Netflix Documentary "Sugar Coated"

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Originally Posted by Corporal Lance Boil

I try never to talk medicine on the internet, but this is kind of my wheelhouse. The purpose of my response is to educate, as best I can. I'd like to make clear from the get-go that I am not refuting anything your specialist (I assume either a general surgeon or a colo-rectal surgeon) has said. I'm hoping my response might be of benefit to you and your understanding of your problem.

Diverticular disease, diverticulosis as it is known, or diverticulitis when inflammation/infection is present, IS a disease of diet. The human body is designed for high-fiber diet, which the western diet is not, hence the prevalence in our society as opposed to someplace like Japan. The colon has to generate pressure to move stool through it, and it is far easier on the colon to push a single, well-formed stool through then to push loose, low-fiber stool or diarrhea. Hence greater pressures are required for low-fiber stool. The colon, where both blood vessels and nerves perforate the wall, has areas where they are technically "weaker", and these are the areas that bulge out with higher pressures, aka diverticula. The sigmoid colon is far and away the most common site of diverticula, as it is the storage site for stool before defecation.

I would estimate 30-40 million people are walking around with diverticula. I also believe that our propensity to go to CT imaging much quicker now has to do with the increased finding of this condition.

Now on to diverticulitis. Of people who have a first bout, only 30% will have another. Of that 30%, only 30% will have another bout. So, you see, it is far more rare to have recurrence than not.

Diverticulitis used to be something where at your second bout, you would have the area resected, often with what is called a Hartmann's procedure (resection of the segment, bind rectal pouch and end colostomy, to be reversed in 1.5-6 months). Nowadays we treat it on a case-by-case basis, as some people are OK with intermittent flare-ups treated with antibiotics (cipro/flagyl or levaquin/flagyl or zosyn) and basically a liquid diet, whereas others are not. I will tell you this: the chances of you having a permanent colostomy (which is rare and mainly determined by the location of the disease) is exponentially higher if you need an emergency operation for serious perforation (Hinchey Class 3 or 4), as opposed to a planned, scheduled operation for resection when inflammation is not currently present. It is not unusual to have the segments re-connected and a diverting loop ileostomy brought up, to be reversed at a later time.

As a caveat, I perform this operation and am a general surgeon. I also have had a sigmoidectomy 3 years prior for perforated diverticulitis, so I've seen it from a patient's side as well.

I wish you all the best,

Tony Colacino

Great information, Tony, thank you very much!

When I wrote what I wrote above, I was off work due to being constipated and in a bit of pain. I know that is definitely not an ideal situation when one is dealing with this disease, but it occasionally happens to me despite eating good, or at least thinking I am?

My last flare up I was given a prescription for 2 meds, Cipro and Flagyl, which I did not get as my Dr. (not my specialist) said to get only if I thought I needed them? Should I have gotten and taken them anyways?

I haven't seen my specialist in likely 2-3 yrs now, but I guess it wouldn't hurt to go for another check up/and a colonoscopy just to make sure everything is OK.

I have put off the operation but as I am getting older and plan on retiring in the next year or 2, the more I think about it, the more I think I should just go ahead? My specialist, Dr. Wolfson, is excellent, imo. His reviews are A+ and a couple of friends, who also have him, said the same thing so I know I am in good hands.

Question for you. If one decides to have the operation, can this come back on you? (I assume yes if you don't eat properly and take care of yourself) The reason I ask is, a person I know had this procedure done, and she informed me she still has some of it a higher up. I was wondering if she will eventually get as sick as she once was as I assume the diverticulitis will make it's way back down again? (Sorry if I am being ignorant, I just don't know?)

Thanks again for the great information! I appreciate it very much!