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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18448
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am a very difficult patient. I am a 65 yr old married

Customer Question

I am a very difficult patient.
I am a 65 yr old married female; no children.
I had a disc removed from my spine about 20 yrs ago and have continued to have back problems, different procedures, medications, etc. Currently I am on synthetic morphine as needed.
I have sleeping problems and sometimes hyperactivity.
My biggest complaints now are constant diarrhea and gas, I had my gall bladder removed several years ago and had constant problems ever since. I have a large sore lump on my ship.
I get severe cramps in my calves and cannot walk when they come. The joints in my fingers will swell up at different times and are sore.
I am a mess and I hate seeing more doctors.
What are my options?
Thank you
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.

Hello from JustAnswer.

It will help if you could provide some further information.

Have you had any evaluation for these symptoms?

Have you had any recent blood work? If so, what tests were done?

Have you been tried on any medicines to relieve these symptoms?

Are you taking any chronic medicines beyond the synthetic morphine?

Expert:  Dr. D. Love replied 1 year ago.

I had asked for some further information and have not heard back.

When someone has chronic diarrhea and gas after gallbladder removal, one of the primary concerns is that it is due to the bile that is leaking into the small intestine continuously. The primary function of the gallbladder is to store and concentrate bile and then release the bile in response to a meal. When the gallbladder is removed, the bile can be stored somewhat in the bile ducts, but there is some bile that leaks into the small intestine at all times, although the amount will vary from one person to another. In some people, the small intestine is unable to handle this leaking bile, and this leaking bile can cause diarrhea or gas. When this happens, the most common approach would be to use a medicine that offsets the bile acids, called a bile acid sequestrant, such as cholestyramine.

The remaining symptoms that you are having is more complicated. While some people can have muscle cramps with no apparent cause, there are many other possibilities to consider, such as an inflammatory condition, electrolyte abnormalities (particularly potassium or magnesium), vascular disease, and side effects to certain medicines. A lump can be related to inflammatory conditions, but may be an unrelated problem. Swelling in the fingers will most often be due to an inflammatory condition. If you have not yet had an evaluation for the possible underlying conditions, then that should be the first step. I understand when you say that you hate seeing more doctors, but this would be appropriate. It would be OK to try an over the counter anti-inflammatory medicine, but you may already be taking an anti-inflammatory medicine for the back problems.

If any underlying cause can be found, then the treatment would be oriented towards that condition. If no apparent cause can be identified, then there are some options that can be considered. Muscle relaxers may be able to help. There also has been increasing use of gabapentin for relief of muscle cramping, and this medicine is also frequently used for someone with chronic back pain, which is part of why I asked whether you have been taking medicines beyond the synthetic morphine.

n summary then, it may help to use a bile acid sequestrant for relief of the diarrhea and gas, but there should be further evaluation of the remaining symptoms, but it may help to use an anti-inflammatory medicine until the evaluation can be done, if not already taking one.

If I can provide any clarification or further information, please let me know.