question-icon

Suggest medication for gastroparesis

default
Posted on Mon, 31 Aug 2015
Question: Hi. I've been having night sweats, chills (chattering teeth when I first get up in a morning), heat (primarily in the left side of my face, which goes bright red whilst the other side is pale) and have pain in the area of the left ovary (or left side of groin). My spleen is also enlarged (14.5 in size), and I'm seeing a Haematologist for the first time later this week. I had my gallbladder removed at the age of 16 and this caused pancreatitis. The surgeon at the time said I may have some damage in that area later in life and, for years now, I have been suffering pain around the area of the ribs, just under my left breast (the ribs are sore to touch but the pain is deeper). The pain feels like I'm being pulled down, throbs and feels very heavy in my side. Pain worsens with movement. I also have a history of polycystic ovaries, but my gynaecologist says because the pain I'm getting in the lower left of my stomach (as I look down) is worsened by walking it's likely the bowel. A few years ago I was diagnosed with gastroparesis. I recently had a CT colonography before which I did all the preparation right to the letter, including only having liquids after a certain time and drinking the bottled substance I was given at exactly 7pm for two nights before the examination. I also was having two lots of a laxative powder a day AND two laxatives before bed. I'm devastated to have gone through all that only to discover there was still "significant faeces", resulting in only a limited examination in the CT scanner. Please can you tell me if this sometimes happens as I feel so upset and worried that my gastroenterologist might think I didn't follow the instructions (but I absolutely DID)? I now don't know where to turn as surely the fact I still hadn't emptied my stomach does, in itself, suggest something is wrong (maybe gastroparesis still?)?
doctor
Answered by Dr. Anil Parth Desai (9 hours later)
Brief Answer:
Hello mam, the following are my recommendations.

Detailed Answer:
Hello mam,
I did review your concern.I can understand that you have been through a lot with health issues.
I totally believe that you must have taken all the instructions properly before undergoing the ct scan.
1)I would recommend to take higher dose of laxatives or a bowel enema before a repeat CT colon test for better visualization of colon. Some patients do not respond to normal doses of laxatives for bowel preparation and they need higher doses.

2)Your spleen is unremarkable as per CT colon report but as you said it is enlarged so I would recommend a repeat examination by a doctor or an ultrasound abdomen to determine exact spleen size.

3)Your blood count seems essentially within normal limits except few glitches like a marginally high lymph count and high cholesterol(which can be managed by proper low fat diet and exercise).

Essentially to manage gastroperesis domperidone is a great medication followed by metoclopramide. However, it is prudent that you discuss appropriate medication with your gastroenterologist.
So all in all I would recommend a repeat CT colon with stronger laxative meds and bowel enema preparation and and let me know how the meeting with your hematopathologist goes. Atleast, a peripheral smear is prudent to just rule out any hematological problems, which are less likely given normal blood findings. A repeat spleen size estimation to rule out CT colon and clinical discrepancy is needed.
I hope this helps
Wish you all the best.
Let me know if you have any more questions or concerns.
Sincerely,
Dr Parth Desai.
Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Anil Parth Desai

Pathologist and Microbiologist

Practicing since :2009

Answered : 593 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

124 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
Suggest medication for gastroparesis

Brief Answer: Hello mam, the following are my recommendations. Detailed Answer: Hello mam, I did review your concern.I can understand that you have been through a lot with health issues. I totally believe that you must have taken all the instructions properly before undergoing the ct scan. 1)I would recommend to take higher dose of laxatives or a bowel enema before a repeat CT colon test for better visualization of colon. Some patients do not respond to normal doses of laxatives for bowel preparation and they need higher doses. 2)Your spleen is unremarkable as per CT colon report but as you said it is enlarged so I would recommend a repeat examination by a doctor or an ultrasound abdomen to determine exact spleen size. 3)Your blood count seems essentially within normal limits except few glitches like a marginally high lymph count and high cholesterol(which can be managed by proper low fat diet and exercise). Essentially to manage gastroperesis domperidone is a great medication followed by metoclopramide. However, it is prudent that you discuss appropriate medication with your gastroenterologist. So all in all I would recommend a repeat CT colon with stronger laxative meds and bowel enema preparation and and let me know how the meeting with your hematopathologist goes. Atleast, a peripheral smear is prudent to just rule out any hematological problems, which are less likely given normal blood findings. A repeat spleen size estimation to rule out CT colon and clinical discrepancy is needed. I hope this helps Wish you all the best. Let me know if you have any more questions or concerns. Sincerely, Dr Parth Desai.