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Ask Anthony Bray, MD Your Own Question

Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6948
Experience:  14 years as clinician in the field of Family Practice
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Im a 24 yr old female, getting fed up with my IBS diagnosis,

Customer Question

I'm a 24 yr old female, getting fed up with my IBS diagnosis, and continue to have problems. Over 3 yrs ago I began having terrible episodes of diarrhea, lost 30lbs in under 2 months and had bright red blood. That Dec. 2006 I had a colonoscopy, blood work, stool culture, small bowel series, and biopsy from the colonoscopy, and everything was negative for cancer, colitis, crohn's, and celiac. I was diagnosed with IBS-D and tried different meds to slow the GI tract down, nothing was helping. My uncle had colon cancer at 50yrs old, but I'm told this doesn't really put me at risk. I eat very healthy, lots of fiber and water, and my symptoms continue. I have been to the ER with appendix type pain, the CT was normal and was told it was just the IBS. This spring 2009 I saw a 2nd GI specialist because of the pain which can be the whole abdomen but stabbing pain in the lower right, diarrhea, and now bright red blood. I had an EGD, more blood work, and flex sigmoidscopy with biospsies, and all were negative. I'm on Bentyl which helps with the painful spasms, but things are getting worse. I moved to FL and am now seeing a 3rd specialist. A month ago I had a lot of blood for a week straight, with every BM, sometimes several times a day (there is no external hemmrhoids). Sometimes the thought of food makes me so nauseous I start dry heeving, and have no appetite. My weight tends to flucuate when this flares up, but overall I've slowly been losing weight from this. I've had increased joint pain, I thought it was just when I had the flu a few months ago, but I still get body aches. For the past month and a half now, I have drenching night sweats, and I'm normally a cold person. I have no other symptoms of an infection, such as a UTI, etc. The new dr is doing a 2nd flex sigmoidscopy next week and I'm most worried that nothing will be found again and I'll have to continue with this forever without a real finding and treatment. Thank you so much for your time.
Submitted: 4 years ago.
Category: Health
Expert:  Anthony Bray, MD replied 4 years ago.

Hello!

 

I would recommend that for one that you request the GI doctor to perform a colonoscopy and not just a flexible sigmoidoscopy. The reason that I say this is that you have pain in the right lower side and you problem could be in the area near the cecum(which is next to the appendix). You might have a form of infllammatory bowel disease as one possibility. IBS could be part of your problem but is not a cause of bleeding. The bleeding could be related to internal hemmorhiods, ulcerative colitis, Crohn's disease, AV malformation, other forms of colitis, diverticulitis or other cause.With the location of your pain and the bleeding as part of your symptoms I would recommend that inflammatory markers be included with your blood work in case they have not been.(These include the sed rate and C-reactive protein; you might ask your doctor if these have been done) Since you have already had a flex sig , I feel that the entire colon should be examiined and not just the lower portion.

 

I hopr this information helps. further questions are welcome if you have any. If my answer has been helpful and to your satisfaction then please remember to press the "ACCEPT" button. Thank you and Best regards,

 

Anthony Bray MD

Customer: replied 4 years ago.
I had a colonoscopy 3 years ago with the first GI dr. Do you think it's been long enough and with the symptoms worsening, I should ask for it again? This new dr said the other doctors did a "good work up" and didn't feel that any of the other tests should be repeated. The blood is worrying to me, as well as the new night sweats, which is something I never had an issue with before. In your experience, do you think a flex sig is about the same as a colonoscopy, insurance cost wise? What is the sed rate, and C reactive protein?
Expert:  Anthony Bray, MD replied 4 years ago.

Hello again!

 

I think that with the development of the bleeding plus the right lower quadrant pain that a colonoscopy would be preferred. The fact that you had a colonoscopy years ago and this was normal may decrease the odds of a repeat colonoscopy showing anything pathologic may be less. On the other hand you did not have the bleeding 3 years ago as I understand you history and this in particular needs to be diagnosed as to the cause. The colonoscopy would be more thorough and look at the entire colon and not just the lower third. (neither test looks at the small bowel) The colonoscopy does cost more but it depends on your insurance coverage as to if you would owe any more $$$. The colonoscopy is done in a hospital setting usually and under sedation. The flex sig is an office procedure. Your sense of discomfort would usually be greater with a flex sig. The sed rate and C-reactive protein are nonspecific markers of inflammation. They can tell you that inflammation is present or not but many different kinds of things may make them elevated. They would be helpful to rule in or out the possibility of inflammatory bowel disease such as Crohn's or ulcerative colitis. They are especially elevated in those disorders.

 

 

I hope this helps. further questions are welcome if you have further . Best regards,

 

Anthony Bray MD

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