When a patient has a stomach ache, it can be confusing, worrisome etc and I try to help them find a stomach ache remedy as quick as possible. Often the first reaction is: “it must be something I ate”–i.e. food poisoning.
But usually it’s not. Stomach flu or gastroenteritis, often caused by a virus, is far more common in Culver City and Beverly Hills areas than is food poisoning. Food poisoning comes on hard, often more vomiting than diarrhea, and leaves relatively quickly. It can make you miserable in the meantime. Often people you ate with get sick or the restaurant or friend’s house may report other folks with similar responses (if they’re honest).
How about serious conditions? Well severe localized stomach ache, especially in that right lower region could be appendicitis, in the left diverticultis. There is often local tenderness, low grade fever, and it gradually worsens. Any question about this, see a doctor/urgent care or emergency room. But statistically this is far more rare than the annoying and common gastroenteritis. Most of these are acquired by contact with someone who’s sick or is about to be sick or has recently been sick or their kids or your kids.
The symptoms vary from person to person and time to time but include nausea, sometimes vomiting, sometimes fever and a generalized stomach ache without the localized quality of appendicitis (right lower) or diverticulitis (left lower).
Step One: The first thing to do is to deal with the nausea. That’s the bear because it feels terrible and it doesn’t allow you to hydrate, drink fluids, etc. which you need to get better. I like to prescribe ondansetron for this, ideally orally dissolving tablets for their ease in consumption even with nausea. It’s also known as zofran and in my offices I have an injectable form as well which works quickly. This medicine really breaks the nausea cycle and allows the patient to proceed to Step two.
Step Two: hydration. Start with sips of water. Small sips at first to ensure they stay down and then gradually larger sips and larger amounts when you’re sure you can keep fluids down. Too much too soon can set you back to Step One (the nausea cycle). If you have Gatorade or flat regular sprite or cola (not diet), this is your change to sip these as well or mix with water to dilute them. Gradually get the fluid in to keep up your strength, fight the fever and rehydrate from any vomiting, and flush out the virus where possible.
Now you may be dealing with a stomach ache and diarrhea by now. This is the body’s way of expelling the infection, so it’s not all bad. But it feels lousy and it takes a lot out of you (so to speak). Again, the hydration helps this a lot. But with more diarrhea, and less stomach ache, and no nausea, you realize you ready for Step Three.
Step Three: Begin to introduce dry, calming food bits to nourish the body and help the stools to start forming again. The famous BRATT diet is first. Bananas, Rice Applesauce, Toast, Tea is where the acronym comes from. Variations include dry saltine crackers. Start slowly, small amounts, enjoy the white rice (I top it with cinnamon), continue to hydrate, and you’ll gradually feel stronger, replace lost calories and your bowels should begin to bind up. This stage may be a 1/2 day to a day depending.
Stage Four: You are keeping the BRATT diet down, you’re more hungry, stools are tightening up. What do you eat next that won’t blow your gains so far? Chicken without the skin/grilled or baked. Dry grilled fish (or baked). Baked white potato. Avoid dairy products, vegetables, salads. This whole recovery thing is like a chance to eat fairly unhealthy for a couple of days while you are getting healthier. Kind of a medical paradox!
Stage Five: After a day or so of these simpler, drier foods, it’s time to expand the diet, although dairy products and greasy foods should usually be re introduced last of all. Many gastroenteritis infections affect the intestines in such a way as to give everyone a temporary lactose intolerance and that’s why dairy is to be avoided. Greasy foods just seem harder to digest when you’re recovering as well.
Stage Six: Normal diet. Just remember the other stages for a friend or if you get sick again.
Remember: unexplained worsening, high fevers, severe abdominal pain or localized abdominal pain means getting to the emergency room or doctor’s office ASAP. Don’t self-diagnose or rely on this or other educational materials to the exclusion of competent medical care.