Column: My Stomach Problem … And Ours
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.
Cheers! Here's to a bran new year!
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.
My daughter lost 15 feet of bleeding raw large intestine (she has about 4 inches left) by the time she was 23 years old. Ulcerative colitis was the diagnosis. Cutting out the colon was the “cure.” But gut inflammation may be less about roughage and more about needing friendly bacteria. Please research more before you lose it all. She has had a cascade of illness ever since.
This was a very good and insightful article. Beware though of depending on Physician’s Committee for Responsible Medicine for fact-based information, they are less than reputable and I’m being kind by leaving it at that. Genetics also play a huge part with diverticulosis, as is what we eat and what our lifestyle habits are, as mentioned in the article. G.I. problems, particularly what the author has shared about diverticulosis, is very frustrating to both physician and patient and each case varies so much. There isn’t a “one size fits all” protocol to depend on as exists in treating other types of disease. It’s always a good idea to seek out second opinions.
Heh. I teach school in Detroit and I have yet to see anything resembling fresh food, unless you count the bananas at the gas station. Further, as my teacher’s aid (who lives in the D) says, if you got $5 from now until payday and you can get two fast food meals or two bananas, what are you gonna do?
Hope your health improves in the new year…and yeah, I’m going to increase my fiber intake!!!
I drive to Detroit regularly to get the freshest fruit and veggies around — Eastern Market. That’s in Detroit and it’s the largest farmer’s market in the state.
Stomach problems are not fun. As a person who had pulferated ulcer, I know pain. Mine was caused by anti inflammatory meds. Naproxin. Ate a hole on my stomach, forcing emergency surgery. Not realizing that closing procedure was staples, I got infection from them. I did inform doctor when I woke up to get them out, he didn’t believe me, and told me to wait and see. He had to dig them out. He taped me closed, and sent me home. I see my doctor, and immediately was admitted to Jupiter Medical Center. Infection was so bad, had to let close on its own, repacking wound daily, for 14 weeks.
The procedure he did, though, put another lining around the stomach. Like a new stomach wall. No eating restrictions. But ulcer was horrible, pain wise. Infection took 14 weeks to heal. I wanted to sue the surgeon for not listening, and not removing them, when I asked. He doesn’t have malpractice insurance. Go figure. No lawyer will touch case because of no insurance.
The coarse language in the article is unnecessary, and not in keeping with the quality that I’ve come to expect from the Ann Arbor Chronicle.
On the subject, I would strongly encourage you to be tested for Celiac Disease before undergoing such radical surgery. The most accurate method is through a biopsy of your small intestine, which would be a reasonable step before surgery anyway.
If you have the condition, a strict gluten-free diet may resolve or alleviate your other symptoms, either lessening or eliminating the need for surgery. Beware, however, that few American doctors are trained to recognize or diagnose Celiac – the best place in the region to be tested is in Chicago.
In re. the proposed Detroit moratorium: Rob Linn recently took a look at some of the actual numbers on his excellent “Mapping The Strait” blog.
I am very pleased to see the coarse language—which is entirely appropriate to the subject matter and situation—published in the Real Newspaper.
Thank you, Roger, Dave and Mary. Good luck everybody.
I’d rather read the coarse language than navigate the usual tip-toeing around unpleasant subjects you normally read in articles dealing with issues like this.
Good luck, Roger. The UofM docs are really good, but it’s always wise to get a second opinion before getting opened up.
I’m with the folks here that are suggesting that you look into some nutritional, dietary, alternatives. I was diagnosed with diverticulitis about 5 years ago and have been able manage the problem by being more aware of the links between “episodes” and diet. For example, raw vegetables can cause problems. I have also found that psyllium capsules can be helpful. Also, eating oatmeal and other whole grains (e.g. barley, brown rice, etc) on a regular basis makes a huge difference. If I start to feel any pain I immediately switch to a bland and boring diet for a couple of days.
good luck — major surgery is no fun. but I also know that diverticular disease is very painful.
I cast another vote for further research before jumping into surgery. MDs are fantastic for some things, but there are other things they just don’t know about. Celiac (wheat intolerance) and overgrowth of Candida yeast are two chronic digestive issues that can have major long-term impacts and are unlikely to be recognized or treated by MD’s. So getting a second opinion is fine, but I would also recommend getting a third opinion from a naturopath or other holistic practitioner before allowing surgery.
My own experience is minor compared to yours, but I went to three different dermatologists including the UM dermatology clinic before I figured out on my own (using the internets!) that my rash was a form of gluten intolerance. The treatment (avoid gluten) is easy, cheap, and requires no invasive drugs or procedures.
Anyway, good luck!
I’d also like to suggest a dietary alternative. It sounds like you never received a referral to a registered dietitian who would have been able to provide a more detailed dietary approach. PAs and MDs just don’t have the same training and experience because medical nutrition therapy is not what they do all day. As a dietitian, I can tell you that there are some specific foods to eat and avoid to prevent further infections for most people with diverticulosis.
Good luck with whatever you decide to do and thanks for the eloquent words shining more light on the problems in our food environment. I remind patients that our preference for capitalism in this country allows food companies to sell anything as long as it doesn’t kill someone outright(slow death from bad food appears to be allowed), so it’s up to the consumer to learn what’s healthy and buy good food.
I think the article in this link is instructive of a new way of thinking about this subject: [link]
Reminiscent of when they discovered that most ulcers are caused by helicobacter pylori, not pizza and tacos.
Best of luck with the surgery.
Great piece, Roger — thank you for sharing a personal story. I too would second the advice to try everything you can before surgery.
My life has changed wonderfully since I began to understand the differences — as you alluded to in your column — between what humans have evolved to eat and what the processed food industry has found to be most profitable to sell. As a can-do society, we seem to be unusually gung-go about the latest magic bullet (Vitamin C! No, wait — Vitamin D!) but do not want to hear what actually works: drastically less refined grains and sugars, exercise, adequate sleep, etc. In other words, if it keeps us from eating chips and watching American Idol, there’s just got to be a better way.
One other thing I’d recommend of anyone interested in nutrition is to get a skin-scratch allergy test to the whole food spectrum. I was shocked.
Update: Surgery postponed.
You can’t make this stuff up: The day after I spilled my guts all over the Internet, I shared a New Year’s Day brunch at Zingerman’s with a colorectal surgeon.
It was an entirely chance encounter – the surgeon is a friend of a friend (also a physician) who was in town for the holiday. Not wanting to use coarse language in front of the children who were present, nor to monopolize a social occasion, I tried to keep the conversation away (mostly) from my impending decision about whether to have colon surgery.
But I couldn’t resist taking a few minutes to pick an expert brain, and the friendly sawbones indulged me with advice that was not only free, but exactly what I wanted to hear. First, the University of Michigan surgeon I am scheduled with has an excellent reputation, with the hands of a concert pianist. Second, I might be able to safely duck the procedure, at least for now. The Mayo Clinic study, the sawbones confirms, is a reliable report of current knowledge: Colon disasters typically occur on first presentation of diverticulitis, not on recurrence – so I am probably safe holding off to see how my symptoms play out.
You hardly want to make this kind of decision, of course, based on a conversation you’ve had upstairs at Zingerman’s. Nor was I prepared to trust my own reading of a medical paper published in the Annals of Surgery. I could follow it, sort of, but it’s kind of like when I read French, a language I studied for years without achieving fluency. Yes, I can struggle through an article in Le Monde – but I wouldn’t want to take a reading comprehension test afterwards.
Does “never” work for you? My planned appointment for a second opinion with a stomach surgeon, Monday morning at St. Joe’s, turned out much the same as my unplanned one. (Only better, because it included a review of my medical records and a physical exam.) The takeaway: I’m not in any immediate danger of an intestinal catastrophe – but since I continue to have symptoms, it’s likely I’ll want to have surgery eventually.
“Eventually” seems like a much better time to face the rigors of the operating room than, say, this coming Wednesday. So I put off the procedure, and am now faced with figuring out how to manage my disease.
Which may not be so easy. For one thing, while other symptoms have abated, I’m still experiencing abdominal pain – either a low-grade inflammation, say the doctors, or possible nerve damage from previous episodes.
I’ve been popping acetaminophen to get through the day – and long-term use of painkillers, even over-the-counter ones, is often not a good idea. Case in point: the post from my high school chum Jules Juliber (who lives in Florida and got here via Facebook.) Jules needed surgery (which got messy) to address a perforated ulcer brought on, he believes, by use of Naproxin.
I appreciate the kind thoughts and encouragement from several commenters who think a diet-based approach would be helpful. That’s the course I’m on for the moment; I’m not entirely confident it will be a winning strategy. It’s much easier to eat your way into a case of diverticulosis, it turns out, than to eat your way out of one. Unlike smokers, who can potentially reverse damage to their lung tissue by quitting, switching from a low-fiber diet to a high-fiber one will not rid your large intestine of unwanted pockets, or diverticula. Once the little buggers pop out the side of your sigmoid colon, there’s no route for them to bugger their way back in. You’re stuck with them, and with the attendant risks of infection.
Mea culpa: Thanks to Matt Hampel for pointing to Robert Linn’s map of fast food outlets in Detroit. Linn’s count is 195 stores, nearly three times the figure of 73 that appeared in my previous column; I should have attributed the number more clearly to the Physician’s Committee for Responsible Medicine, since I didn’t independently verify it (nor have I checked on Linn’s numbers.)
For those interested in the phenomenon of food deserts – places where it’s hard to get healthy food – Slate has a map showing the percentage of residents in U.S. counties who do not have a car and live more than a mile from a supermarket. Wayne County doesn’t come out so bad – though it would look different if Detroit were separated out. The southeast U.S., according to this definition, is the most foodstuff-deprived area of the country. And see here for a column on the challenges of eating right when your workplace is only a few feet from your refrigerator – my exact predicament.
I tend to agree with ArborRuby that industrial capitalism has a lot to do with the uneven production and distribution of food – not to mention other vital resources, like medical care (a subject for another day.) In my ripe middle age, however, I’ve noticed that capitalism is darn hard to get rid of (kind of like a case of diverticulosis.) You could write a whole book about how other industrialized countries do a much better job of managing this condition – if you were Tom Geoghegan. (Geoghegan, a Chicago lawyer and unsuccessful Congressional candidate, is one of the most elegant writers around on how the economy affects real people.)
Modern medicine can perform astounding miracles, isolating and removing diseased internal organs while leaving the rest of our bodies intact, even thriving. Modern politics – not so much.