morning bowel urgency, lightheadedness, weight loss

Male/23
Symptoms:
- Wake up EVERY morning w/ strong bowel urgency, 99% of time loose stools. Sometimes blood on toilet paper w/ pinching feeling as stool released. Going on for 3 yrs, incidentally after being treated 4 sinus infection with antibiotics.
- Unexplained weight loss. Currently ~ pound/day for the last week, but have seen other times in the past few yrs that I have lost weight. Only started measuring at work daily the last week so this may have been happening longer.Still have good appetite.
- Constant lightheadedness/slightly off balance, started a few months ago. No real pattern, it is always there from morning til night, sometimes more intense, sometimes less.
- Tested with: digital rec. exam, 2 upper GI series, lower GI barium enema, 2 CBCs, sigmoid, stool culture for parasites, abdominal x-ray.
- history of stomach ulcers, but didn't really have common ulcer symptoms.
- blood on toilet paper probably due to fissures (told by gastro)
- bowel habits and lightheadedness attributed to anxiety by GP. I do feel anxious alot, but i thought it was mostly from these health issues, a paradoxical situation? Did my anxiety about my previous bowel problems manifest into the newer problems?

concerned i may have following conditions:
- Celiac disease
- Hyperthyroidism (i've heard that premature graying hair is an early sign, i've had grays since grade 4, but mother also grayed early)

[lizziecee]

Hi there - there could be a number of diseases causing these symptoms. Perhaps an endoscopy of the small intestine, and colonoscopy of the large intestine might throw up some answers. Celiac is a possibility for the weight loss and accompanying lightheadness due to malnutrition. As far as I know, celiac does not present with rectal bleeding, but I could be wrong. And, of course, it could be an IBD - Crohn's or Ulcerative Colitis. Upper GI series, lower GI barium enema are not as conclusive as the scopes, with biopsies.

I was dx with Crohn's when I was 24 yrs, in 1970, as many people with Crohn's are at that age, for some unfathomable reason. It also affects children as young as 8 yrs old, as evidenced by a friend in the USA who has a granddaughter of 8 yrs who has just recently been dx with Crohn's. Some 4 of her classmates - which is worrying as I don't believe it is at all infectious.  My only symptoms were severe loss of weight and diarrohea. I had no abdominal pain or rectal bleeding for the 9 months whilst I was being tested, both as an in-patient and out-patient in various hospitals in London, England. At that time, endoscopy and colonoscopy were not available. I was finally dx by a laparatomy surgery whilst in hospital for 3 weeks, and I suddenly got pain (like a stitch after doing exercise). The Crohn's was extensive in my small bowel, particularly around the terminal ileum, which is next to the appendix, and Crohn's can often be misdiagnosed as appendicitis, when pain is present. In my case I had some 15 different places affected and no resections were advised as the inflammation was too widespread. I was put on 60 mg daily of the steroid prednisolone which eventually brought the flare under control. Biopsies conclusively showed Crohn's rather than Ulcerative Colitis, which attacks the large bowel. Crohn's inflammation also "skips" in the intestines, whereas UC can be found throughout the large colon. Well, that is how it has been explained to me by various doctors over the last 37 yrs.

I didn't have any rectal bleeding until 1987, when it was severe enough to be hospitalised on each occasion, put on IV steroids and blood transfusions. My Crohn's is now termed "panCrohn's Colitis" as it is in my whole GI tract. Luckily in the intervening years, newer drugs like immuno-suppressants (I inject 12.5 mg methotrexate weekly) can keep the disease in remission, and I haven't had a flare now for 4 yrs.

As I said, your symptoms could be the result of a number of diseases and if your symptoms continue, particularly the weight loss and rectal bleeding, I would seek further advice from a gastroenterologist with specific experience in dealing with IBD. I have no wish to alarm you, only to give you my experience of my own diagnosis. I think my severe weight loss, due to the diarrhea and consequent malnutrition - I went down to 70 lbs within the 9 months before diagnosis -  was a significant factor in my doctors trying to find out what was causing it. I was lucky, because in those days hardly anything was known in England about Crohn's, and I had one of the best GI doctors in England.

I am currently doing very well at 62 yrs old - so don't despair - just get to see the best gastro you can. The cause may be something quite simple, but rectal bleeding and weight loss need further examination.

Oh, a thought has occured to me - there is a new test in England for inflammation in the GI tract - called a Calprotectin test. I don't know if it is available outside the UK. It is simple - you just have to give a stool sample- inexpensive and quick to get results, without being invasive. I have had a number of these in the last 5 years. The test will not pinpoint where in the gastro tract the inflammation is, but if the calprotectin level is higher than normal it does give the gastro the information he needs to do further invasive testing, like the scopes. You might try and find out if your local gastro/hospital can do this test.

I hope you get your problem sorted out soon. Apologies if I have given you too much information, but when I got Crohn's, there was no internet, the local library had no information and at times I felt like a leper!
Take care,
Liz.

[lizziecee]

Hi again - I didn't address your GP's opinion that anxiety could be causing your symptoms. My first husband almost convinced me that my problems were "in my head" as it took so long to get a diagnosis. My problem was in my butt, not my head!  So, don't be fobbed off by an ignorant doctor who is not taking your problem seriously. Luckily, I have a wonderful second husband who is very supportive and empathetic with my lavatory problems and takes good care of me emotionally and physically, when I am ill with a flare. We don't talk about the disease in fine detail, but he is always aware when I a having a problem and I doubt I would have lived so long without his incredible caring and support.

Bowel problems still seem to be a taboo subject socially - like cancer and Aids were, and can make you feel very isolated, as you don't want to discuss what people feel is an embarrassing topic and friends/relatives don't want to know the nitty gritties. You sound like a fine, mature and intelligent young man, and I know the social emotional problems these symptoms can bring. I do find that if I am stressed, my diarrhea is exacerbated, but anxiety does not in the first place, cause the disease. Most chronic diseases are exacerbated by stress.
I wish you well in the future and hope the diagnosis is a simple problem that can easily be sorted out.
Liz.

[borast]

thank you for the sincere reply Liz. i will definitely take what you've said here to my doctor's appointment today.

i'm beginning to suspect Celiac more than anything because of my vague symptom onset and ataxia. I've read that Celiac is often undiagnosed because the symptoms can vary widely and come on slowly.

Thanks

[lizziecee]

Hi - glad my post was helpful and trust the appointment with your doctor today yields some information.  If it is celiac, it isn't too bad - you just have to adjust your diet to exclude all gluten. I don't think you even have to take meds. The daughter of a good friend was dx with celiac when 9 months old, and she is now a national tv. presenter, so the disease should not curtail your life if you keep to the gluten free diet. I was tested for celiac 37 yrs ago via endoscopy, but it was quickly ruled out, as my villi were not flattened. There is a lot of information on the internet these days about celiac.
Good luck and hope all goes well for you.
Liz.

[borast]

I got back from the doctor today and he's testing me for thyroid disfunction. I asked him about celiac and he said it usually presents as severe abdominal cramps after eating, and since the test costs extra (not covered by government insurance) he said he would wait until the thyroid test comes back, and if normal, would proceed with a celiac antibody test.

at this point, either would be welcome and relieving as i'd rather know what i have exactly than continue on worrying.

[lizziecee]

Hi again - we really must stop meeting like this! I am old enough to be your grandma, but the saying goes, you can't teach them to such eggs. So pleased you saw your doc today and he has another avenue to test. Sounds symbiotic - I saw my gastro Wed for regular 3 month follow-up (turned into 5 months with our abominable social health service in England) and he has suggested I have a thyroid test next Tuesday, along with my usual blood tests for methotrexate.
I think I saw something on the gastro forum a while ago about a breath test for celiac -  don't know anything really about celiac, so you may wish to google this.
Absolutely agree with your sentiments - I can deal with what I know, but can't live with what I don't.
You sound fine mentally - just need a diagnosis and then you can move along with whatever treatment is required.
Take care - if you want to email me privately, I am at: ***@**** - my husband set up the email address so that explains the nomenclature. I will be interested as to how you progress. Just hang in there.....you are doing fine already.
Liz.

[borast]

Hi again, the thyroid test (sTSH) came back within normal range. i asked if they wanted to take any more tests and they said the office would call me if my doctor wants to follow up with more tests.

I'm guessing he doesn't think I have Celiac, although I am still a bit concerned.  I'm thinking of even getting one of those home Celiac tests. It would even be cheaper than getting the test done through the lab (not covered by Canada's health insurance).

It seems my weight is stabilizing too ( i may have even gained a pound over the weekend).