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Please help with my diagnosis


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#1 Alfred001

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Posted 21 February 2012 - 12:34 PM

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Pardon the long post, I tried to make it as pithy as possible.My symptoms started in June last year when I suddenly got an onset of diahrea. It is possible, though my memory is fuzzy on this and I may have made this up, that the first stool that started all this was green (and I don't remember ever having green stool before).I started eating just rice and toast, which seemed to help slightly and the stool would become more formed, then when I would think things are getting better and eat a slice of pizza or chicken the stool would go right back to being watery.Then for a certain amount of time I had fever, I don't remember exactly how high and how long this lasted.I had also lost weight. Some time before this began my family members remarked how thin I had gotten, but I thought this was just in their mind and I never stepped on the scale until this began. Then after this began I weighed myself but at that point I had already gone on the very low cal diet of rice and toast (on account of the diahrea, of course). My normal weight is around 65 kg (143 lbs) and I had gotten down as low as 60 kg (132 lbs).It seems obvious that this is connected, but it is possible that I was undereating even before this began because I read about the low carb diets and got into eating that way. After I realized I had indeed lost weight I calculated my calorie intake and realized that it is possible I was undereating quite badly.My weight now is back to normal.After, I believe, two weeks I went to the doctor who gave me medical coal, but it didn't help.The situation has presisted since then, but changed slightly over time. I don't remember the progression exactly, but at some point I stopped having full on watery diahrea (I think this was very early), and it changed to like "C" in this diagram: http://www.kcl.ac.uk...ENGLISH.pdfThen for a certain period the most frequent kind of stool I had was first a normal formed part but then followed by something like "C" (to be clear, I'm describing what would happen in a single bowel movement, not two different types in one day).In December I went to the doctor, and literally the day after I went to doctor I started getting normal stools for the first time (the doctor didn't give me anything, and previous to that, during the 6 month period, I believe I had 1 or 2 normal stools), and from that point on I would get the pattern of a few days of normal stool followed by two days of "C" type stool (often it is something in between "C" and normal, like it was on its way to being formed but it isn't formed) and this is the current situation. Sometimes I get 2 days of no bowel movements, which might be due to the fact that I sometimes spend the whole day at school where I don't eat much.When I visited the doctor he sent me to do blood and urine tests. Several parameters came in high or low, and he has since had me repeat the test.The only ones he seemed concerned with were the parameters under the heading "enzymes" (which he said had to do with liver function) and here they are (the third number I believe is what is considered the normal range, and the unit of measurment is U/L): TEST 1 TEST 2 NORMALS-ALT 79 51 (12-48)S-AST 40 32 (11-39)These are the other parameters that were off (all under the heading of differential blood test): TEST 1 TEST 2 NORMALMPV 12.3 9.9 (6.8 - 10.4)thrombocytes 118 142 (158 - 424)Neutrophil granulocyte 52.0 40.2 (44-72)Lymphocyte (rel.) 42.0 48.2 (20-46)After I had done the first tests he sent me to be tested for hepatitis and it came back negative.I should also say that the descriptions of stool patterns I gave above are general patterns, I've had, since this started, various kinds of stools. Ocasionally I'll have the kind of bowel movement where it almost feels like not all of the stool went out, I've had stool in shape of several formed smaller pieces, I've had one big normal stool followed by smaller, well formed pieces, stool that seemed to break apart because it had pockets of gass in between of what would have otherwise been a normal sausage shaped stool, a frequent kind of stool I get is "C" type that sticks very hard to the bowl and it takes many flushings to get it to go away etc.).Also, after that first time I went to the doctor when I suddenly started having normal stools, I had a great run of 13 days where I got nothing but normal stool.I've had no bleeding or pain (except maybe in the first few days there MAY have been some uncomfort, but I can't recall exactly, my memory is very fuzzy).My bowel movement frequency hasn't changed (It is possible it was more frequent in the first two weeks or so when I had watery diahrea, but I can't remember).I've just come back from a visit and it seemed that he had forgotten I had originally come in for diahrea and was focused exclusively on the liver function.After he saw the second test results he said everything is fine and I asked him whether this liver thing accounts for me having diahrea for a year, to which he responded that it wasn't for a year, we did the test in December of last year. Then I said that I originally came in in June of last year for diahrea. He started looking for notes of that first visit on his computer, I asked him what could be the cause of this and he said irritable bowel. After I asked whether that accounts for my symptoms he said that is one of the possibilities. He seemed stumped and to have thrown out irritable bowel as something that in a general way accounts for my symptoms.Was this a good diagnosis? Should I have gotten a colonoscopy or other tests done?


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#2 Alfred001

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Posted 24 February 2012 - 08:29 AM

I've been reading some posts and doctor responses on this forum: http://www.medhelp.o...show/107?page=1 and one of the doctors on the forum said that "chronic diarrhea needs to be evaluated with a colonoscopy - to determine if there is any inflammation or inflammatory bowel disease."So a colonoscopy, unfortunately, seems to be the necessary next step for me.I'm wondering, though, whether I could safely forgo a colonoscopy if my situation completely normalized, as it appears to be moving in that direction. Could I, provided that happened, be absolutely sure that I don't have cancer or something else that would require treatment?While I colonoscopy would be horrible it would be worse to live wondering whether I had cancer or something else dangerous.

#3 CJ78

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Posted 24 February 2012 - 02:56 PM

I think the problem with IBS is that there is no test for it, just symptom checks.Quite often though these symptoms can be slotted in to other conditions, with what seems to be long term D or C indicating further investigation needed.Then, this further investigation is used to rule out the other issues with similar symptoms which can be checked and tested for.Doctors however seem to be hit and miss.I missed, twice, and think I may have hit a helpful one.Anyway, back to your point.Unfortunately I do not think there is a way of ruling out anything without being tested for it. I, like yourself, do wonder about cancer. I was quite anxious when I first went through the symptoms.However, after various consultations with my doctor, and medications, ive started to trust their opinion. To be fair, they said they were 95% sure it was IBS, but couldn't rule out cancer because I hadn't been tested for it.I was tested for IBD which I think was through inflammatory markers from a blood test.With testing though, sometimes you are only tested for what you've asked for.I asked to be tested for H Pylori (as my wife, her sister and her mum have had it!) and when I was in the GP, I asked if they would test for lactose intolerance (considering I had been tested for gluten intolerance previously) - the answer was no!?So, ruling out everything else is a long an tiresome process, and perhaps not always required.But sometimes it can be for piece of mind, rather than a diagnosis....and for what its worth, my understanding is that D is not really a major concern for cancer unless linked with other symptoms.But i'm not a GP.Not sure if this helps?

#4 Alfred001

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Posted 24 February 2012 - 03:48 PM

I think the problem with IBS is that there is no test for it, just symptom checks.

Yeah, as I understand it, from reading the responses of the doctor on the forum I posted above, IBS basically means "I don't know." :) It's a "diagnosis" given when everything has been ruled out. (I just want to say, because a certain tone can be read out of what I wrote, I'm not criticizing the doctors here, I'm sure this is a complicated puzzle to figure out.)

I, like yourself, do wonder about cancer. I was quite anxious when I first went through the symptoms.However, after various consultations with my doctor, and medications, ive started to trust their opinion. To be fair, they said they were 95% sure it was IBS, but couldn't rule out cancer because I hadn't been tested for it.I was tested for IBD which I think was through inflammatory markers from a blood test.

Why didn't you have a colonoscopy? Doesn't that rule out all the bad stuff like C (don't like even writing that), inflammation and the other stuff (thus establishing the IBS diagnosis)?

With testing though, sometimes you are only tested for what you've asked for.I asked to be tested for H Pylori (as my wife, her sister and her mum have had it!) and when I was in the GP, I asked if they would test for lactose intolerance (considering I had been tested for gluten intolerance previously) - the answer was no!?

I'm sure that's the answer this goon I have for a doctor would give me if I suggested he should order some tests that he should.

So, ruling out everything else is a long an tiresome process, and perhaps not always required.But sometimes it can be for piece of mind, rather than a diagnosis.

Do you know whether a colonoscopy rules out everything? If no, what are the things that aren't ruled out by a colonoscopy?

...and for what its worth, my understanding is that D is not really a major concern for cancer unless linked with other symptoms.But i'm not a GP.Not sure if this helps?

Thanks, that's reassuring.

#5 CJ78

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Posted 24 February 2012 - 04:55 PM

Hi Alfred.I'm actually seeing a gaestroenterologist in a couple of weeks, although more of an initial consultation.I guess i'm not too concerned about having a colonoscopy now as I think I am getting my head around IBS-D - but will go with it if they feel I need it.Have a google on the bristol chart - it gives you perhaps an understanding that BM's are actually varied. What you may find as normal, may be strange to someone else.I did find having watery BM's (not loose, but like water) very uncomfortable, along with the high frequency of BM's.But an improved situation, not ideal, makes the anxiety drop and see things in a different light.I guess you are right that a colonoscopy is, perhaps not an fool-proof tool, but gives a good view on whether there is anything to do with the big C. Blood, urine and breath tests can give indications of other issues such as IBD and so forth.But i'm not sure what colonoscopy will and will not pick up i'm afraid, but I guess anything visual.The problem with IBS-D is that patients can get high anxiety about the Big C, and it is a recognised problem amoungst GP circles over here. It even gives guidelines for GP's to provide reassurance, but it took 3 doctors to this for me! So you can then understand how things can have a butterfly effect if anxiety is a trigger!I've had IBS-D for a similar time to yourself and it is so very confusing.I remember a few months a go I had my first green BM - it wasn't until I thought about my previous meal where I had eaten a high chlorophyl meal!I've got a thread going with my history and experiences - have a peek :o)

#6 Alfred001

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Posted 25 February 2012 - 08:30 AM

Have a google on the bristol chart - it gives you perhaps an understanding that BM's are actually varied. What you may find as normal, may be strange to someone else.

Yes, I think what's more important is not how the stool itself is (though it's probably necessarily not good if it is unformed) but rather whether it's a deviation from your normal pattern.The problem is, I never used to look into the bowl before I had this, and now, after 8 months of staring into BMs I feel like I've no idea what is normal and what isn't any more.

The problem with IBS-D is that patients can get high anxiety about the Big C, and it is a recognised problem amoungst GP circles over here. It even gives guidelines for GP's to provide reassurance, but it took 3 doctors to this for me! So you can then understand how things can have a butterfly effect if anxiety is a trigger!

Yes, I can definitely see that. I think it's best to do the minimal necessary research on this, and think about this the minimum amount of time necessary to be informed and make sure your doctor is doing the required tests (it's a lot of fun when you have to police doctors).I see from the account of your situation that you posted on the other forum that you've also had the issue of disinterested and irresponsible doctors. It's just so frustrating.I see now that I forgot to mention that I also had two stool tests. The first tested for salmonella and shingella, and the second one tested for them again, but in addition tested for parasites, all came back negative.

#7 CJ78

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Posted 25 February 2012 - 04:56 PM

Same here Alfred - all negative on my stool and blood tests.Its a frustrating situation to be in - not being able to be 100% diagnosed without there being an actual diagnosis test.But keep your chin up, push your GP (or change if you feel you are not getting the support?) and don't be afraid to ask.I think some GP's think you are making a mountain out of a mole hill, but when my third doctor saw how paranoid and anxious I was getting took me more seriously and things have progressed.I guess I have taken a slightly different approach - i'm trying to be pragmatic (if that's the right word for it) and look for an ease to the situation than trying to work out what caused it all in the first place.Sometimes, I don't think there is always an answer.

#8 BQ

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Posted 26 February 2012 - 05:52 PM

Actually IBS is a diagnosis largely reached by exlcuding other GI diseases and disorders. A colonsocopy is a very definitve test that does that.Please take advantage of the info available here. Right above us here in the dark blue menu bar you will see the tabs "Home" "Forums" "Blogs" etc.. Go to the "Manage" tab and read all the info there: ie: "Symptoms" "Medical Tests" "Diagnosis" etc...
Please remember this is a group of folks seeking support on how to live with and manage IBS. THESE ARE ONLY MY OWN THOUGHTS. IF YOU WANT AN EXPERT OPINION, ASK A MEDICAL PROFESSIONAL.

#9 Alfred001

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Posted 27 February 2012 - 04:26 AM

Actually IBS is a diagnosis largely reached by exlcuding other GI diseases and disorders. A colonsocopy is a very definitve test that does that.

That's what I thought, thanks!

Please take advantage of the info available here. Right above us here in the dark blue menu bar you will see the tabs "Home" "Forums" "Blogs" etc.. Go to the "Manage" tab and read all the info there: ie: "Symptoms" "Medical Tests" "Diagnosis" etc...

Will definitely do so.I should mention that on the other forum I referenced someone asked me the following:

Did you every get a stool test for other things besides salmonella, shingella, and parasites? For instance were you tested for C Diff, Campylobacter, pathogenic E Coli (all bacterias)?

And the answer is no. So that's how unconscientious doctors can be.





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