Gastroparesis- Monday Zebra

Condition- Gastroparesis

Pronunciation- Gas-trow-pah-re-sus

Rarity- not rare

Difficulty in Diagnosis- mixed, while there is a test to diagnose this condition, finding a doctor that will know to test for it can be difficult.

     Gastropasresis, also known as delayed gastric emptying, is a medical condition where the stomach does not contract normally, resulting in food remaining in the stomach for a longer period of time than normal. Normally, the stomach contracts to move food down into the small intestine for digestion within a short time of eating The vagus nerve controls the contractions in the stomach and gastroparesis may occur when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. This results in food moving slowly through the digestive tract, causing a myriad of problems.

     The term "Gastroparesis" when broken is - 'gastro'-stomach and 'paresis'-paralyzed... so the name actually means "paralyzed stomach".

     Gastroparesis is often associated with Diabetes (since neuropathies can be common in diabetes) but it can also be caused by smooth muscle disorders (such as Lupus and Scleroderma), other neuropathies (such as MS and ALS) Myopathies (such as Shy Dagger Syndrome) or may be caused by a viral infection.  In many cases the cause of the Gastroparesis is never found and the condition is called Idiopathic Gastroparesis.  Other things that can cause Gastroparesis are chemotherapy, radiation therapy and opiate based pain killers such as morphine and codeine.

      Some of the more common symptoms are:

• Early satiety (feeling full early in a meal or after just a few bites)
• Heartburn
• Weight loss (unintentional)
• Weight gain (unintentional)
• Abdominal bloating
• Abdominal pain
• Diarrhea
• Constipation
• Erratic blood glucose levels (mainly in Diabetes)
• Lack of appetite
• Gastroesophageal reflux
• Spasms of the stomach wall
• Chronic nausea
• Vomiting (especially of undigested food)
• Inability to tolerate dietary fats

     If Gastroparesis is suspected your Doctor will order a "stomach emptying scan" to check to see how long it takes for your stomach to empty.

    

     This is a pretty straight forward test-

     You are asked to fast for 12 to 18 hours before the test then will be taken to the testing room and given a small meal (often scrambled eggs, oatmeal or a sandwich) that has had a small amount of a radioactive tracer dye added to it.  This dye is not harmful and will pass through your body within 24 hours in most cases.

     You will then either be asked to lay on a table for 90 minutes as a 'camera' is placed over your abdomen which takes a reading every 10 seconds to see how long it takes the tracer to leave your stomach or will have a reading done over a period of 2 to 4 hours where you are allowed to leave the room between image captures.  Unfortunately, there is no one standardized test for the Gastric Emptying Scan (often called the GES) and it seem that every testing facility does it differently, but the results are all read in the same way.  They are testing to see how long it takes for the tracer in the food to leave your stomach since in a healthy individual normal ranges for gastric emptying in healthy subjects at 1 hour, 2 hours and 4 hours is 90, 60 and 10 percent meaning that in one hour 10% of the food should have left the stomach, in 2 hours 40%, and so on.

     There is no cure for Gastroparesis... only treatments meant to relieve symptoms and help the stomach empty faster.

     Treatments include-

• Dietary changes- avoiding fat, fiber (since it is hard to digest), raw fruits and vegetables and most meats.  It is also recommended to eat smaller meals through the day instead of three larger meals, though many sufferers have trouble eating even one small meal a day.
• Medications- Reglan (generic name- metoclopramide, this helps increase gastric emptying, but is also known to cause another condition called 'Tardive Dyskinesia'); Erythromycin (an antibiotic that is shown to improve gastric emptying in some patients); Domperidone (a medication that cannot be gotten in the US due to issues with heart conditions and off label use by nursing women who wanted to increase lactation but is probably one of the best medications to help with symptom control and for this reason many patients get this medication from pharmacies outside of the US, such as Canada.  The FDA is cracking down on this, much to the detriment of patients who desperately need the medication); Zofran (a medication used for nausea that has a high incidence of migraine headaches as a side effect); Phenergan (an antihistamine that helps control nausea); Botox (when Gastroparesis is caused by nerve damage of the pyloric muscle at the base of the stomach it can cause it to spasm closed, causing delayed emptying and injecting botox into this muscle can give relief for a period of time to some sufferers)
• Medical Intervention- Nasogastric Tube (often referred to as an NG tube, this is a long flexible tube that is inserted through the nose and down the throat to the stomach or more often to the first section of the small intestine so that medication and nutrients can be fed directly into the small intestine, bypassing the stomach completely.  Like all forms of 'tube feeding', this tube is then attached to a pump that continuously trickles a nutrient formula into the digestive tract ); G and J Tubes (inserted through the abdominal wall directly into the small intestine); IV Nutrition (carries the constant risk of sepsis and organ damage as nutrients are given via IV to the bloodstream); Gastric Stimulator (much like a pacemaker for the heart, the Gastric Stimulator uses electric pulses from a small battery back to cause the stomach to contract and empty and is useful for some patients in easing symptoms)

     There are many good websites to go to where you can find more information about Gastroparesis and other Digestive Tract Paralysis Conditions as well as places you can go to find other sufferers and support, both for yourself and family members.

• G-PACT - Gastroparesis Patient Association for Cures and Treatment- a legal non-profit in the United States of America who is striving to raise awareness of Gastroparesis and other Digestive Tract Paralysis Conditions.  They also have support groups set up in many social online sites (like FaceBook) where hundreds interact daily to share support, tips and frustrations in a safe and understanding environment.
• Gastroparesis- Current Concepts and Considerations - an online article from the Medscape online Journal of Medicine in 2008 giving facts and figures about the number of people affected, costs of the condition and more.
• Gastroparesis- A Common Gastric Disorder - a PDF of the minutes from a meeting at the National Institute of Health in Bethesda, Maryland on April 2, 2004 discussing Gastroparesis.
• Gastroparesis Awareness - a small free website with some helpful information and facts about Gastroparesis including a page for friends and family and helpful kitchen tools.

     While Gastroparesis is not a rare condition, it is incurable and people do die as a result of either the condition itself (from malnutrition leading to heart attacks and organ failure) or the available treatments (sepsis, organ failure, etc) and the lack of awareness is a huge problem for those who suffer from it.

     Just to give an example of the rarity in comparison to the awareness-

• 1 in every 550 Americans have Crohns Disease
• 1 in every 500 Americans have Cerebral Palsy
• 1 in every 185 Americans have Lupus
• 1 in every 150 Americans have Autism
• 1 in every 25 people have some severity (from mild to severe) of Gastroparesis

     People have heard of the other conditions listed, thanks to the awareness of those conditions in the general public and the Medical field.

      Many of those estimated to be affected by Gastroparesis are un-diagnosed because their Doctors do not understand that Gastroparesis is not a rare condition or do not know enough about Gastroparesis to diagnose it or even recognize it... many Doctors thinking that it can only be caused by Diabetes.

To Hunt or not To Hunt...

    I have heard both sides of the debate on this one and I have to say that when all the facts are presented there really is no alternative to hunting to protect the deer population.

     "Wait a minute!!! How can shooting poor little defenseless deer protect deer??? That makes no sense!" is the response I have gotten more than once when I have said that hunting protects the deer population.

     "Deer hunting is evil... those poor little deer have done nothing to nobody and just want to prance around in the woods and eat.  People just like to go kill things and I think it should be outlawed."

     I remember one meal I was having at my In-Laws where my Mother-In-Laws best friend (someone who is about as negative and close minded as they come and will openly insult and deride anything she does not personally like and refuses to hear or listen to the 'other side' of any issue because she refuses to ever admit she could be wrong) was making gagging noises and saying loudly how a holiday meal I grew up with and love is disgusting and sounds like vomit on a plate.  

     It was New Year's Day and we were sitting down to eat 'Ham and Black Eyed Peas', something that I did not grow up with as a Northerner and have never really personally liked but was eating a small portion to be polite and mentioned that where I am from the lucky New Year's meal was 'Pork and Sauerkraut' and barely got the words out of my mouth before she started in.  "What a stupid and disgusting thing to eat...."

     To change the subject I turned to my Mother-In-Law and mentioned that I would be bringing over a venison roast from the deer my Father shot soon for a nice roast dinner and the friend felt the need to jump in with her opinion again "OMG! Your Dad shot a deer? How evil... I would never eat a deer and think hunting is evil and against the Bible!"

     I turned to her and tried calmly and politely to explain to her why hunting is a necessary evil, but she wanted to hear none of it and talked louder and louder over me, almost chanting "I do not care what you say... hunting is evil and should be against the law and hunters should be shot and I would never eat a poor little deer!"

      She continued to tell the table about "Bambi" and how evil hunting is... and how evil guns are... and how it is all against the Bible... and how as a conservative she believes in the sanctity of all life and hunters need to be shot to see how it feels...

     Why is hunting a necessary evil?

     Before man started killing off the large predators to protect livestock on farms the deer population was kept in check by wolves, bears, lions, bobcats and coyote.  The weak and injured were picked off reducing the chances of them getting sick and passing the illness to the herd and with herd numbers lower the available browse (food) through the winter fed a smaller population meaning healthier fawns in the spring.

     With the natural predators gone the deer population grew, spreading into more urban settings and farms to find food meaning crop destruction and more and more incidents of deer being hit by cars.  Their health declined as the population outgrew the available food sources... spreading disease through the herds and to domestic livestock and to people.

     Wild deer suffer through the winter to find browse and will resort to stripping the bark off of trees to survive or nibbling the ends off branches when they cannot find other food sources, damaging young trees and killing many as well as doing untold damage to orchards every winter and early spring.

     I will explain it this way... if there is enough browse to support 100 deer through the winter and there are 150 deer in the area then none of the deer will get enough to eat and many of the deer will die of starvation and exposure.  Without enough food they will not be able to store insulating fat or grow a thick coat to keep warm and will freeze to death.  The pregnant does (deer mate in the late fall/early winter and carry their young to the spring when they give birth) will not have the nutrition they need to have healthy fawns and will only give birth to single fawns instead of twins... the fawns will be underweight at birth and there will be more stillbirths.  From that original 150 deer at the beginning of winter only 75 will survive to spring and those will be in poor condition and give birth to fewer young of poor condition.  Now... if those 50 extra deer were culled before winter hits the remaining 100 deer would have enough to eat through the winter and would have less of an impact on the surrounding farms and orchards and in the spring more fawns of a healthy weight would be born... and the deer in the spring would be in over-all better condition meaning a healthier immune system.

     Before hunting season the regional and local Game Commissions do studies on the deer population taking into consideration the available browse for the coming winter and the winter weather outlook and set the number of deer to be culled that year from the population to best maintain a healthy herd size.  They decide how many doe and buck tags to sell to hunters (each tag allows a hunter to shoot one deer, if it is a doe tag they may shoot one doe, if it is a buck tag they may shoot one buck) and as deer are shot the hunters attach the tag to the animal and send in the form telling the Commission the day they shot it, where they shot it, etc... so that the Commission can keep track of the population.

     Not every hunter manages to shoot a deer every year and many tags are un-used for this reason... but the Game Commissions know this and take into consideration the number of deer that are hit on the roads by cars and die of natural accidents in their figures... and unfortunately they also figure in illegal poaching.  (Quick fact- poachers who are caught with deer face fines and jail time, their guns are confiscated and the deer are processed and the meat sent to food banks, soup kitchens and shelters to feed the homeless and poor.)

     If the natural predators were still in the areas that deer populate then maybe hunting would not be a necessary evil... but the same people that do not want hunting to happen do not want wolves, bobcats, lions and coyotes in their area because they want their pets and children to be 'safe'.

     Guess what... you have to have one or the other... either you live with the large predators or you accept hunting because those are the only ways to keep a healthy deer population.

     Want to kill off all deer in a slow torturous method that will not only see them suffering but risk the lives of domestic livestock and our own foods (livestock and grown crops) then just outlaw hunting and let them slowly starve and die in waves of disease as thier health declines.