I had my appendix removed and no one frickin’ told me.
That was one of the surprise discoveries I made when my surgeon sent me the pathology report from the bowel surgery I had done at the end of the summer.
While the appendix does serve some purpose (it’s rich in immune cells that help fight off germs), it’s not essential. Still, you would have thought my doctors would have at least mentioned it.
I learned a lot from that pathology report about the state of my disease.
First, the Crohn’s disease I’ve had since I was 12 was a lot worse than I’d understood. In addition to removing 13.2 cm of ailing terminal ileum (this I knew about), another 14 cm of my right colon was excised during the surgery.
I also had “creeping mesenteric fat” wrapping around the bad parts of the bowel which had adhered to my appendix. To remove the diseased part of the bowel, it was necessary to also take out this evolutionary afterthought.
Arrivederci appendix.
What else did I learn? My bowel wall was 0.9 cm thick, about three times the normal thickness; that helped explain why food wasn’t passing through and what had caused the obstruction and pain.
The good news is that, other than the nearly 30 cm of bowel and colon that were taken out, the rest of my digestive system looked clean. There were no signs of dysplasia – precancerous cell changes – so no hidden lymphoma.
Another surprise: I thought the intention to remove my gallbladder in tandem with the bowel was mainly prophylactic after my previous bout with gallstones. However, the report stated that my gallbladder was filled with yellow and black stones, and that the cystic duct (the exit from the organ) was impeded.
By the time the gallbladder was expunged, it had already granted me a second “present” – another stone that, like its predecessor, had gotten stuck and was in danger of getting infected.
My obstructed gallbladder, along with the thickened bowel wall, both made it difficult to eat. From the start of the CAR-T I received in 2025 until my bowel surgery a year and a half later, I shed some 26% of my peak weight, plunging me into a “catabolic” state.
The body’s metabolism functions in two directions. “Anabolic” is where you want to be – it means you’re getting enough nutrition to maintain or gain weight. Catabolic, by contrast, means you’re breaking down stored tissue faster than it can rebuild.
When you’re catabolic, your body basically consumes itself – literally. In order to keep essential organs pumping, it siphons energy from muscle and fat.
The signs were all there: thinner arms and face, pants that were starting to fall off, declining strength and steadily worsening stamina.
The science is simple: You want to gain weight? Eat more. To lose weight? Eat less.
Think of it this way: The body has a kind of built-in “thermostat” controlling hunger and satiety. Suppose it’s set for the caloric equivalent of 24 degrees. When you reach that point while eating, you feel full and stop.
Certain medications, hormones and eating highly processed foods can effectively turn the thermostat up, so you need to masticate more before feeling satisfied. You don’t even realize how much you’re eating because the body is screaming, “I’m still hungry” – yet it feels the same to you.
GLP-1 drugs such as Ozempic and Mounjaro work by doing the opposite: They turn the thermostat down, so you feel satiated sooner.
My body was essentially acting like it was on a super high dose of a GLP-1, feeling full after just a few bites.
I started eating smaller portions, taking just half a bowl of chicken soup Friday night, then a quarter. When I couldn’t finish a sandwich in one meal, I thought it was cool at first (I got to enjoy it again the next day for lunch) until I realized that I was probably taking in just a few hundred calories a day when what I needed was four or five times that amount.
I was catabolic – starving – without ever knowing it.
The most frustrating part of all this is that none of my doctors could “see” the bowel obstruction. It should have showed up on the multiple ultrasounds, CT scans and PET CTs I had over the past two years. But, like the cancer before it, the obstruction would run away or “hide” – perhaps because some of these tests required fasting, so there was less food flowing through me to get blocked.
When an ultrasound finally imaged the obstruction, the path to TPN (IV nutrition) to build back some of what I lost before being able to undergo surgery was clear. I may never return to where I was before this all began, but for now, I have reentered the world of the anabolic. I am hungry – all the time.
Why did it happen now?
I suspect my terminal ileum had been progressively narrowing and my bowel successively thickening, a little at a time, over many years until, one day, it hit a tipping point. Previously, the bowel stayed just wide enough so that food could slip around any potential obstruction. For 40 years, I forgot about my Crohn’s disease.
I will probably never know what caused this tipping point – was it the CAR-T or one of the chemos? – or when exactly my catabolic journey began. I would have had to have been scanned weekly so a gastroenterologist could track the constriction and subsequent obstruction.
That actually sounds like a good topic for a research paper by an enterprising doctor.
Just one piece of advice: Tell your patients when they remove a body part, even if it is just a friggin’ appendix!
I first said goodbye to my appendix in The Jerusalem Post.
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