Help

I started have sever panic attacks in January. I have finally found medication to help the attacks and am in therapy. I am on 3 .05 long acting xanax a day and 100 mg of Wellbutrin. I have become not really constipated but my BM never look the same. I had two episodes where I had blood on the toilet tissue. I went to my GP and she found a fissure. She advised me to drink Mettamucil and eat more fiber. When I do that my BM's look normal and have no problems with blood. I have had extreme anxiety from day one thinking that I had a neurological condition. Everything from ALS to MS. I have had the following normal tests: MRI of brain and C-spine, 2 CT scans of the brain, 2 complete sets of blood work, 2 chest x-rays, sedimentation rate, thyroid. My doc blames my problems with constipation on what I have been thru mentally. I do not have any major cramping in my stomach, no diarhea (diarrhea). I do however gag every morning several times to where I feel I am going to throw up. I have very mild nausea but it passes within an hour or two. My stool has ranged from light colered to hard round kind of dark colored to what looks like it has cob webs on it to multi coloered pieces that are round and kind of hard. I had a mucous come out once. I have a very mild ache sometimes under my right rib cage and someone I work with said that could be Gall bladder. Could that be related to constipation and gagging? The back of my legs ache a lot but when I force myself to relax and do relaxation tapes that goes away but as soon as I tense up it comes back. Before my attacks I NEVER had abnormal bowel movements or problems at all. My doc thinks all of this will resolve when the panic attacks go away but I am worried I have something undetected b/c my grandma died of colon cancer. My mom and her bros and sises are fine to this day. I have been thru so much being convinced I had ALS, MS, cancer, you name it. Along with my neuro test that I had my exam was perfect but I have the sensory sensations that go along with panic attacks, like pins and needles etc... all agravated by anxiety. I still have plenty of anticipatory anxiety. My doc says I don't need a gastro referral right now b/c my risk is a first degree relative only and she said the mental state I have been in can explain my constipation, etc...Like I said I only have mild pains once in a while on my right side under rib cage and occasional right mid to lower back pain but I have contributed that to picking up my 27 pound daughter. These concerns have taken over my life to where I don't want to go anywhere or do anything. What do you think could anxiety be causing all of this. It just seems to extreme to just be anxiety. I am a 36 year female. I also had panic attacks 12 years ago but recovered from them much faster tthan this time so I never had the constipation issues. Thanks for your response.

[Kevin Pho, MD]

Any change in bowel habits warrants further evaluation.  Causes can include irritable bowel syndrome, but also can be caused by things like cancer or polyps.  I would suggest a lower endoscopy - either a flexible sigmoidoscopy or colonoscopy for further evaluation.  These are pretty comprehensive tests to ensure there are no anatomical abnormalities causing the symptoms.

Regarding the pain under rib cage, gallbladder is certainly a possibility.  An ultrasound would be a reasonable first test to evaluate the liver and gallbladder.  Other causes would be GERD, an ulcer or inflammation of the upper digestive tract.  An upper endoscopy or upper GI series can be considered for further evaluation.  I would also consider an H Pylori test - this is a bacteria that is associated with inflammation or ulcers.  A GI consult can be considered to discuss these options.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[dont]

forgot to mention that she did a blood fecal test in the office and it was normal. No blood found in stool.

[subpar]

Hello dont,
I am a 47 year old white male and since 1987 I have been "diagnosed" with some form of anxiety or panic attacks. However I have also had atrial fibrillation (had to be shocked back into rythhymn in the ER), I have been told I did not have GERD after some tests, then that I did after some tests, that I had mono (twice--blood tests showed elevated monocytes--similar to epstein barre) that I have PVCs but told they are nothing, told I have a Schatzky's ring (when my throat and neck stayed tight for a year-currently going on).........anyway what I am trying to say it don't let the MDs just tell you it is all anxiety!! Maybe there is a component of that involved but chances are you do indeed have some underlying physical cause whther it is gall bladder or who knows? But anyway you just may be more sensitive to physical symptoms which cause you to get anxious sooner than  maybe the average Joe or Jane out there. Anyway keep asking questions,playing attention to your symptoms and I hope you figure it out. You are not crazy!!
subpar

[PAJ]

Try this
What are the symptoms, side effects of Candida overgrowth?

[dont]

wouldn't an infection of that sort show up in blood work?

[PAJ]

No ,the doctors generally don

[dont]

I will make an appointment with a GI doc but does anyone think any of this can be caused by extreme anxiety and depression?

[tuff case]

First off I am not a dr. But I can tell you from my experience only.  I was diagnosed with diebetes (diabetes) 8 years ago now.  It started with pain in my chest at that time the Dr. told me I was either having anxiety attacks or it was diabetes, well mine was diabetes, but along with that is ithe tingling and numbness I get in my hands and feet that can be or was in my case diabetes related.  Because you have a history of panic/anxiety attacks make sure this is not over looked.  I noticed that you have been through the ringer in regards to having a complete nuerological work up as have I over the last year along with the gastroentrology work-up because of different symptoms. Nausea for over a year created the gastro work-up and dizzy spells the nuero and many more symptoms but these were the major ones.  I have recently been put on an "anti-depressent" paxil to treat for IBS, not deprssion, which has created more gastro/stool problems.  I noticed that you are taking Walbutrin not sure if you were taking this the last time you had attacks, or not but it maybe causing some of you bowel problems.  Also you may want to do some research on autonomic neuropathy.  depending on which nerves are effected will depend on what symptoms you might have.  All is treatable.  Good Luck!