>I recently had a patient referred to me who was having problems with bowel obstructions.
This older gentleman came into the office alone and sat down for counseling. I knew he had come to the clinic with someone I thought was his wife, so I asked about her and wondered if he would like to have her join us. He told me she had said he was a "big boy" so he could do the appointment by himself and shouldn't need her. She was the one who did the cooking and shopping, so I asked her to join us, and she did.
His wife offered insights and ideas regarding significant factors that may be affecting his bowel problem. She soon realized that without her there, we would have been missing some important background and key points that were found to be useful.
The patient may have been a big boy, but the most effective and successful nutrition and health counseling involves more than just the person needing the help. If someone lives with another person, whether they are married, otherwise related or even just roommates, it is a good idea to have at least one other person present for the counseling.
As it turned out, it appeared the most likely reason the patient was having bowel obstructions was because he only drank about two cups of water or juice per day. He was trying to eat more fruits and vegetables but was not getting in as much as he should.
He was also eating more whole grain products and was even taking a fiber supplement. The doctor had suggested he take a psyllium fiber product, but he had not yet started to do that. This was good since, without adequate fluid, taking fiber supplements can basically cause a cork to form and create a blockage.
He was getting a good amount of activity daily, so that should have been a help except that he was probably getting a bit dehydrated in the heat. He noted that his urine was frequently dark.
So this patient had a lot of changes to make and he was going to need help with at least some of them. First, he needed to drink more fluids, especially water. He should be keeping track of the amount he is drinking. Second, he will also need to take note of how his urine looks and make sure it is not too dark. Third, getting in plenty of fruits and vegetables, along with a good amount of liquid, was important.
The patient's wife happened to also indicate that, although they were eating mostly chicken and turkey, he was very fond of beef and had about three large steaks recently. These were not just nominal 3- or 4-ounce portions of meat. High protein foods, especially red meats like steak require extra water to flush out the ammonia by-products that are so hard on the kidneys. Also, that amount of beef is very slowly digested and takes a lot longer to pass through the intestines.
We may have been able to hit on many of these points during a one-on-one session, but the fact that his wife participated in the conversation had a significant impact on the outcome. It is not easy to remember everything that is discussed during a counseling session, so his wife will likely be able to remind him of some of the things we talked about. She also can be a huge support for him in his efforts.
Chuck Newcomb, MS, RD, CDE, is a consulting registered dietitian currently providing medical nutrition therapy services for Memorial Hospital Los Banos. He has a master of science in clinical nutrition from New York University. E-mail questions to the Attention of ChuckRD at: MHALosBanos@SutterHealth.org or on his website MySmartRD.com.