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An attack of the collywobbles

Two days ago I learned something alarming about my aging body. From one perspective, my newly diagnosed condition is gross. But from another, it's fascinating. Let’s explore the latter, as it is relevant to anyone who is getting older.

As I surfaced from my anesthetic slumber following an endoscopy, my doctor popped his head past my curtain and said “Your stomach is in your chest.”

What?

“You have a hiatal hernia,” he said. “And your esophagus is raw meat from stomach acids burbling up.”

(I guess I led with the gross stuff, after all.)

I was still groggy enough to let his words blow around me like a surprise breeze, chilling but not alarming.

“Is there any way to fix it?” I asked.

“There’s surgery,” he said. “I’ll explain that when we meet in two weeks. For now, take this.”

He casually scribbled “one-half tablet OTC Omeprazole before breakfast and dinner” on a shred of yellow paper and handed it to me.

“It will change your life,” he said as he rushed out of the recovery room.

Ok, I thought. A lifestyle revision is imminent.

Hiatal hernias are quite common, and dramatically more common in older people. A Brazilian study found hiatal hernias in 10 percent of people ages 14 to 24, 43 percent of 25 to 54 year olds, and 65 percent of those between 55 and 64. Not all of these hernias cause significant problems. However, mine apparently was really acting up.

I had never thought much about the complex system that starts with our hands putting food in our mouths and ends with us sitting on the throne, beyond the fact that I’ve long found food prep, meals and nutrition puzzling -- if the creator designed us in his image, why didn’t he just make us perfect, without the need to eat, digest and all that follows. Maybe it would be better if we just needed one meal a week with friends and family for sociability and culinary fun, and skipped the rest? Clearly, the creator disagrees with me (even though my idea would solve a lot of the world’s most pressing problems, such as climate change and inequality).

To accommodate this divine error, a very long sequence of organs runs between our mouths and our underwear, with four primary functions: to move the food through the system, via muscle movement called peristalsis; to digest the food and turn it into fuel; to absorb nutrients; and to secrete the body potions that make it all possible.

Yeah, the mouth is the first stop of many on the long journey through your body. Photo by Alexander Krivitskiy.

The organs that do this are laid out from top to bottom:

Mouth

Salivary glands

Esophagus

Stomach

(With a sideways slide into the liver, gallbladder and pancreas)

Small intestine, which, at 9 to16 feet of curled intensity, includes the duodenum, jejunum, and ileum (the latter two would be great children’s names)

Large intestine, which, at a paltry 5 feet long, includes the appendix (so called because it “hangs on” the intestine), cecum, colon, rectum and anus (not to be confused with Uranus).

And, as all of us are realizing more and more, the millions of bacteria and other creatures that guide and help our digestive tracts. Our symbiotic relationship with these potent gut inhabitants is one of the most important we have, yet many of us pay less attention to our gut biome than we do to our pet fish.

Just now I put three cashews in my mouth. The process is so baroque. The nuts themselves grew on the outside of strange fluorescent fruits on tropical trees -- one nut per fruit. The fruits themselves taste metallic, but once the nuts are separated out, roasted and transported from the tropics to my local New York City grocer, they are delicious.

Yes, this is how cashews grow, one per fruit. Photo by Anton Shuvalov on Unsplash

As I chew the cashews, I notice saliva filling my mouth -- it wasn’t there earlier. As I swallow, I’m intellectually aware that my esophagus is inflamed from repeated washes of digestive acids that have risen up from my stomach in ways that aren’t “normal.” But I don’t feel any discomfort. No coughing. The OTC pill has taken care of that.

“How does this pill work?” I wonder. I’m grateful for the relief, but suspect that, as with most medical miracles these days, there must be a risk associated with this medicine. I haven’t yet looked up the side effects.

When my doctor said my stomach was in my chest, he meant that the hiatus muscles that separate my esophagus from my stomach had weakened, allowing a portion of my stomach to protrude into my chest via an opening normally used only by the esophagus, or food tube. This weakening is more common in older people, but it can happen to anyone. Obesity (I’m overweight), coughing (the stomach acids have given me a chronic cough) and other factors such as muscle strain, can cause the hernia.

I had no reason to suspect I had a hiatal hernia, because I’d never considered it as a possibility. The symptoms had been going on for a few years now and I never thought that I could actually do anything about them. Que sera, sera.

I finally went to the gastroenterologist because my kids were worried about my cough. Plus, they made fun of my Tums habit -- two to three tablets a day. I also went because a few times a year I have trouble swallowing food, meaning it will neither go down all the way nor come back up, a condition the doctor described as “steakhouse syndrome.” In retrospect, I see that these symptoms should have sent me to the doctor long ago. But that would have shattered my bubble of masculine invincibility.

(The shards are now on the floor, waiting for someone to sweep them up.)

I attributed the cough to allergies, stress, and excess weight gained during the pandemic -- all conditions that I felt I could control if I only ate better, exercised more and meditated. It was only recently that I deduced that acid reflux (heartburn) might be a cause. And sure enough, just two half doses of Omeprazole have demonstrated quite clearly that reflux plays an important role in all of this. I’ve hardly coughed since yesterday.

Still, the pills turn out not to be a miracle cure. I looked up the side effects, which include changes in the all important gut biome, and a long list of potential travesties like bone loss. The label says not to take them for more than 14 days every four months. So I’m going to try the non-drug self care methods, which are kind of familiar ways to control a lot of diseases: avoid red meat, high fat dairy, processed foods, citrus, tomatoes, chocolate and coffee. This last nectar will be the most difficult for me to banish, and I’ll have to taper myself off of it.

I would like to accept my new limitations as liberating. They free me from the tyranny of self-destruction. That acceptance will be a process.

The thought of my stomach being out of place, or squeezed, makes me very uncomfortable. I fear that it could just get worse as I enter my mid 60s and move on towards 92 (my target end-age number, though I’m open to revising it upwards). I believe it’s the reason I feel too much pressure on my chest when I’m doing certain pilates moves. And, to be honest (and irrational), having a physical ailment makes me feel like a failure. I’m that twisted.

I tell you all this with encouragement and hope that you will attend to any difficulties you might face, with either informed self-care or a doctor’s help. I wish I’d gotten an endoscopy months ago. Because now, just one day after getting mine, I feel better. And I know that will set the stage for doing the important self and medical care that will heal my esophagus and, I hope, my stomach itself.

The cashews I ate a little while ago are doing well, my body tells me. That’s good. I hope my progress continues. I’m still puzzled as to how there could be enough cashew fruits on earth to supply all of us humans.

When I return to my doctor for further advice in a couple of weeks, I’ll share my new joke, stolen from the Internet:

Watson: “What is another name for the digestive tract?

Holmes: Alimentary, my dear Watson.

Ha ha. Ja ja. LOL.

Cheers to you, Stephen

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