Stress and Gastroparesis

Stress can cause HUGE problems with Gastroparesis as it tends to exacerbate all symptoms.  Life deals us unseen changes all the time.  Some of these changes will be small and some will be life altering.  It is in these times that those of us with Gastroparesis MUST adhere to our own personal Comprehensive Management Plan.  (see my Comprehensive Management Plan post)  This is of the utmost importance.  Yes, easier said than done, because as I sit here typing these words of wisdom I myself have not been managing my Plan as well as I should be.  I am getting it back on track but I am not anywhere near where I once was. 

So as we must do when we get off track is to not beat ourselves up over it and just start right now with what works for each of us individually.  For me it means starting my day with my Yoga workout, follow that with another 30-60 minute workout.  Eat whole fresh foods that I know I can tolerate and limit the white carbs, like the biscuits with honey I have been living on lately.  Juice more fruits and veggies, which I have not been doing at all lately.  Drink Glucerna shakes as meal replacement or snack.  Eat beets daily as they help to cleanse the digestive tract.  Take my vitamins daily.  Take walks.  End my day with a Stress reducing meditation CD as I fall to sleep. 

The stress reducing measures such as the Yoga and meditation CD that I use make a tremendous difference in how I am able to handle the stressful situations that I find myself in.  This may not be the answer for everybody, you just have to find what works for you.  What makes you relax and feel calm?  Once you figure out what that is, find ways to incorporate it into your daily routine.  Exercise is a great stress reliever and it has those wonderful benefits of getting us in shape, weight loss and just overall feeling better.  So I must practice what I preach now and go do my workouts.  Don't forget to checkout my links to Crystal Saltrelli's pages http://livingwithgastroparesis.com/ and see what she is up to.  She is a wealth of good information and knowledge on the subject of Gastroparesis.

Dealing...

It's been a little while since I've added any posts to my blog.  When I started this blog it was my intention to let others who are struggling with dealing with having Gastroparesis know that there is life after a Gastroparesis diagnosis.  Because getting that diagnosis is mind blowing and often times debilitating.  At least it was for me.  To learn that I may never eat normal food again and there was no cure!  This my friends is life altering.  It is all too common to find yourself focusing on the long term instead of dealing with the right here and right now.  As I've learned from Crystal Saltrelli, I have Gastroparesis right now and I need to deal with it right now in the present.  Maybe in the future I won't but in order to live my life right now I have to deal with my having Gastroparesis right now.  Because if you focus on the long term it becomes very overwhelming and creates high levels of stress and anxiety which will in turn exacerbate symptoms.

I've had some major setbacks in the last couple months and I find myself feeling like I did before I had developed my Comprehensive Management Plan and was utilizing it.  The truth is that I have not been utilizing my Plan and I've been struggling with getting it back in place.  I know this is what I need to do to feel better but I've been feeling so bad that I have not been doing it. It is so easy to get caught in this viscous circle but it is imperative to get out of it.  Some of the biggest complications of Gastroparesis are, in my opinion, a result of poor nutrition.  So it is imperative to make sure to get the daily nutritional requirements.  If that means I have to go back to meal replacement drinks and soups until I am able to tolerate more foods, then so be it.  It may mean I need to juice more or puree my foods.  If that is what I need to do then I have to do it. 

You see I thought I had accepted the fact that I have Gastroparesis and had been dealing with it quite well.  And I was feeling great!  So as it is so easy to do when I start feeling good I want to forget that I am sick.  Then the treatment starts slipping because why do I need treatment if I'm not feeling sick?!  I could make up a number of reasons why this has happened but regardless of why I have let myself slip away from my Plan.  I've been struggling with getting back on track and I simply have to make the adjustments needed to keep my Plan in place.  The biggest setback I had was my change in my job schedule and it has been a real struggle to get myself back on a routine that works for me.

Getting through the holidays is a real challenge with anyone dealing with Gastroparesis.  Talk about stress overload and not to mention the variety of food and social gatherings surrounding food around the holidays.  When going to these social gatherings be prepared.  Talk to the Hostess ahead of time to see what will be served and/or to see if you can bring a dish that you know you can tolerate.  Don't assume that there will be something you can eat there and be sure to bring something with you or eat before you go.  I've learned this lesson the hard way a few times. 

Another hard lesson that I have learned is that Gastroparesis does not care what day it is.  The symptoms can flare up at any time, even Christmas day.  I was so sick on Christmas day it was horrible.  Then to add to that it is even harder for family members and loved ones to understand and be as compassionate as you need them to be about your being sick interfering with plans made.  There's no easy answer in these situations.  I am still working on this hurdle.

I am certain that I will get past these setbacks and get back on track.  When I do I will be sure to share how I did it.  I have Gastroparesis but Gastroparesis does not have me!

Getting back on track

Here I am home sick from work again.  I hate this!! I have been vomiting half the night and all morning.  My back has a huge knot of pain between my shoulder blades and I feel like shit.  I have not been taking my own advice and I let the busyness of life get in the way of managing my Plan properly and now I am paying the price.

Yes this sucks but I know that I can and will get back on track.  I had gone shopping at Jebbia's (our local produce store) and stocked up on fresh fruits and veggies for juicing and smoothies.  So back to taking the time to prepare those nutrient packed meals instead of grabbing what's quick (foods that will make me sick).  It's easier to know the right plan of action but it's harder to implement it.  As I said before a good Comprehensive Management Plan takes time and work, but it is so important to put in that time and effort to feel good.  I wish I didn't have Gastroparesis but I do and if I want to live symptom free I have to manage my plan. 

That being said it is also important to remember that getting back on track doesn't happen instantly. You have to be patient and stick to your Plan and it will come around but it takes time.  Don't give up if you don't feel better after sticking to your Plan for just a day or two.  It might actually take a week, or even two, before you are feeling better and symptom free.  Then once you are feeling better, stick to your plan!  I know easy for me to say, right.  It is easier said than done but I can not stress enough how important it is to do the work.  A good Comprehensive Management Plan is a lifestyle change, it is not a short term "diet".  Unfortunately Gastroparesis is a chronic condition that has to be managed.

Also, don't let yourself wallow in self pity because that does not do anything for you.  Instead take the time to take care of yourself.  Take a long hot bath, listen to some relaxing meditation do anything that is relaxing for you.  Tension and stress will exacerbate symptoms so try to relieve the tension and stress as much as possible.  It's easy to get stressed out when the symptoms flare but that will only make the flare up worse.  A viscous cycle I know!  So I am going to take my own advice and fill up my jacuzzi tub and take a long relaxing bath.  Then hopefully I'll feel good enough later today to do my Yoga routine.  In the meantime I am going to make some fresh juice and water it down so that it won't be so upsetting to my stomach.  Then I plan to sip on it throughout the day.  Once I'm confident my stomach won't reject it I might try some pureed beets, but for the most part it is going to be an all liquid diet kind of day.  I of course will make sure I'm getting the proper nutrients in and hopefully my stomach will stop rejecting everything.  If not I may have to make another trip to the ER to get fluids.

Another point I would like to make.  There are different stages of diets that you sometimes have to change to depending on your symptoms.  For example, I am very symptomatic right now so I am going to stick to an all liquid diet.  Then once I start to feel a little better I can go to a semi-liquid diet.  After that I can work up to the semi-solid diet that I can tolerate.  I say semi-solid because most solid foods are intolerable for me at any time regardless of how good I feel.

The alternative to getting back on track is to stay sick or get even more sick.  That is not a choice I am going to make.  I will get back on track and I will feel better.  In the meantime I have to let this flare up run its course and be very strict with my Plan so that I don't exacerbate the symptoms I'm already dealing with. 

The Importance of Maintaining Your Comprehensive Management Plan

I can not stress enough how important it is to maintain a Comprehensive Management Plan that works for you.  I had been feeling really good and had gotten busy with different things and let myself get distracted from my Plan which resulted in a severe flare up with violent vomiting that caused me to miss a couple days from work.  Gastroparesis reared its ugly head and brought me back to reality real quick.  Life gets busy and maintaining a good Plan takes work and is very time consuming.  It's easy to get distracted or off track, especially when your feeling good, but it is just as important to get yourself back on track and stick with the Plan that you know works.

My back has been bothering me and has made it really hard to do my morning workout routines.  I've even had a hard time doing the Yoga and that has been killing me because I just don't feel good if I don't get my Yoga routine in.  Then I made a trip out of town for a dear friends wedding.  As I've expressed in other posts, I am horrible at directions.  I get lost sooo easy.  I stress out and get severe anxiety and tense up all over.  After that trip my entire body was tensed up for a week, no exaggeration!  Wouldn't have missed being a part of my friends wedding for anything but I should have found someone to go with me to do the driving.  I had some other issues going on that was causing me a lot of stress and all of these added stressors just exacerbated my symptoms.  I had also not had a massage in about a month.  I didn't really realize how much getting a massage had become a part of my Plan until I was no longer getting them.

So now I am getting a massage about once a week and my back is feeling better.  This is allowing me to start getting my workouts in again.  I am also getting back into my daily routine that I know makes me feel better. 

It's important to remember that the Plan works but it is not a cure.  I still have Gastroparesis and that has not changed.  Maintaining my Plan allows me to live 90% symptom free but if I do not manage my Plan that results in being more symptomatic instead of being symptom free.  This is a lifestyle change not a short term objective. For me it seems that if I let one part of the Plan slide it doesn't take long for the rest to follow.  Before I know it I am very sick with nausea and vomiting and it doesn't go away very fast.  Maintaining your Plan is hard work and time consuming but the benefits are sooo worth the time and effort.  I have Gastroparesis but Gastroparesis does not have me!

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.

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.

 

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.