Ulcers

My stomach is really hurting. It’s not upset in the digestive sense any more than it always is, and I’m not especially nauseous, though I do I have pervasive queasiness. Instead, it’s the insufferable, burning ulcer pain I used to have years ago. I’ve had two diagnosed peptic ulcers. The first was during my freshmen year of college at Duke. The gastroenterologist who diagnosed it attributed the damage to the prescribed 800mg of ibuprofen I was taking twice daily for a musculoskeletal injury. Non-steroidal anti-inflammatories (NSAIDs) have been shown to be highly damaging to the stomach lining, and the high dose I was taking for an extended period of time eroded a region of my stomach wall, which resulted in an ulcer. At this point of my life, I was not yet diagnosed with celiac disease, so I think all the gluten I was ingesting as part of my anorexia recovery refeeding was obliterating all my microvilli (as gluten does for those with the autoimmune disease), predisposing my digestive tract to injury and dysfunction.

The reason I think gluten was also a culprit that was partially responsible for the first ulcer was that the second ulcer was found via endoscopy, during which the widespread intestinal damage from the undiagnosed celiac became readily apparent. Duodenal biopsies confirmed these findings and I was officially diagnosed with celiac. This was several years after the first ulcer, when I was living in NYC and training for my first marathon.

After the terrible discomfort and scare from the first ulcer, I completely avoided NSAIDs, even when I had bad injuries or illnesses. I would only take acetaminophen on rare occasions because this analgesic doesn’t carry the same gastric risks. Accordingly, NSAIDs played zero role in the development of the second ulcer. That one was absolutely horrendous after eating and running. Both activities were guaranteed to invoke the fetal position, writhing, and moaning on the couch gripping my stomach without relief until sleep. I had more than a hunch that the foods I was eating (think lots of marathon-driven gluten-filled carbohydrates) were directly instigating the pain, but I didn’t want to believe it or have my suspicions confirmed because I didn’t want to give up my beloved foods. At least for me, when you have had such an extended, restrictive eating disorder, wherein you denied yourself so many foods and any food in ample quantities, the biological drive to consume these foods eventually becomes grossly exaggerated. This is part of the rebound effect that occurs during recovery. I starved myself for about eight years, so even though by the time I was living in NYC I was several years into my physical recovery, my psychological recovery was still incomplete. Eating disorders are psychological disorders that manifest in behavioral and physical symptoms. Pediatrician (or physicians, for adults) often consider the patient to be recovered from anorexia when normal body weight has been restored or when the patient has achieved what is considered for his or her body to be healthy. Diagnostically, I believe one of the criteria of anorexia nervosa is a body weight of at least 15% below what is determined to be healthy for that patient’s body size. Once the refeeding process has begun and the body hits this target, many patients are prematurely considered recovered or no longer anorexic. In my option, this is a disservice to the patient and a major oversight. The physical body may meet the criteria for healthy, but many patients still suffer with the psychological issues that are at the root of the disease. These can take years to resolve, as they did in my case. My relationship with food was distorted and unhealthy for about six years after my physical body was no longer starving. The psychological recovery can lag for quite some time unless the issues are directly addressed and worked through. I never received formal eating disorder treatment, despite the duration and severity of my illness. Perhaps this contributed to the extended lingering of the dysfunctional thinking and feeling.

This tangent serves only to point to the reason I avoided going to see a doctor about the ulcer pain, in hopes of delaying the inevitable dietary changes that the celiac diagnosis I had suspected for years would implicate. Eating was, at that point, one of my favorite pastimes and the risk of a medical professional “taking away” my coveted foods and, in a sense, controlling my diet (which was always the one thing I did and could control), was an unworkable notion for me. Or so I thought.

After a few months of the stabbing pains after eating, my stubbornness finally evaporated. I caved and went to be evaluated. Of course, the procedures revealed the dual diagnoses of another peptic ulcer and celiac disease. By this point, I was so burnt out on the excruciating pain that I readily and willingly complied with the prescribed diet, and I’ve diligently done so in the ten years since diagnosis. The ulcer healed within a couple months and the pain resolved.

I haven’t deliberately had gluten in ten years. A few times, I accidentally was contaminated with traces of gluten, but even these instances have been completely avoided for years. At home, we have designated gluten free preparation and eating areas, cooking appliances, and dishes. The risk of cross-contamination is essentially eliminated. Since that diagnosis a decade ago, the list of my other food allergies has grown tremendously, so we have to be meticulous at all times. It’s certainly a hassle, but the logistical challenges can’t hold a candle to the emotional impact of feeling excluded from regular social eating culture and deprived of foods I want. It even baffles me how self-imposing limitations when you have an eating disorder doesn’t feel like deprivation, yet mandated avoidance because of serious allergies does. I guess that’s part of the psychological disease aspect of anorexia: because you are controlling and implementing the rules, it doesn’t feel confining and upsetting. I never felt like I was missing out or wanted the foods I wasn’t eating. It’s a vicious sickness that I’m very proud to have fully beat. That said, perhaps I wouldn’t feel the sense of loss I do now when I can’t eat certain foods.

This brief dietary and gastrointestinal retrospective yields no clues as to the cause of the current ulcer pain. It’s only been evident for a week or so, but once you’ve had an ulcer, you only need the briefest and slightest of physical reminders to recall all too well the agonizing pain. I’ve been eating all my normal safe foods and rarely taking NSAIDs of any kind, especially lately. That said, clear culprit or not, the ramifications are ultimately the same: my stomach burns with a ravishing fire and I feel like crap. I couldn’t sleep last night because the discomfort was so substantial, and much of the afternoon was suffered through with gritted teeth and a forced smile, my genuine happiness compromised by the pain. I’ve buried my head and prayed for an acute bout of something transient, but at this point, it’s been close enough to a week to realize that fantastical alternative is not a reality. I need to aggressively pursue treatment, even if I hate medical appointments. I know how quickly these stomach issues can precipitate into something that takes a long time to treat. Why would I want to subject myself to extended suffering? It’s better to just push through the diagnostic hassle and discomfort of appointments so that I can more quickly get to the other side. So that’s now a project for tomorrow: schedule a GI appointment. It can often take weeks to get on the books, so there’s another reason to hop on it as soon as possible. And I’m already following my restrictive diet, so likely, I have less to lose!

 

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