Frustrated and confused

Crohn's Disease Forum

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Joined
Apr 15, 2012
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39
Location
San Francisco, CA
Hi guys.

I've written a lot over the last couple of months. You have really helped me out, and I can't tell you how much I appreciate it. I promise that this is the last time I'll bother you all, especially since it now appears that I don't even belong here.

Basically, about seven weeks ago, I woke up in the middle of the night with severe abdominal pain. I used the restroom, and had what I thought was diarrhea, but then realized I was actually hemorrhaging. I'd had issues with pain, diarrhea, and constipation since I was a teenager, but was always too embarrassed to tell anyone about it, and just figured I had IBS. I was really scared of the tests that might be run, so I refused to go to the doctor and just dealt with it. This was the first time I'd ever bled like that, though. I was really scared and knew something was really wrong.

After spending a day at urgent care, followed by the ER, I was referred to a GI and had a colonoscopy. The first thing my doctor said afterwards was that I had Crohns, and she started me on lialda, donnatol, and a hydrocortisone enema.

However, when the biopsies came back, my doctor was confused. The biopsies indicated ischemia, rather than CD, but my doctor still felt it was probably CD, based on my history (joint pain and mouth ulcers, in addition to diarrhea and constipation), age (33), and what she saw on the colonoscopy and CT scan. She continued to treat me for CD, and later c diff as well (I had initially tested negative twice, she thinks I picked it up when I was on IV antibiotics in the hospital). She tested me for just about every infection and parasite known to man just to be sure, and then ordered the Prometheus IBD panel. In the meantime, my symptoms continued, and I saw her several times - she kept saying I had Crohn's, but that she couldn't really treat it (oral steroids, etc) until I was through with the c diff (I just started my third week of flagyl).

This morning, she called to tell me that the Prometheus test came back negative, meaning I don't have an IBD after all. She admitted that she no longer has any idea what is wrong with me, and referred me to another GI.

I'm terribly frustrated and confused, and was wondering if any of you had an ideas about this, or any experience with something similar. Throughout this entire ordeal, my ESR and CRP have been normal, but my platelets have been low (134 as of last week), my neutrophils have been low (29), and my lymphocytes and monocytes have been high (56 and 14).

I'm freaking out that something is really wrong and that I'm actually dying or something. I've had diarrhea since the first week of April, and am still having lots of crampy pain, especially in my left and lower right sides. My diet has left a lot to be desired. I just don't know how much longer I can keep this up. I couldn't get an appointment with the new doctor for three more weeks. I've lost 26 pounds (I was thin to begin with), and am really at the end of my rope emotionally. I had been relieved to know that at least the doctors knew what was wrong with me, and that they were treating it and that I would get better, but that's all gone out the window. You guys have been unbelievably helpful, and I'm sorry to have to ask yet again, but if there are any ideas out there, I'd be really, really grateful.

Thanks for listening.
Em
 
The Prometheus panel isn't that accurate and Ischemia can result from Crohn's Disease or Ulcerative Colitis, although a finding of Ischemia warrants other tests as well.

Have they conducted any tests to check higher up in your small bowel such as a pill cam? If your IBD is in your small intestines, the Lialda likely wouldn't benefit you much.

You haven't told me anything that makes me think IBD is ruled out yet.

And you're not dying. :)

*hugs*
 
Hello Em,
I'm really not an expert but I've read quite a bit about other type of diseases that can "mimic" IBD most frequent symptoms. Because you mentioned presence of ischemia and because of your blood results (even if it does not completely fit the other possible scenario either) but on the overall it makes me think it could potentially be an auto-immune vascular related disease. Has your GI mentioned anything regarding that possibility? Maybe it worth asking your GI (or the new one) if it would worth asking for a rheumy or internist opinion? Get a look at the portrait depicted by the overall results from your tests?

Do you only have digestive issue recently (which would be enough already)? Do you have issues with your skin, with the sun, problems with your joints (I know you said you already had but is it a symptom you currently have?)? With everything going, I suppose they did test your urine, right?

I'm sorry if I seem invasive with my questions... I'm just so used to what I call the "drawer" medecine... at times, I feel like specialists can't see anything that does not fit in theirs.
 
I was wondering about vascular related as well PsychoJane. What kind of doctor specializes in that?

Em, what were the findings of the CT Scan?
 
I think it depends of the location but here, it is usually the Rheumatologists and Internists can also be really competent when it comes to undifferenciated diseases.
 
Thanks! :) I know my Rheumy tested me for vasculitis but he took 13 vials of blood and tested me for just about everything, so I wasn't sure if that was their specialty or he was just running everything in the book. :D
 
Haha, no... it's really them. I think they probably are the best at looking at everything. I think they are the Kings and Queens of critical thinking when it comes to medical question. But hey, that's just my opinion =)
 
Thanks so much for your replies, David and PsychoJane. You really are incredibly awesome.

The CT scan showed "inflammation". They did the scan my first day in the hospital, before the colonoscopy or anything, when they had no idea what was going on. I haven't heard anything else about it since.

I also haven't had any additional tests, small intestine, vascular, or otherwise. My doctor was going under the theory that it was Crohn's, but didn't want to further investigate it until the c diff was dealt with. The plan was to re-test for that once I'm finished with the flagyl, then do a sigmoidoscopy and barium swallow. But now I guess everything's up in the air.

They have tested my urine, but didn't find anything remarkable. Besides the "gut-rot," I've had a persistent rash on my ankle for about 2 years that my GP can't figure out. It's not a really big deal, it comes and goes, and is mostly just very itchy. I get sunburned very easily, but I'm also quite pale so I'm not sure that's a big deal either.

PsychoJane, I'll definitely bring up your suggestion with the new doc. I just really appreciate both of your insights. I'm so desperate to figure out what is wrong with me so I can just get on with my life already. And eat a cheeseburger or twelve. I'll keep you posted. :)

Thanks again.
Em
 
*Raises left eyebrow*

That ankle rash, it is tender red bumps/nodules that seem to be under the skin and are smooth/shiny?
 
Indeed!! My GP thought it was foliculitis, but it hasn't responded to any of the treatments she has tried, and I just sort of gave up and stopped bothering her about it. Also, not sure if this is relevant, but I get the same thing on my scalp - really itchy and scaly, but it comes and goes, usually when I'm stressed out.

I really, really thank you for letting me pick your brains about all this. Seriously.
 
That is really interesting - thanks. I haven't showed the rash to any of my doctors since all of this happened - honestly, I just haven't thought about it. But I'll definitely show it to the new GI.

Hope you have a good night. And thanks again for all all of your help. :)
 
em6263 sounds like what you are going through is very much like my wife went through. Most people don't know, but more than 50% of the people that are treated with crohns don't really have it, they have colitis or other imune type issues going on that sometimes they never find out what it is. My wife went over 4 years with low grade fever, anemea, B12 deficency and she lost about 15% of her over all lbs. They said crohns, then limpoma, then colitis and on and on. It is very hard for a Dr. to say You have crohns without patholigy reports. She ended up having colitis, but I had the big D for for over 15 years 3-4 times a day and just lived with it, until I lost 20lbs in one years so I went to the Dr and they did a colonostomy and said that everything looked ok except that there was a small bump like tumor thing on my apendix, so they took 2 CT's and said my apendix needs to come out and I have IBS, well, when they went in to remove my apendix they found a LARGE mass of crohns at the end of my small bowl, the CT didn't show this and everything was all messed up, they couldn't identfy my apendix, they had to cut damaged what ever ( they couldn't say what it was, from around my arterys and did a resection for about 23cm of my colon and 12cm of my upper intestine, they sent that to patholagey and that CONFERMED that I did have crohns. I think you need to have them do a specal type of CT that will show if your upper has crohns. This is not a run of the mill CT, you drink alot of stuff and they use die with a IV. If they have not checked your upper gi track this needs to be done before they can rule out crohns.
Good luck
Pop
 
em6263 sounds like what you are going through is very much like my wife went through. Most people don't know, but more than 50% of the people that are treated with crohns don't really have it
Can you please provide a link to a source that can back up that assertion?

Thanks! :)
 
By the way, the CT Pop is referring to is called a CT-Enterography if ever you want to discuss that with your GI. It has the advantage it can show various things like various type of fistulae, change in intestinal wall thickness, etc etc. I think it might be more accurate than the SBFT. Also, Pill cam is great for the imaging... both these exams are great in what they provide but, they have the inconvenient of not allowing biopsies...

Don't forget mentioning your ankle rash or any weird things you could think of in process. I usually try to write these things down as I always forget what I wanted to say once I pass the GI's door lol... thank God for Smartphones.
 
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