This all began back in mid July. I basically woke one morning and my abdomen was so bloated and distended, I looked like I was pregnant and couldn’t breath. No big deal for most people, as everyone gets bloated from time to time, but when you have severely compromised lung function, it’s a whole nuther story.

Not just a nuisance, when you have chronic lung disease such as asthma, abdominal bloating and distention caused by gas in the GI track, can inhibit the movement of the diaphragm making it difficult to breath. If ones asthma is simultaneous flaring or one is experiencing air trapping, this can amplify the sensation of breathlessness, which then can lead to cycle of anxiety and even more respiratory distress. On August 22nd, I was admitted to the hospital for the 144th time for this very reason, a severe asthma flare complicated by abdominal bloating.

The trigger for the asthma was probably environmental allergies, hot temps and high humidity. But what really threw me over the edge was the GI bloating, which had been plaquing me on and off for several months. Up until this point I had blamed the symptoms on steroids, my cholesterol meds, inadequate hydration and improper diet. I figured it was just part of growing older and that it would get better in due time. Well it didn’t.

The day prior to ending up in the hospital, my abdomen became so distended I literally could not move my diaphragm to take a breath in, and with my asthma already flaring, I could barely force a breath out. Talk about hell, it was so difficult to breath I felt like I was going to suffocate. I had to lay flat on my back to breath, which is usually the opposite of the way you position your body when your asthma is out of control. This led to a cycle of dyspnea and anxiety that I just couldn’t shake.

Once in the hospital my asthma turned around fairly quickly. I spent 2 very intense days in the ICU battling it and thankfully got through the attack without needing to be intubated. With my asthma under better control and after complaining that I believed the bloating contributed to the severity of my flare, they took xrays of my abdomen ( what they call a KUB flat plate), but didn’t see any obvious bowel obstruction or anything grossly out of whack. The GI doc who I had seen earlier in the week in clinic also stopped by and assure me that the bloating would subside after completing the course of antibiotics that she had put me on. Well, again it didn’t.

So what’s with all this bloating? Am I swallowing too much air? Am I eating the wrong foods? Am I not drinking enough water?(that’s a given). Are my intestines not moving things along fast enough? And why did this come on so sudden?

Ive been through so much year with my health issues, its really hard to pin point the culprit. Ive been in and out of the hospital a lot for my breathing problems and part of that involves the use of a of narcotics….lots of them. Yes, opiates medications are used often and in high doses when managing patients with lung disease on ventilators. They’re also used in treating the symptoms of air hunger. And while they help relieve breathlessness, over the long term they’re notorious for slowing down the GI tract and causing constipation. This has never been a big problem for me, but I can see how it might be contributing to my bloating issues.

Because I tend to get bloated after eating only small portions of food, they did a Gastric Emptying study to see if I had Gastroparesis. The test came back totally normal. In fact, 95% of my stomach contents ( the radioactive scrambled eggs you eat for the test) passed out of my stomach in 3 hours. They also tested for Gluten sensitivity and H pylor, which also came back negative. So it appears there’s nothing mechanically wrong with my upper GI, but how about the lower GI? Well, Ill probably never know, because both of my GI doctors refuse to to do invasive tests on me, like colonoscopy or endoscopy, for fear that my lungs might act weird during the procedure and I would end up a ventilator. In my Gastroenterologists blunt words.. “It’s far more likely you’ll die from your lung disease long before you’d die from colon cancer“. Hey, Im no fan of colonoscopies, but I can’t help think that they are placing too much attention on my lungs when Im sure I would tolerate these other procedures just fine. It just seems like every time a new medical issue or problem pops up, it always takes a backseat to my asthma and lung problems. I understand the concern of some of my doctors, but I’ve managed to live a long time despite my lung issue, and I would hate to die prematurely from another condition that could have been prevented or cured with early intervention. Just saying……

Having ruled out just about everything else out, the possibility exists that because I’ve been intubated so many times for my asthma, and because they always insert an Naso-Gastric tube ( a feeding tube) into your stomach when they intubate you, that some foreign bacteria might have made its way into my lower gut, throwing everything out of balance, which can excessive gas build up. They call the condition SIBO or “Small Intestine Bacterial Overgrowth”. The treatment for SIBO involves killing all the of gut bacteria with an antibiotic called Rifaximen and then to re establish a environment for good bacteria to re-grow by taking probiotics afterwards. I completed the first round of Rifaximen 6 weeks ago, and may do another round in a couple months if my symptoms continue.

So where do we go from here? Well, the good news is that while I still get easily bloated and distended, it’s been a little more manageable and a little more tolerable lately. Some of that is probably from a change in eating patterns and diet changes. I think some of it is also from behavior modification in not letting the resulting anxiety make things worse. But the key in keeping the bloating in check in my opinion, is by keeping my asthma in check. When my breathing is bad, it makes the bloating feel worse. It’s the perfect storm if you will. Of course finding ways in keeping asthma flares at bay is going to be a challenge, as my triggers are many and pretty much unpredictable.

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