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Wednesday, March 12, 2014

An NJ Tube Story by Alley Samms

So, I have decided to showcase a couple of guest bloggers so that they can write about things that I don't really have experience with. An NJ tube is one of them. Over the next few weeks, I will be incorporating guest bloggers to write about things like TPN, gastric sleeves, and GP and pregnancy. Thank you in advance for reading my blog and thanks to everyone who is helping me out in this endeavor. It means a lot to me.

This article was written by my good friend, Alley Samms. She has several Youtube links that also discuss her NJ tube and she has a store in which she sells gastroparesis jewelry. I met her on one of the many support groups I'm in for GP and she is an amazing woman! She's a very strong person and I'm glad to have her as a friend.

The LINK to her store is: http://hopesalley.bigcartel.com

Her most recent Youtube video about NJ tubes: https://www.youtube.com/watch?v=B9D-0eto-Uk&list=UU9dhy8cIzb97vgMOdeJf_8A

Her first Youtube video after her tube was placed: https://www.youtube.com/watch?v=2tMVbnGQ4Jc&list=UU9dhy8cIzb97vgMOdeJf_8A

Now, her story:


An NJ Tube Story by Alley Samms

My name is Alley Samms. I am 27 years old and have Gastroparesis, and severe GERD, which lead me to get a NJ feeding tube because of malnutrition. I was “wasting away” in my GI’s own words and most likely would not have survived a few more months without some sort of feeding intervention. I have now had a NJ tube for the last consecutive 16 months with no breaks and feeding 24/7.

A NJ tube or Nasojejunal Tube is a long tube that is inserted in your nose, follows down thru your stomach and ends in your jejunum so you can feed into your small intestines while by-passing your stomach. Not to be confused with the NG or Nasogastic tube that stops and feeds into your stomach. As we all know feeling into your stomach would be pointless with GP patients.

When I got my first NJ (Nasojejunal tube) I was approx. 83 lbs., and severely malnourished. Gastroparesis caused me too much pain and nausea after eating or drinking even water. I could not sustain my health or weight by myself.

My GI had suggested I go straight to a J tube for months and I even met with a surgeon who described the tube and how he would make a 9-inch vertical open incision on my belly for placement. I freaked out and told my GI I wanted to trial the NJ tube to see how I do first before I go through such an invasive surgery placement, and boy, I am glad I did.

The day of my first NJ placement I was terrified and was NPO (nothing by mouth) for a day already. I arrived at the hospital and sat in the freezing waiting room for about an hour until they finally called me back. I sat in the holding area in the IR department on a hospital bed; they didn’t even have me change into a gown. The first time getting an NJ tube is always the worst, I tell you it gets a lot easier to handle after your first.


What happens when they placed my first NJ Tube:

First I Always bring my own big bottle of water and my own bendy straw, this is very important, also I take 8mg of ODT Zofran about an hour before my replacements/placements just to ease my nervousness about gagging.

I sat up in the bed, the nurse tech then told me what’s going to happen (Ha like that will ever help coming from a nurse) and I was about to have a panic attack.

They cover the end up the tube which is weighted with lidocaine jelly and insert the end of the tube in my nostril, once they start pushing it in my nose I started swallowing the tube. Now on my first placement like normal for most I gagged so much they had to take that tube out and start over because I could not stop gagging.

Lets try this again… Second try, the tech-nurse starts pushing it past my throat, I sip on the water and he gets it all the way into my stomach with me only gagging once.

He gave me a big high-five and told me to hold my tube in place until I could get into the Fluoroscopy machine room to have it advanced.

I sat there for about 30 minutes holding my tube and joking with the EMT’s that came in and out bringing in people from other hospitals. Finally I got into the Fluoroscopy room. Basically, this is where the Dr. will advance your tube into your jejunum. You lay on a hard table with the “Fluoroscopy” machine, which is taking a constant x-ray to check the placement of the tube. I lie there as the doctor pushes and pulls the tube in and out, laying from side to side until the end of the NJ tube gets far enough past the duodenum. Once the tube is in place, they taped it to my nose (Yuck) and I was on my way home.

The first day, like I said is always the worst. I gagged the entire way home, any time I talked and I ended up throwing up a few times without displacing my new tube thankfully. Rest assured this sensation of gagging or chocking will go away in a day or over night.


The placement of an NJ Tube.



Now fast forward to the not so great experiences with my NJ Tube I have had later down the road.

My first bad incident was partially my own fault. I used to leave the “slack” of my tubing hang out of my backpack by my leg and up to my face. Bad idea.

My first tube was ripped out violently by my poor puppies paw. I ended up in the ER that day with my sinus cut open and needing a replacement. Always tuck your tubing slack into your backpack if you have kids or animals around. You can even get caught on a door handle, and you do not want that.

That brought on issue two that can happen with NJ tubes, or any tubes for that matter: Kinking, coiling and displacement.

I got a new NJ tube placed after my dog yanked my first one out of my face. The Dr. who placed my new tube had issues advancing it past my ligament of treitz (for me this is a certain place after the duodenum where my tube will safely stay in my intestines because I have sections of reverse motility). By the time I got home that night and tried to hook up to my feed I noticed I could not flush my tube. Back to the ER I went; yes it was coiled backwards in my duodenum and almost tied into a knot.

This leads to another great tip for NJ tubes. When my tube kinked, they did not replace it with a new tube, but just un-coiled it by pulling it slightly in and out and pushing it back in further. Do Not Do This! Get a New tube if yours kinks!

Tubes, especially small NJ tubes (mine is a 8Fr) have kink memory and once they get kinked, it will kink again soon if not immediately. So, low and behold 3 days later, yup, my tube was kinked and flipped backwards in my jejunum.

I don’t quite remember how many tube replacements I have had now, if I had to guess its only about 9 or 10 but that’s over a course of a year and three months.

To make your life easier you will learn what works for your body and making living with and replacing tubes a lot easier on you. I have had my share of horrible experiences of tube replacements. My last replacement the Dr. was so pompous and thought he was the best, that he did not listen to me and ended up fracturing my nose and getting the tube stuck in the top tier of my sinus cavity. Extremely painful. I have had it ALL done. I have never been asleep or sedated thru any of my NJ tube placements so I get to enjoy every little moment. However, I prefer not to be sedated because once it is placed there is nothing to really recover from so I can go on about my day as normal.

I have had my share of really bad doctors who act like they know what they are doing but don’t when it comes to NJ tube Replacements. I first will tell you my easiest way to get a replacement, then tell you some of the horrors I have been through.

First, lay down and have a nurse pull your tube out for you in one smooth motion. Breathe thru your mouth the entire time, I even found humming works too. It takes less than 15 seconds to pull out and its disgusting but not as bad as you would imagine. But do not make the mistake of cheating and drinking something like pedia-sure before you get your tube pulled or else it will be in your nose all day long. It will taste and smell sort of gross like bile but ask to blow your nose and you will be fine.

Then, if you trust your Dr. they can do the rest but I Don’t so I ask the nurses to do my placements. Basically as I stated before, sit up, sip water thru a straw then go lay on the Fluoroscopy machine and get it advanced. And breathe thru it all, long breaths out while they push the tube in and out helps. And if it hurts very badly, something is wrong and they need to stop right away.

Then tape your tube to your Cheek, not your nose. Taping it to your nose will make you gag more. The closer you tape your tube to your nostril on your cheek the less it will move and bother your throat.

Tape I recommend: Hypafix, Durapore, Tegaderm, Tendrgerips and I also get Band-Aids in cute designs and cut the sticky ends off and place them on for some pizazz. If you apply something called “ No sting Barrier Spray” your tape will stick much longer.



Now some things you should know about what Doctors Should NOT do during NJ tube replacements:

When switching the tube in nostrils: If there is sharp severe pain STOP the placement. Your nose is deviated and no matter what even if they get it placed you will be in horrible pain the entire time you have the tube. Like myself, I have to keep my tube on the Right side the entire time. I learned that after screaming bloody murder.

When a doctor tries to tell you he is going to replace the tube by using a guide wire or another tube as a guide for the new tube, tell them no, or run far away. I speak from too much experience on this and it NEVER works and is miserable to go through.

What I mean about guide wire- The Dr. will want to put a guide wire inside your existing tube, keep the guide wire in you while pulling out your tube. He will then slowly pull your tube out inch by inch (takes about 20 minutes or more) Then he will want to keep that guide wire in and put the new tube over it. This is agonizing and very slow. This does not work, you will gag your brains out, vomit and not be able to breathe while you are chocking on your own vomit. Don’t let them do this.

What I mean about a tube guide: Similar to the guide wire but worse. The Dr. will keep in your existing tube. Then he will place another tube in the same nostril in the hopes it will follow the line of the tube you already have. That’s right, two tubes in one nostril down the back of your throat. This also does NOT work and results in the same, crying gagging, vomiting chocking and begging for someone to stop. (I actually had to punch this Dr. and then throw up on him while I was begging in pain with tears in my eyes for him to stop this, which resulted in an investigation on that Dr.)

Do not let my horror stories scare you away from NJ tubes and their placements. I just have bad luck and have to go to the worst hospital in my town because they are the only ones who will place them here. Not all Dr.s will do this to you, but now you have things to look out for and know the outcomes to better judge your own situation.



A few tips about NJ tubes:

Clogs: With and NJ tube being so much smaller than all other tubes, it will clog. Depending on what feed you are on, it may clog a lot. Get some SMALL syringes. Under 20mls. I personally use 15ml-5ml-and the occasional 3ml for everyday use and clogs. I do not know why but the 60ml syringe will take 10+ hours or never unclog your tube. If you use a very small syringe it will come out in less than 20 minutes.

Upkeep: I have obviously have had an NJ tube much longer than the normal person would normally have one. I get checked by an ENT (Ear Nose Throat specialist) in-between all replacements now to O.K. my sinus for a new tube.
I have not had a sinus infection yet at all.

My secret: Neti Pot, use when needed, can be used daily but I use it only when I feel gunk building up. Use the Neti pot frequently if you start to get postnasal drip or else the tube in the back of your throat will start getting coated with hardened mucus and will start irritating your throat. The Neti Pot will prevent this buildup.

For days your nose hurts, because that will happen sometimes especially if you have severe allergies like I do. Use Affrin Spray, but do not use this more than 4-5 times a month or it can cause more permanent congestion. So only when very needed.


Why I have Chosen to keep my NJ tube instead of getting a GJ or J tube placed instead:

When I had my first NJ tube placed I was severely malnourished and 83 lbs. I did start to improve fast after starting NJ feeds. My GI and I agreed after a few months I was responding so well and gaining weight that I may only have to have the tube for a few more months. Well, by the time we discussed the G/J – J tube again I had gained about 15lbs. My Body is one that takes forever to gain but a minute to loose. I can easily loose 5 lbs. in a day with still eating. For example years ago before the tube I had my wisdom teeth removed, I was still eating daily just soft foods and I lost 16 lbs.

In a week, my body recovers horribly. So, with that in mind the surgical placement of the G/J – J tube alone would cause me to loose all the weight It has taken me over a year to gain (about 20 lbs. to be accurate) and I would start all over again and I just do not want to do that. I am the lucky one who has little issues living with an NJ tube day to day, no real pain, I forget its there most the time. Because of the NJ tube I am now able to eat orally without pain in my stomach (still have pain in my intestines) so my health has overall improved because of tube feeds and my NJ.

My GI’s and I’s goal is for me to reach 110 lbs. and then pull my tube and see how I do, if I start loosing weight I will re insert the NJ tube and basically play it by ear.

Thursday, February 20, 2014

The Grieving Process for a Chronic Illness and How to Overcome It

I woke up today to find that the Gastroparesis community on Facebook has lost another GP warrior. It makes me incredibly heartbroken that modern science has no cure for this yet. How many more people have to die before awareness can be spread?

On that note, I decided to write about the grieving process and how to overcome it with a chronic illness. Being told you have a chronic illness can be devastating and shocking, especially when you're told that your stomach will not work as it used to. Everyone goes through the grieving process - grieving for their life they'll never have again because chronic illness changes you. So, let's go through the grieving process together. That way, we can understand how to get through the process.



According to Judy Axelrod from Psych Central (LINK: http://psychcentral.com/lib/the-5-stages-of-loss-and-grief/000617)

The stages of mourning and grief are universal and are experienced by people from all walks of life. Mourning occurs in response to an individual’s own terminal illness or to the death of a valued being, human or animal. There are five stages of normal grief that were first proposed by Elisabeth Kübler-Ross in her 1969 book “On Death and Dying.”

In our bereavement, we spend different lengths of time working through each step and express each stage more or less intensely. The five stages do not necessarily occur in order. We often move between stages before achieving a more peaceful acceptance of death. Many of us are not afforded the luxury of time required to achieve this final stage of grief.

The death of your loved one might inspire you to evaluate your own feelings of mortality. Throughout each stage, a common thread of hope emerges: As long as there is life, there is hope. As long as there is hope, there is life.

Many people do not experience the stages in the order listed below, which is okay. The key to understanding the stages is not to feel like you must go through every one of them, in precise order. Instead, it’s more helpful to look at them as guides in the grieving process — it helps you understand and put into context where you are.



1. Denial and Isolation

The first reaction to learning of terminal illness or death of a cherished loved one is to deny the reality of the situation. It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain.



2. Anger

As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us. We feel guilty for being angry, and this makes us more angry.

Remember, grieving is a personal process that has no time limit, nor one “right” way to do it.

The doctor who diagnosed the illness and was unable to cure the disease might become a convenient target. Health professionals deal with death and dying every day. That does not make them immune to the suffering of their patients or to those who grieve for them.

Do not hesitate to ask your doctor to give you extra time or to explain just once more the details of your loved one’s illness. Arrange a special appointment or ask that he telephone you at the end of his day. Ask for clear answers to your questions regarding medical diagnosis and treatment. Understand the options available to you. Take your time.


3. Bargaining

The normal reaction to feelings of helplessness and vulnerability is often a need to regain control–

If only we had sought medical attention sooner…
If only we got a second opinion from another doctor…
If only we had tried to be a better person toward them…

Secretly, we may make a deal with God or our higher power in an attempt to postpone the inevitable. This is a weaker line of defense to protect us from the painful reality.



4. Depression

Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words. The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell. Sometimes all we really need is a hug.



5. Acceptance

Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.

Loved ones that are terminally ill or aging appear to go through a final period of withdrawal. This is by no means a suggestion that they are aware of their own impending death or such, only that physical decline may be sufficient to produce a similar response. Their behavior implies that it is natural to reach a stage at which social interaction is limited. The dignity and grace shown by our dying loved ones may well be their last gift to us.

Coping with loss is a ultimately a deeply personal and singular experience — nobody can help you go through it more easily or understand all the emotions that you’re going through. But others can be there for you and help comfort you through this process. The best thing you can do is to allow yourself to feel the grief as it comes over you. Resisting it only will prolong the natural process of healing.




The tricky part is, how do you overcome the grieving process with a chronic illness?

Therese J. Borchard, from Psych Central (LINK: http://psychcentral.com/blog/archives/2009/06/16/5-rules-for-living-with-chronic-illness-and-depression-an-interview-with-elivra-aletta/) has these tips for you to help you overcome the grieving process. There are five rules of living with a chronic illness:

1. Be confident you have the right doctor.

When you have CI your relationship with your doctor is second only to your spouse or your parents. Being honest (and you must be honest!) with that person means you need to be able to trust them to hear you. If you don’t have that kind of relationship get a second opinion. Shop around. In my CI career I fired three highly recommended specialists because they were jerks. Thankfully I’ve also had wonderful physicians who literally saved my life and my mind.


2. Define your circle of support carefully.

Isolation leads to depression and it is so easy to isolate when you feel lower then dirt. People may surprise you. Peripheral friends may step up and be terrific support while others you thought you could count on cave. If someone inside the circle asks, “How are you?” Tell them the truth. When someone outside the circle asks, lie, say, “I’m fine” and change the subject. Too often they can’t handle the truth and they suck any energy you have taking care of them. A patient of mine found her mother would get hysterical at any medical news so it was better to keep her at arms length.

If someone asks if they can help say yes. Accepting help is a gift to them. Trust that someday you will be on the giving end. My patient’s mother could do laundry for her and that made both of them happy. One big way someone can help is to go to doctor’s visits with you. The extra eyes and ears take the pressure off you when the news is emotionally laden and important, even if the news is good.


3. Protect your health as you would a small child.

You are more than your illness. That part of you that functions well needs you to advocate for it. Of course there are the basics of getting plenty of sleep, exercise and eating smart. In addition to all that I suggest learning a new set of signals that are your clues for when you’re wearing your health thin. For me it’s lowered ability to concentrate, tension in my neck and shoulders, irritability and loss of my usually dependable sense of humor. When those yellow lights are blinking, it’s time for me to stop, assess and make changes. When I ignored those signals I relapsed and looking back I can see where I ran the red lights. So be a fierce protector of your health. Set limits and find the courage to say ‘No’!


4. Create a new measuring stick.

Our self-esteem lies in the standards with which we measure ourselves as we go through life. To thrive with chronic illness, throw out the old and rethink your standards. If you are used to defining yourself by your 50-hour workweek, for instance, you may feel lousy about yourself because now you can’t manage it.

Finding a new standard can be tough. One technique I use with patients is to have them ask themselves what is reasonable? Is it reasonable to do it all yourself or is it more reasonable to delegate? Is it reasonable to register the kids in travel hockey or is it more reasonable to stay local? This is where a lot of courage is needed. Courage to address old pressures to be a certain way and to imagine value in doing things differently. In my own life and in my work I find that those who thrive despite chronic illness creatively find opportunity in their new reality.


5. Have dreams and strive for them!

You had ambitions to get a degree or promotion, to see the world or save it, to get married and have kids. Now you’re thinking, do I have to give that up? No, you don’t. It’s imperative for your spirit that you have goals for living, big and small.

What might change with the reality of chronic illness is the path and timing. I wanted to have kids and was told for years, ‘No.’ I had to adjust to the idea of life without kids or adopting. Then in my late thirties, my doctor said, go for it. After a scary, thrilling journey, today I have two thriving teenagers.

As we reach for the stars let’s appreciate the ground we stand on. Mindfulness has a real place in keeping depression at bay for everyone. Sometimes our dreams are right before our eyes.


To overcome grieving for a chronic illness, you must adjust to life with a chronic illness. Mary J. Yerkes, from Focus on the Family (LINK: http://www.focusonthefamily.com/lifechallenges/emotional_health/living_with_chronic_pain_and_illness/adjusting_to_life_with_chronic_illness.aspx) tells us how to adjust with life with a chronic illness so that we may be able to move on.

She writes,

Adjust to life with chronic illness?

It might seem counterintuitive, but according to experts, you can live a full and meaningful life despite having compromised health. Millions of people living with serious chronic conditions have used their struggles as a springboard for spiritual, relational and emotional growth. Many have gone on to launch new ministries, careers, and friendships.

"Eventually, you adjust to a new normal," explains Lisa Copen, founder of Rest Ministries, Inc™*, an organization that serves the chronically ill.

According to Copen, once you find the right doctor, medication and support, you can learn to cope successfully with your limitations—as long as you remember that you're not just dealing with your physical well-being; instead, you're learning to cast your relationships, emotional and spiritual health and physical health in a different light.
Adjusting Relationally

Couples should devote as much time to managing their relationship as they do to managing the illness, advises Deborah B. Dunn, Licensed Marriage and Family Therapist.

"Find a third-party, outside of the family, who is supportive, encouraging and able to help you process the changes," she says. "Don't let your illness define you or your marriage."

She also advises against telling children that "everything will turn out fine."

It may not.

"Don't make promises you can't keep," she says. "I've talked to so many children during the years who have gotten so angry with God because they think He fell down on the job. Be honest without being graphic."

Family relationships are not the only ones to suffer. Friends, co-workers, neighbors—even people from church, may not know how to respond to the "new" you. Some may reject you because they're uncomfortable with your physical or emotional pain.

Copen also advises relying on a confidant who understands what you're going through.

"If you're having trouble finding support at the local level, use the Internet to find the help and support you need. In addition to Rest Ministries*, organizations like Joni and Friends* and Dave Dravecky's Endurance* offer tools and practical resources to guide you."
Adjusting Emotionally

For many, healthy grieving, which includes periods of shock and numbness, denial, anger, disorientation, and intense emotional pain, is the greatest challenge. Experts say it is essential that you engage your grief reaction. If you do not, they warn, it will surface in other, more destructive ways.

Here's another important point experts want sufferers to remember: While, the "grieving timetable" is different for everyone, changes in your condition may provoke additional losses and seasons of mourning. That's why it is important to practice patience with yourself, eat well, get sufficient rest, express your feelings—journal, cry, sing, and talk to others about your pain.

Scott Twentyman, M.D., a practicing psychoanalyst in the Washington, D.C. area, urges the chronically ill to watch for signs of depression and to seek professional help when needed.

"Trouble sleeping, loss of appetite, weight gain or loss, loss of interest in activities that were previously enjoyable, lack of energy and certainly suicidal thoughts… all are indications of clinical depression."

And if you are depressed, don't rely on medication alone.

"Treatment for depression is more effective when medication is used in conjunction with therapy," says Dr. Twentyman.

Here are some additional tips that will help you adjust to life with chronic illness:

Educate yourself about your condition.
Recognize your limits and learn to say no.
Accept help from others.
Build fun into your life.
Focus your physical and emotional resources on those things that matter most.
Share your gifts and talents with others.

Facing the Future

One of the biggest fears those living with chronic illness face is about the future. While no one can predict it, the experiences others have faced can help it if we have to deal with chronic pain or illness.

Trish Robichaud lives with relapsing remitting multiple sclerosis and depression.

"My health challenges…have taken my life in a direction that I would never have gone with the illness."

After her diagnosis, Trish built a home-based business that gives her flexibility and allows her to manage her condition.

"It's been a blessing," says Trish, "and I thank God daily for where I'm at in life today."

Then there's Linda Aufrance. She suffers from Lupus, but she believes her health issues has taught them compassion and sensitivity for those who are hurting; it has had positive affects on her marriage.

"As hard as it has been, my illness has brought me and my husband closer," she says.

Trish and Linda still struggle with physical pain. Still, they live rich and meaningful lives. And so can you.

It can be difficult to see God's hand in our pain. But we can be confident that, in Christ, there is always hope for your future.



When you accept your chronic illness and realize your limitations, it's almost like a weight lifts off of your shoulders. You can then find ways to cope. With myself, I've joined support groups, started this blog, started groups and pages on FB to get my illness out there, and I've done fundraising for it. All of this has helped me cope with having a chronic illness. I've come to terms with the fact that I may never go out to eat with my friends any time soon, but I'm happy to know that my friends and family love me and care for me no matter what. Unconditional love is almost as good as a cure!




NOTE: If you are interested, I have a Facebook Page. I'm trying to reach 500 Likes. If you want motivation, inspiration, and just straight up positivity, here's the link: https://www.facebook.com/emilysstomach

Monday, February 17, 2014

How to Pass Time in a Hospital

So, I have been thinking about this a lot lately, how do people spend their time during long hospital stays? I was hospitalized last year for eight days straight and I thought I was going to go crazy. I probably would have without my laptop!

Therefore, I am going to help you come up with ideas to pass time in a hospital. If you have more suggestions than I was able to think of, please comment and post them so that I can update this list. I want to make sure our members have suggestions. Also, if you can think of things to do in a pediatric hospital, let me know. But, for now, this is the list for the adults who are hospitalized.




According to Carepages, LINK HERE: http://cms.carepages.com/CarePages/en/ArticlesTips/HelpfulTips/BetterYou/pass_the_time.html

"Staying busy can be strong medicine for someone facing a long or extended hospital stay. Here are some ideas to keep boredom at bay. Use them for yourself or suggest them to someone in need. These tips also work well for someone recovering at home.

Take an online class. Have you ever wanted to learn how to scrapbook or speak fluent Italian? Now’s your chance. The Internet has plenty of online resources. Here are a couple to get you started:

Learn to play an instrument. The therapeutic effects of music have long been established. Depending on your mobility and situation, strumming a guitar or even simply picking up a harmonica can both soothe and distract [side note: this may not be the best thing to do at a hospital around a lot of sick people trying to rest]

Play board games or cards. A heated game of good old-fashioned Monopoly or Scrabble can take everyone’s mind off things for a few hours. And a deck of cards can be enjoyed together or solo (hellooooo, Solitaire).

Start a website journal. CarePages.com (that’s us) makes it easy to create a free website to share your journey, post photos and stay in touch with everyone. Create a website in minutes. [I use www.blogger.com]

Write letters. There’s nothing quite like getting a hand-written letter in the mail. While email and texting are instant, the flavor and fragrance of a real letter can be priceless (not to mention the anticipation of letter opening). Now that you’ve got some time, why not put pen to paper? Don’t forget to say “write back.”

Load up on brain food. Sudoku and crossword puzzles can be found everywhere these days. And studies show brain exercisers can sharpen mental acuity and even ward off age-related illnesses such as Alzheimer’s.

Watch movies. If hospital cable doesn’t tantalize you, create your own entertainment by downloading and watching movies on a laptop or iPod. Portable DVD players do the trick, as well.

Decorate your hospital room. Many hospitals have “Art-Cart” programs that provide a rotating art collection from which patients can choose for their rooms. Inquire at your facility or help get a new program started. [I have done this during Easter and my nurses loved it]"



Here are the thoughts that I've gotten from members or thought of myself, without reading this list. I apologize for duplicates:

1. Make friends with other patients
2. Make phone calls and talk to friends
3. Play around on the Internet
4. Read the news
5. Read books
6. Do a crossword puzzle
7. Play board games
8. Play card games (like solitaire)
9. Play video games on your laptop
10. Have friends and family visit for a distraction
11. Bring your own clothes from home to change into because gowns are awful
12. Play games on an IPAD
13. Read your Kindle/Nook/etc
14. Walk around the hospital and get some exercise
15. Watch TV (but it always seems like nothing is ever on)
16. Connect with friends through Facebook/Social Media
17. Text your friends
18. Sleep through your hospital visit
19. Watch Netflix
20. Watch movies on Laptop
21. Decorate your hospital room
22. Listen to Music (with headphones, of course)
23. Make your own Youtube videos about your illness
24. Make and write your own blog about your experience in the hospital for others
25. Write reviews for the hospital nurses, doctors, and staff online
26. Talk to the x-ray tech and ask what’s the weirdest thing they’ve ever seen
27. Write stories, long or short
28. Write poetry
29. Play video games on your Nintendo 3DS
30. Skype with loved ones who can’t see you at the hospital
31. Complete a puzzle
32. Learn to knit



If you can think of anything I might have missed, please comment with a suggestion. I hope this will give you enough ideas to stay busy the next time you are hospitalized. I know that I will be loading up a to go bag!

Friday, January 10, 2014

The Gastroparesis Diet & Recipe Help/Ideas

Gastroparesis Diet for Delayed Stomach Emptying Link found: http://gicare.com/diets/gastroparesis-diet/

Author: Frank W. Jackson, M.D.


Below is a published paper by Dr. Jackson explaining the Gastroparesis diet. I know it's a *huge* change to make, especially since you could eat almost anything before GP. But, following the GP diet will help avoid those severe spasms and pain if you can stick to the diet.




Purpose

Gastroparesis is the medical term for delayed stomach emptying. During the process of digestion, the stomach must contract to empty itself of food and liquid. Normally, it contracts about three times a minute. This empties the stomach within 90-120 minutes after eating. If contractions are sluggish or less frequent, stomach emptying is delayed. This results in bothersome and sometimes serious symptoms, as well as malnutrition, because food is not being digested properly.

Gastroparesis may be caused by various conditions such as diabetes mellitus, certain disorders of the nervous system, or certain drugs. Often however, no cause can be found although a viral infection is suspected in some. Usually, the physician prescribes medication to stimulate the stomach to contract. The purpose of the gastroparesis diet is to reduce symptoms and maintain adequate fluids and nutrition. There are three steps to the diet.

STEP 1 DIET consists of liquids, which usually leave the stomach quickly by gravity alone. Liquids prevent dehydration and keep the body supplied with vital salts and minerals.

STEP 2 DIET provides additional calories by adding a small amount of dietary fat — less than 40 gm each day. For patients with gastroparesis, fatty foods and oils should be restricted, because they delay stomach emptying. However, patients at the Step 2 level are usually able to tolerate this amount.

STEP 3 DIET is designed for long-term maintenance. Fat is limited to 50 gm per day, and fibrous foods are restricted, because many plant fibers cannot be digested.



Nutrition Facts

The STEP 1 Gastroparesis Diet is inadequate in all nutrients except sodium and potassium. It should not be continued for more than three days without additional nutritional support. STEP 2 and STEP 3 Gastroparesis Diets may be inadequate in Vitamins A and C, and the mineral iron. A multivitamin supplement is usually prescribed.


Special Considerations

Diets must be tailored to the individual patient. This is because the degree of gastroparesis may range from severe and long-standing to mild and easily corrected. Patients may also have various medical conditions to be considered. For example, diabetes patients with gastroparesis are allowed sugar-containing liquids on the Step 1 diet, because that is their only source of carbohydrate. On the Step 2 and Step 3 diets, these patients should avoid concentrated sweets. These are noted with an asterisk (*) on the food lists.





On all of the diets, liquids and food should be eaten in small, frequent meals. This helps to maintain nutrition.




Step 1 Food Groups


The Following are Acceptable:

Milk & milk products: Avoid All

Vegetables: Avoid All

Fruits: Avoid All

Breads & grains: only allowed plain saltine crackers, avoid all others

Meat or meat substitutes: Avoid All

Fats & oils: Avoid All

Beverages: Gatorade and soft drinks (sipped slowly throughout the day) and avoid all others

Soups: fat-free consommé and bouillon and avoid all others


Sample Menu Step 1

Breakfast
Gatorade 1/2 cup
ginger ale 1/2 cup
bouillon 3/4 cup
saltine crackers 6


Lunch
Gatorade 1/2 cup
Coke 1/2 cup
bouillon 3/4 cup
saltine crackers 6


Dinner
Gatorade 1/2 cup
Sprite 1/2 cup
bouillon 3/4 cup
saltine crackers 6

This Sample Diet Provides the Following:

Calories 790 Fat 9 gm
Protein 11 gm Sodium 3531 mg
Carbohydrates 156 gm Potassium 244 mg


Step 2 Food Groups

The Following are Acceptable:

Milk & milk products skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses whole milk products, creams (sour, light, heavy, whipping), half & half,

Soups fat-free consommé & bouillon, soups made from skim milk, & fat-free broths containing pasta or noodles and allowed vegetables soups made with cream, whole milk, or broths containing fat,

Bread & grains breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers oatmeal; whole grain rice, cereal, bread

Meat & meat substitutes eggs, peanut butter (maximum 2 Tbsp/day) beef; poultry; fish; pork products; dried beans, pea, & lentils

Vegetables vegetable juice (tomato, V-8); well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summer squash, strained tomato sauce, yams) all raw vegetables; cooked vegetables with skins; beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini

Fruits apple juice, cranberry juice, grape juice, pineapple, prune juice, canned fruits without skins (applesauce, peaches, pears) citrus juices, all fresh and dried fruits, canned fruits with skins (apricots, cherries, blueberries, fruit cocktail, oranges, grapefruit, pineapple, plums, persimmons)

Fats & oils any type of fat, but only in small amounts none

Sweets & desserts* hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups high-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves

Beverages Gatorade*, soft drinks* (sipped slowly throughout the day) all others, except allowed juices
*Concentrated sweets


Sample Menu Step 2

Breakfast
skim milk 1/2 cup
poached egg 1
white toast slice
apple juice 1/2 cup


Lunch
mozzarella cheese
2 oz
saltine crackers 6
chicken noodle soup 3/4 cup
Gatorade 1/2 cup


Dinner
peanut butter 1 Tbsp
saltine crackers 6
vanilla pudding
1/2 cup
grape juice 1/2 cup


Morning Snack
ginger ale 1/2 cup
canned pears 1/2 cup


Afternoon Snack
skim milk 1/2 cup
cornflakes 1/2 cup
sugar 2 tsp

Evening Snack
frozen yogurt 1/2 cup
saltine crackers 6

This Sample Diet Provides the Following
Calories 1343 Fat 35 gm
Protein 52 gm Sodium 2639 mg
Carbohydrates 206 gm Potassium 1411 mg



Step 3 Food Groups


The Following are Acceptable:

Milk & milk products skim milk, products made with skim milk, low-fat yogurt, low-fat cheeses whole milk products, creams (sour, light, heavy, whipping), half & half

Soups fat-free consommé & bouillon, soups made from skim milk, & fat-free broths containing pasta or noodles and allowed vegetables soups made with cream, whole milk, or broths containing fat

Fruits fruit juices, canned fruits without skins (applesauce, peaches, pears) all fresh & dried fruits, canned fruits with skins (apricots, cherries, plums, blueberries, fruit cocktail, oranges, grapefruit, pineapple, persimmons)
Meat & meat substitutes eggs, peanut butter (2 Tbsp/day), poultry, fish, lean ground beef fibrous meats (steaks, roasts, chops), dried beans, peas, lentils

Fats & oils any type of fat, but only in small amounts none

Breads & grains breads & cereals, cream of wheat, pasta, white rice, egg noodles, low-fat crackers oatmeal; whole grain rice, cereal, bread

Vegetables vegetable juices (tomato V-8), well-cooked vegetables without skins (acorn squash, beets, carrots, mushrooms, potatoes, spinach, summers quash, strained tomato sauce, yams) all raw vegetables; cooked vegetables with skins: beans (green, wax, lima), broccoli, Brussels sprouts, cabbage, cauliflower, celery, corn, eggplant, onions, peas, peppers, pea pods, sauerkraut, turnips, water chestnuts, zucchini

Sweets & desserts* hard candies, caramels, puddings & custards made from skim milk, frozen yogurt, fruit ice, gelatin, ice milk, jelly, honey, syrups high-fat desserts (cakes, pies, cookies, pastries, ice cream), fruit preserves

Beverages Gatorade*, soft drinks* (sipped slowly throughout the day), coffee, tea, water (note: non-caloric beverages should be limited if patient cannot maintain adequate caloric intake) all others, except allowed juices
*Concentrated sweets



Sample Menu Step 3


Breakfast
skim milk 1/2 cup
cream of wheat 1/2 cup
sugar 2 tsp
orange juice 1/2 cup
white toast 1 slice
margarine 1 tsp
jelly 1 Tbsp


Lunch
tuna fish 2 oz
low-fat mayonnaise 2 Tbsp
white bread 2 slices
canned peaches 1/2 cup
Gatorade 1/2 cup


Dinner
baked chicken 2 oz
white rice 1/2 cup
cooked beets 1/2 cup
dinner roll 1
skim milk 1/2 cup
margarine 2 tsp


Morning Snack
low-fat yogurt
1/2 cup
Sprite 1/2 cup



Afternoon Snack
chocolate pudding
1/2 cup
gingerale 1/2 cup


Evening Snack
ice milk 1/2 cup
pretzels 2

This Sample Diet Provides the Following:
Calories 1822 Fat 42 gm
Protein 75 gm Sodium 2234 mg
Carbohydrates 286 gm Potassium


According to LiveStrong, the link is HERE: http://www.livestrong.com/article/408015-foods-you-can-eat-when-you-have-gastroparesis/#ixzz2PjiAmh3D

"Gastroparesis is a condition in which food is delayed in emptying from your stomach into your small intestine. According to a 2008 article in "The Medscape Journal of Medicine," 4 percent of the United States population experiences symptoms of gastroparesis, which include nausea, vomiting, abdominal pain and bloating, weight loss, acid reflux and early satiety. Uncontrolled blood sugar with diabetes is often the cause of gastroparesis but intestinal surgery, Parkinson's disease, multiple sclerosis and other unknown causes contribute to the development of this condition. Treatment involves medication to stimulate stomach emptying and a diet that helps manage gastroparesis symptoms.


Meal Patterns

With slow stomach emptying, the amount of food you eat during a meal can trigger gastroparesis symptoms if you are not careful. Eat a balanced diet, broken down into six small meals throughout the day. Sitting up at meals and walking between meals will also help with digestion and increase your appetite for the next meal. If weight loss or maintenance is a concern, be sure you are eating enough or consider adding additional small meals during the day.


Low-Fat Foods

The amount of fat in your meals can further delay stomach emptying. Low-fat meals are recommended for better tolerance. Meat is a good source of protein, but can be high in fat. Choose lean cuts and remove any visible fat during meal preparation. Poultry, lean ground beef, fish and eggs are good diet choices. Milk, yogurt and cheese are rich in protein, calcium and vitamin D, but can also be high in fat. Pick low-fat versions for easier digestion. Added butter, margarine, sour cream, oils and salad dressings can contribute a lot of fat to your diet. Use this group sparingly and instead flavor foods with natural herbs and seasonings.


Dietary Fiber

While fiber is important for bowel health, a high fiber diet may exacerbate gastroparesis symptoms. Low fiber foods are better tolerated. Stick with white bread, rice and pasta. Read cereal labels and choose low fiber versions. Fruits and vegetables can be included in your diet, but stick with low fiber choices such as applesauce, canned peaches, tangerines, skinned potatoes, zucchini, lettuce and celery. Once your gastroparesis symptoms improve, you may incorporate more fiber foods in your diet with caution. Start with very small amounts to determine if you are able to tolerate any of these foods.


Carbohydrates and Concentrated Sweets

Managing your blood sugar level and being aware of the carbohydrates in your diet is important if diabetes is the cause of your gastroparesis. Carbohydrate sources include breads and grains, fruit and fruit juices, dairy, vegetables, sweets and desserts and some beverages. Be consistent with the amount of carbohydrates you are eating and the timing of your meals. Reading labels is helpful to identify the serving size and carbohydrate amount in your foods. Avoid a lot of sweets and desserts with added sugar and fat like cake, cookies and brownies. Instead choose low-fat cake or pudding which can help control your intake of sugar and fat."


For any more guidance or help with the diet, please visit: http://attachment.fbsbx.com/file_download.php?id=166937710179851&eid=ASvAlblP21aLoXUqJ0hQVstmFw63qF94GOkRyL2X9KHhmNmV4mee_We3Q421G85FG14&inline=1&ext=1389409563&hash=ASvp6Agd3yDl4V3r


If you are traveling with Gastroparesis, please refer to below:



Recipe Ideas and Help on Pinterest

I have a board on Pinterest that my GP friends and I post GP friendly recipes to. Please check it out. As always, be careful because some people can tolerate things better than others. You know your body better than anyone else and what you can tolerate and what you cannot. Please keep that in mind when browsing recipes. However, there are lots of "GP friendly" recipes on our board that will give you some ideas about what to make for yourself. Changing your diet can be tough, especially when most of us don't feel like eating most of the time. However, my GI recently told me to try and eat small meals as often as I can, because it gives your gut a work out, so that your gut will move things through. If you are interested in helping pin Gastroparesis Friendly Recipes to the collaborative board, leave me a comment and I'll contact you. Having help really does help me and it helps others.

For recipe ideas and help, please visit my Pinterest Board at: http://www.pinterest.com/chikensrule/gastroparesis-friendly-recipes/

Saturday, December 21, 2013

Ovarian Cyst on Top of Gastroparesis

I went to the emergency room tonight because not only do I have an allergic reaction from adhesive tape and/or latex, but now I have a right ovarian cyst.

The allergic reaction happened after the doctor removed my Impanon. He put a strip of tape on my arm to stop the bleeding that I wasn't supposed to take off for another two days. However, I removed it when I saw this reaction:

My allergic reaction.

It was bothering me and really burning, so I called the doctor and sent him a picture on my cell phone. He wanted me to come to his other office today (more than an 1 & 1/2 away) but I wouldn't make it before he closed. I was in so much pain and I thought it was from the procedure yesterday. After I sent him the picture and waited a bit, he called me back to tell me to go to the Emergency Room.

We got there at 6pm and left at 1:30am. I thought I was going to die of boredom after my Kindle died. I didn't think to bring my charger and my husband tried his best to distract me. The nurse came in and gave me morphine and steroids in my IV. At least they got my IV on the first try but I would have loved to see my labs.

They came and got me for an ultrasound - regular and vaginal. I made them call my doctor because I didn't know if I could have the latter yet but he OK'ed it. It HURT like hell. They stopped and made me empty my bladder, so I went until I couldn't go anymore and went back in for the pelvic. That made me want to cry and jump off the table. This was around 12am, so my morphine had worn off. It was like torture and usually ultrasounds aren't bad. When they finished, they told me that the doctor would take 30 minutes to get the results.

When we got to my room, I waited more. The nurse came in and gave me Toradol, which helped with the cramping day before yesterday. Then, the doctor finally came in. He told me that I had an ovarian cyst on my right ovary and that my GYN will see me on Monday. I've seen my GYN twice this week, I should just put a cot in his office. So, I'm going Monday to see the doctor. I have an ovarian cyst on top of Gastroparesis now. I just want to scream!

The ER Doctor gave me prescriptions for codeine and for steroids. I put cortisone on the allergic reaction to speed up healing a bit.

Information about ovarian cysts can be found here: http://www.mayoclinic.com/health/ovarian-cysts/DS00129

You can read it here:

Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. Women have two ovaries — each about the size and shape of an almond — located on each side of the uterus. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during your childbearing years.

Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months.

However, ovarian cysts — especially those that have ruptured — sometimes produce serious symptoms. The best ways to protect your health are to know the symptoms that may signal a more significant problem, and to schedule regular pelvic examinations.


Symptoms:

Most cysts don't cause any symptoms and go away on their own. A large ovarian cyst can cause abdominal discomfort. If a large cyst presses on your bladder, you may feel the need to urinate more frequently because bladder capacity is reduced.

The symptoms of ovarian cysts, if present, may include:

Menstrual irregularities

Pelvic pain — a constant or intermittent dull ache that may radiate to your lower back and thighs

Pelvic pain shortly before your period begins or just before it ends

Pelvic pain during intercourse (dyspareunia)

Pain during bowel movements or pressure on your bowels

Nausea, vomiting or breast tenderness similar to that experienced during pregnancy

Fullness or heaviness in your abdomen

Pressure on your rectum or bladder that causes a need to urinate more frequently or difficulty emptying your bladder completely



When to see a doctor:

Seek immediate medical attention if you have:

Sudden, severe abdominal or pelvic pain

Pain accompanied by fever or vomiting

These signs and symptoms — or those of shock, such as cold, clammy skin, rapid breathing, and lightheadedness or weakness — indicate an emergency and mean that you need to see a doctor right away.


Treatment:

Treatment depends on your age, the type and size of your cyst, and your symptoms. Your doctor may suggest:

Watchful waiting. In many cases you can wait and be re-examined to see if the cyst goes away on its own within a few months. This is typically an option — regardless of your age — if you have no symptoms and an ultrasound shows you have a small, fluid-filled cyst. Your doctor will likely recommend that you get follow-up pelvic ultrasounds at periodic intervals to see if your cyst has changed in size.

Birth control pills. Your doctor may recommend birth control pills to reduce the chance of new cysts developing in future menstrual cycles. Oral contraceptives offer the added benefit of significantly reducing your risk of ovarian cancer — the risk decreases the longer you take birth control pills.

Surgery. Your doctor may suggest removal of a cyst if it is large, doesn't look like a functional cyst, is growing, or persists through two or three menstrual cycles. Cysts that cause pain or other symptoms may be removed.

Some cysts can be removed without removing the ovary in a procedure known as a cystectomy. In some circumstances, your doctor may suggest removing the affected ovary and leaving the other intact in a procedure known as oophorectomy.

If a cystic mass is cancerous, however, your doctor will likely advise a hysterectomy to remove both ovaries and your uterus. Your doctor is also likely to recommend surgery when a cystic mass develops on the ovaries after menopause.




Brief drawing of the cyst that I have. Image found: http://www.mayoclinic.com/images/image_popup/r7_follicularovary.jpg




According to http://www.medicinenet.com/ovarian_cysts/article.htm#what_is_the_ovary_and_what_are_ovarian_cysts

Ovarian cysts facts:

Ovarian cysts are closed, sac-like structures within the ovary that are filled with a liquid or semisolid substance.

Ovarian cysts form for numerous reasons.

Pain in the abdomen or pelvis is the most common symptom of an ovarian cyst, but most are asymptomatic.

Most cysts are diagnosed by ultrasound or physical exam.

The treatment of an ovarian cyst depends upon its likely diagnosis and varies from observation and monitoring to surgical treatment.


What is the ovary and what are ovarian cysts?

The ovary is one of a pair of reproductive glands in women that are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of a walnut. The ovaries produce eggs (ova) and female hormones estrogen and progesterone. The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. They also regulate the menstrual cycle and pregnancy. Ovarian cysts are closed, sac-like structures within an ovary that contain a liquid, gaseous, or semisolid substance. "Cyst" is merely a general term for a fluid-filled structure, which may or may not represent a tumor or neoplasm (new growth). If it is a tumor, it may be benign or malignant. The ovary is also referred to as the female gonad.



What causes ovarian cysts?

Ovarian cysts form for numerous reasons. The most common type is a follicular cyst, which results from the growth of a follicle. A follicle is the normal fluid-filled sac that contains an egg. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg. Usually, follicular cysts resolve spontaneously over the course of days to months. Cysts can contain blood (hemorrhagic cysts) from leakage of blood into the egg sac.

Another type of ovarian cyst that is related to the menstrual cycle is a corpus luteum cyst. The corpus luteum is an area of tissue within the ovary that occurs after an egg has been released from a follicle. If a pregnancy doesn't occur, the corpus luteum usually breaks down and disappears. It may, however, fill with fluid or blood and persist as a cyst on the ovary. Usually, this cyst is found on only one side, produces no symptomsand resolves spontaneously.

Endometriosis is a condition in which cells that normally grow inside as a lining of the uterus (womb), instead grow outside of the uterus in other locations. The ovary is a common site for endometriosis. When endometriosis involves the ovary, the area of endometrial tissue may grow and bleed over time, forming a blood-filled cyst with red- or brown-colored contents called an endometrioma, sometimes referred to as a chocolate cyst or endometrioma. The condition known as polycystic ovarian syndrome (PCOS) is characterized by the presence of multiple small cysts within both ovaries. PCOS is associated with a number of hormonal problems and is the most common cause of infertility in women.

Both benign and malignant tumors of the ovary may also be cystic. Occasionally, the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. Cysts with these abnormal tissues are really tumors called denign cystic teratomas or dermoid cysts.

Infections of the pelvic organs can involve the ovaries and Fallopian tubes. In severe cases, pus-filled cystic spaces may be present on or around the ovary or tubes. These are known as tubo-ovarian abscesses.



How are Ovarian Cysts Treated:

Most ovarian cysts in women of childbearing age are follicular or corpus luteum cysts (functional cysts) that disappear naturally in one to three months, although they can rupture and cause pain. They are benign and have no long-term medical consequence. They may be diagnosed coincidentally during a pelvic examination in women who do not have any related symptoms. All women have follicular cysts at some point that generally go unnoticed.

Ultrasound is useful to determine if the cyst is simple (just fluid with no solid tissue, suggesting a benign condition) or compound (with solid components that often required surgical resection).

In summary, the ideal treatment of ovarian cysts depends on what the cyst is likely to be. The woman's age, the size (and any change in size) of the cyst, and the cyst's appearance on ultrasound to help determine the treatment. Cysts that are functional are usually observed unless they rupture and cause significant bleeding, in which case, surgical treatment is required. Benign and malignant tumors require operation.

Treatment can consist of simple observation, or it can involve evaluating blood tests such as a CA-125 to help determine the potential for cancer (keeping in mind the many limitations of CA-125 testing described above).

The tumor can be surgically removed either with laparoscopy,, or if needed, an open abdominal incision (laparotomy) if it is causing severe pain, not resolving, or if it is suspicious in any way. Once the cyst is removed, the growth is sent to a pathologist who examines the tissue under a microscope to make the final diagnosis as to the type of cyst present.




What are the risks of ovarian cysts during pregnancy?

Ovarian cysts are sometimes discovered during pregnancy. In most cases, they are an incidental finding at the time of routine prenatal ultrasound screening. The majority of ovarian cysts found during pregnancy are benign conditions that do not require surgical intervention. However, surgery may be indicated if there is a suspicion of malignancy, if an acute complication such as rupture or torsion (twisting of the cyst, disrupting the blood supply) develops, or if the size of the cyst is likely to present problems with the pregnancy.

Medically reviewed by Edmund Petrilli, MD; American Board of Obstetrics and Gynecology with subspecialty in Gynecologic Oncology
REFERENCE: eMedicine.com. Ovarian Cysts.
http://emedicine.medscape.com/article/255865-overview

Previous contributing author: Carolyn Crandall, MD, FACP




Friday, December 20, 2013

Essure Permanent Birth Control and ThermaChoice

Yesterday, I had my procedure for essure permanent birth control control done. I have decided to have my tubes tied, and this is a big decision for me. After years of begging for the doctor's permission to tie my tubes, because of my endometrosis and ovarian cysts. But, the doctors decided, albeit probably correctly, that I was too young.

However, on the 17th, my doctor finally recommended it. The best thing of all was that I had no copay! It was covered completely! I also want to mention that I've lost 30 pounds since July of 2013 when I went into the doctor's office.

He suggested Essure. To read more about it please click here: http://www.mwobg.com/services-procedures/library/how-essure-works

He suggested ThermaChoice in addition. To read more about it please click here: http://www.pelvichealthsolutions.com/thermachoice-expectation

I never planned on having children, so if I decide to have a baby later, I will adopt. I've come to peace with that. I just want some of this pain to end. I deal with enough pain in my stomach and digestive system, if I can get rid of the pain in my reproductive system, I might have sort of a chance to leave a better life with this procedure.

Gastroparesis seems to make the endometrosis worse, so if I can eliminate some of that pain, that would be amazing. Additionally, to get me ready for the procedure so I wouldn't feel any pain, he gave me two dilaudid, a valium, toradol, and a nerve block. I felt pressure but not a whole lot of pain.




According to Planned Parenthood's website, they describe the Essure procedure and benefits:

Permanent contraception (sterilization) is the most common form of birth control for women over the age of 30 and the second most common birth control method for all women of child-bearing age.

Essure offers women whose families are complete a proven and easy birth control choice that doesn’t require incisions, hormones or slowing down to recover. Women who choose Essure never have to worry about birth control again – no daily pill, no side effects, no quick trips to the pharmacy.

We are pleased to offer Essure, a permanent birth control procedure that works with your body to create a natural barrier to prevent pregnancy. The Essure procedure offers women benefits that no other permanent birth control can.



The Benefits of Essure:

Surgery-free

During the procedure, the Essure inserts are placed in the fallopian tubes through the natural pathways of the vagina and cervix, with no incisions and no surgery.

Hormone-free

Unlike many temporary methods of birth control, the Essure inserts do not contain hormones. Therefore, they will not interfere with your monthly cycle nor cause the side effects that many women experience with hormone-related birth control.

Virtually recovery-free

Following the Essure procedure, most women return to their normal activities in less than a day.
Most effective

Essure is proven to be the most effective permanent birth control available, based on five years of clinical data.
Trusted

More than half a million women have chosen Essure as their permanent birth control since 2002. Additionally, the Essure inserts are made from the same proven materials that have been used in heart stents for many years.


What to Expect:

During the procedure, your doctor will slide small, soft inserts through the natural pathways of your vagina and cervix into your fallopian tubes. No incisions are necessary, and this process typically takes less than 10 minutes. The inserts are designed to allow your doctor to see immediately that they have been properly placed. Anesthesia is not required for the procedure, although some doctors may offer it. Some women report mild discomfort or cramping during or after the procedure that is similar to a normal monthly cycle. Most women go home within 45 minutes of having the Essure procedure, and return to normal activities in less than a day.

Over the next three months, your body works with the Essure inserts to form a natural barrier within your fallopian tubes. These barriers prevent sperm from reaching the eggs so that pregnancy cannot occur. During this time, you and your partner will need to continue to use another form of birth control.

You will continue to have a regular menstrual period, but some women who have had the Essure procedure find that their period changes afterward, becoming slightly lighter or heavier. These changes may be due to discontinuing hormone-based birth control, such as the Pill, and returning to your normal cycle. Your ovaries will continue to release eggs, but they will be absorbed through your body’s normal process.

That’s it! Now you can focus on yourself, your family and the life you have created, with the confidence that you are protected from unplanned pregnancy.

Like all permanent birth control procedures, the Essure procedure is not reversible. You should make sure you do not want to get pregnant in the future.

The Wikipedia article for Essure can be found here: http://en.wikipedia.org/wiki/Essure

He also gave me a shot of Depo Provera, so I would be covered until things heal over.



ThermaChoice

This is a procedure the doctor is going to do for me in three months. He wants to make sure that the Essure procedure has completely blocked off before he does this.

You can read about it more at this link (http://www.pelvichealthsolutions.com/thermachoice-expectation but this is what the website says,

GYNECARE THERMACHOICE® Uterine Balloon Therapy with Fluid Circulation offers an effective, nonhormonal treatment for heavy periods, also known as menorrhagia. GYNECARE THERMACHOICE® is a minimally invasive, 8-minute procedure that can be performed in your doctor's office or in a hospital. What happens during the procedure? GYNECARE THERMACHOICE® uses a method called global endometrial ablation (GEA) to remove the endometrium, the lining of the uterus (womb).

Under local anesthesia, the doctor inserts a small silicone balloon into your uterus, which is filled with fluid and then gently heated to treat the lining of your uterus. No incision is required. You may feel a slight warmth or pressure during the treatment time, which is 8 minutes; the entire appointment usually lasts approximately 30 minutes. See step by step how GYNECARE THERMACHOICE® works.

In most cases, patients can resume their normal activities the next day.



What happens after the procedure?

The first postoperative check-up usually occurs within 7 to 10 days after the procedure, and your doctor may determine that sexual activity can resume after that check-up. Your first few periods after the procedure may continue to be heavy, with improvement thereafter. Some women experience a pinkish watery discharge for about 2 weeks that can last as long as 1 month.

All medical procedures carry risks. Talk to a doctor to determine whether GYNECARE THERMACHOICE® might be the right choice for you. Find a doctor familiar with GYNECARE® products who can provide treatment.
What are the risks with GYNECARE THERMACHOICE®?

All medical procedures present risks, so talk to a doctor about whether GYNECARE THERMACHOICE® is right for you. Find a doctor familiar with GYNECARE® products who can provide treatment.

As with all procedures of its type, GYNECARE THERMACHOICE® poses a risk of injury to the uterus and surrounding tissues. Most common side effects include discharge, cramping, nausea and vomiting.

Global endometrial ablation procedures, including GYNECARE THERMACHOICE® III Uterine Balloon Therapy System, are intended for pre-menopausal women with heavy bleeding due to benign causes who do not wish to become pregnant in the future. It is not appropriate for a patient who is pregnant or wants to become pregnant in the future. Becoming pregnant after this procedure can be dangerous for both the mother and the fetus.

Pregnancy after ablation is unlikely, but if it does occur, you and your baby could be at risk because the endometrial lining of the uterus has been removed. After treatment, you will need to continue to use a birth control method that is appropriate for you. There are several options available for birth control. You should discuss these options with your doctor.

For a complete description of risks related to this treatment, please see the Potential Adverse Effects section of the Risk Information.

The information represents no statement, promise or guarantee by Ethicon, Inc., concerning insurance coverage, levels of reimbursement, payment, or charge. Please consult your payor organization with regard to local or actual coverage determination processes.


This will get rid of my painful periods permanently. That would be amazing because they hurt and are erratic. So, I will be sterile with no periods, but I get to keep my ovaries so I don't need hormone replacements. This was a tough decision for me but I knew I could never carry kids to term. So, I figured that this would help the pain. And I need all of the help I can get with pain because Gastroparesis causes enough pain in itself.

So, I am very happy and a little sad, but I'll be OK. I think I've done the best possible thing that I could do for me and wanted to write about it because I had never heard of these procedures before.



Disclamier

My friend Stephanie wrote this for her group and I figured it was applicable to this site as well.

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