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.

Paul Saginaw

Editor’s note: The following is an edited version of a letter that Paul Saginaw, co-founder of Zingerman’s, sent to his partners following a heart attack he suffered last month. Here at The Chronicle, we wish Paul all the best in his recovery, and thank him for sharing this cautionary tale.

Although hard for me to believe, I did, in fact, suffer a small heart attack. I also understand that if I do as I’ve been told, I am going to be okay. 

I believe that it occurred on Thursday night during a tennis match when it felt like “an elephant was stepping on my chest” and someone was pulling my arms out of their sockets. (What’s scary is that this is exactly how it was described in the book Lori [Saginaw] brought home for me, on page 20: The No Bull Book on Heart Disease, Okner and Clorfene.) 

Because I have the lethal combination of high tolerance to pain combined with low intelligence, I continued to play tennis for 2 1/2 hours more despite my partner’s willingness to forfeit. And although we lost, I have to say I played some of my best tennis. Probably due to my lacking the energy to over-hit the ball and having only enough in me to barely manage the basics. In retrospect, passing up the beer afterwards should have been a clue, but instead of the ER, I headed home and directly to bed.

Friday evening climbing up the back steps, I started to sweat profusely and felt uncomfortably fatigued. But once again, I missed the obvious clue of not having the normal desire to overeat or drink.  

Saturday morning at the gym on the elliptical, that nasty elephant pain returned and it got the owner and my trainer, Heather, (a good Roadhouse customer and wife of Carsten Hohnke, the councilperson who helped save West Side Farmer’s Market this year) to come over and ask why I was moving like a turtle. “Angina.” Whoa, she yanked me off the machine, told me to get my ass to the doctor, and forbid me to come back until I had a doctor’s release. Liability, I am thinking.  

Then walking two blocks to my car I actually had to stop to rest twice. So maybe by now slightly shaken, I finally called Lori in California. And though I protested that I would see a doctor on Monday, she used some unauthorized tactics to extract my promise to get to the ER that afternoon.  

At the ER were the usual suspects – a crack head with self-inflicted wounds and his scantily dressed girlfriend screaming for someone to do something (definitely Jerry Springer Show candidates), a man handcuffed to his gurney, a baby, two small children, an elderly woman, and me. Well, I found that just mentioning chest pain got me cuts in line and whoosh – I was ahead of everyone.  

After the EKG, it really started to speed up – wheelchair, bed, IV’s, monitors, lots of questions. The attending physician came in, sat down, looked me in the eye and said, “Mr. Saginaw, you have experienced a heart attack.” To which I argued, “I don’t really think so.” To which he replied, “It’s not my opinion, it’s a fact that the test results indicate.” For some reason he believed the EKG and cardiac enzyme levels in my blood. 

“Wow. Is this really happening?” I thought. I’m supposed to be at the Downtown Home and Garden annual summer party right now. Dancing to the Lady Sunshine Band, overeating, and drinking.  

The words “heart attack” are shocking. Heart attacks happen to other people. But he had finally gotten my attention and suddenly I was taking stock of my life. Are things in order? Have I been a good husband, a good father, a good son, and a good partner? Am I at peace with the people in my life? Are there things that have been left unsaid? I’m not joking – actually serious as a heart attack. That doctor got my mind racing as fast as my poor heart. 

Before I knew it, I’m admitted, wheeled into a room, tested more times then a laboratory rat, and scheduled for a catheterization on Monday morning. My cardiologist neighbor, Jim Bengston, did me the favor of deciding I’d already administered my own stress test over the past three days so we could skip that step. Thanks a lot, Jim. 

Next morning, Sunday, Rabbi Leibowitz and Father Mangigian arrived to administer my last rites – a #48/old – and I savored every bite as I tasted what I would be missing from then on. 

The catheterization worked like a charm and showed that my right anterior coronary artery was 98% blocked, so Dr. Bengston efficiently installed a stent to open it up. He saw the left main coronary artery was 30% blocked but decided to leave it alone and treat it with drugs and changing my lifestyle. Next day I was discharged with more medications than a pharmacy and the idea of this new lifestyle.

At my neighborhood CVS, it was a very humbling and humiliating moment when I purchased a “7 day AM/PM” pill dispenser. What’s unbelievable is that I stood there actually comparing all the different models and weighing their merits. Well Paulie, welcome to the aging process. I hope it doesn’t get much more thrilling than this cuz my heart can’t take it anymore… 

The docs discharging me emphasized that I needed to start taking it easy. “Learn to relax,” they all said. Well, I have begun to try to relax these past few days and I will tell you that it is harder work than it would seem. Definitely not the sort of work to which I am accustomed. Yesterday I sat on my living room couch and just read (fiction, no less) and watched all the neighborhood activity through the front windows. It dawned on me that the only time in my adult life that I have ever done anything remotely similar was when I was immobile with a high fever.  

It’s hard to pull back and stop. It takes conscious effort because everything around me just keeps going on and no one wants to feel left out of the action. But in slowing down I have been given the rare opportunity to actually consider what’s important and contemplate what really matters to me. My sons have noticed and my wife has even complimented me. It’s going to take me a while to get the hang of this. I will be taking the next several weeks to figure it all out and I’m considering not returning to work until September 7.  

There’s actually a simple moral to this story and it is this: Pay attention to what your body is saying to you; life is short enough without shortening it through carelessness, stupidity or arrogance. I feel humbled and grateful. And this also occurs to me: We all work so damn hard, committed to providing the Zingerman’s Experience for our customers, our co-workers, the Community and one another. But if each of us doesn’t provide that quality experience to our own individual selves, how can we count on doing it for anyone else? We cannot. Would each of you please slow down, relax, and take better care of yourself – starting today.