The recent unpleasantness in my gastrointestinal tract, which sent me on a search for painkillers one Saturday night a few months back, has finally started to heal.
After four months, the cramps, gas, bloating and diarrhea are fading away. During those long 16 weeks, from August to December, I was treated to what seemed like every antibiotic in the modern medicine cabinet, attempting to get an inflammation in my gut under control.
None of them worked.
I finally got better after modifying my diet, as instructed by a helpful physician’s assistant to one of the GI specialists I consulted. I had to go gluten-free for a couple of weeks, and also cut out a lot of gas-producing foods that you would normally think are rather healthy: beans, tofu, asparagus, broccoli and so on.
Now that I’m better, the sage doctors at the University of Michigan Health System are proposing – quite emphatically – to knock me unconscious, cut open my stomach, and forcibly remove a substantial piece of my large intestine.
If this sounds odd to you, imagine how I feel: I haven’t been able to eat right or shit right since summertime. Now that everything is more or less back to normal, I’m being instructed to head into the hospital for a controlled catastrophe, which will cause a lot more unpleasantness, at least in the short term. Not the least of which, as I found out at today’s pre-operative appointment, will be the insertion of tubes into several parts of my anatomy which – in my layperson’s opinion – are not suitable for said insertion.
[Idea for Obama: Write a regulation requiring doctors to say, “We’re putting a tube into your penis,” in place of the more clinical sounding, “We will be utilizing a catheter during this procedure.” Surely, thousands – if not millions – of men will go running from hospitals in terror, reducing surgical costs for half the population. Think of the savings!]
Blood and Guts
On top of the stomachaches, I’ve spent months worrying about whether I should say “yes” to surgery – or run away from the hospital in terror. Is the hoped-for elimination of symptoms – three chances out of four, according to the literature – worth the potential risks of the procedure? The risks include, for example, about one chance in 20 of a leaky colon, requiring further surgery.
The proximate cause of my distress is a condition called diverticulosis, a potentially nasty little condition that affects something like one-third of the U.S. population over the age of 45, and nearly half of those over the age of 60. [At 52, I’m a prime suspect.] Diverticula are little pockets that bulge out of the sides of your large intestine, creating small traps where food can get caught.
It’s kind of like having a tooth you can’t floss. But if you don’t floss and get a cavity, you can open your mouth for your dentist to get a filling. An infected intestine is a trickier proposition.
Luckily, most people with diverticulosis never get infected. If you’re middle-aged or beyond, there’s a decent chance you’ve got some side pockets in your colon that you don’t even know about. And really, I hope you never find out. Because if a bit of the semi-digested mush that is supposed to flow through your large intestine and out the business end of your ass takes a detour instead into one of your diverticula, then you’ve got diverticulitis. This is an inflammation that (a) hurts like hell, and (b) can cause real problems if you don’t get it under control.
By “real problems” I mean an abscess [I had one in March] or worse, a perforation – a hole in your colon. If any of the mush in your colon migrates through the hole, you are mixing yourself a shit-and-blood cocktail – and you don’t need an MD to know this is a really, really bad idea. According to the National Institutes of Health (NIH), 20-30% of diverticulitis patients who get perforated go home in a box.
That’s one of the reasons surgery is recommended in cases like mine, after an inflammation that has subsided. It’s a prophylactic measure, intended to prevent the risk of an urgent procedure at some later date, because once you’ve had one inflammation, there’s a good chance you’ll have another. [I’m at two and counting, for those keeping score at home.] Surgeons prefer to operate on non-inflamed patients – for the sake of the patients, who are less likely to have bad outcomes.
Our Unevolved Intestines
Why is my own colon laying such an unwelcome trap for me? For one thing, I seem to have been born in the wrong place. Diverticular disease, the NIH reports:
… is common in developed or industrialized countries – particularly the United States, England, and Australia – where low-fiber diets are consumed. The disease is rare in Asia and Africa, where most people eat high-fiber diets.
A diet without enough fiber, the theory goes, makes your digestive system work extra hard. This causes a kind of hydraulic pressure that can weaken the walls of the colon, creating the dread diverticula.
It’s tempting to kick myself for not eating more raisin bran over the years. But when I talked over my stomach problem with David Share, a friend and physician, he pointed out that personal taste is just one factor influencing our food choices — and probably not the most important.
“The amount of protein, the amount of fat, the lesser amount of vegetables all contribute to the rate of disease,” says Share, who oversees health care quality for Blue Cross/Blue Shield of Michigan, and serves as medical director of the Corner Health Center in Ypsilanti. “There’s a tendency to blame the victim: Why don’t you have more will power? Why don’t you make better choices? But cultural and environmental factors are very powerful; the foods you are presented with have a big influence on what you wind up eating.”
The Japanese, for example, eat much differently than we do – and not only do they have less incidence of diverticulitis, they are also less obese and less likely to experience diabetes, hypertension, heart attacks and other so-called “diseases of civilization.” These conditions afflict citizens of Western countries because our guts – which evolved millions of years ago to process a plant-based diet – have not kept up with the more recent activities of our cerebral cortexes and opposable thumbs. In the past 10,000 years, we managed to invent agriculture, mechanize it, and create a food production system that is heavy on fat, refined sugar, and processed grains, but perilously light on fresh fruits, vegetables, and fiber.
Why do people eat better in Japan, a country every bit as wealthy and industrialized as the United States? It’s not because the Japanese are smarter, more in touch with their inner hominids, or read more manifestos by Michael Pollan. It’s because for various historical and cultural reasons, you can buy fish and rice on every street corner in Tokyo, while in Toledo or Tampa, you are much more likely to encounter burgers, pizza, and fried chicken.
Especially, Share points out, in low-income communities. “Why are poor people overweight?” he asks. “Because they can’t get any fresh food [at affordable prices], but there are plenty of Wendy’s, McDonald’s and Burger Kings.”
Detroit is one of the nation’s most notorious food deserts – a city of more than 900,000 people with without a single national grocery chain operating within its borders. There are, however, 73 fast food restaurants. Earlier this month, an outfit called the Physician’s Committee for Responsible Medicine proposed a moratorium on new outlets of such establishments. The idea doesn’t seem to be going anywhere. Among other things, it reeks of nanny-statism: Where do a bunch of DC-based doctors get off telling Detroiters what they can and cannot eat?
Yes, it’s a free country. But it’s hard to argue with physicians who feel their job description includes not only treating sick patients, but also wrestling with the broader environment that has an enormous impact on whether people get sick in the first place.
I sure wish some fiber-obsessed physician had read me the riot act 30 years ago, which might have helped avert my present predicament.
Speaking of which, in the course of writing this column, I’ve surfed through quite a few medical studies. One that got my full attention, from the Mayo Clinic, suggests that the danger of a life-threatening diverticular perforation is extremely rare in a case like mine, after I’ve already survived one bout of the disease. Which leads me to wonder, again, if having my gut cut open is really and truly necessary. At the moment, I’m scheduled for surgery on Wednesday, Jan. 5. But as a fail-safe, I’ve made an appointment for a last-minute second opinion at a different hospital next Monday.
Wish me luck. And if you’d prefer to stay out of my shoes – who wouldn’t? – you might consider starting off the New Year with a bit of wheat bran dissolved in your champagne.
About the author: Roger Kerson is an Ann Arbor resident and media consultant at RK Communications.