#pain management is important if you're lucky and privileged enough to find it useful

[not-poignant]

Speaking of the stomach symptoms that Ef has to go through, how do you cope with your own symptoms and do you have any protips for dealing with the pain?

Hi anon!

This one's tough, because the cause of the pain can be so multi-factorial. Digestive issues - for the best pain treatment and management - require:

1. A diagnosis 2. Understanding your allergies and intolerances*** (and they are not the same thing) 3. Understanding your triggers

The thing is, a diagnosis can be as good as a cure for some people who are lucky enough have treatable digestive conditions. A person with a finicky digestive system who learns they're gluten intolerant has a cure, even if it's not an easy one (avoid all gluten - symptoms and pain gone! Huzzah!)

Anyone who is having difficult digestive times should, imho, never just leave that as something to self-diagnose and just accept. I get diagnosis is a matter of privilege in some cases, but where it's not, this is one area where you don't want to fuck around and find out. There are literally hundreds of different things it could be, all with different treatments, medications, options, and supports out there. And I do know people who've ended up with severe autoimmune conditions and losing like, feet of their intestinal tracts, or cancer-like conditions, because of chronic diarrhea in particular, because they just 'waited' on the pain they were experiencing in their digestive tract.

And then the rest of this post is mostly like, 'I can't help you because bodies are diverse and 'stomach symptoms like Ef' means hundreds to thousands of different illnesses and hell, I've suggested pain management techniques in that story that you can try right now, and also I can't tolerate any pain treatments so good luck anon but I got nothing.' But like, the long scenic route version.

I can't speak to your issues, anon, because I don't know what your diagnoses are. There's not really many 'idiopathic digestive issue' diseases, but there are a lot of chronic illnesses that can be diagnosed through exclusion that can't be cured. But again, of those - and there are many - I don't know what yours are. And what I have, may not apply to you. It may not even apply to someone with exactly the same symptoms I do.

A person having Efnisien's symptoms could just have some intolerances that could be easily cured by avoiding those foods. Another person might have cancer. Like...you'd be amazed how many diseases cause non-specific and painful cramps and diarrhea. Sometimes it seems like all of them can.

For example, one of my many digestive illnesses is severe medication resistant gastro-esophageal reflux disease. Everyone in my family on my mother's side has it to varying degrees.

My grandma has needed to have two Nissen fundoplication surgeries to survive it, and has taken a proton-pump inhibitor since they were invented to manage it (since the 1980s), and because she's been taking a PPI for 40+ years, her stomach is now also riddled with hundreds of (so far) benign polyps and cysts as a result of the medication that she must take.

She avoids certain foods that I don't have to avoid, but I also need to take more medications than her, my food triggers are different to her food triggers, my brother's food triggers are different to my food triggers and he has the same disease and presumably, with a very similar genetic make up because it comes through the family line. His is very severe like mine, and nearly caused esophageal cancer for going so long untreated (the medication to treat has side effects, but leaving medication-resistant GERD alone can cause cancer of the throat and esophagitis, which my brother has been diagnosed with). My sister also has it. My Mum's is very mild, and she just has to avoid certain foods but needs no medications. And so on and so forth.

So how I manage the pain of just that one digestive disease - for I have more than one - (PPI and H2 receptor antagonist, certain food avoidance, no NSAIDs at all) is different to how my grandmother manages the pain (two surgeries, food avoidance that I don't have to avoid, PPI only), is different to how my mother manages the pain (food avoidance only, and different foods to me), is different to how my sister manages the pain (heat packs). Even the specialists we see are different, and our doctors suggest different management protocols. In that sense, I'm lucky, because my GERD can be medicated and I can generally enjoy eating and not choking on my own stomach every single night. Though I still have 'breakthrough days' where I do wake up choking on my own stomach acid, and have a sore throat / cough for the rest of the day.

So like, I can't take anti-inflammatories for the pain because that affects the stomach lining and mine's already fucked from GERD, but you might be able to. I can't take Buscopan for the pain, but you might be able to. I can't take Immodium on bad days, but you might be able to! Don't get me started on opioids or tramadol, it is very much like my body wants to suffer sometimes, the way I can't tolerate meds that are specifically for pain management. :/ I highly recommend looking up some support groups for the diagnosis/es you have, and seeing what people are recommending.

Because I don't tolerate almost all painkillers, I can't take any pain relief for my digestive illness/es (of which there are like...four, not including doctors thinking that my genetic cancer is causing some of it too, which is just a whole lot of oh well) that isn't just paracetamol (acetaminophen) which doesn't work.

There are no medications that help my chronic diarrhea at the moment, because it doesn't seem to be an autoimmune disease (at least so far, despite flagging for mild autoimmune stuff in every bloodtest I've ever had since I was 18 years old, but that's another story), but if yours is autoimmune in nature, there will be options that aren't pain-medication that may help you, and anything that helps with symptoms also, by default, helps with pain.

Some of my symptoms/pain is stress-triggered (my PTSD and my tumours can cause massive and unusual amounts of adrenaline to dump through my system, and one of the side effects of adrenaline entering the system is diarrhea - it's part of the flight/fight response: digestive disturbance). Therefore, less stress would certainly help me. But one of my specialists just laughed at me gently when I asked him how people stress less. You have to be awfully privileged financially to even try, even without a diagnosis of PTSD. And my tumours will still likely do this to me for the rest of my life, whenever they just feel like manufacturing hormones. They're neuroendocrine tumours, they want to fuck up my hormonal system, lmao.

Basically, anon, your question is kind of too vague to suggest much more than what's in Falling Falling Stars - perhaps some pain killers, perhaps some food avoidance, perhaps some heat or cold packs. Who knows? I have no idea what your diagnoses are, what you can tolerate, and I know what other people use for support, I can't, so I can't speak to how good those things are.

I'm going to level with you, anon. I have no protips for dealing with the pain aside from sucking it up and dealing with it, because I have almost no other options myself except to develop a high pain tolerance (which I have, which is terrible, because it means I wait too long to see doctors for very serious issues, and this has fucked me over more than once - one of my specialists literally yelled at me for it only last year: 'WHY DIDN'T YOU COME IN SOONER, DO YOU NOT TRUST US' which was great).

I'm really hoping you are not in my situation, because my 'dealing with the pain' is a version of 'I am in moderate to significant and sometimes severe pain 24/7 and no one can do anything to help me.' I wish it was only my digestive issues causing that, but the Fibromyalgia is certainly part of that. Sometimes the only way to deal with pain is to see a psychologist, and learn how to live with pain.

Find the support groups for your illness/es anon, they will have big personal lists that everyone is doing, they will be highly diverse and everyone will be doing something different for pain management, from ketamine infusions, to low-dose naltrexone, to ultrasound therapy, to heat packs, to a billion different medications, some for pain, some for your diagnosis. Having a diagnosis will help, because there are medications for specific diseases and disorders, someone with Crohn's will be on a very different cocktail of drugs compared to someone with IBS-D type compared to someone with IBS-mixed type, compared to someone with food intolerances.

And if you're lucky, your issues will be caused by intolerances, in which case you have a cure, even if it's an inconvenient one. But that cure (avoiding the food) can permanently remove the pain in some cases.

I'm sorry I can't be more help. There's just...thousands of things that can cause diarrhea and stomach cramps, and thousands of ways to manage those things. It's too nonspecific, beyond what I've already suggested in Falling Falling Stars. And anything more than that comes with side effects, and it's not good to already strain a digestive system that's strained, when you can potentially avoid it.

*** Please remember that there is almost no way to know your intolerances except through a food elimination diet, and anyone trying to sell you a blood test that tells you otherwise (i.e. naturopaths) is a fucking charlatan. There are, I believe, only 2-3 intolerances that can be read through blood test, one of them is lactose. There is no such thing as an accurate 'intolerance blood panel.' And only an allergist can diagnose allergies (with the exception of coeliac and again probably lactose issues lol), and finally, allergy =/= intolerance. Elimination diets should be overseen with the help of a doctor or specialist or dietician, because they are difficult to do and can cause or exacerbate eating disorders and disordered eating. I am not a doctor, always talk to your doctor about this stuff first, if you're concerned.