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What is Gastroparesis?

Understanding Gastroparesis
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What Is Gastroparesis?

Gastroparesis is a condition in which your stomach cannot empty itself of food in a normal fashion. It can be caused by damage to the vagus nerve, which regulates the digestive system. A damaged vagus nerve prevents the muscles in the stomach and intestine from functioning, preventing food from moving through the digestive system properly. Often, the cause of gastroparesis is unknown.
However, the causes of gastroparesis can include:
Uncontrolled diabetes
Gastric surgery with injury to the vagus nerve
Medications such as narcotics and some antidepressants
Parkinson’s disease
Multiple sclerosis
Rare conditions such as: amyloidosis (deposits of protein fibers in tissues and organs) and scleroderma (a connective tissue disorder that affects the skin, blood vessels, skeletal muscles, and internal organs)

What Are the Symptoms of Gastroparesis?
There are many symptoms of gastroparesis, including:
Heartburn or GERD
Nausea
Vomiting undigested food
Feeling full quickly when eating
Abdominal bloating
Poor appetite and weight loss
Poor blood sugar control
What Are the Complications of Gastroparesis?
Some of the complications of gastroparesis include:
Food that stays in the stomach too long can ferment, which can lead to the growth of bacteria.
Food in the stomach can harden into a solid collection, called a bezoar. Bezoars can cause obstructions in the stomach that keep food from passing into the small intestine.
People who have both diabetes and gastroparesis may have more difficulty because blood sugar levels rise when food finally leaves the stomach and enters the small intestine, making blood sugar control more of a challenge.

How Is Gastroparesis Diagnosed?
To diagnose gastroparesis, your doctor will review your symptoms and medical history. He or she will also give you a physical exam and may order certain blood tests, including blood sugar levels. Other tests used to diagnose and evaluate gastroparesis may include:
Barium X-ray : You drink a liquid (barium), which coats the esophagus, stomach, and small intestine and shows up on X-ray. This test is also known as an upper GI (gastrointestinal) series or a barium swallow.
Radioisotope gastric-emptying scan (gastric scintigraphy): You eat food that contains a very small amount of radioisotope (a radioactive substance), then lie under a scanning machine; if the scan shows that more than 10% of food is still in your stomach 4 hours after eating, you are diagnosed with gastroparesis.
Gastric manometry: A thin tube that is passed through your mouth and into the stomach measures the stomach’s electrical and muscular activity to determine the rate of digestion.
Electrogastrography: This test measures electrical activity in the stomach using electrodes placed on the skin.
The smart pill: This is a small electronic device that is swallowed. It sends back information about how fast it is traveling as it moves through the digestive system.
Ultrasound : This is an imaging test that uses sound waves to create pictures of body organs. Your doctor may use ultrasound to eliminate other diseases.
Upper endoscopy : This procedure involves passing a thin tube (endoscope) down the esophagus to examine the lining of the stomach.

What Is the Treatment for Gastroparesis?
Gastroparesis is a chronic (long-lasting) condition. This means that treatment usually doesn’t cure the disease. But there are steps you can take to manage and control the condition.
Some patients may benefit from medications, including:
Reglan (metoclopramide): You take this drug before eating and it causes the stomach muscles to contract and move food along. Reglan also decreases the incidence of vomiting and nausea. Side effects include diarrhea, drowsiness, anxiety, and, rarely, a serious neurological disorder.
Erythromycin: This is an antibiotic that also causes stomach contractions and helps move food out. Side effects include diarrhea and development of resistant bacteria from prolonged exposure to the antibiotic.
Antiemetics: These are drugs that help control nausea.
People who have diabetes should try to control their blood sugar levels to minimize the problems of gastroparesis.
Dietary Modifications for Gastroparesis
One of the best ways to help control the symptoms of gastroparesis is to modify your daily eating habits. For instance, instead of three meals a day, eat six small meals. In this way, there is less food in the stomach; you won’t feel as full, and it will be easier for the food to leave your stomach. Another important factor is the consistency of food; liquids and low residue foods are encouraged (for example, applesauce should replace whole apples with intact skins).
You should also avoid foods that are high in fat (which can slow down digestion) and fiber (which is difficult to digest).
Other Treatment Options for Gastroparesis
In a severe case of gastroparesis, a feeding tube, or jejunostomy tube, may be used. The tube is inserted through the abdomen and into the small intestine during surgery. To feed yourself, put nutrients into the tube, which go directly into the small intestine; this way, they bypass the stomach and get into the bloodstream more quickly.
Using an instrument through a small incision, botulinum toxin (such as Botox) can be injected into the pylorus, the valve that leads from the stomach to the small intestine. This can relax the valve, keeping it open for a longer period of time to allow the stomach to empty.
Another treatment option is intravenous or parenteral nutrition. This is a feeding method in which nutrients go directly into the bloodstream through a catheter placed into a vein in your chest. Parenteral nutrition is intended to be a temporary measure for a severe case of gastroparesis.
Electrical stimulation for Gastroparesis
Electrical gastric stimulation for gastroparesis uses electrodes that are attached to the stomach wall and, when stimulated, trigger stomach contractions. Further studies are needed to help determine who will benefit most from this procedure. Currently, only a few centers across the country perform electrical gastric stimulation.

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Phantom Pains

Although amputations are visible the phantom pains are not.  The exact cause of phantom pain is still unknown  but originates in the spinal cord and brain.  when a patient feels these pains, it can be seen in a MRI machine.    It is believed that it is a response from mixed signals from the brain.

When a amputation takes place, areas of the spinal cord and brain lose your input from the missing limb and adjust to this detachment in a unpredictable way.  It may send a message to your brain the pain is else where.   Because the sensory information is referred elsewhere-from a missing hand to a present cheek.  So when the cheek is touched its as the missing limb is present.  It is a version of tangled sensory wires.  Thus results in pain.

Phantom pain can be caused by damaged nerve endings, scar tissue at the site of amputation and the physical memory of pre-amputation pain.

Know your triggers, usually you can feel a tingle or some sensation before pain begins, Try to empty your bladder, don’t get constipated, drinking alcohol can add to the pain,  If you learn your triggers you may be able to stop them before they happen,  meditation, calming one self down can prevent the pain.  Number one trigger is Stress!  so if you can exercise, de stress, calm down, you may be able to find tricks by massaging the limb before bed to help prevent the pain or using a (tens) machine to the affected limb.

Treatments and drug

Acupuncture and Transcutaneous electrical nerve stimulation

(TENS), have been found to be effective treatment for those that don’t want to take oral medications.  Also more invasive options include injections or implanted devices .  This is usually a last resort.

Medications

Although no medications specifically for phantom pain exist, some drugs designed to treat other conditions have been helpful in relieving nerve pain.  Not every pain medication will work for every person’s pain.

Medications used in the treatment of phantom pain include:

  • Antidepressants. Tricyclic antidepressants may relieve the pain caused by damaged nerves. Examples include amitriptyline, nortriptyline (Pamelor) and tramadol (Conzip, Ultram).

    These drugs work by modifying chemical messengers that relay pain signals. Antidepressants may also help you sleep, which can make you feel better.

    Possible side effects include sleepiness, dry mouth, blurred vision, weight gain, and a decrease in sexual performance or desire.

  • Anticonvulsants. Epilepsy drugs — such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Epitol, Tegretol) — are often used to treat nerve pain. They work by quieting damaged nerves to slow or prevent uncontrolled pain signals.

    Side effects may include depression, anxiety, suicidal thoughts, irritability, and allergic reactions such as hives, fever and swelling.

  • Narcotics. Opioid medications, such as codeine and morphine, may be an option for some people. Taken in appropriate doses under your doctor’s direction, they may help control phantom pain
  • receotor antagonists. This class of anesthetics works by binding to the NMDA receptors on the brain’s nerve cells and blocking the activity of glutamate, a protein that plays a large role in relaying nerve signals.

    In studies, NMDA receptor antagonists ketamine and dextromethorphan were effective in relieving phantom pain. Side effects of ketamine include mild sedation, hallucinations or loss of consciousness. No side effects were reported from the use of dextromethorphan.

Noninvasive therapies

    • Nerve stimulation. In a procedure called transcutaneous electrical nerve stimulation (TENS), a device sends a weak electrical current via adhesive patches on the skin near the area of pain. This may interrupt or mask pain signals, preventing them from reaching your brain.

      Used properly, TENS is safe. To avoid an unintentional shock, don’t wear a TENS device in the shower or tub or turn it up too high.

    • Mirror box. This device contains mirrors that make it look like an amputated limb exists. The mirror box has two openings — one for the intact limb and one for the stump.

      The person then performs symmetrical exercises, while watching the intact limb move and imagining that he or she is actually observing the missing limb moving. Studies have found that this exercise may help relieve phantom pain.

    • Acupuncture. The National Institutes of Health has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts extremely fine, sterilized stainless steel needles into the skin at specific points on the body.

It’s thought that acupuncture stimulates your central nervous system to release the body’s natural pain-relieving endorphins. Acupuncture is generally considered safe when performed correctly.

Minimally invasive therapies

  • Injection. Sometimes injecting pain-killing medications — local anesthetics, steroids or both — into the stump can provide relief of phantom limb pain.
  • Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord can sometimes relieve pain.
  • Nerve blocks. This method uses medications that interrupt pain messages between the brain and the site of the phantom pain.

Surgery

Surgery may be an option if other treatments haven’t helped. Surgical options include:

  • Brain stimulation. Deep brain stimulation and motor cortex stimulation are similar to spinal cord stimulation except that the current is delivered within the brain. A surgeon uses a magnetic resonance imaging (MRI) scan to position the electrodes correctly.

    Although the data are still limited, brain stimulation appears to be a promising option in selected individuals.

  • Stump revision or neurectomy. If phantom pain is triggered by nerve irritation in the stump, surgical resection or revision can sometimes be helpful. But cutting nerves also carries the risk of making the pain worse.

On the horizon

Newer approaches to relieve phantom pain include virtual reality goggles. The computer program for the goggles mirrors the person’s intact limb, so it looks like there’s been no amputation.

Along with this pain from amputation, a patient may experience grief of the loss of the limb amputated, also depression over the loss can be common,  Loss of activity, or ability to work, or function pre amputation.  So support from family and friends are a important part of the recovery of a amputee.

One patient told me the pain was so bad he wanted to cut his entire leg off or kill himself.   Life was not worth living.

 

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