The Specialist

I had my appointment with Dr. Sanjay Ramrhakiani today, who went over all of my tests and results with me. He was much more thorough and explanatory than my other doctor and I really appreciated his approach. Nothing was found in my blood tests or any of my previous tests, which means that it’s possibly just that my nerve endings near my pancreas are at a heightened sense of alertness and will identify even small amounts of pain or discomfort as severe pain back to the brain.

He doesn’t know what else could be wrong, as I tested negative for auto-immune pancreatitis and my enzyme levels for the pancreas were normal. Granted, I did get the blood work about a week after the rice incident, but he can tell for certain that I did not have any sort of pancreatitis flare-up.

He’s prescribed me a sort of anti-depressant to help reduce my brain’s pain response and has given instructions to taper down from the Dilaudid. He’s also suggested that I continue on a chicken broth diet for a few days, then branch out to other things, and hope to get to a soft food diet next week — when he can then remove the feeding tube.

Additionally (and this is the best news), the pancreatic scarring that he found is not caused from pancreatitis but is actually common in most adults that drink moderate amounts of alcohol. The scarring he said was normal and that he himself would probably have a similar looking pancreas.

I’m supposed to just start eating, starting with clear liquids and slowly move towards soft foods over the next week and then go from there.

I’m somewhat encouraged by the news, though I still have this fear in the back of my mind that there is something they’re missing. Either way, his priority is to get me off of the tube ASAP and that I’ve suffered through this enough. Hopefully, next week will be the week. We’ll see!

A Second Opinion

After a chaotic morning of having to truck down to Mountain View to get some blood work done for my pancreas specialist appointment on Monday, I had to come back up to San Francisco for my appointment with Dr. Tan at the Noe Valley clinic to get a second opinion on my pancreatic woes.

I reviewed my case with the doctor and went through my existing records and he felt that everything that could be done is being done — and that he’s in agreement with everyone else about my condition. He is not a pancreas specialist, but rather a naturopathic doctor that specializes in digestive and enzyme issues. Without a concrete diagnosis, he is unable to provide any necessary treatment.

He did, however, provide me with some ideas of what might be going on. For example, the fact that I still experience pain when I eat (mild pain for something like chicken broth, severe pain for something like rice) that my pancreas has not in fact healed. That there is still something wrong with it, which is likely why my GI doctor escalated my issue immediately when he heard that I had trouble eating rice and scheduled an emergency appointment with the pancreas specialist for Monday (rather than next Friday).

There are really only a few possible things that he believes could  still be causing the pancreas irritation, though each of these may have already been ruled out by a GI or Pancreas Specialist early on in the diagnosis.

These are:
1) A Obstruction in my pancreatic duct which is causing pain when any enzymes are secreted, especially enzymes for digestion.
2) Auto-immune Pancreatitis, whereby my body is attacking the pancreas because it thinks it’s a foreign object.
3) Cystic-Fibrosis, which can be ruled out  because I would’ve had this from the day I was born.

For a pancreatic obstruction, something like a gallstone still blocking the duct would’ve been visible on the endoscopic ultrasound, but there are sometimes obstructions caused by swelling and irritation of the pancreatic duct. Which basically constricts the duct in size and thus is painful when anything passes through it. This cannot typically be found through ultrasounds. This could be resolved with a surgical procedure to clear and clean the ducts.

The blood test I had this morning was to check my enzyme levels as well as a screening for auto-immune pancreatitis. If this is the case, it’s not a particularly good diagnosis as there is no clear treatment for this condition.

That said, he is eager to hear what the outcome of my appointment will be with the specialist on Monday and that his role will be much clearer once a clear diagnosis is made and he will be able to help with my recovery and rehabilitation. All in all, I felt the appointment was still productive, even though there is no clear outcome. He thinks seeing the specialist on Monday is the best idea and to update him as it goes.


A little bit of lactose

One thing that has been particularly frustrating with every gastroenterologist that I have seen throughout the last ten years of my life has been their lackadaisical approach to my very severe lactose intolerance. I discovered that I was lactose intolerant about 9 years ago when I found that I was having severe chest pains every night when I’d try to go to sleep — to the point that I felt that I was having a heart attack.

After talking with my doctor at the time, she suggested that I get an ECG test to check to see how healthy my heart was. Shortly thereafter I mentioned these symptoms to my mom, who explained that I was most likely lactose intolerant and to keep track of what I ate.

After doing a bit of testing, I found that even the slightest amount of lactose left me with severe stomach pains, cramping, and other common digestive problems that you would expect from someone who can’t digest milk. I’ve become so aware of my intolerance, that I can tell within minutes of eating something if it will bother me. Continue reading A little bit of lactose

The little things

I wanted to take just a minute to talk about climate change and just a few of the little things you can do to help reduce your carbon footprint. There are two tips in particular that I like, that are not only better for the environment, but also make your life a lot easier.

The first is pretty simple. Start replacing your standard incandescent light bulbs with the newer compact fluorescent (CFL) bulbs. These have significantly come down in price since the days when they were first introduced, and you can usually grab a four pack for about $6. Granted, it’s a wee more of an upfront cost than what you were paying for your traditional light bulbs, but think about how less frequent you’ll need to change those suckers? A typical light bulb lasts about 6 months or so, right? These incandescent bulbs last a lifetime of approximately 1500 hours. CFLs last for approximately 10,000 hours. That’s more than 6x longer! Meaning that instead of changing out a bulb every six months — you’ll do it once ever 3 years. This is especially important for those bulbs that are a pain in the ass to change. You know which ones, I’m talking about — the ones that you have to get the ladder out and bring a screwdriver to remove the light fixture. Swap those first! Save yourself the hassle.

So, that extra few dollars isn’t really going to waste. Not to mention the fact that these bulbs are more energy efficient and will significantly reduce your overall energy bill if you replace all of them. So, what’s not to love about them? The only downside, and it’s a minor inconvenience, is that you need to recycle these — they cannot be thrown away in the trash. Just save them up for when you need to run to the hardware store and bring ’em with you. Problem solved.

The second thing, which I always thought was so granola, is bring your own bags to the grocery stores. Here in California, nearly every grocery store sells these now for usually $0.99 and most of the time the store will credit you $0.05 for each time you bring in your own bags. So these will pay for themselves in less than 6 months, if you shop weekly.

What’s even nicer, though, is that these bags make it so much easier to carry groceries. You can fit so much more stuff into one fabric/hemp grocery bag than you can in one plastic or paper bag. Plus — they don’t break! Yesterday, coming back from my mini shopping run, they threw a gallon of apple juice into one bag plus rice, a few jars of baby food and some other goodies. With traditional grocery bags, the apple juice would’ve been not just one — but often two bags itself, to double bag it. I was really surprised at how much more efficient these bags are when shopping. So just throw them in your car and bring them with you when you go into the store. That’s the only hard part. But it’s worth it!

So, that’s just some of the small things you can do around the house to make an impact on the world around you. For more tips, check out this post from the Practical Environmentalist.

This message was brought to you as part of Blog Action Day.

The latest and greatest

I had my latest doctor’s appointment this morning, and it didn’t go nearly as planned. Going into it, I had expected one of two outcomes:
a) I’d be put on enzyme therapy, my feeding tube would be removed, and I’d be free to start eating food again.
b) I’d be put on enzyme therapy, my feeding tube would NOT be removed, but I’d have a follow-up appointment scheduled for another week or so if all goes well.

I wasn’t expecting a third possible outcome: none of the above. More specifically, or vaguely if you prefer, the outcome was:
c) I don’t know what’s wrong, but let’s just wait 2 more weeks and see if it goes away.

If this was the first time I’ve heard this, I’d be ok with it. Instead, I’ve heard this same line pretty much every time I’ve seen this doctor for the past two months. I probably could’ve had my endoscopy scheduled for a month ago and the same result mild scarring would’ve been found. At that point, waiting two weeks to see if I got better would be an acceptable and viable option. At this stage, however, I am not going to continue to just idly wait while nothing seems to be improving. Especially if the only thing wrong with me is that I have scar tissue on my pancreas that is causing the discomfort — when was the last time you saw a scar heal itself in two weeks?

Continue reading The latest and greatest

X.com

So, I happened to see an ad while on the Paypal / eBay site for a new project called “X.com,” which is briefly Paypal’s new payment mechanism that is in the works.

Once there was a day where X.com was actually something else (and get your mind out of the gutter). Back in 1998-2000, X.com was the very first online bank. They offered all of the same online banking services offered today (including a 1.25% interest rate on your checking account), but also reimbursed up to $30 in monthly ATM fees. They were great!

Then.. the bubble burst. X.com was bought up by Paypal and went under. I had to then open an account with US Trust, who then became Citizens, which I later swapped for Fleet who is now the behemoth Bank of America.

Where am I going with this story? Well, in short, I want to point out the closest thing to X.com today: The Charles Schwab High Interest Investor Checking account. I learned about this great account from the book I Will Teach You To Be Rich. The Schwab account offers ATM fee reimbursement and a high interest checking account.

While I’ve not hung up my B of A account just yet, I’m seriously considering this as a viable option once I get out of my 21st St Prison. In any event, this was purely intended as one of those “I-am-so-old-school-that-remember-when-x.com-was-actually-a-bank” posts and turned into a pitch for Schwab. Eh. Whatever. It’s the Diatribe. Things happen.

And the endoscopy says…

This past Wednesday, I trucked into El Camino Hospital to get an endoscopy to find out what the heck is going on down there in my pancreatic region. The procedure was quicker and more painless than I had remembered from the last time I had one of these (10+ years ago) and I’m scheduled for an appointment on Wednesday to discuss what the results mean.

Basically, they found that there is some permanent damage to my pancreas. This likely means some pretty dramatic lifestyle changes from here on out, which is to be expected. I think the biggest question that comes to mind, however, is how long I may have had pancreatic issues.

I’ve been struggling with digestive problems (lactose intolerance among other things) for over 10 years. I remember back in Boston just after I graduated college, that I had spent several months going to a gastroenterologist going through various tests (colonoscopies, endoscopies, barium swallows, and other fun things) to try to identify the cause of these issues.

Nothing was conclusive, and the doctor said it was likely just a bad case of GERD (acid reflux) and we’ve left it at that. The daily doses of Protonix have helped keep the stomach pain to a minimum over the years, but this case of pancreatitis very well may have been the last straw.

I’m obviously speculating here. What surprises me the most about this condition is that it’s most likely linked to alcohol. In my case, over the last 10 years, I rarely drank over the medical recommendation for alcohol drinks for a male (14 drinks/week). This does not necessarily mean that the alcohol could not have impacted this. If I had a pre-existing condition, even small amounts of alcohol may have made this worse. This in combination with my high cholesterol could very well have led to gallbladder issues and other digestive problems.

That said, regardless of what got me here — it looks like I’m going to be managing this condition for the rest of my life. I will most certainly know more once I talk to the doctor on Wednesday. I’m just hoping for some kind of path to short term resolution of the immediate symptoms (ie. NOT EATING) and being able to get back to work and my life. I miss being around people and this entire situation is wearing on my patience.

Nonsense makes you smarter?!

See, this is what I missed about the Google ‘ole diatribe. The ability to find a crazy ridiculous article and post a few good thoughts about it!

Ahh, it’s good to be back.

In case you missed it (and if you’ve seen my Facebook recently, you probably didn’t), there was a great article in Today’s NY Times about how Nonsense can actually make you more intelligent. I think this is extraordinary!

Being a gigantic fan of the absurd (and I’m sure my fellow diatribe cohorts would agree), I’m happy to learn that my absurdity (and the absurdity of my friends) is actually improving society at large. The next time I’m at a pizza joint, and I convince a guy to order a specific meat topping (just for the heck of it) or use olives for what they’re really intended for, I will know deep down, that I am helping out the human race.

So, the article talks about how after witnessing absurd behavior (or reading an absurd story in this case), people were more apt to identify patterns in chaos than those people who read a more traditional story.

In the most recent paper, published last month, Dr. Proulx and Dr. Heine described having 20 college students read an absurd short story based on “The Country Doctor,” by Franz Kafka. The doctor of the title has to make a house call on a boy with a terrible toothache. He makes the journey and finds that the boy has no teeth at all. The horses who have pulled his carriage begin to act up; the boy’s family becomes annoyed; then the doctor discovers the boy has teeth after all. And so on. The story is urgent, vivid and nonsensical — Kafkaesque.

After the story, the students studied a series of 45 strings of 6 to 9 letters, like “X, M, X, R, T, V.” They later took a test on the letter strings, choosing those they thought they had seen before from a list of 60 such strings. In fact the letters were related, in a very subtle way, with some more likely to appear before or after others….

But perform they did. They chose about 30 percent more of the letter strings, and were almost twice as accurate in their choices, than a comparison group of 20 students who had read a different short story, a coherent one.

I can definitely agree with this. I’m constantly looking for patterns in all sorts of stuff. Patterns on the wall. Patterns of a row of bikes. You name it! Maybe you do too, I don’t know.. I don’t live in your brain, but considering my general nonsense mindset — I think there’s something there.

So, you heard it here, folks.. now, go stand backwards in an elevator and make some people smarter.

Update: To prove my point, this post was filed in a category known as “Nonsense.” A category of which, this now becomes the 69th post (get your mind out of the gutter). The nonsense category is also the most posted category, followed closely by the Internet. But I mean, c’mon… where would The Diatribe be without these two things? I rest my case.

What I’ve been up to..

It’s been quite a while since I’ve come ’round these parts. It’s been a hectic couple of months, for those of you that know me well.

The Design
The look of The Diatribe was driving me nuts. It didn’t feel right. I needed to revert it to a more blog-like style. I figured this was a little more appropriate. Considering the lack of authorship from my cohorts, I’ve also personalized it a little more for your truly. I’m not kicking anyone out of The Diatribe, just personalizing it, considering I have more than 3/4 of the posts on here. 🙂

Where am I
I moved up to the Big City a few months ago. It was partially this move that probably prompted my downfall, but I’ve taken up residence in the Noe Valley neighborhood of San Francisco — which is right about here (and no, that’s not my house):

View Larger Map

My Health
Over the past two months, I’ve been battling a terrible case of pancreatitis that was brought on most likely by a gallstone. I spent 2.5 weeks in the hospital (two of them, actually) and the rest of the time I’ve spent resting in bed and on the couch laying down. In my most recent doctor’s visit, I found out that I was no longer suffering symptoms caused from my pancreas, but it’s most likely that the gallstone that caused this little issue is now in some inappropriate place in my innards, causing the pain and discomfort.

I’ve been on a lovely feeding tube for the past 2+ months, and would die for some pizza, chicken wings or pad thai. Regardless, I have a procedure scheduled for this Wednesday to find that little bugger and then I should know more about my return to normalcy.

Conclusion
So, for the most part, I won’t be updating the Diatribe that regularly. It’s more of a place to put some thoughts or commentary that is longer than 140 characters. So, stay tuned.. but don’t expect a flood of new bathroom reading material to crop up here. We’ll take it in stride. 🙂