She's sick; advice needed

Factual Questions
1

A woman I know, let’s call her Pat, has been ill recently, and she doesn’t know what’s causing it. Here’s a recent email I got from her, followed by her own synopsis:

"I’m currently under treatment for a host of infectious diseases, but I don’t think I’m showing appropriate progress. My stomach emptying results were normal, so I’m pretty sure it’s not esophageal muscles. I have no trouble swallowing.

"What happens is that I get a build-up of “gas.” There’s only three ways out - fart, burp, or dry heave until it is expelled. I hate the dry heaving part. It’s the worst of the three. In the meantime, the gas gets in the way of my ability to eat, should it be there around meal time.

My next stop is Gastroenterology again, on the suspicion that it is “post infectious irritable bowel syndrome” or some other such malady."

…and her synopsis:

“Following a bout of diarrhea and nausea in August, 3 months later, after being treated for giardia and other infectious diseases, I am still experiencing stomach gurgling, especially at night that leads to excess “gas” which leads to dry heaving in the morning to clear the gas. During the day, symptoms are lessened, but still present, manifesting in burping most of the time, but sometimes resulting in dry heaving.”

The buildup of gas, or whatever it is, has interfered with her eating, so much so that she’s lost 17 pounds and is having to work from home, since she doesn’t have the energy to go in to work.

A mutual friend, let’s call her Mike, who is a (non-practicing) doctor, suggested cancer (because of the weight loss) and so Pat has been CAT scanned, with no cancer found. Mike’s latest guess was some kind of aphasia of the esophageal muscles; but Pat says that she passed the “stomach emptying” test.
So we need some ideas. What kinds of illnesses should Pat tell her doctor to be looking for? I don’t want ideas for treatments, since I think those would violate the terms of this board; I’m just looking for ailments that Pat and her doc can consider and eliminate.

2

First, let me state in no uncertain terms that I am not a doctor. OK, that’s out of the way.

Earlier this year I had first a gastrointestinal infection (norovirus, if you’re curious) followed by post-infection irritable bowel or collitis - basically, my entire GI tract became ridiculously hypersensitive.

I lost about 30 lbs in 3-4 weeks. At one point, I couldn’t even keep water down and went almost a week with nothing by mouth while the opposite end continued to… ah… let’s just say the elimination system was working overtime, OK? They ran all sorts of tests, I was subject to enough medical imaging to glow in the dark (and that crap for the CAT scan DID NOT taste like pina colada!). Conclusion - no cancer, the infection had cleared, etc., etc. Basically, I was “healthy” aside from a hysterical bowel, which is pretty unhealthy really.

I had a lot of gas, too. And heaves both wet and dry. Most days I felt like a tube of toothpaste squeezed really hard in the middle and erupting at both ends.

So, yeah, I could see her symptoms possibly being related to post-infection irritable bowel or other assorted digestive bits. What helped ME was going to a GI guy. I had to radically adjust my diet for several months, including cutting out all dairy for awhile, and a bunch of restrictions on fibrous food, raw fruit and vegees, small seeded items… I learned to like nutrional drinks and mush, basically. And I’m happy to say that after several months I was able to gradually resume eating a normal diet and I’m back up to healthy weight.

BUT - if that IS her problem - she really will have to be extremely careful with her diet, follow doctor’s orders to the letter, and probably will have some additional medications for symptom relief of various sorts. And, let me emphasize again - it took MONTHS for this to get better. About 5 months in my case. My doctor emphasized very strongly that attempting to consume anything that irritated my system would only delay recovery further, so if she needs to adjust her diet it is really, really important that she do so.

So I’d definitely suggest going to a GI specialist in this case, and not rely on the opinion of friends, even those with MD’s, who have not actually performed an exam or ran tests on Pat.

3

How about she sees a practicing doctor, and lets the doctor evaluate her and guide the process?

QtM, a practicing doctor. But not for her.

4

And what Qadgop said.

(Don’t doctors find patients who self-diagnose annoying, anyhow?)

5

I’d suggest a gastroenterologist. I’ve been having similar problems, especially the gas, and it was diagnosed yesterday, by the radiologist after a CT scan (w/ the “pina colada”,ugh) as diverticulitis. I’m going for a followup w/ the gastroenterologist in a few days. Probably means a lenghty regimen of the appropriate antibiotics.
Mine has been going on for about eight months, but was complicated by intervening chemo and radiation therapy for an unrelated cancer.
See the doc and follow instructions.

6

What QtM said.

She needs a gastroenterologist to give her a thorough exam and workup.

From my personal and family experience there are approximately an infinite number of diseases, conditions, and syndromes that cause any one set of symptoms. Celiac disease, various colitis types, cancer, allergies, nerves, gall bladder, appendicitis, weird parasites, viral or bacterial infections, fungal infections… The list goes on and on.

It’s useless for a non-gastro expert to even speculate as to the cause.

7

I disagree. A good internist or Family Medicine specialist should have enough knowledge to cover the basics, and ought to refer if they need help making the diagnosis or fine-tuning the treatment.

8

I guess my post was ambiguous; Mike (the non-practicing doc) is not Pat’s doctor; she’s just another resource. Pat has her own physician and has seen (been referred to) a number of other doctors as well.

9

Pat is too rational and level-headed to self-diagnose. What I’m trying to do is get suggestions for things to consider that Pat’s doctors may have overlooked.

10

Could it be Lupus?

11

It’s never lupus.

12

:smack:

13

I don’t know what Pat has and IANAD and all that other disclaimer stuff but my sister developed the same symptoms and was found to be lactose intolerant.

14

There is also the point to be made that if Pat is not happy with her current doctor then seeking a second opinion is not a bad idea at all.

15

Pat has been following this thread, and she had a couple questions for you:

-how soon after eating something that was irritating did Broomstick get a reaction? (within minutes, hours, days?)

-which nutrition shakes did Broomstick find worked best?

16

That varied somewhat - on the worst days things wouldn’t stay down more than a few minutes. When that got better, fibrous foods could lead to diarrhea a couple hours later. For about 5-6 weeks dairy led to gas that could knock over an elephant. And I had to eat really small meals.

I used Ensure, mostly the vanilla and chocolate (I thought the banana flavor rivaled the CAT scan “pina colada” for “most likely to be served by an alien bartender from a planet with a toxic-to-humans biosphere”). The doc steered me away from the “diet” shakes to the “adult nutrition” ones, and for awhile I was drinking the high-protein versions to put on weight.

Also consumed a lot of soup broth and jello.

Of course, she should follow a doctor’s advice in this, and I will remind her that it took months to get past this.