Saturday, July 11, 2015

My bowels hate me

Seriously. They do.

And fair warning--if discussions of all things bowel-related isn't your thing, please feel free to skip this one because I will undoubtedly use the word diarrhea once or twice or a dozen times, and I totally get if hearing about someone else's poop doesn't do it for you. But in my family, we regularly talk about things like poop. We even think it's a good, healthy thing to do. And since you are all like family to me, I want to share stories of my poop and fussy bowels with you, mostly because it's, unfortunately, a significant contributing factor in my subpar health and well-being at the moment, but also because seeing as bowel issues are on the rise these days, perhaps some of you can commiserate. But truly, I'll be sure to write about cute cats or hilarious toddlers or husbands with selective hearing next time, things I'm sure we can all relate to, right? Right.

So. Here we are. You, me, and my bowels. Some of you may remember that about a year and a half ago, I had my first diverticulitis flareup and it was one of the absolute most tragic experiences of my life, as not only was I in excruciating pain, I was put on nuclear strength antibiotics (two of them, in fact) on which I could no longer nurse my still-nursing toddlers, and was forced to wean them cold boobie. It fucking sucked all around, and not in the way the wee folk would have liked.

Since then I have dealt with several more intense episodes requiring antibiotics, plus countless other minor ones that I've had to deal with by immediately cutting all fiber and roughage from my diet for extended periods of time in order to calm my bowels and avoid a full-blown infection. Which means I have spent much of the past 18 months eating a diet heavy in things I generally eat far less of and devoid of the things that generally make up a large portion of my diet. You know, like salad. Have I mentioned how much I love salad? It probably deserves its own post, so I won't go into it too much here, but suffice to say I LOVE SALAD. So not being able to eat salad, as well as whole grains and other fibrous vegetables and fruits, makes me very, very, very fussy. And you wouldn't like me when I'm fussy. Just ask The Barbarian.

But after my last major episode at the beginning of this year, things have been a little different. I've still been regularly bloated and uncomfortable, but it's been localized in a different spot--my upper abdomen, as opposed to the classic lower left quadrant pain associated with diverticulitis of the sigmoid colon. Even before the pain would start, I could tell my system was in revolt because the area centered just below my ribcage, essentially where my stomach is located, would become a hard, distended ball of unhappiness. So, thinking it was always the beginnings of a diverticulitis flareup, my only real frame of reference for abdominal bloating and pain, I would return to my now fairly normal diet of flour tortillas, white rice, eggs, cheese, bananas, etc. But it wouldn't really help like it used to. Or if it did, the pain and bloating returned almost immediately.

The past few months especially have been so epically horrendous on this front, it has greatly contributed to my depression. Chronic pain will do that, I suppose. And because there just isn't much if anything to do for diverticulitis, I was receiving almost zero help from my gastroenterologist. Not that he's not an awesome specialist. I quite like him, in fact. But he's very evidence-based, which is where it's at for me, and there is currently a very large question mark when it comes to the causes of diverticulitis, and, therefore, an even larger question mark when it comes to how to prevent and treat it. Some people seem to be able to identify food triggers, but I've never been able to. Something would seem to cause issues one day but not the following, one week but not the next. It seemed completely random and I literally became afraid to eat. I would constantly open the fridge or pantry (we have one of those now!) and just stare blankly and despondently for a minute before closing the door and walking out of the kitchen, still hungry. And I'm not sure if you know this, but I fucking LOVE TO EAT. So an issue like this is a really damn big deal for me.

One day a month or so ago, I was perusing my long and comprehensive list of test results from my gastro's office online to see if I could glean anymore info on what might be going on and how I might go about dealing with it. I suppose I'm a problem-solver by nature and definitely subscribe to the idea that, surround yourself with as many wonderful doctors as you like, your health is still ultimately your own responsibility. So I was looking at my current diagnoses and it struck me that I rarely if ever ruminate on the fact that I have IBS (irritable bowel syndrome, for the uninitiated). I actually began seeing my gastroenterologist several years ago, before getting pregnant with our adorable progeny, because my chronic diarrhea seemed to be getting worse and my poop in general was just weird--light-coloured and very thin--and my usual 2-3 BMs a day was becoming more like 5-6 a day (see? You want to know this stuff, I know you do). And because I was young and otherwise healthy, my gastroenterologist ran a plethora of tests, both blood and stool (yaaaaaayyyyy), and finally scheduled me for a colonoscopy, the results of which all showed nothing out of the norm. So I basically have fussy bowels, akin to my fussy uterus, and just like my infertility, there was no explanation to be found. So a diagnosis of IBS was stuck on my chart as a sort of catchall, it seemed, even though I never had any of the pain or bloating or excess gas normally associated with the condition. I'm just the Queen of Loose Stools apparently. I have only ever been constipated as a side-effect of certain medications, didn't even deal with the constipation so common for pregnant women, and have certainly never had minor stress-related constipation as some of my family members experience while traveling, camping, or in public. When I need to poop, I poop. Even if it's in the middle of nowhere in a hole I dug myself. (Seriously, it's a skill everyone should have. If you haven't pooped in a hole of your own digging while listening to birds chirp and feeling the breeze through your're missing out.)

I eventually remembered that during a conversation, my gastro mentioned that it's really hard to identify actual diverticulitis symptoms, as they can mimic those of IBS and other digestive issues, a key piece I hadn't really internalized as perhaps relating to my issues, as aside from my norm of chronic diarrhea, I don't have any other classic IBS symptoms. Or so I thought. When I finally contacted my PCP in desperation around this time to ask her advice on any sort of dietary recommendations she could offer that might help, she asked me to clarify whether the symptoms were from diverticulitis or IBS, as her suggestions would be different for each one. I said I assumed it was all from the diverticulitis, but that conversation with my gastro was still in my head, so I admitted I wasn't really sure anymore. Her recommendation for IBS symptoms was a diet I had seen referenced in several places over the past year or two, mostly in relation to a possible explanation for those suffering from what's come to be known as non-celiac gluten sensitivity, a condition most medical professionals and researchers still don't believe even exists, as aside from emphatic anecdotes, the evidence is seriously lacking (the current gluten-free fad fascinates and frustrates me, so I read up on this kind of shit for fun). And even though the very idea of restricting certain foods from my diet in any way, shape, or form makes me cringe, I was getting nowhere with simply not eating most of the day, so I looked into it.

The diet? One very low in FODMAPs, which are a group of highly fermentable sugars and starches (including those found in gluten-containing products, hence the previous references I had come across) that aren't digested or absorbed well when eaten in excess by people dealing with intestinal issues like IBS. There they remain, pulling water into the intestines and becoming excess food for gut microbes, causing colonies to grow out of hand, producing the classic gas, bloating, pain and other symptoms of IBS. My doctor said the diet was terrible in that it's very restrictive (you can get a sense for just how restrictive here), but that most people see results within a week, and when I asked my gastro about it, he agreed it was worth a shot. But the real kicker was that, digging further into the possible causes and symptoms of both diverticulitis and IBS and where they may overlap or be related somehow (because I am a nerdy researching fool like that), I found that doctors are increasingly noting patients experiencing either an appearance or worsening of IBS symptoms post diverticulitis attack. Fuck me. So even though the diet is essentially gluten-free, very restrictive of dairy, forbids garlic AND onions (seriously, that's so mean), as well as things like stone fruits, which are TOTALLY IN SEASON RIGHT NOW, I gritted my teeth and jumped in.

The results? Dramatic. STUPID DRAMATIC. Like night and day within a week dramatic. Like normal people poops dramatic. LIKE I DON'T EVEN HAVE TO WIPE SOMETIMES DRAMATIC. I mean, I still do, just to be sure, of course, but damn. Cohesive shits? Is this how other people live? And three weeks later, I've lost almost 10 pounds without trying, and minus the severe bloating, my stomach is as flat as, well, as an overweight twin mama's can be, okay?

But full disclosure time: I totally got impatient (so out of character for me, right?) and tried to add back some of the possible offenders this past week to horrific results. You're supposed to wait 6-8 weeks and then do one group of FODMAPs and just a little at a time to see how it affects you before upping the serving and then moving on to other foods. Not all FODMAPs affect everyone the same, and the more I read up on it, the more I realize the serving size has a lot to do with what and how much your system can handle. Undertaking this diet and quest to find your triggers, you may find you do totally fine with lactose (dairy), but have huge issues with galactans (legumes). Or you can have small amounts of polyols (found in artificial sweeteners and stone fruits) but eat too many cherries at once and you're fucked. Really, it's THAT obnoxious and particular to your body. Oh, joy.

So, because it really has made such a ginormous difference for me, I am back on the elimination phase and will probably remain here for a few more weeks before attempting to reintroduce anything. It sucks and I fucking HATE IT, especially because I'm still the family slave cook and refuse to drag everyone else down with me in this, so I'm preparing foods I can't but so desperately want to eat all damn day long. Luckily I can still have my beloved peanut butter and strawberry jam, but I enjoy them on brown rice cakes now, and you know what? It's fucking delicious. And while most alcohols are out, I can still have coffee, so things aren't nearly as dire as they could be. I have to enjoy it with half and half instead of my preferred whole milk, but at least I can enjoy it. Because, yeah, ummmmmm, this mama without coffee would be, well... Let's not even think about it, shall we?

So while this post was mostly written just to complain about my current restrictive diet and talk about poop, I suppose it's also meant to encourage others dealing with somewhat mysterious health issues and coming up empty when looking for answers from their healthcare professionals to remember that your health is still YOUR responsibility. That isn't to say that the medical profession is full of pompous assholes who don't hold your health and well-being as priorities, and the University of Google and "alternative" medicine are your friends. They do--and they're not. (I suppose we'll need a post on effective researching and evaluating sources in this age of information overload one day, eh?) But the answers your doctors give (or don't give) you are not the end of the road. Ask different questions. Research the answers (in/on reputable sources) for yourself. You know your body. Listen to it and advocate for it. Because it's the only one you've got.

I mean, with our current tech, that is. I don't know about you, but I could seriously go for some bionic bits right about now...

But alas. Fussy bowels it is.

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