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.

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.

Reminiscent of when they discovered that most ulcers are caused by helicobacter pylori, not pizza and tacos.

Best of luck with the surgery.

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.

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!

Good luck, Roger. The UofM docs are really good, but it’s always wise to get a second opinion before getting opened up.

Thank you, Roger, Dave and Mary. Good luck everybody.

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.