So many symptoms - but tests negative, what do I do next?

Here is a synopsis:

Symptoms

3 months ago
Loose stools, burning, pain in rectal area, blood on toilet paper.  Went to family doc, saw hemmroid during rectal exam, perscribed suppositories and ointment.
Some anal discharge

Symptoms appeared to go away for about a week after medication, but returned a week later

2 months ago
Additional symptoms now: upper abdominal pain, decreased appetite, nasuea (especially in morning), seeming to have
more frequent bowel movements, weird type bowel movements, (almost like little balls which seemed to float)
some back pain, chest soreness/pain, frequent urination,  [water seemed to go right thru me],
still rectal bleeding sometimes within stool, bitter, sour taste in mouth, fatigue, weakness,
some weight loss 8-10 lbs between 2 months and 1 month ago.  Was very stressed during this time as not knowing what I might have.  Went back to famliy doc, referred to GI doc.

1 month ago
Symptoms starting to relieve, abdominal pain starting to go away, appetite returning, less nautious/weak, going
normal amount of bowel movements which for me is 3 times a day, but stools still seem odd. Sore throat upon waking sometimes in morning, drink usually relives throat symptoms, still frequent urination also at night, rectal
bleeding very infrequent.  

Current
Mild very intermittent upper abdominal pain, normal appetite, chest/ribs still sore at times, sometimes seems like a lot of stool, and odd when I go (but not sure as never paid much attention to my stool before), still some fatigue and seem to get tired easy, sore/dry throat shortly after sleeping,
still somewhat frequent urination but not like before, no more rectal bleeding.

Details about myself/tests during this time:
I'm 31 years old, male, 6 ft 2, (was 205) now 196 lbs.

Had Endoscopy - results negative, only thing found was some "heartburn" (i.e. stomach acid)
Had Colonscopy- negative except for small Hemmroid found
Abdominal Ultrasound - normal
Hectorbactor Pylori - negative
Fasting Blood/Glucose - negative
Urine Chem Analysis - everything normal

Doctor currently perscribing Prevacid as believes it's GERD

QUESTIONS:
- 1) My biggest concern is the weight loss and still somewhat lack of energy, what additional tests should I go for??
Could all of this have been caused by a hemmroid, GERD and stress?

- 2) Could this be something I had and have now almost gotten over and not seen by the time I had most of the tests
     (2 weeks ago)?

- 3) Could this still be something serious??

- 4) Is there anything more specific I should look for when looking at my symptoms?

- 5) What do these symptoms seem to point to as the cause?

Thanks in advance for any help you can offer.

[Kevin Pho, MD]

To answer your questions:
1) The upper and lower endoscopy would rule out many of the major GI tract cancers.  If GERD is still considered, a 24-hr pH study can be discussed.  An abdominal CT scan can also be considered to further look at the liver, gallbladder, and pancreas.

2) A hemorrhoid is possible, and can present this way.

3) Can't say without evaluation.  However, a negative upper and lower endoscopy would rule out many of the major GI disorders.  

4) Specialized testing, like stool tests for malabsorption and blood tests for celiac disease, can be considered.

5) Again, difficult to say without evaluation.  Discussion of the aforementioned tests can help yield a diagnosis.

These options can be discussed with your personal physician.

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.

Kevin, M.D.
kevinmd_

[Shebah]

You have had alot of examinations and alot of serious stuff has been looked into via biopsies taken during endoscopy and gastroscopy.

You say nothing about bloodwork tho. I guess it is all normal since you dont mention. The only think I can think of that you should have looked into is STD's. You might be carrying something in you and dont know about it. Like chlamydia and so on.

Also, It could be some kind of IBD. IBD (colitis and crohn's) isn't always easy to find or diagnose. So I would keep an eye on it and have some of the tests repeated after 6 months if your symptoms dont go away.

I know how frustrating it is to have the kind of problems you are having. Good luck and I hope it all clears up soon.

[lizziecee]

Hi, there is a very cheap test that can identify inflammation in the intestines (small and large)  called a faecal calprotectin assay. You only have to do a stool and take or send it to the hospital laboratory. I have this done regularly for my Crohn's disease. It will not show WHERE the inflammation is, but is a good enough marker for your GI to do further tests. The small bowel in particular, can be difficult to access for biopsies. If you Google "calprotectin", look at the 3rd item for an explanation that is easy to understand. I believe this test was developed in England, where I live, so may not be available in the US, but it is worth asking about.
Good luck with a proper diagnosis of your problems.

[Idab]

This sounds all to familiar... all these symptoms, but no diagnosis!

*      I became ill in March 2006, with vomiting/cramping & diarrhea - self
treated myself with buscopan and pain killers.  
*      I again fell ill in May 2006, was diagnosed with a stomach bug
*      I then fell ill in June 2006 and was diagnosed with gastro enteritis, a week later I was admitted for an appendectomy - no appendix found.
The surgeon requested a CT Scan and blood tests - all clear  
*      On the 27th July 2006 I was taken by ambulance to ER and treated for vomiting/cramping & diarrhea.  On 1 August the surgeon requested a 2nd CT Scan.  Various bloods were taken. All clear. I was told to go home and eat well.
*      I then became ill on 18th September 2006 with vomiting/cramping & diarrhea - self treated myself with whatever I could find.  I could not take the bladder infection any longer (after effect from the diarrhea) and made an appointment to see my GP, She did a urine test and confirmed blood in the urine, but due to the above history would not prescribe antibiotics and referred me to a Gastroenterologist.  Here is where the fun and games of my mind really get screwed up.
I saw the Gastro specialist on 29 September 2006 for an overall assessment.  He believed that based on the history, a Colonoscopy and Gastroscopy would need to be carried out, which he performed on Thursday 5th October 2006.  Various bloods were also taken.  The Colonoscopy and Gastroscopy were clear; ruled out ulcer colitis, any ulcers, celiac disease & diviticulus & many more, however the bloods were not clear - ESR Levels too high???
*      On Tuesday 17 October 2006 I fell ill with vomiting/cramping & diarrhea.   A small bowel x-ray was carried out on Tuesday 17th October 2006. Ruled out Crohns disease.
Various bloods were taken.  On the morning of the 18th October 2006, I felt I was going to die.  I then received a phone call from the gastro specialist stating that he had received all the blood results taken the day before and they did not look good (a white cell count of 39 0000) and he would rather have me admitted to hospital.  I was admitted and given pain relief for 48hrs.  A mecals scan was carried out on Thursday 19th October 2006 and a Galion scan on 24/25/26 October 2006 and various bloods - all scans and these bloods were clear - ruled out pancreanitis, metal blood poisoning and many more.
A 3rd CT scan on Tues 31st October 2006 was also carried out, which also came back clear.

These attacks are extremely aggressive - there is usually no warning apart from a feeling of nausea prior to the cramping setting in.  I have had 2 natural deliveries and that pain was mild compared to what happens when I go through these attacks.  It feels as though someone is ripping my intestine out and usually after the diarrhea a horrific burning sensation and hot feeling is left throughout the whole gut area - from ribs to bladder right through to my kidneys.  I literally cannot eat for 2 - 3 days after the attack and am left with nausea (no vomiting) for at least a week afterwards and then I feel terrific????

Other pains which are intermittent and bothering are that something is flowing in my blood, It feels like someone is pulling a thread through my bone/veins, especially in my arms.  My legs up to my knees have a constant deep dull gnawing sensation - like something is eating away at the
muscle/bone.   This keeps me awake at night as I constantly have to move my legs.  Hellish tender fingers, heart palpitations, ringing thumping sound in ears and uncontrollable trembling in hands every now and then.  

There has been a happy ending to all of this (although still no diagnosis)I have not had an attack since the 18th October 2006.  I still have the odd nausea, pain in muscle/bone, chest pains - but NO GUT ACHE, and this is all that matters to me.  When there is no diagnosis you have to remain positive as the thoughts that one can conjure in one's mind could surely lead you to a mad house.  But so far, I have gained weight again, have a wonderful appetite and my only consolation is my self diagnosis that I lived through a burst appendix (which according to the medical professionals, is impossible) Well I just proved them wrong. So don't despair, if all the results turn out clear, just be happy with that and be grateful.

[billbaggins]

Ever considered having some sort of colonic irrigation? Sounds like there might be some obstruction in your intestines...not enough to block them, but enough to slow things down.

Also, I didn't see note of it, but have you had tolerance tests for lactose, glucose, etc?

[Joanie68]

Have you considered a food allergy?  Do these symptoms come on after you eat certain foods?  I know when I eat things like dairy and soy or too much wheat I get really affected.  I never thought it possible but I eliminated them one by one because I kept getting hives, stomach and other symptoms and sure enough this was cause.

Trust your instincts - you will find the answer.