Discussions By Condition: I cannot get a diagnosis.

Paging dr Cottle!

Posted In: I cannot get a diagnosis. 16 Replies
  • Posted By: Felsen
  • May 7, 2009
  • 08:38 PM

Dear dr Cottle,

I have not been at the forum for a while, because I have been sick. I don’t see either your or Richard Wayne’s posts. I was just wondering how your sister is. Has she recovered from the car accident? It must have been an awful experience. I do hope that she is fine.

Warmest greetings to you and your sister!
Felsen :)

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16 Replies:

  • Why Hello Felsen. It's good to hear from you. Indeed, my sister is doing well and I took her back home several weeks ago. Thank you for your concern. I responded on the forum within the past couple of days, but I have not heard from Richard again, despite repeated attempts to reach him. I am hoping that all is okay with him. I trust that your illness was limited and that you are feeling much better. If I can be of assistance to you, please do not hesitate to call upon me. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • I just took some time off.I'm glad to see I was missed!
    richard wayne2b 1232 Replies Flag this Response
  • Welcome back, Richard! Nice to see you here again, too! :)
    Felsen 510 Replies Flag this Response
  • Ah, Richard. Good to hear from you, my friend. I trust that all is well. I may be taking a short break myself. I'm toying with the idea of taking another trip to Europe. I keep waiting for my brain and body to start slowing down, but I guess it's just not going to happen anytime soon, so I might as well keep on playing out my hand. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Dear dr Cottle, I am glad to hear that both you and your sister are fine. I am happy that we have found Richard Wayne. Good to have both of you back! About my illness, I do have a question, I need some advice. Already as a child I had a “bad tummy”. I remember having the same pain as a child as I have now. As young I saw several doctors, all of them saying that I have Irritable Bowel Syndrome, which means that they didn’t know what was causing the pain. In the 80s probiotics were introduced and taking them regularly made me completely well. With time I have become worse and this regimen doesn’t always help any more. My symptoms are from colon and possibly small intestine, but as I see it, not from the stomach. I have never had problem with too much acid (have even tried anti acid drugs but they didn’t help). At some point they made gastroscopy (also taking a look at duodenum) and rectoscopy, which didn’t show any pathological changes. My colon and possibly small intestine are extremely sensitive to the change in bacterial balance. When the rest of the family might develop slightly more frequent bowel movements or bad smell afterwards in the bathroom, when I’m in a bad period (which I am now) I end up with disaster. I almost never have diarrhea, on the contrary, the peristaltic movements in the colon stop and loads of gas accumulate in colon transversum, which is very painful and also gives referred pain and sometimes even nausea. I have also noticed that I rarely have this problem in the morning (I never eat breakfast), it starts in the afternoon and evening, after my meals. I do not seem to connect this with any special kind of food. Normally I have healthy diet habits (a lot of fruit, vegetables, egg, fish, not much meat) – right now in the middle of a bout, I eat very little. Normally I have bowel movement every second day. I am rather skinny. Exercising doesn’t seem to help. I am 53 years old female. I have never smoked or used drugs. Occasionally I might take a glass of wine a week. My only medication is 80 mg aspirin daily (I have a stent in my left iliac vein). Usually I take several capsules with probiotics a day, drink probiotic fruit drink and if they don’t help, I take activated charcoal. Usually this regimen keeps the symptoms at bay, but right now nothing seems to help. I am extremely afraid of doctors, I only seek medical care in life-threatening situations. I have ruled out gluten and lactose intolerance. Four weeks of strict diet excluding each, didn’t give any improvement. I was thinking if my condition could have something to do with some other kind of malabsorption. Maybe too low enzymatic production in pancreas (I don’t have any pain in the area of pancreas, liver or gallbladder)? How does one diagnose such a condition? What is the treatment? Any ideas? Thank you in advance, dr Cottle! Or anyone else!
    Felsen 510 Replies Flag this Response
  • Well, when you say "referred" pain, specifically where is the pain experienced? I can recall a number of patients with IBS who had occasional referred pain under the right scapula, mimicking biliary colic but in the case of IBS was relieved following repeated eructation or belching. Let me comment here that although IBS is a diagnosis of exclusion, it is not one of relegation. Visceral pain, in this case the GI tract, occurs with many conditions and is not well understood since the tract itself is devoid of pain sensory terminals. The basis for IBS, as you may well know, involves certain serotonin transmitters that create dysregulation in the colon's function of water re-uptake. The symptoms, however, extend well beyond the mere association with this function and can demonstrate variable symptoms, in some cases near disability. I'm presuming that your diet is restricted out of fear it will exacerbate symptoms and I can tell you that in my experience, it matters far less what you eat than how you eat, including how much. The dysregulation of the colon extends to erratic peristalsis as well and the resulting symptoms are mainly what patients with IBS loathe more than either the diarrhea or constipation that accompanies the syndrome. The resulting pain can be quite intense in some instances and many a patient has described the need to pace back and forth for sometimes several hours before the upper epigastric pain subsides. There is also a rather incomplete understanding of why patients with IBS produce excess gas, which has little to due to production by intestinal flora in IBS. When you say that you rarely have diarrhea, do you contrastly experience difficult bowel movements or constipation? Does the stool change in diameter? In other words, in most persons with IBS-C for instance, patients report feeling their worst when the bowel movements are ribbon-like and require extended time for passage. It is in the cases of constipation predominant IBS where nausea is most reported, particularly following a bowel movement, but also during instances of intense visceral pain. Also realize that peristalsis and GI function in general is under parasympathetic nervous response. In cases where patients are under considerable stress, bowel movement is restricted because sympathetic nervous activity predominates. So in cases where GI function is depressed, fermentation is largely responsible for subsequent discomfort. Your symptoms would be inconsistent with either acute or chronic pancreatitis or cholestatic disease. Unless you already do so, the use of enteric-coated aspirin is preferable to the simple binded form and helps relieve any irriation to the mucosal lining of the stomach. I don't see anything else among your symptoms that would suggest an underlying organic pathology. The length of history with your condition, together with the particular symptoms experienced, would make a diagnosis of IBS very likely. Let me know specifics about the referred pain and we'll talk more. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • The referred pain can be anywhere in the belly or even in more distant places like in the back or scapula.I am very skinny and feel in my skin if a bubble moves across colon transversum. That’s how I know it is referred pain. A bubble moves and the referred pain disappears immediately. For me, as for any person with IBS belching and especially letting off is the best feeling in the world. I personally don’t have the impression that I produce more gas than others. It’ just that in my case it has difficultiy finding its way out. You could probably call me a person with constipation sometimes, but bowel movements are not painful. What I also experience is that the peristaltic movements after the bowel movement cease very often, and if there still is excess gas, it can be quite painful, since it doesn’t find its way out. I am not sure if the stool changes in diameter. Maybe it does. I have started to take Omeprazol, just in case, since I am now in a rather stressful situation. Thank you dr Cottle for your kind reply.Felsen
    Felsen 510 Replies Flag this Response
  • Have you tried good quality pancreatic digestive enzymes before meals? I would think this would help you. You may have to experiment with a few kinds before finding one that fits. Betaine HCL also may be helpful. I personally have liked Pan 8 by Progena, but it may be hard to find. Vitacost's NSI brand has some good ones - google this for more info. Do you drink liquids with your meals? If so, what kinds? Do you eat on the run or when you are rushed? This also can cause problems. Also have you been checked for B12 deficiency? It can cause digestive problems. Have you been checked for H pylori? Best wishesDOM
    acuann 3080 Replies Flag this Response
  • HI,I'm new here but thought I'd mention a product I recently learned about called "Align" It seems to work similarly to acidopholis, but of course is different. I'd encourage you to look into it and research to see if you think it may help you. (I learned of it through a Gastroenterologist who has used it with much success.) Additionally, I know someone who had allergy testing revealing a sensitivity to foods such as dairy and potatoes so that even intaking small amounts would produce gas.I appreciate Doc's info about *how* we eat. Food for thought. ;) Thank you.KayAnna
    Anonymous 42789 Replies Flag this Response
  • Acuann, Sorry for late reply. Thank you for a very informative post. I am educated in medical field and during our studies, we were encouraged to be skeptical to health stores. During the years I have developed a much more humble opinion. I didn’t know one could buy pancreatic digestive enzymes at health stores. Betaine HCL sounds like hydrochloric acid and since I am already on aspirin, I am not sure that I would benefit from it. I never noticed any change for the better since I started with aspirin. Vitacost's NSI seems like a whole line of products. Which of them did you have in mind? But Progenas Pan-8 seems like something I would like to try. You seem to have personal experience from it. Please tell me if it has helped you and how it works. I always drink liquid with my food, most often black, green or red tea. Sometimes probiotic fruit drink. I do not eat on the run and am not rushed. I am very aware of what I eat. It’s also often organic food or directly from the garden. No earlier testing has shown B-12 deficiency, but I do admit that I eat very little meat. Problem is, I’m too scared of doctors to get it tested. I think I was tested for H pylori during my gastroscopy and what ever it was that was tested, it was negative. They tested something from the duodenum (biopsy?), could it have to do with H pylori? I am grateful for more of your thoughts, Acuann. KayAnna, Thank you also for your response. Can you please explain what “align” is? It’s difficult to google. As I’ve mentioned, I have excluded sensitivity to dairy products and I admit that I can only eat potatoes well cooked.
    Felsen 510 Replies Flag this Response
  • Acuann, Sorry for late reply. Thank you for a very informative post. I am educated in medical field and during our studies, we were encouraged to be skeptical to health stores. During the years I have developed a much more humble opinion. I didn’t know one could buy pancreatic digestive enzymes at health stores. Betaine HCL sounds like hydrochloricacid and since I am already on aspirin, I am not sure that I would benefit from it. I never noticed any change for the better since I started with aspirin. Vitacost's NSI seems like a whole line of products. Which of them did you have in mind? But Progenas Pan-8 seems like something I would like to try. You seem to have personal experience from it. Please tell me if it has helped you and how it works. I always drink liquid with my food, most often black, green or red tea. Sometimes probiotic fruit drink. I do not eat on the run and am not rushed. I am very aware of what I eat. It’s also often organic food or directly from the garden. No earlier testing has shown B-12 deficiency, but I do admit that I eat very little meat. Problem is, I’m too scared of doctors to get it tested. I think I was tested for H pylori during my gastroscopy and what ever it was that was tested, it was negative. They tested something from the duodenum (biopsy?), could it have to do with H pylori? I am grateful for more of your thoughts, Acuann. KayAnna, Thank you also for your response. Can you please explain what “align” is? It’s difficult to google. As I’ve mentioned, I have excluded sensitivity to dairy products and I admit that I can only eat potatoes well cooked. I think it is a good idea to have a healthy skepticism of health food products. There is no regulation of these products and some are great, and some can be harmful. Betaine HCL some people do great on, and some don't. The symptoms of too much acid are virtually the same as the symptoms of too little acid. The only real way is to try it and see (if you have heartburn symptoms within an hour of taking, then discontinue). I agree that digestive enzymes could be a better choice. Pancreatic enzymes are very helpful for digestion. I can only offer suggestions for ones that I have tried and liked...everyone is different. NSI has something like "Mega Enzyme" or something similar and I think it is very good. You take 1 capsule or tablet right before a meal. It is a good idea to always eat something when you first wake up...I know this is hard for some people to do, but it is never a good idea to go more than 6-8 hours without eating as it puts stress on the pancreas and can cause your blood sugar to spike. A small snack in the am should suffice - you may want to play around with certain foods - fresh fruit, a protein, some toast, etc. I also think that it is helpful to only have a glass of water with meals, and to drink sparingly. Too much liquid, especially iced or hot teas and such, can increase the likelyhood of bloating. I'd try saving your tea for after you finish your meal. If you eat meat rarely I suggest trying a sublingual methylcobalamin B12 lozenge - Jarrow's methyl B12 is well rated and very inexpensive (about six bucks on vitacost.com). Try a month taking one lozenge a day and see how you feel. Most people who need this feel much better supplementing with B12, and it is a water soluble vitamin so your body just excretes out what it doesn't need. If you don't notice any difference at all after a couple weeks, then you haven't spent a fortune and there is no real harm done. Align is a very expensive probiotic, with the strain Bifidobacterium infantis. Don't know much about this product, but some report feeling improvement with their symptoms. I feel it is very expensive and there are other less expensive and just as good probiotic options. Google align probiotic for info. Best wishesDOM
    acuann 3080 Replies Flag this Response
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  • Acuann, Thank you for your answer. I am so impressed with your knowledge. You seem to have a solution for me, who is scared of doctors. I am so grateful. I will definitely try pancreatic enzymes, it will be interesting to evaluate. Betaine HCL I will save for later. When I wake up, I usually have a big mug of coffee with milk ( mostly milk). But I never go 6-8 hours without eating after that. Three hours later I usually have a bowl of fruit. Regarding drinking with meals, I only drink lukewarm tea, never hot or iced. The tea I drink is never strong, I prefer it diluted. Since my food usually contains some deal of dietary fibers, I reckon that these need liquid to absorb, not to cause constipation. Am I wrong? But I will of course try to have the tea after the meal. It’s worth a try. And I will definitely try B12 for a month. Even though I don’t find it very likely, since I had problems long before I decreased the amount of meat in my diet. But you never know, it is also worth a try. Any more thoughts or suggestions are greatly appreciated.
    Felsen 510 Replies Flag this Response
  • Just a bump....
    Felsen 510 Replies Flag this Response
  • Acuann, Thank you for your answer. I am so impressed with your knowledge. You seem to have a solution for me, who is scared of doctors. I am so grateful. I will definitely try pancreatic enzymes, it will be interesting to evaluate. Betaine HCL I will save for later. When I wake up, I usually have a big mug of coffee with milk ( mostly milk). But I never go 6-8 hours without eating after that. Three hours later I usually have a bowl of fruit. Regarding drinking with meals, I only drink lukewarm tea, never hot or iced. The tea I drink is never strong, I prefer it diluted. Since my food usually contains some deal of dietary fibers, I reckon that these need liquid to absorb, not to cause constipation. Am I wrong? But I will of course try to have the tea after the meal. It’s worth a try. And I will definitely try B12 for a month. Even though I don’t find it very likely, since I had problems long before I decreased the amount of meat in my diet. But you never know, it is also worth a try. Any more thoughts or suggestions are greatly appreciated. The idea of not drinking fluids with your meals is so the saliva can do its job of digesting the foods...if you are washing down each bite with fluids it can impair this important first step in digestion. At least that is my take on it;). It should not have any ill effect or should not cause constipation issues. Try it and see...make sure you are chewing your food thoroughly with each bite. How are your symptoms currently? How are you handling your stress levels? DOM
    acuann 3080 Replies Flag this Response
  • To Dr Cottle and Richard Wayne!Hope you both doing well. Are you around? I see that your advice is needed here. I have not been around myself for a while, but will try to do some good again. Just wanted to say hello to you both :)Felsen
    Felsen 510 Replies
    • January 14, 2011
    • 06:45 PM
    • 0
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  • hello my name is alan,as i,m new here this might not be the appropiate thread but here we go, for some years i have had like a very sore piece of skin (only pimple size) on my inner thigh getting around to my buttocks which only bothers me when i,m sat down, even more so if its moquette surface as it appears to rub and then gets sore, leather is a lot easier,the wife has looked many times and can not see anything,no probs when upright. regards alan
    mroalan 1 Replies
    • January 14, 2011
    • 07:59 PM
    • 0
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