Sunday, September 14, 2014

GASTRONOMIC ISSUES

I was always proud of my flat stomach and skinny legs and got many compliments from the fairer sex too. I don't drink beer often to develop a beer gut most Aussies have.

All this changed after my stroke in year 2000. Lack of exercise and sedentary life style post rehab meant I was piling on kilos after kilos.

I was on strong Pain killers like Endone, OxyContine and Panadene Forte post stroke that I developed chronic constipation and it was accompanied by bloating

One would have thought it was all part of the THE AGEING PROCESS but it was not.

I have had colonoscopies and endoscopies done in 1998, 2006, 2008 and 2010 by three different gastroenterologists with the same complaint - Bloating and chronic constipation, to rule out anything sinister. I was told everything was fine and to increase fibre intake....

From a size 40, I needed pants size 46 and thats a big jump and I needed suspenders. Family and friends believed I was very fashionable. The truth was the pants would slip off the belly and almost fall off.

HOLDING MY PANTS AND NOT MY BREATH

Since 2010 I had to figure out the hard way to handle constipation and bloating. Dulcolax, Senna and Movicol. I took all three together and it took exactly 15 hours for the bowel to empty.. Most people take laxatives at night before going to bed and the bowels move in the morning. Not me I am the unlucky Jonah who has to be different.

This July I decided enough I had to find answers. So I consulted another GP for a second opinion. He looked at the medical history and said Boy oh Boy there are so many things going on in your body. I confirmed that my GP often said I was his most complicated patient.

My sleep apnea specialist when I consulted him first asked me if I would do him a favour? Was I interested in being a Long Case Patient for FRACP exams. I have been a long case the last three years at Seventh Day Adventist Hospital and doubt if any of the students who had me as a long case cleared the exams..

I told the New GP I wanted some tests done to see what was wrong with the digestive system.

The First was a Barium swallow test and everything was normal.
The second test I requested was a Gastric emptying study to completion.

I was there at the clinic at 8.30am when I was given an egg sandwich with a trace. Images were taken every 30 minutes for the first three hours followed by imaging every hour.

80% of the trace should leave the stomach in two hours and in my case after six long hours more that 205 of the trace was still in the stomach. Diagnosis was Gastroparesis caused by Diabetes.

There are many symptoms of gastroparesis, including:

  • Heartburn or GERD.
  • Nausea.
  • Vomiting undigested food.
  • Feeling full quickly when eating.
  • Abdominal bloating.
  • Poor appetite and weight loss.
  • Poor blood sugar control.
I do not believe Diabetes caused delayed emptying of my stomach because my wife has been a type 1 diabetic for 45 long years and she has no Gasteroparesis. My take is that it was caused by max dosage of Diabex ( metformin) for a prolonged period plus side effects of Losec for 16 long years.

I wanted to see a Gasteronterologist recommended by the GP.

He was a clever man albeit a bit patronising. Understandable as most of his patients are demure Asians he being a Chinese man.
I appreciated the fact that he took the time to read my medical history in detail.

His first question was why are you seeing so many gasteroenterologists? I said doc no one has solved my problems so far that is why I am here.

Why are you on two blood thinners Warfarin and Plavix ?
I said neurologists put me on both in year 2000 and no one will take me off these drugs. He did not want to take me off either.

You have been on Losec since 1998 and that is too long a time. I said none of the specialists I consulted over the years said I should stop Losec..

He took me off Losec and prescribed Somac and Tazak and to continue with Dulcolaz, Senna and Movicol if they were helping.

I had a full blood test done before seeing the specialist.

INR was           1.8 (2 to 2.5)
Platelet count   378 (150-450)
HbA1c              7.8 ( was 7.3 earlier)
HDL                  0.7 (> 1.0)


Iron Studies
Iron                  6.0 (10.0 - 30.0)
Saturation         8.0 (20 - 50)   
Ferritin              10.0 ( 20 - 300 )

Comment: Consistent with Iron Deficiency    

I am concerned that the iron level is so low and it could mean internal bleeding perhaps microbleeds that are not detected in testing stools.

Considering your near death experiences with the endoscopy procedures I want to do a Virtual colonoscopy to rule out anything sinister. They empty your bowels over three consecutive days and then do CT scans of the large intestines.

Fortunately the large intestines are fine.

So far so good.



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