GERD Update: Follow Up Visit with my Gastroenterologist

What a busy January!  I can finally sit and write a "gut update."

Since October, I've noticed an increase in bloating, nausea, constipation, and unusual motility issues (stomach pain, diarrhea, and one case of greasy stools -- whoa).   I also lost five pounds, probably due to increased exercise (Hurricane Sandy caused my commute to involve massive miles of walking when the subways were down) and diet changes, but this concerned me as a "symptom."  What if there is another, more serious, reason?   I decided a follow up visit to Dr. C., my gastroenterologist, was warranted, and met with him before the holidays in December.

We discussed my symptoms, looked at my blood panel (normal), and Dr. C. reconfirmed his thought that I have a sensitive gut, that my pathology is caused by stress.   For the first time, he mentioned the possibility of my having Irritable Bowel Syndrome.   (See the National Digestive Diseases Clearinghouse's good intro to IBS.)

We also talked about constipation as a cause of many of my symptoms, including the nausea  (I agree -- I have definitely noticed a link between the two in my experience) and "stress" is still a prime suspect in triggering the whole cycle.  (I agree with this as well.)   Dr. C. notes I could also be suffering from the horrible sounding condition,"fecal retention" -- my brain/muscles become conditioned to "holding it in" for whatever reason, and this becomes a bad habit, translating into chronic constipation or the equally hideous term, "incomplete voiding."  It's especially irritating because my diet is very high in fiber -- I shouldn't have this problem!

At some point soon, I am supposed to schedule my first colonoscopy.   (For a good "first time" story, see CNN correspondent Lisa O'Neill's account.)  I'm fascinated by the thought of seeing my guts -- but the process upsets me -- ingesting that substance, spending 24 hours "prepping" for the procedure, getting to the doctor after 24 hours of fasting and exuding.  And the colonoscopy itself is a little scary and overwhelming, let's face it.  In Lisa's account, Dr. Anthony Kalloo at Johns Hopkins admits "It's a potentially embarrassing procedure. It's not like an eye exam in terms of personal exposure."  But wondering if "anything else" is going on aside from IBS and bile reflux makes me want to bear it.  I'll be less stressed after a good diagnosis.  (And if the results are not good -- then we can tackle something specific, right?)

MOTILITY ON THE CLOCK

Let's talk motility.  I know I am having major timing issues.   In the morning, I exercise, eat breakfast, shower, get dressed, and head to the subway to get to work.   I'm supposed to fit in my bathroom hygiene in there somewhere.  As the clock ticks, I get more and more anxious -- "I need to use the bathroom" vs "But I have to get ready to leave!" -- and I can literally feel my bowels stop and contract.  "Time's up!!"  I have not mastered the art of using public bathrooms for complex tasks, so the anticipation of feeling bloated and full all day creates additional stress.   My mornings and days escalate into panic mode.   I become fixated on "using the bathroom."  What a cycle!

Ideally, I'd just remedy anything in the evening, but the timing issue returns.    The best plan for managing reflux involves cooking my own food, and eating early.  I don't get home until around 6:15 or 6:30 PM due to my commute, so I need to get into the kitchen right away.  Once again, rushing around means no attention to my bowels.

There are solutions:

• I could eat out or get take out, but that compromises my nutrition -- restaurant food is (almost) always going to be more fatty, too meat-centric, more salty, more spicy, and overall not-as-healthy as home cooking.  
• What about places that are healthy?  There is the Whole Foods salad bar fare, but how many gigante beans and macrobiotic dumplings can one eat?  (If I lived above Angelica Kitchen or Souen, I might have a different point of view.)  I suppose I can explore this more. 
• Bring prepared food home.  A variation on eating out -- I could pick up brown rice from the Whole Foods hot bar and mix it at home with greens.  (But this seems silly to me -- why not just there, why bother half-cooking?)
• Cooking in batches.   I usually make a few dishes at once on Sunday so the first few day of the week are less hectic.  I make pots of beans and freeze them, cook up soups, bake casseroles, and make my own "frozen lunches."  
• Take Miralax or a similar "gentle" medication.  I don't like this idea.  This addresses the symptom but is, in my mind, a temporary solution.   I need to address the cause.  I'm not going to rely on medication every day.
• "Retrain" my schedule to a later hour -- see if my bathroom hygiene can take place post-dinner.

It's all easier written/said than done.  Freshly prepared food is just so much BETTER.    Isn't it?   I love to cook, even if I'm a little bit tired.  It's de-stressing, creative, and the results are usually worth it.   And after a long day, the whole bowel issue is tiresome - I just want to relax, not worry about my body again!

The Plan for now:  book the colonoscopy, try to relax about the whole "going to the bathroom" issue and make time/experiment with new timing, and continue to eat well and mindfully.

MORE MOTILITY READING

• Merck Manual, Irritable Bowel Syndrome
• In Potholes in Your Colon, Dr. Chutkan talks about diverticulitis and how that can affect bowel movements.
• Read a recent peer-reviewed article on the subject:  Leung, Riutta, Kotecha and Rosser, Chronic Constipation: An Evidence-Based Review.   J Am Board Fam Med July-August 2011, vol. 24 no. 4, pp.436-451.  
• The Bristol Stool Chart
• WebMD's The Scoop on Poop