flwyd: (Trevor over shoulder double face)
[personal profile] flwyd
This is an incomplete post that I started on June 28th. I was going to finish it on the 29th, but ended up going to the ER after a day of vomiting and dehydration. At my GI appointment that Friday, "Stop taking NSAIDs" was the key suggestion and the vomiting issue subsided.

Organizing my thoughts for a gastroenterology appointment on Friday, here's what's been going on with my esophagus and stomach lately.

Non-acid Reflux
For all of 2015 (starting either after oral surgery for wisdom teeth or a bad night of vomiting), my main health problem was acid reflux. Sometimes it would cause me to wake up in the middle of the night with heartburn. Other times, it would make it difficult to eat because of acid bubbling up the throat during a meal. I needed to carry ginger candies around in case I got a sudden acidic discomfort while sitting around.

In late January I was diagnosed with psoriatic arthritis, an autoimmune inflammatory condition. I tried a bunch of anti-inflammatory things, including cutting out gluten, drinking lots of home-made chai (largely for the ginger and turmeric), and took occasional meloxicam (an NSAID) when feeling achy. I'd already started feeling better when I got the diagnosis, since I'd had a couple weeks of steroids fixing my acute eye problem, and by mid-February I was feeling fairly good as we left for Hawaii.

I reintroduced a mild amount of gluten in Hawaii, figuring the experience would be more fun if I enjoyed some saimin noodles and a brewery. About half way through the trip, I felt like I was fighting a mild sickness. (When traveling outside the continental U.S., it seems I almost always get sick at the half-way point, no matter how long the trip is.) That night, I had the worst night of acid reflux since the problem began; totally unresponsive to ginger and so intense I didn't sleep all night. Around 3am, I took a famotidine (an H2 antagonist), and took one or two a day for the next three days or so. During that period, the feeling of acid basically went away, though swallowing was often still difficult.

Since returning, I've had almost no acid or heartburn (except, ironically, during a physical exam at the doctor's office). I'm still not sure why it would have come to such a crescendo and then suddenly disappeared. It also seems unlikely that a total of three or five H2-blockers would clear an acid issue for four months. Maybe I picked up a bacterial colony on the Road to Hana, they fought it out with some acid-encouraging bacteria, and the invaders won?

Unfortunately, while the acid reflux has stopped, reflux has still been a recurrent issue. I'll often, usually during a meal, have an overwhelming upwelling of mucus, which I have to eject from my esophagus (in a half-spit, half-vomit maneuver that's no fun but that is no longer frightening). After a big mucus reflux episode, I generally have trouble swallowing new food for an extended period. I even have trouble ingesting water, which generally produces a sensation of overflow (like it can't get out of the esophagus) and quickly triggers a new bout of vomiting. This experience ebbed and waned in intensity and frequency over the last four months. It was particularly bad in mid-June, before, during, and after my trip to the annual Apogea event (possibly made worse by a body adjustment the day before the trip).

On Friday of the event I was hard-pressed to eat something as soft, moist, and easily-chewed as spam. The difficulty drinking water after an episode made me worry that I would get dehydrated, not because I ran around in the heat without paying attention to my body's needs, but because I could not physically consume the bottle of water at my side. I was fortunately able to get some salt and protein from a bag of bean chips. And then a few hours later, I came upon the remains of a potluck in a camp with good music playing. I found that I could eat a slice of apple and then a second one. Eyeing what I thought was cold cut turkey, I grabbed what turned out to be injira (the spongy Ethiopian bread) and man was it fulfilling when I could swallow that set of morsels. Interestingly enough, even though my GI system was largely nonfunctional during the event, my musculoskeletal system was doing great: I had no problem dancing.

A Tough Ill to Swallow
With the acid reflux replaced by mucus reflux, it's a lot easier to tune into the bodily sensations of the problem in a more precise way than "my whole throat is burning and my stomach feels weird." Sometimes it feels like the problem is mostly in my stomach: there's a bunch of goo at the top, so after I've eaten several bites, new food can't come in. But when the major problems subside, I still often have trouble swallowing. I've been eating slowly for the last year (more so than usual), and these days it can take me a few hours to finish a meal. Fortunately, I have a job where I can eat lunch outside for an hour and then take a plate back to my desk and take a bite now and then until I leave, five or six hours later. This slow-food approach makes eating at restaurants difficult, though; particularly if I need to suddenly eject things from my esophagus while half-way through a steak.

A few stimuli seem more likely to induce swallowing issues (dyspepsia). Dry foods, particularly the gluten-free ginger snaps I got to replace my glutenous camping staple peanut butter delivery mechanism. Corn chips and somewhat dry grains sometimes cause an issue as well. Leafy greens, particularly with dressing or oil. There's something pathetic about not being able to eat a small piece of lettuce or kale. Simple meat; I've had to give up multiple times on steak or bunless hamburgers. Spices, and not limited to capsicum. I've had difficulty swallowing everything from fish with wasabi to sausage and seasoned meat to food flavored with peppercorn to chai with cloves.

I haven't started a food journal yet ('cause that's a lot of bookkeeping), so I don't have any multi-day regression analyses yet, but I haven't found any foods which I always have trouble swallowing (except those darn ginger snaps). Someone asked me what foods I can handle; I responded "On a good day, anything. On a bad day, nothing."

A couple indirect theories worth exploring:
• As part of the psoriatic arthritis diagnosis, I learned that my spine has been fusing with calcium. I've noticed that I've got a definite back curve or slouch while standing, and my height has been decreasing slowly over the last several years. Perhaps the curvature is pushing my esophagus into my stomach, or my hardening spine is pushing from behind.
• Kelly has theorized that my vagus nerve, responsible for the heart, lungs, and digestive tract, might be having issues. This theory is strengthened by the fact that I've had a few fainting episodes in the last few years (including one around the time of acid onset), but it needs further exploration with a GI expert.

This is where the outline continues but details stop, in favor of getting some sleep.

Bowel Movement and Stagnation

Grain proteins

Legal drugs
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