by Dr. Iain Corness
Professor Hickey’s Wayside Inn of Ill Repute
The good book states
that the term ‘diverticular disease’ comes from the Latin word
‘diverticulum’ which means a “small diversion from the normal path”.
However, the late Max Hickey, my old Professor of Anatomy, claimed it was
Latin for a “Wayside Inn of Ill Repute”. His definition was much more
However, a diverticulum
as it refers to you and me, is a small bleb or ‘pouch’ that pops through
from the inside to the outside of the colon, and usually seen in the
descending colon which leads down to the rectum and anus.
When you have a few of
these diverticulae (plural of diverticulum – Latin) we say you have the
condition called ‘diverticulosis’. This condition, on its own, does not
produce any symptoms, so you do not know if you have it. A bit like early
stages of hypertension or even diabetes.
causes symptoms, it can do so in one of two ways: first the pouches can
rupture into the abdominal cavity, causing localized irritation and
inflammation or produce an abscess. This inflamed diverticulosis is now
called ‘acute ‘diverticulitis’ (remember when we put “-itis” on the end of a
word it means inflammation). Patients who have diverticulitis often will
usually present with a sudden onset of pain located in the lower left part
of the abdomen over the sigmoid colon. It is frequently exquisitely tender
and is associated with fever and a high white blood cell count.
diverticulae can begin to bleed to produce significant amounts of rectal
bleeding. This can also be painless, just to confuse your
So who gets it? If you
are Caucasian and you are over 65, then you have a 50 percent chance of
having it already. The reason given for this is the lack of bulk present in
the diet of industrialized countries allowing muscle contractions to create
localized areas of high pressure allowing diverticulae to form. Some pundits
say that the pressure created by muscle contractions of the left side
(sigmoid) of the colon are considerably greater than those of the right side
(ascending colon). This could explain why diverticulae are more common on
the left than right side of the colon. However, this does not explain why
Asians get diverticulae on the right side. (Ah, the mysterious East! Or
perhaps the theory is wrong!)
Acute diverticulitis is
usually diagnosed by the typical history and a physical examination
demonstrating tenderness over the sigmoid colon (left lower part of the
Caucasian abdomen). Fever and a high white blood cell count generally
confirms the diagnosis. A CT scan or ultrasound of the lower abdomen can be
very helpful in showing an inflammatory mass over the sigmoid colon.
If the presenting
symptom is rectal bleeding, this can be a bit more difficult to diagnose and
is frequently a “diagnosis of exclusion” by which we can find no other cause
for the bleeding. Fortunately this is not common, and less than five percent
of people with diverticular disease of the colon will bleed.
Acute diverticulitis is
treated with antibiotics for 7-10 days. These antibiotics frequently have to
be given intravenously. Diet is often severely limited during the first few
days of treatment. Most patients will recover completely, but occasionally
surgery is necessary in order to drain all the infected material and
completely empty an abscess cavity.
So can you do something
to stop your diverticulosis becoming diverticulitis? It hinges on eating
more fiber. High-fiber foods, such as fresh fruits and vegetables and whole
grains, soften waste and help it pass more quickly through your colon. This
reduces pressure inside your digestive tract. Aim for 25 to 30 gm of fiber
each day. Fiber works by absorbing water and increasing the soft, bulky
waste in your colon, but if you do not drink enough liquid to replace what
is absorbed, fiber can be constipating.
Respond to bowel urges.
Do not delay. Delaying bowel movements leads to harder stools that require
more force to pass and increased pressure within your colon.
regularly. Exercise promotes normal bowel function and reduces pressure
inside your colon. Try to exercise at least 30 minutes on most days. At
Are you ready?
I have it on good
authority and the evidence would appear very strong, that unfortunately,
we are all going to die. That’s you, Auntie Annie and even me (and I
used to be 10 foot tall and bulletproof).
OK, the dying thing is something we
all consign to sometime in the future, and anyway, I’m not ready to die
yet. I jokingly proclaim that if you can’t take it with you, then I’m
not going! But that is just a good throw-away joke line.
This week’s column reminded me of
the death of an old acquaintance. Lovely bloke who took life seriously
and would ask me all sorts of medical questions – but were all related
to ‘living’. We never discussed ‘dying’.
He had an accident that resulted in
a brain injury that rendered him unconscious – a condition he never
recovered from and eventually he died, leaving a grieving wife.
Unfortunately, these scenarios do
tend to be common place – we are all going to die, and since, in
general, we are older than our Thai wives, we can expect to rock up to
the pearly gates first to be fitted up with a harp and a comfy cloud.
Unfortunately, whilst it may be
ethereal up there, you may have left bedlam down here. As well as
grieving wives and family you may have left a financial mess.
Answer this question: when you die,
how does your wife get the money necessary for daily living? Was this
something you paid her each month, like a salary? But now you’re not
there to pay that salary.
Where does your money come from? A
pension or superannuation that is paid regularly directly into your
account? And does your wife/partner have any access to that account?
Even if your “exit fees” are
covered by an insurance policy, does she know where that policy is kept?
Or even the name of the company?
And where is your money kept, once
you’ve popped your clogs, so to speak? Banks can get very pernickety
about people trying to withdraw money from a deceased person’s account,
no matter how long they had lived together.
Then there’s wills. If you die
without making a will (intestate) then everyone hops in for a slice of
the action, right the way through to the gardener and the soi dog.
Sorting that lot out takes months (sometimes years), and money is not
dispersed until all claims have been verified. (You can relax a bit here
– the soi dog won’t get anything.)
But there’s another important will
here – your Living Will. You are ensconced in the ICU, unconscious and
unable to function on any level. Who has the authority to tell them to
pull the plug? If you don’t nominate somebody in your Living Will then
nobody has the authority. And while your body is lying there, the taxi
meter is ticking away.
However, there is confusion in the
minds of many people, as to what a “Living Will” actually is and what it
covers. Borrowing from the Mayo Clinic in the US, it states on their
website “This written, legal document spells out the types of medical
treatments and life-sustaining measures you do and don’t want, such as
mechanical breathing (respiration and ventilation), tube feeding or
resuscitation.” The important words to note are “life sustaining” and
“resuscitation”. Neither of these concepts imply medically assisted
suicide, or euthanasia.
Remember that we are talking about
terminal situations here. Not situations from which it would be
reasonably expected that you will recover and still have a good quality
of life. A fractured hip when you are 90 is a serious situation, but
provided you are healthy otherwise, then it would be expected that you
would recover. You might need a stick for a while, but you would still
be able to have a beer with your mates or play Scrabble or whatever your
pursuits were before the incident. In other words, the expectancy of a
reasonable quality of life is there.
However, if you are in the terminal
phase of metastatic cancer, which has progressed despite treatment, the
future quality of life is not there. Artificially prolonging life under
that situation is then covered by the Living Will.
Exercise for Health.
Does that include sexercise?
Probably the commonest advice a doctor gives is to lose weight and get some
exercise. Does that ring a bell in your memory? Was that part of the advice
after your annual physical check-up?
Unfortunately, there seems
to be very little real understanding of what exercise should consist of, how
often, what type, how long and what about sex? For example, I was reading an
article on exercise the other day and it said authoritatively that one
should wear comfortable clothing and socks with the correct size of
non-slippery, shock-absorbing shoes. If this includes sexercise, there are
some strange shoe fetishes out there that I haven’t heard of yet!
However, getting a little
serious, exercise will be good for you, provided that you pick a form of
exercise that is not harmful for you! Now I know that looks as if I have put
my money on both horses in the race, but take that sentence at its face
value. Enough research has been done to show that regular exercise is
beneficial for everybody, in both the physical and psychological aspects,
but, and it is a big ‘but’, all forms of exercise have relative bodily
risks, and this has to be taken into account before you buy a pair of
expensive jogging shoes and tackle a 10 km trot in the middle of the day.
True stories – a medical colleague in Australia took up playing squash when
he turned 50 and dropped dead on the court of a heart attack, and another
acquaintance of mine turned 40, decided he wasn’t fit, bought a bicycle to
ride to work each day and was run over by a bus.
The same article that
advised non-slippery shoes, did have some wise words, however. These
included to choose appropriate exercise according to your ability. Never
exceed your limit. Remember that it is not the harder the better. If you
have acute medical problems (such as fever, or pain), stop exercising. If
you have chronic medical conditions (such as hypertension, diabetes,
ischemic heart disease and arthritis), seek advice from your doctor or
physiotherapist beforehand. All of these I agree with. If you are happy to
take your body to your medical advisor when it is sick, take it back to your
doctor for advice on how to tone it up as well.
The other words of wisdom
suggested that for prolonged exercise such as hiking, continually drink
water to supplement the loss of body fluid due to sweating. Do not wait
until you are thirsty. Take appropriate breaks during exercise. Do not
over-exert yourself. Forget about “powering through the pain barrier”. Leave
that for Olympic cyclists.
As well as the form of
exercise, there is the frequency. At least three times per week, 20-30
minutes (or more) is necessary each time, to derive the maximum benefit. And
always remember, if there is dizziness, fainting, shortness of breath, chest
pain, vomiting, nausea or severe pain during exercise, stop exercising
immediately and seek medical advice as soon as possible.
I am a great believer in
taking the animal kingdom as a bit of a guide for us human animals, and the
lion pride is a good one to follow. The Alpha male is not seen dashing
around the plains. He leaves that to the younger males, while he himself
exercises at a slower pace. Regular light exercise is much better than
severe exercise once a week.
Now I did mention at the
start of this week’s article, the word “sexercise”, and some of you have
been impatiently reading, while nervously fiddling with your expensive
packet of Viagra, Kanagra, Cialis and other lead-in-your-pencil medications
(I draw the line at tiger willy). OK, what about sex? The problems with this
form of exercise when you have some chronic complaint (such as hypertension,
diabetes, ischemic heart disease, etc.), should be part of the advice you
get from your doctor beforehand. The danger of over the counter willy
stiffeners is that you don’t get advice with them. The blue diamonds are
only for use by males who have a reasonable level of fitness.
Finally, the learned article
did say “Exercise with friends. Company provides enjoyment, mutual
encouragement and support.” That goes for sexercise too!