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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 65642
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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I am having real problems and I would welcome any advice

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I am having real problems and I would welcome any advice including on whether I should see a specialist (and if so what type) or whether I should seek further tests. I seem to currently be suffering from a complete loss of appetite combined with a fairly constant feeling of nausea (especially in the morning). I've not actually been sick however, but have retched quite a few times. I am male in my late 50s, and have generally been in good health. I seem to currently be suffering from a complete loss of appetite combined with a fairly constant feeling of nausea (especially in the morning). I've not actually been sick however, but have retched quite a few times. I am male in my late 50s, and have generally been in good health. While my problems started last October, the current severe symptons (as of 10 March) have been going on for a little over a week. In this time I have had to force myself to have any food at all and have largely been sticking to soup, porridge and drinking water and very weak black tea. It's easier to eat a little in the evenings. This is the second period of severe appetite loss. The previous period lasted around 10 days starting just after XMAS. I don't have any fever, although I did when the inital problems started. I'm not having diarrhea or constipation, although I did have diarrhoea at the start of this second period, but didn't for the first period. I have had blood tests and and a stool samples tested, which I'm told were normal, thus ruling out of number of things including anaemia and liver problems. Amylase was also tested for. I was given co-amoxiclav for this second period of appetite loss (for possible diverticulits and due to the diarrhoea). This has not affected the almost total appetite loss (I have just completed the course). I had hoped the stool sample taken when I had diarrhoea might have given some clue, but I don't know how comprehensive the testing is. In late January I had a barium enema, which showed 'early signs of diverticular disease, but nothing to worry about'. I also had a endoscopy which showed the stomach to be normal. I have had several blood tests (including for amylase). All came back normal. I avoided Gluten in the period after XMAS, just in case that's a factor although I don't think it is. Initial symptons in October were waking up the night feeling dizzy and unwell, typical symptons for a virus / bug and that cleared up fine after a couple days. However for the next 6 weeks or so, my appetite was generally a little poor, my digestive system seemed a bit upset (slightly lose stools, queasy stomach). Also, at roughly weekly intervals I would feel a little unwell for a day or so. I had assumed this was a virus being slow to clear. A week before XMAS my stomach started feeling very queasy (lots of gurgling) and this was followed by very poor appetite for about a week, although I was able to eat modest amounts of food and did not have any significant nausea. This settled down for a few days for which I ate normally. However, one evening I got the same stomach feeling of gurgling and queasiness and the following morning the complete lack of appetite and feelings of nausea arrived. My stomach felt a little uncomfortable at times, but there was no sharp pain. I didn't have any fever, although I did when the inital problems started and I didn't have diarrhea or constipation. I have had blood tests and and a stool sample tested, which I'm told were normal, thus ruling out of number of things including anemia and liver problems. I'm quite worried about this - which probably doesn't help! After about 10 days of no appetite and nausea in January the symptons died away significantly. This did follow taking 2 Zantac tablets a day (although this may be coincidence) and appetite is returned to nearly back to normal (especially in the evening) although I did feel a little unwell once and possibly may have had a slight temperature. However my stomach did not feel properly right (unsettled might be the best discription). I took 3 Motillium tablets as well as the Zantac for this period. I stopped taking these when the endoscopy was normal. Because the intermitent unwell feelings continued and my stomach 'wasn't right', the GP prescribed antibiotics in case of diverticulitis. I had diarrhoea half way through, which was put doen to a side effect of the ciprofloaxin. However, I continued to have loose stools after completing the course, but a further blood test and stool sample were normal. Further info - in case it's relevant: I had a Fundoplication operation in 2011 to cure Acid Reflux. This was successful in curing the problem. I had sharp heartburn once during the current issues. I also had had a general anaesthetic for a minor knee op a few days before the sever appetite loss occured.

Submitted: 3 years ago.
Category: Medical
Expert:  DrRussMD replied 3 years ago.
Hello
Have you been tested for h pylori
In addition, did they do PH monitoring of your stomach?
Customer: replied 3 years ago.

Yes I believe h pylori was tested for.


I am not aware of PH monitoring having taken place.

Expert:  DrRussMD replied 3 years ago.
What did they see exactly on the scope?
Customer: replied 3 years ago.

I was just told the stomach was perfectly normal.

Expert:  DrRussMD replied 3 years ago.
OK
Any problems with dizziness
Headaches
other symptoms?
Customer: replied 3 years ago.

Slight headaches occasionally. But only slight.


Very briefly light headed a couple of times. Lack of food may have been a factor. I had slight discomfort in my left abdomens (only) one day last week on moving, but have not had any sharp pains or tender areas. Main symptons are really the lack of appetite, especially 1st half of the day, and the loose stools. After eating it often feels a bit like stomach is 'overactive' - as if too much of someting is being squirted in there - very hard to describe the feeling. But generally I don't feel that unwell considering how little if been able to eat.


I have lost weight over the last week - but no more than would be expected with not eating. Did not lose weight before then - except when I couldn't eat much in Jan.

Expert:  DrRussMD replied 3 years ago.
OK
I would suggest a hydrogen breath test.
If positive this would indicate small bowel overgrowth, which could account for all of these symptoms, and is often missed.
Rifaxamin, and antibiotic, would be used to treat it, followed by a course of pro biotics.

Stones in the ducts of the pancreas and gallbladder could be missed, but this usually causes severe pain.

Use reply to let me know if you have further questions. [click reply to expert].
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Customer: replied 3 years ago.

I will ask my GP about a hydrogen breath test.


A couple of questions.


1) Wouldn't the co-amoxiclav be effective against small bowel overgrowth?


2) Any advice on what to eat while my symptons are so severe?


3) Is Kaolin a good idea?


4) Is there any point in getting a specialist analysis of a stool sample?


 

Expert:  DrRussMD replied 3 years ago.
1. No. It might make it worse.
2. As vegetarian as possible and as cooked as possible.
3. No.
4. A comprehensive stool analysis might be helpful. Also, 3 samples for parasite analysis.

Use reply to let me know if you have further questions. [click reply to expert].
Please do not forget a positive rating.
Customer: replied 3 years ago.

looking on the web, there is no mention of loss of appetite as a symptom of small bowel overgrowth (or nausea). I'm happy to have the test suggested, but are there any other possible causes I should pursue?


 

Expert:  DrRussMD replied 3 years ago.
That is the problem with the web.
SBO can have a huge variety of the symptoms.
This is why it often goes undetected.
You should have a good neurological examination. Nausea can also be from brain problems.
Abdominal migraine can caused this situation.
I have already mentioned the need to check for parasites.
Use reply to let me know if you have further questions. [click reply to expert].
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