NURSE KNOW-IT-ALL

Hear me, Medicine Woman:

I don’t know what the hell’s going on with my innards, but what’s coming out is a high-octane stench. Humiliating? You bet. And the fiendish bellowing my bowels beget throughout the day make the song of the humpback whale sound like a whisper. What do you have to say to one gassy guy?

—Let It Rip


Dear Rip:

My heart goes out to you, dear, even if you’ll excuse me for holding my nose whilst it does so. I’m sure I don’t have to tell you that flatulence is nothing to sniff at. The antiretrovirals and anti-OI drugs that you take every day often mess with your gut in more ways than one. So voila!—flatus guaranteed to peel paint, curl nose hairs and clear crowded subway cars.

Here are Nurse’s tried-and-true windbreakers: Swallowing one to three tablets of digestive enzymes (Ultrase MT 20, available by prescription, is one recommended variety) with each meal or snack seems to clear the air for many HIVers—and those in their immediate vicinity.

If friends are still carrying nosegays when they venture close to your tailpipe, give glutamine a go. Doses of up to 40 grams a day, mixed with liquids, are often an antidote to toxic gas. Adding a high-colostrum whey product like Optimune sometimes enhances the fart-free effect. Whey protein and glutamine—which has the added benefit of solidifying stool for those with protease-induced diarrhea—can be had at your local health food store or PWA buyers’ club. Another tip: Turn two or three large meals into a greater number of snacks.

Some people have given their emissions as excuses for falling off the med wagon. Don’t even think of it, sweets. For what it’s worth, I’d much rather suffer your smells than attend your memorial service. So let one go—and tell those who snicker to get over it!

Dear Nurse:

I never thought I’d be reduced to putting my ass on the line like this, but here goes. I’ve got hemorrhoids—but bad. I’m praying you’ve got something to help me crack a smile.

—Blood on the Saddle


Dear Saddle:

Whoa, Nelly! I never promised you a rose garden, especially when your rosebud’s rubbing you the wrong way. They say the best way to avoid becoming a martyr to the piles is to avoid getting them in the first place, but Mother of God, that’s vintage victim vilifying if I ever heard it.

Those who share Nurse’s fascination with the body beautiful might enjoy learning that hemorrhoids are really rectal varicose veins, not unlike those that bedevil the legs of so many of my sisters in white. In fact, three out of four Americans have hemorrhoidal episodes at one time or another. Constipation is a common cause: Straining for stool stresses out your butt’s blood vessels. Lifting heavy weights, obesity, pregnancy, standing or sitting for excessive periods, not to mention lingering long in the loo following a bowel movement, and—my own favorite—anal sex, are also culprits. Hemorrhoids come in three varieties—internal, prolapsed and external—and result in varying amounts of itching, bleeding and pain in the ass.

Most flare-ups can be remedied simply by increasing your fiber and water intake, thus easing stools’ passage through your lower stretches. And, since more than 50 percent of HIVers are magnesium-deficient—a major cause of constipation—magnesium supplementation (300-500 milligrams a day) can also help you to take a load off. Treating your bothered bum to soothing sitz baths (15-minute sit-in soaks) can work wonders, and cortisone-containing creams (Preparation H), suppositories or aerosol sprays (Proctofoam is one) have spread joy to many a cranky keister. Persistent pain and bleeding should signal you to have a doctor assess your anus. Rubber-band ligation may be called for, a relatively painless process by which a tiny rubber band is slipped around the hemorrhoid to sever its blood supply; the shriveled stump sloughs off a week later. Other procedures include infrared coagulation and bipolar electrocoagulation (“bicap”), which zap the hemorrhoid’s blood vessels; expensive laser therapy; and surgery. While the most effective, surgery also means a longer, rougher road to recovery.

Whatever route you choose, be good to your harassed bottom by not overdoing spicy foods, citrus fruits, alcohol and strenuous post-op exercise. Stool softeners and baby wipes are pennies well spent. A final word to the wise—and please excuse my French: Avoid vigorous butt-fucking until healing is complete, unless yours is an implacable predilection for pile-driving. And when your bum lies bleeding, other people’s mouths and tongues should leave it alone, unless, of course, it’s wrapped up tight in a little latex outfit.

If you have nagging health problems, send your complaints to Nurse Know-It-All at 349 W. 12th St., New York, NY 10014 or e-mail nurse@poz.com.