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Gastroenterology (Expert Forum)
Crisis started 4 weeks ago!
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Crisis started 4 weeks ago!
by John Stewart, Mar 20, 2006 12:00AM
BACKGROUND: My wife has never been sick in her life other than colds. She takes no medication whatsoever. She is 60 years old and in excellent health. She works out and is in very good condition.
Slightly more than 4 weeks ago while visiting in Tampa my wife woke up early in the morning with an incredible, piercing headache, nausea and limited vomiting. Her temperature was running between 103-104. She had started feeling bad the evening before but we let it pass.
The pain was so bad we visited a walk-in clinic and they gave her a shot of Imitrex. Less than 2 hours later we called the office and reported she still had the migraine-like headache. Take her to the hospital, they suggested.
We returned to our home on the east coast and drove directly to the emergency room. They gave her a shot of Diladin for the headache, some nausea medication and ran all the typical tests. Nothing.
Her temperature continued for the next 3 days and then went back to normal. Her nausea continued but with little vomiting. She would have very high anxiety attacks, shiver, eyes flickering,etc.
For the next 12 days she/we persisted with tylenol and three visits to the doctor. It could be a virus they said but none of the blood tests came back with anything too high other than slight elevated thyroid. No neck stiffness. By the time of the last visit, she was feeling so bad, shaking, knots in stomach, bouts of anxiety, that we insisted she be hospitalizd. She remained in the hospital for the next five days.... she has had endoscopy, checked by neurologist and an endochronologist and nothing jumped out. Family doctor wanting early on to strongly suggest it was something emotional in her life.... BS! There is nothing. She is a strong woman who owns her own successfu business.
Seven days ago she was discharged with prescription for Xanax (.5 mg taken every 8 hours as needed... Xanax seems to do little and sometimes it seems to aggravate her anxiety. She is actually only taking .5 mg. of Xanax and we have experimented with timing but to no avail.
Her energy level is probably a 3 on a 1-10 scale, and her anxiety that something is seriously wrong is almost persistent, with only a few limited bouts of normalcy. She had an MRI today but no one expects them to find much if anything.
90% of the times she does not feel like eating and I am afraid she will have to go back in the hospital if that continues.
Remember, this is an individual that was in almost perfect health 23 days ago, has never visited a hospital in her life... also, it all clearly in my mind seemed to start with a severe, dibilitating headache. No, she has never suffered from or had migraines.
We have made a new appointment with an internist but the appointment isn't for 4 more days and I am running out of ideas. I could really use some help and suggestions.
John Stewart
Slightly more than 4 weeks ago while visiting in Tampa my wife woke up early in the morning with an incredible, piercing headache, nausea and limited vomiting. Her temperature was running between 103-104. She had started feeling bad the evening before but we let it pass.
The pain was so bad we visited a walk-in clinic and they gave her a shot of Imitrex. Less than 2 hours later we called the office and reported she still had the migraine-like headache. Take her to the hospital, they suggested.
We returned to our home on the east coast and drove directly to the emergency room. They gave her a shot of Diladin for the headache, some nausea medication and ran all the typical tests. Nothing.
Her temperature continued for the next 3 days and then went back to normal. Her nausea continued but with little vomiting. She would have very high anxiety attacks, shiver, eyes flickering,etc.
For the next 12 days she/we persisted with tylenol and three visits to the doctor. It could be a virus they said but none of the blood tests came back with anything too high other than slight elevated thyroid. No neck stiffness. By the time of the last visit, she was feeling so bad, shaking, knots in stomach, bouts of anxiety, that we insisted she be hospitalizd. She remained in the hospital for the next five days.... she has had endoscopy, checked by neurologist and an endochronologist and nothing jumped out. Family doctor wanting early on to strongly suggest it was something emotional in her life.... BS! There is nothing. She is a strong woman who owns her own successfu business.
Seven days ago she was discharged with prescription for Xanax (.5 mg taken every 8 hours as needed... Xanax seems to do little and sometimes it seems to aggravate her anxiety. She is actually only taking .5 mg. of Xanax and we have experimented with timing but to no avail.
Her energy level is probably a 3 on a 1-10 scale, and her anxiety that something is seriously wrong is almost persistent, with only a few limited bouts of normalcy. She had an MRI today but no one expects them to find much if anything.
90% of the times she does not feel like eating and I am afraid she will have to go back in the hospital if that continues.
Remember, this is an individual that was in almost perfect health 23 days ago, has never visited a hospital in her life... also, it all clearly in my mind seemed to start with a severe, dibilitating headache. No, she has never suffered from or had migraines.
We have made a new appointment with an internist but the appointment isn't for 4 more days and I am running out of ideas. I could really use some help and suggestions.
John Stewart
Doctor's Answer
by Kevin Pho, MD, Mar 21, 2006 12:00AM
, Mar 21, 2006 12:00AM
There has been a pretty comprehensive evaluation, with evaluations by a neurologist and endocrinologist. The head imaging - including an MRI - would rule out many of the neurological causes.
The upper endoscopy is a good test to evaluate many of the upper GI causes - such as GERD, an ulcer, or inflammation of the upper digestive tract. I would consider further abdominal imaging including an ultrasound and/or CT scan to evaluate the liver, gallbladder, or pancreas.
More specialized testing, like a 24-hr pH study with esophageal motility or gastric emptying scan, can be considered to look at more uncommon causes like motility disorders or gastroparesis.
Another neurological and/or GI opinion should be considered if the tests continue to be non-revealing.
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_b
The upper endoscopy is a good test to evaluate many of the upper GI causes - such as GERD, an ulcer, or inflammation of the upper digestive tract. I would consider further abdominal imaging including an ultrasound and/or CT scan to evaluate the liver, gallbladder, or pancreas.
More specialized testing, like a 24-hr pH study with esophageal motility or gastric emptying scan, can be considered to look at more uncommon causes like motility disorders or gastroparesis.
Another neurological and/or GI opinion should be considered if the tests continue to be non-revealing.
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_b
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