Fuckin McDonald's

Things were going so well. The new medication was moving everything down appropriately, especially at night. Everyday the boot under my ribcage was getting one size smaller. I started genuinely believing my hiatal hernia would be a thing of the past and washboard abs would be in my future. The arc of history was bending towards health.

Then I got cocky. I started believing history's ultimate destination was a foregone conclusion. I forgot that vigilance is what bends our arc.

I was on my way to BWI airport from Philadelphia, on my way to picking up Avi and then boarding with him in D.C. for the week. I was running a little early and hadn't eaten dinner so I took an exit, tempted by the promise of a Taco Bell, and followed the signs only to find a dark and empty restaurant. I wasn't running that early so I was left one option, the fucking golden arches. Now, I wasn't so cocky to think I down a whole jumbo sized value meal or whatever. I just got one of those Southwest Chicken Sandwiches they were hyping a while back and an order of fries. I didn't think it was too extreme.



But all week, the boot just grew and grew. My streak of days with bowel movements was broken, and the bowel movements I did manage were measly little ones. Worst of all, I could feel food lingering in my esophagus again, not going down. I would wake up with soreness in my chest. And for what? Damn McDonald's. Never again. Not while I'm still this fragile.

New News: My Stomach is Upwardly Mobile

Last Wednesday I had a visit with the ol' doctor. The ostensible reason for my visit was to ask him whether I need any vaccines or medications for my upcoming trip to India. Really, though, I wanted to vent about my bowels. Spew the accumulated anxieties since my last appointment onto a receptive and knowledgeable lap.

Here's what we discussed:

1. The glorious return of motility spanning my trip to pittsburgh and the phillies + election euphoria.
2. The subsequent onset of doldrums, bowel- and life-related.
3. He confirmed that, in patients with irritable bowel, digestion can respond to even these brief periods of productivity and happiness. One doesn't need, say, a year of normalcy to see improved digestive function.
4. Food triggers, specifically, the recent blog entry I read that mentioned whole grains as a common IBS trigger. The doctor soothed my worries and may have softened my instinct for dietary vigilance by insisting that the long-term retraining of the bowels via fiber therapy is more important than avoiding this or that food.
5. Paranoia that after-effects from my abscessed, ruptured appendix are to blame for my since-heightened internal woes. This recent paranoia was spurred by a throwaway comment made by my brother's girlfriend about her grandmother, who, since her appendicitis, could not eat the same foods or resume the same lifestyle she had beforehand. Poor doctor, he heard me out, joked that "we can treat paranoia too if we have to," and calmly insisted that we are on the right track.

But! The most important revelation of the appointment came thanks to a question I almost wasn't going to ask, just as the doctor was getting ready to leave. I was afraid that I was perhaps being too needy, but then I went ahead and told him that, lately while I was laying bed before and after sleep I would notice that my esophagus felt sore. I told him how I also felt that food would linger in my esophagus for what seemed like hours after meals. I told him how it felt like I swallowed a giant boot, and that I could feel this boot in my chest, right behind my ribcage. I then reminded him of the barium x-ray I took several months back (here's a picture of what it looks like when your insides are x-rayed after swallowing some barium), in which it took more than three hours for the barium to pass through to my stomach. (The normal time is less than an hour.)

The mention of soreness seemed to catch his attention. He asked how often I felt this sensation. He then reminded me of my hiatal hernia. Honestly, I vaguely remember one of my doctors mentioning this, but as he didn't make a big deal of it I quickly forgot. Basically, what happened is that, due to my acid reflux, the upward pressure of food refluxing has pushed my stomach into the esophagus's territory, beyond the diaphragm and sphincter which usually form the boundary between these organs. Here's a picture:



That bulge, the hiatal hernia, is the boot that I feel. It's why I always feel bloated and never feel hungry. It's why my lower digestion was improving with fiber therapy and the amitriptylene, but my chest still feels like cement. My doctor then offered a bit of a jibe for my specialist, saying that by giving me Prilosec the specialist was treating the acid but not the reflux in my acid reflux disease. Doc then proceeded to prescribe a drug that would treat the reflux.

Less than a week into this drug, I feel better already. My only lingering question is whether the act of taking this drug alone can reverse the hernia, or if it just stops the the event that caused it. I'll ask him when i call him in about a week. Things are looking up.

Paranoia

A couple nights ago I was lying awake, convinced that there was something living inside of me. Like, a parasitic worm of some kind. As you might expect, this realization was distressing. I know that my doctor checked stool samples (that I collected, with little tiny shovels, from a deuce I had to take on newspaper laid out on the ground) and concluded that parasites were not the source of my woes. Still I went back to the thoughts I had, laying in that bed about 14 months ago, just back from China. Then, too, I felt FOR SURE parasites were doing some things in my insides. What I pictured as a worm moving around was just my body's asynchronous damn peristalsis, my doctor assured.

The fact that I had been down this road did not stop me from utterly convincing myself it was indeed a parasite. On one shoulder was an image of doctor, laying out in very rational statements that we already checked for parasites, that if I had a parasite my symptoms would be restricted to the lower half of the GI tract rather than the whole thing, that IBS is the only real conclusion. But on the other shoulder was a statement my nurse made in passing while I was waiting to go in for my endoscopy, casually offering that there are so many parasites you can contract in other parts of the world that they can't even test for. For the first time in probably 400 days my subconscious canceled with my doctor granted an audience to that nurse.

When you are sick for an extended period of time, as I've been for about two years now, you start to become paranoid. Because there hasn't been a firm diagnosis, you can't completely buy into the doctor's prescriptions. For example, I've been back on extended fiber therapy for a few months now and while I have seen some improvement in my symptoms, it has not been a silver bullet. How do I know my body isn't getting better despite the fiber? For every report that probiotics may help soothe the more flagrant flareups of IBS there is one that says the contrary, saying probiotics might do more harm than good in some IBS patients. This lack of certainty is probably the most annoying aspect of having a chronic, vague problem like IBS. Especially since IBS has a strong mental component. If you can't totally buy into the fact that you're on the right treatment path then you're fighting against your brain and your body.

Who knows what I'm going to convince myself of tonight?

Bowels Responding To Happiness

One week ago: THE PHILLIES WON THE DAMNED WORLD SERIES. FIRST PHILADELPHIA MAJOR SPORTS CHAMPIONSHIP IN MY LIFE. THE CITY AND I GO CRAZY HARMONIOUSLY. PARADES. RIOTS. HUGS.



Yesterday: OBAMA GOT R DONE. ABSOLUTE GIDDINESS. HUGGING STRANGERS. BEER. STOPPING CARS AND HIGH FIVING EVERYONE INSIDE. A DAMN NEW ERA. TELLING CUTE GIRLS THEY ARE CUTE.



It seems my bowels are responding to all this happiness. I've been having bowel movements on the regular for over a week. At least one a day. Like clockwork, right after I eat my bowl of fiber one cereal and my fiber cookies I feel the rumbly in the tumbly. I feel a little like a normal person, minus the bloating and the knot/brick that is still sitting somewhere in my GI tract. But my gut knows something for sure: things are looking up.

My Bowels Are Trying To Tell Me Something

It's been well-documented, my struggles to take regular craps.

But this weekend, something remarkable happened. I went out to Pittsburgh for a weekend, ostensibly to meet some people to ask them to write me letters of recommendation for grad school, but really to hang out with friends. Soul night, huge costume party, lots of alcohol and more friends than I have here - amazing. A theme of the weekend was people making the argument that I should in fact move to Pittsburgh. My rational side was weighing both sides of the argument (anti: intertia, pro: happiness).

But meanwhile my subconscious, acting in concert with my bowels, was trying to make it clear where it stands on the issue. In a span of 2 days I had FOUR, count 'em, FOUR solid, relieving poops. And usually travel disrupts digestion in people with IBS.



Four giant turds might have just made an important life decision on my behalf. Pittsburgh!

Barack Obama and My Bowels

It had been many weeks of straining. I was straight up constipated.

But then something happened. Just in the past few days things in my belly have started looking up, like Obama's numbers in Virginia. In a span of four days I had two of what I'm calling, in Obama spirit, "fierce urgency of now" dumps. I think you can figure out what I mean by this. You feel a rumbling in the tummy, you stifle it, and it flares up, no longer willing to be ignored. For the latter of these two I was at an open house at Columbia, and I defiled their public bathroom with an enormous and ridiculously relieving number two. And in the days since I've had almost daily poops, but these have been a bit more troubling since they are almost black in color and really quite stinky.



I don't know what to attribute this to. The Phillies? Obama? Either way though, it's good news.

Reaching for the Stars, Hoping for a Ceiling

I wish I could take an impressive dump everyday.

Have sown; trying to reap

There's a loose pattern: I go jogging, do some crunches and push-ups, let sit some hours, and voila!- a bowel movement. Sometimes, sometimes not. I did the exercise bit. I could really use a nice deuce right now.

Reminiscing

So, while I was on the pot earlier today, trying to channel Obama and hope my bowels into regularity, I had something like a flashback. I thought back to the whole gut transit study that Dr. Parkman at Temple University's Digestive Disease Center scheduled me for. I chuckled when I remembered that it involved eating a "radioactive egg sandwich" that was spiked with radioactivity. This test is designed to chart the progress of a typical meal as it meanders down my irregularly lethargic digestive tract, so the doctors can get a better since of where the major point of blockage is. Because if it gets stuck in my esophagus that would be treated differently than if it gets stuck in the lower bowel, say.



Anyway, I was fine was this test, a) because I get to eat a radioactive egg sandwich, and b) I felt like it was good information to have. My constipation and incessant bloating told me there was definitely some bottleneck point, and knowing that would expedite my recovery. Back then, you know, I was hoping for recovery. But, for some reason, after analyzing the pictures that were taken over the course of four days, the doctors concluded there was nothing abnormal. And for that week, they were right. It baffled me that during the four days of the test my bowels stopped acting up. By the way, this mysterious behavior led me to speculate that there was a mental element to my sickness- that since my mind believed with these tests being taken that steps were being taken that would lead to recovery, it got soothed and let the poop flow.

But as I was sitting on the toilet, straining, skimming The Economist and hoping for my first satisfying bowel movement in over a week, I was wondering why they couldn't trace the movement now. Clearly, it isn't "normal." In a lot of psychological studies I know there is a phenomenon where the investigator has to take what the test subject says with a grain of salt, knowing that responses might be altered with the presence of the investigator. No objective point of view, etc. I need a whole gut transit study redo. And not just because I want more radioactive scrambled eggs.

State of Digestion: 10/6

Breakfast: 1 bowl Kashi Honey Almond Flax cereal
Contains 8 grams of fiber, 4 grams of soluble fiber and 4 grams of insoluble fiber. Apparently, insoluble fiber is better for constipation.

Lunch: Chicken Tikka Masala from Jaipur, a bit of Eggplant Curry
Normally, this would have been a dish I would have shied away from. Oily, spicy, meaty. But during this recent digestive detente I've decided to push the envelope. I even had taco bell last week. Let's see if I wind up any worse for the wear.

I followed this up with one small dose, about 3.4 grams, of Metamucil, orange flavor. My doctor recommended about 20 grams of non-dietary fiber supplements per day to retrain my intestines, with the goal of eventual resynchronization. Remind me, I'll show you the hand motions he used to demonstrate this to me.

**BOWEL MOVEMENT ALERT** The bowel movement I had after lunch was strained. Maybe all the beer I drank on Friday at the Barbary constipated me up. And for what? Frustration, the beauty of it.


Snack: Small Pumpkin Spice Latte (bless fall drinks) and 2 Metamucil Fiber Wafers
Again, coffee is something I'm trying to avoid, especially on consecutive days. But I was feeling really sluggish at the library so I splurged. So freakin delicious too. Those wafers, though, are terrible. The 2 wafers are another dose of Psyllium fiber, 3.4 grams. Running tally, 6.8 grams.


Dinner: Dokadi(?), dunno the translation
Good, light dinner. Easy to digest. Perfect for when I feel particularly blimpish. I had to take it easy tonight because I was scheduled to play a tennis match at nine.

**BOWEL MOVEMENT ALERT** I had a somewhat more satisfying number two on my way out the door for my match. I thought it would freshen me up for my match. Alas. I played terribly. My opponent didn't put any pace on the ball, but never made any errors, and with all the time to think about my strokes I overthought and mishit eventually. Fuckin brutal. My forehand was especially pathetic. Though I redeemed myself with a doubles win (my opponent was my partner).

Upon my disgraceful return home I munched on some ridiculously tasty chocolate covered pretzels. Again, in the bygone era of lactose paranoia I definitely would have avoided even the modest amount of milk in the chocolate coating. Now that I think about it, I've been really good at depriving myself of pleasure during this whodunnit of a stomach disease/disorder/malady. I accompanied that with my daily Activia, vanilla flavored. In my endless grasping for a remedy, I noticed that the day I went back on the probiotics I had a brilliantly satisfying dump. This could have been pure coincidence rather than causation, but I'm desperate. I think when I was regularly taking probiotics I was more regular, though still bloated, but again, who knows. Desperation.

Nightcap: Large Dose of Metamucil, about 6.8 grams.
That gets me at about 13.6 grams for the day, the number I've been around for a couple weeks. And, this is true- I feel better lately. Slightly more regular, still bloated, but less sluggish and mentally inert. I really hope I've really turned a corner.

Bedtime: 10 milligrams of amitriptylene.
At 100 grams this drug is used as an antidepressant. But since there is a hormonal element to the body's movement of food through the intestines, people with more serious irritable bowel syndrome have to take drugs for the nervous system in addition to fiber therapy and diet modification. This, I think, is the real reason I feel much better lately. Hopefully that's a light at the end of this fucking tunnel.