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Foul smelling gas, fatigued, unable to sleep at night. Dr gave Abeim, Adderall. Had colon resection. Is treatment correct ?

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I had colon resection in August of 2010. Followed by chemo for 6 six months ending in May of 2011. I don't eat much at work due to the awful gas smell that is produces. The smells overwhlems our teams entire worksite. I am also fatigued all day but can't sleep at night. I went to a physciatrst and I had an MRI that showed bilaterial Fuci Focal spots in the frontal lobe into the white matter. The doctor felt it was a concentration issue and has me on Adderall for concentration and mpw I take Abeim for sleeping at night. I am now able to manage at work but what my question is, "Am I treating the symptoms and not finding the problem." Why can't I sleep and why can't I stay on task at work. Prior to taking the medicines I would fall asleep right at my desk. Should I just continue taking medicines to work through the symptoms or should I contine looking for the real problem? I have always listened to by body in the past and that is how the original colon cancer was found.

The doctor also had a scan of my thyroid which showed two small nodulers less then 1 cm. Says they are no big deal that many people have these. I feel many people have colon polpys that aren't cancer but I did. She took at TSH and it came back fine. Should I ask for a T3 and T4 test to be certain? Test shows problems that would agree with my symptoms but not bad enough to suggest problems. Should I just blindly do as I am told?
Posted Thu, 14 Jun 2012 in Colon Cancer
Answered by Dr. Prasad 23 hours later

Thanks for the query.

From what you mentioned in your query and the reports, you have the following health issues:
- Recently diagnosed low grade colorectal cancer managed with appropriate surgical resection and 6 cycles of chemotherapy
- Excess flatus / gas
- Difficulty sleeping associated with fatigue
- Few thyroid nodules detected on a scan

Let me address the above concerns individually.

1. I am glad that the colorectal cancer was detected early. Low grade cancers are manageable and you’ve had the right treatment for it. What you would need now is just regular follow up’s with your surgeon.

2. Flatus develops as a result of microbial action on the fecal products. The more time feces remain in the intestines, the more chemical/biological reactions occur and more / obnoxious flatus develops. So if you been suffering from constipation, it can be the cause of excessive gas/flatus development. Further loss of harmless and essential intestinal flora can cause pathogenic microbes. These pathogenic microbes can also cause excessive gas/flatus.

I would suggest you to try some probiotics such as yoghurt, lactobacillus supplements, etc. This can enhance the development of colonic flora and relieve the distress. In addition consult your surgeon if you are facing constipation issues.

3. Lack of proper sleep can result in increased fatigability. The cause could be plenty. I am glad to know your MRI scan of brain was unremarkable. It rules of structural causes which are sometimes associated with tumours as a cause.
Though the pills given to you are helpful, the cause may be related to anemia, hypothyroidism, stress associated with recent cancer / its treatment / occurrence of other health problems, obesity, endocrine disturbances, in adequate nutrition and hydration and so on.

Are you depressed? – I do not intend to hurt you, but depression has been found as one of the important cause of sleeplessness. Discuss with your psychiatrist if you have symptoms of depression.

At this point of time, I encourage you to continue the pills suggested to you. Your sleep cycle should settle in soon. You can consider evaluation to rule out aforementioned causes if the sleep issues persist.

4. Finally regarding your last concern, I agree with your doctor, small thyroid nodule is usually a benign condition. It doesn’t need medical attention unless the nodules grow further. An ultrasound guided fine needle aspiration cytology (FNAC) can be considered if there is any suspicion about the nature of these nodules.

Though thyroid stimulating hormone (TSH) is a good screening test to know about thyroid status of an individual, getting a complete thyroid profile is advisable to complete the study.

Hope I have provided you with enough information pertaining to your query. Let me know if I have missed on any concerns.

Wish you good health.

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