This topic is about an 80-year-old individual who has been living with an ileostomy since April 2023. They are experiencing black stool after taking multivitamins and are having difficulty gaining weight. They are looking for confirmation that the black stool is normal and seeking advice on how to regain weight. Additionally, they have a chronic abdominal wound that requires daily care.

Here are some helpful insights and advice:

- Black stool is often caused by the iron content in multivitamins and is generally harmless.
- Consider switching to an iron-free multivitamin or trying chewable, gummy, liquid, or oral-spray vitamins, which are absorbed faster and less likely to discolor stool.
- Only take a separate iron supplement if it is prescribed, as too much iron is not ideal.
- Some users have found that Centrum can cause black stool, while Vitafusion gummies do not.

- For gaining weight with an ileostomy, consider these strategies:
- Enjoy calorie-dense desserts and snacks like ice cream, pie, gummy bears, nuts, and high-fat cheese.
- Add extra calories wherever possible, such as butter on bread, powdered milk in eggs, extra cheese, and full-fat dairy. Nutritional or protein drinks can also help.
- Include carbohydrate-rich foods like bread and rice along with protein shakes.
- Prepare high-calorie dishes, such as rice pudding baked with protein powder, eggs, and milk.
- Snack frequently or eat several small meals throughout the day.
- Ground flaxseed can be mixed into foods to add nutrients and calories.

- With an ileostomy, nutrient absorption can be limited due to rapid transit. Gaining weight may require a significantly higher calorie intake than before surgery.

- Medications and aids that might help:
- Lomotil (diphenoxylate/atropine) can be taken before and after the evening meal to slow output and improve absorption.
- Monthly B-12 injections can help maintain energy levels when absorption is poor.

- General reassurance:
- Slow and gradual weight gain is common and often considered acceptable by healthcare teams if lab values and energy levels are good.
- Staying physically active is beneficial even while increasing calorie intake.