Food Journal and Bristol Stool Form Scale
By: Kate Coleman
Ever since I can remember, I have loved elephants. My most beloved toy as a child was a stuffed elephant, and my favorite book was “The Story of Babar.” As an adult I have watched every documentary ever made about elephants, and I have read and reread “The Eye of the Elephant” by Delia and Mark Owens. For years my fondest wish has been to see a real elephant. So when my daughter’s teacher asked me to help chaperone a class trip to the zoo, I said “YES!” without hesitation. I couldn’t wait to tell my husband and daughter the great news! Then reality set in. The zoo is over two hours away, and I will be riding on a school bus with 32 fourth graders. There will be no bathroom and probably no stops between the school parking lot and the entrance to the zoo. Given my constant battle with chronic diarrhea, I couldn’t trust my stomach to make the drive without an incident. I had to call the teacher and tell her that I couldn’t go. Because of my stomach I wasn’t going to get to see the elephants.
That was the moment that I decided that I was tired of GI problems controlling my life. I was sick of having to plan every moment of my day around my bowels and where the nearest public restroom was located. It was time to make an appointment with a gastroenterologist.
My appointment is in three weeks. The receptionist who booked my appointment told me to keep a Food and Mood Journal every day until the appointment. When I asked why, she gave me several reasons.
- It gives the doctor an insight into my daily diet, and may help alert him to habits or trends that exacerbate my symptoms.
- I will be better prepared to answer questions about current medications and dosages.
- It may facilitate the discussion of sensitive or embarrassing topics.
This sounded like a good plan, so I went out and bought a spiral notebook and took it home to start my journaling. The minute that I put pen to paper, it occurred to me that I didn’t really know what the doctor expected me to include. I decided to go online for suggestions. According to The International Foundation for Functional Gastrointestinal Disorders (IFFGD), these are the things that are essential for a comprehensive Food and Mood Journal:
- Date and time
- What went into my mouth? (This includes food, beverages, prescription, over-the-counter and herbal medications)
a. If this is food or drink, record how much was consumed.
b. If this is medicine, write down the dosage taken.
- What are my current physical symptoms?
a. Am I having any pain? If so, where and how bad is it?
b. Do I have a headache? Gas? Burping?
c. Since I am a woman, I should include any menstrual issues like ovulation or menstruating.
- How am I currently feeling emotionally? Stressed? Tired? Angry?
- Have I exercised? What kind? Duration? How strenuous?
- A description of my bowel movements.
Now that I had my outline, it was time to start recording. Very quickly I noticed a couple of things. The first was my tendency to want to leave out any food or drink that I knew wasn’t healthy. As crazy as it sounds, I was actually embarrassed for my doctor to know about any bad food choices that I had made. I had to remind myself that this was not a job resume. I was not trying to fool my doctor into thinking I am someone that I am not. I was trying to feel better. So, if I didn’t write down that bag of Cheetos that I ate or the three glasses of wine at a party (because I was ashamed of what the doctor would think), I was only making it more difficult for the him to diagnose me.
The second problem was number six; describing my bowel movements. I just couldn’t do it. I felt foolish enough studying my stool before every flush. But writing down a description of it? It was just too much. I considered drawing a picture, but I’m a terrible artist. Then I considered comparing my stools to chocolate: After breakfast my poo looked like Milk Duds. After dinner my poo looked like chocolate pudding. But I knew that after three weeks of doing that I would never be able to eat chocolate again. This was obviously too much of a sacrifice.
Luckily, I discovered the Bristol Stool Form Scale (or BSF) which classifies human feces into seven categories. There are even pictures included so that I could compare my poop to each category.
Now instead of a lengthy description of each bowel movement, I just put a number one through seven. Every gastroenterologist knows the Bristol Stool Scale, so when I say that my poop was a six that is all he needs to know. I printed off a small image of the Bristol Stool Scale and taped it into my journal so that I can refer to it whenever I need to.
So today is day one of my Food and Mood Journal. I made a promise to myself to carry it around with me for the next three weeks and record in it faithfully and accurately. I’m sure that it will be helpful in diagnosing what is wrong with my stomach, and by this time next year maybe I can even ride the bus to go see the elephants.