Dr. Cranquis' Mumbled Gripes

TSK: "Like a toilet-bowl full of jelly"?

Cranquis: Well, Mrs. Bezoar, you can clearly see the little metal object on your son's stomach xray. So it appears that he ~DID~ actually swallow the Santa Claus-shaped game piece.
Mrs. Bezoar: Oh no! Will he be ok?
Cranquis: Oh I think so. It's already in his stomach, and in a few days to weeks, it'll come out in his diaper.
Patient's 4-year-old sister: OH NO! THAT MEANS SANTA WILL BE ALL POOPY!

TSK: The Alpha and The Omega

When the first thing you say to the Urgent Care doctor is:

Doc I think I’m gonna die from all this puking and s—-ting!

But the last thing you say to the Urgent Care doctor is:

Naw, f—- that “bland diet” s—-, the medicine worked and I’m gonna go eat a burger!

The Urgent Care doctor will mock you online as fast as possible.

GUARANTEED.

FLUTTERY INTESTINES

I swear sometimes I can feel my intestines flutter a little bit and its always really random. It isn’t painful, it just feels really weird. Is this bad or just normal digestion?

Have no fear! It’s just ripples in your intestinal tract, either from gas bubbles and digesting food matter (i.e., poop) gurling merrily along, or from your intestinal muscles contracting as part of the normal digestive process.

As for the feeling of “butterflies in the stomach” that show up when someone is nervous, this prior post explains that.

There now, feel better? :)

***Pending Cranquis-Mails: 6; Inbox: Closed***

REBLOGGED TO INCLUDE THE INSIGHTFUL COMMENTS BY DINGYACK AT BOTTOM:

dingyack:

cranquis:

UNINSURED W/ STOMACH PAIN… AND MORE!

I have abdominal pain that started out as a dull throb/stab and then progressed to feeling like I was being stabbed, all in one specific point an inch to the right of my bellybutton….

Whew. That’s a lot of symptoms to worry about, All Stressed Up and No Place to Go!…

What kinds of causes?…

Allergic: hives, flushing of hands, intermittent stomach pains (without changes in bowel movements)…

I’ve had all these symptoms (plus others) for almost two years now. One difference is I experience full body hives not just hives at my elbows. Try researching “histamine intolerance” and see if that helps at all. Stress and exercise exacerbate my symptoms (hives, headaches, joint pain/arthritis, constipation/diarrhea, asthma, eczema, abdominal cramp, insomnia), but since I’ve diagnosed myself with histamine intolerance and have followed methods in which to ease my symptoms, I have indeed felt better.

The gist of histamine intolerance is that you do not have enough of enzymes (the main one being diamine oxidase) to digest the amount of histamine you intake (histamine is in all foods. many more than others.). Since the stomach can’t digest it, the histamine gets into the bloodstream and starts messing around. It clogs joints, causes hives to build up, makes it super hard to sleep, creates asthma problems, etc. I, too, went to about 9-10 doctors and took so many allergy tests with no results. I did a bunch of research and was skeptical on claiming a self-diagnosis, but hey, it worked.

If histamine intolerance isn’t what you have, I hope you don’t give up hope on figuring this out. It took me a really long time to figure out what was wrong with me and the thing that really hit me was that there are SOO MANY different things out there that people don’t think about. None of the doctors I went to knew about histamine intolerance, which is fine, but you’ve just gotta stay strong and eager to fix your problem. Don’t let it ruin you.

So you can add me to the list of doctors who had never heard of Histamine Intolerance (HI) before. I did a bit of online research - HI is obviously a poorly-understood beast, and most of the online info is from community-run message boards and websites that are obviously selling something. But this was the best scientific article I could find summarizing the research and symptoms of HI. If you wade through to the “Clinical Picture” section, you’ll find a bunch of the symptoms connected with HI — including stomach pain, hives, headaches, flushing, and hypotension (which could cause lightheadedness). It does not mention joint involvement, though.

Since the main therapy for HI is avoidance of histamine-rich foods (see Figure 3 in that article), you may want to try that too. But a future visit with an allergist may be particularly beneficial, from the sound of it.

Thank you to Dingyack for the tip.

UNINSURED W/ STOMACH PAIN… AND MORE!

I have abdominal pain that started out as a dull throb/stab and then progressed to feeling like I was being stabbed, all in one specific point an inch to the right of my bellybutton. I don’t have a fever (in fact every thermometer tends to say I run from 96.9 - 97.4) and it’s not appendicitis. I saw a doctor and was told by 5 different doctors/nurses to try TUMS although I already had and the pain was not in my stomach. Now, it’s at 4-5 specific points in my abdomen… an inch to the right of the bellybutton, half an inch each to the left and above the bellybutton, and one near the rib under each breast. Sometimes in the middle of my abdomen above the belly button I will get the same pain. It doesn’t seem sensitive to any specfic food or anything, and coincides with and without gas, diarrhea and constipation and poop of every color, consistency, volume, and density…it seems random but it does get worse with stress, and all happen together. Along with this, I have the same feeling (that I am being stabbed) in some of my joints, usually coinciding with the abdominal pain. I also get hives pretty badly on my inner side elbow, all of these symptoms get worse with stress. A really hot rice bag can numb the pain a little bit but nothing really helps. I have tried gluten free, dairy free, liquid diets, and fasting altogether…nothing helps. Even water seems to make me feel like someone is shredding my intestines with a tiny cheese grater. I have also been getting VERY lightheaded, especially if I stand up too fast but it also happens sometimes even when I have been standing for a while. I’m 21 and never have had a blood sugar or blood pressure problem. Finally, my hands flush red (especially at the joints/knucles) sometimes, especially if I exercise. Exercise also makes my hives worse. These symptoms have all developed over the years but I may have had joint/muscle pain before and attributed to my being significantly overweight, which I am not anymore. There is no fever, loss of appetite, and rarely nausea.

I am uninsured and working on getting a doctor to see me but I am scared I will be brushed off again. Do you have any idea of what I should ask a doctor to look for or tests I should try to get? I only had the abdominal pain when I went to the doctor. OR… what do I do if I am brushed off again without making doctors hate me or think I’m a “Googler” who thinks I am better than them? (I know you hate two-for-ones so please just answer the one you think is most relevant/informative, thank you!)

Whew. That’s a lot of symptoms to worry about, All Stressed Up and No Place to Go! I went ahead and bolded the symptoms and most-important related facts, just to help me keep track of it all.

My biggest piece of advice to you would be: you need to see a doctor, but not just an ER or Urgent Care doctor. You need a primary-care physician (family medicine or internal medicine) who will be your main doctor through whatever further studies/consults may lay ahead for you. You have symptoms which could indicate MANY different causes, but if you just go bouncing from specialist to specialist without a primary doc to keep a “birds’-eye view” on everything, you might just end up more confused than ever.

What kinds of causes? Here’s some guesses about possible causes for some of the various combinations of symptoms (keeping in mind that it’s possible you could have more than one cause):

Allergic: hives, flushing of hands, intermittent stomach pains (without changes in bowel movements)
Rheumatologic: joints, skin, GI and blood-pressure (?light-headed?) symptoms — plus loss of weight (which you haven’t specified if it was intentional or not) —
Psychiatric: stress-related stomach and dizziness — anxiety?
Gastrointestinal: stomach pains + weight loss + joint pains — celiac disease, inflammatory bowel disorders like Crohn’s?
Endocrine: skin and joints, light-headed, stomach pains — thyroid?

So that’s for starters. With as many new symptoms as you’ve developed, I think most primary-care docs would do a bit of exploring at this point — but just in case, I present to you “BEHIND THE MEDIC: Tips on how to make a doctor become interested in actually addressing all of your symptoms”:

Make a concise, coherent list of your symptoms with a basic timeline + factors which make them feel better/worse, and take that to your appointment.
Number the symptoms in order of priority — in other words, if the doc doesn’t have time to address all the symptoms at the first visit, what would you like to explore first?
At the first visit, tell the doc: “I know we’re just meeting each other, so you may not have time to answer all my questions and explore all of my symptoms right away, but here is a list of my concerns. I don’t know if they’re all related, but they’ve all shown up in the past [X amount of time] and I’m very concerned about what is causing them and what to do about it.”
If the doc appears affronted at you (the cash-paying patient) being organized and trying to save the doc’s time (and your money) by developing a game-plan from the start, then take your money elsewhere and try again!
Take notes of the doc’s instructions during the visit, and keep a basic diary of how you follow those instructions between visits.
If the doc takes you seriously, but the exploration of your symptoms appears to stall out after a couple visits, inquire politely about getting a second opinion from whatever specialist the doc feels most appropriate.

It takes quite a bit of work on your part, but it will set you apart as a serious patient with legitimate concerns in the midst of the doc’s busy schedule. Good luck to you!

***Pending Cranquis-Mails: 8; Inbox: Closed***

Fast Lane Reply: “Heartburn” in a child

30somethingcrisis submitted:

Well hey, if I can’t make it to Philly, at least I can soften the blow by winning the fast lane reply. ;)

I have a question regarding my 7 year old son. He recently began complaining about a pain in his heart that felt like a “flickering flame”. When we had him point to the location of the pain, it was actually at or just below his sternum. My husband and I both came to the same conclusion that it was probably heartburn.

He continued having this sensation frequently over the next month, so we tried giving him the generic version of Pepcid Complete, and the first day his symptoms went away completely. It’s been a week that he’s taken it daily, and the “flickering flame” is back, but much milder when he takes the acid reducer/antacid. As far as I can tell, it isn’t improved or worsened by what he eats…. although his diet doesn’t include a lot or any of most typical heartburn triggers, such as fruit juice, fried foods, spicy food, soda, caffeine, and, obviously, no alcohol. Also, according to him, it isn’t there when he first wakes up, but usually begins shortly thereafter, before he eats breakfast. Since we have been using the acid reducer/antacid for a week now, and really it has been at least a month that he’s been experiencing this, I am wondering a few things: is our initial suspicion correct? Or, is it GERD? Or, could it be something completely different? I need to schedule a yearly check up in about 4 months when he turns 8, so we could address it then if it lingers; but I wonder if this is something that warrants bringing him in now? As far as I can tell, the types of food he eats doesn’t seem to make it worse or better….but, his diet doesn’t include common heartburn triggers on a regular basis (juices, spicy food, fried food, soda, caffeine… And obviously no alcohol).

[Submitted later] Because I forgot to mention it, and you’d probably ask: no, I know of no changes, such as in diet or physical activity, for my son before his burning pain/ possible heartburn started a month or so ago. And I promise, I’m not concealing something like starting him on a diet of nothing but fried oranges covered in hot sauce, like in many of your “TSK” posts. ;)

Ha! Thanks for clearing up the “hidden dietary clue”, that would’ve obviously been my first question. ;) Ok, here’s your Fast Lane Reply for winning the Facebook Fan Page contest.

Food Comas and Rashes

Hello Dr. Cranquis!

I have a two part question.
After eating a meal, whether it be at breakfast, lunch, or dinner, (or a midnight snack), I tend to feel drowsy and sleepy after eating. I’m not sure as to why this happens most of the time, but it is starting to interfere with my school work at college. I do get about 6-8 hours of sleep every night and regardless of that, I still manage to feel sleepy/drowsy after eating. It has come to a point where I will skip my lunch break in between classes so that I do not fall asleep in class. Could you help me out and explain how to prevent this from happening?

Also, part two of my question is that I have gotten two rashes since the winter. They are located on my back left hip and do not seem to go away. I have tried searching what I have through the internet, but have only come across that it is a rash and believe that it is something else. At times, they will get very itchy regardless if I am wearing any clothing. I also noticed that when I do itch it, the ‘rash’ becomes itchier until it feels painful because I am breaking the skin to a point of very minor bleeding. If the rash is not itchy and I accidentally itch (or activate) the rash, then it becomes very itchy as well. I am unsure of what this is and how to go about treating it.
Here is a picture of the ‘rash’: http://i41.tinypic.com/21brko6.png

I would like to hear what you have to say about these two topics and would appreciate the advice!

Thank you,
Fellow Tumblr

Howdy! Now, let’s be clear: what you submitted was not a “two part question” — it’s two separate questions. I’ll let it slide… for now… :)

1) Your postprandial somnolence (feeling sleepy after eating) could be totally normal, or not. Hard to say, based on the few details you provided. If you were my real-life patient, I’d get some of these details out of you:

Has this been going on all your life, or is it a recent development?
Have you developed any symptoms consistent with a thyroid or adrenal condition?
Does the amount of sleepiness vary, depending on whether the meal is high in protein vs carbohydrates?

And if nothing helpful came out of that search, along with some basic lab-work, I’d send you to either an endocrinologist or a sleep specialist for further evaluation. But for now, I gotta admit, I’m, uh, really not sure what to suggest?

2) The picture of your rash makes it a bit easier to understand what you’re describing. Your rash looks quite suspicious for either (a) some kind of contact dermatitis (Do you wear anything metallic or dyed that is in contact with those particular spots on your body? A wallet-chain, a belt, an iPod waist-strap, a fanny-pack? Something you wear during working out? You may be allergic to that), or (b) ringworm (Do you have any pets with hair problems? Do you participate in contact sports, such as football or wrestling?) My best advice, when it comes to rashes that don’t go away after trying basic over-the-counter creams for a couple weeks, is: let a doctor actually examine the rash. All the pictures and words in the world don’t outweigh the diagnostic value of being able to touch and see a rash in person.

Good luck! And no more two-for-one questions in the future, k?

***Pending Cranquis-Mails: 6; Inbox: Closed***

Medically-Correct Nursery Rhymes: Jack and Jill

Jack and Jill went up the hill,

to fetch a pail of water.

Jack fell down, due to dizziness from an inner-ear infection, and suffered a depressed skull fracture with intracranial bleed;

so Jill drank all the water herself, but it turned out to be contaminated with Giardia, resulting in a severe bout of diarrhea.

(These are the kinds of things I think about as I’m singing/patting/whispering Baby Cranquis to sleep.)

TSK: Update on “Ayeli”, the 3-month old with fever and diarrhea and dumb parents.

Remember this story from last week? It got a lot of feedback from you folks, including a few readers who wanted to know “what happened after?”

Well her folks did do the stool studies, which only showed fecal leukocytes (white blood cells in the stool) but no bacteria or parasites or blood. I called a pediatric GI doc who said that was STILL probably due to a urinary tract infection (gee, what was that test I had wanted to do on the child? something about a urine analysis or something? hmm…) and recommended treating her with antibiotics if she was still having fevers.

I then tried to contact the parents at all of the phone numbers listed in the chart. SURPRISE, none of those phone numbers work. I was on the verge of writing them a certified letter, imploring them to call me ASAP, when my secretary found the child’s pediatrician’s phone number. I spoke with that doc, who said the child had come in for a recheck visit (woah! the parents actually followed that instruction!) the day before, and her fevers and diarrhea were gone now.

So, in summary, crisis ~~averted~~ ignored, and she got better, for now.

Oh, and here’s a useful little fact to point out from this story (even though it makes me sound like some kind of money-grubbing greedy bastard, which I am not): all that extra time spent following up on the labs, calling specialists, tracking down phone numbers, writing letters, talking to the primary care provider to ensure that the patient’s case hasn’t been overlooked — that’s all done “gratis” by (many) doctors around the country every day without reimbursement, out of the goodness of our hearts and our sense of obligation to the patient’s well-being. So next time you start to grumble about how your doctor doesn’t take any time for you, keep in mind that he/she is probably spending extra time caring for you when you are NOT in the office. That is all. :)

TSK: I guess you could call it a "gut feeling".

Cranquis: Ok, Lilly, climb up on the big table so I can figure out why your tummy is hurting.
6-year-old Lilly *mumbling, obviously nervous*: Ok.
Cranquis: Now let's use my stethoscope to listen to your tummy. I bet I can hear it talking!
Lilly *small glint of interest in her eye*: Ok.
Cranquis: Hmmm... aha... oh my, your tummy says it's hungry! Is that right?
Lilly: Yeah! [Sweet! A hungry tummy is rarely anything serious.]
Cranquis *uses the distraction to palpate Lilly's stomach deeply, noticing a lack of any pain reaction*: Hey Mr. Tummy, what are you hungry for? What's that? You want a cheeseburger?
Lilly *obviously amazed*: That's my favorite thing!
Lilly's mom: Wow, how did you know?
Cranquis *winks wisely, to cover up the fact that it was just a wild guess*: Magic, I guess!

Pen in GI tract for 25 years, still writes. →

Best part of this article: paragraph 5, describing the patient’s (rather dumb) behavior that led to swallowing the pen in the first place.