QUERY:
Dear Dr. Kerr,
I am hoping you can shed some light on my problem.
I am a 31 yr old female with a long history of digestive problems which have been
diagnosed as irritable bowel syndrome. ( I have had no diagnostic testing done, only
seen a gastroenterologist). Last March, I had a rather nasty bout of it that lasted
weeks and included loss of appetite,diarrhea, cramping on the lower left side of my
abdomen etc. (oh, the joy). However, I also noticed (sorry to be graphic)what
looked like oil on the water surface of bowl after each movement and a greenish or
yellowish tinge to the movement, as well as mucus. At this time I was also unusually
fatigued and saw my doctor. I told him about these symptoms as well. A blood test turned
up low blood iron and a B12 deficiency ( 5 points below the bottom of the acceptable
range. My doctor also had mentioned doing a gallbladder ultrasound but said I did
not need it as my liver function tests were normal.
I quit my stressful job in April and moved and the symptoms abated. I began to develop
frequent heartburn in June. At the end of last month, I had a very sudden bout of stomach
pain with fever that lasted several hours. It happened 2 more times, one bout taking
8 hours to go away. and my new PCP prescribed Donnatal for the pain as I requested.
On Aug 11, I was seen in the ER and had blood and urine work done - my white cell
count was elevated and my blood pressure was higher than normal (138/80, I think). I
normally run 90/60 to 110/70 at the most. My pulse was rapid as well.
The ER doctor prescribed Ranitidine and recommended a low fat diet, which I have adhered
to with no more serious bouts of pain. However, I continue to have the elevated
temperature, chills, rapid heartbeat, off and on appetite and intermittent pain and
tenderness in the abdomen as well as upper back pain. (At this point, I am assuming
it is the gallbladder). When my doctor returned, he referred me for an ultrasound
and told me not to travel in case I had needed emergency surgery. However, I never
met him and my phone calls with questions went unanswered, so I got a new doctor, who I
will see tommorow.
My questions for you:
Besides the gallbladder ultrasound, what other tests might I request?
Do you think the irritable bowel perhaps might have something to do with the gallbladder?
I am concerned about having these signs of infection for so long. Is this normal?
I am functioning day to day, but wearing out. Would this be treated with
antibiotics? If I need surgery, I am concerned to have it done while I am still
sick.
Are there any other symptoms I should watch for? Any other ideas as to what this
might be? I am very anxious to really get to the bottom of this. Your input
would be most appreciated.
Some other pertinent info:
I have moderate asthma, which I treat w/ OTC allergy meds, Singulair, Albuterol and
Serevent.
I do not smoke, drink,or use drugs
I am about 15 lbs. overweight
I am of Irish/English/Austrian descent
Dr. Kerr, thank you for your help! I wish you well and I think your website is
terrific!
M.
ANSWER:
Hello M! It sure sounds appropriate to be
asking the things you are asking. You wrote an excellent and thorough
question so I'll see if I can help shed some light on the issues.
Your symptoms definitely deserve more of a workup than you have had. A
sonogram of your gallbladder would be useful to at least rule out the
possibility of gallstones. Gallstones could cause upper abdominal pain that
radiates into your back - pain that comes in attacks and often follows a
high fat meal. Just for more information if you want it, I give you a link
here to see what we look for when we are considering gallbladder disease.
General Info
About Gallbladder Disease
On the other hand, the cramping in the lower left part of your bowel and the
diarrhea do not necessarily sound like gallbladder disease. Several of your
other symptoms also make me want to look elsewhere. Irritable bowel
syndrome is a diagnosis of exclusion and unless someone has checked for
other causes of your symptoms you really can't assume that it is IBS. A
colonoscopy (scope looking at the inside of your colon) would be essential
to figuring out your symptoms. There are at least two other possibilities
that should be considered. I think it would help you if you knew more about
these other considerations, so I'm giving you some more links to explore.
First, about Irritable Bowel Disease:
Irritable Bowel
And about Ulcerative Colitis:
Ulcerative Colitis
And lastly, about Crohn's Disease:
Crohn's Disease
I don't want to overwhelm or scare you, only educate you so you can see how
important it is to get a good diagnosis if possible! The fact that you have
had low blood iron (anemia), low B-12, a fever, high white blood count, etc
etc - you certainly deserve a good look at your colon! That is the only way
you'll be able to get to the bottom of this ongoing problem.
Of concern also is that you need a doctor who will work with you and one
that you can trust. It sure seems like you have not been able to connect
with anyone yet and that would be essential if you are going to figure this
all out. Keep looking until you find someone who listens to you, who takes
you seriously enough to talk to you and make sense out of whatever plan they
come up with, and someone who follows up on tests ordered. You need someone
you trust and it's worth it to persist.
M, you wrote an excellent question and I do believe you are on the right
track in figuring this out. You have changed doctors in an attempt to get
what you need, and you are questioning the things that don't make sense to
you. Take the time to educate yourself about the possibilities and then ask
for what you need.
Good luck tomorrow with your new doctor!
Best, Dr. Kerr