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Ask Dr. Phil, MD Your Own Question

Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54213
Experience:  GP in the United States
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Hello doc, I am a 28 year old man, who works out and is

Resolved Question:

Hello doc,
I am a 28 year old man, who works out and is good shape. I eat healthy majority of the time and my diet is balanced with fruit, vegetables etc.
Since March of this year i have had a myriad of symptoms the main ones
are, Constant Fatigue, Lightheadedness, Insomnia (difficulty getting to sleep), Impaired cognitive function, G.I Problems.
It is really messing with my life at the moment, it all started (well that was probably the culmination of earlier symptoms) in November 2013, I ate a large meal of chicken and was constipated for 4 days, i used ducolax out of frustration and had a bowel movement.
I had a blood test in dec 2013, everything came back normal accept
LOW MCV - 76.6fl range 80 - 99
elevated Bilirubin 21 uMol range 0 - 20
Between Nov 2013 and now ive had pretty much constipation/bloating/smelly wind %70 of the time.I have figured out that Meat, Poultry generally tend to aggrevate it im not sure why but its almost as if it it does not digest properly and it just cause putrid wind and constipation and bloating.
For the first few months i used ducolax daily, about 4 tablets for about 2- 3 months it was the only way i could have a bowel movement.
Safe to say i was very worried so i ended up having a private colonoscopy and biopsy which came back clear this was in Apr 2014.
But since around march 2014 i have had this lightheadedness coupled with fatigue which has gotten progressively worse to the point that its now a daily 24/7 permanent dibillitating spectre overshadowing my existence.
The fatigue is the main issue, the closest thing i can compare my waking state to is the feeling you have when you have not slept for 36 hours, reactions slowed, spaced out, dizzy, it is a horrible feeling and i feel like there is no end in sight.
Ive been to my GP 3 Times since may all they ever tell me is its stress but i dont think it is. Im pretty sure there is something going on in my G.I system somewhere that is causing insomnia or malabsorbtion of some sort of vitamin or something.
I Feel like my visiting my GP is a waste of time i leave with nothing, no answers, no suggestions, nothing just a blank expression.
THE fatigue, clouded thought, dizziness are defacto now.
i've decided to summarise my symptoms and the tests ive had done so far and there results. The tests i had done are a result of my own research on the internet but i don't have a concise picture or definitive direction to go in, someone please advise. Ive bought every supplement under the sun from selenium to b12 to b-complex, co-enzyme Q10, vit A, E, K, acupuncture, Chinese herbs to no avail.
I would like to know can the low MCV microcyotic anemia cause the fatigue symptoms, and could this be caused by the G.I issues possible bleeding. Sorry for the
long incoherent essay.
I have a cousin with Crohns but the colonoscopy came back negative for this apparently.
MAIN SYMPTOMS IN CHRONOLOGICAL ORDER:
INSOMNIA DIFFICULTY GETTING TO SLEEP
CONSTIPATION/BLOATING
EXTREME LIGHTHEADEDNESS
EXTREME SPACED OUT FEELING
EXTREME FATIGUE THROUGHOUT THE DAY
PAIN IN LEFT KNEE
sensitive to sunlight
tingling in my left index finger
tests
b12 - 422 ng/L may 2014
ferritin 110 ug/L (30-400) may 2014
Vitamin D 78 ng/ml (after supplementing 3000IU spray daily for 2 weeks) may 2014
elevated CK 830 (CK isoenzyme test showd CK-MM)
Can someone please give me there professional opinion on how to solve this or what possible test i can have done to figure out what is wrong with me.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 2 years ago.
Dr. Phil, MD :

Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Dr. Phil, MD :

please enter chat

Dr. Phil, MD :

.

Dr. Phil, MD :

Hi I'm Dr. Phil

Dr. Phil, MD :

Can I ask your first name?

Customer:

Hi

Customer:

Bertrand

Dr. Phil, MD :

Hi Bertrand

Dr. Phil, MD :

Nice to meet you

Dr. Phil, MD :

I think you have celiac disease my friend

Customer:

Hello Doctor, same to you

Customer:

but i had a colonoscopy, and biopsy of the bowel and i think the small intestine where it meets the bowel

Dr. Phil, MD :

you need an upper endoscopy with biopsy

Dr. Phil, MD :

blood tests can be suggestive though

Customer:

my GP just completely sidesteps my health concerns

Dr. Phil, MD :

I am sorry he is not listening

Dr. Phil, MD :

there is clearly something wrong

Customer:

can i add, that i had a long history of partying and alcohol

Dr. Phil, MD :

Okay

Customer:

since february i have not drunk

Dr. Phil, MD :

that shouldn't cause GI issues though

Customer:

can that have aggravated things? Thats what i thought

Dr. Phil, MD :

No I doubt it

Customer:

So what would your advise be to do next, all my GP has given me is promethazine

Customer:

to help me sleep

Dr. Phil, MD :

A few things

Dr. Phil, MD :

1)I would get the blood tests for celiac.

Dr. Phil, MD :

tissue transglutaminase antibody and anti endomesial antibody

Customer:

which does not work, i have felt like a zombie since march

Dr. Phil, MD :

2)try to follow the FODMAP diet

Dr. Phil, MD :

This is a special diet for both celiac and IBS

Dr. Phil, MD :

http://www.health.arizona.edu/health_topics/nutrition/handouts/FODMAPs%20diet.pdf

Customer:

ive got the FODMAP on my phone

Dr. Phil, MD :

excellent!

Customer:

it just seems to be meat, although maybe the bread is not helping, would a stool test be of any use ? The main symptom i would like to shake is the fatigue

Dr. Phil, MD :

fatigue is a big part of celiac

Dr. Phil, MD :

stool test would be worth it yes

Dr. Phil, MD :

to rule out parasites and c diff

Dr. Phil, MD :

.

Customer:

Thanks alot doctor, im going to ask my GP on tuesday when i see her *rolls eyes" if not i will probably try and pay privately. But it is definitely possible in your opinion that i could still have celiac even after a colonoscopy biopsy ?

Customer:

I have copied and saved the key suggestions you made.

Dr. Phil, MD :

yes it is my opinion that is possible

Dr. Phil, MD :

definitely

Dr. Phil, MD :

Okay Bertrand?

Dr. Phil, MD :

any more questions sir?

Customer:

Erm.... not at present lol. Thanks Doc !

Customer:

Have a good evening

Dr. Phil, MD :

you're welcome :)

Dr. Phil, MD :

would you mind rating positive before leaving?

Dr. Phil, MD :

I greatly appreciate it

Dr. Phil, MD :

are you there?

Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54213
Experience: GP in the United States
Dr. Phil, MD and 2 other Medical Specialists are ready to help you
Expert:  Dr. Phil, MD replied 2 years ago.
If you have more questions, I'm happy to help
If not, please don't forget a positive rating
Customer: replied 2 years ago.

Hello again doc,



Just a quick question. I Googled coeliac disease and it led me to read about Pancreatic Insufficiency, is it possible that i may have this as a result of coeliac disease ? I have the symptoms of 3+ bowel movements a day, foul smelling and bulky, sticking to toilet bowel when its not constipated. Would the stool test fecal elastatse or the 72 hour fecal fat test be worth considering plus the tests for vit A E K ?? If i am not digesting meat, could it be that im not producing enough protease or lipase ??


 


P.S I've had an ultrasound aswell because my Aspartate Transferase was elevated 55 iu/l (0 - 37) .


 



Ultrasound Result:


Liver Normal Size and Echogenicity


Pancreas, Well Demonstrated and Appears Normal


 


Ultrasound features of a small Haemangioma in the right lobe of the liver, re-scan in 3-6 months to re-assess internal change.


 


http://congenitalhi.org/wp-content/uploads/2013/06/pancreatic-insufficiency.pdf


 


Could the G.I issues be causing the elevation in liver enzymes ?


 


Would it be worth mentioning this to my GP ? Or a G.I Specialist ?

Expert:  Dr. Phil, MD replied 2 years ago.
Celiac disease is a common cause of abnormal liver function tests

Pancreatic insufficiency is possible but much more rare and doesn't come on abruptly
Customer: replied 2 years ago.

ok, thanks.

Expert:  Dr. Phil, MD replied 2 years ago.
I appreciate the excellent rating.

I would be happy to help you in the future. Just ask for feedback. Thank you. :) Dr. Phil in your question opening or bookmark this page http://www.justanswer.co.uk/medical/expert-irondoc/

I greatly appreciate a positive rating in the customer satisfaction survey that you will receive via email. It is important for me to get your feedback. Thank you. :)
Customer: replied 2 years ago.
Will do thanks.

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