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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35473
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I am 29 y/o female 5'5 112lbs. almost 4 years ago I had a

Customer Question

I am 29 y/o female 5'5 112lbs. almost 4 years ago I had a little girl :) During my pregnancy I was very ill the entire time. Since the pregnancy I have had a struggle with me health and my doctors cant seems to figure it out. First I will start with my symptoms today and work my way back. I seem to have what seems like heart burn accept my chest doesn't have the burning sensation. I do however have massive waives of nausea mostly followed by dry heaving and occasionally stomach acid or foam comes up with what looks like huge loogies but mostly dry heaving that sounds like a really large toad. I also have diarrhea all the time, no appetite, really tired but unable to sleep. I get the WORSE hot flashes and I get very shaky in the hands and legs often I also have persistent dull lower back pain, super itchy skin. Last of the symptoms is my nostrils are dry but I am CONSTANTLY swallowing snot down my throat. if I push on my face I will instantly have snot drain down my throat but the ENT did a lil scope and she said no signs of sinus infection. Yet that was almost a year ago and I still have the symptoms.
All of these symptoms I have had for the last 4 years. I have been told to take antidepressants, anti anxiety meds and a cocktail of acid reflux meds. None of which have worked....I have been diagnosed and treated for a rare high risk cancer causing form of HPV (most of my cervix is gone due to the presence of cancer cells) and a year and a half after that I was told I had graves disease and then went for a follow up with the endocrinologist and she said my levels were good and sent me on my way.
Does any of this ring a bell to anyone?? I am at a loss and want better quality to my life.
Submitted: 4 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 4 years ago.

Hello Natasha,
I am Dr. Arun and will be helping you today.

How many motions do you pass in a day?
Are they liquid, semi-solid or solid?
Are the bowel motions bulky?
When were your last thyroid function tests done?
Was an upper gastrointestinal endoscopy and barium esophagogram done?

Customer: replied 4 years ago.

1. it depends on the day it could be every time I put something in my body to not at all. generally 3-4

2. the are liquid in the morning and sometimes through out the day (looks like cloudy water in the toilet or sometimes bright green). if I can keep food down it will be loose

3. no they are not bulky

4. Jan 2013 was my last uptake

5 there was not a gastro scopy or barium done

Expert:  Dr. Arun Phophalia replied 4 years ago.

Hello Natasha,

What are the specialists you have consulted; gastroenterologist, rheumatologist (clinical immunologist), endocrinologist?
Are you anxious about the past history of cervix changes due to HPV?
Any other past history?

You mentioned about the Graves disease; were you prescribed antithyroid medications and were your thyroid antibodies high anytime?

Customer: replied 4 years ago.

my pcp, endocrinologist, and ENT. I have not been referred to a gastro so I havent gone they said the bowel issue was because of my thyroid and I wasnt given antithyroid meds because the endo said my thyroid didnt "feel" like a graves thyroid and because my uptake was only slightly elevated (not enough to prescribe RAI) she felt it was thyroidtoxosis (something where the thyroid attacks itself and then crashes). I wasnt really impressed so I didn't go back. and no I am not anxious about my cervix it is what it is so I have let that go. by past history I have environmental allergies and migraines. I have an 11 y/o daughter and a 4 y/o both vaginal normal births. and I forgot to mention I have night sweats and major hair loss

Expert:  Dr. Arun Phophalia replied 4 years ago.

Thanks Natasha for the details.

You should proceed as following.

The first step would be to consult a gastroenterologist who is likely to perform the following investigations;

1) Barium esophagogram
2) Upper GI endoscopy.

Your symptoms are likely due to a condition called as Hiatal hernia and gastroesophageal reflux disease (GERD). Following collective measures are helpful in these;

1) antacids; Maalox

2) acid blocker; Prilosec

3) loosing weight, if overweight.

4) avoiding alcohol, citrus fruits and juices, chocolate, and tomato based products

5) avoiding large meals. Eat 5 small meals in a day.

6) wait three hours after the meal before you sleep.

7) elevate head end of the bed by 8 inches.

For acid reflux (GERD), following also would be helpful;

A. Herbs;

1) Cranberry
2) Peppermint

B. Homeopathy

1) Nux Vomica
2) Pulsatilla

C. Nutrition and supplements;

1) Multivitamin; vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
2) Probiotic supplement
3) Omega 3 fatty acid
4) Avoid; cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.

5) Also avoid; white breads, pastas, and especially sugar, red meats,
6) Eat lean meats, cold water fish, tofu, beans, olive oil.

In hiatal hernia sometimes surgery may also be needed if the above measures are not effective.

The gastroenterologist should also get a CT scan of abdomen and stool exam for the evaluation of your diarrhea. The initial evaluation of diarrhea is on these characteristic;

a) stool volume,

b) frequency,

c) consistency, and

d) gross appearance.

This description to use the term "diarrhea" to describe urgency and the frequent passage of small-volume stools suggests a functional disorder such as IBS.

Stool volume can give an idea of disease location and underlying mechanism.

a) Large-volume stools (more than one liter per day) would point to small bowel disease and secretory diarrhea.

b) Small-volume stools (less than 300 ml per day) suggest large intestine diseases and functional gastrointestinal disorders like IBS.

Stool consistency can be varied ranging from formed to watery, and correlates with the rate of intestinal transit.

a) Secretory diarrheas are liquid.

b) Functional diarrheas are soft or semi-solid.

c) Stool floating will be indicative of if being filled with gas from fermentation of mal absorbed carbohydrates.

d) Mucus can point to both inflammatory and noninflammatory diarrheas, such as ulcerative colitis and IBS.

Your symptoms are suggestive of intestinal motility disorder. One of the commonest is called as irritable bowel syndrome (IBS). Following investigations may also be considered (if not done);

1) The complete blood count (CBC); altered in irritable bowel disease (in whom leukocytosis / high WBC count is the more frequent result).

2) Protein electrophoresis pattern may show alterations of both albumin and globulins (especially alpha-1 and gamma globulins) in IBS.

3) Thyroid function tests; an high thyroid may cause loose and frequent bowel motions.

4) A barium meal is a helpful study in the diagnosis of intestinal motility disorders.

5) Computed tomography (CT) and nuclear magnetic resonance examinations are also necessary.

6) Defecography

7) Scintigraphic study of the small bowel or colonic transit time is currently most preferred investigations for your symptoms. It shows the intestinal progression of the meal.

Medications like neostigmine, bethanechol, metoclopramide, cisapride, and loperamide may help you.

Following measures collectively may help;

1) Fiber supplementation may improve loose motions. Citrucel and FiberCon may produce less flatulence than psyllium compounds (Metamucil).

2) Caffeine avoidance may limit exacerbation.

3) Lactose and/or fructose should also be limited or avoided.

4) Lomotil and the other medications we discussed above.

The second step would be to consult an endocrinologist to recheck the thyroid and do the blood work for the anti thyroid antibodies. A condition called as autoimmune thyroiditis should be ruled out. All your symptoms can be explained by the abnormal thyroid levels too.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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Customer: replied 4 years ago.

holy cow. I should do all of those tests and see all those doctors? Where do I start and is there a way to treat these conditions naturally or with herbs rather that chemicals?

Expert:  Dr. Arun Phophalia replied 4 years ago.
Hello Natasha,

Ideally both the specialists; gastroenterologist and endocrinologists (second opinion) should be consulted for a complete evaluation as the symptoms are going on for very long. The specialists would get the work up, step by step. We have discussed some herbs, supplements, dietary measures, fiber supplements, etc above. These can be started. If you have any associated anxiety, you may try following;

1) Relaxation training and biofeedback.

2) Hypnosis

3) Acupuncture and acupressure

4) Yoga

5) Meditation

6) Group sporting activities

7) St. John's wort

8) Melatonin
9) Valerian root.

The best way to start would be to get the thyroid functions checked. If these are normal, seek a referral to the gastroenterologist who may evaluate for IBS and hiatal hernia.

It is privilege assisting you.