Friday, February 6, 2009

Appendicitis Hypothesis

(<--- Picture of my lovely new scar)

Following the removal of my appendix last week (an appendectomy), I was determined to understand why my appendix became inflamed.

Given that my diet is fairly well-balanced, and contains mostly fresh, organic, unprocessed, and minimally preserved foods, I was intrigued to know just what went wrong.

The surgery I had was not laproscopic, so I now have a new 2-inch incision below the right side of my belly button. The cut was also temporarily held together with staples (picture above of the actual incision on my belly), so I had to get them removed after 7-10 days. The visit with my doctor to do the removal was this past Tuesday, and it was then I asked him what caused my appendix to go crazy on me.

He explained that the cause was likely a fecal lith (a small stone-like ball of poop basically; the name is similar to gall stones which are correctly called chollithiasis). This ball could have formed for numerous reasons, but whatever caused it, the ball obstructed the opening of the appendix. Since there is only one way in or out of the appendix, the organ became upset, over-run by stagnet bacteria and then, Ta-da!, it turned into appendicitis. Since many doctors don't take the time to figure out what caused the appendicits, this is what they decide to be the most likely cause. In my case, they didn't try to figure it out either; the surgeon just saw dollar signs and his next vacation.

The appendix is one of those structures in our body that don't really have a purpose anymore. There may have been a role of it with out ancestors, but in today's age, it really does nothing for us at all.

One of my friends, Roland, sent me this message the other day regarding a hypothesized cause of appendicitis:

When I was a kid, I watched a show where they sent people out to the boonies to live like our ancestors might have. Tons of raw veggies, found grains and seeds, plus what meat they could hunt/catch. Several of them developed appendicitis. The theory was that the appendix once provided some enzyme or something to help with the additional fiber and tough to digest elements of our diets back then. No longer needed, the appendix has withered. The harsh diet triggered it to start producing, but at that tiny size, it's not up to the task and took a beating. Poor appendix...

This theory about the cause of appendicitis is very interesting. It does make logical sense, but in my case, with my high fiber diet, I should have developed this years ago. Not saying it's wrong, but maybe not so in my case.

The poop-stone theory does seem plausable. Due to all the fiber in my diet, my stools are well-formed. Thus, it would be easy for a small amount to become lodged in the opening of my appendix (yes, poop talk is both gross and cool, but we have to accept that it's a natural part of our lives... and should be everyday). However, in my scans of the literature on Pubmed and Web of Science, I've read that many pathologists don't feel that fecal obstruction or some other obstruction is the primary cause.

For example, this document by Carr NJ in the journal, Annals of Diagnostic Pathology, 2000, states:

Although acute appendicitis is frequent, it is subject to common misconceptions. Furthermore, there is little good evidence to support some of our beliefs. This report reviews the role of the anatomic pathologist in diagnosis when acute appendicitis is suspected clinically and discusses what is known of its pathology. The conclusions that can be legitimately drawn from the literature are emphasized. A classification is proposed that incorporates intraluminal inflammation, acute mucosal inflammation, acute mucosal and submucosal inflammation, suppurative (phlegmonous) appendicitis, gangrenous appendicitis, and periappendicitis, and the significance of each of these diagnoses is discussed. The etiology and pathogenesis of acute appendicitis is reviewed. Contrary to popular belief, the best evidence indicates that obstruction is unlikely to be the primary cause, at least in the majority of cases. Ancillary techniques in the diagnosis of appendicitis, including laparoscopy and peritoneal aspiration cytology, are discussed.

His discussion goes over the other more likely causes of appendicitis such as acute (sudden) inflammation in the middle of the colon, in the mucus membranes of the colon, in the membranes of the appendix, and deterioration of the walls of the appendix, among others.

Similarly, a 1983 article by Scandavian researchers stated:

The role of obstruction of the pathogenesis of acute appendicitis was studied by measuring the pressure in the appendix peroperatively in 33 patients undergoing appendectomy because of suspected acute appendicitis. The technique involved insertion of a fine needle via the apex into the lumen of the appendix and measurement of the hydrostatic pressure required to inject a saline solution. In all six patients with gangrenous appendix and in two patients with phlegmonous appendix there were signs of obstruction of the appendix lumen expressed as raised intraluminal pressure. In 19 patients found at operation to have phlegmonous appendix there were no signs of obstruction. The experimental data suggest that obstruction is not an important factor in the causation of acute appendicitis, but may develop as a result of the inflammatory process.

Other articles I read on this topic listed malrotation of the appendix as a cause, hernias or andominal wall defects as another cause, and then inflammation secondary to other bowel diseases like chrohn's and cholitis.

When the appendix is biopsied, the inflammation is often a result of bacterial overgrowth, and the most common bacteria is E.Coli. This bacteria lives in our bowels normally, so if they ever had a chance to overgrow in the appendix for whatever reason, this would send someone to the hospital.

Since I'm not an expert on the pathology of the appendix, and in the articles I read on the topic there was no clear answer, it doesn't seem that we (I) can assume one theory or diagnosis over another in any one case.

In my case, the cause may have been bacterial, leading to inflammation. I've been known to have bacterial imbalances that I've not been able to totally control or prevent. I do what I can to maintain a healthy flora in my gut, such as using high-qualtiy probiotics such as VLS#3, Align, and Saccromyces boullardii on a daily basis, obstaining from any alcohol and avoiding sugar. But, I'm not 100% balanced in this case.

My diet prior to the appendicitis may have also not been most ideal for preventing bacterial growth. Vinegar and vinegar-containing foods are often shown to encourage pathogenic bacterial growth in the gut. I'm known as a ketchup, mustard and salsa-aholic because I cover my food in these dressings (I used Carb One Ketchup though). I also love, love, love salads and use many vinegar and olive oil emulsions to dress them up. Thus, my addiction for these foods may have been my down fall.

As I spoke of earlier, as per my blood type (Type A), these foods are highly contradicted. I tried to abstain from them before, but they call my name. However, since the surgery and my attack, I've not used a drop of any. It's been a bit hard, but I'm getting used to it. I'm hoping this will help out my gut, and prevent anything else from arising.

Some people asked what evidence I have for Blood Type dieting, and I'll admit, there isn't really much out other. But, you can't prove everything in the lab, and with the loads of inaccurate and poorly run science investigations out there, it's hard to trust something just because it's published in a journal anyhow. Thus, I'm going with Blood Type dieting for the time being based on instinct. It feels right and it makes sense (for example, Type As are supposed to avoid bananas, oranges, and cow's dairy and those are two things I hate anyhow, but was experimenting before my appendicitis.). I'm not saying it's the end-all answer, but it can't hurt to give it a try. It contains all the nutrients I need to function properly, and I'm not omitting something my body needs essentially.

Overall, it's hard to completely accurately say what caused my appendicitis, or any of the millions of cases that occur each day (the surgeon who removed my appendix told me he removed three others that same day). It may be a function of the appendix not having the ability to keep up with our re-occuring high fiber intake, or it may be bacterial imbalances that are specific to each person. It may also just be obstruction. Whatever it is, I'm glad it's over with and hope others don't have the same thing happen. My recovery is still in progress... cut abdominal muscles don't heal fast enough :)


Mike T Nelson said...

Thanks for the update.
You may consider some non painful visceral massage work once you get the ok from your doc on that.
Heal fast
Mike N

Cristina said...

I've been told today I will have to have a surgery to remove my apendix, so thanks for all that info :) It was very useful!