Question: Hello - my mother is a 61 year old who has been poorly for the past few years. She has had various bouts of vomiting and diarrhoea over the past few years, several of which have meant she's ended up in hospital through dehydration. She's lost a fair bit of weight over that time and last year had an endoscopy, ultra sound and colonoscopy. The latter showed 3 polyps - one of which was large and bleeding (mum was quite anemic) and was located on the right hand side of her colon very low down (near groin area). She had this removed but continued to feel poorly - vomiting etc. She had the metal plate in her leg removed but continued to feel extremely nauseous every day. A couple of weeks ago, she had another bout of D and V and was hospitalised. She had lots of blood and stool tests and nothing showed up so it was thought Mum had a virus. The gastro enterologist suggested she come off co-codamol (which she has been on for several years for rheumatism). She has done this and thinks it's making a difference but it's difficult to tell due to after effects of virus still in system. Today, she had a follow up colonoscopy to the one last year and the bowel prep hadn't worked properly so it was difficult to get a clear view. However, the gastroenterologist said that he couldn't see any large polyps but it was possible that small polyps were present and hidden by waste still in the colon. He did say that at one point, her colon was very narrow and he struggled to get the scope through. He said there was a patch of inflammation at this point and it was immediately above the spot where the large polyp had been removed last year. He said he did manage to get the scope through and couldn't see a growth. However, he seemed quite concerned and said he had taken a sample of the inflammation. We now have to wait 2 weeks for the results. Also mum probably will have to have another colonoscopy as bowel wasn't entirely clear. I am worried what might be causing this. He didn't think it diverticular as there were no pockets. Mum has had radiotherapy 30 years ago when she had cancer of the cervix. She ended up having the cervix removed but her ovaries (such as they are) remain. She has had a niggling pain in the spot where they initially found the polyp for quite some time. She had a bone x XXXXXXX on her hip in case it was that, but it was clear. She still does get the niggling pain though not as much. I suppose what's going through my mind is what's the likelihood of this inflammation being a symptom of cancer? Also, could it be likely that the narrowing of the colong is due to something behind it, rather than in it? Could it be something affecting her reproductive organs that's impacting on the colon? Mum does have a history of Clostridium Difficile - which she has had 3 times over the past 10 years. She recently had a lot of blood and stool tests (the latter mainly for bacteria) but they have all come back clear. We have recently had 2 bereavements and Mum is physically and emotionally exhausted. She is upset and I now can't get hold of the Consultant she saw today as he is on leave. Is there any light you can shed on this for us??? Thanks so much, XXXXXXX

Hi Dr Shanthi

Thanks so much for your very clear reply.

Can I ask what cachexia is please?

Also, the gastroenterologist, Dr XXXXXXX said that although the bowel prep hadn't worked well, he could tell there were definitely no large polyps. He wanted to redo the colonoscopy as there was residue of waste products lining the colon and might possibly be hiding small polyps. He confirmed that the narrowing could be generally caused by a growth but he said he couldnt' see one.

The vomiting has been going on since XXXXXXX 2009. It began after my mother broke her leg and had a metal plate and screws inserted. Every 10 days or so, she would have attacks of vomiting to the point of dehydration. She would then collapse and be hospitalised. So many tests were done and only the polyps were found last year which seemed to be causing anemia.

Mum then had the metal plate out of her leg this year in February and the vomiting ceased. However, she's had nausea (she describes it like travel sickness or morning sickness) every day for varying periods.

It seems she might be wheat intolerant and she can certainly not now take iron since the metal plate was inserted. That has a dreadful effect on her - vomiting profusely. Also, certain antibiotics bring about the same reaction. When she had the last bout of vomiting 2 weeks ago, it was actually following diarrhoea. This was following her having taken a betaine hydrochloride tablet as one gastroenterologist thought her stomach acid levels might be low and she might not be digesting her food properly (she has also been diagnosed with gastritis).

We are wondering if Mum is just too sensitive to certain chemicals and this causes upset for her. Hence, she has now stopped taking her codeine medication and up until the recent colonoscopy (which has made her feel unwell), she had started picking up a bit.

She has had changes in her bowel habit all the way along. Notably, when she first started these vomiting attacks in 2009, if she had diarrhoea, she wasn't sick. She used to say she could feel the discomfort and pain start in her stomach and work it's way through her body to the abdomen. She used to describe the feeling as like being poisoned. It was almost as though her body had to cleanse itself one way or another. One of the paramedics thought she had a blockage but the colonoscopy last year and barium enema revealed nothing. Perhaps it's possible her bowel was just constricting? Perhaps that's what is happening now, and she is struggling to get rid of her food, hence she can sometimes not go to the toilet for a couple of days then have diarrhoea.

If this recent colonoscopy and the battery of blood, stool and urine tests she had 2 weeks ago didn't reveal any growths or anomalies, would you say that if there is anything cancerous there, it sounds likely that it might be at a stage that's treatable? I know it's difficult to say with any degree of certainty but I'm just wondering what this all sounds like to you.

She has done another stool sample today to test for pancreatic functioning. However, she did have an ultra sound in the Summer of 2010, just after the endoscopy to look for anything to do with gallbladder etc. She had a general sweep of her abdomen too and nothing could be seen.

Although she has lost a lot of weight since she broke her leg nearly 3 years ago, she has maintained this for a while now and is not underweight. She doesn't have a huge appetite but is quite low in mood due to the prolonged length of time she's been ill and all the tests she's had. She is finding it difficult to get on with her life. She's also scared to eat in case something in the food is triggering a reaction in her stomach and bowel. So, she isn't eating a great deal.

She is intending to go back for the repeat colonoscopy but each time she has a test, it seems to knock her back. She was just starting to pick up before this and now is tired and feels off colour.

Thanks for listening and for your help.
XXXXXXX
PS - The polyps she had last year - 2 smaller ones very close to the anus and the larger one in the proximal sigmoid. This is where the current patch of inflammation is and narrowing of the colon. The Consultant said it wasn't present in last year's colonoscopy.

Dear dr shanthi
Bless you for your response. My mum is very precious to me.

I have discussed your responses to me and she just wonders what medication can be given for inflammation of the colon (if that's all it is). Also, is the narrowing of the colon wall (only seems to be on one side where polyp was removed) due to the inflammation? And if so, will the colon remain narrow or will it widen? I think she is worried about it closing up altogether and whether she might have to have an operation to widen it.

Thanks so much. I'm sorry to keep asking questions but I am feeling clearer and more optimistic as a result of your answers. Its been a very touch 3 years for us. But all in all, it doesn't seem as though mum has got worse over that time. Certainly the vomiting has almost entirely ceased apart from isolated incidents. It's more the nausea that's been the problem, which we are hoping might fade now she has given up the co codamol tablets. She very occasionally has days or times when she feels "normal". It's just that these haven't lasted.

Fingers crossed for the best! We have recently lost our 2 little dogs and I know that has impacted on her mood. I so hope mum can be treated soon now so she can have more of a satisfying life. She deserves it.

Thanks again. Take care

XXXXXXX