Severe chronic abdominal pain (X-Post)
I had a RNY Gastric Bypass done in November 2009. About 3 weeks after surgery I started having pain in my upper abdomen and between my breasts and nausea. I was started on Carafate and Nexium suspension for supposed marginal ulcers, which were later confirmed on Endoscopy in December. Despite this treatment, the pain and nausea continued, with the pain moving somewhat to below the right ribs and in the center of my upper abdomen . A second Endoscopy in February revealed that the ulcers were healed, but a small 7 mm round non-fixated nodule in my esophagus was an incidental finding.
Additional workup of the cause of my pain and nausea included an Abdominal Ultrasound, which showed sludge in my gallbladder, and a HIDA scan, which revealed an ejection fraction of 8% meaning the gallbladder was not functioning adequately. Therefore, I had a Laparoscopic Cholecystectomy in March 2010. A week later, I again developed fluctuating epigastric abdominal pain (lower and gradually stronger than before, which worsened with exercise), nausea and abdominal distention. An abdominal/pelvic CT in April 2010 only showed copious amount of stool in the colon consistent with constipation. I used numerous laxatives to clear up the constipation, but it did not effect the pain, nausea or distention.
My surgeon referred me to a Gastroenterologist, *****commended an Enteroscopy with Balloon assist past the Jejunojejunal anastomosis to look for problems lower than the pouch, as well as an Ultrasound and biopsy of the Esophageal nodule, which was done in June 2010. A small, superficial jejunal ulcer was found there, but no specific treatment recommended as they apparently are not very responsive to medication. A repeat abdominal CT again only showed constipation. Again, the use of Miralax did not improve the symptoms, although it affected the constipation. These symptoms worsen with eating and drinking, and I have seriously reduced the consistency and types of food I eat - mainly soupy/very soft and mostly the same thing every day. I struggle to take in 625-725 cals. a day (and I'm 9 months out!)
A Diagnostic Laparoscopy was done August 3, 2010 to determine if there was any anatomical reason not picked up on previous tests for my symptoms. My surgeon found and repaired 2 small defects in the adhesions between the large and small intestines that "could" be places where the small intestines could get herniated and cause an intermittent partial obstruction, but he is not convinced this was the problem. He also released excess air in the remnant stomach, which he believe was iatrogenic from too exuberant inhalation by the anesthesiologist. There were very few adhesions present, and the area where the jejunal ulcer was looked fine from the outside.
If the pain and nausea continue despite the repair in the defects, Dr. Kligman is recommending addressing the issue as a pain management one and going for a Celiac Axis Block. Given the lack of findings on these many procedures he does not think there is likely to be a significant yield looking further. I am concerned that just blocking the pain ignores a possible treatable or serious condition. I just talked to my Gastro, who stated that he did not have anything else to offer in his differential diagnosis at this time, but that I certainly could reconsult him should symptoms change or become more specific. He recommends following my surgeon's recommendations for treatment via pain management should my pain and nausea continue after the healing period from the Diagnostic Laparoscopy. I'll see my surgeon in about 2 1/2 weeks for follow-up. I would appreciate other opinions.
Additional workup of the cause of my pain and nausea included an Abdominal Ultrasound, which showed sludge in my gallbladder, and a HIDA scan, which revealed an ejection fraction of 8% meaning the gallbladder was not functioning adequately. Therefore, I had a Laparoscopic Cholecystectomy in March 2010. A week later, I again developed fluctuating epigastric abdominal pain (lower and gradually stronger than before, which worsened with exercise), nausea and abdominal distention. An abdominal/pelvic CT in April 2010 only showed copious amount of stool in the colon consistent with constipation. I used numerous laxatives to clear up the constipation, but it did not effect the pain, nausea or distention.
My surgeon referred me to a Gastroenterologist, *****commended an Enteroscopy with Balloon assist past the Jejunojejunal anastomosis to look for problems lower than the pouch, as well as an Ultrasound and biopsy of the Esophageal nodule, which was done in June 2010. A small, superficial jejunal ulcer was found there, but no specific treatment recommended as they apparently are not very responsive to medication. A repeat abdominal CT again only showed constipation. Again, the use of Miralax did not improve the symptoms, although it affected the constipation. These symptoms worsen with eating and drinking, and I have seriously reduced the consistency and types of food I eat - mainly soupy/very soft and mostly the same thing every day. I struggle to take in 625-725 cals. a day (and I'm 9 months out!)
A Diagnostic Laparoscopy was done August 3, 2010 to determine if there was any anatomical reason not picked up on previous tests for my symptoms. My surgeon found and repaired 2 small defects in the adhesions between the large and small intestines that "could" be places where the small intestines could get herniated and cause an intermittent partial obstruction, but he is not convinced this was the problem. He also released excess air in the remnant stomach, which he believe was iatrogenic from too exuberant inhalation by the anesthesiologist. There were very few adhesions present, and the area where the jejunal ulcer was looked fine from the outside.
If the pain and nausea continue despite the repair in the defects, Dr. Kligman is recommending addressing the issue as a pain management one and going for a Celiac Axis Block. Given the lack of findings on these many procedures he does not think there is likely to be a significant yield looking further. I am concerned that just blocking the pain ignores a possible treatable or serious condition. I just talked to my Gastro, who stated that he did not have anything else to offer in his differential diagnosis at this time, but that I certainly could reconsult him should symptoms change or become more specific. He recommends following my surgeon's recommendations for treatment via pain management should my pain and nausea continue after the healing period from the Diagnostic Laparoscopy. I'll see my surgeon in about 2 1/2 weeks for follow-up. I would appreciate other opinions.
Highest Weight 277; Surgery Weight 237, Goal Weight 128;
Lost 40 pounds before surgery
Lost 40 pounds before surgery
My heart goes out to you. As someone who has suffered serverly from Vitamin D toxicity, I would highly recommend that you try discontinuing it for a small period of time just to see if this may have been the cause. Vitamin D3 (cholecalciferol) is the main ingredient in rat poison (quintox, rat be gone). It is used to kill the mice by mobilizing the calcium from the bone and putting it into the blood stream. This causes hypercalcemia and subsequently heart failure and death. For me, it only took 1000UI daily for 45 days. I was throwing up violently towards the end. This was accompanied by bad headaches which I normally dont get and serious pain in my upper left quadrant of my abdomen towards the back. The pain left about a month after stopping the vitamin D. The day I stopped the vitamin D, I stopped throwing up. Also I was plaqued with serious constipation wich was not normal for me either.
Hope this helps. This may NOT be your problem but I am just offering an avenue to check. Your chemistry may be as sensitve to the poison as mine. Please let me know how you go.
Wishing you all the best.
Straw Walker
Hope this helps. This may NOT be your problem but I am just offering an avenue to check. Your chemistry may be as sensitve to the poison as mine. Please let me know how you go.
Wishing you all the best.
Straw Walker
Shrinking Violet , i empathize with you. i have had almost all of the same problems, testing and surgeries as you. mym diagnostic lap showed intussusception(where your intestines telescope into themselves) a mesenteric defect and adhesions. i still have pain and nausea, now throwing up and have a low grade fever now and then(the fever came after my egd with ballon assist). i feel like my doctors are blowing me off, my surgeon told me i need a psych consult. i'm not crazy and neither are you or anyone else on this board suffering from abdominal pain, nausea or any complications. i've been told numerous times by different doctors that "you are high risk" well do something, don't just sit on my symptoms!
please keep us updated, message me, there's alot more i'm sure we can chat about.
ill be sending you a friend request with my personal email so you can email me.
i'll keep you in my prayers
scho5
on 1/29/12 4:07 am - WI
on 1/29/12 4:07 am - WI
Would like to hear how you are doing. I have had similar problems. Thanks
scho5
on 1/29/12 4:08 am - WI
on 1/29/12 4:08 am - WI
I would like to hear how you are doing. I have similar problems. Take Care
scho5
on 1/29/12 4:09 am - WI
on 1/29/12 4:09 am - WI
HOW are you doing? I would really like to know. I am having similar problems. Take Care
Things have changed greatly for me over the past 1+ years. After another CT and Endoscopy with biopsies were negative, as well as were blood tests for Celiac Disease, both the University GI and my Bariatric Surgeon offered no additional options. Eventually the worst of the middle abdominal pain decreased (i think the last ulcer finally healed).
I started to have dropping blood counts and thyroid functions (especially my T3). The University Endocrinologist was only interested in my TSH, which was not significantly low, and did not want to change anything other than minimally increase my Synthroid dose. In April 2011 I started seeing a different Endorpcrinologist, who started me on Cytomel - I am now taking 5 mg twice a day and do have more energy. I also saw a Hematologist who is jus****ching my blood counts as the low WBC, RBC, and platelet counts are not enough to do further invasive work up unless I want a bone marrow.
In November or December of 2010, I started to experience severe abdominal distention to the point that my waist could increase in size by 4 inches or more between morning and evening, associated with pain and some nausea (with rare vomiting). Work with my Acupuncturist was not successful. I also tried Colon Hydrotherapy without benefit, although was told i had excessive amounts of gas! I started wondering if food sensitivities could be playing a role and worked first with a nutritional consultant and more recently an Integrative Medicine physician. IgG testing showed many food sensitivities, some severe, and I started an elimation diet of the foods I am severely or moderately sensitive to (all forms of dairy, eggs, asparagus, brewers yeast, honey, basil, thyme, cilantro, ginger, kiwi among other things) and all other foods to be eaten on a 4 day rotation for at least 6 months. I am 4 months into this - it isn't fun or easy, especially since I was vegetarian and now have to be vegan. I am monitoring my blood counts and protein levels closely. She diagnosed me with Leaky Gut Syndrome, and feels the RNY was the precipitant. Within 2 weeks my waist measurement decreased over 3 inches and i felt better - still not perfect but much improved. She also started me on Nutrametrix vitamins and minerals, thinking I might absorb the isotonic liquids better (I had a LOT of abdominal pain initially with these as they bubble, but can tolerate them now if I wait to take them until after bubbling stops).
I also saw a new GI who had me do a Hydrogen Breath Test, which was positive for Small Intestinal Bacterial Overgrowth, for which I took Cipro for 20 days with much reduction in flatus. I was told I might have to take antibiotics intermittently for a long time as the conditions that lead to the overgrowth might not go away. A capsule endoscopy was negative except for mild redness at the jejunojenjunal junction ( where the last ulcer was).
So, all in all, I am doing better. I saw many health practitioners and even tried alternative therapies ( despite being a physician myself!). I was unwilling just to go the pain management route. I still eat mostly soft,finely chopped foods and a restricted range of foods but it is worth it given the improvements. I still have pitting edema at times and mostly cannot eat at restaurants. My weight is generally stable ( within a 5 pound range) and at my goal over the past year.
I started to have dropping blood counts and thyroid functions (especially my T3). The University Endocrinologist was only interested in my TSH, which was not significantly low, and did not want to change anything other than minimally increase my Synthroid dose. In April 2011 I started seeing a different Endorpcrinologist, who started me on Cytomel - I am now taking 5 mg twice a day and do have more energy. I also saw a Hematologist who is jus****ching my blood counts as the low WBC, RBC, and platelet counts are not enough to do further invasive work up unless I want a bone marrow.
In November or December of 2010, I started to experience severe abdominal distention to the point that my waist could increase in size by 4 inches or more between morning and evening, associated with pain and some nausea (with rare vomiting). Work with my Acupuncturist was not successful. I also tried Colon Hydrotherapy without benefit, although was told i had excessive amounts of gas! I started wondering if food sensitivities could be playing a role and worked first with a nutritional consultant and more recently an Integrative Medicine physician. IgG testing showed many food sensitivities, some severe, and I started an elimation diet of the foods I am severely or moderately sensitive to (all forms of dairy, eggs, asparagus, brewers yeast, honey, basil, thyme, cilantro, ginger, kiwi among other things) and all other foods to be eaten on a 4 day rotation for at least 6 months. I am 4 months into this - it isn't fun or easy, especially since I was vegetarian and now have to be vegan. I am monitoring my blood counts and protein levels closely. She diagnosed me with Leaky Gut Syndrome, and feels the RNY was the precipitant. Within 2 weeks my waist measurement decreased over 3 inches and i felt better - still not perfect but much improved. She also started me on Nutrametrix vitamins and minerals, thinking I might absorb the isotonic liquids better (I had a LOT of abdominal pain initially with these as they bubble, but can tolerate them now if I wait to take them until after bubbling stops).
I also saw a new GI who had me do a Hydrogen Breath Test, which was positive for Small Intestinal Bacterial Overgrowth, for which I took Cipro for 20 days with much reduction in flatus. I was told I might have to take antibiotics intermittently for a long time as the conditions that lead to the overgrowth might not go away. A capsule endoscopy was negative except for mild redness at the jejunojenjunal junction ( where the last ulcer was).
So, all in all, I am doing better. I saw many health practitioners and even tried alternative therapies ( despite being a physician myself!). I was unwilling just to go the pain management route. I still eat mostly soft,finely chopped foods and a restricted range of foods but it is worth it given the improvements. I still have pitting edema at times and mostly cannot eat at restaurants. My weight is generally stable ( within a 5 pound range) and at my goal over the past year.
Highest Weight 277; Surgery Weight 237, Goal Weight 128;
Lost 40 pounds before surgery
Lost 40 pounds before surgery
I am going through the same thing and am looking for answeres too. I can't eat hardly anything other than soft foods and soup. My weight is always dropping because I am sick weekly. I am in pain constantly and throwing up. I have had many of the same tests only to find my gall bladder is ok and i have an ulcer. I am taking nexium as well as carafate, and have been for 7 months, still i am no better. It has really become frustrating. the gastrologist has scheduled me for a colonoscopy and upper gi. please keep me posted and i will do the same. i know the answer is out there somewhere.
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