Tuesday, October 19, 2010

Why is everyone talking...

Posted by Sarah Thiel at Tuesday, October 19, 2010

about poop?

Now, I know that many of you will read this and have the same reaction I did. As students, we chose pharmacy over nursing and medicine for various reasons, but for me (especially after I worked as a nurses aid at a nursing home in Germany one summer), I knew I did not want to physically handle or care for patients they way a nurse or physician may be required to, and that included seeing, handling, or discussing "bodily habits".

So what does this topic have to do with pharmacy rotations?

While attending rounds everyday last month on the Bone Marrow Transplant service, it got me wondering why half the time the medical and nursing team was talking about poop. What does poop have to do with being a pharmacist? I mean, I know we learn about constipation and diarrhea in therapeutics, but how much is poop really going to impact my therapeutic plan?

Well, the answer is- A LOT!

Color, consistency, frequency (or lack thereof), volume, and even the smell of excrement can tell you a lot about a bone marrow transplant patient.

First, there are concerns of graft versus host disease (GVHD) in these patients. Simply put, this is when the transplanted stem cells and resultant mature immune cells recognize the patient's body as foreign and begin attacking. The most common sites for this to occur are the skin, liver, and gut. To diagnose and grade GVHD of the gut, stool volume has to be >500ml.

Second, poop can tell you about infections. BMT patients are severely immunocompromised- we just completely whipped out their own immune system and gave them back stem cells that take time to develop into mature immune cells (in the BMT world, thats called engraftment). Therefore, infections of any kind can pose a serious threat to these patients. If the patient is having diarrhea, is it C-Diff? rotavirus? adenovirus? Other potential causes? And if you smell something extremely foul...there's a good chance its C-diff.

Third, poop can tell you about other complications. If there is no poop, does the patient have an illeus? Will they need parenteral nutrition if it doesn't resolve? Or is it just constipation from antiemetic and analgesic medications? If the stool is black and tarry or bright red, that can tell you there is a GI-bleed (upper verses lower respectively).

All of these affect how you treat a patient and your therapeutic plan as a student pharmacist. From pharmacokinetic dosing of immunosuppressants to prevent GVHD, adding steroids or other therapy to treat GVHD of the gut, adding antimicrobial or viral therapies to treat infections, addressing possible GI bleeds, to requesting a nutrition consult, knowing all the gory details about your patient's poop can help you choose the best therapeutic plan for you patient.

So why is everyone talking about poop? Because sometimes in life, crap actually is important.

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