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Suffered nausea, vomiting, constipation and abdominal pain after taking tetracycline for acne. Weight loss and fatigue. Any opinion?

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My fourteen your old daughter was prescribed tetracycline (antibiotic for acne) by her dermatologist in November. She took the prescribed dose for about a week and had to stop because she had nausea, loss of appetite and felt as though she was constipated. In December I took her to the ER because she would vomit/regurgitate after a meal and would suffer from severe abdominal pain. She has considerable bloating (Her navel is protruding which it never did). She has extremely loud gurgling sounds coming from her stomach/intestines that sound like a water drain when the plug is released. She is under the care of a GI who currently has her avoiding dairy products but she is not exactly following the advice. Blood work will be the next step. He seems to want to avoid scoping her except for a last resort. This has affected all of our lives. She has lost weight and is painfully thin looking and has lost her energy. She seems tired a lot. I am very concerned and would like to know if this is something that can be turned around? Should I be pushing for more answers or is this a slow process to figure out the cause/treatment?
Posted Mon, 8 Apr 2013 in Child Health
 
 
Answered by Dr. Grzegorz Stanko 12 minutes later
Hello!

Thank you for the query.

Intestines are covered with many useful bacterias (lets call them good bacterias). This bacterias do produce vitamins and its presence protects intestines from patologic bacterias development (bad bacterias). When you do take an antibiotic, the good bacterias become weaker and its amount drops down, so the bad bacterias can now grow freely. And most likely this is what has happen to your daughter. Some kind of balance has become destructed and now she is having symptoms from digestive tract which has never been there before. In some cases such patologic bacteria presence causes severe symptoms and we do call it IBS.
That is why my advice for you is to start with removing this bacterias. To do that, you should try Rifaximine antibiotic (this one kills the bad bacterias and leaves the good once) along with probiotic supplementation.
If it wont help, than you should start looking for another reason. And this should not be slow process, as your daughter is growing and this process needs proper nutrition. You should keep pushing your doctor to keep looking and do not wait for miracle. Stool tests and blood work should be done right away as well as pancreas and liver tests. Same with abdominal ultrasound.

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffered nausea, vomiting, constipation and abdominal pain after taking tetracycline for acne. Weight loss and fatigue. Any opinion? 2 days later
I did follow up on some of your advice regarding not waiting for a miracle. I contacted the GI who ordered additional labs and xrays. xrays showed an abnormality which required a visit to the ER which in turn became an admission. CT scans with contrast confirmed an abnormality and an obstruction. My daughter had surgery this morning and a portion of her intestine near the illeum was removed. Everything else appears to be fine. The diagnosis as of now seems to be Crohn's disease which we are being told can be controlled with diet and meds. Surgeon indicated that there may be a possibility that the removal of the obstruction may end up becoming a cure or may put the disease in remission. Any thoughts?

Thanks for your help,
XXXXXXX
 
 
Answered by Dr. Grzegorz Stanko 11 minutes later
Hello!

It is very hard to tell which person with Crohns disease will need one surgery, which will need no surgery and which will need more surgeries. This disease is an autoimmune were the immune system attacks hosts tissues. And the reason of such behavior lefts unknown. However nowadays we do have biological therapy which gives great results and it is possible that your daughter wont need any further surgery.
What does worries and terrifies me is how your doctor could ignore bowels obstruction. This could happen worse.
Hope now all will be fine.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffered nausea, vomiting, constipation and abdominal pain after taking tetracycline for acne. Weight loss and fatigue. Any opinion? 17 days later
I understand that it is not possible to look into the future to determine whether the Crohn's disease will present symptoms and problems again. I have a difficult time even believing that she actually was diagnosed with Crohn's. There is no family history. Is it possible that this obstruction could have been caused by something else?

Also, the GI doctor prescribed the medication Pentasa (2 500mg capsules by mouth twice a day) at discharge. She has a post op follow up on Monday with the GI and the surgeon. I am reluctant to start the medication because if the diseased area has been removed, and according to the surgeon, everything else looked normal and healthy, why put her on the medication that she may not even need. Does this mean she needs to be on medication for the rest of her life?

I am looking forward to your input.
 
 
Answered by Dr. Grzegorz Stanko 11 hours later
Hello!

Young age, bowels obstruction and inflammation in the ileum area are very strong and characteristic symptoms of Crohns disease. So I really would like to give you some other diagnose than Crohn, but in this case it is impossible. So it seems like there is no other possible reason of such obstruction.
Pentasa is a medicine which task is to prevent your daughters intestine from further inflammation. Without is, most likely the disease will strike in other place. That is why it is necessary to use this medicine to have her in remission. Not giving it to your daughter you cut off her chances for health and proper growing. And yes, unfortunately it might be necessary to use this medicine permanently. But you should try to find it as positive, as some Crohns patients does not respond for this medicine so the disease can not be stopped with it.

Hope this will help.
Regards.

Above answer was peer-reviewed by
 
Follow-up: Suffered nausea, vomiting, constipation and abdominal pain after taking tetracycline for acne. Weight loss and fatigue. Any opinion? 10 days later
Hello,

It seems that with each step we take I come up with more questions.
My daughter has had her post op follow up. So far everything looks good. She will have blood work in two weeks and will be scheduled for a colonoscopy in about 2 months. She is taking the Pentasa as directed and has been feeling fine. Her Gastro dr. has also prescribed 2 50mg tablets by mouth everyday. After filling the prescription I read that this medication can increase her risk of developing skin cancer and lymphoma. My 15 year old son just completed his treatment for Hodgkins Lymphoma. Needless to say I am extremely concerned. I have decided not to give her the medication. I would like to see what the colonscopy shows. What is your opinion?
I failed to mention the new medication....it is Imuran 2 50mg tablets by mouth once a day.
 
 
Answered by Dr. Grzegorz Stanko 1 hour later
Imuran contains Azathioprinum which is an immunesupressive medicine. This means it suppresses host immune system and prevents it to attack own body cells.
One of side effects of it are skin cancer and Non-Hodkins Lymphoma indeed. However this side effect appears very rare with frequency about 1 to 10 000 cases. Moreover, Hodgins Lymphoma (not the one caused by Imuran) is caused by EBV infection and in most cases is not hereditary (however in some cases it can be).
This is the theory. Who will get the cancer after this medicine is unknown.
According to guidelines of Crohns disease, Pentasa is the first medicine which should be used in inflammatory type of Crohns disease and there is no need to use such strong medicine like Imuran.
Imuran should be used in the first row only in fistulizing type of Crohns disease (when it causes fistulas).

So it seems to be good decision not giving it (however it should be consulted with your gastroenterologist).

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffered nausea, vomiting, constipation and abdominal pain after taking tetracycline for acne. Weight loss and fatigue. Any opinion? 2 hours later
My daughter did in fact have a fistula but I am still reluctant to start her on the Imuran. I really don't want to take this risk. I think that once we have the results of the colonoscopy we may be in a better position to decide what medications are absolutely necessary.
 
 
Answered by Dr. Grzegorz Stanko 11 hours later
I understand. Imuran is quite strong medicine. Can not advise you to do not give Imuran (it should be your doctors decision).
However in my opinion you may try Pentasa only. Especially if your daughter does not have any symptoms. Just be aware of gas or stool blockage, abdominal pain, diarrhea, constipation, blood in stool, mucus in stool. Any of this symptoms can indicate disease recurrence.

Hope this will help.
Regards.
Above answer was peer-reviewed by
 
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