Diverticulosis & Diverticulitis

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Who cares about diverticular disease? Not me, particularly; but if you or someone you know is affected by it, then you would. So I have undertaken an exhausting research project (thanks, Google) that probably anyone could duplicate or improve on in some way. This is Poonurse reporting on... Diverticular Disease.


So What's The Deal?

Even though these two names sound the same (and no, I didn't make them up), they are very different in the opinion of your colon.

Diverticula are small pouches in your colon that bulge outward through weak spots, like an inner tube poking out through weak places in a tire, or like my ass bulging out when I try to wear jeans that are obviously too tight in a pathetic attempt to reclaim my lost youth and former attractiveness before multiple marriages to controlling losers sucked the life right out of me.

Each pouch is called a diverticulum. When you have more than one, you have diverticulOSIS. When the pouches become infected or inflamed, you have diverticulITIS. Stay with me, now... this will get semi-interesting at some point soon. Hopefully.


What Could Cause This?

Now that we know about our colons' potential to make deadly pouches inside of any one of us, it would be good to know how to prevent this from happening. Doctors believe that a low-fiber diet is the main cause of diverticular disease. (Let's just refer to it as DD from now on because I'm getting very tired of typing out the whole thing. *Note* DD is very different from the ED that Bob Dole is always talking about in those commercials.)

So it's the old story: not enough fiber. Genetics might play a part, too, but since there isn't anything that any of us can do about that, let's just latch right onto the fiber theory.

Fiber is the part of fruits, vegetables and grains that the body doesn't digest. There are two kinds of fiber -- soluble and insoluble -- but I'm not EVEN going to get into. One kind of fiber is all I can deal with at this point in my life. Fiber makes your poop soft and easy to pass and prevents constipation- - that's all I think we need to know. Aim to get 25 to 30 grams a day.


Brief Boring History Part You Can Skim Over Without Endangering Your Health

DD was first noticed in the United States in the early 1900's. This was about the same time that processed foods were introduced into the American diet, although I can't think what processed foods these could have possibly been. I know there weren't Cheetos, Fritos, Little Debbie Cakes or anything like that available back then, so I am a tad suspicious of the supposed link to processed foods. Also -- who the hell knew what was going on in the world in the 1900's? I guess a lot of people kept diaries or something. Anyway, DD's been around a while.

DD is most common in developed nations -- particularly the U.S. where we tend to come down with a lot of stuff like this. Low-fiber diets are rampant in the U.S. The disease is rare in countries in Asia and Africa, where people eat high-fiber vegetable diets. Although I have to wonder -- in Asia and Africa, aren't they are too busy worrying about deadly diseases like AIDS and the plague to really concentrate on DD and the pouch-making activities of the large intestine? I think DD would be the LEAST of their worries.


How Do You Know If You Have It?

Diverticulosis' symptoms can range from nothing at all to mild cramps, bloating, and constipation. Other non-deadly bowel diseases, such as Irritable Bowel Syndrome and ulcers might cause these same symptoms, so don't run around saying "Poonurse said I have Diverticulosis" if you experience any of these symptoms. In fact, keep my name out of it altogether, if possible.

Diverticulitis is far more serious, anyway. The most common symptom of this is abdominal pain, usually on the left side of the lower abdomen. You might also have fever, nausea, vomiting, chills, cramping, and constipation. Bad things can happen from here on out.


Like What?

Diverticulitis can lead to severe complications like bleeding, infections, perforations, or blockages in the intestines. It ain't fun. If you develop any of these, you'd better get yourself to a doctor, pronto. Bleeding rarely happens, but sometimes a blood vessel in a diverticulum weakens and bursts. (I HOPE it goes without saying that if you are bleeding from the rectum, go to a doctor. But judging by the number of people who write in saying, "I'm bleeding from the rectum, what should I do," it apparently needs saying. So I'm saying it: go to the doctor.)

An infection caused by diverticulitis often clears up after a few days of treatment with antibiotics. But if it doesn't, you might get an abscess in your colon. Colons are pretty particular about who they let set up housekeeping in there, and if you get an abscess (an infected area that fills up with pus), the colon will serve an eviction notice in the form of rupturing and sending the pus to a new home in your spanking-clean abdominal cavity. This pisses off the abdomen, which will retaliate by doing its best to kill you. At this point, doctors have to get all involved to settle the dispute. To get rid of an abscess that doesn't respond to antibiotics, the doctor has to stick a needle into your abdomen and drain the fluid out through a catheter. This is expensive and probably very painful. Sometimes surgery is needed to clean out the abscess and actually remove part of the colon.

One more bad thing (but an interesting little complication) is called a fistula. This is an abnormal connection between two organs. When damaged tissues come into contact with each other, they tend to stick together. If they heal that way, a fistula forms. The most common type of fistula is between the bladder and the colon. It occurs mainly in men, thank God. It makes them have frequent urinary tract infections, and requires surgery to fix. I don't know why I think fistulas are so interesting, but I do.

Your intestines can also just go on strike and shut down production completely. While it sounds restful for the colon, it is a serious emergency and requires immediate surgery.


OK -- I'm Scared -- So What Is The Treatment?

The best treatment, of course, is prevention, which is why I'm constantly on your backs about fiber. For God's sake -- if you can't be bothered to eat properly, get Metamucil or some other fiber product and use it.

If you do get DD (and remember, it's not always your fault. Genetics plays a role, so feel free to blame your parents), adhering to the aforementioned high-fiber diet and pain medications will in most cases help relieve the symptoms.

Until recently, doctors believed people with diverticulosis should avoid foods with small seeds, such as tomatoes or strawberries or brownies with pot in them (unless you take the seeds out). They thought the seeds could lodge on the small pouches and cause problems. Apparently someone decided that this is no longer true, so I'm giving you a green light on the pot brownies. Zucchini, cucumbers, raspberries, and poppy seeds are also generally considered harmless. You should, however, avoid nuts, popcorn, sunflower seeds, pumpkin seeds, and sesame seeds. But your colon may have a different idea about what it will and will not tolerate, so keep track of what seems to piss it off.

If you get mild diverticulitis, your doctor will often prescribe antibiotics, put you on a liquid diet (no, not a beer diet), and give you some nice pain relievers that can often be hoarded and used just to get a buzz when you need one.

A severe attack will require a hospital stay. Along with your nice liquid diet and pain medication, you might also part with a portion of your colon. The goal of this surgery is to keep the attacks from coming back, and to prevent serious complications.


What Have We Learned?

Probably nothing, but what I'm trying to get across is that it's always best to do what you can to prevent these kinds of things from happening. Go get your Metamucil or Citrucel or generic fiber supplement. Often times they can be mixed with Jack Daniels for a tasty and entertaining way to ensure colon happiness. I also hope you know I was kidding about the brownies. That would be a waste of some perfectly good green.

Poonurse is an RN with 25 years experience in labor and delivery. Her qualifications
include seeing a lot of poop, and owning a computer. Also, she works in Michigan, which she calls the asshole
of the universe, so that's another bit of credibility.
Got a question for her?













88 Comments on "Diverticulosis & Diverticulitis"

Tydirium's picture
k 500+ points

Poonurse- I love your writing. Who knew this subject could be interesting?

Wait, I take it back. How could pus-filled holes in the colon NOT be interesting?

And Mr. Poonurse is an idiot. You rule.

Rob D. Troit's picture

I just returned from Michigan, where I was visiting family and attending the Fried Pork Convention 2004. After consuming massive amounts of bovine, I noticed that my once fresh deuce was now slightly crimson tinged. I gave it no thought, as I believed it was simply due to the three-fingered "prostate manipulation" that my woman and had been partaking in. Now, I will visit the doctor and inform him of my possible Diverticulosis. Also, it gives me another excuse to make him look at my perfectly manicured brown eye. First post rules.

Brown Seymour's picture

Pigs are not bovine. Cows are.

daphne's picture
PoopReport of the Year AwardSite AdminComment Content ModeratorComment Quality Moderatore 6000+ points

Dear Poonurse,

My gramma has this disease. She is the healthiest woman alive, otherwise, and she turned 90 this year. She still drives, to the dismay of my dad, whom she almost killed last summer by accidentally getting into the left hand turn lane across from in downtown Sharon, PA traffic. (She only knows how to turn right, so she just went through the intersection causing mayhem and lots of squealing tires. Yes, I'm serious.)
Anyway, she eats donuts like they are going out of style and biscuits. Tons of them. She always talks of going downtown to get biscuits at the bakery as a girl.
Could the processed food in the beginning of the century you referred to be from the "new fangled" mills of the early 1900's and the baked goods they produced? What do you think?
I think it could be.

Either way, excellent article, and we all appreciate you.

.....hugging bunnies since 1969
www.daphneszoo.com

Poonurse's picture
j 1000+ pointsk 500+ pointsl 100+ pointsm 1+ points - Newb

Ty-Thanks! I didn't think it was terribly interesting, and it took several drinking glasses full of wine to complete.

Daphne--you could well be right. But that would be too much thinking for me. I try to skim over just about everything.
Less thinking=happier Poonurse!

Di Uhreea's picture
Comment Quality Moderatorl 100+ points

Excellent report, PN! Keep 'em coming.
Did you kick Mr. PN yet?

dookie dog's picture

Thank you poonurse for the information I will put it with all the other diseases I suffer from, I do hope this is not whats making me constipated that would really suck.

Pooper's picture

Actually I think there were a lot of processed foods in the early 1900's. Potato chips have been around that long. And, although Little Debbie might not have been around since 1900, prepared cakes similar to them were available then. Hot dogs were also around - the were originally called "frankfurters" but the name was changed during World War I to avoid using any German words.

Professor Lump's picture
m 1+ points - Newb

I have had diverticulitis for about 5 years now. Trust me you don't want to get it. It feels like your side is tearing. I have been taking Cipro and lots of fiber. I still get a eipisode once in a while where I can't move but for the most part I have it under controll.

woof's picture

Poopnurse; you wouldn't happen to be in Ann Arbor, would you?

Poonurse's picture
j 1000+ pointsk 500+ pointsl 100+ pointsm 1+ points - Newb

woof--funny you should mention Ann Arbor--I went there for the first time last week, to visit Whole Foods b/c someone at work raved about it. What a trippy place!
Then I took a drive thru the illustrious downtown. I hated it--too much traffic and weird people wandering around. I'm a hick at heart!

Pooperscooper's picture

Guys, listen to Poonurse on this one.

Years back, when I was in college, I volunteered several summers in a row in the surgical pathology department at a major medical center.

The doctors let me read case reports and I got to watch autopsies.

I will never forget witnessing the autopsy of a woman who had severe diverticulitis. She had what looked like a multitude of inflamed large boils studding the inside of her large intestine. And, just as Poonurse describes, over the years two of them had become so infected that the poor lady had not one, but TWO fistulae leading from her large intestine to the outside of her body--the diverticula/boils were so full of infected matter that the bacteria and attendant inflammation had chewed through from her large intestine to the outside of her body.

The chronic inflammation probably weakened her and contributed to her death. She was in such fragile condition that apparently surgery was not feasible.

A hell of a way to go.

Eat your veggies, people. And never strain at stool.

dookie dog's picture

I got this lump on my upper left side having had my ribs broken man when I get gas it hurts like hell and I can't move I dont think it's D.D. I have had this for years. The things we get in our bodies I think when they get me on the table and cut me open I'm going to explode I got so much gas, I have been quite constipated since I quit drinking I have to force things out so I have changed my diet and I quit smoking cigarettes, not pot. I used to call my x-girlfriend who was a R.N. and ask her about my B.M.s as I'm sure poonurse can attest it drove her crazy. She passed away I got all her stuff including this old computer, I never had a computer before. I turned it on typed hemmorides in and I FOUND YOU GUYS. I think her spirt found you guys, and now I'm going to drive you crazy, naaa just kidding, Sturgis? Poonurse, is it Sturgis? I used to be in that military school just over the boarder in Indiana, Howe military school, anyway signing off for now love, dookie dog.

dookie dog's picture

Whatdafuck?? am I alone here?

erick's picture

anything that i can do by myself without seeing a doctor cure my self from this?

erick's picture

oh yea can this desease happen in any age?

pointy dookey's picture

I have crack-off dookey.

Bean Shit's picture

Cool article! For a fibre supplement I really reccomend the brand "Bowel Buddy" They are tasty little crackers PACKED with fibre. Plus the name sounds funny and they're embarassing to buy. You can buy them at most health food stores.

terry rol's picture

Thank you for this information, i love the way the writer gave the info, i usually do not read anything to the end this was interesting and funny at the same time, i just want to tell you i learned a lot about this desease that the doctor told me that i got DD, now i have to deal with it, if you have any new studies on it please forward it to my e mail address thanks again
Gracias

sincerely

terry rol

Anonymous Coward's picture

I'm a sixty year old Southern lady who loves wine and an occasional Jack Daniels or gin.
Obviously I have diverticulitis or I wouldn't be writing.
You are one cool lady.
Do I drink or will this kill me?
What about avoiding people who irritate the hell out of me?
Thank you for your sage advice.

The Dumpster's picture
i 2000+ points

Keep drinking, big sister. If the diverticulitis don't kill you, the alcohol will!
And avoid those obnoxious people. In our own Southern way, they come up to us and we profess to be GL-A-AD to see them, but almost instantly, our attention is called elsewhere, so you are off with an air kiss, and a shrieked promise to "SEE YOU LATER!!!!!!!!!"

_______
"Say, has anybody seen my sweet Gypsy Rose Volcano?"

Bunghole In the Jungle's picture
l 100+ points

Anonymous Coward (not verified) -- 03.22.2006
[I]'m a sixty year old Southern lady who loves wine and an occasional Jack Daniels or gin.'

Lady, from viewing your post I would venture to guess that you've had a nip too many this evening. Your post is barely coherent. Take it from someone who lost a very good friend to alcohol-related illnesses. It will catch up to you if you don't slow or quit your intake.

Assert your sassy 'Steel Magnolia' fortitude and politely but firmly tell those who deliberately annoy you to "shove off." Why should you lose your comfortable chair by leaving the room?

keeping the whack in tally-ho...
Fartuituos!
Serenshittipy!

Bunga Din's picture
j 1000+ points

Wadda yu no Bunghole in the jungha. Maybe shesss happie, doniker,./

7.
][p;,m=i900871

Bunghole In the Jungle's picture
l 100+ points

Bunga, you trippin biggg timee.

Back to diverticulitis: I did pull this up the other evening because I have close elderly relative who has recently been diagnosed with this affliction. It is a severe case but surgery is not an option. Thoughts? Experiences?

keeping the whack in tally-ho...
Fartuituos!
Serenshittipy!

ShitEatingGrin's picture

I just found out I have this shit yesterday from a ctscan. I think that I may have a fistula from some very old scar tissue (cut from my ribs to pelvis). As I have gained weight it seems the scar tissue is really tight and the swelling is awful. I start Cipro and Zelnorm tonight. Does anybody know anything about how to reduce swelling and could dairy allergies cause this? Glad this site is here thanks :)

CitiGirl@heart's picture

Hi PN: Thank you for all the info it was not only helpful, but you made me laugh (first time in a couple of days.) I was just at the hospital for two days with extreme pain in my lower left side. They did a CT scan and found no inflammation, also a ultrasound found many cysts on my ovaries. My white blood count is elevated. They sent me home with Zofram for nausea and Darvocet for pain, but no antibiotics. They believe that the pain is from rupturing cysts and the white bllod count is just a reaction to the cysts rupturing. If it is diverticulitis, will the pain just get worst or would they have found it on the CT scan? P.S. My friend's mom has this and she waited two weeks in pain and ended up with a perforation in the colon, they had to put in a colostomy bag and she just had her colon reattached. This is really nothing to play around with. I am going to start taking metamucil and eating my fiber.

Push-n-Grunt's picture

About two weeks ago, I awoke feeling like I needed to crap with diarrhea. Yet after, I looked in the can and it looked like a Steven King flick. Nothing but blood.
A few minutes later, I went again, same thing. I started feeling lightheaded, then passed out for a few seconds. I took a rescue ride to the hospital where I had a colonoscopy and bleeding scan. Both negative. They sent me home. Over the course of the next week, it happened two more times. What a horific experience. After all the tests, the colo-rectal specialist says that I have diverticulosis and that a blood vessel in one of them probably burst, stopped and burst again during the course of the three episodes. Tomorrow will be 2 weeks since the last one. Hopefully this shit is over. At 45 years old, I haven't had anything worse than a cold in my life. Bottom line: FIBER!

DD-RSA's picture

Hi PN, I have just been diagnosed with DD and have had most of the symptoms you mention, however my major discomfort is on the lower right side, close to the pelvic bone (not left, as most people are saying in their replies to you)irritated by my trouser belts. I also feel as if my urine is slightly hot most of the time & I get bouts of feeling slightly feverish (almost like an allergic reaction that worsens with stress or high emotion) do these also sound like symptoms of DD? Thanks for the Great DD info. Keep up the Great Work!

Anonymous Coward's picture

I have been diagnosed with this horrific thing and my doctor put me on antibiotics .. I stayed on liquids for three days but the antibiotics certainly did not rest my bowels ..

Nope so how do you KNOW IF THIS WORKED OR NOT

THE BED REST THE ANTIBIOTICS AND THE BOWEL REST

HOW DO YOU KNOW WHEN YOU ARE SAFE

Thank you

Anonymous Coward's picture

can you drink wine when you have DD

GottaGoGirl's picture
i 2000+ points

If you have to ask...
_______
Hey! Don't touch my wenis!

oregona go number 2's picture

Untreated diverticulosis can also lead to abcesses in or on your liver. I know form experiance. This will guarantee you a hospital stay (17 days) with catheters inserted into the abcesses on the liver to drain the puss. Very gross I assure you!
Anyway, I now take a fiber supliment every day, and I have never missed a day...

BWR's picture

At 59 I thought I'd never get this stuff. Here I am, having just consumed half a bottle of Pinot Grigio, will it kill me? What should I do? Help.............

tired of poop's picture

The information in this article was very helpful. Thank You. I have never been diagnosed with DD. But have all the symptoms. But where broccolli and cabbage is recommended it is some of my many flare up foods. Information on foods that will help with lessening the occurances would be appreciated.

Shittynoshitty's picture

Excellet read... I hate taking antibiotic! I have been diagnosed with Diverticuliti and have a little pain...went to urgent care and they gave me cypiro and flagyl (or something like that) I took one dose... even thoough I was feeling better before I took the dose. The next morning I felt fine... a little tender but fine... Should I keep taking them or wait to see if any signs of pain return?

toppyy's picture

Hey PN,
Ive read your great informaiton off and on for a couple of months. I am usually constipated, I feel like I'm going to blow a gasket when I try to go and I usually only get diarehha when I take ducolax although I can get it without. I stay bloated and I throw up a lot but usually not food just icky tasting dark yellow liguid I have pain on lower left side sometimes, lots of puss when I have bm. I am tired, and I tend to feel hot or cold. Please help.

GottaGoGirl's picture
i 2000+ points

toppyy -- 09.04.2007 wrote-- "
... diarehha ...bloated and I throw up a lot... not food just icky tasting dark yellow liguid... pain on lower left side... puss... tired... hot or cold...
"

Good Lord. Go to the ER.

Damn. What is WRONG with people?!?

too young's picture

I quite enjoyed your writing...made me smile, while googling DD remedies.
My partner has been diagnosed with DD; unfortunately he's only 34, rather than 60'ish. Popcorn is definately evil. I find his worse times, are after a boozefest, but I cannot find anything stating alcohol as bad? Rather than a drink or two will help??!
I thought I would add that during flare-ups one should eat a 'low residue diet' (low fibre), to lower bowel movements, so the infection can heal. Once healed; keep with a high fibre diet and tons of fluids.

Anonymous Coward's picture

Your writing is so witty, but I'm so scared. I was diagnosed with acute diverticulitis and a blockage in my bowel last Jan after a CT scan. Prior attempt at a colonoscopy failed because my colon was so inflamed and the instrument would not go very far because of a blockage - something I've never heard of. This all cost over $10,000 and I had no health insurance because it was going to cost over $600 a month for private insurance - now I can't get it. I refuse to go to the doctor ever again - would rather die - it's just not worth the hassle. It's possible the blockage is malignant - I've got all the symptons. Don't tell me to see a doctor - it's not going to happen!

The Shit Volcano's picture
Comment Quality Moderatorh 3000+ points

So, don't see a doctor. What do you expect from us? A faith healing?

_______
Beware the shitticane. Election, 2008.

I found Jesus! He was behind the sofa the whole time!

daphne's picture
PoopReport of the Year AwardSite AdminComment Content ModeratorComment Quality Moderatore 6000+ points

It pisses me off that so many people in this country can't get decent health care. It should be an inalienable right.


_______
.....hugging bunnies since 1969
www.daphneszoo.com

.....hugging bunnies since 1969
www.daphneszoo.com

Anonymous Coward's picture

i just had a colonoscopy and the dr. said he found about 23 pouches, how many is too many? i cant find anywhere where it says the average number of these pouches are found.i had 5 pouches last time i had the test which was about 8 years ago. Had a terrible attack of diverticulitis a month ago, hence the colonoscopy yesterday. I am scared that 23 is an awful lot to have.

Anonymous Coward's picture

I had diverticulits back in feb of 06, I was pregnant at the time, and I had really bad pains on my right side, thinkin I was losing the baby, wrong I had diverticulits that bursted had gangreen all inside, I had a tube down my throat, I was so scared.. Now here it is, I am constipated again, nausea, no pain, but gassy.. I am worried I have it again

Anonymous Coward's picture

I found some interesting information about Diverticulitis here. Check it out!

Diverticulitis Treatment's picture

diverticulitis is a problem for many. with all the junk and processed foods intake on a regular basis this is happening. so people take good care of your health and prevent it from happening to you.

Cindy in nc's picture

Hello PN,

Enjoyed the article and it was very funny and informative. My mother has DD, and I have had Ulcerative Colitis for many years. I was able to cure mine by drinking 4tblsp of organic apple cider vinegar with water and 4 ounces of organic aloe vera juice mixed with the juice of my choice each day. I also cut out all pork and drink only organic milk occasionally. My mom started the vinegar and aloe vera juice about 6 months ago and has had not had any attacks of DD except for one due to not having the juice to mix with the aloe vera. She used fibercon instead and had a severe attack of DD the next morning. I don't know if Aloe Vera and the vinegar are a cure but they have done wonders for my mom and I. I had been hospitalized at least 12 times over the last 30 years with UC with a total shutdown of my bowels and kidney on 2 occasions. So if anyone wants to give it a try here is where you can get some info and here for the vinegar . We also cut out all prescribed meds, prilosec, antibiotics.
Good luck to all!
Cindy

ChiefThunderbutt's picture
PoopReport of the Year AwardComment Content ModeratorComment Quality Moderatorf 5000+ points

Here is some interesting news for everyone, not only can a diverticulum form up your butt, your bladder is also fair game for these little pouches. I was referred to a urologist several years ago to check out blood in my urine.

Using a medieval torture instrument that looked like a straightened coat hangar with an eye-piece on one end the good doctor invaded my weenie and decided that my problem was an inability to empty my bladder completely. While he was up there looking around he discovered three little pouches bulging out from my bladder.

This procedure was marvelously educational as I discovered that I was able to curl my toes under until they touched my heels. The next time the urologist invaded my weenie it was with a knife on the end of a coat hangar so that he could
remove part of the old prostate. It was a few weeks before my peeing became joyful again.

_______
Eat chilies and feel the burn!!

How long a minute is depends on what side of the bathroom door you're on!

Dallas in Pcola's picture

Very informative. I was just diagnosed of having diverticulosis in my mid-decending and mid sigmoid. Which is a sort of relief (I went to the ER thinking it was my Spleen) Anyhow- I have other pains now- and i'm having the upper endoscopy done tomorrow and praying it's not the pancreas. Thank you for your humor injected information. I laughed soo hard i pooped all over myself (which is a good thing- since I may have IBS and haven't done the deed today)

Thanks again!

dave61's picture

I've had diverticulitis for the past two weeks. I just finished up a course of antibiotics. I'm still having quite a lot of pain in my lower left side. Do I need to go on a liquid diet in order to heal up? How long will it take to start feeling better. I didn't realize how serious this condition is. It it has really sapped my energy and I'm feeling quite sick. This has happened to me only one other time and it came on the day after my first colonoscopy. I thought maybe the instrument was contaminated and it caused an infection. The doctor who administered the colonoscopy said my colon was clean. No pouches or polyps. A previous doctor who performed a barium enema determined that I had diverticulosis. But I did get sicker than a dog and spent one week in the hospital. I sure don't want to repeat that experience.

Anonymous Coward's picture

Your descriptions have been very helpful to me. I've been having flare-ups now for about every 3 months, and am currently on another round of Cypro. In pain, and a colonoscopy showed many diverticulii.

Thanks for the tips, and your friendly way of discussing ways to avoid these flare-ups. made me smile and I am in such pain at the moment.

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