Fly Well: Avoid crud

Tires, grist, and exhaust pipes

February 1, 2013

Sackier

Remember old-fashioned bicycle tires? If a weak spot developed, the inner tube bulged out. Doctors’ $100 word for that is diverticulum and troublesome colonic “tics” is diverticulosis. Your colon is a twisty tube that takes a circuitous route around your belly down to your exhaust pipe. Its job is to store excrement while extracting water prior to sending it off to sea.

Rare before grist mills replaced roller mills around 150 years ago—because earlier flour production did not remove most dietary fiber—diverticulosis is now rampant in Europe, America, and other industrialized nations. One in three people over age 45 probably have these pesky pouches waiting to cause mischief; and in the UFO population (United Flying Octogenarians, not Martians) the number is closer to two out of three. Smoking, obesity, sedentary behavior, and too much alcohol and caffeine also contribute.

Swallowed plant fiber holds water and salt, keeping stool bulky and soft. Conversely, low-fiber diets cause smaller, drier feces requiring more expulsion effort, thereby raising colon pressures. Eventually, the colon gets more muscular, shorter—and tics protrude through weak spots where arteries pierce the wall.

Although many people are asymptomatic, hints that you may have problems with your internal bicycle tire should be suggested by reaching a certain age and remembering what you have eaten. Dull, chronic abdominal pain—maybe with changed bowel habit, flatulence, blood in the stool, or bloating—may indicate that you have diverticulosis. Classically, temporary improvement might follow passage of a motion or flatus.

Diverticula have small openings from the main colon channel and food can get stuck inside, causing localized infection, or diverticulitis. This medical emergency presents with marked tenderness, fever, vomiting, and diarrhea. It potentially can perforate into the belly, causing peritonitis, or form a fistula—an abnormal and unwanted connection from colon to skin or bladder. The artery next to an inflamed tic may be compromised, leading to passage of a large volume of blood and buying you a high-speed ambulance ride. Recurrent episodes with cyclic inflammation and healing can result in a narrowed segment of bowel, which eventually might cause obstruction. About 15 percent of people with diverticulosis will have one of these major problems.

Diagnosis is based on medical history, examination, and studies such as a contrast CAT scan or ultrasound. Sometimes asymptomatic diverticulosis is picked up during a screening colonoscopy—which everyone over age 50 should undergo. Any change in the way your bowels are behaving merits a visit to your physician—many symptoms of diverticulosis are similar to those of colon cancer, so it’s better to be safe than sorry

In symptom-free diverticulosis, adopting a high-fiber, higher-fluid diet with other lifestyle modifications may suffice. While there’s scant evidence that avoiding foods that could theoretically get stuck in the orifice of a tic (popcorn, seeded fruit, nuts) will help, I am old-fashioned and recommend this. If inflammation or frank infection is suspected, antibiotics are administered and intravenous fluids may be required. Recurrent episodes might suggest the need for electively removing the mischievous section of bowel, which now can often be performed under laparoscopic guidance, obviating the need for a big incision. Occasionally, emergency operations are required to drain abscesses, close a fistula, or control bleeding. At such times, most affected bowel usually is removed; ideally the two free ends are joined together, although sometimes surgeons have to fashion a temporary colostomy where the bowel drains into a plastic bag affixed to the belly wall.

If you fly into lousy weather you may be able to deal with the consequences, but avoiding crud is preferable. So here’s the key message: Eat more fiber. The average American eats much less than the recommended 1.3 ounces a day. Some elect to take a daily dose of a supplement (e.g., psyllium powder with water), but I think these are much less pleasurable and pricier than munching on veggies, beans, or apples—one a day really can keep the doctor away.

Assuming you got “tic’d off” and want to get back to flying, you will need a thorough gastrointestinal workup and all hospital records, including an operative report if appropriate. Having a colostomy is not a barrier to flight.

Given the pilot population demographic, there could be 100,000 or more of you out there with this condition, so keep your exhaust pipe working and avoid those blowouts.

Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through the AOPA Pilot Protection Services plan. Email the author at jonathan.sackier@aopa.org.

Jonathan Sackier