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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6486
Experience:  14 years as clinician in the field of Family Practice
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Weve talked before. I had the elevated gastrin level.

Customer Question

Weve talked before. I had the elevated gastrin level. I have diagnosed with Chrohns
Submitted: 10 months ago.
Category: Health
Expert:  Anthony Bray, MD replied 10 months ago.

Anthony Bray, MD : Hello again!
Anthony Bray, MD : the diagnosis is new isn't it? This would make sense to explain some of your GI troubles. What are you taking for your Crohn's??
Anthony Bray, MD : How are you doing?
Customer : I was diagoised a week ago. They have me in pentasa and folic acid. Btw im also pregnant
Anthony Bray, MD : As I recall you were very concerned that the elevated gastrin level might be due to gastronomy...
Customer : I was ver concerned of that
Anthony Bray, MD : congratulations on your pregnancy! I hope that things go well for you...
Customer : Thanks
Anthony Bray, MD : The Crohn's probably fits with causing higher gastrin levels.... This may be characteristic of inflammatory bowel disease....
Customer : I thought for sure if i had crohns disease it would shown up on biopsies
Anthony Bray, MD : Of course the Crohn's may be very difficult in its potential .... I have some patients with this diagnosis whom stay more inactive with the disease but others with terrible active cases... There is a lot of variability with diagnosis of Crohn's ....
Anthony Bray, MD : well Crohn's can be very irregular in the segments of the GI tract where it is active... Biopsy of inactive segment of GI tract would NOT give the diagnosis... This would explain some of the difficulties that you have had in getting it diagnosed ....
Customer : It sure was a frustrating process
Anthony Bray, MD : Yes -- I am sure that it has been. I hope that you have benefit with getting the problem correctly and completely diagnosed and treated...
Anthony Bray, MD : Of course the ulcer part was/is still a correct aspect of the diagnosis....
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6486
Experience: 14 years as clinician in the field of Family Practice
Anthony Bray, MD and 4 other Health Specialists are ready to help you
Customer: replied 10 months ago.
Any foods i have to avoid?
Expert:  Anthony Bray, MD replied 10 months ago.
Hello!

Well -- yes for the ulcer aspect you know already to avoid hot spicy acidic foods....tomatoes , onions , peppers, citrus fruits ( while active ulcers are problem)

When obstructive type symptoms may be present -- segments of intestine or colon may have constrictions... Low residue diet needed for this type problem( opposite of bulk type foods or roughage)

By contrast if diarrhea is the problem then increased dietary fiber may be helpful( equally in this regard a regimen of daily Metamucil would benefit aspects of problems in which increased fiber or bulk help) so these are helpful in the case of loose watery diarrhea but not if you had bloating / distention and perhaps constipation

I hope this helps! Let me know if you have further questions or discussion ...

I will be happy to get back with you! Best regards!

Anthony Bray MD
Customer: replied 10 months ago.
Can stress make crohns disease symptoms worse
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Yes definitely Crohn's is a disease that will have very much an increased tendency of being active or Inflamed if you are stressed out psychologically . So keeping anxiety and stress factors under control would be helpful to your cause in regard to helping Crohn's tend to be less active.

I hope this helps! Let me know if you have further questions....

Best regards ,

Anthony Bray MD
Customer: replied 10 months ago.
What could happen if i delay starting the pentasa until after igive birth
Expert:  Anthony Bray, MD replied 10 months ago.
Hello!!

Oddly Pentasa 's active ingredient has been given pregnancy category B in some products but cat C in others. ( cat B is the safest category that we tend to see in medications. This rating indicates that there are no adverse effects known in human pregnancy cases ( also that there exists a body of evidence enough to be considered adequate to give a safe for pregnancy estimate)

Most common category for majority of meds is category C ... This indicates a lack of evidence of harm in human pregnancy but that the body of evidence is not considered strong enough to guarantee safety. Some animal results with adverse outcomes related to pregnancy may exist within this category ( usually such animal results would tend to be with exaggerated dose levels making it difficult to draw firm conclusions...)

Mesalamine is the active ingredient and as I have indicated the products containing this have been given a mix of FDA cat B and others cat C... So this is to my perspective more reassuring than not... Many meds such as phenergan for nausea are category C and have been very frequently used in pregnancy.

There are a bit of mixed results with regard to mesalamine and pregnancy. There have been studies reassuring as to lack of harm with pregnancy but inconsistent results with some studies showing POSSIBLE ADVERSE OUTCOMES.. Such as preterm birth and low birth weight... The results are confusing because inflammatory bowel disease may Also be associated with similar adverse outcomes in pregnancy.


From my perspective I would advise close consultation with a high risk obstetrician and gastroenterologist. ( you may well ding that the OB/GYN may favor holding the Pentasa unless active disease while GI may well be more encouraged with pregnancy. It is the goal BOTH to try and minimize medications during pregnancy in general , identify and eliminate drugs that are contra-indicated ( cat D and Cat X )

It is more important to guard your health and the health of the baby and this goal may be best served by a review and reduction of medicines but still that you may very well need some!!

I am not going to pretend to offer the final word on the Pentasa issue. Active Crohn's may have consequences to hurt pregnancy and so I think the Pentasa is likely to be favored for you to take but this judgment could go either way( the less active your Crohn's then the less benefit to take during pregnancy)

I invite you to review the med and the pregnancy indications and precautions--- www. drugs.com -- enter Pentasa or mesalamine ...professional information / FDA monograph / -- then look at pregnancy indication and precautions... This is excellent source to reliably review information with regard to this. You will find it is a complex issue.

So I would encourage you to review this information to note the data that is available. Take this into account both the positive and negative. The medicine is not contra- indicated with pregnancy but there is obvious concern also to minimize meds in general. To me I would be interested in your current GI symptoms, the judged extent of your current disease. I would be very interested in send rate and CRP as markers for probable activity of the disease. If your inflammatory markers were low then I would look at this as a sign that you may have less benefit to take the Pentasa currently but could always start if you needed. If the inflammatory markers were high or you had a lot if ongoing clinic signs of disease then I would more favor you taking the Pentasa now...


So that is how I would go about making this decision . I hope this helps! Let me know if you have further questions/ discussion . Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
I think my crphas only been elevated once and that was when i had an ovarian cyst. Is it possible the crohns wouldnt cause elevated crp?
Expert:  Anthony Bray, MD replied 10 months ago.
Hello ,

The CRP is the more sensitive marker for inflammation. I follow this in patients with Crohn's or ulcerative colitis as an indicator of disease activity. I take this as one of several factors to gauge the level if activity of the bowel disease. Abdominal pain, tenderness on exam and other GI symptoms would also factor in. I would expect that increased Crohn's activity would BE EXPECTED to correspond to elevated CRP. It has been a reliable indicator in my experience. ( at the same time I would not dismiss other findings...)

I hope that this helps! Let me know if you have further questions! Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
I just dont think i have crohns.
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Well I don't know what the evidence is exactly in your case. What area showed the positive biopsy for you? How are you doing in terms of symptoms now?

That may help to know more of your need for treatment....

Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
None of my biopsies showed Crohns. He did an IBD sgi diagnostic panel and it showed Crohns. I still have a lot of abdominal pain and a lot a nausea
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

I see.... Well it sounds that Crohn's would be the logical conclusion if your test results were consistent with this. It would seem to help explain the degree of GI difficulties that you have had . I recall back to episodes of bloody diarrhea --- right?? This would make sense with Crohn's as a cause.... Also if you have reduced abdominal pain after being on the Pentasa a while then this would support the diagnosis....

Ok to be skeptical but avoid being in denial...

I hope that this helps. Let me know if you have further discussion! Best regards!

Anthony Bray MD
Customer: replied 10 months ago.
How much weight should i gain during pregnancy. What happens at the first ob visit
Expert:  Anthony Bray, MD replied 10 months ago.
Hello,

You should expect to gain 30 - 40 pounds during pregnancy...

First OB/ GYN visit probably have history , physical exam including pelvic , blood work. That would be typical to expect.

I hope this helps. Let me know if you have further questions. Best Regards,

Anthony Bray MD
Customer: replied 10 months ago.
Thats goingv to be hard with my history of an eating disorder
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Well keep in mind that you have important responsibility both to YOURSELF and baby to maintain good nutrition. This important and you need to be able to rise above the psychological issues that are behind the eating disorder. You need to take charge and not fall into bad habits--- the importance if the pregnancy should be if help to you in this situation I think. I think it is more often the case with women with this history that the need to take care of nutrition will help to keep you better motivated to eat. The potential troubles with morning sickness is mainly in the first trimester for most pregnancies ( but this may vary) medication for nausea may be used if they should be really needed by the way! ( with your history I realize here that you have multiple factors that may lead to nausea but again this problem can be treated if needed)

I hope this helps! Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
I was 5 weeks dated from my LMP and my hcg was only 433
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

It sounds that they would probably follow up your hcg level as this should rapidly rise if you have healthy pregnancy. An ultrasound to confirm intrauterine pregnancy may be recommended.....

I hope that everything goes well for you! Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
On saturday it was 171. Monday it was 433. Just wondering if those are toonlow
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

I trained doing OB but this was only in residency....

I agree with your concern that the hcg level seems too low for 5 weeks gestation --- I am not that attuned to following hcg levels however!! I may look this up...

The rise seems healthy though....

Best regards XXXXX XXXXX me know if you have further questions...

Anthony Bray MD
Customer: replied 10 months ago.
Can you look it up to see if tgats normal
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Ok --- I looked up the hCG levels and week one 5 to 50 mU/mL.....week 1> 2 : 50 to 550 mU/mL ( this seems to be more of fit in your case) 2 - 3 weeks : up to 5000 mU/ mL // 3 to 4 weeks : up to 10,000 mU/ mL // 4 to 5 weeks : up to 50, 000 mU/ mL // 2 to 3 months though range 10,000 to 100,000 mU/mL

So your level rising from 171 to 433 would seem to me to be more consistent with earlier level gestation than you figured by last menstrual period....

I hope this is helpful. Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
I had a positive pregnamcy tests on the 28th but negative test on the 26th
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Well I think that may fit as you having negative pregnancy test of the 26th would be consistent with you NOT being five weeks along at this time ... The positive test on the 28th and your levels would make me estimate early gestation ... The rise from 171 to 433 ( 8/31 to 9/2 ) would seem consistent with progress within the second week of gestation....so you need follow up on the ongoing hCG levels to ensure continued rapid rise....

I hope this helps! Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
When would you guestimated i concieved
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

From the combination of info I would guesstimate that you probably conceived near 8/22.... This date or close would seem to fit with negative urine pregnancy test on 8/26 but positive on 8/28 and hCG of 171 on 8/31. I can't say with absolute certainty....

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
So how many weeks would that make me? The last day i had sex was on the 20th
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Ok then that must be your day of conception. So that would make you then estimated day 19 of pregnancy. So in two days you would be up to 3 weeks gestation.

That would be my estimation based on our facts in hand...

Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
Dont they add two weeks on to it
Expert:  Anthony Bray, MD replied 10 months ago.
Hello,

No you don't add two weeks to date of conception. You would estimate 2 weeks plus USUAL LMP ( last menstrual period) this is because day 14 would be typical time of ovulation in a menstrual cycle. So LMP + 14 days would be usual time of conception --- so I think this is what you are referring to.... Or date of missed menstrual cycle to present plus 2 weeks would also correspond to estimated gestation....

I hope this helps. Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
If i date from my lmp is be almost 6 weeks
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Well the hCG levels do not seem consistent with 6 weeks at all really .... Your LMP is probably not the better indicator in your case here....

Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
I concieved on clomid. I have an u/s scheduled for wednesday. But if im only 3 weeks than an u/s wont show anything
Expert:  Anthony Bray, MD replied 10 months ago.
Hello!

I agree that at est. 3 weeks gestation that U/S will probably be very limited in what they may be able to see. I simply advise that you discuss findings with your OB/GYN at next opportunity ...


Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
Im just really worried about bligted ovum
Expert:  Anthony Bray, MD replied 10 months ago.
Hello ,

I understand your concern. I hope that things are fine with you just having an early gestation. I hope that you have a healthy intrauterine pregnancy and go on to have a successful and joyful pregnancy. It is early and a blighted ovum scenario is a possible concern --- I still look mainly at your hCG values and the pace of gain from 171 to 433 in three days seems to be on pace. This to me at least would seem to suggest this is an early pregnancy. You would not expect this healthy jump - I don't think--- with a blighted ovum scenario...

I hope that this is helpful. Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
Hcg level Its 5983. Somaccording to our values that puts me atleast 5 weeks
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Well I think the progression of hCG values 171- 433- 5983.... ( 8/31, 9/2, 9/9) would best fit with three to four weeks gestation .... The single value of about 5000 would have a broader range possible as to the gestational age it corresponds to .... I don't think that your early numbers would correspond with you being as far along as 5 to 6 weeks now ... Discuss if course with your OB doctor...


Best regards ,


Anthony Bray MD
Customer: replied 10 months ago.
My labs levels are
3 wk 6-71
4 wk 10-750
5 wk(NNN) NNN-NNNN
7 wk 3697-163563
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

I see... By this scale then you are right the value would seem to fit with 5 weeks...

Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
My u/s today Showed a single intrauterine gestational sac with yolk sac identified. Mean sac diameter corresponds to a gestational age of 5 weeks 2 days. However no fetal pole identified. Follow up exam recommeneded in 1-2 weeks to confirm viability
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Well I hope that your follow up indeed shows everything to be going well. I think your rise in hCG is reassuring. The presence of the gestational sac and intrauterine pregnancy are good findings... ( at least ectopic is one less thing to worry about)

Again I hope that your pregnancy remains healthy and I wish you the best!

Let me know if you have further questions or discussion. Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
Is it normal at 5 weeks not to see thr fetal pole
Expert:  Anthony Bray, MD replied 10 months ago.

Hello again,

 

5 weeks gestation is still early.. I am not sure exactly how common this finding is at this stage however.. again I did Obstetrics in residency but that has been a while back!!

 

It does not strike me as being that off base to have concern of this differentiation of the gestational sac at this stage however. I defer to your OB/GYN really on this issue however...

 

The interpretation of OB ultrasounds is creeping out of my comfort zone with regard to clinical medicine however...

 

Take Care and let me know if I may help you further....

 

Anthony Bray MD

Customer: replied 10 months ago.
All my skin feels itchy
Expert:  Anthony Bray, MD replied 10 months ago.

Hello!

 

For improvement in symptoms you would probably benefit to the Zyrtec 10mg in the AM and Benedryl 25 to 50 mg at bedtime.

 

Watch for possible rash,

 

Taking a cool shower may help. Cooler skin tends to be less reactive, Application of moisturizers of the skin ...

 

I hope this helps. Best Regards,

 

Anthony Bray MD

Customer: replied 10 months ago.
I think its from the pentasa
Expert:  Anthony Bray, MD replied 10 months ago.

Hello again,

 

That may be the case >> discuss this new symptom with your gastroenterologist and express your concern with regard to the itching and the question of Pentasa as a possible cause...

 

Do you have any history of adverse reactions such as cough, wheezing, trouble swallowing , rash or itching as you have now?? Any of the other symptoms now?? When did you first notice the itching>> today??

 

Any history of problems taking medicines such as aspirin, Advil or Aleve??

 

Some people can have a broad rate of allergy type symptoms with standard NSID , anti-inflammatory medicines...

 

I hope this helps. Let me know if you have further questions. Best Regards,

 

Anthony Bray MD

Customer: replied 10 months ago.
What causes someone to be tired all the time
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Well in your circumstance you should know that fatigue is very common with pregnancy. Increased sleep requirement is typical . So this would be the first thing which I would suspect as cause.

On a broader view the causes of fatigue can be extremely broad in scope of the causes. Anemia, iron deficiency, hypothyroidism, B12 deficiency, sleep deprivation ( sleep disorders and other) . If exertion makes fatigue worse or there is easy shortness if breath as a symptom then we would need to rule out possible pulmonary causes ( asthma as quick example) or cardiac causes ( atrial fibrillation as quick example) Psychological problems are yet another possible cause>>> looking for symptoms of depression/ anxiety/ stress...

The qualities of fatigue such as do you feel tired more easily with exertion? --- do you feel short of breath? -- sense of weakness? -- are you sleeping the same , less or needing more sleep? -- do you feel increased drowsiness? These questions help to categorize the fatigue by type and this then helps to lead to the more suspected causes.

Off hand I would first suspect your pregnancy as the cause most likely however.

I hope this helps. Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
Ive been nauseous all day
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

Do you have anything for nausea? Even Benedryl can be helpful with this symptom...Phenergan or Zofran are options for treatment if the nausea is severe enough. I would suspect your pregnancy as cause but with your complex GI history leaves it very possible that other reason such as the ulcer disease could be responsible.

I hope this helps. I hope you feel better soon! Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
Can i take zofran if im pregnant
Expert:  Anthony Bray, MD replied 10 months ago.
Hello!

Yes... Zofran is category B for pregnancy which is the best category that we see.... There is no evidence of harm with pregnancy but it is still precautioned that the drug has not been actively studied in pregnancy in large numbers so we would consider this lack of big numbers in studies to weaken the evidence in favor of the record of safety for Zofran.

I hope this helps . Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
My chromgranin a level was 69
Expert:  Anthony Bray, MD replied 10 months ago.
Hello!

That value is high for chromogranin A . Normal healthy individuals without disease are reported to have values of CgA less than 19U/L on average.

A cutoff of value of 31-32 U/L would have reported sensitivity of 75 % for neuroendocrine tumor type pathology and 85 %,specificity....

The setting specificity of 95% would correspond to CgA level of 84 to 87U/L ...

So your level of CgA would seem highly suggestive of a neuroendocrine type process ( including gastrinoma as possible

So your GI disease is suspicious for a neoplastic or malignant type process but it is not entirely specific for this... So further consultation and interpretation of results with your gastroenterologist is recommended.

I know this is a major concern for you...( about 60 % of gastrinomas may be malignant)

I hope this information Is helpful for you. Let me know if you have further questions. Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
I think my labrange says 93 but im still really concerned that its high
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again ,

I agree that it is of concern! I would discuss the result further with your GI doctor most certainly!

As with other labs each lab may vary some in their methodology and the cutoffs for normals into abnormal ranges may vary with the specifics of the lab's methods if testing.

I agree that your values appear abnormally high...

Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
Even if my lab cutoff is 93?
Expert:  Anthony Bray, MD replied 10 months ago.
Hello !

I gave you values above as reported in a summary research paper on CgA. I am not out to contradict the labs given cutoff values as these may be different vs my resource. So go by the labs values as the primary source of information here! They have developed their own values for the normal range of their testing with regard to CgA...

Review with your gastroenterologist of course...

Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
But it seems so high Dr Bray for a 24 year old
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,

I agree with you that it does seem high. The key question it would seem to me is if this was consistent possibly with Crohn's as the cause vs neuroendocrine neoplasm or malignant process. I doubt that you have multiple causes of your symptoms and abnormal labs. I suspect that Crohn's may be reason for both the high gastrin level and CgA but I would have to defer to the gastroenterologist on the opinion of the differential diagnosis at this point...


I hope this us helpful. Best regards,

Anthony Bray MD
Customer: replied 10 months ago.
But why would he check the chromogranin a level if crohns couldncause an elevation. Do you think its a gastrinoma
Expert:  Anthony Bray, MD replied 10 months ago.
Hello again,Right, I do not know if Crohn's may affect CgA level or not... I defer you to ask your gastroenterologist on this one.... The CgA is meant to detect activity of neuroendocrine cells related to the GI system..On the question of if this may be a gastrinoma... I do not know that this is the case at all but it is possible and a concern I agree.... The inflammatory bowel disease may be associated with elevated gastrin levels and ulcers... ( I don't know that it would be associated with elevated CgA levels though) part of my reasoning has been that I doubt you having multiple problems causing the GI problems but feel it more likely one problem( Crohn's or gastrinoma (Zollinger- Ellison syndrome ) I hope that things go well for you and I hope better than you have seen in the past couple of months...Take Care,Anthony Bray MD
Customer: replied 9 months ago.
Im kind of freaking out
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

I'm sorry. I understand, the results would make you worry ... I hope that the explanation behind the seemingly high CgA value and the gastrin level is not a bad player...I hope that your diagnosis is benign in nature and that your treatment goes well. I hope that you feel better soon.

Best regards,

Anthony Bray MD
Customer: replied 9 months ago.
My repeat gastrin level was normal
Expert:  Anthony Bray, MD replied 9 months ago.
Hello !!

Well , that's good . Perhaps a similar result may be found for the CgA too then...

Best regards,

Anthony Bray MD
Customer: replied 9 months ago.
I have fever 100.9 and mucousy bloody stool
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

Those are concerning symptoms. The repeat pattern could fit with diagnosis of Crohn's here. The bloody stools are suggestive sign consistent with inflammatory bowel disease. Much abdominal pain? I would watch these symptoms closely... try to get in touch with GI doctor tomorrow...

Best Regards,

Anthony Bray MD
Customer: replied 9 months ago.
I have a whole bunch of epigastric pain. I also have chills
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

I see. It may be aggravating your ulcers with this flare up... I would plan to get in with your GI doctor tomorrow if I were you. If higher fever or worse abdominal pain then you may need to go to ER...

I hope that you feel better soon. Best Regards,

Anthony Bray MD
Customer: replied 9 months ago.
My gi drs gone until wednesday. Is this going to hurt my pregnancy
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

Probably not and hopefully not!! IT is a stress to your system but the pregnancy should be resilient vs this stress...

I hope that you feel better soon!

If your doctor not available in the AM then I would consider seeing someone.. your primary care doctor perhaps... I think it would be prudent to have some exam in next 24 hours.. abdominal exam and CBC for example...

Best Regards,

Anthony Bray MD
Customer: replied 9 months ago.
Haveyouheard of taking unisomefor morning sickness
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

Yes -- Unisom ( tablets // gel tabs )) ( one is diphenhydramine and the other is doxylamine) -- both are antihistamines-- both may be used to benefit nausea.. This is an effect or benefit of the antihistamines as well... Benedryl is also an option for nausea but it is just not as well known for this!

I hope this helps! Best regards! Anthony Bray MD
Customer: replied 9 months ago.
I work up this am with a big pus pus pocket on my tonsil. Ive never had strep before. What could it be
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

Well;l it sounds that you probably have a case of tonsillitis. This can be associated with strep or mononucleosis frequently. I would advise that you have it examined by your primary care doctor. Evaluation of this and possible need for antibiotics...

I hope this helps. Best Regards,

Anthony Bray MD
Customer: replied 9 months ago.
Quick strep was negative. The dr recommended watching it for a couple days
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

I see...I would take the step to gargle with EITHER >> sat water >> or 1:1 hydrogen peroxide diluted with water >> or a commercial product such as Listerine... Either of these would tend to help reduce the infection whether viral or bacterial ...

Do keep a watch on how you do with the appearance of the throat and tonsils. Watch for pain , fever ongoing...

Despite negative rapid steep it is possible that this could be due to bacterial infection ... Bacteria other than steep may be causing the infection. It is also possible that the infection may be viral ( note a CBC with differential could be helpful to determine the type of infection...


The better you do over the next few days then the less likely that anything further needs to be done. If it is not improving or getting worse then your doctor might consider a throat culture ( a step beyond the rapid strep...) blood tests for mono might be considered too as this is a common culprit.

I hope this information helps. Let me know if you have further questions. I will be happy to get back with you! Take care ,

Anthony Bray MD
Customer: replied 9 months ago.
Im having a constant pain in my stomach thats intensifying
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

Is this the epigastric area? That could be due to flare up of the ulcer disease. Other could be flare up of Crohn's as another real possibility.

What meds are you taking now? I realize that your regimen may be tapered down due to your pregnancy...

Let me know and I will get back with you..

Best regards,

Anthony Bray MD
Customer: replied 9 months ago.
Im on pentasa folic acid and ranitidine
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

I see. The ranitidine would be expected to help control your ulcers. Still I would be concerned that it is possible that ulcer troubles might have flared despite this medication.

If you are having loose stools and perhaps done bloody stools then this could be more consistent with the Crohn's disease.

Either of these problems may be making things worse for you at this time...

Further follow up with your gastroenterologist should be helpful.

What part if your abdomen hurts? Epigastric area or other ??

Let me know and I will get back with you! Best regards,

Anthony Bray MD
Customer: replied 9 months ago.
Its the epigastric region
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

That sounds consistent with a flare of the ulcer disease. I think you may do better on Protonix with your GI's approval. ( it is category B in pregnancy so that should not be a problem)

I hope this helps. I hope that you feel better soon! Best regards,

Anthony Bray MD
Customer: replied 9 months ago.
Had a repeat u/s today. Vmy baby had a heartbeat of 156
Expert:  Anthony Bray, MD replied 9 months ago.
Hello !

Congratulations! That is exciting news !

Best regards,

Anthony Bray MD
Customer: replied 9 months ago.
Im so excited.
Expert:  Anthony Bray, MD replied 9 months ago.
Hello!

I am very happy for you!! Many congratulations!! It will be biggest change of your life !

Best regards XXX XXX the best wishes for you and baby!!

Tony Bray MD
Customer: replied 9 months ago.
Why do yoh say itll be the biggest challenge of my life
Expert:  Anthony Bray, MD replied 9 months ago.
Hi there,

I think I said CHANGE but challenge could fit as well. As parent of three I think that being a parent is the best experience has to offer. The live that you develop for your own child( children ) will probably surpass that of any other!!

Again best wishes!!

Anthony Bray MD
Customer: replied 9 months ago.
How old are your kids
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

They are ages 14, 18 and 23...

Youngest 2 are daughters, and oldest is son.

Best Regards,

Anthony Bray MD
Customer: replied 9 months ago.
I wish i was done being pregnant. I just want tohave a baby already. I saw its heartbeat and fell in love
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

That is very sweet! I have heard that wish to be done with pregnancy with baby in arms many times!!

Take Care,

Anthony Bray MD
Customer: replied 9 months ago.
I had 3+ ketones in my urine yesterday should i be worried
Expert:  Anthony Bray, MD replied 9 months ago.
Hello!

Ketones in the urine occur when you are not getting enough nutrition. When you eat normally the energy comes from your food as it should!! When you skip meals then energy comes from your body breaking down energy reserves and this causes the presence of ketones.

You have had long history of having very irregular eating habits. So work to make sure that you eat normal at least three reasonable meals/day...

I hope this helps. Take Care!

Anthony Bray MD
Customer: replied 9 months ago.
i have morning sickness all day long. So its hard to eat and when i do eat i throw up
Expert:  Anthony Bray, MD replied 9 months ago.
Hello!

What are you taking for nausea? It is better to control the nausea with something--Unisom , Benedryl, Zofran or Phenergan-- than to have too much nausea and vomiting and not keep adequate food and liquids. Starvation and dehydration are danger to pregnancy but not those medicines..

I hope this helps! I hope that you feel better!

Best regards,

Anthony Bray MD
Customer: replied 9 months ago.
Ive been taking unisom but its not working. My ob wont rx zofran unless im puking 7 times a day
Expert:  Anthony Bray, MD replied 9 months ago.
Hello again,

Well over the counter you may try Dramamine, Benedryl.. but you really need a prescription for Zofran or Phenergan it sounds to me. Perhaps one of your doctors will be a bit more liberal for you and help out...

I don't see the value in waiting until you throw up 7 times a day! I guess that your OB/GYN is just very conservative with regard to prescription medicines...

I hope that you feel better soon.

Please start a new question thread soon if you have further questions as this one has grown very long again. Thank you and take care. I hope that you have an easier ride of things soon!

Best Regards,

Anthony Bray MD

Customer: replied 9 months ago.
What does it mean if:
Blood type: O
Rh: neg
Antibodies: positive
Expert:  Anthony Bray, MD replied 9 months ago.
Hello!

Well that sounds that your blood type is O negative ( you would be a universal donor) if baby has type A, B or AB or positive Rh factor then you may form antibodies to these blood proteins. It is generally not so much a risk for first pregnancy but in particular if baby has positive Rh factor and you negative then you would be given Rhogam at time of delivery to prevent you from forming as many antibodies vs the positive Rh factor in particular. Second pregnancies and beyond would have more risk due to mismatch of blood type vs mother...

When baby is born and if he/she should be more exposed then antibodies may cause hemolytic anemia for example ...


I hope this information is helpful . Best regards,

Anthony Bray MD
Customer: replied 9 months ago.
Howcome antibody is positive? Isnt that bAd
Expert:  Anthony Bray, MD replied 9 months ago.
Hello,

I believe that it simply indicates a protein of the baby's blood will either be Rh positive OR TYPE A OR B... One if these proteins must be positive for you to form antibodies. Consult further with your OB/GYN!! This finding may need to bring about precautions such as the Rhogam for example but this itself does not indicate problem at this time.

I hope this is helpful. Please start a new thread for further questions or discussion if you have further. Thank you,

Anthony Bray MD
Customer: replied 9 months ago.
Last thing i know i need to close this. Ive been puking all day. Im on zofran
Expert:  Anthony Bray, MD replied 9 months ago.
Hello !!

I'm sorry that you are having the ongoing nausea and vomiting. At least you are getting treatment with the Zofran. Hopefully this will help. ( the nausea is supposed to be associated with healthy pregnancy) the first trimester is usually worst but that can vary...

I hope that you feel better soon!

Take Care!

Anthony Bray MD
Customer: replied 9 months ago.
Can i use an enema while pregnant
Expert:  Anthony Bray, MD replied 9 months ago.
Hello ,

Yes you can--- Fleet's or similar? There are medicated enemas with steroids and those would be advisable during pregnancy-- just to clarify...

I hope that you feel better.

Please start a new thread for new questions.

Thank you and take care!

Anthony Bray MD
Customer: replied 9 months ago.
I havent been able to eat/drink all day without puking. I am miserable
Expert:  Anthony Bray, MD replied 9 months ago.
Hello!

I am sorry to hear that you are having such trouble. I guess you have taken Zofran? Second dose? Try eating soup in sips? Gatorade in sips?

If ongoing not tolerating anything then you might have to go to ER . It may be necessary especially with you being pregnant.

Please start a new thread for further questions. Thank you and best regards,

Anthony Bray MD

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