Bleeding blue, silver and teal

Friday, April 3, 2009

It started with feeling a little run down after working extra, perhaps there was some lightheadedness when he stood too quickly and then came the fatigue. The baseball world blamed Ichiro Suzuki’s malaise on playing too much in the just completed World Baseball Classic. This time of year, baseball players are supposed to lounge in spring training and gradually get themselves into shape, not play like it’s the World Series in October. But the baseball world was wrong, Ichiro was tired because he was anemia and he was anemic because he was bleeding from an ulcer.

The scenario plays out routinely off the playing field too often. A person feels run down and blames it on all sorts of circumstances but finally presents to their doctor to get some help. The clues come from the history of heartburn and indigestion, or maybe it was the extras aspirin or ibuprofen to help with the stress headaches at work. There may be a little tenderness in the belly and after some coercion on the part of the doctor, the patient agrees to a rectal exam. It shows that the stool has occult blood in it; that is blood that cannot be seen but shows up with a chemical test. A blood test shows that the patient is anemic, meaning there is a low red blood cell count. Put the clues together and the doctor tells the patient that the fatigue and tiredness is due to bleeding.

The stomach is a mixing bowl, allowing food and digestive juices to mix together and allow digestion to begin. But the stomach is just another piece of meat and it has a protective lining that prevents digestive enzymes from eating away at it. If the lining is damaged, inflammation and pain may occur. If the inflammation becomes worse it can cause the stomach or the duodenum (the first part of the small intestine) to bleed. The bleeding may not be noticeable and the patient may not seek medical care.

Red blood cells carry oxygen to the organs of the body. If there are too few, symptoms may occur. Some are pretty non specific like fatigue, weakness or lack of energy. As the anemia becomes more severe, shortness of breath or chest discomfort with activity may occur. Lightheadedness may happen if a person stands too quickly since the body isn’t able to pump red cells fast enough to the brain. It usually resolves in a few seconds as the body adapts or if the person sits down. Sometimes, though, the lightheadedness leads to passing out.

Inflammation in the stomach may also cause a small crater or ulcer to form. If there happens to be a blood vessel under the ulcer, a lot of bleeding can happen and then the symptoms aren’t so subtle. The patient may vomit blood or the blood may pass into the intestine, get digested and come out as black, tarry stools.

Bleeding ulcers are a big deal. Often having endoscopy is diagnostic and therapeutic. A gastroenterologist can use a fiber optic camera to look inside the stomach and duodenum, searching for a source of bleeding. If a blood vessel is leaking, it’s possible to cauterize or burn the blood vessel and take care of the problem right away.

However, there is still plenty of work for the patient to do. The treatment of ulcers is multi-pronged. Aspirin, ibuprofen, alcohol and smoking are toxic to the lining of the stomach and needed to be stopped. Medications like zantac, prilosec and prevacid can be used to decrease acid secretions into the stomach and allow it to heal. Routine use of antacids can mop up whatever acid production there is left.

Baseball players are superstars when they hit .300, meaning they succeed only 30 percent of the time. As an elite athlete, Ichiro knows his body well and also knows when something is wrong. It’s a good thing that his doctors listened and batted a thousand when they got the diagnosis right.

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