Suggest treatment for sever abdominal pain and blocked sinus

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Posted on Mon, 8 Jun 2015 in Digestion and Bowels
Question: Dear Doctor,

I have been suffering daily since the last 8 months...My problem started in Oct 2014 with acute pain in the stomach--like cramps and twisting pain in the abdominal area --This used to happen whenever I would eat any food --especially more intense after meals..I was also unable to pass motions daily and this was impacting my sleep since my stomach would bloat and there would be severe pain if I didn't pass motions that day . I felt severely constipated and fatigued throughout the days........I visited five gastro's at prominent hospitals who recommended to me tablets like Superia / Rifagut/Entogermica/Normaxin/Lactifibre/ Colospa Retard/Drotin/ Pega move...I did every tests related to the abdomen and it came normal..endoscopy..CT Scan..sonography...blood tests....Drs said my gut was hypersensitive...With these tablets the pain subsided (though not completely) and the bloating sensation stopped and I was able to eat food without the fear of any pain on intake of food....the abnormal and difficulty in passing motions however still persisted....However after this another problem arose....My head consistently felt heavy on the intake of food ....the area behind the eyes particularly feels heavy and because of this I am unable to sleep daily....even though I am exhausted at nights I cannot sleep because my head (sphenoid area) feels heavy...I did a CT scan of the Para nasal sinus and it showed found that my frontal and maxillary sinuses are blocked ...A small polyp/mucus retention cyst is seen in the right ethmoid air cell .minimal mucus thickening is seen in both hemi -sphenoid sinus causing obliteration of the ostia...I then visited 3 ENT’s who recommeded to me nasal sprays with no relief...I tried duonase nasal spray and Flomist Nasal spray and was getting suffocated with this spray....My main problem is that on the intake of food....i feel a strong pulling catch in the sinuses.....like the whole area is blocked ( similar to the feeling of wax in the ear) ..i feel the cranial nerves behind the head get strained and as a result of this I am unable to sleep every night nor can i concentrate or do anything...The moment my stomach is cleaned and I pass motions...the muscles in the head are eased and I feel good and only then can i think and sleep ..as a temporary relief measure I use a water based enema daily...I find that only when I take an enema to relieve my guts only then can I sleep peacefully...else whenever there if a food intake and no motions that night i cannot sleep...what is the linkage between these two problems ? How do I get it resolved ?Why is this happening ? what is the correlation between the head and the gut...i feel depressed almost every day and each day is a drag ....
doctor
Answered by Dr. T Chandrakant 2 days later
Brief Answer:
Some practical and some out-of-box thinking/ 5 Gastro and 3 ENT seen

Detailed Answer:
Hi.
Dear friend. I am getting an opportunity to answer your question as these are associated with my two specialty.
I am Dr T Chandrakant, practicing General Surgeon and an ENT Surgeon.

I can understand the plight you must be going through.
Yes, there is a relationship of both the problems as you have been experiencing and as noted by you above
>> .My main problem is that on the intake of food....i feel a strong pulling catch in the sinuses.....like the whole area is blocked ( similar to the feeling of wax in the ear) ..i feel the cranial nerves behind the head get strained and as a result of this I am unable to sleep every night nor can i concentrate or do anything...The moment my stomach is cleaned and I pass motions...the muscles in the head are eased and I feel good and only then can i think and sleep

Let us solve the riddle one by one:
- Since all the investigations done for the abdominal issue are essentially normal and you have been seen by 5 Gastros and got a lot of relief with the medicines you have mentioned, this is suggestive of IBS-C, Irritable Bowel Syndrome of Constipation variety.
The best part is tat the water based enema is helping you so much as to empty the bowel, have sound sleep then and relief of the head problems.

Your second problem is related to the > 'head consistently felt heavy on the intake of food ....the area behind the eyes particularly feels heavy and because of this I am unable to sleep daily'' ... CT PNS findings noted - 3 ENTs and nasal sprays causing more problems. - .My main problem is that on the intake of food....i feel a strong pulling catch in the sinuses.....like the whole area is blocked - unable to sleep every night nor can i concentrate or do anything - relieved by passing motion... (irrespective of the so-called positive findings in CT PNS)..

This means the head problem is necessarily related to intake of food and the passing of assisted motion.

Hence the correlation goes as thus:

Stress and anxiety are the basic causes of both the problems.
There is an aggravating factor and a relieving factor- same for both the problems.

The solution:
Control of the stress and anxiety or any other factors, which you must have noticed but not bothered to be related to these problems as they would have been very trivial or unrelated as per your thinking.

The root problems are related to the following factors and it is up to you to list them, write them and think over them; some are easily solvable some are difficult to but nothing is impossible. Everything has a solution.
- Personal
- Familial
- Sexual
- Spiritual
- Social
Think over these, list them write them, share them with someone to get a solution as you may not.
I know this is out-of-box thinking but helps all my patients with similar problems and should help you too.

Coming to the Medicinal / Surgical part of both the problems:
- By this time you must be knowing which medicines work the best for you and you should continue on including the daily water based enema.
- For the CT scan PNS > Most of the CT scan we do usually show some or the other problems due to the increased pollution and so on; your problems have to be correlated with the clinical picture on ENT examination (ENT ENDOSCOPY), blood reports and the CT findings.
Unnecessary surgery may not solve the problem and may in fact increase in some patients. I hope no one has advised you to undergo any surgery.

I would advise you the following:
Almost all the changes in the sinuses may just vanish on a 3 week course of a oral antihistamine and steroids like Deflazacort (if available in your country) or whichever in a ''tapering dosages''. Since this is a prescription medicine, you will have to take help of your Family Doctor or so.
I am hopeful that this will help for both your issues.
Just see that you are not diabetic (the only contraindication for oral steroids).
Topical sprays are causing you the problems.
- Medicines that can help you for the anxiety/ stress / depression - all are again prescription medicines.
Dear friend, I have tried my best to understand myself and make you understand the problems, discussed and gave you the solutions.
This helps all my patients with similar issues and should help you also. Start today and let us see the progress.

Please feel free to communicate more, this will help you more, ask relevant queries if you feel so or if you feel there is a gap of communication.





Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 14 hours later
Dear Doctor,

The cause of ,my problem is definitely not stress related...I have been sitting at home and there is no stress at all in my life..no problems....social, sexual, relationships..everything is fine...the only problem is my health issues...I fail to understand what the real cause of the problem is ? Can you explain what is the relation between the head problem and the intake of food and the passing of assisted motion ??
doctor
Answered by Dr. T Chandrakant 4 hours later
Brief Answer:
There are nerves connected

Detailed Answer:
Thanks for your positive feedback and nice to know that you do not have any stress.

Your concerns:: .I fail to understand what the real cause of the problem is ? Can you explain what is the relation between the head problem and the intake of food and the passing of assisted motion ??

There is direct association between the head problem and the intake of food as the nerve called a Vagus nerve supplies both the area and hence both the problems are interconnected as you have explained up.

Similar nerve pathways via the sympathetic and parasympathetic govern the evacuation of the bowel are also connected to the area of affection in the head and sinuses, hence your problems are inter-connected.

I hope this clears your doubts.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant 8 hours later
Dear Doctor,

Thank-you for the insights...I did Google it and read up on this ...is there any specific tests I can do to find out if I have Vagus Nerve disorder ? or any medication that would help my condition ?
doctor
Answered by Dr. T Chandrakant 2 hours later
Brief Answer:
An opinion and further treatment under Neurologist also.

Detailed Answer:
Sincere thanks for your appreciation and very happy to know that you are getting near to the diagnosis as you wanted.

The discussion about Vagus syndrome will be beyond the ambit of this discussion, I would request you to consult a Neurologist for knowing the details and get to the root cause as well as to get a proper treatment.
This is highly specialized field and I hope the best person to tell you the details is a Neurologist

I hope you agree with me. If you read it on internet, there is detailed information in many many pages.
Please feel free ask further relevant information if you need to or if you feel that there is a gap-of-communication.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 17977 Questions

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