Subacute, Chronic or Recurrent Appendicitis

[daninho]

Hi folks:

A question regarding some symptoms I have: I have been seeing a GI specialist for the following symptoms: RLQ pain, rectal bleeding, weight loss and general weakness. The doctor I have been seeing is talking a lot about IBS, which I question since I appear to have none of the major symptoms (no cramps, no diarrhea, no constipation). What I do have are the symptoms I mentioned above, which have been worsening steadily of the course of the past few years, with periods of remission. I have also had episodes of severe pain in a U-shape below my bellybutton for several years, but never experienced the 'typical' migration of the pain to the RLQ until now.

My labs are always normal, no elevated WBC or sed rate.

I have also experienced dramatic improvement each of 4 times that I have been prescribed antibiotics (for other conditions) over the last few years, which makes me feel fairly certain that there is a bacterial problem, which could possibly point to some form of non-acute appendicitis.

I am having a colonoscopy on Thursday, which of course might reveal other things, but in the meantime I would like to be prepared to discuss the possibility of some form of appendicitis with the doctors in the event that the colonoscopy is not revealing. I admit I am keen on not being 'labeled' with IBS and sent away, as in spite of the doctors frequent mention of IBS, I do not seem to have any of the key symptoms, and I also know that bleeding and weight loss are not typically associated with IBS.

Any advice on how to have this conversation with the doctors, assuming they find nothing else revealing in the colonoscopy (which of course they might)?

Thanks

Dan

[daninho]

Hi there,

thanks for the feedback - I had thought about the small bowel possibility, which might have to be checked out. I actually had a sonogram of the kidneys and liver a few months ago, and that all checked out fine, although the reason they ordered that was for high liver panel values which suggested hepatitis (which was ruled out). I have had 3 blood tests this year, which all came back normal (except for the liver values), which is part of what makes me wonder about sub-acute appendicitis, as I know that often people have normal labs but only discover post-appendectomy that that was indeed the problem.

I'm not sure if I can get an 'elective' appendectomy - in any case, I'm relatively sure insurance won't cover it if it's not ordered by a doctor.

I should have mentioned that I recently had what amounts to a sigmoid colonoscopy, because when attempting a full colonoscopy, there was too much pain to go more than about halfway, which is why I'm having another one soon. But in what they were able to see, there were no problems, no anal fissure, hemorrhoids, etc.

I'm male and 39, so no problems with ovaries, etc.

I'm also not taking any meds, so I don't think there's a problem there.

If anyone has further thoughts, I'd appreciate it!

Thanks

Dan  

[ggreg]

Well, you could just plain ask him to take your appendix out.  But I sort of think if the colonoscopy doesn't reveal anything, you should inquire about possibly a small bowel issue, there is another test they can do to check that.  You can also ask for an ultrasound, which is less expensive than a scan, just to see if you've got a growth or perhaps gallstones or kidney stones.  

You said you have taken antibiotics four times for other conditions, and it helped this current set of problems, so they should definitely draw blood again and check for a variety of bacterial infections in the body, to include the digestive tract.  And you do not say your age or gender, but if you are a female, you must visit a gynecologist to make sure your ovaries are doing okay.  

And the colonoscopy could reveal you simply have hemorhoids or an anal fissure, which they will bleed, causing that blood in your stool.  One other thing, some medications will cause IBS-like symptoms, so check the side effects of anything you're taking.  I was on Ativan for a short while, and it really did a number on my digestive system.  Just look for the side effect of bleeding, and for any of your other symptoms, too.  

I wanted to respond to your post because a ruptured or an abscessed appendix can kill you.  But when I read the whole post, I got worried about your bleeding and yet lack of digestive problems, which I presume you don't even have anal problems.  Bleeding like that is not normal, which a colonoscopy is a basic sort of thing to check on first, before they go through a lot of other more difficult investigations.