Saturday, January 29, 2011

Medications – Nausea / Vomiting

One of my least favorite aspects of being sick is the all too often encountered duo of nausea and vomiting.  It feels horrible and for me eventually leads to pulled muscles and ER trips for IV fluids and meds.  I spent most of the MLK holiday afternoon a few weeks ago in the ER for this.  I can think of a few places I would have enjoyed more.  

There were two major benefits to my recent trip to the ER and some other good info.  
  1. First, it got my stomach calm enough to keep liquids down so I was only there for a couple hours. 
  2. Second, and more important in the long term, the ER doc told me about the oral rapid dissolve form of Zofran that is available.  I was intrigued and relieved that there was an alternative to the pills that were clearly not being absorbed properly in my stomach.  I’m happy to report that the dissolving tablets feel like they’re working a little better.
  3. Third, more as a point of interest because I didn’t know it exists, the ER doc also told me about a suppository form of Phenergan.  Personally, I’m a little squeamish about this method of delivery, but when the options are go to the ER or find a non-oral route… the decisions sometimes make themselves.
I’ve also found the old standby, ginger ale, to be helpful as a restart fluid.  I’ve been mixing it with juice or Gatorade to create the illusion of a flavor variety.

Oh, shoveling also seems to aggravate this, so mother nature can keep diverting the snow around DC for the rest of the winter. I thought my days of throwing up in bushes were over. ;)  


Wednesday, January 26, 2011

Medications - Gastroparesis

A few weeks ago my GI doc did an upper endoscopy to take a look at my stomach and see what was going on.  I had fasted for about 12 hours prior to the test per instructions, but not everything had cleared my stomach.  Hence, my working suspicion of a pseudo diagnosis, Gastroparesis.  The doc sent me home with a prescription for Reglan and a faint hope that it would be helpful.  

Reglan is a prokinetic drug, meaning that it is meant to induce the contraction of the stomach muscles that aren’t working due to nerve damage (I’ll leave the ranting about wanting to know how exactly I acquired stomach nerve damage for another post).

It was definitely short lived.  Within 48 hours of starting Reglan I had started having tremors in my arms and legs and became violently ill.  I believe they call that ‘not tolerating’ the medication.  Sounds much more pleasant in doctor speak.  I was laid up for a week while my system recovered from the reaction. 

To summarize…. Reglan 1, Me 0.

This all occurred right before the Christmas holiday toward the end of December.  My GI then referred me to one of his colleagues in his office who has the ability to prescribe Domperidone which is also a prokinetic.  Domperidone is actually supposed to have fewer side effects; most notably the neurological side effects should be far fewer with it since it does not cross the blood brain barrier. 
The issue is that for whatever reason, the FDA has not approved domperidone for general sale in the US so docs have to jump through hoops and get approval to prescribe this medication, then it has to be purchased from specialized pharmacies.  Oh, since it’s not FDA approved, no insurance company is going to pay for it.  

I've been taking the domperidone for about a week now and I'm not sure whether I think it's doing much in terms of motility.  Whether it's coincidence, placebo effect or just good luck, the nausea has been a little better so I'm not having to pop Zofran a couple times a day.  It hasn't really caused any too bothersome side effects, so I'll take it for a few weeks and see what else it might be capable of.  

What other strategies or medications have you found helpful?


Tuesday, January 25, 2011

I can (not) has cheeseburger.

Well, that isn't exactly true. I can have a cheeseburger. What I can't have is the classic beloved soft and moist cheeseburger bun. You know the one I mean. They come in packages from 4-24 and you can never find them on the store shelves on Memorial Day or the 4th of July. Of all the things I can't have since my diagnosis of gluten intolerance this is one of the foods I miss the most. Sure I have had GF cheeseburger buns. I'm not knocking any particular brand, yet they always seem dry and tend to crumble from the weight of the burger and the moisture of the ketchup and mustard. My husband says he enjoys cheeseburgers just as much without the bun. "That's because you can still have the bun.", I tell him. He is a real trooper and hasn't had any gluten at home since my diagnosis. He does, however, eat what he wants when he's not at home. It would seem as though that until you are told you cannot eat something, both by your body and your physicians, that you can flippantly say "oh, I can live without (insert food here)". I guess that is just human nature.

Since I went GF I've accomplished many things. I've created delicious bagels and scrumptious cinnamon rolls. I've learned that it is possible to make roux with rice flour that taste's just as good, if not better, than traditional all-purpose flour. Life without gluten has been good to me, right to the point where my mother makes me my own favorite cake for special occasions so I don't have to watch others feast on dessert with longing and whimpers. I've also made mistakes and discovered gluten in foods that I never would have suspected. Most recently I was sidelined by a jar of black olives. Yep, olives. I still don't know why they contained gluten and my guess is it was hidden in the 'natural seasonings' on the label. Alas, gluten is natural, even if the human body cannot digest it.

We are in the grips of a frigid cold snap here in Vermont and I'm guessing it's my longing for warm weather, longer nights, barbecues and campfire marshmallows that is driving my mourning over this classic mound of bread. My mission for the week is to dig out my apron and practice my best June Cleaver in the kitchen. Without the heels mind you. I am going to bury myself to my elbows in flours until I've created a cheeseburger bun I can not only live with, but like. Failure is not an option... Well it is, however, I prefer not to call baking trials failures. They are merely minor trip-ups to better bread. With luck and good dough I will have my favorite veggie burger smothered with Vermont cheese on a plump, moist bun by weeks end. I shall let you know how it goes.

After all when life hands you dry bread, make breadcrumbs.


Friday, January 21, 2011

My Journey So Far

I’ve been lucky in that my digestive symptoms are fairly recent.  I had my first severe gallbladder attack in April of 2010 (coupled with a nasty ear infection for extra fun) and was diagnosed with gallstones after a few days of poking and prodding.  The doctors said that I would probably need my gallbladder removed at some point in the future, but we all agreed that surgery while I had an infection wasn’t the best idea.  So, being the less than cooperative patient that I am, I figured that maybe I could get my gallbladder under control with dietary changes and some new supplements.  This strategy worked for a while, though the duration and intensity of the pain associated with the attacks was increasing slowly over time.  By the end of the summer it was a moderately annoying issue, but still not bad enough to warrant surgery (in my opinion, anyway). I am not a fan of getting internal structures removed unless it is absolutely necessary.  And I have a knack for waiting until there’s a major surgery inducing crisis.  Cutting to the chase, I had one of those surgical emergencies in October 2010 and am now short one gallbladder.

I’d really like to tell you that I felt much better after that….  Well, I did, for a little less than a week.  Then the stomach / digestive issues started.  The surgery had shocked my entire digestive process to a screeching halt.  I spent longer in the hospital a week after the surgery than I did for the surgery itself.

So the last three months have been a steady stream of doctor’s visits, a growing list of symptoms, more pain, nausea, stomach infections and dehydration than I would rather shake a stick at. Combined with different medications which haven’t worked, endoscopies, CT scans, IVs and lots of Zofran and Phenergan. I’ve thankfully been able to resume a normal class schedule but still haven’t been well enough to get back to my research, which, well, just pushes out the date of my next job and paycheck.  Minor detail. :-)  
As of today I don’t have a formal diagnosis.  The suspected cause of at least some of my issues is Gastroparesis, which translates to English as ‘food stays in my stomach for way too long and doesn’t digest properly’.

Inaugural Rant

If you’ve found this blog then most likely I have either bribed you to follow it, or you’ve stumbled onto it looking for information about digestive disorders.  To the bribed, you know I love you. To the stumblers, I’m sorry we had to meet this way but I hope you find some useful information and support here. 

Starting this blog came about after a while of discussing my current digestive issues with a friend who also deals with these types of things.  I figure the information might help others and at the least we can catalog our experiences and strategies as they unfold.  You’ll find our personal experiences with these disorders as well as what we’ve found works for us for symptom management, medications, procedures, recipes, food suggestions and staying silly about it all.  Because well, you either learn to laugh about things or you go nuts.

Anyway, welcome to the site.