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Suggestions to improve gastric, rectal and urinary problems - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Urinary and Bladder Problems
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
Doctor :   hi
Doctor :  
how can i help you?
User :   hi, first I'd like to mention I have used this service many times before already and also seen half a dozen dr's for treatment in the past few months but I keep feeling sicker from many symptoms
User :   but I want to ask if all my symptoms could be related
Doctor :  
ok
Doctor :  
i will help you in this.
User :   thank you, I realize this may be a challenge
User :   First I am only 26 yo male
Doctor :  
ok
Doctor :  
are you there?
User :   symptoms are 1.) Rectal pressure from gas everyday, dry stool, but regular bowel movements every day, had external hemmorhoid and skin XXXXXXXX and fissure. Hemmorhoid and XXXXXXXX were removed (very easy office surgery), fissure was treated with nitroglycerin and botox injections, surgeon said it all healed but the area was very red and started bleeding again during exam, he suspected a fungal infection, antifungal with steroid cream was given, things got much better for a day or two but then went back to pressure and burning rectal pain, and also small amount bloody soily discharge in underwear, feeling of tearing, sometimes also aches like a bruise towards back of anus / tailbone 2.) About once a week I have abdominal burning
User :   yes listing symptoms
Doctor :   ok
Doctor :  
please give me some time to go through them
User :   both 1 and 2 seem to improve when I pass gas
User :   but often it is more difficult to pass gas then it used to be and it is frequent
User :   3.) I have increased urinary frequency and sometimes burning and dribbling after urination or burning sometimes when walking or sitting. like a quick stinging pain. I saw a urologist that did an exam, urine flow test and urine culture, all came back normal but he could not do a prostate exam because I had just had the rectal surgery
User :   4.) I have had severe chest pain once or twice a month, so severe that it prevents breathing for a second or two
User :   but the emergency room said it is not cardiovascular
User :   ok that should be it except for sinus issues
Doctor :  
ok
User :   I am wondering if I could have some kind of major infection that causes all this, but so far all tests show normal
Doctor :  
may i ask, is there a family history of rectal/colon cancer?
User :   no history that I am aware of
Doctor :  
ok
User :   no growths have been noted
User :   by either the surgeon or GI dr.
User :   I had a sigmoidoscopy a few months ago
User :   he said normal except for the piles and fissure
User :   but I had that all fixed by the surgeon
Doctor :  
ok
Doctor :  
are you taking any medications now?
User :   yes, I am continuing to take the antifungal with steroid cream
User :   occasionally a stool softner too
User :   weekly allergy shots too
Doctor :  
ok
User :   I am on immunotherapy
Doctor :  
when was the last time you had an examination?
User :   about 2 or 3 weeks ago
User :   that was with the colorectal surgeon
User :   who didn't know why the area was inflammed and bleeding but said maybe a fungal yeast infection
User :   he said the fissure and pile site healed perfectly
User :   but wasn't sure about the redness and bleeding
Doctor :  
ok
Doctor :  
ok
Doctor :  
ok
Doctor :  
are you taking sitz bath now?
User :   no, he said sitz bath may have caused a fungal infection, he said warm water on a wound can cause this
User :   so I am making sure to avoid baths now
Doctor :  
ok
Doctor :  
are you taking any anti-inflammatory drugs for the redness?
User :   no, not at present
User :   I thought about taking an NSAID
User :   but these can increase bleeding
Doctor :  
have got your liver functions checked recently?have you got the blleding time and PT checked?
User :   so I did not want to without dr's advise
Doctor :  
ok
User :   liver function no
User :   but bleeding time yes
Doctor :  
it is good not to take any self medications
Doctor :  
ok
User :   I was diagnosed with von willebrands when I was young and 9 minute bleed time
Doctor :  
what was the report for bleeding time?
Doctor :  
ok
User :   but when I went to the hemotologist / oncologist recently
User :   right before the pile surgery
User :   she did about 30 blood tests and bleedtime
Doctor :  
so that explains the cause for the repeated bleeding and redness that you have.
User :   very good bleedtime
User :   only 30 seconds I think
Doctor :  
ok
User :   and all tests normal
User :   except one that was very minor
Doctor :  
ok
Doctor :  
which one was abnormal?
User :   I think one of the multimers
User :   but she said it would not affect bleeding because it was too minor and other things were good enough to compensate
Doctor :  
for you due to the von willebrands disease, bleeding time will be ok
Doctor :  
clotting time will be affected
User :   she said both were excellent though
Doctor :  
which will affect the ability of blood to clot to stop the bleeding
Doctor :  
so people will have bleeding
Doctor :  
shall i explain you the von willebrands disease? may be it will help you to figure out why you are still having the bleeding problem after the surgery, though the surgery site is looking healed?
User :   you could but I think that has been looked into deep enough to rule out the von willebrands as the cause in this case
User :   she said it wasn't even detectable that I had VW right now
User :   only when I was younger
Doctor :  
the fact is that the von willebrands is of two types
Doctor :  
the people with type 1 will have problem only after they have any surgery, tooth extraction, or trauma.
Doctor :  
type 2 is easy to detect as it causes major bleeds
User :   ok
Doctor :  
and is detectable in small amounts
Doctor :  
Von Willebrand disease (VWD) is a bleeding disorder. It affects the blood's ability to clot.
User :   I had no signs of type 2 recently, so I had tests done for type 1 I believe
Doctor :   and it is most common hereditary coagulation abnormality described in humans
User :   yes it does run in my family
Doctor :   It arises from a qualitative or quantitative deficiency of von Willebrand factor (vWF), a multimeric protein that is required for platelet adhesion.
Doctor :   There are four types of hereditary vWD. Other factors including ABO blood groups may also play a part in the severity of the condition.
Doctor :   There are four hereditary types of vWD described - type 1, type 2, type 3, and platelet-type.
User :   I had multimers checked and platelet coagulation at a specialized lab, also platelet quality and count checked I believe
Doctor :   in Type 1 vWD (60-80% of all vWD cases) is a quantitative defect (heterozygous for the defective gene) but may not have clearly impaired clotting, most patients usually end up leading a nearly normal life.
Doctor :   i will come to the various tests that could be done to diagnose it, if something out of these are not done, you could ask your doctor in the next appointment to do it
User :   ok
Doctor :  
in type1, trouble may arise in the form of bleeding following surgery (including dental procedures), noticeable easy bruising, or menorrhagia (heavy periods) in case of women.
Doctor :   and the levels of vWF (von willebrand factor) are decreased and detected at (10-45% of normal, i.e. 10-45 IU).
Doctor :   In type 2 vWD (20-30%) is a qualitative defect and the bleeding tendency can vary between individuals.
User :   is there such thing as a factor 12?
Doctor :   and vWF levels are normal, but the multimers are structurally abnormal, or subgroups of large or small multimers are absent. Four subtypes of this can exist: 2A, 2B, 2M and 2N.
Doctor :  
yes there is factor 12 in the body
User :   I think of the almost 30 tests done, she said factor 12 was the only one a little off, everything else was well within normal limits, even better then people without vWD
Doctor :  
ok
Doctor :  
i will come to explain factor 12 and its need and the problems related if it is less after i finish with this.
Doctor :   so coming back to the types
User :   ok
Doctor :  
subtype 2A, has abnormality of the synthesis or proteolysis of the vWF multimers resulting in the presence of small multimer units in circulation. Factor VIII binding is normal. It has a disproportionately low ristocetin co-factor activity compared to the von Willebrand's antigen. these factors are related in the the process of formation of a clot.
User :   thrombosis?
User :   the pile I had removed was thrombosed at one time
Doctor :  
Type 2M, is the next subtype, here also, factor VIII
Doctor :  
binding is normal
Doctor :  
in Type 2N, there is deficiency of the binding of vWF to factor VIII. This type gives a normal vWF antigen level and normal functional test results but has a low factor VIII.
Doctor :   which leads to a misdiagnosis of hemoplihia an dother bleeding disorders
Doctor :  
Type 3 is the most severe form of vWD
User :   bad platelet quality?
Doctor :   here, there is no detectable vWF antigen, and a person may have sufficiently low factor VIII that they have occasional hemarthroses (joint bleeding), as in cases of mild hemophilia
Doctor :   Platelet-type of the disease is (also known as pseudo-vWD or platelet-type (pseudo) vWD)
User :   ok
Doctor :   it is caused by gain of function mutations of the vWF receptor on platelets; specifically, the alpha chain of the glycoprotein Ib receptor (GPIb).
Doctor :   here, the ristocetin activity and loss of large vWF multimers is similar to type 2B, but genetic testing of VWF will reveal no mutations.
Doctor :   now coming to the diagnosis part
Doctor :  
achieved by measuring the 1).amount of vWF in a vWF antigen assay and the 2).functionality of vWF with a glycoprotein (GP)Ib binding assay, a 3).collagen binding assay or, a ristocetin cofactor activity (RiCof) or ristocetin induced platelet agglutination (RIPA) assays.
Doctor :   40. Factor VIII assays
Doctor :  
4). Factor VIII assays
Doctor :  
5). platelet function assays
User :   RIPA sounds familiar, I had that test done
Doctor :  
6) factor VIII binding assay
Doctor :  
ok
Doctor :  
other than these, there are complete blood count, APTT, PT, thrombin time, and fibrinogen levels
User :   I had to go to a special lab for the RIPA and multimer tests
Doctor :  
coagulation factor assays
User :   I beleive those were done as well
Doctor :  
all these tests are done in specialized labs, other than the common blood tests
Doctor :  
so now that you know the various types of the disease, and the tests, you can interlink the test results and come to a conclusion which type of the disease you are affected with.
Doctor :   and this will help you to figure out the symptoms you are going through.
User :   ok
User :   I don't have my results in front of me but I remember she said only test that was a little off was factor 12
Doctor :  
ok
User :   And I do believe most of what you listed was done
User :   they took about 30 tubes
User :   of blood over 3 days
Doctor :  
ok
User :   and the bleedtime test of course
Doctor :  
ok
Doctor :  
as per the discussion that we just had, it could be probably type 2N, or type 3 that you may be suffering
Doctor :  
so the other tests are on a normal side, but the factor VIII is affected
Doctor :  
now coming to factor 12
Doctor :  
it centers on how the protein is a step in the process of forming a clot
Doctor :   and people with the deficiency usually do not experience bleeds and normally do not require treatment.
Doctor :   However, it may increase the risk of thrombosis, due to inadequate activation of the fibrinolytic pathway. The deficiency leads to increased activated partial thromboplastin times (APTT)
User :   so a factor 12 deficiency could actually lead to increased clotting instead of poor clotting>
User :   ?
Doctor :   yes
Doctor :  
it will not cause hamorrage
User :   interesting, I guess that could explain why the pile may have become thrombosed, but does not explain why I have bleeding
User :   so I am more apt to believe that I have some kind of infection
User :   or something else
User :   but the antifungal did not help long term
Doctor :  
it could all be interrelated
User :   could this be bacterial or viral?
Doctor :  
you have von willebrands, and factor 12 involved
Doctor :  
along with fungal/bacterial infection
Doctor :  
so first i would suggest you to do a extensive liver function test
Doctor :  
as almost all the factors are linked with liver
Doctor :  
so any abnormal function of liver also will cause in bleeding problems, along with the added diseases.
User :   ah, could the liver be related to my chest pain?
Doctor :  
not really, but if it is enlarged it could cause it
Doctor :  
as there are other causes of chest pain other than cardiac
User :   what what does the liver test consist of? Is this just a blood test?
User :   for liver enzymes?
Doctor :  
you could also have gastroesophageal reflux disease which could cause chest pain
Doctor :  
also spasm of the sphincter at the esophago-gastric junction can cause this
User :   yes, this came up with my dr.
Doctor :  
yes it will consist of a blood test
Doctor :  
for liver enzymes
User :   ok, that should be easy
User :   I tried taking an antacid after the chest pain on one occassion
User :   it didn't seem to help
User :   and it happens in shots it comes on in less than a second
Doctor :  
antacids will not help if the pain is due to spasm
Doctor :  
ok
User :   from nothing to unberable pain like breaking a bone or tearing a muscle
User :   and I can't breath
Doctor :  
ok
User :   and certain movements like lifting my arms
User :   can cause it
Doctor :  
it does sound like the spasm of the sphincter
User :   what is the treatment for this, nitroglycerin or muscle relaxants?
Doctor :  
i will help you with this
User :   ok
Doctor :  
esophageal spasm could be in upper or lower esophagus
Doctor :  
upper zone spasm usually happens with food bolus getting stuck
Doctor :  
and it is like a wave starting at upper end and going down
Doctor :  
the spasms can be diffuse or located in one place
Doctor :   and the symptoms due to this will be
Doctor :  
1).Pain in your chest, often intense, which you might mistake for heart pain (angina)
Doctor :  
2) difficulty swallowing
Doctor :  
3). pain on and off even with swallowing saliva in severe cases
Doctor :  
4) regurgitation of food
User :   this may be what I have but no taste like reflux
Doctor :  
anything can trigger these contractions, which lead to chest pain
User :   and sneezing is so painful that I feel my chest will burst open
Doctor :  
even having food at different temperatures can trigger it
User :   hmm
User :   Are there any tests that can completely confirm this?
Doctor :  
so best will be to see a gastroenterogist
Doctor :  
for the symptoms
Doctor :  
explaining in detail each symptoms
Doctor :  
and asking the following questions
Doctor :  
1). What is likely causing my symptoms?
Doctor :  
2). Are there any other possible causes for my symptoms?
Doctor :  
3). Is there a way for me to safely tell if my chest pain is being caused by an esophageal spasm, rather than a more serious condition, such as a heart problem?
Doctor :   4).What kinds of tests do I need? How do I need to prepare for these tests?
Doctor :   5). Treatment options, diet changes, cost of treatment.
User :   ok
User :   my diet is already too restrictive
Doctor :  
also you can look for the possible triggers that causes the chest pain, write them down
Doctor :  
and tell your doctor
User :   I need to eat high fibre, but low gas and food that helps weight gain
Doctor :  
which will provide him clues to come down to the causes and treatment options
Doctor :  
ok
Doctor :  
that is good
Doctor :  
what you can do is try to take the same foods, but take in small quantities
User :   but I have to eat a lot just to stay at a healthy weight
Doctor :  
say like dividing meals such that you eat 6-8 times a day, small quantities
User :   oh okay
User :   so spread it out more
Doctor :  
so that you get the same amount of calories required
Doctor :  
yes
User :   ok
Doctor :  
spread it more
Doctor :  
so it will prevent heartburns to an extent
User :   sounds like most of my conditions should be evaluated by the gastroenterologist
User :   liver function and esophical spasm
Doctor :  
yes
User :   how about infections?
User :   could I have a bacterial or viral infection
Doctor :  
that too will need to get evaluated
Doctor :  
best will be to get a culture and sensitivity done from the area
Doctor :  
to see what organism grows
Doctor :  
and to what drugs it is sensitive to
Doctor :  
and then start the appropriate treatment
User :   could you explain how a culture works? they swab the area of inflamation and send to the lab?
Doctor :  
yes
Doctor :  
they will need to take two to three swabs
Doctor :  
for bacterial, fungal cultures
User :   how about viral?
Doctor :  
viral infections will need serology to be done
User :   blood tests?
Doctor :  
to see the type of antibody response
Doctor :  
yes
User :   So I should ask the surgeon for bacterial and fungal cultures and viral blood tests, and the GI for liver function and esophical discussion?
Doctor :  
yes you can do that.
Doctor :  
Is there any thing else I can help you with?
User :   well the one remaining item was the urinary burning
User :   that I think stems from the prostate
User :   does that fit into the rest of this?
Doctor :   urinary burning can be due to infections
User :   urologist said my urine looked okay
User :   (I have had this for almost 2 years by the way)
Doctor :  
can be due to enlarged prostate, which leads to more infections.
User :   can it be infected but not enlarged?
User :   and urine comes back normal?
Doctor :  
no, the urine will show infection if there is infection
User :   if no infection what else could cause a stinging after urination and need to urinate again?
Doctor :  
a enlarged prostate can cause these symptoms
User :   ok
User :   it was never noted to be enlarged during my exams but I can ask again
Doctor :  
yes
User :   ok
Doctor :  
it will help you better to resolve the problems
User :   ok thank you
User :   I need to go now
User :   but this should help
Doctor :  
ok
Doctor :  
Please fill the feedback form say done when done.
User :   thank you for taking the time to help with a number of issues, very appreciative
User :   I have submitted the form
Doctor :   Thanks for consulting HealthcareMagic. Please chat with our doctors 24/7 for medical queries. Bye for now.
User :   thank you bye!
Doctor :   wish you a speedy recovery. We are there to help you 24/7 with the medical queries.
Doctor :  
bye for now
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