Warning: This is a rambling, steam of consciousness post. I hope to return to topical post next week.
Last week I encountered increasingly acute abdominal pain through the week. I tried to continue normal activities until it knocked me out and forced me to take a few days off work. I debated going to the ER or urgent care but decided to rest instead. After three days of long mid day naps I felt well enough to at least get through a day without a nap. I didn't have any severe symptoms (fever or bloody stool) that would have indicated a medical emergency. A trip to the ER was likely to end up the same as my March visit. A very large bill and four to six hours to find out I had nothing life-threatening and needed to just follow up with another doctor. On day 5 after it knocked me out of work I saw a GI specialist and he did not have any immediate concerns. He diagnosed me with likely IBS and scheduled follow up tests to make sure it is not something more serious. It is now day 11 and I am trying to return to normal. I walked 3.5 miles today at a brisk pace (3-3.5 MPH). A slight pain is a constant reminder that the ordeal continues, but hopefully I'll be fully back to normal soon. There are three things that have struck me as I have dealt with this. The first is that I don't have a single healthcare provider I can trust to act in my best interest. There is a safety net to prevent me from dying that can provide some support, but I am largely on my own. I need to spend some time thinking about that. The second is that two different GI doctors have been quick to jump to an IBS conclusion despite the fact that it is questionable whether I actually meet the Rome IV criteria (gold standard for GI disorder diagnosis) for IBS. I need to spend some time thinking about that as well. The third is that my research into IBS has revealed how totally fucked up our healthcare system is. IBS is estimated to negatively impact the lives of 10-20% of the population. The first intervention both GI doctors pointed to was a low FODMAP diet. How much evidence is there that a low FODMAP diet helps? A 2017 NIH article says "There remains controversy as to whether the low-FODMAP diet has sufficient evidence to be considered a legitimate first-line therapy."[1] and later it says "There is currently no widely recognized standard for dietary advice for patients with IBS." Further investigation reveals that many of the studies the guidance is based on are from short term studies conducted with small sample sizes (30-80) and very strong placebo effects in all cases. A well designed and large study could be created. The results of that study would improve the lives of millions of people. There are no systems currently in place to make that study happen. I need to spend a lot of time thinking about that. In the meantime thousands of doctors and millions of patients will continue to receive lower quality information and care that our society is capable of producing. [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390324/
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September 2020
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