Irritable Bowel Syndrome Message Boards | Re: KaybeeC, I have a question for you

Hi, Donna -

I don't blame you for being frustrated! I have a couple of questions:

1. Did the GI doc take tissue samples during the colonoscopy? If not, why not? There are a couple of sub-types of "microscopic acute colitis" -- which can have pain and frequent diarrhea as symptoms. However, the 'scope can show that "everything looks fine" to the doc - it's the biopsy that will tell. I speak from experience - developed almost constant pain in Feb/Mar w/diarrhea unless I just ate bread and applesauce. And, my pain included the feeling of a "knot" behind the navel. 'Scope showed healthy tissue but biopsy revealed colitis. So, you might want to dbl-check with your doctor - did s/he take biopsies?

2. As for the gallbladder / ultrasound: someone else's reply to one of your earlier posts describes another type of gb test - hydascan?? So, if the answer to #1 is that, yes, your doc did take tissue samples for biopsy to rule out microscopic colitis, then you might want to ask if there would be any value in having additional testing for your gb functioning (not just looking for stones).

3. As for the gynecologic symptoms / questions: a "quick pelvic exam" doesn't sound thorough enough to me, but it depends, I suppose, on what the doctor was looking for and his/her level of expertise. However.... a "transvaginal ultrasound" (sometimes called "pelvic ultrasound") might be a good idea. I've discussed my experience with that in earlier posts - and others have weighed in with theirs. For me, it's always been painless though a wee bit uncomfortable: a technician hands the patient a lubricated probe which the pt is (usually) allowed to insert herself. Then, the technician (or the gyn - my doc usually did one every year) manipulates it just as for an external ultrasound - watches the screen to make sure she's getting good pictures. There is a second part to this - an external abbdominal ultrasound - sounds like you've had a "partial" when the gb ultrasound tech ventured a little farther afield than was necessary. Anyway, this external ultrasound should encompass the entire abdomen, all the way down to the pelvic region and the ovaries. This gives a doctor a great view of what's going on inside: the thickness of the uterus, any ovarian cysts, etc. BTW, this is usually done with the external ultrasound performed first, while you have a VERY full bladder. Then, you have to empty your bladder for the transvaginal u/s. I got smart, however, and a little assertive - why couldn't they do it backwards? I have a "shy bladder" and I could never empty my bladder completely for them to do the transvag - my first experience with this at a hospital took several hours and I was near tears. The next time I needed one, I chose a different hospital and it made all the difference - the tech was sympathetic and gladly did the procudures out of order. My own gyn never made me drink the water - he just did the transvag after my pelvic exam. Too late to make this long story short, but ... this might be a good test to have.

4. Regarding the bipolar issue: the bipolar medication needs / restrictions should more than likely trump the IBS / antidepressant need / benefit! It's tricky enough to get the meds right for bipolar (you're bipolar I, right?)! I agree with you that it's probably not a good idea to try to experiment with the meds in order to gain some benefit for the IBS - you could just cause yourself more problems. (BTW, I'm in the process of making psych appts myself - suspect soft bipolar or ADD. The researchers I've emailed think there's enough evidence to warrant being thoroughly checked out - think I'm probably somewhere on the bipolar spectrum, based on my history. I know that I feel better without antidepressants - antidepressants are contraindicated for soft bipolar and I was taking them for years! Prozac was nearly my undoing)

5. What does your primary care physician (pcp) say about all this? Has s/he been involved in this process? If not, I would recommend having each doctor send your pcp any and all results of exams, history, and tests. Then, ask your pcp for guidance. S/he might be able to get on the phone with her peers and delve a little deeper into their reasoning for the tests they did and the conclusions they reached. Together, they might come up with a different approach - more tests, etc. Doctors just usually respond better to their peers than to their patients when there is some question about "why"... although some docs are great about patient input. I've always been very fortunate, but I'm also rather assertive (primarily because I'm scared to death they'll miss something! lol!).

6. If your pcp isn't too helpful, and if the gastro & ob/gyn docs don't perceive any need to do further testing, and you're still having the symptoms, have you considered getting a second opinion from another doc in each of these specialties? "Bev82" asked for info on good docs in NC recently and both shawneric and I replied. Shawneric highly recommends UNC, as it is the #1 ranked GI functional motility center in the country. Duke also is highly ranked in this area. Both offer gyn depts as well. However, thinking you might not need to venture that far from home yet.... I found a North Carolina business magazine that lists "best docs in NC" (according to peer-review, meaning, who would other docs in NC choose to treat them for different health needs). You might want to check it out, because it listed GI docs in the Charlotte area (now I can't remember if it listed gyns, but I think it did - but just ob/gyns). The web address is:

www.businessnc.com/archives/2003/07/top_doctors.html

It gives names, addresses and ph #s for the docs. I can't speak for the criteria that was used, other than the fact that it is peer-review. (If your doctor shows up on the list, that should either reassure you or give you pause about the quality of the docs on the list!) You can also contact both Duke and UNC and ask for the names and phone numbers of the "academic offices" of the division directors for both gastro and gyn. Then call each dept in turn and ask to speak with the academic secretary. Tell her/him that you know that "dr. smith" is well-respected in his area and you would appreciate the names of one or two doctors who have trained or worked with him, or whose reputation s/he knows, who are now practicing in your area. If she doesn't have names at her fingertips, offer your email address. If she doesn't seem too interested, ask for her fax # and then fax your request, addressed to the division head (make sure you ask her for his/her name). I would recommend that you keep any communication, either by phone, email or fax, brief and to the point - they don't need to know your medical history, just what you need from them. And make sure you thank them upfront for their time and courtesy - which I'm sure you would! (This approach is more likely to get you the names of doctors who are perhaps regionally or nationally peer-recognized than if you were to just call a physician referral line). (PS: if there's no "acad ofc" ask for the Clinical Nurse Coordinator for the depts).

I hope this helps -- remember, I'm not a healthcare professional. If you need any more help, just ask - this was really just off-the-cuff with a very limited web search. I'd be glad to look into this a little further if you need me to, to try and find a doc in your area if this info doesn't help you make any progress. (BTW, and I'm sure you know this, many people who have multidisciplinary needs - gastro, gyn, psych - make a trip to a regional or national center of excellence, like Mayo Clinic [there's one in Jacksonville FL but I don't know offhand which disciplines are represented there] and spend a couple of days there for tests and consults. They usually have an intake office that sets up the appointments in the various departments and they can help with lodging discounts. Just fyi -- don't think you're there, but just thought I'd throw it out)... Hope this helps somewhat - and hope it's not information overload! Sometimes, I can get carried away...

Blessings,
Kaybee C

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