 Hey guys welcome back to my YouTube channel. This is Daniel Rosal here Another video on functional dyspepsia or about functional dyspepsia because I really really think There's a dearth. That's the right word. I think of online resources about this condition, especially Resources delivered in the format of video Videos and from people who actually have this condition. So that's why I put these up I do sometimes feel like apologizing saying for those people who are subscribed to my YouTube channel Not that with my 800 and something subscribers. It's a huge base But I do realize the topics vary a lot It is something that has been on my mind for a while and it's a plan probably sometime towards the end of this year and going to be Going going through the long process of figuring out how best to split up my YouTube output into Different channels that are more logically focused probably one about tech maybe one about FD because it is really Something that again, it's just this it's hard to track down content about this Which is just weird because if you look at the estimates estimates as to the prevalence of functional dyspepsia in Populations there should be a lot of info about it, but for some reason it's just kind of hard So two two different things two different things I want to talk about in this video one I want to talk about my experience so far taking Amitriptylin for functional dyspepsia. That's gonna be part one According to my Google calendar. I've been on it for eight weeks now second part want to just talk quickly about what is this Thing called post-prandial distress syndrome or PDS if you're watching this video I'm gonna assume you know about FD because you've probably found it through a Google search And that will be it and just to say as well I know I've gotten quite a bit of a feedback in the form of emails and stuff like that Stamina for my interview with professor Nick Talley, which I did I think probably six months ago Although time has really flown this year. I'm gonna be doing another interview with John Damianos who is a Primary care resident in Yale very active on Twitter very interested in the ghost brain axis and the microbiome and Frequently tweet stuff about FD So he struck me as a logical person to ask to talk about this fascinating thing for us patients about the gut brain axis So interviewing John later this month Interviewed Nick Talley, and I'm trying my best to find other FD researchers clinicians To bring on this YouTube channel because I do know that as an FD patient talking to other FD patients Even these little briefs about what is in the treatment pipeline? What's in the drug pipeline? What do we know about these conditions is helpful? So it's all that intro aside Let me talk a little bit about taking Amitriptyline for post-prandial distress syndrome So this is actually only the second drug. I've had FD my functional dyspepsia My journey with this really really irritating condition because I think that's the best word for it It's just like you know the probably worse. There are for certain worse things to have worth the jet worse digestive Problems, but FD seems to be very much like IBS a really sticky condition That's my impression anyway from having talked to a lot of other patients once you have it It seems like you're stuck with it for a long time. So I've had it for almost three years for me it all started after my gallbladder surgery and I'd love to hear from other people with FD who've had a similar experience I just seemed to have woken up from that surgery with a different digestive system and I'm gonna go on to my screen in a second and we'll just I want to talk about a couple of things But if you have also been diagnosed with post-prandial distress syndrome impaired gastric accommodation Let me describe what it's like for me at this condition. So I woke up as I said from surgery and after the initial phase which was Pain and I also had like really bad bowel reflux, but after that kind of leveled out And I wasn't super distracted by those things. I started noticing that whenever I would drink water let's say a cup of water or At a meal or Had some soda regular things that I wouldn't think twice about I could feel this is gonna sound crazy But if you have it, I Hope this connects. Well, I hope you don't have it. But if you do have it It just felt like it's sad in my stomach and I could feel my Bloating now before my surgery I don't think I ever experienced bloating and now there's not a day where I don't have bloating Sorry, if you're if you're one of my friends who somehow got this video and you're like too much information It is usually but if you have FD this we have we have to talk about our symptoms to find other people with the same Conditions if you're trying to use crowdsourcing to get a bit of relief. So that's what it's like for me My stomach just sort of blows up with air and bloating and I start burping and this is to me the one facet of it that really convinced me that this is not a This is a real like physiological problem. It's like this. It's like these weird small burps That'll eat something or drink something This is me simulating but I'll get these like weird burps that just don't relieve it And this can go on for hours now So you're probably thinking this doesn't sound too bad but imagine every single time you want to have a cup of water from the fridge or Drink a glass of milk or ease and The more you eat the worse it gets you get bloated and so that's what post-prandial Distress syndrome is it's after meals Prandtis and Latin means a meal as far as I remember and For me again talking about my experience of this condition. It's 110 and 10% is 100% meal related if I don't eat I can prevent all the uncomfortable bloating and burping and fullness and this strange sensation that you feel Food going down inside you and it just sitting there in your stomach around about If I just step back from the microphone a little bit around about here In fact before I started recording this video. I very cheekily finished off some soda And made myself a sandwich and now I can feel us I can feel the air in my abdomen in my kind of mid-area Just kind of puffing me out and I think what bugs me most about it. I it's not painful for me It's just very distracting. I would rather not be feeling these sensations Which I never did before it started for me So for me it really it really was like an overnight thing and I've heard a lot of people the same so this is what's called post-prandial distress syndrome bloating fullness burping and From what I understand in medical terms. This is called upper GI symptoms, right? So you have your colon and your lower GI and you can have painful if you've ever had a Bad stomach bug and you got kind of you know IBS like stuff for a few weeks You get this kind of cramping and pain. It can be very painful. I don't have any of that stuff. So FD the F in FD stands for functional and I've heard that the Rome Foundation who are kind of the international body Who've come up with diagnostic criteria for functional GI disorders are considering changing the name Don't quote me on that. Maybe 100% wrong It's called functional because if a doctor puts a scope an endoscope into your stomach into my stomach or Do a Dean and whatever they're not going to find anything structurally wrong organically wrong The pathology is not visible now from what I understand and the biggest claim in this video is that I'm not a doctor I'm just someone Living with this we would rather not be living with it and I've done and the course three years is a long time I've done I've done my research into this It's kind of a misnomer because they have found as I was saying as Nick Talley was explaining my interview They have actually found pathology in parts of the in parts of the intestine so Functional dyspepsia is a bit of a misnomer. It does not mean it's in your head at all It just means that it's not a it's it's it's it's really the function the functioning of the organs is what's problematic It's not the actual organs as opposed to you know Crohn's disease or other forms of bowel disease, right so There's two class two different types of FD One is the one I've just described called post-prandial distress syndrome and the second one is called Epigastric pain syndrome and that is EPS in terms of its initials Now I was going to I was going to talk to you about amy tryptolin. So this is actually the second drug I've tried for PDS The first thing I tried was nothing I hoped I was going to go away to be honest and I actually waited the best part of a year after my surgery I think I mentioned it to a family doctor once he said yeah, it's probably your system adjusting to living without a gallbladder and it'll just kind of go away and That never happened. So after about a year. I was like, okay, I'm recovered from the surgery I'm used I have no gallbladder. I can eat stuff, but Every time I eat stuff I'm getting this very uncomfortable feeling and you know, you can live with it for three months But after a year I was like, I should probably need to get this seen to so that was the beginning of my Diagnostic journey. I went to see a very very good I went to see one very unhelpful gastroenterologist. He was like, no, it'll be fine and Then I find then a the second one I looked out on I went to a Neuro gastro. If you're also by any chance in Israel, I would be happy to recommend him privately. I Don't want to say who he is publicly because that's maybe sharing too much personal info that might be used In a bad way But I'd be happy to recommend him privately. He's a neuro gastro. This is really the stuff He's laser focused on so I began seeing this doctor at a hospital and He had me firstly do a test for gastroparesis, which they give you a radioactive egg, which is fun Less fun or I was gonna say sounds cooler than it is I was very excited to get to swallow a nuclear egg once in my life It's a great story, right? But that came up negative so my gastro it wasn't so that rules out That's how they rule like gastroparesis and usually the symptoms can be so similar that if you don't have GP Gastroparesis or gastroparesis, however, it's pronounced. You have FD functional dyspepsia. So I said, okay Well, it's FD. So let's try sulparide sulparide is a actually believe it or not an anti psychotic medication Used by people with schizophrenia and this when I saw the script, you know, he was I was waiting for taxi So he gave me a prescription. I pulled it on my pocket. I'm like hang on schizophrenia This is like for my stomach like am I missing something here and the interesting thing is that for these disorders of the brain gut axis The medications are a lot of the medications are psychiatric meds used in very low dosages because These problems seem to be related to some kind of nerve signal between the brain and the stomach that for various reasons breaks So the doctor was very good. He said look that well actually, sorry, that was the second second visit. So I Was skeptical, but I took sulparide and it helped a bit But I went back to the doctor because after three months or whatever the time was and I said look It's helped a bit but not enough like if I'm going to be taking Serious medications. I want them to like work. Well, like I think it's helped a little bit 20 30% So that was sulparide, which if you're watching this video from the US You probably haven't heard about it. The reason is it's not approved by the FDA I'm based in Israel and sometimes Israel uses strange drugs for whatever reason because it's got a different approach to Medical regulation. It's I've also heard of people taking sulparide in India and Russia so maybe those slightly less developed countries tend to use this drug in any event I At some point of this FD journey became pretty depressed to be Frank This is me going on for two years. It wasn't getting better. I couldn't exercise really because I felt so bloated and Sulper I put on weight from the sulparide because that's one of the side effects of antipsychotics. So he's just getting fatter Not fitting into my clothes feeling terrible every time I asked And I was like I need some help. I'm gonna really read at this point. I was in a bad place Mentally not just physically So when to see a psychiatrist and I said, okay, I've read about you know, these functional gastro disorders I read anxiety and stress can play a role in them. I'm really really depressed Let's work on the depression. So that was when I started taking Lexa pro and This is like I just I realized I've gone way off topic here So I'm gonna have to change the name of this video from Amy tripling because that's kind of glossed over that a little bit But we'll I'll get back to us so Yeah, I was really depressed and I said the psychiatrist Says oh Lexa pro will it's gonna fix you. It's gonna It's great drug for depression and I'm confident your stomach issues will resolve with Lexa pro Now something I knew and I was a bit skeptical of after I started was Research says the older antidepressants the tricyclics called TCA's is their abbreviation Work better than Lexa pro. So did Lexa pro out my stomach? Not really. I was still having these problems So at this point this took me another six months Which is I think why I'm almost at the three-year mark and still finally finally trying amy tryptyline The psychiatrist did not want to use amy tryptyline Period you wouldn't hear of it. So I had to go back to the gastro And the gastro this time after it's upright said okay next thing we're gonna try is amy tryptyline in low again in low non-psychiatric dosages So I started taking amy tryptyline eight weeks ago. I'm on it for two months now I'm taking 25 milligrams and I'm still taking the lexapro. I did a video about that in fact about Taking an SSRI And a tricyclic lots of folks like me who are very anxious Go on to google and they read all these things about serotonin syndrome now. Nothing in this video is medical advice I'm just a patient as I've already mentioned but My doctor told me it was it was fine. A lot of people do it if you're not using that high dosage of the tricyclic It's probably very safe. So it actually probably took me a month before I was like Okay, if the doctor says it's okay. I asked a pharmacist and at that point you're like What else can you do? You can ask 10 pharmacists and 10 doctors until someone tells you know But bottom line I was told it was safe and I've been taking this for two months And I've had nothing whatsoever To suggest there may be any kind of a drug interaction, which is what I was worried about or serotonin syndrome The amy tryptolin at the start makes you exhausted, but I haven't had any Weird stuff like tremors or whatever So, um now finally you get to amy tryptolin. Has it helped? Again like sulparite I think a little bit maybe in the bloating but bottom line as I said Before I sat down to record this video. I Had a bit of food because it's 4 p.m. Of the afternoon here and I'm bloating again. So I'm supposed to be even I'm supposed to be giving it a four month trial I'm going to do that And if that doesn't help we'll try the next thing the other thing I started doing the other things I've started doing low fat diet. I try to eat low fat now as much as possible. I mean doing this for about Five or six months at this point. I don't love it, but it's it does help a bit definitely But again, not enough by itself to get rid of these symptoms and um Ox boil is another thing I've been taking sometimes Trying it when I go for a very fatty meal. It's supposed to if you don't have your gallbladder It's supposed to help you digest the fats adding in the missing boil Again, all these things have helped a bit, but I'm really looking for something that Helps more than that either helps majorly or puts this fully into remission and I come I can go back to I used to drink water, you know on a hot day Just drink a liter of water and then eat falafel and I never had these feelings if I can go back to that That's my dream to go back to my old body my old digestive symptoms. Um Um So There is a very good facebook group for folks who have functional dyspepsia I will put a link in the Description for this video because there's a few of them, but this one is really really good And there's a lot of folks in exactly this boat Some of them it started like me after their gallbladder Some folks after a stomach bug Some folks after something else. We're trying to figure it out a bit of crowd sourcing Given that you can wait four or five months between doctors appointments. I don't think it can hurt Um, just to put this out there as a non-doctor just as a patient. I have heard that Oh, let me let me jump into my screen quickly as well This is a paper from tack. There's a really big researcher in this area and he Um describes a treatment algorithm for functional dyspepsia that again is split into Eps pds They say firstly look they look for this h pylori drug They try to kill that and then you got prokinetics and all this Uh for the Eps side. Sorry for for the pd for the post-prandial side His his algorithm has prokinetics as the first line of option Asset suppressant agents and then if that doesn't work Maybe going in for the add-on therapy here and if that doesn't work neuro modulators, which are like the reason they use these Anti these older antidepressants and low dosages and no one really seems to understand why specifically it's the older ones Why specifically they work? It's a it's a common topic of conversation among fd patients I've read that it dulls down Hypersensitive nerves in the stomach or if the nerves were damaged and you're getting all this unwanted Neural feedback that you're feeling all the food go down. I don't know. I'm not a doctor I'm just trying to figure this out like a lot of people with this condition Oh, yeah, the second thing I wanted to show you guys are folks watching this video Um something nick tally mentioned when we did our talk Was he mentioned that he believes post-prandial fd and epigastric fd are actually two separate diseases And I did find this paper he wrote for the lancis in 2018 if I'm not mistaken. Yep New insights into functional dyspepsia further evidence for post-prandial distress syndrome as a distinct disease So that seems to be the emerging consensus Uh, and certainly in this in these fd communities the one that I found online The conditions a lot of people are describing with a lot of pain And no bloating sounded like completely different problems To what I've been experiencing Uh, since my surgery Um, and just finally just a definition just uh, so you don't have just me to go by here's what somebody said about it Um fd is to subdivide into post-prandial Meal related symptoms such as post-prandial fullness and early satiation. That's a definition So where does this leave me? I'm trying amy triptyline and what's next? So something I've Heard from this group Of people is that um those with it seems to me it's beginning to become quite clear That people with the post-prandial type have been trying After amy triptyline some people were helped with amy triptyline Noor triptyline des imipramine imipramine all these old tricyclics Noor triptyline did I mention noor triptyline? Um And then others have found relief with specific medications for reducing for um Increasing your gastric accommodation and the two ones I've heard about that if this doesn't work Will be the next things I'll try Are boost barone and mirtazepine. So those are the two ones and then there's a drug called accotiamide which is Making its way through regulatory approval In I believe both the us and in europe it's already used in india and I think in japan So it's one of those weird I wouldn't say it's a weird drug, but it's in that kind of in-between world of They're already using it in the developing world countries and in the developed world countries. It's uh Going through regulatory approval. I've heard some folks have been able to get it specially authorized even in the us I've no idea if such a thing exists in israel if I could try if I could find a doctor to prescribe it Right now. I'm just taking it one step at a time. So I'm giving my amy triptyline trial four months If that doesn't work, um, I'm not gonna I will ask about these other drugs I mentioned But uh, it's going to be up to the gastroenterologist To decide what to try next So I hope this video if you do also struggle with post-prandial distress syndrome pds form of fd Trust me. I know how much it sucks. Do boy. Do I know how much it sucks? It's it's uh It's an unfortunate one, but um, I I do believe in cred sourcing uh And I'm hopeful that um, it'll get better for me and other people I'm going to share this in the functional dyspepsia group So it's hopes hopes hopes of useful the people there If you're in the group and you've recommendations for more folks who you think I should interview who might have insights Into this mysterious prevalent condition that we're very very quickly I would say this is my impression medical science is learning more about and as our process continues It seems to be becoming more and more obvious that this is a real physical physical Condition somehow related to stuff going going ori in the digestive system We don't yet. It seems have ideal therapies, but hopefully as uh medical science progresses as clinical trials progress We're going to be getting better treatment options in the future And I'll leave it there. Thank you guys for watching Uh more videos from me We'll be coming soon