Stomach Convulsions

[Candiflip]

I haven't been writing on the board lately but I have been following a low carb way of life religiously. I am down to 163 pounds, blood pressure down from 120/80 to 120/70 and thought that I was doing good. Until a few weeks ago.

I started having these really bad pains in my stomach. It is hard to describe but the pain was so bad that it shot up my back. I went to the Doctor and she sent me to get a Barium Swallow to see if there was anything wrong with my stomach. When the results came back they showed that I had been having convulsions and at times my stomach wasn't expanding. This is what was causing this horrible pain...My doctor told me that this was caused by diet and the only way now to have it stop is Medication. She put me on Nitroglycerin, a very small pill I put under my tongue. Usually used as a heart medication.

I really hope this helps, but I want to know why this happen to me....Like I said I have been following my low carb way of life or diet, whatever you would like to call it and this happen. It hurts and now I have to be on another medication.

Has this happen to anyone else?

Thank you

Candice

[Candiflip]

No one?? :(

[doreen T]

hi Candice,

Y'know, I read this earlier, and I was stumped. Never heard of stomach convulsions before. Then I read back through a thread you'd posted a couple months ago, about feeling sick and nauseous, aversion to food .. and "butterfly" sensations when you swallow. Then it clicked.

Achalasia ... Esophageal Spasm.

In this condition, the sphincter where the esophagus joins the stomach is in constant spasm, and it fails to relax and open properly when food is swallowed. As a consequence, food sits in the esophagus, which becomes distended and uncomfortable, leading to nausea, difficulty swallowing, aversion to eating and chest pains.

Nitroglycerine helps by dilating the blood vessels around the esophagus, which can help the muscle to relax and stop spasming. For some folks though, they have to have a tube put down to help dilate the opening ... and this often brings relief.

You can read more about achalasia at Medline Plus (http://www.nlm.nih.gov/medlineplus/ency/article/000267.htm).

hth,

Doreen

[Candiflip]

Yes, my throat has been hurting alot. It has been raw and has been hard to swallow. I have had to clear my throat alot like when you are sick ya know. I thought that I just had a cold but it just didn't go away.

Candice

[Candiflip]

I have also been caughing alot too.

Is this going to go away??


Thank you

Candice

[doreen T]

No, it won't go away on its own. If the medication doesn't help to relieve the pressure, then the dr. might choose to dilate the esophagus with a tube, as I described ... or possibly surgery to release the spasming muscle. (note .. surgery would be done by means of a tube down the throat, probably using a laser .. so no big operation or incision). There's more description at the Medline link I gave in my post above.

The cough may be due to several things. Physical irritation from the distended esophagus is one .. or there may be some regurgitation of stomach contents when the sphincter does open. The reflux of stomach acids can irritate the throat and possibly can be a risk for aspiration if it happens at night :( Or ... if you've been sick to your stomach a lot ... your throat will be irritated from that.

Hope you get some relief soon :rose:

Doreen

[Candiflip]

My doctor didn't go into detail about all of this because I do not have insurance here in Canada... :( I don't have the option to do anything but take medication. It was expensive enough to get all the tests done. She know's that the test were expensive and knows that I am going through my immigration process right now but it is going very slowly. I am just going to turn in my papers.

My throat hurts all day as well as coughing all day. But most of my pain comes at night and early morning. I don't sleep good and wake up at all times of the night. It is really bad around 6-6:30am...

Why does this happen?? Could it of been from foods that I eat?

Thank you for helping me

Candice

[Marie_D]

Candice -

I can answer your questions based on my own 10-year personal experience with achalasia and esophageal spasms. This story ends well, so bear with me.

Achalasia means that when you swallow you have either no or weak peristalsis (the involuntary wave-like motion that propels the food down your esophagus.) Then when the food reaches the sphincter muscle that should automatically open and let the food into your stomach, that muscle doesn't open or opens only if there is a lot of pressure on it. For some reason, spasms seem to go with the achalasia. The nerves to your esophagus are misfiring and when they do fire they can cause the muscle to go into EXTREMELY (and believe me I know) painful spasms.

When I first went to the doctor, he tried to convince me that I was insane. I was living in Uruguay at the time. I lost 25 pounds in less than three months. His response: "Well you look good." This doctor finally prescribe procardia (adalat; generic name: nephedipine) for me but not in a sufficient dose. It did help somewhat however.

(Niphedipine is a blood pressure medicine that relaxes smooth muscles, like those inside the arteries -- it also relaxes the smooth muscles that line your esophagus. I would ask your doctor if she could try you out on some of this medicine -- for a medicine it is quite inexpensive. You can get it in either in capsules that you can break under your tongue 15-20 minutes before you eat or in time-release tablets that you can take once or twice a day. I had no luck with nitroglycerine myself.)

Anyway, the situation got so desperate that I returned to the U.S. I think to properly diagnose the problem you need to have an endoscopy (doctor looks at your esophagus using a laser light - you are out thank god) and through a manometry test which measures the muscle contractions in your esophagus and the pressures required to open the sphincter (manometry is quite unpleasant but I think you need it to see if any kind of surgical intervention is required).

This was 1992 and I had to go back to the country where I lived. After my diagnosis, the doctors recommended surgery and I had an esophagocardiomyotemy. They cut the sphincter muscle so it can't close. At the time, they had to open me up. If they can do it with a laser now, that is really, really great.

I would say that the surgery solved about 80% of my swallowing problem. I continued to be plagued by spasms for several years afterwards. I got them somewhat under control by working with my doctor in the U.S. and taking a number of medicines. They greatly reduced in frequency over the years and now I can go for months without having an attack.

If you actually do have achalasia, I would bet money that the problem with your coughing is that the food is not going down into your stomach in the first place. When you lay down, the food goes back up into your mouth where it then can get into your windpipe. Your body reacts and clears the windpipe by coughing. I've had a lot of experience with this too.

YOUR FIRST COURSE OF ACTION IS TO RAISE THE HEAD OF YOUR BED! You need the help of gravity to keep that food from coming back up. Put a couple of bricks (or more) under the legs at the head of your bed. Extra pillows can work too but the pillows tend to slip while you are sleeping. Please do this right away. It has never happened to me, but if the food finds its way down your windpipe you will end up with pneumonia.

Sorry for writing a book but I know a lot of things now I wish I had known when I was first starting out with this.

P.S. NOBODY knows what causes achalasia but it almost certainly is NOT diet!

[Candiflip]

I was put on another medication today because I went back to the dr.
She told me that this is, At least in my Case, brought on by my diet. My stomach can not digets the foods(fats) and it has been sitting in my stomach for a long time, they don't know how long but there is quite a build up. So when I eat I contracts trying to push out the stuff that is in there and my stomach can not do anything so the stuff that I just ate will just sit there also. When I lay down or take the Nitroglycerin it relaxes the spasams in my throat & stomach but it also causes a problem. The acids are coming up and that is when I have to clear my throat and cough(that is what you were saying eh?) I have a hard time explaining :( But she says that this new med will take at least 2 months to start working. She also suggested going to a specialist(sorry I do not know how to spell the title of the dr.) But like I said before I do not have insurance so it makes it hard to do that.

My doctor said that when she has patients like this she usually puts them on a Low fat high carb diet because the carbs are digested first. I told her that I would cut back on some of my fat but I was not going to eat carbs. She says that is fine.

Marie, like you she also suggested the brick under the bed and extra pillows.

Candice

[Marie_D]

Candi -

I'm so glad you went back to the doctor and are getting some help! It also sounds like you don't have achalasia -- also very good.

I only hope that your insurance problems will soon be sorted out.

All the best,

Marie

[Candiflip]

I woke up this morning and started coughing up blood. It wasn't all blood it was also flem. Was this blood just from what has been happeing to my stomach/throat lately? Should I not worry about it or go to the Doctors? I haven't done it before. Kinda just freaked me out ya know...

Thank you
Candice

[Marie_D]

Just four words, Candice. Go to the doctor.

At least that's where I would head if I were coughing up blood.

[doreen T]

Yes indeed .. get to the Emergency department of the nearest hospital.:exclm: With your history of acid reflux, you may very well have developed an ulcer in your esophagus.

I'm sorry you're going through this hell Candice. I think a visit to a specialist (likely a Gastroenterologist) would be worth it in the long run, even if you did have to pay out of pocket. This sounds more serious than what a pill can fix. Hope things get resolved soon. :(

Doreen

[Candiflip]

I went to my doctor and she took a throat swab and set up an appt. with a specialist. Nothing really happen today, I didn't want to go to the ER because, I DON'T HAVE THE MONEY. :( It's easier said than done when you have insurance right.
Thank you
Candice

[suze_c]

Hi candi~ hope that you are doing better with all of this..it sounds like it has been a real trial. My grandmother use to have problems like what you described, and back then,they did not have all the tests like they do now... but something that you said about your stomach was not digesting the fats.... My grama did not have the right kinds of stomach acid, or enough of it to help digest certain foods properly. Her dr. prescribed some sort of acid for her to take... that was then... now they probably have a better alternative. I know that you have the problem with reflux, but even a minute amount of stomach acid can do that, if your body is not working in sync with itself. Anyhow~ pls. no one yell at me, if I am way off base here... I am just sharing what caused my grama to have the same symptomology.

[CindySue48]

Candace.

When I saw your post I had to answer!

First, I'm a nurse....have been for over 25 years. And second, I too have all kinds of trouble with my throat and stomach....and have for over 20 years.

First there are several things that could be causing your problems. But in my opinion, it's unlikely that the diet itself is causing your problems.

If you are in fact having trouble with food remaining in your throat (esophagus) the low-carb diet is unlikely the cause! If it's a spasm, it usually goes with relaxing of the muscle between the stomach and esophagus (cardiac spincter), leading to stomach acid splashing or moving up into the throat and can be caused by chocolate, alcohol, peppermint, red wine (some people all wine) and butter (it's not the fat, it's a chemical in it's make-up....although several publications have recently sopped specifying butter and just say fat!). Very hot or (especially) very cold liquids can also induce spasm. "Concentrated sweets" can make things worse and can by itself (without any stomach/throat problems) by irritating the lining of the throat or stomach. Acid foods are also questionably a cause....it never was for me and is still debated.

If you are having problems where you are retaining food in your stomach, it sounds more like Gastroparesis. With this, people have a delay in emptying of their stomach, sometimes accompanied by pain, nausea and vomiting. Although there are other causes, such as previous stomach surgery, the most common cause is a complication of diabetes. You don't mention if you're diabetic or not?

The other possibility is that you have an ulcer. Many people that do have ulcers also have a bacteria (h. pylori) in their stomach that contributes to the formation of ulcers. And this "bug" loves sugar! A simple blood test can tell if you have this. And if you do, antibiotic therapy is the treatment of choice. The ulcer can be anywhere in the esopahagus, stomach or even the beginning of the intestine. If you do not have h. pylori, you can still have an ulcer....only a scope or, sometimes, a barium swallow can tell for sure.

Now for my opinion!

With the coughing and the time of your pain, it sounds to me more like you're having reflux, possibly accompanied by spasm of the esophagus and/or relaxation of the cardiac spincter muscle, and/or stricture of the esophagus (basically scar tissue due to irritation). The cough might be caused by food, liquids, or stomach acid coming up into the esophagus...or it might be that your esophagus is full of food....but it's likely that you as inhaling small amounts of something....and this is what's inducing the cough.

From personal experience, try this:
1. Raise the head of your bed! The higher the better, but at least 30 degrees. You can use bed blocks or cinder blocks under the bedframe, pillows or wedges under your mattress or pillows, or several pillows piled one on top of the other.
2. Avoid very hot or very cold foods and liquids. A hot cup of coffee or tea doesn't bother me, but ice water can sometimes cause problems.
3. Take an antacid as needed. The over the counter ones are fine. Some taste better than others...and some work better than others...but the liquid types are usually better than the tablets. Test various preparations and see what's best for you. Don't suffer! If you are having heartburn, you are likely doing damage to the lining of the esophagus! (also be aware these can leaad to diarrhea, which can cause Potassium depletion, so be careful that you get enough in your diet!)
4. If your doc ordered Prilosec, Zantac, Tagamet, etc (Histamine H2 receptor blockers ) take it faithfully. Even when the pain is gone, take this medication daily. If your doc has not ordered anything, ask for it, or consider trying some of the over-the-counter preparations.
5. Avoid butter, peppermint, all alcohol (including wine!), chocolate, spicey foods, and concentrated sweets. Some docs also recomend avoiding all coffee....even decaf. Also avoid ALL Asprin containing medications. (Acetaminophen is fine, but do be careful of the dose!) NSAIDS, like Motrin, Celebrex, etc can also cause problems.
6. Pay attention to what you eat and when the symptoms come up. You may be able to pin-point certain foodd that induce symptoms.
7. Don't eat for at least 2-3 hours before lying down. Even just lying down to watch TV, read, etc.
8. If you smoke try to quit (I wish I could!)

I would also see a specialist. Make sure s/he is up on the latest research....one at a major teaching hospital is probably best. I'd ask for, if the doc doesn't order, a barium swallow, gastric manometry (much easier to tolerate today due to the size of the tube, but still unpleasant), and a gastroscope. Esophageal PH monitoring might also help with diagnosis. Also make sure this doc knows about the bleeding! And watch for black, tarry BM....this is caused by blood loss when you pass the blood instead of coughing, vomiting it up.

One other thing I'd like to add. The specialist I have, recently afilliated with Duke University Medical Center (quit for private practice), is 100% in favor of the low-carb WOL. At my last visit, just a few weeks ago, we got talking about it and he told me that he had been approached by one of the docs from the VA (I assume one involved in the low-carb experiment) asking him to participate in a secondary study. It seems several of the VA doc's patients had reported a dramatic increase in reflux, heartburn, and other stomach difficulties.....AFTER stopping the low-carb diet!

Good luck! Please don't agree to surgery unless you've exhausted all other means. It is much easier than it was years ago, but there is still a risk....as there is with any surgical proceedure!

[Candiflip]

Well the appt. for the Specialist isn't until the 15th so I have to wait till then to see him. But till them to keep my food down because I haven't been able to by myself, Everytime I eat I feel the food coming up, not acid coming up, I throw up, she prescribed Domperidone. I am to take this 15-20 minutes before I eat. So far it has worked about half of the time. :(
I have an ultrasound secluded for the October 3d to check for an ulcer this time because it is getting worse.
Me throat isn't getting any better either, the other me that she gave that is supposed to reduce the acid in my stomach was supposed to take care of that right? I mean so that less comes up. It is called Ranitidine.
When I talked to my doctor the other day she was telling me that she really thinks that my stomach isn't empting and that is what the problem is. She doesn't know what the cause is and why it is getting worse (that is why I am getting the ultrasound to check for the ulcer) but she is hoping the the specialist can help.

CindySue:
I do not eat Peppermint, Chocolate(if I do it is not more than a once or twice a week and it is made w/ splenda), red wine, any kind of alcohol, coffee, & spicy foods( I used to eat hot wings about once a month but haven't in since I was sick.).
I don't know what you mean by Concentrated sweets but the only sweets that I eat are an atkins bar or home made sf pbcups occasionally. The only liquid I drink is water. It is never w/ ice just cold to room temp. I haven't even had a diet soda since I started this W.O.L.
The only thing I do eat on that list is butter. And I do take medications. Other than the new ones I was put on I take medications for BiPolar. My doctor haven't mentioned anything about these causing the problems in my stomach. I am taking Topamax & Wellbutrin.
I have never been tested for diabetes as far as I am sure...but last time I checked my blood sugar (when I stared LCing it was normal)
About the Ulcer, Like I just said my doctor ordered an ultrasound. I just had a barium swallow done but my stomach spased up so much that she said that if there was an ulcer they wouldn't of been able to see it. :rolleyes: I dunno...
I do not get heartburn.
I already have the head of my bead raised and I already am using 2 big pillows. The seemed to work in the beginning but like I said it has been getting worse lately.
I guess I will just have to see what happens

thank you for all your help. I appreciate everyones input :)

Candice

[Candiflip]

Sorry to post again.....forgot to add something


I have been feeling so week because of the food coming right back up. I hate throwing up so it had forced me to not eat more than one meal a day for a week there(before I got this new med. that helps me about 1/2 of the time). I was eating normally for a while there but every time I would eat I had to run to the bathroom it was embarrassing..we can not even eat out anymore cuz I don't know how I am going to do. Like I said the meds don't even works 100% of the time. I have been trying to drink enough water to keep myself hydrated. I just feel horrible. But there isn't I can do about it. I can't make this thing in my stomach go away. I know it isn't like I am dieing but it is serious to me, I was doing so great on my W.O.L. & losing weight and then just all of a sudden this all had to happen and ruin things. I feel sick all the time I am not eating right....... it isn't fair.

I feel horrible for whining to you. Thank you for listening, it really means a lot to me.

Candice

[CindySue48]

You're NOT whining! This is the place you'r supposed to come for support...and that's what youre' doing!

Please keep us informed. You've got me stumped.

I'm sure you feel horrible! It's gotta be painful and uncomfortable...and scarey!

Have you talked to your doc about the med not working as well as it did in the beginning?

I hope they're watching your blood electrolytes....sodium, potassium, etc....those can get all out of whack with vomiting.

Years ago, when I was first diagnosed, it took a long time....I know the doc thought I was nuts....but I persisted and finally found out what was wrong with me. Don't let them blow this off!

It might be from your meds, but it's unlikely if you'd been on them for a while before the symptoms started.

It's also unlikely that it's the diet....by concentrated sweets I mean sugar, etc...cake, cookies, etc....even tho the doc might try to blame it. (lots of docs blame just about everything on Atkins!)

Hang in there....and be persistent. If you don't get results from the ultrasound, ask about having a scope done. That's where they look directly into your stomach and see what's there. It is something done under heavy sedation, so you shouldn't be concerned about it. (I've had it done at least 8 or 9 times...and I'd have it done weekly if I needed to!) Just make sure you take the day off and have someone to drive you!

You've gone thru a lot....and will get thru this too! Dont' worry about the diet, just eat what you can when you can....and pick up the diet again when you're healthy again!

Oh! One thing I just hought of! Have you tried shakes? The low-carb ones would be best....but hell, if you're taking in as little as you have, any kind would be fine! Try a "frappe", it might help...it's made from milk, icecream and flavoring all blended up (if you don't have a blender, try one beater on a hand mixer!). I know it's not low-carb....but right now you have to worry about getting enough calories!

And feel free to come back here and vent whenever you need to! That's what we're here for!

Cindy