Sunday, June 23, 2013

Phone Tag

When to Call the Doctor

Having a chronic illness creates complications in deciding when to call the doctor.  Both Ulcerative Colitis and Crohn’s Disease have common symptoms that would send anyone without a chronic illness running for the ER.  To quote the Mayo Clinic’s web page, you should see your doctor if you have diarrhea and:

1.       Your diarrhea persists beyond three days without any sign of improvement
2.       You become dehydrated — as evidenced by excessive thirst, dry mouth or skin, little or no urination, severe weakness, dizziness or lightheadedness, or dark-colored urine
3.       You have severe abdominal or rectal pain
4.       You have bloody or black stools
5.       You have a fever of more than 102 F (39 C) (1)

These are great general guidelines, but they may need modification for those with IBD.  Looking at them in order:

1.       Diarrhea is frequently chronic, and can last extensive periods of time (and can even be the baseline for some folks). 
2.       This one is pretty good.  Dehydration is always a problem, and should result in a call to the doc.
3.       Many folks with structuring have frequent abdominal pain, and rectal pain from bowel movements is common as well. 
4.       Small amounts of bleeding from rectal irritation (“surface blood”) can be the baseline for some with IBD.  Black, tarry stools is generally an upper GI bleed and should result in a call to the doc.
5.       Night sweats are common with IBD and several of the treatments.  Frequent night sweats can make differentiating a serious fever difficult.

From just this one symptom, it’s easy to see why calling the doctor when you have IBD may not be as easy of a decision to make.  Calling five times a week isn’t practical, but there are times when you should absolutely give your doc a call.  A few guidelines:

1.       When your doctor wants you to.  You should discuss with your GI doctor, based on your personal situation, when you should call.  This will vary greatly based on your status (flaring or stable) and your particular manifestations, as well as what medications you are taking.
2.       When there is no proximal cause.  Though we can never definitively attribute a symptom to a single data point (a proximal cause), it does become a factor in when to call.  If you are lactose intolerant and consumed a large milkshake, a little GI upset may be expected.  On the other hand, if you have a poison-ivy like rash appear and haven’t left the house for a week, it may be worth checking in.
3.       When your baseline changes.  Each of us has our own baseline.  “Normal” may mean 5 loose bowel movements a day and fatigue in the afternoon.  If that number increases to 8 a day, it’s time to call the doc. 
4.       When there are immediate threat symptoms.  Bloody tar in the stool, vomiting bile, and sustained fever are all reasons to call the doctor immediately (and if they are not available, its time for a visit to the ER). 
5.       When in doubt.  If you are on the fence about whether or not to call your doctor, err on the side of caution and make the call.  The worst that will happen is you expend a couple minutes of your time in exchange for piece of mind.

Bottom Line

-          Symptoms that would necessitate a call to the doctor for those without IBD may be “normal” for those with Crohn’s and Colitis.
-          When experiencing a new symptom or in doubt about your current state, call your doc.

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