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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is further consultation required for treating indigestion, IBD with rectal bleeding and anxiety?

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Dr. Ivo Ditah

Internal Medicine Specialist

Practicing since :2002

Answered : 3920 Questions

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Posted on Thu, 24 May 2018 in Medicines and Side Effects
Question: Hello,
I take 80mg lipitor, cholesterol is good. I had an artery dissection repair in '14 and have CAD. I see the heart dr every six months. I live with insomnia, chronic fatigue and IBS which has become IBD with rectal bleeding. My pcp retired. The office assigned me another md.
I went for my annual exam. I asked for celiac test not knowing you have to be on gluten for the test. He said gluten sensitive is just indigestion and dimissed it. But i think it damaged the villi and caused my symptoms. He wants me to get colonoscopy but i want ct scan and capsule camera first. What do you think?
The heart dr took blood pressure last month at my check up 120/70.
I went to the pcp for the physical, took blood pressure 140/90 and he wants to put me on meds based on one test. Is that normal?
Also the exam was 15 minutes, didn't check throat, ears or prostrate. Is that normal?
Didn't take history. Is that normal? I asked some questions about my symptoms, he stuck his face into mine almost nose to nose and smugly said "I'm VERY good at what i do".
Within five minutes he diagnosed general anxiety disorder and wants to give me lexapro but didn't tell me side effects or other options. What do you think?
Also, is lexapro temporary or permanent?
Should I get a different pcp?

Thank, XXXXXXX


doctor
Answered by Dr. Ivo Ditah 33 minutes later
Brief Answer:
I recommedn you get a different PCP if you can!

Detailed Answer:
Hi and thanks so much for this query.

I can tell there is a breakdown between the rapport you have with this doctor or you have failed to establish one. Having a strong believe in your doctor is the first and most important precondition for healing. This is clearly absent. I will recommend you get another one.

A colonoscopy at your age is highly recommended. A capsule camera and Ct scan wouldn't replace this. With rectal bleeding, a colonoscopy is the first line and not a subsequent test.

For the high blood pressure and anxiety, I will recommend you wait until this is confirmed at another visit. They require longterm treatment and the diagnosis should never be done in a hurry. A single elevated blood pressure values of 140/90mmHg doesn't meet the diagnostic criteria for hypertension.

In all, see a new PCP if this relationship cannot be repaired. I recommend the colonoscopy as a first line testing given your symptoms.

I wish you well. Feel free to keep me updated and ask for more information and clarifications if need be.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ivo Ditah 42 minutes later
Hello,is that 15 minute exam without taking history normal?
Is lexapro temporary or forever? What are side effects and other options?
Should i take it?
The bleeding only happens when i accidentally eat gluten, otherwise just IBS with irregularity. Do 'you' think gluten sensitive is a real malady and damaged the villi causing malnutrition?
If i get bleeding i check my food diary and it's only after gluten.i got seafood salad from the grocery deli, had a flare up, went to the store and sure enough it had wheat. Why seafood salad has wheat, who knows.
What are possible dangers of colonosopy/endoscopy?
So, my conern is that IBD returns even after surgery!
Biologics seem to have a lot of bad side effects, is that true?
Also, my brother passed in May from a cardiac event. The pcp doesn't realize why i would have anxiety about my health and high blood pressure on meeting a new pcp.
Thanks again, XXXXXXX
doctor
Answered by Dr. Ivo Ditah 3 days later
Brief Answer:
Seee below

Detailed Answer:
Hi XXXXXXX

Lexapro could be forever or short term. I am not exactly sure how he would have wanted to see that play out!

At your age, you need a colonoscopy for normal screening. This would accomplish both aims and assuredly, no doctor would be pardoned for not proposing this test at your age and more so when these symptoms are reported.

Be calm and relaxed during your doctor's visits. Being too apprehensive and anxious would certainly lead to increased blood pressure values which might make you to be erroneously labelled as being hypertensive.

I wish you well and keep me updated about your developments.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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