You comments Please

[Martynj]

Dear Doctor
Can I please ask you to comment on my situation as I have to admit that I am currently very scared.I am a 41 year old male with up until now no previous medical problems. Until recently I have been a regular beer drinker with a habit of up to 7, yes seven, pints of beer each and every evening, also a smoker however I have cut that down now to almost none. Last November I started to have repeated bouts of diarrhea which I could not  explain. In Jan 2003 I visited my local doctor where upon I was asked to have a series of blood tests. These included a CBC, Thyroid, Anemia, Diabetes, ESR Sedimentation, C Reactive Protein. The results came back all normal with the exception of a “slightly raised” Bilirubin level. I was then asked for a stool sample, these showed nothing at all. The doctor suggested that my Bilirubin level was raised due to my alcohol intake. Another set of bloods were taken a month later showing the Bilirubin level still raised however it had gone down from it’s previous position. I was put on Lomotil and my doctor suggested that I had IBS. After a few more months of this I went back to my doctor and insisted that I was referred to a gastroenterologist. I went to see him, he went over my history, my family history, performed various examinations which included pressing around my abdomen, a DRE and a rigid sigmoidoscopy. He found nothing at all and informed me that I had classic IBS. I must also tell you that I also decided to take a HIV test, negative that goodness. Three months passed and the symptom of chronic diarrhea still carried on almost every day, oh yes and sometimes the smell can be something terrible. Over the last few days for instance, day 1 large bulky soft stool in the morning followed by a little diarrhea later on. Day 2 diarrhea. Day 3 in the morning constipation however when stools were passed they were quite small. Day 4, today, again another bulky stool in the morning followed by dark diarrhea this evening, although I must add that I have drank a lot of strong coffee today. I have been a bit of a health website junky and I have read lots on the web about various types of cancer mainly colon and have of course tried to self diagnose, not good. At my insistence I have been scheduled this week for a flexible sigmoidoscopy, I am not at all looking forward to this, not because of the procedure but because of the fact that this has gone on for quite a long time and I am concerned that I may have left it too late if something terrible is going on inside. My only other symptoms are the odd cramp in the lower abdomen after diarreah and pain just below both knees when I stand up, I even read about secondary`s and had myself diagnosed with bone cancer, mind you I have to also say that there is a very strong family line of arthritis. I have put on around 10 pounds this year and in essence I do feel fine. Finally I have been under great stess due to loosing my job 3 times in 2 years.
Your thoughts please.
Martyn

[Kevin Pho, MD]

First of all, I would suggest a liver ultrasound to evaluate the elevated bilirubin and the liver.  With your history of heavy drinking you certainly are at risk for liver disorders (i.e. cirrhosis, fatty liver etc).

Regarding the diarrhea.  A rigid sig was negative.  CBC, thyroid, anemia, diabetes, ESR Sedimentation, C reactive protein all negative.  There are various causes for chronic diarrhea in addition to IBS.  They can include inflammatory bowel disease, chronic infection, and malabsorption syndromes.  The question is what is the most reasonable next test.

The flexible sigmoidoscopy is a good next step.  Studies show that over 90% of causes of chronic diarrhea are within the range of the flexible sigmoidoscope.  If the diagnosis remains unclear after the flex sig, I would then consider the colonoscopy.  

If the endoscopy is negative, I would consider tests for malabsorption - which can cause foul smelling stools.  A fecal fat test, test for lactose intolerance and serum tests for celiac disease can all be considered.  

If all the GI tests are negative, then IBS should be considered and the treatment of this disease optimized.  

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.

[surgeon]

I have two thoughts: first, if you haven't already, you MUST stop drinking. Cirrhosis of the liver is an ugly thing to have, and you are a candidate. Second, I wonder what kind of gastroenterologist would still be doing a rigid sigmoidoscopy, especially with your symptoms. I'd suggest full colonoscopy, and would ask around about your gastroenterologist. Or ask him directly whether he's experienced with colonoscopy and why he hadn't recommended it. If his answers make sense to you, well and good!

[Martynj]

Dear Surgeon

Please do not take my next comments as being ungrateful however if I had of been satisfied with my doctor to date I probably would not be on here asking questions like this. For the record, yes my drinking has stopped, I said this in my initial posting.

I asked kindly for your thoughts, enlightened ones I had hoped. To be told only that I need colonoscopy and that my doctor is probably inept and that if I believe what he says then all well and good, what use to me is this?

[surgeon]

evidently not much. The good news is you can expect to get an "official" answer at some point, as well. I just post here when I think (erroneously, in your case) that I might be helpful.

[Martynj]

Well thank you.

[Martynj]

It feels as though I have provoked some sort of anger here, may I ask why? All I did was ask questions.

[Katenyc]

From what I know, a colonoscopy is a very helpful procedure to see what is really going on.  I'm sure that was the surgeon's best advice to you -- and I have to agree with him.

[eveningstar]

I agree with surgeon.  With your symptoms, it is quite difficult to understand why a  doctor would not recommend a colonoscopy!   You asked for help, and surgeon respectfully gave you some excellent  advice!   A colonoscopy can save your life.  I hope you get it scheduled soon.

[tessa0825]

Its very good news that you have quit drinking,congratulations, however, you didn't mention that in your first post.....You stated you have cut way down on smoking and thats good news also....Please remember that when people post on the internet we do not have the advantage of observing facial expressions or all those other things that account for so much in our communication skills.....We get the words and that's it....Its easy to interpret those words in an entirely different way than how they were intended.....Almost everyone that responds to posts do it because they genuinely want to help and offer advise or suggestions....To be critisized for offering support just doesnt seem right......Im sorry for what you are going through, I hope you get some answers that will help you....Tessa

[shelbert6]

You said in your initial posting that a stool sample had revealed nothing.  What sort of stool testing was done?  Hemocult? Ovum/parasite?  Could you possibly have ingested contaminated water or food?  Giardia can present as foul smelling stool, alternating between diarrhea and constipation.  It is also common to belch a sulfur taste, like rotten eggs.  With giardia, these acute symptoms can come and go with days in between with no symptoms.  Unless the little buggers have completely coated your intestinal tract.  It then can drag on forever without treatment.  Anyway, this was only a thought since this idea hadn't been mentioned, yet.  I probably wouldn't have even thought in these terms considering the alcohol consumption history had it not been for your description of the stools as being foul smelling.