recurring symptoms, mysterious cause?

[ob]

Hello,



I am 44 yrs. old, generally in good health: eat well, drink less than moderately, active. Since the early 90's I have had recurring digestive disturbances of unknown cause.  I had been in Mexico, and in '95 was treated alternatively for IBS caused, it was presumed, from dysentary/parasites I had while in central america.  Acupuncture and chinese herbs and Ultra Clear really helped me at the time.  Now, once in a while, every 2-3 yrs, I will have recurring upsets that generally always begin around 2am and involve gas, emptying of bowels ending in watery & foul diarrhea, burping (sometines rotten egg-y),and nausea that usually results in vomiting of undigested food, and then I will have colic-y feeling intestines for about 1-2 days after.  I will have 1-2 episodes like this a month for a few to several months, then the episodes stop and all seems OK.  I am in one of those bouts now, and have had 6 episodes since early december.  I will occasionally feel some pain front to back in gall bladder/liver area. I can not track the onset of one of these upsets to any specific food (I do feel very susceptible to certain food borne bacterias)or behavior (believe me I have tried), although I know that I am sensitive the older I get to alcohol, and sometimes I have had wine when this has occured,  but not every time.  Lots of times I have had no alcohol at all.  



I have always thought its parasitic in origin, but I wonder about: gall stones, liver, pancreas, ovaries (cancer)?  What would produce these symptoms and have them chronically occur yet not all the time?  I am tired of it and want to figure it out.  My last GYN was seemingly normal (9/02), although since then I have not had a period since October. Feel aware of low pelvis being sometimes achey (achy), but do not seem bloated really, and have lost a bit of weight, but am by no means underweight.  I have felt peri-menopausal for a couple years.  I do seem to swing between times of having loose and then more dehydrated stools.  I can't say I am completely constipated as I do go once a day.  Its just sometimes its very dry and harder to eliminate.  I am a good eater, very balanced, but do crave sweets (chocolate). One thing:  this current string of upsets (first in almost 4 yrs)started one month after getting a new puppy.  He has had bouts of bacterial/amoeba infections, has been on flagyl, and it wouldn't surprise me if if I had picked that up.  I have cats and the dog, and I am very mindful of cleanliness...but just the other day he got me with his tounge in my open mouth.



I want to be armed with some info before heading to a Dr.. I prefer alternatives treatments, but if this is still happening even though I do "all the right things", then something else is up and needed.  I want healthy digestive functioning, and I need help to figure it out, especially if this is indicating something more serious with the liver, gall bladder, pancreas, or what have you.



Thank you for your time.

[Kevin Pho, MD]

Hello - thanks for asking your question.



You report symptoms of burping, foul-smelling diarrhea, occasional vomiting of undigested food, and colicy abdominal discomfort.  



There are several conditions that you may want to suggest to your personal physician.  Of course, there is irritable bowel.  Abdominal pain in IBS is usually described as a crampy sensation with variable intensity and periodic exacerbations. The pain is generally located in the lower abdomen, often on the left side; however, the location and character of the pain can vary widely. The severity of the pain may range from mildly annoying to debilitating. Several factors, such as emotional stress and eating, may exacerbate the pain, while defecation often provides some relief.  Patients with IBS complain of diarrhea, constipation, alternating diarrhea and constipation, or normal bowel habits alternating with either diarrhea and/or constipation.



Another consideration may be some kind of malabsorption syndrome.  The classic manifestations of global malabsorption are pale, greasy, voluminous, foul-smelling stools and weight loss despite adequate food intake. However, this spectrum of findings is relatively uncommon, even in generalized mucosal disease. The majority of patients with malabsorption have relatively mild gastrointestinal symptoms, which often mimic more common disorders such as irritable bowel syndrome. In some cases, anorexia, flatulence, abdominal distension and borborygmi (rumbling sounds caused by gas moving through the intestines) may be the only complaints suggesting malabsorption; other patients may be asymptomatic.



Other considerations may be an infections etiology as you are suggesting, or it can be atypical manifestions of gastroenteritis, pancreatitis, inflammatory bowel or ischemic bowel.  



I strongly suggest followup with your personal physician.



I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

[Bionic Granny]

I also had some of the symptoms you describe. I had just had surgery on Dec.9th to remove adhesions and thought I was doing alright. On Christmas day, I started hurting really bad, nausea and couldn't have a bowel movement. Went to er. and they gave me a shot for pain and wanted to keep me for observation, but I chose to go home. On the 28th, I could not take the pain anymore and meds weren't helping. Spent 7 days without food or liquids-ran small bowel series and had to be operated on for partial small bowel obstruction and lost some intestines. Don't wait for symptoms to subside--this could have been really serious, had I waited longer. Am having the same symptoms and they will be doing the series again on Thursday. I hope you get help soon.