting it down to the "bug".  On the Thursday morning, I went shopping, despite not being quite right.  What I hadn't realised was that I was becoming more and more dehydrated - this was no 24 hours "nasty but short" as I'd experienced before.  By Thursday evening, my ostomy output was clearer than urine.  I was asked if the doctor should be called.  I said "no". My family has strict instructions "Bill knows best" when it comes to matters Vesuvial.  Normally that's a safe, if arrogant, assumption.  This time it was wrong.  I had no idea just how much trouble I was in.  In 24 hours, I'd drunk at least 7.5 litres of liquid (when later totting it up, I could account for at least this much; it's probably considerably be more).  Assuming my pouch holds 200ml of liquid, and knowing that I was emptying it every 30 minutes for those 24 hours, 9.6 litres passed through Vesuvius, instead of the more usual 1500cc.

What I hadn't realised was that I was no longer passing urine - my body wasn't accepting fluids orally. What was going in one end was going straight into the pouch at the other. To paraphrase something from The New Outlook, (Chicago, USA's North Suburban Chapter Ostomy Association)

"This is a critical situation. If it persists for many hours with no relief in sight, you may want to go directly to a hospital emergency room while you're still conscience. Tell them your circumstances. They should put you on a saline intra-venous feeding tube.  The saline IV will re-hydrate your body and you should be able to urinate again.  The diarrhea may then be treated.  Most of the time, our bodies can fight this temporary illness after receiving fluids and electrolytes.  This means the hospital will send you home after a few hours, and you should probably be fine.  If you can urinate, you have some time remaining to see if your body accepts the above home treatment."

Naturally, I only read this article AFTER the crisis was passing. So, I wasn't passing urine, and my physical state was affecting my mental state to the extent that I was no longer thinking straight. I was frightened and I didn't know what to do but still, stubborn me, I wouldn't call for help. Luckily, the Gods were on my side, and on Friday evening I started urinating.  Not much, but enough to matter. Slowly, very slowly, an equilibrium was re-established, although I was very weak for another 48 hours and today, Monday 23rd, is the first day I've felt well enough even to turn on my computer.

I still have a long way to go.  I'm still outputting twice as much as I should, and keeping things in check with ORT.  But it's under control, and, in a week or so, I should be back to normal.

Please don't make the same mistake as me.  If in doubt, get help.  If there's a next time, I will.

23rd December 2002

POSTSCRIPT: 27th December 2002.

As is very common for me, when my defences are down, something else will always hit me.  I've caught a cold. Nothing severe, and nothing related to Vesuvius, but it makes it impossible to say how much of my current low state is due to the aftermath of the dehydration episode, or is simply due to my cold.  However, my output is now normal, and I no longer have strange cravings, so perhaps things in that respect are back to normal.