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Suggest Remedies For Persistent Diarrhea While On Gabapentin

Posted on Fri, 8 Dec 2017

Question: OK Here is the problem. Loose stools started about a month ago. Diahrhea started about 10 days ago. a solitary symptom. No fever, vomiting, nausea. Appetite normal. Don't feel sick but am tired. Slight pain in lower left side of stomach, comes and goes. No obvious blood in stools. Went to my GI doc a week ago Tuesday. Sent me to lab for tests with 4 different capsules to check for celiac, giardia, parasites, maybe c. diff can't remember it all . Seemed exhaustive.. All came back negative. I called my primary doc today to ask what he thought. He said try giving up gluten and dairy. I asked if it could be listeria since I'm eating a lot of bagged salads. He thought unlikely. Now tonight i have itching skin but it might be weather.
I had a colonoscopy 2 1/2 yrs ago - a small polyp. Had stage 3 colon cancer almost 10 years ago. GI doc said I don't need a colonoscopy. But wondering about a recurrence. Also wondering if a blood test would show anemia. Anemia was the first symptom of my colon cancer 10 years ago.
I also started wondering if it might be some kind of "salt" poisoning from using Neilmed for sinus 4 times a day. BP is normal . I don't have hbp.
Only med is gabapentin 1600 mg daily for PN due to oxalyplatin agent used in chemo. Started taking vitamins awhile ago but stopped when diahrrhea started, thinking maybe an allergy to a new vitamin -
Any other possibilities other than "salt" poisoning or colon cancer recurrence?

Answered by Dr. Ramesh Kumar (1 hour later)

Brief Answer:
Colonoscopy should be done before looking for other rare possibilities.

Detailed Answer:
Hello my dear patient,
Thanks for choosing HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.
See as loose stools and diarrhoea are not associated with fever,nausea and vomiting etc its unlikely that you have Gastroenteritis or acute inflammation in your gut wall.
Normal stool routine and microscopy test also rule out possible infestation by parasites or bacterias.

As you had a stage 3 colon cancer earlier you should definitely go for colonoscopy specially if loose stools and diarrhea does not respond to medications like imodium.Change in bowel consistence is usually the earlies sign of colorectal pathology.Anemia is usually due to blood loss but it may take some time to develop as initially body compensates for lost iron through its ferritin store.
My suggestion is that you should follow up with colonoscopy.Secondly in a patient with colorectal pathology colonoscopy should be done every 5 years as per protocol.It has been 10 years already in your case so colonoscopy is a must.

Tiredness is because of electrolyte depletion in your body.Try drinking Oral rehydration solution with coconut water and orange juices.As electrolyte level would be repleted you would start feeling energetic again.

However in case stool test and colonoscopy is normal we could treat you on guidelines of Irritable bowel syndrome.
IBS is a diagnosis of exclusion and could be suspected only when other tests are normal.
As of now my suggestion is that colonoscopy should be done.

Hope i was helpful.
Feel free to follow up.
Thank you my dear.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Ramesh Kumar (1 hour later)

Yes, very helpful. One clarification. My last colonoscopy was 2 1/2 (two and a half) years ago. GI doc said standard of care would be a colonoscopy every 5 years. However, when my colon cancer was dx 10 years ago, the symptoms began just 3 1/2 years after previous colonoscopy. Also, my father and grandfather both had colon cancer (and now me). That is why I have so much concern. GI doc I have now is not the same one I had before. Primary care physician is also new, my other guy retired. I do like your observation that I should be looking for most obvious dx and not obscure, rare possibilities. I will call both doctors tomorrow and appreciate very much your recommendations.

Answered by Dr. Ramesh Kumar (5 hours later)

Brief Answer:
Follow up answer.

Detailed Answer:
Hello there,
Thanks for follow up my dear patient.
Answers are as follows-
GI doc said standard of care would be a colonoscopy every 5 years-My dear patient protocols are usually developed to keep a check on development of new growth.Therefore prophylactically every 5 years a colonoscopy is done.However if a patient is having prime symptoms then it should be done asap.Secondly you have a very strong history of colon cancer in family therefore these symptoms can't be neglected.

I wish you a great day ahead and please do follow up with reports of colonoscopy or what your doctor suggests you tomorrow.

Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Ramesh Kumar (5 hours later)

Thank you so much. I totally agree with your advice.

Answered by Dr. Ramesh Kumar (21 minutes later)

Brief Answer:
Your welcome.

Detailed Answer:
Thank you and get well soon.
Regards!

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Above answer was peer-reviewed by : Dr. Prasad