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Monday, April 9, 2018

Addressing Emails Written to Me



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

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

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











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










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










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


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


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


Heidelberg pH Test

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




According to Heidelberg Medical,

"What is a Heidelberg pH Test?

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

The Physician will require a complete Medical History before the Test

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

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

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

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

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

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






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





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

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

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

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

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

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


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

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




Physicians

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

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





Researchers

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

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

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

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

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

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

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





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






Heidelberg pH Diagnostic Systems

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

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




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





Exclusivity

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

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

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


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

View our testing software simulation.


Included…

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


pH Capsule Locator

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






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

Gastroparesis and Eating Disorders Part Deux: What is the Difference?

I was watching a documentary about Amy Winehouse, and I had so much going on personally when she was going through her own troubles, that I did not give her a lot of thought. I was really sick, and knew there was something really wrong with me but the doctors who were testing me for different things could not find an answer, until 2012, when I was finally diagnosed with Gastroparesis. I had never heard of Gastroparesis before then and made it my mission to find out more about it, start my blog to keep track of research, and start Facebook pages and groups to help others who may have been diagnosed with the same.

I have been really sick the past week because of allergies to things growing, so I have a lot of mucus production, plus the nausea that comes with the mucus draining down my throat, and the throwing up of mucus and stomach acid because I have not been able to eat. I watch movies and listen to music to distract myself from the nausea, and I also use it to get me through the vomiting attacks. That sounds weird, I know, but it helps me to have something else to focus on. Because I have been sick for the past week, I've finally gotten to see Amy. I want to say that I have written about Gastroparesis vs Eating Disorders in the past, and you can read it here: http://www.emilysstomach.com/2015/04/gastroparesis-vs-eating-disorders.html.

I loved Amy Winehouse's music and her voice was a welcomed change at the time from the other voices already on the scene. She was not a part of a girl group, she did not look like a carbon copy of anyone, and she maintained her individuality. That is a feat that is hard to do in the entertainment industry when people are trying to market you, and are concerned with sales. I wanted to talk about her because something in her documentary bothered me more than anything else that was mentioned. She went to her mother and father, telling them about a diet she found where she could eat anything, and then vomit it all back up later. Her parents can be heard in the film saying they thought it would pass. However, it would not pass because it was bulimia.

According to National Eating Disorders (NEDA)

"Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.



Image Source: http://www.geronguide.com/gallery/index.php/Bulimia-Nervosa/bulimia-06




DIAGNOSTIC CRITERIA

According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).

Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of anorexia nervosa.




WARNING SIGNS & SYMPTOMS OF BULIMIA NERVOSA

Emotional and behavioral

In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns

Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

Appears uncomfortable eating around others

Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)

Skips meals or takes small portions of food at regular meals

Disappears after eating, often to the bathroom

Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

Fear of eating in public or with others

Steals or hoards food in strange places

Drinks excessive amounts of water or non-caloric beverages

Uses excessive amounts of mouthwash, mints, and gum

Hides body with baggy clothes

Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories

Shows unusual swelling of the cheeks or jaw area

Has calluses on the back of the hands and knuckles from self- induced vomiting

Teeth are discolored, stained

Creates lifestyle schedules or rituals to make time for binge-and-purge sessions

Withdraws from usual friends and activities

Looks bloated from fluid retention

Frequently diets

Shows extreme concern with body weight and shape

Frequent checking in the mirror for perceived flaws in appearance

Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating

Purges after a binge (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)

Extreme mood swings

Physical

Noticeable fluctuations in weight, both up and down

Body weight is typically within the normal weight range; may be overweight

Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

Difficulties concentrating

Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

Dizziness

Fainting/syncope

Feeling cold all the time

Sleep problems

Cuts and calluses across the top of finger joints (a result of inducing vomiting)

Dental problems, such as enamel erosion, cavities, and tooth sensitivity

Dry skin

Dry and brittle nails

Swelling around area of salivary glands

Fine hair on body

Thinning of hair on head, dry and brittle hair (lanugo)

Cavities, or discoloration of teeth, from vomiting**

Muscle weakness

Yellow skin (in context of eating large amounts of carrots)

Cold, mottled hands and feet or swelling of feet

Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a 'true' period)

Poor wound healing


Impaired immune functioning





Image Source: https://anorexianervosaforpharmacists.weebly.com/eating-disorders.html





Many people with bulimia nervosa also struggle with co-occurring conditions, such as:

Self-injury (cutting and other forms of self-harm without suicidal intention)
Substance abuse
Impulsivity (risky sexual behaviors, shoplifting, etc.)
Diabulimia (intentional misuse of insulin for type 1 diabetes)
Learn more about co-occurring conditions





Image Source: https://www.fullcirclehealthcareinc.com/eating-disorders.html





HEALTH CONSEQUENCES OF BULIMIA NERVOSA

The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.

The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body."
**You can get the same dental effects from Gastroparesis, see my article: http://www.emilysstomach.com/2017/12/gastroparesis-effects-on-dental-health.html





Image Source: https://it.123rf.com/photo_71030037_la-bulimia-%C3%A8-un-disturbo-alimentare-binge-eating-e-tentativi-di-sbarazzarsi-del-cibo-consumato-segni-e.html




Image Source: http://gi-north.com/are-you-at-risk-for-gastroparesis/


I found this article while I was doing research on eating disorders and Gastroparesis. I thought it would bring hope to those who have both, or maybe just have an eating disorder. According to Mirror Mirror, Eating Disorder Help,

"GI Symptoms in Eating Disorders

Gastrointestinal (GI) complications are commonly seen with anorexia, bulimia and binge eating disorder. Heartburn, gas, bloating, early fullness, nausea, abdominal distention, rectal pain, constipation or diarrhea might be considered simply 'irritable bowel syndrome' – potentially delaying rapid diagnosis and treatment of an underlying eating disorder. Often referred to as functional gut disorders, there is an impairment in the body’s normal 'functioning,' such as delayed movement of food through the digestive tract, hypersensitivity of intestinal nerve cells, and the way in which a person’s brain responds to these stimuli (1). Re-feeding and in turn, recovery, is difficult physically as well as emotionally.


Anorexia Nervosa, Restricting-Type

gastrointestinal symptoms eating disorders

Prolonged food restriction causes muscular atrophy of the entire digestive tract. This leads to slow stomach emptying (called Gastroparesis) and is a direct cause of the trapped gas, bloating and abdominal distention seen with anorexia. Post-meal pain, pressure and constipation can be quite severe.

Consumption of sugar-free products and high fiber fruits and vegetables to blunt hunger can add to GI discomfort. Sorbitol — found in sugar-free gums and mints, and fructose –found in many fruits — can increase gas production. Psychological factors such as depression and/or anxiety, as well as pelvic floor dysfunction, can lead to heightened awareness of pain sensations in the gut, making the problem feel even worse (2,3).

A rare but documented cause of severe abdominal pain can be seen in extremely malnourished individuals. It is called Superior mesenteric artery (SMA) syndrome and is caused by compression of the artery by the first portion of the intestines called the duodenum (4). This is a medical emergency and therefore is imperative that individuals struggling with overcoming any type of eating disorder work with medical professionals to safely guide and monitor them.



Bulimia Nervosa

Purging can lead to a condition known as acute sialadenosis, in which the parotid glands become swollen and painful. This condition will cause an individual to have a characteristic “chipmunk-like” appearance. Treatment involves warm compresses, tart candies, and anti-inflammatory medication (5). Individuals struggling with bulimia also experience gas, bloating, indigestion and constipation as well as gastritis, an inflammation of the lining of the stomach causing upper abdominal pain.

Upper GI symptoms of acid reflux occur due to repeated bouts of self-induced vomiting. The valve (called a sphincter) that controls the connection between the stomach and esophagus becomes floppy, allowing stomach acids and partially digested foods to back up through the esophagus and into the throat. This is involuntary and may cause erosion of the mucosa of the esophagus, leading to a condition known as Barrett’s esophagus, a pre-cursor to esophageal cancer (3). Repeated bouts of self-induced vomiting can ultimately cause tears in the esophagus, referred to as a Mallory Weiss Tears. Vomiting blood is a very frightening experience and requires emergency medical care. Daily vomiting can put tremendous strain on the heart muscle resulting in arrhythmias, palpitations and death (4).

Bloodwork may show characteristic abnormalities more commonly seen when purging becomes frequent and habitual. The pancreas and liver enzymes may be elevated without other symptoms and electrolyte levels may be abnormal (5,6)

Difficulty swallowing is another problem commonly seen in anorexia and bulimia and may be related to the loss of muscle tone in the esophagus. It is important to see a physician when a patient complains of difficulty swallowing while increasing nutrition.




Image Source: http://www.eatingdisorderpro.com/2013/02/28/diabulimia/





Other purging disorders – Laxatives, Diuretics and Exercise

Laxative abuse has been reported in more than 1/3 of patients with eating disorders. Patients believe they are purging calories to stay thin, when in fact, most absorption of calories occurs in the small intestine. Most commonly (though not exclusively) seen in patients with bulimia, laxative abuse causes the bowel to become dependent on laxative stimulation to pass a bowel movement. Individuals who use laxatives, diuretics or both (to purge calories) become severely and chronically dehydrated. Kidney function can then suffer impairment from chronic depletion of blood flow due to dehydration. Stimulant laxatives work by irritating the nerves that stimulate the colon to cause frequent watery stools, while bulk-forming laxatives work by increasing stool mass to the point the bowels force it out.

This chronic overstimulation can cause complete bowel shutdown which is referred to as cathartic colon. Once a patient’s colon becomes incapable of transporting fecal material, they may require partial or complete colon resection, or even require a colostomy bag (7,8). Additionally, stopping these behaviors ‘cold turkey’ can cause extreme fluid shifts, renal shutdown and life threatening electrolyte imbalance. This is referred to as Pseudo-Bartters syndrome. (5,6) Medical practitioners need to carefully monitor patients as they wean off laxatives and diuretics for this reason. Over exercise is another form of purging behavior.



Rectal Prolapse

Rectal prolapse occurs when the rectum protrudes outside the opening of the anus. Although not a common feature, rectal prolapse has been seen in patients who binge and purge, and in patients suffering from severe constipation and/or laxative abuse.

Increased intraabdominal pressure from vomiting, among other factors such as medication, poor diet and low fiber intake contribute to this condition. Surgical treatment is the definitive treatment for recurring prolapse but steps to prevent further constipation are essential. (5,6)




Binge Eating Disorder

Individuals who binge-eat tend to have erratic and irregular eating patterns around all meals, in turn causing a host of GI symptoms including constipation, gas, bloating and diarrhea.

Patients with anorexia who binge eat are at risk for acute gastric dilatation. This is due to slow gastric emptying and overeating large volumes in the face of weakened stomach musculature. The large quantity of food exceeds the stomach’s ability to empty which obstructs of blood flow to the stomach and intestines. The result is potential rupture of the stomach (4). Symptoms include vomiting, severe abdominal distention and pain.




Practical Suggestions to Reduce GI Discomfort While Recovering

It is advisable to see a physician to evaluate the many causes of gastrointestinal distress. Although many symptoms mentioned resolve with normal eating, it is important to rule out the potentially serious GI issues we see commonly with eating disorders.

The best long term relief for the discomfort accompanying normalized eating at the start of recovery is to schedule meals, snacks and fluids at regular intervals, and to sit calmly and mindfully while eating. Often referred to as “the rule of threes” (7,8) it is advisable to consume three meals and three snacks, at least three hours apart. Re-introducing foods as well as any type of nutritional supplementation should be done under the proper care and guidance of a physician and the dietitian to collaboratively treat these problems in a multidisciplinary approach.



GI Symptoms in Eating Disorders



Constipation Relief

For people with eating disorders, adequate fluids and fiber are the first line treatment for chronic constipation. It is advisable to increase fiber intake slowly to avoid additional gas and bloating. Examples of fiber-rich foods include whole grain breads and cereals, bran, nuts and seeds, lentils, beans and some fruits and vegetables.

Patients who are continuing to struggle with constipation should consult with their physicians for any potential medication needs. The fact remains that with continued good eating over time, many of these GI complains will resolve.



Gas, Bloating and Cramping

Physicians will recommend simethicone (Gas-X) to help with gas pain, and recent clinical guidelines by the American College of Gastroenterology suggest the use of metoclopramide (Reglan) to help with slow gastric emptying (9). Metoclopramide increases muscle contractions in the upper digestive tract and speeds up the rate at which the stomach empties into the intestines. This medication must be given with caution, however, as it can affect the heart rate of someone with anorexia.

One of the main goals in treating the GI symptoms of bulimia is to reduce and eliminate purging behavior. In cases where associated heartburn is frequent doctors will recommend a protein-pump inhibitor, a medication that protects the esophageal wall by reducing the stomach’s production of gastric acid.

In some cases, therapies to calm the gut including meditation or anti-anxiety meds, can be quite helpful. It is important to note that 'special' diets, or eliminating certain foods in an attempt to alleviate symptoms is not wise to try while in recovery. Dietitians need to individualize meal plans for the specific needs of each client.




Final Words

If you are in recovery or caring for someone in recovery, the abdominal discomfort with eating is very real. The body has gotten used to eating smaller amounts of food and the additional anxiety of increasing intake is truly distressing. As long as you’ve consulted a medical professional, the best treatment for GI upset is to continue following a plan of regular meals and snacks. Some patients have found heat pads or hot water bottles placed directly on the belly after meals to be helpful when pain is severe.





New Research Ahead – The Role of the Intestinal Microbiota

New research on the role of the intestinal microbiota in anorexia and other eating disorders is exciting. This research looks at the enteric nervous system, comprised of more than 100 million nerve cells lining your entire GI tract. This neural complex is thought to be equivalent to “a second brain” affecting digestion, weight regulation and even mood. Entirely new treatments are on the horizon as we begin to understand the interactive regulation that now clearly exists between the gut and the brain (10). Hopefully, we will continue to find new treatments for the gastric distress that eating disorder sufferers encounter as they work towards meaningful recovery.




Image Source: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry-psychology/eating-disorders/




About The Author:

Erica Leon, MS, RDN, CDN, CEDRD is the founder of Erica Leon Nutrition. She specializes in nutrition counseling for eating disorders and unhealthy eating patterns, as well as intuitive eating coaching.

Thank you so much to the following clinicians who kindly (and generously) reviewed this paper for accuracy of content:

Marcia Herrin, EdD, MPH, RDN, LD, FAED
Fellow, Academy of Eating Disorders
Author: The Parent’s Guide to Eating Disorders (Gurze Press, 2007) & Nutrition Counseling in the Treatment of Eating Disorders (Brunner-Routledge, 2013)

Patsy Catsos, MS, RDN, LD
Digestive Health Expert
Author: IBS—Free at Last! (2012)
Nutrition Works

References:

1) Janssen, P. Viewpoint, Can eating disorders cause functional gastrointestinal disorders? Neurogastroenterol Motil 2010; 22:1267-1269.

2) Wang, X, Luscombe, G, Boyd, C et al, Functional gastrointestinal disorders in eating disorder patients: Altered distribution and predictors using Rome III compared to Rome II criteria, World J Gastroenterol 2014; Nov 21; 20 (43): 16293 – 16299.

3) Sato, Y, and Fukudo, S, Gastrointestinal Symptoms and disorders in patients with eating disorders, Clin J Gastroenterol 2015; 8:255-263.

4) Norris, et al. Gastrointestinal Complications Associated with Anorexia Nervosa: A Systematic Review. Int J Eat Disord 2016; 49:3 216-237.

5) Mehler, S & Walsh, K, Electrolyte and Acid-Base Abnormalities Associated with Purging Behaviors. Int J Eat Disord 2016; 49:3 311-318.

6) Forney, J, Buchman-Schmitt, J et al, The Medical Complications Associated with Purging. Int J Eat Disord 2016; 49:3 249-259.

7) Herrin, M & Larkin, M, Nutrition Counseling in the Treatment of Eating Disorders, 2nd ed. Publ. Taylor & Francis, 2012.

8) Herrin, M & Matsumoto, N, The Parent’s Guide to Eating Disorders, 2nd Ed. Publ. Gurze Books, 2007.

9) Camilleri, M et al. Clinical Guideline: Management of Gastroparesis. Am J Gastroenterol, 2013; 108: 18-37.

10) Kleiman, S, Carroll, I, et al. Gut Feeling: A Role for the Intestinal Microbiota in Anorexia Nervosa? Int J Eat Disord 2015; 48 (5):449-451."


There is a wonderful documentary that looks into recovery of people who are facing an eating disorder. Even if you have Gastroparesis and no eating disorder, I would recommend this video highly. It brought me to tears. It's a really well done documentary:

https://youtu.be/mU6MT6Bzyw0



Eating disorders like Bulimia can lead to motility disorders like Gastroparesis. A lot of people have trouble understanding the difference between an eating disorder like Bulimia and a motility disorder like Gastroparesis, because both include vomiting and with Gastroparesis, there is the ability to get full easily because you retain food in your stomach because the stomach does not function normally.

People with Gastroparesis can gain weight instead of losing weight, but that does not mean they are not malnourished or vitamin deficient. A lot of people with Gastroparesis lose weight, and they do not want to lose the weight because they get down to scary levels of weight loss. Most people end up with a feeding tube at that point or TPN, because there is not much in the way of treatment for Gastroparesis. Bulimics can develop Gastroparesis and motility disorders because of the vomiting and weight loss. They can damage their vagus nerve, which controls so much in your body. if you do have an eating disorder and have been diagnosed with Gastroparesis, I do have a support group that you can join to talk to others and get support from others in the same position at: https://www.facebook.com/groups/GPandEDSupport/. You are NOT alone.

Gastroparesis, according to the Mayo Clinic, is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach. Ordinarily, strong muscular contractions propel food through your digestive tract. But if you have gastroparesis, your stomach's motility is slowed down or doesn't work at all, preventing your stomach from emptying properly. Gastroparesis can interfere with normal digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition. The cause of gastroparesis is usually unknown. Sometimes it's a complication of diabetes, and some people develop gastroparesis after surgery. There is no cure for Gastroparesis.

The Medscape Journal of Medicine has a really detailed, in depth look into Gastroparesis and what causes it. You can read the article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258461/, but I will post an excerpt here,

"Gastroparesis presents with symptoms of gastric retention and nongastrointestinal manifestations, with objective evidence of delayed gastric emptying in the absence of mechanical obstruction. Diabetic, idiopathic, and postsurgical gastroparesis are the most common forms, although many other conditions are associated with symptomatic delayed gastric emptying (Table 1). Gastroparesis is estimated to affect up to 4% of the US population[1] and may produce either mild, intermittent symptoms of nausea, early satiety, and postprandial fullness with little impairment of daily function, or relentless vomiting with total disability and frequent hospitalizations. A recent report estimated that inpatient costs for patients with severe gastroparesis approach $7000/month.[2]

Gastroparesis presents with a constellation of symptoms. In one study, nausea was reported by 93% of patients whereas early satiety and vomiting were noted by 86% and 68%, respectively.[3] In another series, nausea, vomiting, bloating, and early satiety were reported by 92%, 84%, 75%, and 60% of patients, respectively.[4] Many patients in both case series (89% and 46%) also reported abdominal pain (Table 2). Others experience heartburn from acid reflux into the esophagus that is facilitated by fundic distention which increases the rate of transient lower esophageal sphincter relaxations.[5] Although some gastroparetics with frequent vomiting lose weight and develop malnutrition, most patients were overweight or obese in one series, indicating that the disorder does not necessarily restrict food intake.[6] Phytobezoars are organized concretions of indigestible food residue that are retained within the stomach. These may increase gastroparesis symptoms or produce a palpable epigastric mass, gastric ulceration, small intestinal obstruction, or gastric perforation.[7] Bezoars are eliminated by endoscopic disruption and lavage, enzymatic digestion (papain, cellulose, or N-acetylcysteine), and dietary exclusion of high-residue foods. Variably delayed gastric emptying may cause unpredictable food delivery in diabetics with gastroparesis, affecting glycemic control and increasing risks of both severe hypo- and hyperglycemia.[8]

Gastroparesis has many causes. In a case series of 146 gastroparesis patients seen at a large US tertiary medical center, 29% had underlying diabetes, 13% developed symptoms after gastric surgery, and 36% were idiopathic.[4] The mean age of onset for gastroparesis is 34 years. Eighty-two percent of cases occur in women.[4]"



Image Source: http://studylib.net/doc/7356614/super-cereal-recipes



If you do have an eating disorder, and you want to get help - there are several ways you can do so. You can make an appointment with your primary doctor, who can refer you to a doctor who can help you. There are several numbers you can call for help and links below (click on the bold words):

Shoreline Eating Disorders.

Eating Disorder Hope.

National Eating Disorders.

Help Guide - Helping Someone with an Eating Disorder.

Selah House.

Magnolia Creek - Bulimia Help for Women.

National Eating Disorders Collaboration.

Bulimia.com - for 24/7 hour advisors to help you, call 1-866-578-1604.






Image Source: https://www.eatingrecoverycenter.com/blog/2016/04/30/eating-recovery-day-why-we-celebrate





I am not a doctor, I am a researcher. Please call your doctor if you have any questions or concerns so that they may decide the best care for you. Everyone is different. Everyone with Gastroparesis is different. I just wanted to distinguish between eating disorders and Gastroparesis, and to make sure people know that eating disorders can lead to Gastroparesis as well. Like I said before, if you have any questions or concerns, please consult your doctor.

Sunday, April 8, 2018

Gastroparesis: The Different Ways it Effects the Body

This idea and article dedicated to: Laurie Jayne

Her story, "After 14 years of being diagnosed with gastroparesis, a nurse practitioner told me this morning, that I don't have gastroparesis because I am not thin enough and don't vomit."

There are many kinds of Gastroparesis, many faces of Gastroparesis, and because everyone is different, it is hard to diagnose and treat. I, myself, have had Gastroparesis since about 2000 after an appendix surgery but was officially diagnosed in 2012. I do vomit, but that doesn't make my Gastroparesis more than someone who does not vomit, or my Gastroparesis less than someone who may have a feeding tube. There are also people who gain weight with Gastroparesis. However, Gastroparesis is Gastroparesis. It does not matter how much you weigh, because that does not mean that you are not malnourished or that you are not vitamin deficient. The Vagus Nerve is still damaged.

First of all, let's go into what Gastroparesis actually is and what causes it before we go into the different types of Gastroparesis.



Sources from GPACT and Imgur from years ago for the above images.


According to Gastroparesis Clinic,

"What is gastroparesis?

Gastroparesis is a gastric motility disorder in which the function of the stomach is impaired. The stomach is an important organ in our digestive system, which uses a series of muscular contractions to store meals after they have been eaten, grind up any solid food and pump this liquid into our small intestine at the right rate, so that the next steps in the digestive process can take place. In the case of gastroparesis, the muscular contractions of the stomach are defective, and as a result the contents of the stomach are emptied too slowly leading to symptoms.



Source from Imgur.



While gastroparesis is a relatively uncommon disorder, it can be very debilitating for those who suffer from it. Gastroparesis can have a significant impact on quality of life including the physical, emotional, and financial aspects of life. Sufferers may find that the nausea, discomfort, and pain associated with gastroparesis interfere with their ability to work, socialise, and maintain normal eating patterns. In severe cases, the inability to properly digest food can result in hospitalisation for fluid and nutrition supplementation, or sometimes the need for extra nutritional supplementation by a tube.

Gastroparesis is considered to be a motility disorder because there is no evidence of physical obstruction of the stomach, meaning that the primary issue is in the movement of the stomach. Impaired movement of the musculature of the stomach can be related to many underlying health problems, including diabetes, infection, neurological disorders, side-effects of medication, and following gastric surgery. However, in a large percentage of cases, gastroparesis is idiopathic – there is no known cause. In addition to the abnormalities of movement, there are also abnormalities of sensory function, so that the stomach becomes oversensitive and the sensations arising from the stomach are perceived as different or abnormally intense.

There are a variety of treatment options available to help gastroparesis sufferers manage their symptoms, though there is currently no cure. Health professionals are likely to recommend dietary changes, medications to minimise symptoms, psychological support, or hospital-based interventions depending on the severity of the symptoms and their response to treatment.







How many people are affected?

There are very few statistics on the prevalence of gastroparesis. It has been estimated that up to 4% of the population may experience gastroparesis-like symptoms, but it is uncertain how many of these people have the actual condition, as the sympotms and abnormalities of gastroparesis can be similar to other chronic functional gastrointestinal diseases such as functional dyspepsia or chronic idiopathic nausea. The lack of clarity around the incidence of gastroparesis is partially due to variation in the recognition of the condition by health professionals, as well as variation in the interpretation of test results.

As gastroparesis may be caused by diabetes, estimates about how many people are affected by gastroparesis are sometimes made based on diabetes statistics. These statistics suggest that more than 1.5 million Americans suffer from severe gastroparesis, and one estimate suggests that approximately 120,000 Australians are affected by the disorder. Women are more commonly affected than men, with approximately 80% of gastroparesis sufferers being female. The reason for this difference is not fully understood.









When does gastroparesis start?

Gastroparesis can begin at any age, although the average age of onset is 34 years.


Types of gastroparesis

In some cases, gastroparesis may be categorised as one of the following:

Idiopathic gastroparesis – there is no detectable abnormality responsible for the symptoms experienced, although sometimes the symptoms began following an infectious episode (gastroenteriltis with vomiting, nausea and diarrhea) – postinfectious gastroparesis

Diabetic gastroparesis – diabetes mellitus is the most common disease associated with gastroparesis, with 20-50% of longstanding diabetics experiencing gastroparesis, mostly in association with other complications of diabetes.

Post surgical gastroparesis – symptoms began following surgery to the upper gastrointestinal tract – the esophagus (gullet) or stomach.






Source from Imgur years ago.




Symptoms of gastroparesis

The symptoms associated with gastroparesis range in severity, but can be very debilitating. Common symptoms include: nausea, vomiting, bloating, early satiety, postprandial fullness, and abdominal pain. In extreme cases, the inability to digest foods and liquids properly can also lead to malnutrition, weight loss, and dehydration.



Source included in the image.



These symptoms can mimic a number of other health conditions (e.g., functional dyspepsia), and a medical history, physical examination and testing will help to discern if gastroparesis is the most likely explanation for the patient’s symptoms. Imaging tests and physiological measurements are used to determine the functioning of the stomach and the rate of gastric emptying. Some patients have severely delayed emptying but little in the way of symptoms, whereas other patients may have severe symptoms with only minor delays in emptying. In other words the severity of symptoms and the rate of emptying may not be closely correlated, which is why the abnormalities of sensation (which cannot be as easily measured) are likely to be important.










Further details about specific gastroparesis symptoms

Nausea: One of the main symptoms of gastroparesis is a feeling of nausea that may be accompanied by vomiting. Whilst dietary modification and prescribed medications can be helpful in addressing this symptom, there are also some other approaches that can lessen nausea. Using ginger to make a tea, as an ingredient in recipes, or taking ginger capsules, is known to ease nausea and speed up gastric emptying in some people. There is also evidence that stimulation of acupoints PC-6 and ST-36 can help relieve nausea and improve gastric emptying.

Bloating: Abdominal bloating is commonly associated with gastroparesis. Dietary modification may decrease abdominal bloating and discomfort. A discussion with your doctor can guide you in the necessary direction however, a specialised dietician’s advice is usually required in more severe cases

Abdominal pain: Many people with gastroparesis experience abdominal pain and discomfort. Gastroparesis generally does not cause sharp stabbing pains, but instead pain that is vague and crampy in nature. It is commonly made worse by eating, and may disrupt sleep at night.

Pain relief in the form of applying a hot pack to the abdomen for short periods may be helpful. The frequency and severity of pain episodes may also be reduced by treating gastroparesis with dietary modification, as well as natural, over the counter, and prescribed medications. Opiate based medications (eg morphine) are best avoided as they can lead to an increase in symptoms in the long term and are highly addictive.

Pain in gastroparesis can have a significant impact on quality of life. Learning techniques to cope with the symptoms is an effective strategy to make living with gastroparesis easier. Techniques that can be helpful in managing pain include those used by psychologists, for example cognitive behavioural therapy.

Depression and anxiety: It is common for gastroparesis sufferers to experience anxiety or depression. This may be due to the symptoms themselves, or to other issues such as family, relationships, financial stresses, or even to significant life changing events from the past.

The symptoms of gastroparesis may interfere with the normal activities of day-to-day life. This can lead to tiredness, low mood, low energy levels, and feelings of being out of control, tense, or anxious. This in itself will make the experience of living with gastroparesis more difficult and can create a vicious cycle of increasing symptoms leading to more anxiety and a further increase in symptoms, impacting on the overall condition of the person’s health and quality of life.

If any of the above feelings or events is pertinent to your care, then this should be discussed with your doctor, and if there are previously unresolved psychological issues then it would be the right time to address these as part of the treatment plan. Treating these issues can improve the ability of the mind and body to cope with gastroparesis. If your doctor feels that depression and/or anxiety is contributing to your symptoms, your doctor may suggest medication. It can often take some time to work out the right medication and dosage before it has a favourable outcome. Alternatively, a referral to a psychologist for further assessment and treatment may be appropriate."



Source: A friend made these images.


Just because people have Gastroparesis, does not mean that they vomit or have all of the symptoms listed. Everyone has different body chemistry and not everyone may have developed Gastroparesis from diabetes. I am here to talk about the different kinds of Gastroparesis people have because:

1. Gastroparesis is misunderstood.
2. Everyone is different (and that is why it is so hard to treat and find a cure).
3. Not everyone has the same symptoms (for instance, I vomit but my friend Kenny does not).
4. Not everyone with Gastroparesis is on a feeding tube.
5. Gastroparesis can range from mild to severe.
6. Just because people have a "mild" form of Gastroparesis, that does NOT make their Gastroparesis any less than someone who vomits or has a feeding tube with it. Vagus nerve damage is vagus nerve damage.





I wanted to upload this PDF from John Hopkin's because it explains everything regarding Gastroparesis, the different types and how a person could get them, as well as other useful information. This source comes from, which you can click on to make the images bigger if you have a hard time reading them below: https://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/esophagus_stomach/gastroparesis.pdf



In conclusion, Gastroparesis can effect each person who has it differently. It does not mean that the person is less sick if they have a milder form of Gastroparesis. In the end, it is a motility issue that will be with that person for the rest of their life. It is not fair to compare someone on a feeding tube with Gastroparesis to someone who vomits daily with Gastroparesis. That serves no purpose because those people are both very sick with a motility disorder and they deserve respect and understanding.

Wednesday, April 4, 2018

Freezing The 'Hunger Nerve' Could Help with Weight Loss

I felt like this needed to have it's own post. Yes, it is going to be quoted word for word and I want to hear your thoughts on it. This is an article taken from http://abcnews.go.com/Health/freezing-hunger-nerve-weight-loss/story?id=53912867.



Freezing The 'Hunger Nerve' Could Help with Weight Loss

"Weight loss can sometimes seem impossible because even after hard-won success, the pounds can creep back.

'Ninety-five percent of people who embark on a diet on their own will fail or gain their weight back at the six- or 12-month mark,' Dr. David Prologo, an interventional radiologist at Emory University School of Medicine in Atlanta, said in a news release video. 'The reason for this is the body’s backlash to the calorie restriction.'

Prologo recently conducted a trial that looked deeper into the issue, targeting the 'hunger nerve' and its possible connection to one's ability to lose weight and keep it off.

The 'hunger nerve' -- also known as the posterior vagal trunk -- is a branch of the larger vagus nerve that works on the heart, lungs and GI system. When your stomach is empty, the nerve signals your brain that you're hungry.

For a small study based at Emory University School of Medicine, Porlogo and researchers tried a minor surgical procedure on the study's participants where a probe was inserted into the patient’s back, freezing the nerve for two minutes, with the guidance of live images from a CT scan. By freezing the nerve, the hunger signal was shut down.

The experiment was meant solely to test the safety of the procedure, and the team ran the study on only 10 people. All were overweight, between the ages of 27 to 66 and had body mass indexes (BMIs) ranging from 30 and 37 (those stretch from 'moderately' to 'severely' obese). Eight of the 10 participants were women.

At the end of the procedure, the probe was removed and a small bandage was applied to the skin, with patients going home the same day."




STOCK PHOTO/Getty Images. Stock photo of a person using a scale to weigh themselves.




"The researchers saw the patients again seven, 45 and 90 days after the procedure. Because it was a phase 1 trial, primarily looking for negative side effects, the technical success rate was 100 percent, there were no procedure-related complications and no adverse events on which to follow up.

Though they weren't really looking at weight effects at this stage, patients said they had a decreased appetite at each clinic appointment, and there was an average weight loss of 3.6 percent. Additionally, all of the participants' BMI numbers came down about 13.9 percent. There was no mention of how long any effects on the nerve might last.

'I had struggled with weight since my 6-year-old was born ... and I’m constantly rebounding [with various weight-loss programs],' Prologo’s first patient, Melissa, said in the news release video.

After the procedure, she said, 'I’m literally never hungry ... I’m not eating because I’m bored. It’s gradually coming off, so now I know it’s not going to come right back on like all the previous diets that I’ve tried.'

Ten other patients also had the procedure but the researchers have yet to analyze the results. The next goal for the research team is to enroll people in a phase 2 study so they can have a control group for comparing possible results.

This study was presented at the Society for Interventional Radiology Conference this week in Los Angeles, and has not been published in a peer-reviewed medical journal.

It is far from proven that freezing the nerve will result in permanent weight loss but if it does, it could have a profound effect on the lives of those who have struggled to maintain a healthy weight.

Najibah Rehman, MD, with a Master of Public Health, is a third-year preventive medicine resident at the University of Michigan in Ann Arbor, working in the ABC News Medical Unit."





Sources taken from www.pinterest.com




As a person suffering with Gastroparesis, who have had over 42 friends die in the past year, this really angers me. Why can't they work on the vagus nerve to fix the damage so that people with Gastroparesis will get to lead some kind of normal life? I understand that morbidly obese people really need help too, I'm not disparaging them, but reading this article pissed me off. When I first read it, I had to check the sources to make sure it wasn't in the Onion or anything like that. No such luck. This is real and this is happening. There are no words ... I cannot even express how furious I am.

I guess I will keep on spreading Gastroparesis Awareness to the best of my ability. I am having business cards drawn up with my blog attached to them, having them explain Gastroparesis (GP), and providing my group support link. I want people, especially medical professionals, to know Gastroparesis DOES exist, it is VERY real, and complications that stem from GP can be fatal.





Sources taken from www.pinterest.com





This article just brought out a slew of emotions in me; rage, pain, sadness, anxiety, depression, and just frustration. How come these scientists can do this for people who want to lose weight but cannot find a way to help fix or repair a damaged vagus nerve in order to help people like us?

I wrote an article on the Vagus Nerve and everything that it controls here: http://www.emilysstomach.com/2016/07/information-about-vagus-nerve.html

Three is a Vagus Nerve Stimulator, which I wrote here: http://www.emilysstomach.com/2017/06/the-vagus-nerve-stimulator.html







Source taken from www.pinterest.com


This is why I am mad at the article above. I am CONSTANTLY being doubted that my Gastroparesis is real - by family members, friends, and even medical professionals. It's not right, but yet, the scientists in the article above are freezing the vagus nerve to curb cravings for overeating? That feels like a slap in the face, to me personally. Why can't they devise a way in which they can repair bits of the vagus nerve so that some of the Gastroparesis Warriors could have a normal life? Why isn't that a priority? I know a lot of medical professionals, in the Emergency Room especially, do not believe Gastroparesis is even real. Something needs to be done. I am tired of losing good friends from complications of this illness.




Source taken from www.pinterest.com


Socializing with an Invisible Illness

Dedicated to Jillian for giving me the idea to write this article. Thank you.


Image taken from Imgur years ago.



Socializing is hard enough when you are a healthy, human being. You could be shy or nervous to talk to others. However, with a chronic, invisible illness, it's even harder. Imagine having that nervousness and shyness leading to vomiting, intestinal spasms, bloating, and many other things but the main culprit is fatigue.



Image taken from Imgur years ago.



So, what are some activities that you can do when you have a chronic invisible illness?

Personally, what I like to do is to invite my friends over for a board game night or for a movie night. We can have themed movie nights, like a Nicholas Cage movie night where we all sit around and riff the movies, or a serious movie night, watching a recently released movie on Blu-Ray. My friends and I really love board games, and I have a cabinet full. Usually, though, we will find ourselves in a game of Cards Against Humanity. If my friends cannot come over, I may call one of them on Skype or Hangouts and watch a movie with a person that way (we would be watching it at the same time at our respective houses) and talk to each other through the computer. I vomit with my Gastroparesis, so I am always conscious enough to ask my guests if vomiting will make them vomit. I really don't want to start a vomiting conga line in my house. If I get a yes to this question, I still have my Emesis Bags handy, but will try to run to the bathroom, if I can. Some people are really sensitive to others getting sick, so I'm always sure to double check. I might order them food or have snacks ready for them when they come over, but I can not partake. I usually just sip on a soda during the game or movie.





Recognize Your Limitations

I recognized my limitations early on. I cannot go out to restaurants, hike like I used to, go to movies, go bowling, etc. I consider that chapter in my life closed when it comes to socialization in a setting like that. I have to be creative and come up with new ways to socialize because of my vomiting and Gastroparesis. It doesn't mean that I cannot socialize, it is just that I can no longer socialize in those ways. I know that not everyone with Gastroparesis vomits, so individually, you have to recognize what your limitations are in order to work with them, and not against them, so you do not make yourself even more sick.





Video Gaming is Great for Good Gastroparesis Days

If I am having a good Gastroparesis day, then I usually play on my Xbox One, logging into the internet, and play with other people in my game. I can socialize with those people because I have a headset for gaming that has a microphone, which is my way of reaching others in the game, and depending on the game being played, being able to plan a coordinated attack. This also helps me deal with pent up aggression and negative feelings, because I can take it out on killing zombies in my game. That sounds hideous written down, but it really does help me. Additionally, playing the game with other people online helps me to build new friendships and to be able to talk to others. It's a nice escape from watching Netflix all day. Plus, I get to meet new people and maybe even learn new things about the game I'm playing that I did not know before.



Image taken from Imgur three years ago.




Coloring is Good for Stress

Coloring has been a good stress relief for me. I have always loved to color. There are a lot of different coloring groups on Facebook now, as well as websites, Facebook pages, and blogs. You could challenge your friends to a coloring contest and compare each other's work on Skype or Google Hangouts (if you cannot leave your house and if they cannot come over), and have someone predesignated as the judge. You could do those competitions for fun or maybe real prizes if you are feeling confident. You could have your friends come over and you could all color together. It's an activity that is easy, stress relieving, and is fun for everyone involved.



Movie(s) Night!

I mentioned this above because it is something my friends and I like to do. You can have your friends over for a movie night, or if you are feeling well enough, you can go to a friend's house for a movie night. It can be themed or not. It is all up to you. You can be just as creative as you want to be with it. I mentioned above we had a Nicolas Cage night because we like to make fun of some of his bad movies, in our personal opinions, and we love to watch his better movies. My friends and I have a tradition of having a scary movie themed night once every weekend in October. I love to have serious movie nights of movies just released on Blu-Ray that I haven't seen yet, and I love to re-watch favorites. Sometimes, my friends and I (even my husband and I will do this) download Rifftrax (which are the guys who did Mystery Science Theatre 3000) and listen to Rifftrax accompany the movie we are watching. It is a ton of fun and sometimes, I have issues trying not to stop laughing. My friends and I also had our own riffs to accompany the movie. This way, I can stay at home, but still be social.






Image taken from Imgur years ago.






Board or Card Game Nights

I mentioned above that my friends and I like to play Cards Against Humanity and board games. I have a china cabinet stacked with board games because I am a board game collector. I will say that I think my favorite game is Cards Against Humanity because it is SO funny! I always make anyone new playing the game to make their own card for my deck. However, if Cards Against Humanity is too dirty for you, an alternative is Apples to Apples, which is just as funny. My friends like to play Catan. I am not so crazy about that board game because it reminds me a bit of Monopoly, and leads to arguments. I love games like Trivial Pursuit. It all depends on your tastes and your friends' tastes on what board games or card games you play, but it's still a fun way to socialize when you cannot leave your house. With board games and card games, there are just so many options to choose from, so boredom is never an option.



A Knitting or Crocheting Circle

If you knit or crochet, you could ask your friends to come over and do that activity together while listening to music or the TV. I love to knit but I do not knit traditionally. I use a Knifty Knitter where I wrap the yarn around pegs and then pull them through. I mostly make scarves. It isn't hard to learn or do. I can make a scarf in three days, if I put my mind to it. I can do it while watching TV or just sitting around the house. It gives me something to do. This is definitely something you can do with your friends or if you want to do it on your own, that is fine too. There are lots of Youtube videos to teach you how to use the knifty knitter, as well as showing you different stitches, and different patterns you can do. Yarn for projects like this is also fairly cheap. I get the thicker yarns if I am making a scarf, and a counter to press if I want to make the scarf multi-colored. I have friends who have knitting circles. It is a very relaxing hobby.




Scarves that I have made for friends. I made my husband a Gryffindor scarf from Harry Potter.






Image Source on the image.



Arts and Crafts

My friend Denise loved to make cards. She would make homemade cards and send them out to people. My mother makes jewelry. If a lot of your friends do arts and crafts, and you have no knowledge of how they do their projects, invite them over and have them teach you. Additionally, you may be able to teach your friends some of the arts and crafts that you do in your spare time. You could found an arts and crafts circle that meets once a week. That might help with socialization and also help keep you occupied during the week so that you do not dwell on your stomach or pain. There are several groups on Facebook, Pinterest, Yahoo Groups, and Google Plus dedicated to arts and crafts. It might be nice to have the ability to learn something new, something you did not know before might be something you really like and take up as your own hobby. You and your friends could develop a schedule of meet ups and then present what you have finished and/or ask for help with projects.




Having People Stay Over

You could call your friends and set up a date and time for them to sleep over. You can be as creative with this as you want to, from putting tents up in your backyard to turning your living room floor in pillows and sheets. You can gossip with your friends and get caught up on what has been happening while you are at home and just spend some quality time with you friends. This way, you do not have any stress put upon you because you are not in public, and you do not have to worry about finding a bathroom. It helps you catch up and still be active in your friends' lives, even though you are at home.




Starting a Book Club or Movie Club

I started a group like this on Facebook Books, TV, and Movie Club where you can assign a book, TV show, or movie to your friends, give an amount of time for everyone to finish it, and then discuss it together. You can do this via Skype or Google Hangouts, etc if you cannot meet in person. In addition to that, you can recommend different TV shows, books, or movies for your friends to watch and they can recommend things back to you so that you have something new to do at home. It is a fun way to talk about a show, book, or movie without spoiling anything for your friends. Furthermore, it helps you socialize when you are too sick to leave your house. It's something I really like to do because I love movies. I also love to read. I've had books recommended to me that are out of my comfort zone, that I would not have heard of or read without my group on Facebook, and surprisingly, I found I really liked that suggestion. It helps you explore new avenues of genera you might not have thought of.






Take Online Classes

There are free online classes that you can take at some colleges. This would help you to make new friends without leaving your house. You can also increase your education at the same time! It would help to occupy your time so that you are not home alone, with temptations to be stressed or depressed. Colleges have free classes on a variety of topics, so pick one that you are really interested in. There are other places other than colleges that offer free classes, but you would have to look around for it. You can do anything you put your mind to. But, it would help to expand your circle of friends and you never know, some of the people in your online class might be in the same position you are.






Join Support Groups or Online Groups with Your Similar Interests

There are lots of support groups online now for invisible illnesses. However, you don't just have to join a support group for your illness - there are other groups based on similar interests, like crafts, for example. I would recommend joining a support group for your illness because it helps to have people who understand you, and you need a safe environment to vent in and ask questions. There are also all sorts of groups online for hobbies, and by joining those groups, you may learn new things about your hobby you did not know before. It could be a lot of fun! You would definitely meet new people in both kinds of groups and that will help you socialize if you are like me, and at home a lot. No one should be alone. In this day and age with social media and the Internet, no one should be alone at all. So, search whatever hobby you are interested in among the groups and see which groups fit you best. Do not forget that you can join more than one group.





Image taken from Imgur three years ago.





There are other ideas on this site I found, but a lot of these I have already covered off of the top of my head: https://undiagnosedwarrior.org/tag/socializing-with-chronic-illness/


This article talks about keeping friends with an invisible illness from The Mighty: https://themighty.com/2016/04/making-and-keeping-friends-with-chronic-illness/

This is another great article about how pain affects your relationships and what to do about it: http://princessinthetower.org/how-chronic-pain-affects-your-friendships-and-what-to-do-about-it/


This is a previous article I wrote on how to keep busy in a hospital that has ideas that might help you format them in a way to socialize with your friends: http://www.emilysstomach.com/2014/02/how-to-pass-time-in-hospital.html




Image taken from Imgur years ago.



I'm sure there are many other things you can do to socialize with friends and make new friends, but this is a good list to get you started. I have done all of the above and wanted to share it with everyone so that you do not feel alone. I know that invisible illnesses can be so isolating. It is very hard for me to leave the house because I vomit. I have wonderful friends who come over and spend time with me, and I skype my family, who live two hours from me, to catch up on the family and what is going on there. I hope this helps you. If you have any more suggestions to add to the list, feel free to comment. I will gladly keep adding to this list as I learn more things to do when you're stuck at home.