Saturday, October 27, 2012

Dealing with flare-ups

Unfortunately even with a good Comprehensive Management Plan there are still times when I experience flare-ups.  This week has been one of those weeks.  I changed shifts at my job which started on Monday.  I went from working 3pm - 11pm to working 11am - 7pm.  Definitely a change for the better but my stomach really reacted to the change.  I think a little because I was so excited to get off afternoons.  It started first thing on Monday and has continued everyday this week.  I've been nauseated, bloated, gassy and had episodes of vomiting.  Some days my stomach just ached.  So in order to minimize the flare-up I've tried to stick with just Glucerna, crackers and of course the beets.  Beets will instantly make my stomach feel better. 

Even though I've felt awful all week I still did my Yoga routine and my daily meditation.  I did not do the additional 30-60 minute workout but was able to get my lunch time walk in a couple times this week.  I think it's vital that when you feel bad you don't let yourself wallow in it.  It is what it is and all you can do is deal with it the best you can until it passes.  I think if you let yourself wallow in it you'll only feel worse.  And why would anyone want that?!  So I still do as much as I can and that makes me feel a little better.  Walking is really great exercise on days I feel too bad to do a more intense workout.  Unfortunately we were very busy at work this week and I didn't always get to take a lunch and wasn't able to go for a walk.  When I get off work it's too dark out to walk.  Mornings were out since I was really having trouble getting moving that early when I wasn't used to being awake yet.  However, I know it will get better, I will adjust and this flare-up will pass.

It's also not always easy dealing with friends and family during these flare-ups.  I just have to remind myself that they are not dealing with this and isn't that easy for them to understand.  I mean I have a hard time understanding and I am living it.  When I have flare-ups the initial response is, "Have you eaten anything different?"  It's not always because of something that I've done.  Sometimes flare-ups will just happen, it is the nature of GP.  When they do I just have to keep the right attitude and try not to let it get me down too bad.  That's when I might need to take Zofran or Phenergan.  I might have to eat some Nauzene chewables.  Might have to rely on Glucerna and crackers to sustain me until the flare-up subsides.  The important thing is realizing that they will subside.

Tuesday, October 23, 2012

My experience with the Gastroparesis Clinic

After seeing the Specialists with the Gastroparesis Clinic at Allegheny General I have to say I was left disappointed and frustrated.  I had such high hopes that they were going to provide me with answers and tell me what to do to not feel so damn sick all the time.  Instead I was told that I was not getting enough calories or protein.  Well no shit!  When I eat, even if it's only a few bites, I end up so sick for days.  It was interrupting my personal life, my work life, my relationships with family and friends and especially with my boyfriend.  I was missing an excessive amount of work.  I was missing social functions with friends because I was just too sick to leave the house.  My boyfriend even though he was trying to be as supportive as he could was getting frustrated with me.  This was affecting everything! 

I can not blame the Gastroparesis Clinic completely, it is just the nature of GP.  Unfortunately there is no one plan of treatment that will work for everyone.  There are different degrees of GP and not all GPers (people who have Gastroparesis) have the same symptoms.  This disorder seems to vary quite a bit from person to person.  The clinic appointment was an all day affair.  While there I met with a GI Specialist, a Psychologist, a Nutritionist and a Dietitian.  The GI Specialist seemed to think my GP was due to my Diabetes which would mean that I would probably have this for the rest of my life.  The Nutritionist however believed my GP was caused by a virus which would mean that it may go away someday.  Of course I'm rooting for the Nutritionist to be right!

Without going into too much detail, the doctors were very thorough in evaluating my individual case.  I would recommend if you have Gastroparesis and are in or near the Pittsburgh area to give the Gastroparesis Clinic with  Allegheny General Hospital a chance.  They all looked at my test results and the journals I brought with me which reflected what I was "eating" and my daily symptoms.  My biggest complaints were severe diarrhea, incessant nausea, extreme bloating, gas and vomiting.   So they felt that the caffeine I was in-taking was a big contributor to my diarrhea issues.  Turns out they were right.  I drink a lot of homemade ice tea, so I started making it half decaf and half regular. 

The Psychologist felt that part of my issues were stress related and offered some holistic alternatives such as Hypnotherapy, Bio-Feedback, Meditation and I'm sure there were others that I am just not recalling right now.  I initially saw her every three weeks for awhile starting with the Hypnotherapy and it really helped me to feel better.  Unfortunately the trips to get there did not.  I had to discontinue the appointments because I got so stressed every time I had to make that dreaded trip into Pittsburgh that it defeated the good the appointment would do for me.  The Psychologist was Barbara Jean Nagrant, PhD and she was wonderful.  Too bad she wasn't closer to me.  I am horrible with directions and do not know my way around Pittsburgh AT ALL.  This results in full blown anxiety attacks for me which also made all my symptoms flare up.  This was a 4 hour round trip for a one hour appointment.  It was a no brainer to stop the appointments, but if you are near or in the Pittsburgh area I highly recommend her.  She did however give me a copy of a daily meditation CD by Belleruth Naparstek.  I have since purchased additional meditation CD's by Belleruth Naparstek.

Although they offered some good advice, the bottom line was it was up to me to figure out how to take in more calories and protein without getting sick.  So I have taken a proactive approach and have formulated my own personalized Comprehensive Management Plan which I talk about in another post.

 

Sunday, October 21, 2012

My Comprehensive Management Plan

It took some time to figure out a Comprehensive Management Plan that works for me.  When I first started getting sick it seemed like everything I ate made me sick.  Once I was diagnosed I started searching online for solutions to make me feel better.  Instead what I found was an overabundance of negative information.  I read stories about people who were dependent on feeding tubes to survive.  People who were so ill that they were unable to function at all, that had to leave their employment because they were simply too sick all the time to go to work.  At the time I was having very little luck in figuring out what to eat.  I was terrified that I was going to end up like these poor people I had been reading about.  However through my search I was able to find Crystal Saltrelli, she is amazing.  She has Gastroparesis herself and has become a Certified Health Coach.  Her website is http://livingwithgastroparesis.com/ and she can also be found on Facebook.  She offers very positive and effective advice and has written a few books on how to effectively live well with Gastroparesis.  She also has numerous videos on YouTube that offer great advice and recipes.

I had to start out slow.  When I was symptomatic all the time I mainly relied on meal replacement drinks for my nutrition.  I tried all kinds before finally settling on Glucerna, vanilla flavor.  Mainly because I'm a diabetic and some of the others had too much sugar for me.   I could munch on crackers, toast or biscuits to help sustain me. But on my worst days that was all I could "eat". I tried several protein shakes and have yet to find one I can really tolerate.  I have a new one that Crystal Saltrelli recommended, by PlantFusion, but I haven't tried it yet.  Of course I do take a multi-vitamin and have since added a B12 supplement.  I have found that the gummy vitamins are more tolerable, my favorite is VitaFusion brand.  Then I slowly started adding new things when I felt well enough to try something new.  I learned the hard way that you HAVE to go slow or you'll end up sick and not sure which food you tried was causing it.  So I started a food chart with what foods I knew I could tolerate and became my "go to" foods during flare ups.  In the beginning stage this was my Safe Food List:
  • Glucerna
  • Carnation Instant Breakfast
  • Ensure
  • Crackers: Saltines, Town House, Ritz, Club
  • Chicken Broth, homemade (Andrew Lessman's Cure All Chicken Broth recipe)
  • Toast, French Bread (I have since eliminated this food.)
  • Biscuits
  • Potatoes, baked or boiled, no skin
  • Enlive Apple Juice box
  • Organic White Grape Juice
  • Applesauce
  • Nutella
  • Peanut Butter
  • Olive Oil
  • Butter, whipped, made from Olive Oil
And that was literally all I was able to eat.  Yuck!! I couldn't live like this.  So I found that if I kept it slow and only tried one new food a couple times a week, to see how it did, worked out better.  Then I was able to tell what was making me sick.  Surprisingly pineapple was really good and is actually a natural tummy tamer, it has its own digestive enzyme that helps to settle the stomach.  I put it in my Ninja blender with some ice and vanilla yogurt for a very tasty smoothie. As I progressed and added food to my diet I've found that the following foods are tolerable. 
  • Pineapple
  • Yogurt, vanilla
  • Sweet Potatoes
  • Carrots, cooked
  • grapes, juiced and strained
  • strawberries, juiced and strained
  • HMR 500 Chicken Soup
  • Cheeses: swiss, colby, cheddar, mozzarella and parmesan
  • Vocelli's cheese sticks
But I could not progress past this point.  I was really concerned about my protein because it seemed that was what I was having the most trouble digesting.  So I was doing OK but the above food lists were literally ALL I could eat. 

One day my work place had an opportunity for us to sign up for a free 10 minute massage which led to a free 30 minute massage that led to me giving Nardone Chiropractic & Wx a chance.  They were awesome!  I started going 3 times a week and received a 30 minute massage, a  chiropractic adjustment and then a workout session with the trainer.  Dr. Nardone also introduced me to Zypan a wonderful digestive enzyme that has allowed me to be able to eat chicken again.  Dr. Nardone also suggested I try eating a beet daily to help with my digestive issues.  I can't even begin to tell you how much this has made a difference.  I buy fresh beets, organic when possible, peel them cut them up into chunks and then boil them.  I puree them with a little brown sugar.  It looks like purple pudding and it is delicious.  By eating beets I now have regular bowel movements and let me tell you after dealing with diarrhea for over a year on a daily basis this was a huge accomplishment!  He also told me to stop eating French bread that it literally turns into paste in your system.  I haven't eaten it since.  Dr. Nardone and his team are great and they have done wonders for me.  My experience has also helped me to implement a daily workout routine.  Check out www.nardonechiropractic.com if you are in or near the Benwood, WV area.  I highly recommend them.  Thanks to Nardone I have added the following to my Safe Food List:
  • Chicken, baked or grilled
  • Cream of Chicken soup
  • Spinach, cooked
  • Beets, cooked and pureed
  • Beets, juiced
I've found that small servings, 1/2 to 1 cup servings at a time do best.  I've also discovered that whole foods are more tolerated.  I try to avoid processed foods but still eat some processed foods.  Of course I am still trying new foods but as I mentioned this is a very slow process but that is what seems to work the best.  I only drink water, fresh juice and tea.  I've eliminated soft drinks completely.

Another important part of my Comprehensive Management Plan is my daily Yoga routine followed by a workout of either stretching or cardio.  I try to alternate the stretching and the cardio routines from day to day but the Yoga I do daily.  I also take a 25 minute walk during my lunch whenever I get the opportunity.  Exercise is a great way to minimize my symptoms and it just makes me feel better, more relaxed and happy.

By suggestion of Barbara Nagrant, PhD I implemented a daily meditation routine at bedtime.  I have a couple different meditation CDs by Belleruth Naparstek that I listen to at bedtime every night.  I now sleep better than I ever have in my life.  Stress tends to exacerbate my symptoms so anything I can do to minimize or eliminate stress is a positive thing.

So let's break it down, my Comprehensive Management Plan consists of the following:
  1. Start the day with a Yoga routine followed by a 30-60 minute workout.
  2. Eat a beet daily.
  3. Eat small amounts of food, generally 1/2 -1 cup at a time.
  4. Eat organic when possible.
  5. Eat whole foods and avoid processed food.
  6. Take 25 minute walk at lunch time 3-4 times a week.
  7. End my day by listening to a meditation CD before going to bed.
  8. Avoid stress.
Some of my favorite recipes can be found on my Favorite GP Recipes page.

Of course this is my story and these methods may not work for everyone but the combination of Yoga, exercise, meditation and finding ways to eat healthy, whole foods has made a tremendous difference for me.  I used to be Symptomatic 90% of the time and now I am 90% symptom free!!  So even if this plan isn't right for you please don't give up until you find what is right for you. 

Thursday, October 18, 2012

Gastroparesis, the diagnosis...

About the end of May 2011 I started getting really sick EVERY time I ate.  I could not figure out what was going on.  I had my gall bladder out about 4 years prior to this and what I was feeling was sort of like what I dealt with when my gall bladder stopped working but worse.  It didn't seem to matter what kinds of food I ate, I tried sticking to a bland diet but that didn't seem to make any difference at all.  I would get really nauseated, have vomitting, extreme bloating, heartburn, diarrhea and would belch A LOT.  My belches would smell like rotten eggs.  It was really gross. This would happen after eating just a little bit of food and would last for days.  Eventually I got to where I just stopped eating because I would rather go hungry than to feel that sick. I am a diabetic so going without eating was wreaking havoc on my sugar.  I would also get severe  pain through my diaphragm and in the sternum.  The pain in the sternum would feel like a vice grip that was wrapped around me from front to back and was being tightened, as if to smash my rib cage inside itself.  The pain would be excruciating and could last anywhere from 15 minutes up to 2 hours.  I came to know this type of pain as attacks and discovered they eventually pass.  I also now have medicine specifically for this type of attack when they hit.  It is just dealing with them while they happen that is really hard.

But I am getting a little a head of the story... So I broke down and went to my Doctor.  Initially he thought possibly Gall Bladder Disease, Pancreatitis or some type of blockage.  He said that we needed to see what was going on in there so he referred me to a GI Specialist for an Endoscopy.  The Specialist told me I showed some signs of heartburn but other than that there was nothing wrong with me.  He prescribed me Prilosec for the heartburn but said as far as the rest there was no physical reason why I was getting sick.  I cried and cried and insisted that there was something wrong with me.  I love food!  I mean look at me, I'm a big girl!  There was no way I was intentionally making my self sick or that this was in my head.  When I first got sick I weighed 230 pounds.  This was another reason I felt that the GI Specialist wasn't taking me too seriously.  I was too overweight to be as sick as I was telling him I had been.  So the Specialist ordered a Gastric Emptying Study on me even though he didn't think I had a real problem.  He said my symptoms could be related to how my stomach empties.

So I went for the Gastric Emptying Study which consisted of my eating a radioactive egg sandwich and then they took snapshots of my digestive tract as the radioactive material moves through my system.  The normal stomach should empty half of its contents after approximately 90 minutes.  My test results showed that my stomach would empty half of its contents after approximately 485 minutes.  I have severe slow gastric emptying or Gastroparesis.

The day the GI Specialist's Assistant gave me my diagnosis, yes his Assistant not even the doctor himself, was horrible.  She simply told me what my test results were (the numbers, like that meant something to me, I was clueless) and that it meant I had Gastroparesis. (What the hell does that mean!?)  She gives me a prescription for Reglan and proceeds to tell me that my case is beyond their scope of ability and they are referring me to the Gastroparesis Clinic at Allegheny General in Pittsburgh.  I am given this information like she was just giving a weather report and then smiles and tells me to have a nice day.  What!!??  So I leave with more questions than answers and go home to jump on the internet and find out what this news actually meant.  At first I was just dumbfounded.  Learning that basically my stomach is suffering from a paralysis and no longer works! That there is NO CURE!  That I may never be able to eat normally again!! This is insane!! I've never heard of such a thing.  NO!!! There MUST be some sort of mistake!!!

*Gastroparesis, also called delayed gastric emptying, is a medical condition consisting of a paresis (partial paralysis) of the stomach, resulting in food remaining in the stomach for a longer period of time than normal. Normally, the stomach contracts to move food down into the small intestine for digestion. The vagus nerve controls these contractions. Gastroparesis may occur when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.
* Wikipedia
 
Oh, the denial!!!  It took me quite some time to wrap my head around the fact that this was real and I had to deal with it somehow.  So I started looking for solutions to my dilemma online.  I found a lot of discussions and forums where people were just SO negative and loved to tell the horrors of what they were dealing with.  I was reading about people ending up on feeding tubes and such and thought NO.  This is NOT going to be my story.  And it is not.  With the help of Crystal Saltrelli and all the great information she has availble I have formed my own Comprehensive Management Plan that is working wonders for me.  I will go more in depth about my Comprehensive Management Plan in another post.
 
So anyway...

I am aware of the side effects of Reglan and have chosen to not take it.  This drug can cause Tardive Dyskinesia which is uncontrollable muscle spasms, commonly facial muscles, that don't go away.  There is a great risk of having it for life.  I was prescribed Domperidone (not FDA approved in the United States) by the next specialist, but it did not work for me.  I had to have it shipped from Canada by my doctor since it is not FDA approved in the US.  So I do not take any medications for Gastroparesis itself.  I do take meds at times to alleviate the symptoms when they get bad.  I've been prescribed Zofran and Phenergan for the nausea.  I've also found that Nauzene, an over the counter chewable, works good to alleviate the nausea too.

So the next doctor I meet with tells me that he concurs that I do have Gastroparesis but he believes I also suffer from Sphincter of Oddi Dysfunction (SOD).  So he orders some additional testing and ultimately confirms the suspician of Sphincter of Oddi Dysfunction (SOD).  Unfortunately the treatment for SOD involves surgery which many times results in Pancreatitis.  So he prescribed Hyoscyamine which can be taken at the onset of an attack.  This doctor prefers to hold off on any type of surgery until it is absolutely necessary.  However, he referred me to a group of specialists which are part of the Gastroparesis Clinic who seem to think that eventually I will have to undergo the surgery, that the attacks will come more often and last longer.  Great!  Something to look forward to.  However, with the progress I have made I haven't had a pain attack, not one, in about 5 months.

Beyond the medications the doctors told me to try to stick with low fiber and low fat foods.  To juice or puree foods so that I could digest them more easily.  They recommended meal replacement drinks and that I just had to try until I found what foods I could tolerate.  Basically trial and error.  They suggested I limit my caffeine intake as diarrhea was one of my primary symptoms.  This actually made a huge difference.  I love Ice Tea but I now make it half & half, half regular and half decafinated. 

I have come a long way since my diagnosis.  What I once thought of as the worst thing in the world I now look at as the best thing that could have ever happened to me healthwise. 

Wednesday, October 17, 2012

Hidden Struggles

I ran into an old high school friend the other day.  Mind you high school was 21 years ago and I have not actually seen this friend for at least 20 years.  She asks about my recent health struggles and says something along the lines of, "well you seem to have your weight under control" as she smiles.  I just smile and laugh and say,  "oh I actually need to lose some more weight".  We laugh it off and say how good it is to actually see each other again (as we only "talk" on Facebook).  Little does this well meaning friend know that I have actually lost 35 pounds with my struggles in learning to live with Gastroparesis.  So even though I am still quite over weight, it certainly doesn't mean that I haven't really been truly sick!

Sometimes we forget that even though we can't see the problem someone else is struggling with, it doesn't mean the problem isn't real and it doesn't have devastating effects on that person.  I really don't think my old friend meant to be mean by her comment but it seemed that maybe she believed that I had not really been as sick as I had claimed.

I am doing amazingly well right now, but it has been a hard road to get to this point.  At one point I was making regular trips to the ER because I would get so dehydrated from extreme vomitting and diarhea.  For quite a while I was sick all the time, symptomatic every day.  I've really had to work hard at figuring out what works for me and I am still discovering new things every day.  I have learned SO much by reading Crystal Saltrelli's blogs, websites and Facebook posts.  Crystal is an amazing person with so much information to give and she delivers it with such positivity.  Because of Crystal's advice I have developed my own Comprehensive Management Plan that has worked wonders for me.  I am currently living 90% symptom free!