Re: my visit to the GI specialist

On 2006-05-22, Howard C. Berkowitz penned:
I came late to the discussion, so don't know Monique's original
symptoms, but let me make a few observations.

Hi, Howard! Thank you for contributing to the discussion.

My symptoms are cramp-type pain in my lower abdomen and diarrhea/loose
stool. For a while there was a very well-defined pattern; then it
changed to a completely different but again well-defined pattern.

Acupuncture seems to help settle my abdomen in the short term, but not
for more than a few hours.

Currently I have magnets in both ears, for stress and for intestines.

Hyoscamine is an example of an anticholinergic drug of the
muscarinic receptor antagonist family, about which Wikipedia has an
OK writeup: http://en.wikipedia.org/wiki/Anticholinergic The effect
of interest here is that they relax smooth muscle, which makes up
the gastrointestinal tract. They also decrease an assortment of
secretions, including saliva and sweat.

I seem to still be able to sweat pretty well. I get a little dry
mouth, but not too badly. My GI doctor said that really, these
medicines are not well understood. That they are called
antispasmodics, but no one *really* knows why they seem to work for
some people.

If it works, keep doing it. In general, however, it's worth looking
for dietary adjustments. This could be anything from increasing or
decreasing fiber, or decreasing fat, or looking for food allergies.

This is where I am confused, because this all makes sense to me, but my
GI doctor said that outside of very specific and obvious food
sensitivities, not to worry about what I'm eating. He said there's no
such thing as "hard to digest" foods. That sounds like BS to me. He
said it's okay to look for food sensitivities, but unless it's very
obvious, not to drive myself crazy looking for a connection.

I'm now taking 20g of soluble fiber every day. I've been taking added
fiber for a few weeks now, the 20g for a week, and no obvious effect.
My regular doctor said that fiber supplements help some people, but
make others worse, and the only way to know was to try 20g a day.

I wouldn't dismiss a gastroentology consult so soon, because before
any serious testing, an expert history and physical can tell a great
deal. There are some basic tests worth doing, such as a complete
blood count to give indications of bleeding or infection, a
comprehensive metabolic panel ("chem-24") to check liver and kidney
function (among other things), and, if there are indications of poor
digestion, a fecal fat analysis. Definitely an occult blood test on
the stool. The history and physical may suggest other blood tests.
It's certainly worth testing for Helicobacter pylori infection if
there's the slightest suspicion of an ulcer, because this curable
infection accounts for about 85% of ulcers.

Don't get me wrong: I am seeing a GI doctor and I will get the tests
he recommends. I just wasn't real impressed by his chairside manner,
and I worry about how dismissive he seemed to be of the idea that
foods might affect this thing.

Sooner or later, a gastroenterologist is going to want a look (i.e.,
endoscopy or colonoscopy), either directly through a tube or by some
form of imaging technique. Imaging ranges from upper and lower GI
fluoroscopy with a swallowed or inserted contrast media, to CT or
MRI visualization, to a rather creative new technique called capsule
endoscopy. In the latter, the patient swallows a disposable color
TV camera, and has antennas wrapped around her torso. It transmits
a picture about twice a second, and is lower risk and often lower
cost than some direct imaging. I'm speaking here, however, more of
the rules for evaluating obscure bleeding, not just cramping.

Whatever tests he wants me to try, I'm game. I'd rather do too many
than too few.

Another thing he said that bothered me is that he didn't think
diarrhea had any correlation to reproductive organ problems. I know
I've read that it can be related to ovarian issues. He did say it's
something we can look into if all the GI tests fail to show anything,
but still.

--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca
.

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