diarrhea for 8 months now (blood tests)

[qwertz3822]

Pardon the long post, I tried to make it as pithy as possible.

My symptoms started in June last year when I suddenly got an onset of diahrea. It is possible, though my memory is fuzzy on this and I may have made this up, that the first stool that started all this was green (and I don't remember ever having green stool before).

I started eating just rice and toast, which seemed to help slightly and the stool would become more formed, then when I would think things are getting better and eat a slice of pizza or chicken the stool would go right back to being watery.

Then for a certain amount of time I had fever, I don't remember exactly how high and how long this lasted.

I had also lost weight. Some time before this began my family members remarked how thin I had gotten, but I thought this was just in their mind and I never stepped on the scale until this began. Then after this began I weighed myself but at that point I had already gone on the very low cal diet of rice and toast (on account of the diahrea, of course). My normal weight is around 65 kg (143 lbs) and I had gotten down as low as 60 kg (132 lbs).
It seems obvious that this is connected, but it is possible that I was undereating even before this began because I read about the low carb diets and got into eating that way. After I realized I had indeed lost weight I calculated my calorie intake and realized that it is possible I was undereating quite badly.
My weight now is back to normal.

After, I believe, two weeks I went to the doctor who gave me medical coal, but it didn't help.

The situation has presisted since then, but changed slightly over time. I don't remember the progression exactly, but at some point I stopped having full on watery diahrea (I think this was very early), and it changed to like "C" in this diagram: http://www.kcl.ac.uk...hartENGLISH.pdf

Then for a certain period the most frequent kind of stool I had was first a normal formed part but then followed by something like "C" (to be clear, I'm describing what would happen in a single bowel movement, not two different types in one day).

In December I went to the doctor, and literally the day after I went to doctor I started getting normal stools for the first time (the doctor didn't give me anything, and previous to that, during the 6 month period, I believe I had 1 or 2 normal stools), and from that point on I would get the pattern of a few days of normal stool followed by two days of "C" type stool (often it is something in between "C" and normal, like it was on its way to being formed but it isn't formed) and this is the current situation. Sometimes I get 2 days of no bowel movements, which might be due to the fact that I sometimes spend the whole day at school where I don't eat much.

When I visited the doctor he sent me to do blood and urine tests. Several parameters came in high or low, and he has since had me repeat the test.

The only ones he seemed concerned with were the parameters under the heading "enzymes" (which he said had to do with liver function) and here they are (the third number I believe is what is considered the normal range, and the unit of measurment is U/L):

TEST 1 TEST 2 NORMAL
S-ALT 79 51 (12-48)
S-AST 40 32 (11-39)

These are the other parameters that were off (all under the heading of differential blood test):

TEST 1 TEST 2 NORMAL
MPV 12.3 9.9 (6.8 - 10.4)
thrombocytes 118 142 (158 - 424)
Neutrophil granulocyte 52.0 40.2 (44-72)
Lymphocyte (rel.) 42.0 48.2 (20-46)


After I had done the first tests he sent me to be tested for hepatitis and it came back negative.

I should also say that the descriptions of stool patterns I gave above are general patterns, I've had, since this started, various kinds of stools. Ocasionally I'll have the kind of bowel movement where it almost feels like not all of the stool went out, I've had stool in shape of several formed smaller pieces, I've had one big normal stool followed by smaller, well formed pieces, stool that seemed to break apart because it had pockets of gass in between of what would have otherwise been a normal sausage shaped stool, a frequent kind of stool I get is "C" type that sticks very hard to the bowl and it takes many flushings to get it to go away etc.).

Also, after that first time I went to the doctor when I suddenly started having normal stools, I had a great run of 13 days where I got nothing but normal stool.

I've had no bleeding or pain (except maybe in the first few days there MAY have been some uncomfort, but I can't recall exactly, my memory is very fuzzy).

My bowel movement frequency hasn't changed (It is possible it was more frequent in the first two weeks or so when I had watery diahrea, but I can't remember).

I've just come back from a visit and it seemed that he had forgotten I had originally come in for diahrea and was focused exclusively on the liver function.
After he saw the second test results he said everything is fine and I asked him whether this liver thing accounts for me having diahrea for a year, to which he responded that it wasn't for a year, we did the test in December of last year. Then I said that I originally came in in June of last year for diahrea. He started looking for notes of that first visit on his computer, I asked him what could be the cause of this and he said irritable bowel. After I asked whether that accounts for my symptoms he said that is one of the possibilities. He seemed stumped and to have thrown out irritable bowel as something that in a general way accounts for my symptoms.

Was this a good diagnosis? Should I have gotten a colonoscopy or other tests done?

[qwertz3822]

Flydragon, I haven't.

Thanks for the heads up, I'll have to look into that as well.

[flydragon]

Have you been tested for Celiac disease?  Diarhea and weight loss are common symptoms.

[qwertz3822]

So there are actually other stool tests that could have been done!!!?? That really pisses me off!

I was indeed referring to activated charcoal.

Thank you very much for your help, patient!

I'll report back after I strong-arm this useless doctor I have into giving me proper tests. Probably will be a week or so, I have some other things I need to attend to.

[patient915]

You should really get a stool test for the other things I described, before doing something more drastic like a colonoscopy.  I assume by medical coal that you mean activated charcoal.  This would help with gas but usually wouldn't deal with your underlying problem.

[qwertz3822]

No, none of those (I'm assuming so because the findings of the tests stated "salmonella negative, shingella negative, parasites negative," so I'm assuming that if anything else was tested for it would have been on the paper, whether negative or positive).

It's possible (though I don't know) that the medical coal I was given would have dealt with any bacterial causes.

[patient915]

Did you every get a stool test for other things besides salmonella, shingella, and parasites?  For instance were you tested for C Diff, Campylobacter, pathogenic E Coli (all bacterias)?

[qwertz3822]

Thanks for the answers, patient!

I forgot to mention that I also had two stool tests. The first tested for salmonella and shingella, and the second one tested for them again, but in addition tested for parasites, all came back negative.

[patient915]

I would say that chronic diarrhea should first be investigated with non-invasive tests like a stool test and dietary changes, and then if that doesn't show anything, then you can consider a colonoscopy.  If your situation normalizes, I definitely think that you can forgo any more tests.

[qwertz3822]

Haha, thanks for the longest post award :)

I haven't seen a gastroenterologist yet.

I haven't experimented with my diet much. I've thrown beans out as they're heavy on the stomach, but other than that I eat normally.

Dr. Pho said on the expert forum that chronic diarrhea needs to be evaluated by a colonoscopy to determine if there is any inflammation or inflammatory bowel disease, so I guess that's a necessary next step.

I'm wondering, however, whether I could safely forgo any tests if my situation normalizes completely, as it seems to be moving in that direction.

I would really like to avoid a colonoscopy, but if a normalization doesn't rule out dangerous possibilities such as cancer or other, I would rather go with a colonoscopy than to live in a state of doubt.

[patient915]

Welcome to the gastroenterology community!  IBS sounds like a pretty good diagnosis to me.  Have you ever seen a gastroenterologist about this?  I didn't have a chance to read your entire post (you win as the longest post I have ever seen!!!), so I hope I didn't miss anything important.  I don't think your liver results tests are of too much concern.  What different dietary changes have you tried?