Hi gang,
Actually, I should have titled this post "How Little Doctors Really Know About Our Bodies". As time goes on, I continue to be amazed at how little is really known by our medical community about how our bodies work. There's a facade within the medical community about pretty much every aspect of their knowledge. They do a good job of building what appears to be a solid cocoon around themselves and their institutions in regards to just about every aspect of human health. But when you press on it... it's just made of paper and your finger will pass right through. Most "patients" don't press... either because they've been taught that our medical professionals know their stuff... or because they don't want the image they have in their heads of being treated by those who know what they are doing exposed as a falsehood. Both reasons are understandable. I'll just touch on one thing here, bowel adaptation, but no matter what ails you... if you press hard enough, you'll almost always figure out the Emperor isn't wearing any clothes... or maybe just a G-String.
After coming home from the hospital short gutted back in September of 2014, I started looking for all the info I could find to educate myself on my new condition. The first thing that became apparent was that I had a relatively rare condition. It's seen more in infants that are born with damaged or non-functioning intestines, so that's where most of the information that we have on the subject comes from. That's a little troubling right from the jump because the patients can't yet speak... so we never get their side of the story. Anyway, I read what I could find... and what I did read gave me the impression that what was understood about the intestine and how it worked was pretty solid info. You don't see things written in medical journals and such that say things like "we're pretty sure this is how it works" or "we suspect this or that"... everything is written with a certainty that leads one to believe the subject is well understood. Well, after getting to know a few docs and medical professionals personally... I'm of the opinion that all that is just a load of crap. It's 2020 and there is still way more they DON'T know about our bodies and how they work than what they DO know. But they can't let YOU know that. Think about that for a second. Here's an example:
The "Bible" on Short Gut Syndrome is a book written by a gal at the University of Virginia named Carol Rees Parrish, MS, RD. Never met her, but did chat with her on the phone, and she sounds like a wonderful person. And the fact that she wrote a book specifically on the subject that covers all aspects from diagnosis through treatment is so much appreciated by me and others with this condition... I really owe her one. But in her book, and in talking to a number of gastroenterologists and organ transplant docs... the general rule is your bowels will adapt for up to 3 years after a traumatic surgical intervention (meaning they yank a whole bunch of your intestines out and toss them in the incinerator). Your bowels go into shock, which is to be expected, I guess, and then start to adapt as best they can to be able to perform the same tasks the removed sections used to do. Different sections of your bowel do different things. What gets absorbed is highly dependent on location in the bowel. So if they remove a section... whatever was being absorbed by that section will no longer be absorbed. At least until what's remaining of your bowels tries to adapt to perform that function. So everyone is pretty adamant about 3 years being the number. Beyond that, you just have to live with what you got because adaptation is over and you get what you get. So dieticians and those assisting those with Short Bowel Syndrome use that 3-year block of time as their window to improve a patient's quality of life. And with Short Bowel, it's really all about quality of life. So like everyone else in my position, I had a 3-year hourglass in my head and was tracking progress against that fictional timepiece. Well, long story short... it's been 6 years now since I lost those 18 feet or so of my intestines to the Operating Room trash can... and my bowels are adapting more this past year than in the previous 5. I know that because the transit time of things I eat (the time it takes from when I put it in my mouth to when I see it in my bag) has continued to increase and is showing no signs of stopping. I have no signs of any active disease (Crohn's), so that can only mean the villi that line my intestines have increased in density and length and now do more work than they previously did when less dense and shorter. Now I still can't gain weight beyond a certain point, but that's because even with taking motility meds to slow down the movement of everything through my bowels... there's still a minimum speed for transiting bowel contents that I just can't go slower than. But where I used to have to eat 5000 to 7000 calories a day just to maintain my weight... I now eat almost nothing and maintain my weight. And I pee a lot now. That's significant because it means my bowels are absorbing liquids. And I can hydrate. So my 4 feet of intestines are working their ass off... but there's just not a lot of ass there.
But the point is they were/are wrong about the 3-year window for adaptation. Heck, they're not even close! Adaptation in the body just needs a forcing function. A reason, if you will. And as long as that reason remains in effect, the body will react the way it was programmed to... it will continue to adapt. It's just like building muscle. We use resistance (weights) to convince the body it needs to expend the energy to build more muscle to prevent damage to our tendons and ligaments for the weight we are lifting. But once the body has adapted to that load, your muscles stop growing. So you need to continue to increase the resistance to make the muscles continue to grow. It's the same thing for intestines. Mine will continue to adapt until the short length I have left can perform the same functions as what my original 22 feet of bowel could do. Now mine will never get there, as it's not physically possible, so they'll be adapting until the day I die. I think the 3-year number probably came about because most patients (and infants) with Short Gut just didn't live very long... so there was no long-term data from which to learn. But they should probably just say that instead of sounding like they know what the heck they're talking about. And the sad part to all this is I see the same thing happening with every doc I see, no matter what part of the body we're dealing with. I see it with my mom's cancer docs. Those poor folks know almost nothing about what they're dealing with. Talk about throwing shit up against the wall and seeing what sticks... that's cancer treatment in one sentence. The researchers basically spend their time mixing different chemicals and meds together and trying them to see if anything works... but they don't understand WHY what works works. It's the definition of a crapshoot if I ever saw one.
So when your doc tells you something that sounds concrete... rest assured it's almost certainly not. And it's up to you to decide if you want to trust their judgment or go do a little digging on your own. Personally, I recommend you keep a small shovel with you at all times... but that's up to you. The medical profession is really one crazy, wacky world. They have to appear to be in control of everything that ails us or we lose confidence. And if confidence in the medical system is lost... it all crumbles to the ground. So obviously don't tell anyone I told you about this. Just some food for thought on a slow Wednesday night.
You guys stay safe!
Regards,
Bob
