Sphincter of Oddi Dysfunction

The Gallbladder: An Essential Organ Influenced by Hormones

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I was told I did not need my gallbladder – that it was a nonessential organ. Hearing that from a surgeon convinced me to have it removed to rid me of abdominal discomfort and nausea. An ultrasound showed some gallstones, but no other reason for removing the organ was presented to me. I was 29 years old and not a savvy patient like I am today. I didn’t ask questions or seek alternative treatments or a second opinion. I was a working mom with no time to be sick. “Just take it out,” I said.

That “non-essential” organ proved to be very essential for my body. Immediately following the procedure and for the next 14 years, I suffered from severe pain in my right side, nausea, and a multitude of other disabling symptoms. I was eventually diagnosed with Sphincter of Oddi Dysfunction (SOD), a condition where estimates of 75-98% of sufferers are women. The majority become afflicted after their gallbladder has been removed.  As such, many of us with SOD regret having had this operation.

What Does the Gallbladder Do?

The gallbladder is a small organ that stores the bile produced by the liver. After a fatty meal, the body releases a hormone known as CCK that signals the gallbladder to release bile. Then the bile flows down the bile duct into the small intestine to emulsify and digest fats. The liver, where the bile is produced, also uses bile and the gallbladder to remove toxins from the environment, food, and other wastes. The bile stored and delivered by the gallbladder is different from the bile created and secreted by the liver. Bile in the gallbladder is more concentrated due to its removal of some water and electrolytes.

Gallbladder Removal (aka Cholecystectomy)

Over half a million people in the United States have their gallbladders removed every year. Clearly, it is a booming business. The common reasons for cholecystectomy are:

  • Gallstones (cholelithiasis)
  • Infected or inflamed gallbladder (cholecystitis)
  • Non-functioning or under-functioning gallbladder
  • Blocked bile ducts (ex. sludge or scarring)
  • Cancer and congenital defects (less common)

As you can see in some cases it is in the best interest of the patient to undergo cholecystectomy. However, some develop secondary symptoms that are worse than their original gallbladder symptoms.

Postcholecystectomy Syndrome—Symptoms to Consider

New symptoms may arise following a cholecystectomy. This is known as a postcholecystectomy syndrome (PCS). It is estimated that 10-20% of cholecystectomy patients develop PCS.  Without the function of the gallbladder in place, some of the problems patients experience range from annoying to life-threatening, ex. abdominal pain, bile diarrhea, bile reflux, gastritis, IBS, pancreatitis, liver disease, and what I have–SOD—where the pancreatic and biliary valves do not open and close properly. At the time of this writing, an excellent overview of the various PCS complications and more information about PCS can be found in the Medscape article, “Postcholecystectomy Syndrome.”

The Gallbladder and Hormone Connection

According to Johns Hopkins Medicine, the prevalence of gallstones is higher in women than men. Female sex hormones adversely influence bile secretion from the liver and gallbladder function. Estrogens increase biliary cholesterol saturation (the main ingredient for gallstones) and diminish bile salt secretion, while increased progesterone may lead to inhibition of the contraction of the gallbladder, reducing bile salt secretion and impairing gallbladder emptying. Due to fluctuating hormones women experience during pregnancy, it is not uncommon for women to develop gallstones during this time or shortly thereafter.

Alternatives to Cholecystectomy or “I Wish I Knew Then What I Know Now”

You can prevent gallbladder problems in many ways. Eat a diet low in saturated fats and sugars. Avoid crash diets. Try to eat whole foods rather than processed products with multiple ingredients (especially those with ingredients you can’t pronounce). Exercise. If you are on birth control or hormone replacement therapy, talk with your doctor about the effects they may have on your gallbladder. If they are unsure, your neighborhood pharmacist may be helpful or ask for a referral to someone who may be able to help answer your questions.

If you already have gallbladder issues, here are some alternatives to cholecystectomy to consider:

  • Endoscopic Retrograde Cholangiopancreatography (ERCP): a non-surgical procedure used to remove stones, sludge, treat SOD, place stents or apply balloon dilatation to widen the bile duct, and use special X-rays for diagnostic purposes.
  • Extracorporeal Shock Wave Lithotripsy (ESWL): uses high-frequency sound waves to shatter cholesterol gallstones into pieces small enough to pass through the bile ducts into the intestines.
  • Ursodiol: a medication that suppresses cholesterol production in the liver, reducing the amount of cholesterol in bile.
  • For women: seek out a functional MD or naturopath to get your hormones in check naturally.
  • Supplements and Herbs: I recommend only taking these under the care of a naturopath, herbalist, traditional Chinese medicine practitioner, or other alternative healthcare providers knowledgeable in the benefits and side effects of such medicinals.

Be leery of Internet claims to cure your gallbladder issues. For example, I did not list gallbladder flushes as for some people, these can be very dangerous.

Gallbladder symptoms can be quite disabling and prompt anyone to run to an operating room table for relief.  If your symptoms are tolerable, try alternative therapies and talk with your doctor about ERCP, ESWL, and Ursodiol as alternatives. However, if your well-being and life depend on having your gallbladder removed, take what your doctor says very seriously.

Image: Laboratoires Servier, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

This article was published previously on Hormones Matter in March of 2015.

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Problems after Gallbladder Removal: Postcholecystectomy Syndrome

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Gallbladder removal problems

Obviously, you can survive without a gallbladder. Otherwise, gallbladder removal (cholecystectomy) would not be such a common surgery. In fact, over 600,000 people in the U.S. have their gallbladders removed yearly. However, surviving without an organ and living a healthy life without it are two very different things.

Following a cholecystectomy, you are more prone to developing certain health problems. For example, you are at greater risk of developing a fatty liver, diarrhea, constipation, biliary issues, indigestion and developing deficiencies of essential fatty acids and fat soluble nutrients. Bile, which is necessary for digesting fats and proteins and metabolizing fat soluble vitamins and minerals, is no longer stored and concentrated in the gallbladder. This can lead to unpleasant symptoms.

When your body is void of a gallbladder, bile freely flows from the liver to the bile duct, exiting through the sphincter of Oddi into the duodenum (the first part of the small intestine). The high-water content of bile is no longer removed and overly concentrated bile is not conjugated in the gallbladder.

Change in bile chemistry isn’t the only thing that occurs after cholecystectomy. Surgeries are never perfect and fool-proof. Therefore, human error can bring about injury to the ducts. Adhesions (scar tissue) can form following surgery and some people are more prone to developing them. A remnant cystic duct (the duct that once connected the gallbladder to the common bile duct) may cause problems. Also, dramatic changes may occur within the liver itself due to the absence of a gallbladder.

Any health issues or symptoms arising because of gallbladder removal is called postcholecystectomy syndrome.  Postcholecystectomy syndrome describes the appearance of symptoms after cholecystectomy. It is widely estimated 10-15% of the population experience some form of postcholecystectomy syndrome, but Merck Manual estimates anywhere from 5-40% of cholecystectomy patients are afflicted. Isn’t it interesting that a seemingly disposable organ could wreak such havoc on our bodies once it is removed?

The most common causes of postcholecystectomy syndrome relate to the change in bile flow and concentration, complications from surgery (i.e. adhesions, cystic duct remnant, common duct injury), retained gallstones or microscopic gallstones (biliary sludge), effect on sphincter of Oddi function, and excessive bile that is malabsorbed in the intestines. Jensen, et al described in their research paper, Postcholecystectomy Syndrome, over 60 different etiologies of postcholecystectomy syndrome.

Diagnosing Postcholecystectomy Syndrome

If you are experiencing troubling symptoms following a cholecystectomy, talk to your gastroenterologist or primary care doctor. He/she will likely order blood work, specifically liver function tests. In addition, you may want to ask that your vitamin and pancreatic enzyme levels be tested, since bile is required to metabolize fat soluble vitamins like vitamins A, D, E and K; and some postcholecystectomy issues affect pancreatic enzyme output.

Depending on the results of your bloodwork, your doctor may order an imaging study (x-ray, ultrasound, MRI, or CT scan), a functional test (gastric emptying study or small bowel follow-through) or a procedural test (endoscopy, colonoscopy, barium enema). If these tests are inconclusive, your doctor may want to conduct a more in-depth procedural test like an endoscopic ultrasound or Endoscopic Retrograde Cholangiopancreatography (ERCP) to get a better look at the ducts, liver, and pancreas. In rare cases, your doctor may recommend exploratory surgery.

There are also alternative tests a naturopath or functional medicine practitioner could offer, i.e. comprehensive stool analysis, or hormone and nutritional tests. Keep in mind that for some postcholecystectomy patients, the answers to your symptoms may not be revealed in typical bloodwork, scans, or procedures. Tests are not fool-proof for all patients. Many patients have disabling symptoms and their bloodwork and scans are normal. “Normal” test results can come as a relief. However, when you do not get an answer to your woes, it can be quite frustrating. This does not mean, though, you can’t treat your symptoms.

Treating Postcholecystectomy Syndrome

The most common postcholecystectomy issue is bile acid diarrhea. Because bile is being dumped and no longer processed, the intestines receive an excess of bile or bile that is difficult to reabsorb. This may cause moderate to severe diarrhea in some people, especially after eating.

Ask your gastroenterologist or primary care doctor about prescribing cholestyramine, a bile acid binder. It will bind the bile acids and, in most cases, reduce this form of diarrhea. Always pay attention to side effects like constipation, bloating, or flatulence to gauge how much cholestyramine is appropriate for your individual situation. If the cause of your diarrhea originates from bile, cholestyramine will likely help you. If the cause of your diarrhea is from irritable bowel syndrome (IBS) or another cause, this therapy will not be effective. For other forms of diarrhea, you may need an IBS-specific medication or natural therapy.

Another postcholecystectomy issue, mostly affecting women, is Sphincter of Oddi Dysfunction (SOD). SOD symptoms are upper right quadrant pain, nausea/vomiting, bowel, and other issues. For more information on this condition, read my article, Sphincter of Oddi Dysfunction, or go to the SOD Awareness and Eduction Network website. In addition, I published The Sphincter of Oddi Dysfunction Survival Guide this past summer.

Microscopic gallstones and biliary sludge can cause problems too, but is difficult to diagnose unless you have an ERCP. If you have constipation, upper right quadrant pain, and nausea, you may have biliary sludge. If you and your doctor suspect this, he may want to prescribe ursodeoxycholic acid, which reduces the cholesterol content in bile. Alternatively, an ERCP can clean out the duct.

Consult with a natural health practitioner if you’d rather go the holistic route. He/she can prescribe the essential fatty acids Omega 3 and 6 (bile is needed to convert these fatty acids), digestive enzymes, a bile replacement supplement, homeopathic remedies, and/or herbs (ex. dandelion, milk thistle, turmeric, peppermint, and bitters). In addition, chiropractic, acupuncture and Chinese medicine, and other natural therapies have helped people with postcholecystectomy syndrome.

General Diet and Lifestyle Remedies

After I had my gallbladder removed, I had to change my eating habits to avoid unpleasant symptoms. Overeating spelled disaster for my strained liver, pancreas, and ducts. It is best to try to eat several small meals a day or eat smaller portions at breakfast, lunch, and dinner. Going too long without eating is also bad as our bodies signal bile to be released at certain times of the day. Not eating can lead to bile acid diarrhea and intestinal discomfort.

Don’t eat fast. Instead, chew your food thoroughly and take your time.  This will benefit your entire digestive tract and organs so they don’t have to work as hard.  Your digestive system starts in your mouth where enzymes are released to start the digestion process.  Taking the time to allow these enzymes to mix with your food is essential for proper and thorough digestion.

Eat a low-fat diet. This does not mean you should avoid all fats. Instead, be mindful of the amount of fat grams you ingest, especially saturated fats. The Mayo Clinic recommends keeping fat intake under 3 grams per meal and snack. Greasy, fried food may no longer be your friend. It is wise to hold off on re-introducing fatty foods high in saturated fats.  If you don’t, you may experience pain, gas, or diarrhea. Some of the worst offenders, besides fried foods, are cheese, fatty luncheon meats or sausages, hot dogs, fatty pieces of steak, dark meat portions of poultry, butter, and all oils except medium-chain triglycerides (MCT) oils. MCT oils, i.e. coconut and palm kernel oil, do not require bile for digestion.

The juice of certain vegetables can do wonders for the liver and biliary system. Beets, apples, and ginger all support bile formation. Beets are probably the best vegetable for your liver as they contain important liver healing substances, including betaine, betalains, fiber, iron, betacyanin, folate, and betanin.

Betaine is the substance that encourages the liver cells to get rid of toxins. Additionally, betaine acts to defend the liver and bile ducts, which are important if the liver is to function properly. Additionally, beets have been linked to the healing of the liver, a decrease in homocysteine, an improvement in stomach acid production, prevention of the formation of free-radicals in LDL, and the prevention of lung, liver, skin, spleen, and colon cancer.

Apples contain malic acid which helps to open the bile ducts that run through your liver and reportedly soften and release the stones.  Apples are also high in pectin.  Ginger is reported to increase gut motility and bile production.  You can add ginger to food dishes or eat it raw.  I prefer to juice ginger and drink a small amount of the extract.  The extract can also be added to juiced fruits and vegetables.  Be careful, though, as it is spicy and pungent.  You only need a small amount.

Other foods reported to protect the liver and increase bile production are bitter foods such as dandelion and mustard greens, radishes, artichokes, fruits high in vitamin c, and cruciferous vegetables such as broccoli, cauliflower, and cabbage.

Stay tuned for my next book, Living Well Without a Gallbladder: A Guide to Postcholecystectomy Syndrome, which will be published Summer 2017.

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This article was published originally on January 30, 2017.

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The Importance of Stomach Acid: Why Antacids Could Make You Sick

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Stomach acid is a necessary and vital part of digestion. Yet, stomach acid has become enemy number one in the United States. We are a nation reliant on our proton pump inhibitors (PPI), acid reducers and antacids. Many think they cannot live without these medications but many of the symptoms of low stomach acid actually mimic those of excessive acid or Gastroesophageal Reflux Disease (GERD). A very common misunderstanding is if you have GERD/acid reflux, you have too much stomach acid. Quite the opposite is true. Low stomach acid will cause the lower esophageal sphincter to remain open, causing stomach acid and contents to reflux into the esophagus.

Jonathan Wright, MD of the Tahoma Clinic in Washington state and author of Why Stomach Acid is Good For You has conducted 25 years of stomach acid testing on a variety of test subjects. Time and again patients suffering from heartburn and GERD almost always had low, not high, stomach acid. He found very few people with excess stomach acid and was found only in a few rare conditions like Zollinger-Ellison syndrome. GERD was hardly ever associated with too much stomach acid.

Though the most common treatment for GERD is a prescription for some sort of acid-reducing medication, it is well accepted in the literature that GERD is caused by an increase in intra-abdominal pressure (IAP). Acid reflux occurs when pressure causes stomach bloat, pushing stomach contents, including acid, through the LES into the esophagus. What may cause this, besides low stomach acid, is overeating, obesity, bending over after eating, lying down after eating, and consuming spicy or fatty foods.

9 Reasons Why Stomach Acid is Important

  1. Kills harmful bacteria and viruses. We pick up viruses and bacteria from our hands, utensils, food, beverages, kissing, etc. Our stomach acts as a gatekeeper for a healthy immune system when our stomach acid kills these buggers. Unlike every other part of our body, a healthy stomach is sterile because the acidic pH kills foreign invaders. Many infections, like c diff and h pylori, can be the result of low stomach acid.
  2. Prevents small intestinal bacterial overgrowth (SIBO). Stomach acid that makes it to the duodenum (the first part of the small intestine) will help combat bacteria that has transiently found itself in the small intestine, either from the large intestine or the stomach. Bacteria does not belong in the top portion of the small intestine and an overgrowth can cause horrible symptoms.
  3. Activates the digestive enzymes, pepsin, necessary for digesting protein. Without it you may end up with amino acid deficiencies.
  4. Signals the pancreas to release the enzymes amylase, protease, and lipase. These enzymes are critical to break down proteins, fats, and carbohydrates. Carbohydrate malabsorption can cause excessive gas and contribute to SIBO.
  5. Triggers motility in the small intestine. Small intestine motility is needed to move food along. Slow motility of the small intestine can contribute to SIBO and cause pain.
  6. Is crucial for the absorption of micronutrients. Calcium, magnesium, iron, folate and vitamin B12 depend upon stomach acid for proper absorption. Stomach acid is essential for the breakdown and absorption of these nutrients. Low stomach acid has been linked to iron anemia, b12 pernicious anemia, osteoporosis, and magnesium deficiency.
  7. Reduces food to small particles for easier digestion in the small intestines. When food is not chewed properly or broken down by stomach acid, large particles have been linked to leaky gut syndrome and even celiac disease.
  8. Can prevent gastroparesis (slow gut motility). Stomach acid “turns on” the lower pyloric valve to release food into the small intestine. Low stomach acid will cause food to stay in the stomach longer.
  9. Triggers sphincter of Oddi motility. The sphincter of Oddi is a muscular valve area between the duodenum and the biliary and panacreatic ducts. It is the gatekeeper for the flow of bile and pancreatic enzymes. Studies have shown stomach acid triggers this sphincter to open and close properly. Low stomach acid may very well contribute to a painful disorder called sphincter of Oddi dysfunction (SOD).

Even though all of this is true, doctors rush to overprescribe drugs to reduce stomach acid. I blame the pharmaceutical industry. Doctors these days are putting way too much trust in what their drug reps are selling them instead of facts from a functional medicine/whole body approach. Worse is drug reps will only tell one side of the story, rarely rattling off the numerous and potentially life threatening side effects. Keep in mind the “cure” for low stomach acid is not found on a prescription pad.

Before I was diagnosed with SOD and chronic pancreatitis, it seemed every time I went to a gastroenterologist they would prescribe an acid reducing drug, though there was no proof my problem was from excessive stomach acid. Low stomach acid is rarely tested by gastroenterologists, certainly none of mine offered such testing. The SOD caused me to alternate with excessive bile and a shortage of bile. I also would get bile reflux into the stomach. Bile acid is actually more neutral in ph than acidic. Therefore, bile will neutralize stomach acid. I always felt worse when I’d take an acid reducer so one day I read about low stomach acid and started on a regimen to increase my stomach acid. The results have been miraculous. I feel better, have gained back much-needed weight and muscle, and bloodwork for nutrients has improved.

Three Types of Acid-Reducing Medications

Not all antacids are the same. Here is a breakdown of the three types of antacids:

  1. Proton pump inhibitors (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach. Examples: Omeprazole (Prilosec and Zegerid), Esomeprazole (Nexium), Lansoprazole (Prevacid), Rabeprazole (AcipHex), Pantoprazole (Protonix), and Dexlansoprazole (Dexilant).
  2. H2 blockers are medicines that work by reducing the amount of stomach acid secreted by glands in the lining of your stomach. Examples: Famotidine (Pepcid), Cimetidine (Tagamet), Ranitidine (Zantac), and Nizatidine (Axid).
  3. Antacids are agents that neutralize the gastric acid and raise the gastric pH. Examples: sodium bicarbonate, calcium bicarbonate, aluminum hydroxide, magnesium hydroxide, and Sucralfate (Carafate).

Dangers of Acid-Reducing Medications

PPIs are by far getting the worst press lately. Studies show PPIs have been linked to many chronic and deadly health conditions, including: dementia and Alzheimer’s disease, increased heart attack risk, increased pneumonia risk, weakening of the immune system, weight gain, and the hundreds of ailments linked to the reduction of the absorption of important nutrients, vitamins and minerals. Just one of these pills is capable of reducing stomach acid secretion by 90 to 95 percent. Taking high and frequent doses of PPIs, which most doctors recommend, causes a state of achlorydia (no stomach acid). Chronic use of PPIs has been shown to decrease extracellular concentration of adenosine, resulting in an increase in inflammation in the digestive tract which can exacerbate Crohn’s disease and ulcerative colitis.

It isn’t just PPIs that cause health problems, any of the other drugs reducing stomach acid are suspect. Many people who take antacids not only suffer from more chronic health problems than the average person, but they never actually cure their acid reflux in the process. Without making the proper dietary changes necessary to balance stomach acid, those who take antacids consistently, and for long periods of time, will progressively become more and more unhealthy. In particular, stomach acid can cause atrophic gastritis which can lead to serious disorders like stomach cancer.

Stopping the Vicious Cycle of Low Stomach Acid

Relying on acid-reducing medication causes a vicious cycle of constantly needing to neutralize symptoms, which in turn creates a low stomach acid environment, which in turn causes the LES to stay open and pyloric valve to spasm shut. This equates to more and more reflux and more and more antacids. The best thing to do is stop the cycle!

First: Get Proper Testing

The gold standard medical test for low stomach acid is the Heidelberg Stomach Acid Test. You will have to swallow a radio transmitter in the form of a pill. Then you will drink a solution of sodium bicarbonate (baking soda). The transmitter will record the ph levels of your stomach as long as it stays in your stomach. At the end of the test, a graph will show your response to the baking soda solution. In my opinion, this test should be the first test conducted before an endoscopy or prescribing an acid-reducing medication. An endoscopy does not accurately gauge stomach acid ph but many doctors prescribe medications to lower stomach acid based on physiological findings that may or may not be due to excessive stomach acid—most cases not!

There are two at-home tests for stomach acid. The first is the Baking Soda test. Mix 1/4 teaspoon of baking soda in a small cup of cold water first thing in the morning before eating or drinking anything.

After drinking the solution, time how long it takes you to belch. If your stomach is producing adequate amounts of stomach acid you’ll likely belch within two to three minutes. Early and repeated burping may be due to excessive stomach acid unless it is the light burps from swallowing a little air. Any belching after 3 minutes indicates a low acid level. This test isn’t foolproof but may be a good indicator to ask for the Heidelberg test or to try the second at-home test.

The second at-home test is the Betaine HCL test. Buy some Betaine HCL with pepsin (I like Country Life brand). Eat a high protein meal of at least 6 ounces of meat or meat alternative (this is very important or the test will not be accurate). In the middle of the meal take 1 Betaine HCL pill. Finish your meal as normal and pay attention to your body. Either you won’t notice anything, which means you likely have low stomach acid levels. Alternatively, you may at some point within the next hour or two feel some stomach distress like heaviness, burning, or hotness. These are signs you likely have enough stomach acid. If you do get some burning, don’t worry as it will pass in about an hour. You can also mix up a ½ teaspoon of baking soda and drink it to help stop the discomfort. Do NOT do this test if you take NSAIDs or Corticosteroids as they increase the chances of stomach ulcers when taken with betaine hcl. Consult a physician before trying this test or supplementing with anything. Obviously this test, like the baking soda test, is not foolproof so I recommend repeating the test a few times.

Second: Consider Treating Naturally

The only time I had heartburn was when I was pregnant. It was terribly painful and I thanked God every minute for acid reducers. I don’t know what I would have done without them. Honestly, I needed that medication periodically during that time in my life. However, I haven’t needed them any other time. That being said, I am NOT advocating for anyone reading this to go off their meds. Always discuss medication changes with your doctors. My experience was that mainstream doctors were close-minded to the discussion of low stomach acid or of natural remedies. I got more help from a naturopath and functional medicine practitioner. I suggest seeking a consult with one of these practitioners but do try to discuss your concerns with your doctors.

There are several ways to go about treating low stomach acid. They are all easy and cheap.

  • My therapy of choice is taking one 600 mg. Betaine HCL with pepsin pill with every protein meal. Some people need more but I seem to do ok with just one. You will know when you reached your threshold when the amount of pills causes some burning.
  • Drink an apple cider vinegar (ACV) solution of 1 or 2 teaspoons of ACV with a small glass of water with each meal. Alternatively, you could drink some pickle juice or kombucha tea—a fermented probiotic drink.
  • Consume a small amount of bitters with each meal. Bitters send a signal to your stomach to produce acid.
  • Develop better food hygiene. Eat a healthy, whole foods, clean diet. Don’t overeat. Just because the restaurant gives you a huge plate of food doesn’t mean you have to eat it all. Save some leftovers. Chew food thoroughly. Some say to chew 32 times and count as you chew to make sure you are doing it.
  • Avoid lying down after eating and relax upright.
  • Don’t bend over after eating.
  • Purchase a bed wedge. I found mine on Amazon and it has an elevation of 12”. You can find all different shapes and sizes. I recommend buying one with a washable cover.

Begin balancing your stomach’s acidity level will take time but will pay off with optimal wellness in the end!

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Sources

Benson, J. (2012) Avoid the dangers of proton pump inhibitors (PPIs) and treat your acid reflux naturally. Natural News. http://www.naturalnews.com/036336_PPIs_acid_reflux_side_effects.html

Carstensen, M. (May 11, 2016). The Link between Heartburn Drugs and Dementia. New York Post. http://nypost.com/2016/05/11/the-link-between-heartburn-drugs-and-dementia/

Huaqing Ye, J. and Rajendran, V. Adenosine (2009). An immune modulator of inflammatory bowel diseases. World Journal of Gastroenterology. 15(36): 4491–4498. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751993/?tool=pubmed

Johnson, D. and Oldfield, E. (2013). Reported Side Effects and Complications of Long-term Proton Pump Inhibitor Use. Clinical Gastroenterology Hepatology.11(5):458-464. http://www.medscape.com/viewarticle/804146.

Wright, S. 3 Tests for Low Stomach Acid. SCD Lifestyle Website. http://scdlifestyle.com/2012/03/3-tests-for-low-stomach-acid/

This article is for informational purposes only. It is not intended to diagnose, treat, cure, or prevent any disease. Please discuss all medication issues with your physician. 

Image by Brett Hondow from Pixabay.

This article was published originally on Hormones Matter on May 17, 2016.

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Sphincter of Oddi Dysfunction (SOD)

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I have Sphincter of Oddi Dysfunction or SOD, a female-dominant health condition that caused me to give up a successful career as a not-for-profit director, lobbyist, and advocate. I could not parent and spent a year vomiting, in severe pain, and on a feeding tube. I was 90 pounds and the emergency and hospital rooms became my second home. On several occasions, my gastroenterologist said postpartum depression and stress were causing these extreme symptoms. As I was dying I was told to shake it off, just eat, and reduce my stress. Not only was I very ill, I was blamed and shamed for being ill. Though my tests were normal, I knew my body and this was definitely not psychological in nature.

Fortunately, a surgeon friend of my mom’s suggested I be tested for something called Sphincter of Oddi Dysfunction. Having never heard of this disorder, I scoured the Internet for information and bingo! Everything finally made sense.

Gallbladder Removal and Sphincter of Oddi Dysfunction

The year was 1998. I had my gallbladder removed and soon after developed a severe and constant pain in my right side under my rib. After a few tests proved negative results, I was diagnosed with IBS and given a medication that did not work. Since pain medication barely touched the pain, I went without and learned to live with it. Avoiding certain food triggers, breathing exercises, and mindfulness/awareness techniques helped me function each day.

Fast forward to September 2011, three months after giving birth to my third son. I could not keep food down. The pain shifted to the area below my sternum. Later identified as pancreatic pain, it was searing and relentless. Weight was flying off of my 135 pound 5 feet 4 inch frame. For a year, I suffered; until I took matters into my own hands. I traveled from New York to the University of Minnesota to put a name to the mystery condition slowly killing me. There, I had an endoscopic retrograde cholangiopancreatography (ERCP) with manometry—the gold standard diagnostic test for SOD. Sure enough, the doctor told me I had a terrible case of SOD. The frustrating part of this was my doctors back home could have performed this test but insisted on the psychiatric diagnosis.

What is Sphincter of Oddi Dysfunction?

So what is Sphincter of Oddi Dysfunction or SOD? SOD is a condition where the sphincter valves controlling the flow of bile and pancreatic fluids do not open and close properly. SOD occurs most frequently following gallbladder removal (post-cholecystectomy). Symptoms include (but are not limited to):

  • severe upper right quadrant pain
  • pancreatic pain
  • nausea
  • vomiting
  • diarrhea
  • constipation
  • malnutrition
  • unintended weight loss

Sufferers often go undiagnosed or misdiagnosed as it is common for SOD patients to have normal bloodwork, scans, and procedural workups.

SOD and Women

SOD is most prevalent among women for unclear reasons. A culmination of studies published on the NIH website estimate this prevalence to range from 75-95%. However, surveys conducted in 2013 and 2014 by the Sphincter of Oddi Dysfunction Awareness and Education (SODAE) Network showed an astounding 98% of SOD sufferers are women.

I oversee The Sphincter of Oddi Dysfunction Awareness and Education Network (SODAE Network) website, Facebook page, and support group.  As such, I read and listen to countless stories of doctors telling SOD patients not only that their symptoms are psychological, but that SOD does not even exist! Patients either exhaust their savings to travel far and wide to see a doctor who will help them (yes, there are some fantastic SOD doctors out there) or, those who cannot afford that option, are left with no treatment options and in time deteriorate physically and mentally.

Confusion amongst Physicians: Is Sphincter of Oddi Dysfunction Real?

At the center of this “SOD is not real” movement by some gastroenterologists is the National Institutes of Health study—The Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction (EPISOD) study, which I happened to be a participant in. The treatment at the center of the study, sphincterotomy, showed it did not relieve symptoms in all participants—not that SOD could not diagnostically be proven. The sphincter is cut so it will provide greater access for fluids to flow rather than get backed up. I had this and it did not work for me either. Two months later I had a transduodenal sphincteroplasty–a major abdominal surgery to sew my sphincters permanently open. I am happy to say I am doing well for the most part and consider myself in remission.

Theoretically, if the treatment did not relieve the patient’s symptoms, then the problem could not originate in the sphincter, which was now cut wide open. This makes absolutely no sense. Would we say other diseases measured by symptomology and/or diagnostic methods do not exist when a treatment is found to be ineffective, i.e. cancer, multiple sclerosis, Alzheimer’s, etc.? As we know, many diseases cause secondary conditions. It is quite possible SOD began as a primary condition, but as it precipitated (it often takes years to obtain a diagnosis), it spawned secondary issues like ductal spasms, nerve and/or visceral hypersensitivity, pancreatitis, malnutrition, or gut dysmotility. The original disease did not change. It was always there. However, once the sphincters were cut, the body still had these secondary issues.

Sphincter of Oddi Dysfunction is Real

Rather than spending valuable time recklessly slamming women with SOD and questioning SOD’s existence, researchers, policymakers, and the medical profession should be investing in women’s health, funding research to identify the cause of this condition. By learning the exact nature and cause of SOD, we can then move on to identify and develop effective treatments and preventative measures. Of particular note, is the need for investigating the possibility of a genetic and/or hormonal cause to SOD, since so many sufferers are women.  No such study has been initiated, outside of a prairie dog study conducted in 1994 determining estrogen inhibited sphincter of oddi motility. That is a narrow bit of research on which to base medical opinion.

This article was published previously in January 2015.

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The Nightmare of Benzodiazepine Withdrawal

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Benzo withdrawal

Over four years ago I became ill with what was later diagnosed as Sphincter of Oddi Dysfunction (SOD), a rare defect of the biliary and pancreatic sphincters. I couldn’t keep food down for weeks on end and ended up in the emergency room and hospital several times. There, I was prescribed a low dose of a benzodiazepine (benzo) called lorezapam (generic for Ativan) in combination with an anti-nausea drug called ondansetron (generic for Zofran). The combination of these medications nearly cured the vomiting with the added bonus that I had something to take for the crippling anxiety I had due to chronic illness. Since I have been in recovery for nearly two decades, I was very concerned about the addictive qualities of benzodiazepines. A doctor, I can’t remember which one, changed my prescription to a longer acting benzo called clonazepam (generic for Klonopin). He or she promised me it was a benign drug and I had nothing to worry about. That ended up being a bold-faced lie. This drug, and all benzos, are anything but benign.

I thought I was doing okay on the medication. I didn’t get “high”. I never abused them or wanted to abuse them. Gradually, though, I began to develop a lot of weird symptoms, but I chalked them up to the SOD. By 2012, I was on a feeding tube, intravenous nutrition, and had acute pancreatitis, major abdominal surgery and two sepsis infections that landed me in ICU. During the second bout of sepsis I was given intravenous bags of a fluoroquinolone antibiotic called Levaquin, and subsequently, had a severe adverse reaction. The Levaquin rattled my nervous system and attacked my tendons. I later found out that fluoroquinolones are contraindicated in patients prescribed benzos. By late 2013 I was a sick mess from the never-ending fluoroquinolone toxicity symptoms and was experiencing what I later learned to be inter-dose withdrawal and tolerance issues from the benzodiazepines.

Benzodiazepine Dependence Versus Addiction

Before I talk about the horrendous withdrawal nightmare I went through, you must know there is a difference between physical dependence and addiction. The majority of people I have met coming off benzos are not addicted to their benzo like an addict seeking more and more, abusing them, and/or getting them illegally. Conversely, the majority who are prescribed benzodiazepines become physically chained to the medication to the point their bodies don’t know how to function without them. Your body can become significantly dependent on a drug, even those that are not controlled substances. This can happen with anti-depressants, anti-psychotics, and seemingly innocent blood pressure and cholesterol medications. I have been down this road with anti-depressants. I must be an ultra-sensitive person because anytime I tried to go off a medication—any medication—I had to taper slowly. All that being said, this is not an article about benzo addiction and, quite frankly, many rehabs mistakenly treat benzo-dependent individuals as addicts when they are not.

Why people become physically dependent on benzodiazepines has something to do with its effect on the neurotransmitter gamma-aminobutyric acid (GABA). Benzos bind to these receptors, creating a sedating, hypnotic, and anti-anxiolytic affect. Doctors are prescribing benzos more and more for off label purposes like inner ear disorders, nausea, bladder and pelvic disorders, and fibromyalgia and for long-term use. This practice is concerning as it is well-established in pharmacological literature that benzos are to be used short-term (less than 4 weeks) or only on occasion. The long term use of benzos and their effect on our bodies has not been well-researched. I had to learn about it all through other benzo users online.

My Benzodiazepine Withdrawal Nightmare

In September 2014 I decided I wanted to taper off the clonazepam. I had been on the same dose (two pills a day at the lowest dose they make) for three years. I was terrified the vomiting and disabling anxiety would return but I had a gut feeling I didn’t need them anymore and would be ok without them. I remembered a few people in my health support groups shared how they had a horrible time coming off benzos and recommended a support site called Benzo Buddies. Naively, I ignored their suggestion and went about my taper all wrong. How hard could it be?

I followed no set pattern. I chipped away at pills and dropped down to one dose a day which I learned the hard way was very bad because clonazepam’s pharmacological duration of action was 6-12 hours, meaning I didn’t have a steady amount in my system at some points of the day. This caused withdrawal symptoms because it is something called interdose withdrawal. During the first few months of my taper I experienced an increase in my body wide nerve pain I had had from the fluoroquinolone. Strangely, my teeth hurt terribly and never let up. I thought I needed root canals but when I got them it made the pain worse. Dentists could not explain the severe pain as x-rays were normal. I had a tooth pulled and now regret it, but the pain had been unrelenting. I had frequent urination and pelvic pain. By February 2015, five months after I began my taper, I started having severe pancreatic pain attacks. I thought it was my SOD popping up again but I had surgery for that. I didn’t think it had to do with the benzo. Months later I realized the pain subsided for a few hours after my daily clonazepam dose then resumed when the benzo wore off.

I continued to chip away. I had anxiety but the worst was that pancreatic pain. I finally relented and joined the Benzo Buddies forum and met several other people who developed pancreatic issues during a benzo taper or withdrawal. By July 2015 I decided I was to be done with this drug and completely stopped. I was only taking specks by this time but even the specks seemed to keep me from a lot of nasty symptoms. The weekend I stopped completely, my husband and I went to NYC for a recovery convention. I had vertigo so severe I felt like I was on a boat during the entire trip. I was nauseous, my ears rang loud, muscles ached, and of course my pancreas was worse than ever. I was in rough shape for the next 6 weeks. I did start to feel better but soon was plagued with panic attacks the likes I’d never experienced. I woke up every night at 3:00 a.m. drenched in sweat, in terror. Adrenaline surged through my veins.

I called the doctor. She said I had to go back on a benzodiazepine temporarily. I complied and took a very small amount once a day for a few weeks. My pancreatic symptoms flared to the point I nearly stroked out as the pain caused my blood pressure to double. I had to get off the medication again so I stopped cold turkey. After all, why on earth would I have to taper again? Well, I should have tapered because what happened to me is called kindling. Kindling (withdrawing multiple times) can cause a hypersensitization of the receptor systems and thus causing the nervous system to be hypersensitive. What ensued was a horror show.

The Hypochondriac Disease

Benzodiazepine withdrawal should be called the Hypochondriac Disease. You will feel like you are dying and so many things are wrong but most tests will show nothing is wrong with you, leading your doctors to believe you are crazy. I felt like I was having mini-seizures for an entire month. For several months I had severe thirst and electrolyte imbalances, erratic blood pressure, sweats, chills, nausea, dizziness, near blackouts/seizures, vertigo/boaty feeling, metallic taste, eye pressure and pain, pancreatic pain and damage (by October 2015 an endoscopic ultrasound showed I had damage and was diagnosed with chronic pancreatitis), bad bloat and gas (aka benzo belly), ear fullness/popping, weird stools, constipation alternating with loose yellow stools, food sensitivities, brain fog, depersonalization/derealization, inner vibrations, exercise intolerance, sinus pain that felt like brain freeze, complete intolerance to stress and overstimulation; blood sugars were either very high or very low (I am not diabetic). I pretty much felt like I had the flu every day. At about the three-month mark the fatigue set in. The fatigue was unlike anything I had ever experienced. I was bedridden a lot. I was so tired I didn’t want to drive and could barely take care of my 4-year-old son.  I never seemed to catch a break. When one symptom resolved another would pop up.

My doctors were useless as none believed that benzodiazepine withdrawal caused all of these symptoms or that it could last for months (for some people years). I had already gone down this road with them for the SOD and the fluoroquinolone toxicity I can’t blame them for being perplexed. I am here to say it is real and should be considered as a diagnosis for any mystery ailments. I have tried to warn others but it is difficult to convince anyone how horrible these medications are when they experience a “wonder drug” effect from them.

Feeling Better! There is Hope.

It has been nearly seven months and I am feeling much better. I started having “windows”–feeling normal–and “waves”–intense symptoms. That is actually a good sign that I am healing. I am down to only a few symptoms. Not everyone has the experience I had. Some go off and on benzos no problem. For some of us withdrawal is a painful syndrome that cannot be resolved with a quick cold turkey or month-long stay in rehab. Some are quite ill for years. This is not like opioid, alcohol, or any other type of drug withdrawal. It’s just not that easy and my hope is doctors learn from their patients.

Even if you have successfully and easily gone off them in the past, I strongly suggest anyone who wants to taper off go to the Benzo Buddies site and read the various methods of tapering. Educate yourself. The most common taper method is the Ashton Protocol. Dr. Ashton ran a benzo withdrawal clinic in the U.K. and has probably done the most research of anyone on benzos and how to safely get off them. Always talk to your doctors about the risks of any drugs before agreeing to leave their office with a prescription. I never thought a legally prescribed medication could do this to my body. I now have a medic alert bracelet that states I am allergic to fluoroquinolone antibiotics and benzodiazepines.

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This article was published originally on Hormones Matter on April 25, 2016. 

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When Life Gives You Sphincter of Oddi Dysfunction, Write a Book

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Sphincter of Oddi Dysfunction

Four years ago, I was very ill with disabling digestive symptoms that proved to be a mystery to my doctors and me. I had round-the-clock nausea, vomiting, abdominal pain, and rapid weight loss. It got so bad I lost my job, had to get a feeding tube, and could barely care for my children. My doctors were baffled, but worse, they implied my symptoms were all in my head or from a postpartum syndrome. My family and I, however, knew better.

I refused to give up or settle for a mediocre doctor’s easy way out of blaming the patient for her symptoms. I searched high and low and had to travel halfway across the United States, but I found a doctor who ultimately diagnosed me with Sphincter of Oddi dysfunction (SOD). Though I had a diagnosis, what followed was a series of failed treatments, near death experiences, and treatment-related complications. Today, thankfully, I am doing well.

What is Sphincter of Oddi Dysfunction?

SOD is not easily explained by its title, nor is one definition agreed upon in scientific circles. Essentially, SOD is the result of the biliary and pancreatic sphincters malfunctioning and is most prevalent in women who had their gallbladders removed. The hallmark symptom is pain under the right rib cage that may radiate to the back and shoulder, but nausea is also a frequent complaint. Many women go undiagnosed or untreated due to the fact many GI doctors are ill-equipped to recognize the disease or refuse to believe it exists.

Minimal research has been conducted to find a cure for Sphincter of Oddi dysfunction. It would seem logical to research hormonal effects with SOD since it primarily affects women.  However, that would be too logical for today’s gastroenterology researchers. Instead, they focus on research aimed at cutting the sphincter up (sphincterotomy) or antidepressants. Most recent research focuses on trying to disprove SOD as a valid condition, giving GI doctors the green light to abandon their mostly female patients afflicted with this condition. It is impossible to claim the biliary and pancreatic sphincters are the only body part free from dysfunction.

The Birth of a Book

At the beginning of my journey, I found few patient-friendly resources on SOD. The only book about SOD I could find was a textbook written in 1976. I could not even locate a brochure about SOD. All of the information I did happen to find on the Internet was written in research or medical jargon. Luckily, I am fairly intelligent and could decipher the big words and confusing lingo. However, I often thought how terrible it must be for patients having difficulty interpreting it all, who were desperate for information about their condition.

About a year ago, I started writing articles and blogs about SOD, including one published on Hormones Matter. It was clear to me that a book needed to be written about SOD after seeing the numerous comments from readers and number of “hits” each post received.  I wished there had been more resources when I was searching for answers. Therefore, I began writing a book.

I wrote and wrote and wrote—day and night. Before I knew it, I had written an actual book, The Sphincter of Oddi Dysfunction Survival Guide. It wasn’t difficult because all of the content I had was in my head, from experience and extensive research. Along the way, I had discovered the most helpful SOD information out there did not exist on a website or in a book. It did not come from my doctors either. The best information I gathered on SOD was from fellow SOD sufferers.

Sphincter of Oddi Dysfunction Survival Guide

The resulting guide is a compendium of my and other SOD patients’ personal experiences with trying to find a diagnosis, obtain treatment, and develop coping strategies. I also included a good amount of information regarding the science behind SOD, which I tried my best to decipher into laymen’s terms. I also discussed the need for research and for doctors to stop blaming patients for their symptoms.

It is my hope that GI doctors, primary care physicians, naturopaths and functional medicine practitioners will read this book as most need to be educated about this condition. From my experience, SOD patients know more about their disease and treatments than their doctors. We need to change that.

Writing this book reminded me of the old saying, “When life gives you lemons, make lemonade.” I encourage anyone reading this to do the same. You’d be surprised how easy it is to write and publish a book these days.

 

 

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An Unlikely Advocate for Pain Medication Access: A Chronic Pancreatitis Patient Speaks Out

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Chronic pancreatitis and pain killers

I never thought I would be an advocate for pain medication access. I have been clean from alcohol and non-opiate drug abuse for 17 years. I am an active member of a 12 step fellowship. I sponsor women and have a sponsor. I regularly attend meetings. For most of my recovery I was anti-pain medication. I still believe opioid pain medication should be avoided in most situations. I also advocated against pain medication—so that it would not get into the hands of teens.

From Sphincter of Oddi Dysfunction To Chronic Pancreatitis

I dealt with sphincter of oddi dysfunction pain for over 13 years, never taking opioid pain medication for this condition. I also have painful neuropathy for which non-narcotic medication did not help. I chose to treat with alternative therapies, which sometimes helped. This year I was diagnosed with chronic pancreatitis. Chronic pancreatitis is well documented in the medical literature as being “excruciating”, “severe”, and even “miserable”. Some medical articles have documented chronic pancreatitis pain as worse than pancreatic cancer pain. In some states I qualify for palliative care, one step down from hospice care. There are no evidence-based treatments for chronic pancreatitis pain other than opioid pain medication and total pancreatectomy (pancreas removal).

The horrible unrelenting pain flares drove my family and me to seek pain management. After all, I wanted to die. I am not just saying I wanted to die. I mean I really wanted to die. The pain was on par with labor pain. Imagine trying to function every day in labor—but have no break in between contractions? I learned to function with the daily pain but when the flares came on I thought I would die and if I didn’t I surely needed to figure out how to end my life and suffering. My primary care doctor and a gastroenterologist I later fired tried me on the usual first line treatments for pain. NSAIDs gave me microscopic colitis. Tylenol was useless. Non-cholinergics like amitriptyline caused severe itching in places I’d rather not mention. Nerve medications like gabapentin and Lyrica and anything affecting GABA caused flu-like symptoms and exacerbated my pancreatic symptoms (pancreatitis is a side effect). I tried hypnotherapy, acupuncture, reiki, yoga, meditation, magnesium, and any natural remedy I came across.

Chronic Pancreatitis
The radiating pain of chronic pancreatitis.

Eventually pain of this level wears on the body and mind no matter how hard you are working at treating it. Finally, after heavy consult with my Higher Power, sponsor, mom, husband, and a close recovery friend, it was decided I needed to actively seek stronger more effective pain relief. My primary care and pretty much all primary care doctors in my area have a policy of not prescribing opioid pain medication. Specialists, unless you have cancer, don’t either. No pain management doctor in our area who takes insurance will prescribe pain meds anymore—they only offer injections, procedures, and non-narcotic medications. At one point I relented out of desperation to have a celiac plexus nerve block. The pain doctor kept insisting it was the only thing that worked for pancreatic pain. My primary care totally bought into it too, mostly I felt because he didn’t have to write a prescription. These doctors had no clue how tapped in I was with research. Nowhere was it documented to be a proven treatment for chronic pancreatitis. Regardless, because I was desperate for pain relief and told this was my only hope, I paid a hefty copay, spent half the day in the hospital, was sedated and had a needle stuck through my abdomen. It did nothing. No relief.

A Near Stroke from Severe Pancreatitis Pain

At one point my body just could not handle the pain anymore. I had gone so long suffering that it said, “enough.” One evening a few months ago the pain intensified to a degree my blood pressure doubled (I have one of those little machines) and my right side went numb. I was about to have a stroke! From pain! Luckily I was saved with emergency pain medication. At this point my gastroenterologist was infuriated my primary or any pain doctor would not try to manage this. He ended up prescribing a low but effective dose of an opioid for the flares so I wouldn’t stroke out and die. Unfortunately, the hospital he worked at told him I needed to find pain management. I finally found a doctor quite a drive away who I have to pay out of pocket because apparently insurance companies think they are the DEA now and don’t want to approve insurance for pain doctors who prescribe opioids. For now, I have a safety net. I do not enjoy pain medication and only take when I absolutely need to. My recovering addict friends don’t get it and quite frankly they don’t have to. Try walking in my shoes, having chronic pain and illness for four years straight. Trust me, the only pill you’ll desire is one that makes you feel normal, not one with side effects.

Guidelines on Pain Management Ignore Chronic Pain

When the opportunity arose to comment on the draft Center for Disease Control’s “CDC Guideline for Prescribing Opioids for Chronic Pain”, I looked forward to reawakening my grant reviewer skills to objectively identify the strengths and weaknesses of the document with the hope it would help pain patients. Unfortunately, I found it near impossible and beyond frustrating to review this document in an objective manner. The guideline is not organized like a typical guideline or tool kit. It is nothing more than a literature review of the harms and risks of opioids times 100. It is a warning for all doctors to not treat pain! Reading this document left me scared—really scared. It left me wondering what happened to the United States and to the rights of chronic pain patients? How could this be? No consumer groups or chronic pain patients were included in their peer review or “experts” process.

Yes, there are harms and risks with opioids, but a document meant to help primary care doctors in prescribing should be just that. It is biased in that it quotes very little about the realities of opioid treatment—that it is sometimes the only treatment modality left for some people. Even the DEA and 21 Health Organizations wrote, “Promoting pain relief and preventing abuse of pain medications: A critical balancing act” which states “Effective pain management is an integral and important aspect of quality medical care, and pain should be treated aggressively… Preventing drug abuse is an important societal goal, but it should not hinder patients’ ability to receive the care they need and deserve”.

The guideline talks about other medications and treatments yet fails miserably at discussing the lengthy side effects and risks of these treatments. They are conveniently omitted. The statistics in the Background section do not delineate criminal activity from actual chronic pain patients in a pain management type setting nor does it flesh out overdoses or drug use that involved polydrug use of illicit drugs or alcohol. Instead of a literature review detailing harms and risks doctors need supportive information. I would hope that a doctor knows the risks of any medication they are prescribing.

What Pain Management Guidelines Should Address

The guideline should explain that primary care doctors may be the only opioid prescriber in a patient’s area as most pain management doctors no longer manage chronic pain with opioids and specialists refuse to prescribe. Primary care doctors have by default become pain management doctors. As such, pain patients should not be punished for this trend. Also, doctors need to learn how to educate patients on the difference between physical dependence, tolerance, and addiction/misuse of opioid medications. Just because you are on pain medication does not mean you are a drug user or an active addict.

Patients need to be taught basic opioid safety—keeping the opioids locked away and out of teenagers’ hands. Many patients are naïve to think their teens would never consider experimenting with their meds or visitors won’t snoop through a medicine cabinet. Providing real-world information will prevent unnecessary overdoses NOT limiting chronic pain patients their pain medication.

The CDC is clearly not the appropriate agency to spearhead opioid prescribing guidelines. They are good at authoring literature reviews on ebola and trying to find cures for diseases. They are NOT equipped to publish guidelines of this manner. This is not an epidemic as the media is reporting. Overdoses and drug abuse are rare in the chronic pain patient population. There is no evidence chronic pain patients become heroin addicts. In fact, the only heroin addicts I’ve met who used to be chronic pain patients were those who were cut off from their doctors with no treatment plan. Proper pain management actually prevents illicit drug abuse. Hopefully the chronic pain patient’s story will be heard. So far, the government and media have turned a blind eye to them.

Photo by danilo.alvesd on Unsplash.

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The Lyme Spiral

The Lyme Spiral

Two of the most commonly asked questions I face as someone with Lyme disease is “when were you bitten by