A Woman's Guide to a Healthy Stomach. Jacqueline Wolf
her on Remicade—a potent drug that suppresses an inflammatory substance called tumor necrosis factor.
Importantly, medications given to Susan by physicians played a major role in Susan’s gastrointestinal illnesses. The Clindamycin, an antibiotic, likely caused the bloody diarrhea by inducing a Clostridia difficile infection, which was responsible for the bloody diarrhea. Nonsteroidal anti-inflammatory medications (NSAIDs), like aspirin, ibuprofen and naproxen, can also cause colitis. It would appear that one physician did not know what another physician had done. Susan tried to ask the right questions. She was more knowledgeable than most women, since she worked in the medical field. However, she wasn’t calling the shots—her doctors were. And her questions were rebuffed.
For doctors, it’s an easy trap to fall into. Once a diagnosis is given, it is often difficult to get that diagnosis changed. It’s often easier to fit symptoms into that diagnosis if they seem to “mostly” fit rather than embark on an evaluation for a possible new diagnosis. When all the results don’t fit—like in Susan’s case—a new way of looking at the old and new problems has to happen. Susan tried to foster that way of thinking. However, the sicker she became and the more she was told she had to live with her problems, the more despondent and hopeless she grew. Some of her symptoms were not typical for endometriosis, and this led her doctors astray. Susan was misdiagnosed and on drugs she shouldn’t have been on, and that caused side effects. I was at least able to correct the Crohn’s misdiagnosis, take her off unnecessary drugs that could have caused substantial side effects and refer her to a doctor who could take care of her problem.
The moral of this story is be vigilant—you know your body best. If something feels wrong, say so. If you’re left with more questions than answers after a doctor’s visit, speak up. Get a second opinion.
WHAT YOU NEED TO KNOW ABOUT ENDOMETRIOSIS:
1. Endometriosis is a condition in which the lining of the uterus takes up residence outside of its proper location.
2. It is common in women.
3. It often mimics common gastrointestinal conditions, such as irritable bowel syndrome.
4. Many health-care providers are not adequately informed about endometriosis. Be your own advocate—ask whether you could have it.
5. It is difficult to diagnose with standard radiology tests and often requires an examination with a scope inside the pelvis or abdomen (laparoscopy).
6. There are both medical and surgical treatments for the condition, but recurrence is high if a woman still has her ovaries.
7. It is associated with an increased difficulty to conceive, but endometriosis seems to improve during pregnancy.
Chapter 3
“Do These Pants Come with an Elastic Waist?” The Truth about Gas, Bloating and Irritable Bowel Syndrome
“My philosophy on dating is just to fart right away.”
—Jenny McCarthy
This chapter chronicles what happens when we can’t fit into our pants, when gas escapes at inopportune times, when we have to beeline for the bathroom during an important meeting. We’ve all been there. But why does it happen? And, you’re asking, why does it happen to me? After all, body odor is repellent, bizarre and unpleasant—especially for women. She might be gorgeous, smart and hilarious, but if she smells strange, well…all bets are off. Men, on the other hand, are sometimes allowed to smell rugged and musky. Guys work out and smell “ripe,” and that’s okay, maybe even alluring. Not so for women. So pity the poor woman who does suffer from regular flatulence. This is a mortifying situation, leading to low self-esteem and isolation, or at least complete humiliation.
In this chapter we’ll meet Elizabeth, a thirty-seven-year-old art student who went to dozens of doctors in her quest to figure out why she was, in her words, a “gas factory.” Her story is representative of those of many women I see—IBS can destroy a woman’s life. By the time I met her, Elizabeth’s sex life was lousy, her self-esteem was shot, and she’d been spending money running from specialist to specialist, who prescribed everything from antidepressants to antispasmodic drugs, when indeed she had irritable bowel syndrome. She was beginning to think she was crazy.
Elizabeth hardly seemed like a crazy, smelly woman: fragile and birdlike, weighing just one hundred pounds, she was pursuing a graduate degree in sculpture, which had been consistently derailed thanks to her ongoing stomach issues. By the time I met her, she had quit school and couldn’t work. She told me that she had been “gassy” for as long as she could remember. She grew up in a traditional Asian home, where she suffered from frequent abdominal pain and the inability to control her gas. Her parents were mystified and ashamed—gassiness, in their opinion, was not an especially feminine trait. Her dad took to addressing her as “You, smelly girl!” and went so far as to tell her she mustn’t be a girl, since she passed so much gas. “No man will ever want you like this,” he told her.
Of course, this instilled a deep sense of unworthiness and translated into difficulty in intimate relationships. She spent her high school years isolating herself for fear of rejection. “I feel like my childhood and formative years were spent in the bathroom or in search of a bathroom,” she told me when we first met. She also experienced a great deal of pain on a daily basis, which prevented her from connecting emotionally and participating in activities with her peers. Elizabeth’s life, it seemed, had been defined by an ongoing waltz of pain and shame.
Elizabeth was seen by a physician, who brusquely told her to take a tranquilizer and see a psychiatrist. The psychiatrist helped her cope with some of her emotional baggage, but the sessions did nothing to relieve her symptoms. And what awful symptoms they were. She had severe, often debilitating pain and cramps in the abdomen and severe rectal spasms. These gave her the feeling that she needed to run to the bathroom to pass stool or gas, even if there was nothing to pass. She would end up in the bathroom all day, almost every day. This rendered her more or less housebound.
“Every day my main concern is, ‘Uh-oh, do I have to run to the bathroom? Can I leave the house for ten minutes?’ Wherever I go, I need to make sure I have easy access to a bathroom. At lectures I can hardly focus on what’s going on. I’m plotting my escape route. Or else I show up late because I’ve been in the bathroom,” she told me. At night she’d bolt awake with severe pain and rectal spasms, often spending hours on the toilet.
“I have trouble holding onto relationships because of this,” she said wryly. “But I have great relationships with every bathroom in town.” She did have a long-term boyfriend, but he was beginning to get fed up, too. It was hard for him to enjoy going anywhere with her when she was so clearly filled with dread about leaving the house. “I’m constantly preoccupied, and he’s angry,” she said. “My quality of life is in the gutter. My boyfriend is getting annoyed, and I’m not getting any sympathy from physicians. They think I’m exaggerating. It makes me not want to be around other people at all.” She had begun to feel completely desexualized and had stopped having sex entirely. I felt immense empathy for this young woman whose life had clearly ground to a halt.
When I first met her, she was being treated with the antispasmodic medications belladonna and phenobarbital. She said the belladonna and phenobarbital helped a little, but only if she was not under stress. Stress made all her symptoms worse. Without the belladonna, she felt like she was a gas factory. She had to belch or “fart,” or she would get a pressure in her stomach and lower belly. “I know how bad I must smell,” she admitted to me.
Elizabeth was also coping with heartburn, despite the fact that she wisely avoided coffee, onions, mint and other irritants. Even a few bites of a totally bland food, like pudding, would make her feel full and give her heartburn. I suspected IBS and supplemented her medications with Pepto-Bismol, and for her heartburn she was given a prescription for pantoprazole, a proton pump inhibitor that stops acid. With some relief, she left my office.
Over the next month her upper abdominal pain and heartburn improved. However, in spite of the belladonna and phenobarbital, she had rectal