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How Hiking Diagnosed My Chronic Appendicitis, Which Doctors Say Doesn’t Exist
12-09-2011
LONG STORY SHORT
Chronic appendicitis is apparently a rare condition, and many doctors don’t believe it exists. If anybody tells you this condition doesn’t exist, they are WRONG. I had six appendicitis attacks over two years, after being misdiagnosed multiple times since it’s so controversial. I eventually realized hiking was greatly aggravating my condition. And now for a short story long...
REASON FOR THIS RANT
I suspected over the past couple years, I’d been dealing with an angry appendix. While researching appendix issues and other tummy diseases, I found there wasn’t much data fitting my specific symptoms. I did, however, run acrossed (that’s for you, Joe) username=Fullograce’s post on www.ibsgroup.org. Fullograce’s experience was similar to what I was living, and his/her post gave me confidence which helped persuade doctors to my eventual diagnoses. Now feeling the need to give back to the community/blogs which helped me, I’m going to present my experience below.
SUMMARY
I had six appendicitis attacks over a two year time span = chronic appendicitis. Trouble is, common medical knowledge states this condition doesn’t exist, and that only acute appendicitis occurs…which is obviously WRONG per my experience. This time in my life was painful, and became very depressing. I had to sacrifice my two favorite loves = family and hiking. It also disrupted my career life as well.
In my specific case, I began noticing a trend. Whenever I wore my immune system down, either by excessive hiking/exercise or lack of sleep, an attack would occur a few days later. Attacks always occurred in the evening, and usually later in the week (after hiking the previous weekend). This correlation was difficult to identify, because I hike weekly sometimes and may run even more often…and very few hikes actually caused my appendix to react. My theory is, I had a permanent infection in my malfunctioning appendix, and wearing my immune system down enough allowed that infection to erupt.
I was misdiagnosed a few times, even though the answer/evidence was quite obvious. Much Googling and connecting my own dots may have just saved my life. Our medical infrastructure in the US is inefficient and frustrating, in my own experience.
I find it interesting that running for an hour (8 miles or so) wasn’t intense enough to trigger my appendix, while hiking was. This reinforces that hiking (although maybe only off trail) all day is truly an effective workout.
TIMELINE
Birth – 2010: Never nauseated, vomited, food poisoned, or caught the stomach flu.
ATTACK#1 02/24/10 Wednesday: Three days after hiking 2K vertical feet over 10 miles roundtrip at Lucky Peak Reservoir (east).
ATTACK#2 06/02/10 Wednesday: Three days after running/hiking 1K vertical feet over 3 miles roundtrip to Lucky Peak (queen mine).
ATTACK#3 08/07/10 Saturday: During a harrowing family event with little sleep.
ATTACK#4 08/19/11 Friday: Second day of a marvelous backpacking trip climbing the Matterhorn. Attack set in after 5K vertical feet over 13 miles.
ATTACK#5 09/08/11 Thursday: Four days after an intense 2K vertical feet over 15 miles roundtrip mountain bike ride to Kepros Mountain.
ATTACK#6 11/25/11 Friday: Five days after climbing/skiing 4K vertical over 10 miles roundtrip to Second Peak.
SHORT STORY LONG
ATTACK#1 02/24/10 Wednesday: Three days after hiking 2K vertical feet over 10 miles roundtrip at Lucky Peak Reservoir (east).
Around noon, I noticed I had a slight tummy ache. It felt a little different than your typical stomach ache, but I figured I was just overly hungry. However it slowly progressed until driving home around dinner time, the pain was severe enough I stood up while driving over speed bumps, which I took very slowly. By 10PM, I was coiled on the bathroom floor waiting to upchuck, but it never actually happened.
The pain was terrible for a few days, so much that I couldn’t even wear underwear due to the elastic around my waist inducing too much pain. I slept naked, unable to get comfortable, with pillows between my legs which I found relieved pressure from my abdomen. The pain was tolerable if I didn’t move, but a fever kicked in and made me flu’ish, so I was miserable no matter what.
I’ve never thrown up in my life, nor had the stomach flu or food poisoning. Throughout this experience, I kept thinking to myself “is the stomach flu really this bad?” My wife has had plenty of vomit experiences, and she seemed unfamiliar with my symptoms as I described them to her and as she watch everything unfold. In ways I was hoping she would catch whatever bug I had, just to prove my condition wasn’t something more serious…nobody ever caught it.
My wife urged me to visit the ER, but my stubborn self resisted. My family was dirt poor when I was a child, and I learned to tough out most sickness without doctor visits. I didn’t understand why this episode should be any different. I’ve always felt in control, and I’m annoyed by sissies.
After all was over by the weekend, I felt like I had been hit by a truck. I had very little energy and was exhausted for a couple days. This was definitely one of my bigger “illness” experiences. I’ve never been that close to vomiting, and it was awful (maybe my condition exaggerated that). I’ve still never vomited, and this experience reinforced that I never want to.
ATTACK#2 06/02/10 Wednesday: Three days after running/hiking 1K vertical feet over 3 miles roundtrip to Lucky Peak (queen mine).
This attack wasn’t quite as bad as the first. Pain and fevers hit me, but I never felt all that nauseated…which was the worst component of my first attack. This second attack still played out similarly to the first = pain, fever, some nausea, diarrhea, occurred the middle/end of the week, peaked during the evening/night. The biggest bummer was, it caused me to cancel a spring backpacking trip with Nate/Brady, which I had been greatly looking forward to for months.
This second occurrence didn’t scare or motivate me to do my own research, but I did visit the doctor while recovering. I explained these two episodes didn’t fit my history, and that I was concerned. The nurse examined me, and chalked it up to stomach flu…twice in three months. This somewhat put me at ease, and I didn’t look back…although I wasn’t completely sold.
ATTACK#3 08/07/10 Saturday: During a harrowing family event with little sleep.
This attack was definitely more subtle than the first two, only lasting a single night. Only a low grade fever, and pain was never all that bad.
I did notice laying on my right side was better than laying on my left. This made me reflect back, and I realized I preferred laying on my right side during the first two episodes as well (although one might think lying on the left side would better for appendix pain, but this wasn’t true in my case). I recorded this in my phone, and any other dots I thought may be useful later as more repeatable symptoms were recognized.
I was going through some personal and very stressful family events at the time, and making a doctor appointment wasn’t priority. This episode was mild and wouldn’t have required a doctor visit, although it did make me further question what was happening to me. I correctly assumed this occurrence correlated with my sever lack of sleep and high stress.
ATTACK#4 08/19/11 Friday: Second day of a marvelous backpacking trip climbing the Matterhorn. Attack set in after 5K vertical feet over 13 miles.
We had been working hard over the past two days, hiking nearly 5K vertical feet over 13 miles, with heavy packs on. Apparently, this was enough to trigger my appendix in two days, not the usual three days as before. Because it had been an entire year since ATTACK#3, I was hoping ATTACK#4 didn’t correlate with the previous three. I’d hiked 31 times over the past year without an attack, and a few of those hikes were very intense, so I didn’t recognize my attacks were correlating with hiking. Brady and I figured I swallowed a bug such as giardia, or was food poisoned by the MRE I had for dinner.
I obtained zero sleep due to horrible stomach pain and constantly having to go #2 all night long. By Saturday morning, my body had so little energy Brady had to pack up my gear and carry it out for me (he’s daman!). I felt so flu’ish/nauseated, my initial pace couldn’t have been more than 0.25mph on the hike out. But eight hours later, we reached the truck. This was the most awful terrible hike I’ve ever experienced. At least my condition improved upon reaching the vehicle. Brady drove us home and graciously let me sleep.
I recovered as usual after a few days, slightly questioned the situation, but never visited the doctor. It now puts fear in me to realize if my appendix would’ve ruptured on this trip (this is scary possible), so far from civilization, I may not have made it out. Kudos again to Brady for helping me limp back home!
ATTACK#5 09/08/11 Thursday: Four days after an intense 2K vertical feet over 15 miles roundtrip mountain bike ride to Kepros Mountain.
This episode grabbed my attention…strongly. It took longer to recover from this attack than the previous episodes, and was therefore depressing and worrisome. I immediately made an appointment with the doctor’s office I visited during ATTACK#2. However, they couldn’t fit me in until Monday. So while in pain, I sweat multiple fevers out over the weekend, all while Googling myself “to death”. I followed many people’s blogs, read medical textbooks, and combed WebMD. If I looked hard enough, my symptoms fit almost any disease I dreamt up, although they best fit appendicitis. I learned appendicitis is rare at my age, supposedly never heal on their own, and apparently never repeat (this was my fifth one!). I began realizing my attacks correlated with hiking. I concluded this would be an uphill battle, due to the controversy over chronic appendicitis.
I also discovered part of the nurse’s examination during ATTACK#2 above included the “rebound test” for appendicitis. I remember she pinpointed my pain coming from my lower right abdominal quadrant. At the time, I had no idea what the appendix was or where it was located, and trusted her to tell me if anything seemed concerning. Reflecting back, I realized I failed these basic tests after ATTACK#2, and was irritated she didn’t at least educate me or request further testing (a simple ultrasound would have done the trick), which would have cured me that much earlier. I’m still freaking irritated. Maybe she didn’t mention anything because my appendix miraculously healed (atypical of appendicitis).
Although I was recovering by Monday’s doctor visit, I convinced the nurse something didn’t fit, and she bit. I received my first full physical, including the axel greased finger. Blood/poop/pee samples were taken. I passed everything, and was then sent to a different office for medical imagery.
Ah ha! The ultrasound revealed an inflamed appendix. The radiologist so kindly made an ER reservation for me, before even notifying me about it. I was told to quickly drive myself to the ER for emergency surgery. This was all a little unexpected and occurring quickly, which made me anxious.
Hold the phone! After multiple tests at the ER, and lying on the table waiting to be cut open, the surgeon called everything off. Although his CT scan revealed my sick appendix was the source of pain, he told me there was no need for surgery because I wasn’t showing signs of an acute appendicitis…all because I was on the mend. He went so far to say “I guarantee you haven’t had appendicitis before”. What?!?! I didn’t even know how to respond, but also wasn’t surprised because my Googling taught me most medical professionals don’t believe my condition exists. I’ll admit I was relieved to forego surgery.
The surgeon prescribed Ciprofloxacin (antibiotic) and Metronidaxole (antiparasite)…the thought was I may have contracted giardia from hiking. I was concerned about the latter medication, because the side effects and warnings sounded risky. Tendonitis was listed as a side effect, which I was afraid would render me useless for hiking. I confronted the surgeon about this, but he wasn’t concerned. However, I had been nursing a slightly injured knee since May and sure enough, I could barely walk on it after finishing this medication. It took nearly three months for my knee to return to pre-medication functionality, which prevented me from enjoying any exercise for a couple months (those who know me might understand how depressing this was for me…I don’t know life without hiking). Even more discouraging, after finishing this medication, all my lab results finally came back and all were negative…my knee was now rendered useless for no reason at all.
Entertaining the idea that my appendix may not be the problem, I volunteered myself for a colonoscopy a few weeks later. Again, all results were negative which was a relief, because I was starting to suspect the dreaded Crohn’s disease...and others. My appendix was still the only red flag found, but even the gastroenterologist didn’t consider chronic appendicitis. Their best guess was IBS…what?!?! Again, if looking hard enough my symptoms fit almost any disease, but I found zero evidence/correlations suggesting IBS caused fevers.
ATTACK#6 11/25/11 Friday: Five days after climbing/skiing 4K vertical over 10 miles roundtrip to Second Peak.
My last visit to the gastroenterologist was two days after excitedly summiting Second Peak…my first hike since the previous attack almost three months earlier. Because I suspected hiking caused my appendicitis, I predicted and told them I may have another attack in a couple days. If that happened, they instructed me to check into the ER and order a second CT scan. They believed this would prove I was suffering from chronic appendicitis, and would result in my appendix being removed. They were correct… The ER had no problem performing a second CT scan on my abdomen. The conclusion scheduled me for emergency laparoscopy.
I was surprised how much better I felt waking up after surgery. I went into surgery with a fever, and came out feeling great. I didn’t realize the body would recover so quickly after removing an infection in such a dramatic way (by “dramatic”, I mean removing an organ). I’m also impressed with how fast laparoscopy recovery is, and how quickly the incisions healed…messy mountain bike accidents take multiple times longer to heal! Although in some pain, I only followed surgery with a single one-time dose of pain medication, and was still able to work a 40 hour week.
This surgeon stated he previously didn’t believe in chronic appendicitis, which was the common theme. However, he mentioned recently having a change in heart. I like to think my case further convinced him.
During my postoperative follow-up appointment, they mentioned all physical evidence, including biopsies, supported appendicitis. I’m ecstatic to resume hiking ridiculously hard without fear of subsequent attacks.