A Doctor Visits the Doctor

Not a homeschooling post:)

If you have chronic, severe constipation, I encourage you to have hope.  When the probiotics, Miralax, Colace, Activia, extra psyllium, increased fruits and vegetables, whole grain cereals, and stimulant laxatives seem to be failing, keep looking.  When the doctors offer you nothing but increasing your Miralax or using more stimulant laxatives, bear with them.  Continue to be under their care, but keep looking.

In medical school, we are trained that nutritional intervention in most conditions is a non-player.  Diabetes.  Yes.  Heart disease.  Sure.  Acne.  Umm…no-oooo.  Ulcerative colitis or Crohn’s.  Umm…probably not.  Fibromyalgia.  Whatever.  Chronic fatigue syndrome.  Not likely.  Headaches.  Not unless they’re migraines triggered by red wine or MSG.  Joint pain.  Never heard of diet helping that, for crying out loud.

When patients come in touting this diet or that, we doctors graciously smile and nod as we would to a child. As we’d say to our children in a syrupy, soothing voice:  “That’s nice.  Yes, sweetie.  I know.  I’m so happy.”  Internally, we’re wondering when we can move on to the next question required in our medical history taking to meet CPT coding bullet points for insurances, Medicaid, and Medicare coverage.  So we don’t get accused of fraud.  Because most medical doctors aren’t intentionally fraudulent.  We do not have time to discuss diets that we were taught don’t work and can’t be broken down in such a way they can be actually scientifically studied.  And they don’t work.  Oh, maybe it worked for you.   But, “…that’s nice, sweetie.  I’m so glad it worked for you.  If it’s not hurting you, it sure can’t hurt to try.”  And off you both can go to the pertinent information necessary for this doctor’s visit.

For 37 years, I have dealt with symptoms such as hard stools, straining, lack of sensation to even have a bowel movement for weeks, digital disimpaction, and feeling of incomplete emptying after a bowel movement.  Different laxatives and over the counter medicines would work for a while, and then they would stop helping.  My doctors would ask, “So this has been chronic?”  “Yes.”  “Well, try eating more vegetables.”  Or more Metamucil.  Or Amitiza.  I never fretted too much about this problem as I had no discomfort with it, except when I had a bowel movement.  Which wasn’t too frequently anyway.  And if I just took Miralax, it would keep the discomfort from peristalsis at bay.  But, two bowel movements a month, and those only with stimulant laxatives, magnesium, and Miralax, cannot be healthy.  The bloating started.  Worries of colectomy for years of colonic inertia began setting in.  And I started Googling information.

There is a TON of GI information on-line.  Sifting through it is a tremendous challenge.  Time consuming.  Overwhelming.  Some of it sounds like PURE hocus-pocus.  Maybe it is.  Maybe it isn’t.  I don’t have time to read enough about all of it.  But, for myself, I settled on the Specific Carbohydrate Diet.  Much of the book made sense and seemed logical.  Then, I took it a step further and started on Gut and Psychology Syndrome diet.  Lots of it makes sense.  Some of it doesn’t.  There have been some great weeks and some terrible weeks.  But overall, since June 22, 2012, my GI tract is definitely moving in the right direction.  My husband, an orthopedic surgeon, cannot believe how GAPS has changed my GI tract.  I’m no longer “the butt” of jokes about anal-retentive women.  (I adore my husband.  And the feeling is mutual.)  Neither one of us “poo-poo” the role of diet in medical conditions anymore.

I cannot say what part of the GAPS diet is helping me.  And pure success (near-daily bowel movements) has only been in the last 6 weeks.  I would like to see 2-3 months of this kind of success before I get too excited.  I was going to wait until 2-3 months of success before writing about “success.”

But today I had my gastroenterology appointment.  In some ways, what a waste.  In other ways, a success.

A success because I am now acquainted with a gastroenterologist here.  So if my problem comes back despite this diet, I can go back to her.  Sometimes it isn’t until you’ve been to a doctor a few times that you really get their attention.  A success because she did a Chem 12, which will check out my liver, calcium, and renal function.  Which I know are okay–but it never hurts to check!  I love to get good grades on “tests.”  LOL!  And serological testing for celiac.  Which would most likely be negative as I’ve been off of gluten for 7 months now.  But she said that they can remain positive up to 2 years off of gluten.  So if it comes back positive–question answered.  If it comes back negative–keep on keepin’ on and who knows.  And finally, a positive visit because she said if my symptoms come back, she could set me up over the phone for a Sitz marker study, rectal manography testing, and perhaps a colonoscopy.  I wouldn’t have to drive the three hours again just for an office visit.

A waste because, although she knew I was a medical doctor, she continued to talk to me as if I were my mother.  With no understanding.  Explaining to me as if I didn’t already know about Sitz marker studies and rectal manography testing.  Explaining perhaps the extra fiber and vegetable intake of my diet was making a difference.  That I likely didn’t have FODMAP or SIBO because we should see diarrhea, not constipation.  And the thing is, I’m thinking that IBS, Crohn’s, and ulcerative colitis patients who are out there reading and learning know more than she does regarding FODMAP, SIBO, and dietary interventions for their illnesses.  I expect this from a primary care doctor or a non-gastroenterologist medical doctor.  I expect much more out of a gastroenterologist.  I asked her if she’d heard of the GAPS diet (in a VERY curious, polite, self-deprecating fashion).  No, she had not.  I explained it was similar to the Specific Carbohydrate Diet.  “Oh.  Those are all like the fructose intolerance, FODMAP, diets.”  I didn’t bother to explain anymore.  I chose to be a “silent genius” and not correct her.  She thought she knew, and she didn’t ask me any more questions or show any interest.  She was professional and kind enough.  I wasn’t there to educate her, unless of course she asked me about it.  And she didn’t.  I got what I expected from the visit.

But, I’m being a responsible physician-patient.  Not just treating myself.

I am hoping that dietary intervention will keep my GI tract healthy, and I’ll have no need of further testing.  Time will tell.  For now, I’ll encourage those with chronic constipation that the diet is helping me thus far after 6 months.

For further constipation related posts, please click on the GI Tracts Defying Gravity page.