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.
