Wednesday, January 20, 2010

It's Official: GI Doc Says It's Diverticulitis

Well, it's officially a new diagnosis, most likely completely unrelated to the rest of my health issues, the GI doc says.

He took a quick look at the images from my CT scan and commented on the things my internist had said were very suggestive of diverticulitis. He said he definitely agreed with that diagnosis, especially after palpating my abdomen.

He's changed my medicine to more typical antibiotics for diverticulitis: Cipro, 500 mg twice a day for ten days. And instead of the typical Flagyl, he has put me on a different anaerobic antibiotic called Alinia (nitazoxanide), 500 mg twice per day for 14 days. With my history of gastric ulcers and an overly sensitive stomach, he didn't want to put me on Flagyl, which he said is notoriously hard on stomachs.

What's nice is the Cipro was very cheap: $6.90 without insurance at Costco, and my insurance lowered it to $5.88. I won't turn down saving a buck! And the Alinia, which as a newish drug would most likely have been quite expensive, the GI doc gave me the 14 days worth of pills I needed from his sample closet. Considering how much we've spent on this infection in the past two weeks, I'm thrilled to not find out exactly how expensive this drug is.

(I'm very grateful that we have health insurance and prescription coverage at all, but I'm dreading the first non-generic I have to buy with this year's plan that now charges us the greater of $25 or 10 percent of the negotiated rate. It used to just be a flat $25, which was bad enough because I have way too many prescribed medicines that I take on a daily basis!)

The doctor also explained some of my weird but related diverticulitis symptoms to me.

(Warning: Poop talk ahead! Proceed at your own risk!)

I'd already figured out that my body was doing it's best to, er, hold onto everything because it's so painful to have a bowel movement since the diverticulitis started. The GI doc says that's pretty normal with diverticulitis, and then the whole system kind of backs up. That's why my pain, which started out in a very specific location in my lower left pelvic area, has spread to encompass my entire abdomen.

He says that as the intestines try to stop moving, the stomach slows its emptying and generates more acid to try to break down the food. The increase in acid production despite 40 mg of omeproazale twice a day has meant that I have raging, uncontrolled acid reflux. My entire esophagus burns from the back of my throat all the way to my stomach, which feels like it's got a fire lit inside it too. I'm supplementing with Tums and Mylanta, but I'm still spending a lot of nights sleeping mostly upright.

So he has recommended a bland, soft diet with no fresh fruit or fresh vegetables until I start feeling better in two to four days. Then I'm allowed to slowly start adding foods back in. (And, sigh, if I'd followed the advice of my dietitian neighbor, I'd have started doing that Sunday evening.) It's ironic because I had actually been increasing my fruit and raw veggie intake in hopes of, er, getting things moving again. I don't have a blockage, but the days in between BMs has left me feeling very bloated and uncomfortable.

So I started the bland, soft/liquid diet Tuesday evening with dinner. Instead of the leftover yummy stir fry that Scott had made last night, I had a can of Chunky's savory vegetable soup. (The doctor said veggies cooked until they're soft would be fine for me to eat.) I'm not exactly sure what I'm going to be eating for the next few days, but I'm definitely making some sugar-free, low fat instant pudding!

Meanwhile, I'm supposed to call him on Friday if I'm not feeling noticeably better by then. Otherwise, I'm supposed to call him when I finish the antibiotics and let him know how I'm doing.

He still thinks he wants to look at my small intestine with a pill-cam to see if I have damage farther down than my duodenum that would point to celiac disease. But he says (and I very much agree) that the first priority is to get this diverticulitis under control and calmed down. He says he'll want to talk about doing the additional testing in two to three months. Right now, he says, I have too much inflammation in the area.

Meanwhile, I'm hoping no one else needs to press on my belly until this thing is gone. Man, does it hurt!

Oh, and he told me that it's very rare for this to become a chronic problem with flareups of diverticulitis. He says that the vast majority of people don't have this more than once in their entire lives. Of course, after seeing me through a series of ulcers between 2000 and 2005 that didn't heal particularly well, he makes no promises for me. I'm mentally crossing my fingers that this is true for me, too.


Joan said...

Hey Aviva -

Let's give you some low residue diet suggestions:

white bread. white rice (though I'd stay away from rice because it is tiny). cream of rice cereal, meat, fruit juice, vegetbale juice, milk, cheese, white crackers. No seeds. No nuts. No beans or lentils.

Stay away from whole wheat, high fiber anything.

Does this help a little? Challah would be JUST fine, minus the poppy seeds.

Laurie said...

Hi Aviva,

Sorry to hear about this diagnosis!

My mother was recently diagnosed with the same thing and spent 10 days in the hospital with a small perforation in her bowel. I was so happy to see you are not on Flagyl-she was, and it was tough. She was also on Levaquin and had both her tendons rupture, so she went on Cipro and tolerated that better.

She's eating the same diet and lives on grilled cheese right now! That and toast, yogurt with no fruit, etc. (Of course, let's hope with the toast, etc that you really, truly do not have celiac!)

Avoid seeds like the plague!

Good luck, and I hope you have the speediest recovery possible. This is not what you need right now!

Anonymous said...

I hope the new meds and diet work!!!

Just Jenn said...

He wants to use a pill cam to test for celiac?! While that test is good for sighting large abnormalities of the intestinal tract, such as ulcers and polyps, it does not diagnose celiac disease, gluten intolerance or other food sensitivities. Villi damage is microscopic which is why an upper intestinal tract biopsy is usually preformed.

In light of that, he needs to run a Tissue Transglutaminase Antibody test which looks for the antibodies to the enzyme that a celiacs immune system is attacking when gluten is ingested. In addition to that he should also run a test for Endomysial Antibodies. Of course none of these blood tests will be valid if you're on a gluten free diet. See if you can't schedule a blood draw right away before proceeding further into your gluten free lifestyle.