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Suggest Treatment For Abdominal Pain And Bloating
Question: Hi Doctor.
At the end of March and beginning of April I was having a lot of abdominal bloating and stomach pain. I had been prescribed spernolactone for acne and attributed these symptoms to the drug and stopped taking them. After a week of not taking them I woke up after a restless night of stomach pain to find my face a tint of yellow. I went to the doctor 8 hours later and the yellowness had subsided and my liver wasn't swollen. They had me do blood test that came back with low neutrophil and low WBC count. A month later they had me retake the blood test and this one came back with low neutrophil ( low but not extremely low) and high lymphocyte count (high but not extremely high). The doctor recommended I not drink any alcohol or tea and then retake the blood test in a month, at which time she will evaluate the results and then refer me to a hematologist if need be. My other symptoms are extreme fatigue (sleeping 9 hours a night and needing naps in the afternoon), recently canker sores and a region of red sore gums, and continued upper abdominal achiness. I've always had a really weak immune system, lots of colds and ear infections as a child, adenoidectomy at 6, tubes in my ears at the same time. Shingles at 11. Chronic tonsilities in my 20's followed by a tonsilectomy. At 23 during the winter I had continually swollen lymph nodes in my neck and no antibiotics were working to make me feel better or reduce the swelling of my lymph nodes.
I'm a 29 year old female of european dissent (german and english) 5'8 and 135 lbs.
I hope that gives you some information on my background to be able to help me understand what may be the cause of my symptoms. Also, I am going to my cousins wedding on the other side of the country this week and I was wondering how strict I need to be with not drinking any alcohol. I would like to participate in some of the celebrations with a drink and want to know how likely having a few drinks on the weekend will be to interfering with the results of my next blood test.
Thank you for your insights. Based on my research I'm speculating I could have lupus of lymphoma but would like a doctors opinions.
I forgot to provide some information. The Family Nurse Practitioner I have been seeing recommended I take B-12 after my first blood test came back and a probiotic supplement, both of which I have been taking.
At the end of March and beginning of April I was having a lot of abdominal bloating and stomach pain. I had been prescribed spernolactone for acne and attributed these symptoms to the drug and stopped taking them. After a week of not taking them I woke up after a restless night of stomach pain to find my face a tint of yellow. I went to the doctor 8 hours later and the yellowness had subsided and my liver wasn't swollen. They had me do blood test that came back with low neutrophil and low WBC count. A month later they had me retake the blood test and this one came back with low neutrophil ( low but not extremely low) and high lymphocyte count (high but not extremely high). The doctor recommended I not drink any alcohol or tea and then retake the blood test in a month, at which time she will evaluate the results and then refer me to a hematologist if need be. My other symptoms are extreme fatigue (sleeping 9 hours a night and needing naps in the afternoon), recently canker sores and a region of red sore gums, and continued upper abdominal achiness. I've always had a really weak immune system, lots of colds and ear infections as a child, adenoidectomy at 6, tubes in my ears at the same time. Shingles at 11. Chronic tonsilities in my 20's followed by a tonsilectomy. At 23 during the winter I had continually swollen lymph nodes in my neck and no antibiotics were working to make me feel better or reduce the swelling of my lymph nodes.
I'm a 29 year old female of european dissent (german and english) 5'8 and 135 lbs.
I hope that gives you some information on my background to be able to help me understand what may be the cause of my symptoms. Also, I am going to my cousins wedding on the other side of the country this week and I was wondering how strict I need to be with not drinking any alcohol. I would like to participate in some of the celebrations with a drink and want to know how likely having a few drinks on the weekend will be to interfering with the results of my next blood test.
Thank you for your insights. Based on my research I'm speculating I could have lupus of lymphoma but would like a doctors opinions.
I forgot to provide some information. The Family Nurse Practitioner I have been seeing recommended I take B-12 after my first blood test came back and a probiotic supplement, both of which I have been taking.
Brief Answer:
Peripheral smear to be read by pathology; ANA; Sed rate
Detailed Answer:
Hello and welcome,
First I want to say that the abnormalities on your blood tests, which I looked at in the attachments, are very minimal. I think it is reasonable to pursue looking into it further, but I would not start speculating on things like Lupus or lymphoma. With Lupus, there is usually a positive ANA (antinuclear antibody) and with lymphoma, one would not usually see the very marginal elevation that you have but rather a large increase.
If you are worried about Lupus, ask your doctor for an ANA test and Sedimentation Rate (for inflammation) .
At this point what I'd suggest is a peripheral smear to be looked at by the lab pathologist. This is similar to a CBC but a pathologist actually looks at it (rather than run through a machine) and can tell if the blood cells are immature (which they always are with lymphoma) or are otherwise abnormal in appearance.
One thing I am thinking of, with the very slightly elevated lymphs and lower neutrophils, and fatigue, is a chronic low grade viral infection.
About your liver function: your AST and ALT are normal as is your bilirubin. I am wondering if the yellow tint you had after a restless night of sleep might be related to a problem where people have a temporary transitory liver problem after stress or lack of sleep (variants of Gilbert's syndrome). But I think it would be ok to have 1-2 drinks/night. It should not affect a pathology analysis of peripheral smear.
I would also recommend demanding to see the physician, not a nurse practitioner. Nurse practitioners do not have the medical training to look into something like this.
I hope this information helps. Please let me know if I can provide further information.
Peripheral smear to be read by pathology; ANA; Sed rate
Detailed Answer:
Hello and welcome,
First I want to say that the abnormalities on your blood tests, which I looked at in the attachments, are very minimal. I think it is reasonable to pursue looking into it further, but I would not start speculating on things like Lupus or lymphoma. With Lupus, there is usually a positive ANA (antinuclear antibody) and with lymphoma, one would not usually see the very marginal elevation that you have but rather a large increase.
If you are worried about Lupus, ask your doctor for an ANA test and Sedimentation Rate (for inflammation) .
At this point what I'd suggest is a peripheral smear to be looked at by the lab pathologist. This is similar to a CBC but a pathologist actually looks at it (rather than run through a machine) and can tell if the blood cells are immature (which they always are with lymphoma) or are otherwise abnormal in appearance.
One thing I am thinking of, with the very slightly elevated lymphs and lower neutrophils, and fatigue, is a chronic low grade viral infection.
About your liver function: your AST and ALT are normal as is your bilirubin. I am wondering if the yellow tint you had after a restless night of sleep might be related to a problem where people have a temporary transitory liver problem after stress or lack of sleep (variants of Gilbert's syndrome). But I think it would be ok to have 1-2 drinks/night. It should not affect a pathology analysis of peripheral smear.
I would also recommend demanding to see the physician, not a nurse practitioner. Nurse practitioners do not have the medical training to look into something like this.
I hope this information helps. Please let me know if I can provide further information.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for this response. It has given me direction, insight, and peace of mind.
Would you recommend I bother getting the 3rd CBC test as the FNP prescribed or skip it and go right to the peripheral smear instead?
I have found a new doctor as there was no working doctor at the office of the FNP.
Thank you again!
Would you recommend I bother getting the 3rd CBC test as the FNP prescribed or skip it and go right to the peripheral smear instead?
I have found a new doctor as there was no working doctor at the office of the FNP.
Thank you again!
Brief Answer:
Some information
Detailed Answer:
Hi XXXXXXX
I think after two CBCs, a manual differential/peripheral blood smear from pathology, should be the next step. I wouldn't bother getting the 3rd CBC because the peripheral smear will show what a CBC does (and more, in terms of size, shape, and age of the cells or anything unusual). If the practitioner insists on it, then go ahead, it won't hurt to get it.
One thing I want to clarify, after rereading my note: a peripheral smear WILL have some immature cells normally. It is only an issue if MOST of the cells are immature with very few mature cells seen.
Some information
Detailed Answer:
Hi XXXXXXX
I think after two CBCs, a manual differential/peripheral blood smear from pathology, should be the next step. I wouldn't bother getting the 3rd CBC because the peripheral smear will show what a CBC does (and more, in terms of size, shape, and age of the cells or anything unusual). If the practitioner insists on it, then go ahead, it won't hurt to get it.
One thing I want to clarify, after rereading my note: a peripheral smear WILL have some immature cells normally. It is only an issue if MOST of the cells are immature with very few mature cells seen.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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