5 ms·

I got an ulcer about ten years ago, well after Warren's research, I went to a doctor and he told me that the ulcer was caused by stress. I said something like "

I got an ulcer about ten years ago, well after Warren's research, I went to a doctor and he told me that the ulcer was caused by stress. I said something like "didn't someone get a Nobel prize proving that ulcers were bacterial?" and the doctor hadn't heard that and "prescribed" me to get more rest and try and be less concerned about work. I got a different doctor after that. Robin Warren is someone who I respected the hell out of. It takes a lot of tenacity and determination to go against something when everyone is constantly telling you you're wrong. He will be missed. ETA: I should point out that I am aware that stress can aggravate and (potentially) cause some forms of ulcers, though I really wasn't terribly stressed at that point in my life, which I tried explaining to the doctor and he wouldn't hear it. My job was going fine, I didn't really have any debt, I had a decent relationship with my girlfriend (now wife), I really didn't feel stressed out at all.

Retric 2y ago
There’s an interesting level to this as there is a link between stress and ulcers. Stress reduces the mucous barrier and how quickly you heal, so reducing stress actually was helping people with ulcers. Antibiotics however where more effective in most but not all cases.
- tombert 2y ago
  Yeah I made an edit to kind of clarify on that. I really wasn't stressed at that time; outside of the typical annoyances of being alive, my life was going pretty ok at that point, which I tried telling the doctor and he didn't believe me. After that I went to a different doc and she gave me antibiotics and I healed after a few weeks. I am extremely thankful that I have not had an ulcer again since then, because it was the worst thing ever.
dralley 2y ago
The handful of times I've had ulcers in the past it was certainly correlated with stress. Perhaps indirectly through some other effects, but stress feels like part of the equation IME, at least for some people.
- xenadu02 2y ago
  Stress can aggravate ulcers, as it can aggravate any number of underlying conditions. Similarly eating spicy food can make the symptoms of acid reflux much worse thanks to capsaicin in the refluxing acid. But in both cases the root cause is something else.
- manmal 2y ago
  You likely have chronic heliobacter pylori infection and should really look into that. It’s a silent killer and that way beyond just ulcers since it’s a potent acetaldehyde producing microbe. Tests are often false negative because they can hide in places, eg Candida vacuoles: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101746/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101746/
  - leogao 2y ago
    Is there a better test than the one that is normally prescribed, to distinguish the false positive cases you describe?
    - manmal 2y ago
      AFAIK testing for those just isn’t very good, sorry.
    - retrac 2y ago
      Antibiotics are diagnostic in a sense. Take antibiotics active against H pylori. If your ulcer goes away, it was H pylori.
apwell23 2y ago
https://www.amazon.com/Why-Zebras-Dont-Ulcers-Third/dp/0805073698 https://www.amazon.com/Why-Zebras-Dont-Ulcers-Third/dp/08050... Why zebras don't get ulcers
redhed 2y ago
Same thing happened to me about 6 years ago. Told me to relax and not eat spicy foods. Makes me wonder how long medical advancements like this take to really spread to most doctors.
- Scoundreller 2y ago
  That’s “translational medicine” or “translational science” —> getting lab proven stuff to the bedside. And yeah, it can take a while. My dream is to a have a dumb doctor/mechanic/plumber/blah that just researches even the most basic questions unless it’s something really odd-ball and only then defaulting to their “expert opinion”.
  - I_complete_me 2y ago
    "When you hear hoofbeats in the night, look for horses — not zebras."
  - glhaynes 2y ago
    I've thought for a long time that medicine in the AI era would end up with nurses being even more important than they are today but with doctors being drastically less so. (I know next to nothing about healthcare; this is just a guess!)
- kevinmchugh 2y ago
  Science advances one funeral at a time
  - BurningFrog 2y ago
    Several, if you count the patients.
  - MichaelDickens 2y ago
    Robert Warren is most likely older than the doctor in question, so it would seem the science needs at least two generations of funerals in this case.
  - 2y ago
phaedrus 2y ago
I have IBS. During my last visit, my GI doctor apropos of nothing blurted out, "you've got to get your anxiety under control!" "What are you talking about?" I asked. "You said the stress of getting ready to leave for the office triggers your attacks," he said. "I work from home!!" I said. "_YOU_ posed a hypothetical and I answered with a hypothetical: that it would certainly be stressful if that happened. I also said I still have the IBS attacks when I don't have a stressful day." In my opinion general practitioners (who are not therapists) putting their patient's issues down to "anxiety" or stress is like doctors diagnosing "hysteria" in 19th century women: it contains the in-built subtext that you're not a reliable narrator of your own symptoms, and there is no evidence you can present to disprove the accusation of "hysteria" or "anxiety".
- tombert 2y ago
  Yeah, that's my issue; stress is a somewhat nebulous thing that's hard to directly quantify and therefore it can be a kind of "catch all" for nearly anything. I'm not saying that stress doesn't have effects, but I think a diagnosis based on "stress" can often be reductive; who doesn't feel some stress throughout the day?
  - apwell23 2y ago
    > stress is a somewhat nebulous thing So is IBS. I am not sure its fair to expect precise diagnosis for a nebulous "disease".
  - cladopa 2y ago
    Actually, "stress" is extremely easy to measure: You have stress, you have specific hormones in your bloodstream. Those hormones change things in your body, like redirect the blood in your body contracting or extending blood vessels. >who doesn't feel some stress throughout the day? It is a quantity thing, you can feel stressed during seconds, or during hours or during entire days. For example, in a war when your family members could die at any moment, you feel stress for days. In you live in peace you just don't have an idea what that means. I have not lived war myself but I had close contact with people in Ukraine and in the past conflicts like Congo or Central Africa Republic and other African wars. Stress effects were obvious for people living in farms. Animals like hens can stop laying eggs or cows stop giving milk just by stress alone.
tootie 2y ago
Last time I asked my doc about something he wasn't sure of, he googled it in front of me and frankly I respect the hell out of that.
taeric 2y ago
This is the poster example I use for how dramatically information can change within our lifetime. I still encounter people that are unaware that most of the "stress causes ulcers" was just wrong.
- tombert 2y ago
  It certainly matters more in medicine, where you have very serious risk of causing people pain, but as I've gotten a bit older I've become a lot more sympathetic to people having trouble keeping up with the world sometimes. Like, it's not a good excuse, don't get me wrong, but as much as I try, I simply cannot keep up with the entire state of the art of computer science. I wish I could, and a younger me without a family and responsibilities actually would mostly keep up with everything, but now it just feels like there's never quite enough time to learn everything I really should. I do try and keep up, I have a million textbooks and the like, and I try and at least go through the example problems for them, but it's pretty easy to fall behind in that stuff. While a GP should keep up to date with ulcer research, and "I'm busy!" isn't a great excuse when serious pain and/or lives are on the line, but it's something I at least understand better now.
  - taeric 2y ago
    Oh, I absolutely do not use this to demean people that are wrong. The point is that well established and largely effective knowledge on how things work can be completely changed with most of us not realizing it. All the more reason not to get upset with someone for not being aware of some advances. This should include self.
  - cbsmith 2y ago
    > Like, it's not a good excuse, don't get me wrong, but as much as I try, I simply cannot keep up with the entire state of the art of computer science. I wish I could, and a younger me without a family and responsibilities actually would mostly keep up with everything, but now it just feels like there's never quite enough time to learn everything I really should. This is the part of this conversation that I don't get. Yes, it is impossible for one person to contain the entire body of knowledge, which means you're not going to know some of the time, and that might be embarrassing or otherwise troublesome. However... it should be rare that you operate in complete isolation. You should be regularly interacting with other practitioners, including people whose entry into the field is newer, and therefore should be aware of the current state of the art. There should be interactions where that information is shared, both allowing projects you work on to take advantage of advances in the state of the art even if you don't know about it, and for you to become aware of advances in the state of the art.
odyssey7 2y ago
What do you call the person who graduated last in their medical school class? “Doctor”
nxobject 2y ago
I've always been a little annoyed about the "relax" part – of course stress exacerbates everything. We know how inflammation works globally throughout the body. Of course we would have already thought of that.

Retric 2y ago

There’s an interesting level to this as there is a link between stress and ulcers. Stress reduces the mucous barrier and how quickly you heal, so reducing stress actually was helping people with ulcers. Antibiotics however where more effective in most but not all cases.

tombert 2y ago
Yeah I made an edit to kind of clarify on that. I really wasn't stressed at that time; outside of the typical annoyances of being alive, my life was going pretty ok at that point, which I tried telling the doctor and he didn't believe me. After that I went to a different doc and she gave me antibiotics and I healed after a few weeks. I am extremely thankful that I have not had an ulcer again since then, because it was the worst thing ever.

dralley 2y ago

The handful of times I've had ulcers in the past it was certainly correlated with stress. Perhaps indirectly through some other effects, but stress feels like part of the equation IME, at least for some people.

xenadu02 2y ago
Stress can aggravate ulcers, as it can aggravate any number of underlying conditions. Similarly eating spicy food can make the symptoms of acid reflux much worse thanks to capsaicin in the refluxing acid. But in both cases the root cause is something else.
manmal 2y ago
You likely have chronic heliobacter pylori infection and should really look into that. It’s a silent killer and that way beyond just ulcers since it’s a potent acetaldehyde producing microbe. Tests are often false negative because they can hide in places, eg Candida vacuoles: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101746/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101746/
- leogao 2y ago
  Is there a better test than the one that is normally prescribed, to distinguish the false positive cases you describe?
  - manmal 2y ago
    AFAIK testing for those just isn’t very good, sorry.
  - retrac 2y ago
    Antibiotics are diagnostic in a sense. Take antibiotics active against H pylori. If your ulcer goes away, it was H pylori.

apwell23 2y ago

https://www.amazon.com/Why-Zebras-Dont-Ulcers-Third/dp/0805073698 https://www.amazon.com/Why-Zebras-Dont-Ulcers-Third/dp/08050... Why zebras don't get ulcers

redhed 2y ago

Same thing happened to me about 6 years ago. Told me to relax and not eat spicy foods. Makes me wonder how long medical advancements like this take to really spread to most doctors.

Scoundreller 2y ago
That’s “translational medicine” or “translational science” —> getting lab proven stuff to the bedside. And yeah, it can take a while. My dream is to a have a dumb doctor/mechanic/plumber/blah that just researches even the most basic questions unless it’s something really odd-ball and only then defaulting to their “expert opinion”.
- I_complete_me 2y ago
  "When you hear hoofbeats in the night, look for horses — not zebras."
- glhaynes 2y ago
  I've thought for a long time that medicine in the AI era would end up with nurses being even more important than they are today but with doctors being drastically less so. (I know next to nothing about healthcare; this is just a guess!)
kevinmchugh 2y ago
Science advances one funeral at a time
- BurningFrog 2y ago
  Several, if you count the patients.
- MichaelDickens 2y ago
  Robert Warren is most likely older than the doctor in question, so it would seem the science needs at least two generations of funerals in this case.
- 2y ago

phaedrus 2y ago

I have IBS. During my last visit, my GI doctor apropos of nothing blurted out, "you've got to get your anxiety under control!" "What are you talking about?" I asked. "You said the stress of getting ready to leave for the office triggers your attacks," he said. "I work from home!!" I said. "_YOU_ posed a hypothetical and I answered with a hypothetical: that it would certainly be stressful if that happened. I also said I still have the IBS attacks when I don't have a stressful day." In my opinion general practitioners (who are not therapists) putting their patient's issues down to "anxiety" or stress is like doctors diagnosing "hysteria" in 19th century women: it contains the in-built subtext that you're not a reliable narrator of your own symptoms, and there is no evidence you can present to disprove the accusation of "hysteria" or "anxiety".

tombert 2y ago
Yeah, that's my issue; stress is a somewhat nebulous thing that's hard to directly quantify and therefore it can be a kind of "catch all" for nearly anything. I'm not saying that stress doesn't have effects, but I think a diagnosis based on "stress" can often be reductive; who doesn't feel some stress throughout the day?
- apwell23 2y ago
  > stress is a somewhat nebulous thing So is IBS. I am not sure its fair to expect precise diagnosis for a nebulous "disease".
- cladopa 2y ago
  Actually, "stress" is extremely easy to measure: You have stress, you have specific hormones in your bloodstream. Those hormones change things in your body, like redirect the blood in your body contracting or extending blood vessels. >who doesn't feel some stress throughout the day? It is a quantity thing, you can feel stressed during seconds, or during hours or during entire days. For example, in a war when your family members could die at any moment, you feel stress for days. In you live in peace you just don't have an idea what that means. I have not lived war myself but I had close contact with people in Ukraine and in the past conflicts like Congo or Central Africa Republic and other African wars. Stress effects were obvious for people living in farms. Animals like hens can stop laying eggs or cows stop giving milk just by stress alone.

tootie 2y ago

Last time I asked my doc about something he wasn't sure of, he googled it in front of me and frankly I respect the hell out of that.

taeric 2y ago

This is the poster example I use for how dramatically information can change within our lifetime. I still encounter people that are unaware that most of the "stress causes ulcers" was just wrong.

tombert 2y ago
It certainly matters more in medicine, where you have very serious risk of causing people pain, but as I've gotten a bit older I've become a lot more sympathetic to people having trouble keeping up with the world sometimes. Like, it's not a good excuse, don't get me wrong, but as much as I try, I simply cannot keep up with the entire state of the art of computer science. I wish I could, and a younger me without a family and responsibilities actually would mostly keep up with everything, but now it just feels like there's never quite enough time to learn everything I really should. I do try and keep up, I have a million textbooks and the like, and I try and at least go through the example problems for them, but it's pretty easy to fall behind in that stuff. While a GP should keep up to date with ulcer research, and "I'm busy!" isn't a great excuse when serious pain and/or lives are on the line, but it's something I at least understand better now.
- taeric 2y ago
  Oh, I absolutely do not use this to demean people that are wrong. The point is that well established and largely effective knowledge on how things work can be completely changed with most of us not realizing it. All the more reason not to get upset with someone for not being aware of some advances. This should include self.
- cbsmith 2y ago
  > Like, it's not a good excuse, don't get me wrong, but as much as I try, I simply cannot keep up with the entire state of the art of computer science. I wish I could, and a younger me without a family and responsibilities actually would mostly keep up with everything, but now it just feels like there's never quite enough time to learn everything I really should. This is the part of this conversation that I don't get. Yes, it is impossible for one person to contain the entire body of knowledge, which means you're not going to know some of the time, and that might be embarrassing or otherwise troublesome. However... it should be rare that you operate in complete isolation. You should be regularly interacting with other practitioners, including people whose entry into the field is newer, and therefore should be aware of the current state of the art. There should be interactions where that information is shared, both allowing projects you work on to take advantage of advances in the state of the art even if you don't know about it, and for you to become aware of advances in the state of the art.

odyssey7 2y ago

What do you call the person who graduated last in their medical school class? “Doctor”

nxobject 2y ago

I've always been a little annoyed about the "relax" part – of course stress exacerbates everything. We know how inflammation works globally throughout the body. Of course we would have already thought of that.