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Wednesday, May 16, 2018

Invisible Emergencies Series, Part One - The Personal Story Perspective

I have been sent a lot of different stories by people with invisible/chronic illnesses and Gastroparesis. I wanted to share all of these stories with you because I am not the only one who has problems going to the Emergency Room. I am not the only one who fears going to the Emergency Room. I am terrified of going, scared how I will be treated which you should NOT have to worry about when you feel sick enough that the Emergency Room becomes an option. However, I'll share some of my Emergency Room experiences as well.

I won't go now unless my husband forces me to. I had a really bad fall, almost two weeks ago now, where I ripped my battery of my Spinal Cord Stimulator, which I have done before. Instead of the battery lying flat, it's protruding out at about a 45 degree angle. In January, I went to the ER because my husband watched me do a backflip off of my bed, when I was asleep, and hit my head really hard on the nightstand. I blacked out and do not remember anything. He took me to the Emergency Room, where he said I was slurring my words trying to tell the doctor what happened. He said the doctor was about to write me off as a drug seeker until my husband told him what happened. They did a cat scan, and they probably should have help me for observation that night because I didn't remember ANY of this, but they sent me home with a medication for headaches. What if I had had a sub-dermal hematoma or something that was caused later that night? I am always treated as a drug seeker.

Then, I went to the Emergency Room last year because I was vomiting up blood. I could not stop vomiting to keep my pills down to get a grasp on it. I was dehydrated in a bad way. The Emergency Room doctor treated me like I was only there for drugs, despite me vomiting while he was in the room, and despite me vomiting up blood. He would not even look into it because he had already written me off as a drug addict and a drug seeker. I think I received one bag of fluid and was sent home. I wanted to tell him - you TRY projectile vomiting all day, pulling muscles, aggravating your esophagus enough to make it bleed, and see if you don't hurt.

It really bothers me that doctors in the Emergency Room do not treat us as people, even though we have true emergencies like dehydration. That can lead to organ failure. I know that they do encounter a lot of drug addicts and I understand, but if you have a patient in front of you who is actively vomiting blood, that is an emergency that is not fake. That is something that should be taken seriously. Trust me, if I could have waited for my regular doctor, I would have, but he probably would have sent me to the Emergency Room, too.





Source: www.flickr.com





This is a wonderful article by Caitlyn Kalustian from The Mighty that describes why people with invisible/chronic illnesses fear the Emergency Room:


"Why People With Invisible Illnesses Fear the Emergency Room

As unpredictable as my illnesses can be, there is one pattern I consistently follow. It repeats about every three months.

The first thing I notice is a sharp uptick in my pain levels. My joints hurt more. I ache to my very core. My neck has sharp, shooting pains. The fibromyalgia flare is here. The fibro kicks the Ehlers-Danlos syndrome pain into high gear.

Then there’s that little tingle. It starts at the top of my jaw and creeps its way down my left cheekbone. I know I’m in trouble then.

Soon the hemiplegic migraine hits. As someone with classic, chronic and hemiplegic migraines, along with migraine with aura, I have experienced all that a migraine can throw at me. By far, the hemiplegic ones are the worst. I get the 'stroke' face, where my left eye and smile droop. I start to lose control over my muscles and have weakness in my limbs. I can’t think for the life of me, I can’t concentrate and I can’t form coherent sentences or spell or speak.

Once the hemiplegic migraine beast rears its head, there’s no turning back. If I’m lucky, I’ll wake up tomorrow and it will be gone. Usually, I’m not lucky, though.

Every three months (or sometimes only one or two), I end up with a hemiplegic migraine that goes on for days and days. I’m stuck in the dark (both literally and metaphorically). Sounds and light are overwhelming. Out comes the walker, which I usually stubbornly refuse to use until I absolutely have to.

By day three, I’m headed to the ER. Of course, the migraine doesn’t break with their cocktail, so they admit me. I spend the next two to four days in the hospital, waiting for my migraine to break.

It happens every three months like clockwork. Within my circle, we call it the trifecta. It’s always a combination of Botox wearing off, hormones and one other variable. This time it’s the weather. All of the storms have sent me spiraling.

Sooner or later, my stomach will stop digesting food. It’s not like I’m hungry right now, but food can be important to living (or something like that). Today I haven’t even managed to finish a protein shake.

As my pain gets higher, my dysautonomia kicks in. I can’t regulate my temperature, my blood pressure or my heart rate. My breathing becomes labored, and my heart rate skyrockets as they try and regulate my pain.

Sometimes I don’t wait the 72 hours. Sometimes I can’t.

If you are someone with chronic illness or a rare disease, you know how difficult the hospital can be. The emergency room can treat you like a drug seeker. They can minimize your pain and may even call for a psych evaluation.

I’ve been in the ER so often over the last two and a half years that I’ve gotten to know some of the staff and most of the doctors.

I’m lucky I have doctors who treat my migraines seriously. I’m lucky I have a team of university doctors who swoop in over the local hospital staff and call rank. I always receive excellent medical care, and so I’ve never had a problem going to the ER when I’m like this. I usually hold out as long as I can. Last time I made it two and a half weeks. This time I don’t know if I will make it through tonight.

I’m hoping I wake up better tomorrow. I’m hoping that this isn’t the start of another down season. But I do have that trifecta going on, so the odds are not in my favor.

No one likes having to go the emergency room, especially spoonies. But when the time comes, and it’s different for all of us, I go. I go because I know I will feel better afterward. I go because I can’t deal with the pain anymore.

So many spoonies fear the emergency room because they’re afraid of how they will be treated, so they choose to stay at home — sometimes in agonizing pain. Maybe they’ve already tried going to their local ER several times and always had bad experiences. For those of you out there that this applies to — I’m sorry.

Just because we have invisible illnesses doesn’t make us fakers, liars, drug seekers or psych cases. I see you, my fellow spoonies, and I see that your pain is real. I see that your illness is real. I see that you have searched for help and are being turned away at every door you knock on.

It seems to me that the medical community is lacking in their knowledge of rare and invisible diseases. They seem to lack bedside manner for the chronically ill. ER docs are quick and dirty. Get them in and get them out. They want horses, but we’re zebra unicorns. They don’t want to hear about our medical history or what’s going on. They want to know what hurts, how long it’s been hurting and “What brings you in today?”

Zebra unicorns aren’t that simple. They don’t want to spend the time to get to know our histories and us. They just want to fix us and send us on our way.

But what if we aren’t a quick fix? What if it’s not a cast on a broken arm or an emergency appendectomy?

The best advice I have for you is to be your own advocate. If someone is treating you unfairly in the hospital, ask to speak to the charge nurse or the patient advocate. Demand quality medical care. Everyone has a right to it, and if you’re having issues with the staff, there are specific people at the hospital just to help resolve conflicts.

The best thing that has happened to me is centralized care — all of my records are in one place. Before I got into centralized care, I was lugging around all of my medical information with me. By this point, I retain it all in my brain and can repeat it back like a worn-out cassette. With centralized care, though, all of your records are in one chart where all of the doctors at that facility can look at them.

I know the struggle. I know how hard it is. I know that we never, ever want to go to the emergency room.

But sometimes we have to, and we should be treated with dignity and respect when we do. I like to take someone with me who can advocate for me, like my partner or my mom.

Each of us has different thresholds for what we can tolerate and what sends us over the edge. But fear keeps us from getting the necessary medical care we need when we are over the edge. With so many bad experiences out there, how could we not be afraid?

So to you, my fellow warriors, I say this: Be your own advocate. Respectfully ensure that your rights are not infringed upon. Try to stay calm because getting emotional only makes it worse.

And to the medical community, I say this: Nine times out of 10 it is a horse. But there are those of us, the one in 10, that float through the clouds as zebra unicorns. Broaden the lens that you look at your patients with and don’t dismiss the chronically ill’s attempts to see help. It took a lot of courage for that spoonie to go to the hospital today. It wasn’t their first choice. They waited it out as long as they could, took every medication in their arsenal and are now here, in your emergency room, because nothing has helped. See us for who we are — striped, colorful and beautiful."






Source: www.flickr.com






Another person put down everything I was feeling. I believe it was a family member since it was posted under her account.

For more information, please visit our Grief Group For GP Warriors.

"My good friend Kerri passed away day before yesterday. She was only 40 years old. She used study Human Development and Family Studies at Colorado State University, with degrees for the Deaf and Blind to help them. I feel like I've lost too many friends over the year."


This is going to be long but a mutual friend wrote this and I thought it summed up how I feel:

"She didn't have to die yet, the state of medical care in this country killed her. Kerri and I originally met on a service dog forum many years ago. She was an amazingly talented person as well as selfless and with a childlike innocence and sincerity. She trained her own seeing eye dog! Those in the SD community understand how difficult and special that is. When she needed more mobility assistance she was unable to get another guide from an organization.

Kerri's medical care was complex due to the multiple disorders she had and especially by her blindness. She was dependent upon a form of IV nutrition called tpn to live and many IV medications. Being blind obviously complicated this and she relied on a home health nurse to come daily and set things up for her to be able to use safely and continue to live independently. She struggled with frequent hospitalizations due to life threatening infections. At her last one it was determined she was no longer able to live at home alone. She would need to find a skilled nursing home to be discharged from the hospital. That discharge never happened, after being turned away from 51 different skilled nursing homes. They refused to take her in due to her tpn requirements. Insurance didn't allow for any further assistance in her home than she was already receiving. Kerri had many friends both online and in her assisted living apartment complex. She continued to work from home for jamberry until not too long ago. In her younger years she was a competitive ice skater despite the blindness. Had also recently been correctly dx with conditions that explained symptoms and complications she'd experienced for MANY years and started treatment. (it takes way too long to receive correct dx). Now we will never know how much function she could have gained back. Especially improvement of the immune system to prevent the frequent life threatening infections.

Due to the inability to find medical care in the form of a safe place to live, she made the only choice she had which was to die. It didn't have to be this way. She decided upon the next infection she would not treat it. That was taking too long, and she began to discontinue treatments that sustain life such as the tpn and iv hydration (she was completely unable to use her gastrointestinal tract.) She has now passed on.

We need to improve the medical options available for complex patients. We need to improve insurance so people can receive the care they need. We need to stop the incentives for Dr's to refuse care (for fear of litigation and punishment from the government. Today in medicine it's safer for Dr's to walk away from complex patients than open themselves up to the risk, something I've experienced myself as well.) We need to incentivise medical professionals to provide the best treatment they're able.

We need to improve. We need to change. We need to save the Kerri's of the world, allow them to live as long as possible to contribute to the world. No one should die simply because people weren't willing to TRY. She didn't die because her condition got worse. Not because there were no treatments available. She didn't die waiting for a medical breakthrough. (though one that could have cured some of her conditions instead of maintaining them is a future goal!) She died simply because no one was willing to provide what she needed and was available. She had so much more to give the world. She is survived by family- including her amazing Labrador guide and mobility assistance service dog Sophie as well as her daschund Mandy."

This was a needless death. It makes me angry I lost one of my good friends because she kept getting refused medical care."


I also was sent this video on Facebook and it had me in tears. I know that the VA medical center also treats the people who have fought for our country very poorly, but that does not even begin to sum it up. This video broke my heart:

http://www.facebook.com/100008583374827/videos/1543816222581142/




I have had so many stories told and shared with me about people who have gone to the Emergency Room with an invisible/chronic illness. They are usually treated like drug addicts, are not taken seriously, and they have to bring someone with them to fight for medical care because they are too sick to fight with the doctors and nurses themselves. No one should have to fight with doctors and nurses. I know that Emergency Rooms are there for triage, and to handle really serious cases. I would like to point out that dehydration IS a serious case.


According to the Mayo Clinic,

"Dehydration occurs when you use or lose more fluid than you take in, and your body doesn't have enough water and other fluids to carry out its normal functions. If you don't replace lost fluids, you will get dehydrated.

Anyone may become dehydrated, but the condition is especially dangerous for young children and older adults.

The most common cause of dehydration in young children is severe diarrhea and vomiting. Older adults naturally have a lower volume of water in their bodies, and may have conditions or take medications that increase the risk of dehydration.

This means that even minor illnesses, such as infections affecting the lungs or bladder, can result in dehydration in older adults.

Dehydration also can occur in any age group if you don't drink enough water during hot weather — especially if you are exercising vigorously.

You can usually reverse mild to moderate dehydration by drinking more fluids, but severe dehydration needs immediate medical treatment.

...Anyone can become dehydrated, but certain people are at greater risk:

People with chronic illnesses. Having uncontrolled or untreated diabetes puts you at high risk of dehydration. Kidney disease also increases your risk, as do medications that increase urination. Even having a cold or sore throat makes you more susceptible to dehydration because you're less likely to feel like eating or drinking when you're sick.



Source: www.flickr.com



Dehydration can lead to serious complications, including:

Heat injury. If you don't drink enough fluids when you're exercising vigorously and perspiring heavily, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion or potentially life-threatening heatstroke.
Urinary and kidney problems. Prolonged or repeated bouts of dehydration can cause urinary tract infections, kidney stones and even kidney failure.

Seizures. Electrolytes — such as potassium and sodium — help carry electrical signals from cell to cell. If your electrolytes are out of balance, the normal electrical messages can become mixed up, which can lead to involuntary muscle contractions and sometimes to a loss of consciousness.

Low blood volume shock (hypovolemic shock). This is one of the most serious, and sometimes life-threatening, complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body.




Source: www.Flickr.com





People may need to take in more fluids if they are experiencing conditions such as:

Vomiting or diarrhea. If your child is vomiting or has diarrhea, start giving extra water or an oral rehydration solution at the first signs of illness. Don't wait until dehydration occurs.

Strenuous exercise. In general, it's best to start hydrating the day before strenuous exercise. Producing lots of clear, dilute urine is a good indication that you're well-hydrated. During the activity, replenish fluids at regular intervals and continue drinking water or other fluids after you're finished.

Hot or cold weather. You need to drink additional water in hot or humid weather to help lower your body temperature and to replace what you lose through sweating. You may also need extra water in cold weather to combat moisture loss from dry air, particularly at higher altitudes.

Illness. Older adults most commonly become dehydrated during minor illnesses — such as influenza, bronchitis or bladder infections. Make sure to drink extra fluids when you're not feeling well."



Source: www.Flickr.com


If you have a story you would like to share or tell, and I can change the names if you want me to to protect your privacy, please email me at emilysstomach[at]gmail.com. I would like to continue this series for people who have an invisible illness, because we're just losing too many people.


Source: Made by my friend, Melissa M.


Here are some more articles that might help:

GASTROPARESIS PATIENTS VS DRUG SEEKERS.

GASTROPARESIS AND EATING DISORDERS.

INFORMATION ABOUT THE VAGUS NERVE.

GASTROPARESIS AND EATING DISORDERS PART DEUX.

Monday, April 9, 2018

Addressing Emails Written to Me



I wanted to thank everyone for their emails. I am so sorry it's taken me so long to get back to you and to answer them. I am currently trying to answer as many as I can tonight, but will spend tomorrow trying to get you answers as well, if you still need them. I have emails going back to August. I want to apologize to all who have sent me emails. I hate making excuses but maybe if you understand what I'm going through, you'll understand.

I had to have several back surgeries. Because I bend repetitively to vomit, which is a reflex I cannot stop, I have slipped a disc, which lead to sciatica. It was very painful and resulted in a series of Facet Injections and then I had an RFA done on both sides of my spine to burn the nerves. It did help, greatly! The sciatica went away and I felt much better but I was having procedure after procedure because the doctor wanted to be safe and not do the RFA at the same time for both sides.

On top of all of that, my Gastroparesis has been really rough. I fell about two weeks ago, because my cat jumped on the bed and clawed my leg really hard and it startled me, so I jumped and hit my head on my nightstand and hurt myself pretty bad. I landed on my lamp and destroyed it, cutting myself on the bulb and glass shards. I also ripped the battery of my Spinal Cord Stimulator out of the pocket my doctor made for it. The battery is supposed to lay flat, but with me, it's protruding out of my back at about a 45 degree angle and is rather painful. So, I am working on getting this fixed.











These images made me laugh and I wanted to share them, especially the Simpson's one. I do feel like I'm under construction, but I'm going to fight through these surgeries and my Gastroparesis, and come out STRONGER!










Even though I have a lot going on - I Promise that I WILL check my email at: emilysstomach@gmail.com at least once a week on Mondays, if not more. I will definitely promise that. I am still catching up on emails and have already written some of you back. Please don't stop emailing me. If you have a question, I will do my best to answer it or refer you to someone who can. I love getting your emails. If I don't reply right away, please just be patient with me.










For those who have sent me their TIMELINES: http://www.emilysstomach.com/2013/05/progressional-timeline-of-gastroparesis.html


I have them and thank you so much for taking the time to do them and send them to me! I have a lot of them to go through but I cannot wait to go through them and let you guys know if I find any patterns or anything interesting. I know it's subjective because it's not medical records, and people's memories can be tricky, but it might spark a conversation or inspire doctors to do a research project like this regarding Gastroparesis.


So, from the bottom of my heart, thank you!


Heidelberg pH Test

What is a Heidelberg pH Test? A friend mentioned he had this test on a comment on one of my pages on Facebook. I had never heard of this test before, so I wanted to do some research into it. As it turns out, this test really does encompass a wide range of things it tests for. It reminds me of the Smart Pill test, in a way, but broadened. So, after reading about it, below is the information I found concerning the test.




According to Heidelberg Medical,

"What is a Heidelberg pH Test?

The Test will accurately verify the presence of a common Digestive Disorder

The Physician will require a complete Medical History before the Test

There will be a Transceiver that is placed over the Patient’s stomach during the test.

The pre test instructions will help achieve the most accurate results.

There is no discomfort during a Heidelberg pH test. Patients are relaxed and comfortable.

Remember to grab a good old fashioned distraction to pass the time.

Due to wireless interference, cell phones and personal electronic devices may need to be powered off.

The results are immediate so the Physician may have the post test consultation the same day.






Image Source: http://www.phcapsule.com/physicians/system-configurations/





Heidelberg pH Diagnostic Test will accurately verify the presence of low stomach acid production, high stomach acid production, no acid in the stomach, Dumping Syndrome, Acute or sub Acute Gastritis, Heavy Mucus in the stomach, and Pyloric insufficiency.

The Test is accomplished by measuring the time it takes for the acid producing cells (Parietal Cells) in the stomach to produce the required Hydrochloric acid. The strength of the acid (pH) is also measured during the test.

Patients are required to complete a consent form for the Physician’s Office Staff. If you have reservations about having a pH test, please discuss them with the Physician. Mental anguish and stress will only alter the test results.

The Technician will calibrate the pH Capsule to ensure it accurately records the pH values. The Technician will then place a transceiver over the Patient’s stomach. The transceiver receives and transmits the information from the pH Capsule and sends it wirelessly to the computer where the information is displayed. The nurse will rinse the pH Capsule and give it the Patient to swallow with a sip of water.

There is no discomfort during a Heidelberg pH Test. Patients are asked to relax and get comfortable while the test is being done. Remember to grab a good old fashioned distraction to pass the time.

Results are ready for the Physician to review as soon as the Technician ends the Test. Many Physicians opt to have a post test consultation as soon as the test is complete. In many cases the doctor will establish a treatment protocol on the same day. In many instances, after testing and treatment, patients stated that they feel better and healthier in just two or three days.


Unlike other procedures, the Heidelberg pH diagnostic test is an in-office procedure that does not require sedation or the use of a stomach tube.

There is no trauma or discomfort associated with our test, and the results of the Heidelberg test are available to the doctor as soon as the test is complete. Why go through an unpleasant procedure like the nasal-gastric intubation, when you can have a Heidelberg Diagnostic test?




Physicians

As the examining Physician, you will always hear a wide spectrum of complaints from your patients. By adding The Heidelberg pH Diagnostic System to your method of testing, you can be assured of having a comprehensive overview of the patients’ first stage of digestion. We believe you will find that the results of your treatment protocols will be enhanced from the pH data, which this test provides. There is no guess work involved and the test results are reproducible.

When the total digestive system is in pH balance, You can expect higher levels of conversion and absorption of ingested foods and medications. In addition, you can expect an appreciable enhancement of the patient’s immune systems! This is a very encouraging step for all aspects of successful treatment! The digestive system supports the immune system. Without proper conversion and absorption of the foods, medications, and supplements, the immune system cannot function at its optimum level. The Heidelberg pH Diagnostic System can be used to bring the first stage of digestion to its optimum performance level for good conversion and absorption.





Researchers

The Heidelberg Diagnostic technology has been used over the past 39 years by Researchers and Pharmaceutical companies throughout the world.

Some of the recognized Pharmaceutical companies are; Pfizer (Global Research and Development), Boehringer Ingelheim, Tap Pharmaceuticals, Bayer, Merck, Glaxo, SmithKline and Novo Nordisk (Denmark).

When a pharmaceutical company develops a new medication, they use the Heidelberg diagnostic system to perform pharmacokinetic studies to determine the activity of the medication on the human body. This is where, in many cases, the Heidelberg technology becomes a valuable research tool, in assuring the safety of a newly developed medication. These studies are use to determine bodily absorption, distribution, metabolism and excretion of drugs.

Before testing newly developed medications on humans, many pharmaceutical companies test their products on animals. Tests on animals include the use of swine, dogs, monkeys, etc. As part of their approval process, the Food and Drug Administration (FDA) requires testing of many newly developed medications in humans before being approved for use in the open market.

Researchers in many medical teaching colleges and research facilities use the Heidelberg Diagnostic system for testing the side effects of drugs. They also monitor the body pH when testing new vaccines to counter the effect of contagious diseases.

The Pharmaceutical Grade Heidelberg Diagnostic system can be configured to test from 1 to 8 subjects at the same time without interaction. Custom built systems can be configured to test 16 or more subjects at the same time without interaction.

Our current Bibliography of research studies contains over 150 published studies, conducted by researchers, pharmaceutical companies, clinicians, medical teaching colleges and hospitals. A copy of these studies are available upon request.





Image Source: https://sites.google.com/a/wyckoffschools.org/food-lab/digestion-and-ph






Heidelberg pH Diagnostic Systems

The Portable Heidelberg pH Diagnostic System is an innovative system that is ideal for any busy practice, where a stationary desktop computer system would have it’s limitations. It can be transported from one room to another, or from one facility to another. The dedicated laptop computer, and a compact micro-jet printer, is placed on a movable medical grade laboratory cart that has lockable casters, with an Uninterrupted Power Supply (UPS system), with an 8 foot electrical cord. The laboratory cart has a built security feature that allow you to safely store your computer, printer and other equipment in a lockable storage cabinet, when they are not being used. The portable Heidelberg pH Diagnostic System can be used for single, or multiple, patient pH Diagnostic Testing.

The standard clinical grade Heidelberg Diagnostic systems can be configured to test from 1 to 8 patients simultaneously without interaction. Our custom built systems can be configured to test from 1 to 16 patients at the same time without interaction.




Image Source: http://www.phcapsule.com/





Exclusivity

The FDA requires that system operators (nurses or technicians) be training in the use of the system and do testing under the supervision of a licensed physician. Third party reimbursement depends on individual states and individual insurance companies, and the form in which the CPT coding is submitted.

The Heidelberg pH Capsule package insert reads: CAUTION: Federal law restricts this device to sale only by, or on the order of a qualified physician. A patient history and examination are required before administering this diagnostic test.

Example: Crohn’s Disease, or any history of intestinal blockage, adhesions and/or history of bleeding.


We are active with clinical pharmacology and pharmacokinetic research studies with major universities and major American and European pharmaceutical companies.

View our testing software simulation.


Included…

Medical Grade Lab Cart
Dedicated Laptop Computer
Heidelberg Interface Module
Heidelberg Digital Transceiver
Portable Ink Jet Printer
Comprehensive Technical Training Videos
Comprehensive Technical Training Manual
Heidelberg Testing Program CD Package
Capsule Calibration Test Fixture
1 Pint (500 mL) pH 1 Calibration Solution
1 Pint (500 mL) pH 7 Calibration Solution
Uninterrupted Power Supply(UPS System)
Additional Equipment…


pH Capsule Locator

The per test disposables are pH capsules, distilled water and Saline. Everything else necessary, for over a hundred pH tests, is included with the system purchase."






Image Source: http://www.phcapsule.com/patients/faqs/

Cortisol: Understanding and Coping with Stress

Some people may not be aware that your body stores a hormone called Cortisol. This hormone in your body, as explained to me by an Emergency Room doctor, is your body's main stress hormone. It controls your mood, fear, and motivation. Since I was only given a brief explanation of cortisol in the Emergency Room, I decided to write an article about it to help spread the knowledge around, but also give techniques and coping mechanisms to help you in times of stress.


According to an article from The Mayo Clinic,

"Chronic Stress puts your health at risk

Chronic stress can wreak havoc on your mind and body.

Your body is hard-wired to react to stress in ways meant to protect you against threats from predators and other aggressors. Such threats are rare today, but that doesn't mean that life is free of stress.

On the contrary, you undoubtedly face multiple demands each day, such as shouldering a huge workload, making ends meet and taking care of your family. Your body treats these so-called minor hassles as threats. As a result you may feel as if you're constantly under assault. But you can fight back. You don't have to let stress control your life.



Understanding the natural stress response

When you encounter a perceived threat — a large dog barks at you during your morning walk, for instance — your hypothalamus, a tiny region at the base of your brain, sets off an alarm system in your body. Through a combination of nerve and hormonal signals, this system prompts your adrenal glands, located atop your kidneys, to release a surge of hormones, including adrenaline and cortisol.

Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain's use of glucose and increases the availability of substances that repair tissues.

Cortisol also curbs functions that would be nonessential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with regions of your brain that control mood, motivation and fear.

When the natural stress response goes haywire
The body's stress-response system is usually self-limiting. Once a perceived threat has passed, hormone levels return to normal. As adrenaline and cortisol levels drop, your heart rate and blood pressure return to baseline levels, and other systems resume their regular activities.

But when stressors are always present and you constantly feel under attack, that fight-or-flight reaction stays turned on.

The long-term activation of the stress-response system — and the subsequent overexposure to cortisol and other stress hormones — can disrupt almost all your body's processes. This puts you at increased risk of numerous health problems, including:

Anxiety
Depression
Digestive problems
Headaches
Heart disease
Sleep problems
Weight gain
Memory and concentration impairment
That's why it's so important to learn healthy ways to cope with the stressors in your life.


Why you react to life stressors the way you do


Your reaction to a potentially stressful event is different from anyone else's. How you react to stressors in your life is affected by such factors as:

Genetics. The genes that control the stress response keep most people on a fairly even keel, only occasionally priming the body for fight or flight. Overactive or underactive stress responses may stem from slight differences in these genes.

Life experiences. Strong stress reactions sometimes can be traced to traumatic events. People who were neglected or abused as children tend to be particularly vulnerable to stress. The same is true of people who have experienced violent crime, airplane crash survivors, military personnel, police officers and firefighters.

You may have some friends who seem laid-back about almost everything and others who react strongly at the slightest stress. Most reactions to life stressors fall somewhere between those extremes.



Learning to react to stress in a healthy way

Stressful events are a fact of life. And you may not be able to change your current situation. But you can take steps to manage the impact these events have on you.

You can learn to identify what stresses you and how to take care of yourself physically and emotionally in the face of stressful situations.



Stress management strategies include:

Eating a healthy diet and getting regular exercise and plenty of sleep
Practicing relaxation techniques such as trying yoga, practicing deep breathing, getting a massage or learning to meditate
Taking time for hobbies, such as reading a book or listening to music
Fostering healthy friendships
Having a sense of humor
Volunteering in your community
Seeking professional counseling when needed
The payoff for learning to manage stress is peace of mind and — perhaps — a longer, healthier life."




Source: Cortisol Pathway




According to the American Psychological Association,


"Stress Weakens the Immune System


What the Research Shows

Stressed out? Lonely or depressed? Don't be surprised if you come down with something. Psychologists in the field of "psychoneuroimmunology" have shown that state of mind affects one's state of health.

In the early 1980s, psychologist Janice Kiecolt-Glaser, PhD, and immunologist Ronald Glaser, PhD, of the Ohio State University College of Medicine, were intrigued by animal studies that linked stress and infection. From 1982 through 1992, these pioneer researchers studied medical students. Among other things, they found that the students' immunity went down every year under the simple stress of the three-day exam period. Test takers had fewer natural killer cells, which fight tumors and viral infections. They almost stopped producing immunity-boosting gamma interferon and infection-fighting T-cells responded only weakly to test-tube stimulation.

Those findings opened the floodgates of research. By 2004, Suzanne Segerstrom, PhD, of the University of Kentucky, and Gregory Miller, PhD, of the University of British Columbia, had nearly 300 studies on stress and health to review. Their meta-analysis discerned intriguing patterns. Lab studies that stressed people for a few minutes found a burst of one type of 'first responder' activity mixed with other signs of weakening. For stress of any significant duration - from a few days to a few months or years, as happens in real life - all aspects of immunity went downhill. Thus long-term or chronic stress, through too much wear and tear, can ravage the immune system.

The meta-analysis also revealed that people who are older or already sick are more prone to stress-related immune changes. For example, a 2002 study by Lyanne McGuire, PhD, of John Hopkins School of Medicine with Kiecolt-Glaser and Glaser reported that even chronic, sub-clinical mild depression may suppress an older person's immune system. Participants in the study were in their early 70s and caring for someone with Alzheimer's disease. Those with chronic mild depression had weaker lymphocyte-T cell responses to two mitogens, which model how the body responds to viruses and bacteria. The immune response was down even 18 months later, and immunity declined with age. In line with the 2004 meta-analysis, it appeared that the key immune factor was duration, not severity, of depression. And in the case of the older caregivers, their depression and age meant a double-whammy for immunity.

The researchers noted that lack of social support has been reported in the research as a risk factor for depression, an insight amplified in a 2005 study of college students. Health psychologists Sarah Pressman, PhD, Sheldon Cohen, PhD, and fellow researchers at Carnegie Mellon University's Laboratory for the Study of Stress, Immunity and Disease, found that social isolation and feelings of loneliness each independently weakened first-year students' immunity.

In the study, students got flu shots at the university health center, described their social networks, and kept track of their day-to-day feelings using a handheld computer (a new technique called "momentary ecological awareness"). They also provided saliva samples for measuring levels of the stress hormone cortisol. Small networks and loneliness each independently weakened immunity to a core vaccine component. Immune response was most weakened by the combination of loneliness and small social networks, an obvious health stress facing shy new students who have yet to build their friendship circles.



What the Research Means

Emerging evidence is tracing the pathways of the mind-body interaction. For example, as seen with the college students, chronic feelings of loneliness can help to predict health status -- perhaps because lonely people have more psychological stress or experience it more intensely and that stress in turn tamps down immunity. It's also no surprise that depression hurts immunity; it's also linked to other physical problems such as heart disease. At the same time, depression may both reflect a lack of social support and/or cause someone to withdraw from social ties. Both can be stressful and hurt the body's ability to fight infection.

All of these findings extend what we know about how stress management and interpersonal relationships can benefit day-to-day health, doing everything from helping us combat the common cold to speeding healing after surgery. The research is in synch with anecdotal reports of how people get sick in stressful times, but understanding exactly how psychology affects biology helps scientists to recommend the best ways we can build up immunity.



How We Use the Research

Managing stress, especially chronic or long-term stress (even if it's not intense), may help people to fight germs. When burdened with long-term stressors, such as caring for an elderly parent or spouse with dementia, health can benefit from conscientious stress management.

Kiecolt-Glaser and Glaser confirmed this hopeful option by comparing the immune function of exam-stressed medical students given hypnosis and relaxation training with that of students without training. At first, the immune responses of the two groups appeared to both go down. However, closer inspection revealed that some students took this exercise more seriously than others. Those who didn't take relaxation training seriously didn't fare so well; those who practiced conscientiously did actually have significantly better immune function during exams than students who practiced erratically or not at all.

Finally, the newest findings on social stress underscore the value of good friends; even just a few close friends can help someone feel connected and stay strong. Social ties may indirectly strengthen immunity because friends - at least health-minded friends -- can encourage good health behaviors such as eating, sleeping and exercising well. Good friends also help to buffer the stress of negative events.



Sources & Further Reading

Edwards, K.M., Burns V.E., Reynolds, T., Carroll, D., Drayson, M., & Ring, C. (2006). Acute stress exposure prior to influenza vaccination enhances antibody response in women. Brain, Behavior, and Immunity, 20:159-68.

Glaser, R., Sheridan, J. F., Malarkey, W. B., MacCallum, R. C., & Kiecolt-Glaser, J. K. (2000). Chronic stress modulates the immune response to a pneumococcal pneumonia vaccine. Psychosomatic Medicine, 62, 804-807.

Glaser, R., Robles, T. F., Malarkey, W. B., Sheridan, J. F., & Kiecolt-Glaser, J. K. (2003). Mild depressive symptoms are associated with amplified and prolonged inflammatory responses following influenza vaccination in older adults. Archives of General Psychiatry, 60, 1009-1014.

Kiecolt-Glaser, J. K., Glaser, R. (1993). Mind and immunity. In: D. Goleman & J. Gurin, (Eds.) Mind/Body Medicine (pp. 39-59). New York: Consumer Reports.

Kiecolt-Glaser, J. K., & Glaser, R. (2002). Depression and immune function: Central pathways to morbidity and mortality. Journal of Psychosomatic Research, 53, 873-876.

Kiecolt-Glaser, J. K., McGuire, L., Robles, T., & Glaser, R. (2002). Psychoneuroimmunology: Psychological influences on immune function and health. Journal of Consulting and Clinical Psychology, 70, 537-547.

Kiecolt-Glaser, J. K., McGuire, L., Robles, T., & Glaser, R. (2002). Psychoneuroimmunology and psychosomatic medicine: Back to the future. Psychosomatic Medicine, 64, 15-28.

Pressman, S. D., Cohen, S., Miller, G.E., Barkin, A., Rabin, B. S., Treanor, J. J. (2005). Loneliness, Social Network Size and Immune Response to Influenza Vaccination in College Freshmen, Health Psychology, 24, pages.

Robinson-Whelen, S., Tada, Y., MacCallum, R. C., McGuire, L., & Kiecolt-Glaser, J. K. (2001). Long-term caregiving: What happens when it ends? Journal of Abnormal Psychology, 110, 573-584.

Segerstrom, S. C. and Miller, G. E. (2004). Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychological Bulletin, Vol. 130, No. 4."




Source: Cortisol Effects.





According to the Cleveland Clinic,

"Understanding and Managing Gastroparesis


Description

Gastroparesis is rapidly becoming a common diagnosis. This mysterious illness reduces the ability of the stomach to empty its contents. It can be especially detrimental to people with diabetes.

Gastroparesis is caused by damage to the vagus nerve. In its normal state, the vagus nerve contracts (tightens) the stomach muscles to help move food through the digestive tract. In cases of gastroparesis, the vagus nerve is damaged by diabetes and/or high blood pressure. This prevents the muscles of the stomach and intestines from working properly, which keeps food from moving from the stomach to the intestines. Gastroparesis is a chronic (long-lasting) condition. This means that treatment usually doesn’t cure the disease, but you can manage it and keep it under control.



About the Speaker

Michael Cline, DO, was appointed to Cleveland Clinic in 2012 with the department of Gastroenterology and Hepatology. Dr. Cline completed medical school at Ohio University College of Osteopathic Medicine in Athens, Ohio. His specialty is gastroparesis, and he offers treatments such as colonoscopy, gastric pacemaker, gastric pacer, and other general treatments and services for gastrointestinal diseases.




Let’s Chat About Gastroparesis

The Bottom Line


SamSeven: What is gastroparesis?

Michael_Cline,_DO: If you split gastroparesis into two words, it is by definition: Gastro (stomach) paresis (paralyzed) = slow stomach.

MapleLeaf: What are the symptoms of gastroparesis?

Michael_Cline,_DO: The typical systems are nausea, vomiting, abdominal pain, bloating and belching.

keroppi: Can gastroparesis cause pain on the left side, about an inch under your rib, that tends to worsen after eating? I've had this for years since I've been diagnosed. (Ultrasound, MRI and PET scan were done around that time, and were all normal.)

Michael_Cline,_DO: Gastroparesis can cause pain in some patients, but other sources including neurologic causes need to be ruled out.

Tests and Diagnosis
Fullmoon: Are their certain tests that will confirm I have gastroparesis? Are these tests accurate?

Michael_Cline,_DO: Basically, nuclear gastric emptying and a test called the wireless motility capsule are used. There can be a problem with the nuclear test, depending on how it is done. To be accurate, it really has to be a four-hour test done with scrambled eggs and nothing else.

ycco: Is a gastric emptying test not sufficient to diagnose gastroparesis? I had an abnormal one more than ten years ago and was told I just had "slow motility". Fast forward to three years ago when my health (not just my stomach) took a turn for the worse, I learned about gastroparesis, and it makes me wonder why I was never given the diagnosis back then, as I had the "classic symptoms" and an abnormal gastric emptying test. Thank you.

Michael_Cline,_DO: The gastric emptying test, if it is done the right way (four hours and with solid food), is one of the better tests we have. The problem is it does not coordinate with symptoms, so if it is abnormal, the numbers don't really mean anything.

holleywilliams: What is a good indicator of the need to move ahead to enteral feeding, a percent of weight loss over a defined period of time? Or would it be the length of time without adequate oral intake?

Michael_Cline,_DO: Typically, we don't want patients to lose more than 10 percent of their ideal body weight in three to six months. Another parameter is abnormal lab work suggesting malnutrition.

Fremont: Is the gastric emptying study the only way to diagnose gastroparesis? I've had it three times by three different providers. Two diagnosed mild gastroparesis, the third said it was normal (Mayo Clinic). I understand this test only represents how your stomach empties that particular day. I have pretty major symptoms and get so full so fast, can really only eat one meal and graze the rest of the day. I've also had obstructions just below the stomach. Is this related? Are there other tests that can accurately diagnose this condition?

Michael_Cline,_DO: Your history of having had multiple tests with various outcomes is fairly consistent with what we see regularly. That is one of the problems with the nuclear emptying test, especially when it’s borderline normal/abnormal, in proving whether or not someone truly has gastroparesis.

holleywilliams: Can you be more specific about what you mean by "global dysmotility" and "diffuse dysmotility”? What tests other than gastric emptying should be performed?

Michael_Cline,_DO: By global motility or diffused motility, I mean more than one area of the intestine. The most direct way to rule it out would be the smart pill. For more information, please read: Gastroparesis: ‘Smart’ Pill Uncovers This Mysterious Stomach Condition.

AOddone: What's included in a full gastroparesis/motility work-up?

Michael_Cline,_DO: There is a battery of lab tests looking for autoimmune antibodies that could be related to the motility disorder. Typically, patients will have an EGD or an x-ray of the intestine to rule out anatomic problems. If we are working-up a generalized motility problem, we would go to the smart pill test.









Multiple Maladies

AngelaOddone: What experience do you have treating patients whose gastroparesis is caused by Ehlers-Danlos syndrome in which there are multiple causes. These include poor vagal tone, stretchy tissues in the circulatory and gastrointestinal systems, mast cell activation syndrome causing inflammation, SIBO, leaky gut and endocrine issues such as adrenal fatigue and Graves or Hashimoto's resulting in hypothyroidism?

Michael_Cline,_DO: Ehlers-Danlos syndrome is not an uncommon cause of gastrointestinal dysmotility, and frequently leads to a diffuse motility disorder, not just gastroparesis. SIBO (small intestinal bacterial overgrowth) is a marker of small bowel dysmotility also.

DizzyGirl: I have gastroparesis related to POTS (postural orthostatic tachycardia syndrome) and EDS3 (Ehlers-Danlos syndrome type 3). The only thing that has been suggested for me is to "occasionally" take domperidone. I am a little nervous about taking it with my current drugs for POTS, and I really want something that will help me every day. Are there any other options or natural remedies that can be used to reduce the pain and nausea I have every day?

Michael_Cline,_DO: There are no real natural remedies that seem to be effective. It is very important when you have POTS and EDS3 that you rule out global dismotility.

sonjat: Good Morning. I was wondering if you see a lot of gastroparesis in patients with Sjogren's or other autoimmune conditions. Also, what symptoms do you typically see with this condition? Would excessive bloating and constipation be included? Would this condition cause shortness of breath or "air hunger" symptoms? Thank you.

Michael_Cline,_DO: The gastroparesis is directly linked to the autoimmune disease. We have to make sure, especially in someone who has constipation, that the entire gut is not involved. Typically, gastroparesis does not affect breathing or the heart. The autoimmune disease can, but gastroparesis won't.

keroppi: Is SFN (small fiber neuropathy) a known cause of gastroparesis? Is there any way to prevent the progression of gastroparesis if you don't know the cause? What if you just have idiopathic SFN, or mito issues?

Michael_Cline,_DO: There is an association with SFN and gastroparesis. Typically, SFN has to be fairly advanced to get gastroparesis, and unfortunately, there is no way to prevent it from affecting your stomach.

vateton: I was diagnosed with gastroparesis after a very slow stomach emptying test (eight percent vs. 50 percent normal), but I also have confirmed small fiber neuropathy. Is it possible that the diagnosis is incorrect, and I should consider dysautonomia? What tests will help me differentiate these diseases?

Michael_Cline,_DO: I think this will be best worked-up by a neurologist who specializes in small fiber neuropathy, because gastroparesis can be present in both.

WaveWolf: I am a T9 incomplete paraplegic and also have diagnoses of multi-systemic sarcoidosis (cause of paralysis), RA and several other autoimmune conditions. I have steroid-induced diabetes, which is managed with a strict diet and a chromium supplement. I eat small meals, but try to include fiber as part of managing my bowels and avoiding constipation. In eight years, I have not achieved a regular bowel program. I cannot maintain stool consistency, have a lot of gas and pain (from gas or from partial obstruction), but do not have much nausea or any vomiting unless I eat too much fat, too much food, or sweets. Should I be tested for gastroparesis?

Michael_Cline,_DO: Given the complexity of your history, it is best served to see you in the clinic. Appointment information will follow the chat.

Diet and Digestion
A-Aron: What are the basics of a gastroparesis diet?

Michael_Cline,_DO: It includes low-fat and low-fiber foods and frequent, small meals. Depending on the severity of symptoms, we use liquid nutrition as well.

DizzyGirl: Is the low-FODMAP diet at all beneficial for people with gastroparesis?

Michael_Cline,_DO: I am not a fan of the low-FODMAP diet. It goes in and out of favor, but had never really shown to do much for gastroparesis. It is also a very restrictive diet and is very difficult for patients to stay on long-term.

DizzyGirl: For mild gastroparesis linked to POTS and EDS3 (I am able to eat smaller amounts of solid foods, but have lots of pain and nausea), are there any "diets" that can help?

Michael_Cline,_DO: Stick to a low-fat, minimum fiber diet.

lgmac: How can my obese husband lose weight and keep his bowels moving? He bulks up with kidney beans and rye/wheat bread to keep his bowels going now. He has internal hemorrhoids, gastroparesis, paruresis, history of DVT, and CIDP, and won't eat any "rabbit" food. He says he can't take Miralax. Help!

Michael_Cline,_DO: When a person has gastroparesis, keeping the bowels moving is difficult because the diet becomes primarily carbohydrates. The rabbit food is much harder to digest, and if the stomach is not emptying it, it could make things dramatically worst. I would recommend a nutrition evaluation for weight loss along with a full gastroparesis/motility work-up followed by treatment of whatever is found.

liesel: I am a 77-year-old female. I live a very healthy life; I eat healthy and exercise daily. I do have heart disease and high blood pressure and take metoprolol ER 25mg and Losartan 50mg. I do NOT have diabetes. As long as I can remember, I have had problems with constipation. For the last year, I have constant difficulty with emptying completely. I always have the feeling that I need to go again. I go at exactly the same time every morning, right after one cup of coffee. But in the evening, I have the urge again and feel as if I am constipated to the point that I have been using glycerin suppositories, sometimes with good results and other times with more pain than stool. I do take a daily dose of Miralax and also drink plenty of water. Is there anything else I could be doing?

Michael_Cline,_DO: Given the complexity of your history, it is best served to see you in the clinic. Appointment information will follow the chat.









Talking Treatments

vateton: I started monthly IVIG infusions for small fiber neuropathy caused by sarcoidosis and found it positively impacted my gastroparesis. Is this ever used expressly for this purpose?

Michael_Cline,_DO: IVIG has now been shown to be effective in gastroparesis when there is a co-existing autoimmune disorder. We are using it more and more for gastroparesis.

Agurene: Dysautonomia and gastroparesis often appear together in patients. What is your recommendation for treating or managing gastroparesis in dysautonomia patients who cannot be exposed to neurotoxins in certain medications such as Reglan? What natural options are there – diet, supplements, lifestyle changes, etc. – that could help such patients?

Michael_Cline,_DO: Dysautonomia and gastroparesis frequently occur together. In dysautonomia patients, we have to rule out a global dismotility. We need the entire intestine, not just the stomach. There are very few natural substances that have been looked at. Ginger is used to help with gas, and there is a natural supplement called Imerogest that has been shown to be of some benefit to people. In dysautonomia, the biggest thing is to make sure we have the right diagnosis.

bafke: Is there any treatment that would help the vagus nerve work as close to normal as possible?

Michael_Cline,_DO: Unfortunately, not at this time. There is some research going on across the world in what's called vagal pacing.

DizzyGirl: I've heard some people mention that they have used Iberogast to manage their gastroparesis symptoms. Is that something you think would work or would recommend?

Michael_Cline,_DO: It is not well-studied, but has shown in case reports to be effective. There is really no harm in trying it. It's not going to hurt you, but it would really be trial-and-error process to see if it works for you.

Medication Messages
Iodine: What are some effective treatments for someone with EDS-related overall GI dysmotility, including gastroparesis?

Michael_Cline,_DO: When someone had general dismotility, the medical treatment options are limited. Two specific drugs we have available through the FDA are domperidone and Propulsid. They are drugs that have been designed to move more than just the stomach.

AOddone: Is domperidone FDA approved now? It wasn't a few years ago.

Michael_Cline,_DO: Domperidone is not FDA approved. We do have, however, through the FDA, a program to prescribe domperidone in the United States. It will not be covered by insurance and requires frequent office visits every eight weeks for the first year you're on the drug.

crystalclear: After being diagnosed with gastroparesis ten or 12 years ago, I took omeprazole every day until I read in 2016 that it could be linked to an increased risk of dementia. I have since read that those test results were inconclusive. What is your opinion about those test results? For a while (about a year), I seemed to be doing OK without the omeprazole, until about a month ago when the bloating returned. Should I risk taking the omeprazole again? It's been ten or 12 years since I've seen the gastroenterologist. Once one has been diagnosed with gastroparesis, do they always have gastroparesis?

Michael_Cline,_DO: Once you've been diagnosed with gastroparesis, it is very rare for it to go away. However, it may fluctuate in how severe the symptoms are. The article on dementia showed an association between Prilosec and dementia, but not a cause. In addition, that article used elderly patient and not young patients. So, the best answer would be to use the omeprazole as needed or as infrequently as you can to control the symptoms.





Diabetes Dimension

keroppi: Does gastroparesis affect hypoglycemic patients? Is it likely to cause more hypoglycemic episodes if it takes longer for food to digest and be converted to energy? If you're experiencing a hypoglycemic episode, will it take longer to correct and bring the blood sugar back to normal if digestion is slowed down?

Michael_Cline,_DO: It will make blood sugar control more difficult if you have gastroparesis, and it can activate hypoglycemia. So, it can mess with blood sugars significantly.

BEACHBABIES: Why and at what "stage" is gastroparesis linked to diabetes?

Michael_Cline,_DO: Typically, people with types 1 and 2 diabetes will have had diabetes for more than ten years prior to diagnosis. The more uncontrolled the diabetes, the higher the risk. One important factor with diabetes is the better the blood sugar control, the better the control of gastroparesis symptoms. Gastroparesis is almost never the initial complication of diabetes. Typically, the patient will have other neuropathy.






Specific Circumstances

gatorfrog: Six years ago, I had a subtotal colectomy because my food would not travel through. I don't know if that was gastroparesis or not, but since then, my food takes forever to digest, especially if I eat meat. I have Type 2 diabetes and am wondering what should I be doing or eating because of that? Is there something I should be looking out for and/or not eating? Thank you for any help.

Michael_Cline,_DO: Given the problems with the colon, the fact that you’re still experiencing symptoms and you have the risk factor of Type 2 diabetes, it will be a good idea to get the smart pill study to look at the motility movement of the entire GI tract.

keroppi: In the first few years of my gastroparesis diagnosis, my stomach puffing out after eating was one of the main symptoms. Once the food was digested, usually by the next morning, my stomach would be flat. Now, years later, I'm still waking up with the bloated/puffy belly, though it's smaller than the night before, it's still there, and the bigger the meal I've eaten the night before, usually the bigger the "morning belly”. Is it possible for gastroparesis to progress like this, where the food seems undigested even if it's been 17 hours after eating? I know it can be progressive in other ways, and I was wondering if this was the start? (I have mitochondrial dysfunction and presumed SFN.)

Michael_Cline,_DO: It is possible for it to progress, but more importantly, a work-up needs to be done to evaluate for more than just gastroparesis.

linbow: I had a Nissen Fundoplication (NF) in 2007. In 2009, I began losing weight (80 pounds total in almost a year), and was told my vagus nerve was damaged and was diagnosed with gastroparesis. In 2015, my heartburn and reflux returned, and I had a second NF done in June 2017. My stomach never seems to feel comfortable. Is this mainly due to my diet?

Michael_Cline,_DO: When there is post-surgical gastroparesis, the best approach would be further surgery on the stomach to allow it to empty faster. Typically, medication therapy is not very effective in post-surgery gastroparesis. Your condition probably is not diet related. A high-fiber diet will make symptoms worse, but you’re not going to manage the gastroparesis just by diet.

Clinic Connection
DizzyGirl: What is your normal regimen for patients you see with mild gastroparesis?

Michael_Cline,_DO: First, we do lab work and frequently follow up with tests to rule out causes of gastroparesis. Then, we will institute the four-stage diet with our multidisciplinary clinic. The patients will be evaluated for surgical options and pain management if they have pain issues. Also, we will consider behavioral medicine for non-pharmacological treatment and various medications based on other co-existing diseases and personal health.






Closing

That is all the time we have for questions today. Thank you, Dr. Cline, for taking time to educate us about Gastroparesis.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at http://my.clevelandclinic.org."







Source:http://www.tothegrowlery.com/blog/2017/4/18/six-different-types-of-grounding-exercises-for-anxiety-intense-emotions





Source: (in addition to being on the image itself)https://twitter.com/pookyh/status/882951668882710528









According to Living Well,



"Grounding exercises

Grounding exercises are things you can do to bring yourself into contact with the present moment – the here and now. They can be quick strategies (like taking three deep 'belly breaths') or longer, more formal exercises (like meditation). Different strategies work for different people, and there is no 'wrong' way to ground yourself. The main aim is to keep your mind and body connected and working together.

People who have experienced childhood sexual abuse or adult sexual assault can sometimes be confronted by flashbacks or intense memories of what was done, to the point that they are feel as if they are back there, re-living the abuse all over again. A flashback is an example of being in the 'there and then' rather than the 'here and now,' so grounding exercises can help to bring you back.




Grounding exercises are a way for you to firmly anchor yourself in the present

Grounding exercises are helpful for many situations where you find yourself becoming overwhelmed or distracted by distressing memories, thoughts or feelings. If you find yourself getting caught up in strong emotions like anxiety or anger, or if you catch yourself engaging in stressful circling thoughts, or if you experience a strong painful memory or a flashback, or if you wake up from a nightmare with a pounding heart, grounding exercises can help bring you back down to earth.

It can be helpful to have a selection of grounding exercises that you can draw upon at different times. Just like no one technique works for all people, we often find that not all techniques work at all times. One thing you can do is look over some lists of grounding exercises and write down all the ones you think might work for you. Carry your personal list with you. Then, when you find yourself needing relief, you can run your eyes down your list and pick out the strategy that will be most helpful in that situation.

Speaking of lists, we have one of our own below.

The following grounding exercises are about using our senses – sight, hearing, smell, taste, touch – to reconnect our mind and body in the present. It is our basic human senses that remind us we are here now, and we are safe.

In working through the grounding exercises suggested here, you might find one or two that work for you. Keep in mind to only to use the exercises that you feel comfortable with.



List of grounding exercises

Remind yourself of who you are now. Say your name. Say your age now. Say where you are now. Say what you have done today. Say what you will do next.

'My name is ________, and I am 54 years old. I am in my living room, in my home, in Woolloongabba, in Brisbane, in Queensland. I woke up early today. I had a shower and fed my dog. I just finished my coffee and toast. Soon I am going to walk to the train station and go in to work. I am going to walk down ______ street and then turn left at the bike shop. Then I am going to….'

Take ten slow breaths. Focus your attention fully on each breath, on the way in and on the way out. Say number of the breath to yourself as you exhale.

Splash some water on your face. Notice how it feels. Notice how the towel feels as you dry.

Sip a cool drink of water.

Hold a cold can or bottle of soft drink in your hands. Feel the coldness, and the wetness on the outside. Note the bubbles and taste as you drink.

If you wake during the night, remind yourself who you are, and where you are. Tell yourself who you are and where you are. What year is it, what age are you now? Look around the room and notice familiar objects and name them. Feel the bed you are lying on, the warmth or coolness of the air, and notice any sounds you hear.

Feel the clothes on your body, whether your arms and legs are covered or not, and the sensation of your clothes as you move in them. Notice how your feet feel to be encased in shoes or socks.

If you are with other people, and you feel comfortable with them, concentrate closely on what they are saying and doing, and remind yourself why you are with them.

If you are sitting, feel the chair under you and the weight of your body and legs pressing down onto it. Notice the pressure of the chair, or floor, or table against your body and limbs.

If you are lying down, feel the contact between your head, your body and your legs, as they touch the surface you are lying on. Starting from your head, notice how each part of your body feels, all the way down to your feet, on the soft or hard surface.

Stop and listen. Notice and name what sounds you can hear nearby. Gradually move your awareness of sounds outward, so you are focusing on what you can hear in the distance.

Hold a mug of tea in both hands and feel its warmth. Don’t rush drinking it; take small sips, and take your time tasting each mouthful.

Look around you, notice what is front of you and to each side. Name and notice the qualities of large objects and then smaller ones.

Get up and walk around. Take your time to notice each step as you take one, then another.

Stamp your feet, and notice the sensation and sound as you connect with the ground.

Clap and rub your hands together. Hear the noise and feel the sensation in your hands and arms.

Wear an elastic band on your wrist (not tight) and flick it gently, so that you feel it spring back on your wrist.

If you can, step outside, notice the temperature of the air and how much it is different or similar to where you have just come from.

Stretch.

Notice five things you can see, five things you can hear, five things you can feel, taste, or smell.

If you have a pet, spend some time with them. Notice what is special and different about them.

Run your hands over something with an interesting texture.

Get a sultana, a nut, or some seeds, etc. Focus on how it looks, feels and smells. Put it in your mouth and notice how that feels, before chewing mindfully and noticing how it feels to swallow.

Put on a piece of instrumental music. Give it all of your attention.

If you have a garden or some plants, tend to them for a bit. Plants, and actual soil, can be an excellent 'grounder!'"





Source: https://www.slideshare.net/ShannonCayer/grounding-techniques-explained



A while back, my doctor at the Mayo Clinic gave me print outs on relaxation techniques. These are breathing exercises but they can be found here: http://www.emilysstomach.com/2013/07/relaxation-breathing-techniques-from.html

The grounding technique is also used to not only help with anxiety, but to help people with PTSD. I have never tried grounding techniques before but I will be glad to try them for a week and then keep a comprehensive journal so that I can report my findings and if it helped me or not. The breathing exercises tend to help me when I am having a really bad panic attack and/or to calm down after I vomit due to Gastroparesis.


For more information about Cortisol, please check out this presentation from Pharmaphedia: https://www.youtube.com/watch?v=EFQS7e75vxc