How long is too long on clear liquid diet?

[cal1]

Late last week, I started feeling the all too familiar pain of a partial small bowel obstruction coming on. I stop eating and drinking as always, only sipping water to try and minimize dehydration if it does not resolve and gets worse.

Fast forward, it is Friday 8/21 early AM. I am at emergency with writhing abdominal pain, they are preparing to admit me for what appears to be active Crohn's in the ileum causing the obstruction. Nothing by mouth for 36 hours, then clear liquids only. I tolerate the liquids so they release me and tell me to call my GI Doc ASAP. GI Doc says "see you on 9/11, clear liquids only until then." Hence my question: how long is too long on clear liquids?

I have been drinking gator-aid and taking a bit of clear broth and that is all. I have lost about 10 pounds thus far. Although I am fat and need to lose some weight, this is probably not the best way to lose it. I am guessing I will drop another 10 by the time I see the doc.

I have been considering at least adding something like V8 juice to get some vitamins, but then that is not what I was told to do. Thoughts and insights are greatly appreciated.

By the way, they have me on pred 30mg per day tapering to 20mg in a week and continue until seeing doc. I think pred on an empty stomach is even worse.

 

[Clash]

You could ask your doctor if you could do enteral feeding until. That is formulas like otc boost or ensure or more broken down formulas by px semi elemental and elemental formulas.

There are members on here that drink them and others that use an ng tube. Some insert and pull the tube each day themselves as they take the feeds over night. Others have the tube placed for several weeks. And of course some don't use the tube at all and intake the formulas by drinking them.

You could make a call to your GI to determine if any of these options are appropriate for you. There are a number of patients that use EEN (exclusive enteral nutrition) instead of pred to reduce inflammation since they don't like the side effects of pred. Others supplement with the formulas during flares to ensure they are getting optimal nutrition and to help with blockage causing inflammation.

 

[happy]

I agree with Clash--I was in a similar situation and wasn't able to get in to see a GI for seven months. In the end I lost 60 pounds and be came malnourished--it took me several years to recover. Try to get some EN now. Don't accept a wait.

 

[24601]

I agree with everyone above and think you should be drinking complete nutrition drinks like Ensure or Boost and not just clear fluids.

Even if your BMI is well within (or above) the normal range you risk nutritional deficits which will not help your body deal with inflammation. And if you've been regularly having to stop eating because of obstructive symptoms then you may already be borderline malnourished and decline more quickly than someone who has been having optimal nutrition until now.

I don't think your doctor is doing the best for you by asking you to stay on clear fluids for two weeks. You need to keep your nutrition optimised to heal, both from the inflammation and for what might lie ahead (with an obstruction surgery is possible).

I've had a lot of strictures and the only time I was asked not to drink enteral nutrition drinks was when the degree of dilatation meant my surgeon was concerned that my bowel might perforate so I was also told to only have little sips of water and was on TPN.

I can't see any reasoning for having you on clear fluids rather than enteral nutrition with respect to the obstruction. If there's a high risk of perforation then I would think you should be nil by mouth and on iv fluids if not TPN. If you can have fluids then it's better for you to have the complete nutrition provided by drinks like Ensure and Boost.

And then there's the likely therapeutic benefit of the enteral nutrition. I can't see why you'd wait to start on that either.

Good luck and do let us know what the doctor says :ghug:

 

[Chester31]

Agree with the above. My son has a stricture in the small bowel and is waiting for a date for surgery. He has been on EEN (Ensure) for a couple of months now and will continue until surgery is done.

 

[cal1]

Thanks for all of the responses. I will call the docs office on Monday and raise a bit of hell (one of my specialties). My Doc is great, but his staff sucks IMO. I have in the past demanded they ask him to contact me directly. He always does. I suspect when he gave the clear liquid order, he was unaware that I would be on it for nearly three weeks by the time I saw him.

I have been managing these type of partial obstructions for over 30 years now and typically can tell what is happening based on how my gut feels. Normally, I would have advanced myself slowly to thicker soups and then to low residue foods slowly always going right back to clear liquids if I start feeling the cramping and other symptoms I have come to recognize.

Since I don't hit this site often, I suppose I should add that I had 20 inches of ileum removed 30 years ago. No other surgeries, probably lots of strictures from various flares over the years. Once bowel contents clear the small bowel it is smooth sailing the rest of the way for me. Well, maybe not smooth, lets say expeditious. Bile salts that have not been reabsorbed tend to be the expediters.

 

[my little penguin]

Hope you can get through to your Gi
Fwiw Ds has been on mostly een ( very little food ) for 5 months - growing and gaining great .

 

[Jennifer]

I've been on a clear liquid diet for about two months when I was 9 years old however I was also hospitalized the entire time and had an IV to keep me hydrated. If you ever need to be on a clear liquid diet for more than a few days then you should be closely monitored by your doctor. Mayo Clinic gives a great example of what you can have and how often you should be drinking. http://www.mayoclinic.org/healthy-l.../in-depth/clear-liquid-diet/art-20048505?pg=1

Did you have tests done to see if it was active disease causing the blockages? Since you've had a resection in the past it's possible that you may be dealing with scar tissue at the anastomosis. If that's the case I wonder if you would be able to have a strictureplasty.

 

[cal1]

Thanks so much for the link.

I had a CT scan done while in the hospital. They seem to think there is about 20 cm of active Crohn's proximal to the anastomosis. I tend to be a "doubting Thomas" at least until my GI Doc breaks it down for me. Too many misdiagnosis and just plain old bad doctoring over the years for me to do otherwise.

I have a lovely picture on my anastomosis taken two years ago during a routine endoscopy. Apparently, all was clear then. My gut (pardon the pun) says it is at or near the anastomosis. I have experienced these types of events at varying levels of severity starting just a few months after the resection.

 

[Jennifer]

Did you get a hold of your GI about the liquid diet?