The original version of this page can be found at : http://www.healingwell.com/community/default.aspx?f=16&m=3860690
Posted By : Jklue - 6/5/2017 2:42 PM
Hello all. 34 year old male in good shape. For the past 6 months or so I have been battling repeat episodes of pain below my right rib (about the third rib up from the bottom) and also back pain below the shoulder blade. When this flares up it can last days to weeks and is often associated with bad belching after meals. I have been through a battery of tests, included bloods 3 times, 2 Ultrasounds, upper scope, HIDA, and a CT with contrast. Through all of this the only things that were found were slightly low rbc blood counts (just above low cut-off), a 95% ejection fraction (that caused burping and then pain for 3 days), and a single diverticulum of the transverse colon near the gallbladder region.

I was on the path to have the gallbladder removed when the surgeon asked for a CT and the diverticulum was found. There was some evidence of slight past inflammation (mild hyperemia of the omentum adjacent to the diverticulum), thus my GP thought I may be suffering from recurrent diverticulitis. I am a little uneasy with this diagnosis as it seems the pain is up under my rib (perhaps too high for transverse colon) and it almost always radiates or refers to my back under my right shoulder blade. I also seem to be set off by big greasy meals and in particular caffeine (coffee is the worst trigger). Belching can help relieve the pain when this happens. My new GI has me scheduled for a colonoscopy tomorrow to rule out more sinister causes such as cancer, although I'm not sure it would cause such symptoms? Thanks for the help!.... I'm running a little tired on Dr. suggestions and would like to hear from patient experiences. smile

Posted By : (Seashell) - 6/5/2017 3:46 PM
Jklue:
Colon cancer rates are fastest growing in the under 50 year of age group. This is leading physicians to pay more attention to persistent GI symptoms in those under 50 and to order an earlier baseline colonoscopy than is typically recommended. It is good that your gastroenterologist is suggesting the colonoscopy given the statistical upward trending in the under 50 age group.

Given that caffeine/coffee and "big greasy meals" are triggers for you, it is logical to ask if you have tried an elimination diet to see if dietary changes can quell your symptoms. Just thinking of a "big greasy meal" gives me heartburn. Food sensitivities certainly can play a role in GI Alain and distress.

Gallbladder dysfunction is more common in female than males and tends to have a heritary link. Do you have any members of your family that have had gallbladder dysfunction?

With a HIDA scan showing a 95% ejection fraction, "pure" gall bladder symptomatilogy from calcium oxalate stones or slug seems unlikely. There can be dysfunction if the valve to the gall bladder, The Sphincter of Odi. The valve can spasm, causing a backup of bike salts, and causing transient symptoms similar to a gall bladder atrack.

I recall my gall bladder attacks as extremely painful. The pain was more than a nuisance. I was unable to eat practically anything (although I am not a big eater or overly fond of food to begin with). All to say, the pain was significant to where I was losing weight week by week.

You mention gas and benching frequently. Bacterial Flora in the gut that is out of synch can be a prime contributor to gas and either diarrhea or constipation. A quality probiotic can be helpful as well as refraining from foods that are high in simple carbohydrates and high fructose corn syrup. Bacteria in the gut have their own metabolism and produce gas from their on metabolic byproducts. Bacteria in the gut enjoy dining on simple sugars and carbohydrates that you consume.

The neurology of the gut and intestines is primitively. Pain felt in one region may have no relation to where the pain is originating. This is one reason why diagnosing abdominal pain is so difficult. The site of pain is often not a good indicator of where the pain is originating.

I would encourage you to ease off if foods that you know to be triggers of your GI episodes.

I hope your colonoscopy tomorrow is all clear of any significant finding.

Let us know how your work-ups proceed. Your information may help someone else with the same or similar queary.
- K -
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Posted By : Jklue - 6/5/2017 4:39 PM
Seashell,
Thanks for the detailed response. I had read that CRC was on the rise in younger groups, and I am still worried about this, however I have not seen any blood in my stool (also had an occult test 3 months ago) and the pain hasn't been constant or getting progressively worse. It just seems to come knocking every 3-4 weeks or so. My BMs have also been pretty consistent as well (no D, etc), except they are lighter then they used to be. My CT report also said no bowel-wall thickening and no lymph node enlargement, so I guess that's good for what it's worth... although this was during a period of no pain.

I have tried the elimination diet, and have even been put on the FODMAP. This did seem to help, although if I slip up and eat meals out (that have more fat in them), or drink caffeine, I seem to relapse. Alcohol doesn't seem to bother me. I did some extensive searching on hyperkinetic gallbladders and found a number of recent medical papers (e.g. Afaneh et al., 2016) that seem to be considering this a condition doctors should take into account. From what I read >80% seems to be considered high, with >90% very high. The surgeon I met with said he had heard of this, but it wasn't a sure thing to relieve pain removing it.

When it does flare up it can last a few days to weeks and I typically loose 5-7 pounds, but then gain it back. This is mainly because I don't eat because of the pain, which I would put at an 8 or so. The worst episode was 3 months ago and I felt pain all the way up my right shoulder, almost to my neck. I wasn't able to sleep at night. It felt like I pulled a muscle. I guess with the "referred" pain I was trying to convince myself that right shoulder pain couldn't come from the colon, but I really have no clue. I had read that the nerve receptors from the biliary tree enter the spine at the same spot as the upper right back/shoulder.

Thanks again for the response. Also, my mother just found out she has a distended gallbladder and also Addison's. My sister has microscopic colitis.
34 year old male
Life long asthmatic
Chronic hives
URQ pain since Dec. 2016 (unresolved still)

Posted By : Jklue - 6/6/2017 6:53 PM
Update: Just got out of colonoscopy and feel much less out out if than the upper GI. Doc found a flat (sessile) polyp 2-4 mm in the hepatic flexure. Also found out I have diverticulosis (which I knew) and internal hemorrhoids (which I suspected). Unless the polyp comes back cancerous I think the focus shifts back to the gallbladder. More fiber is coming to my diet.

Worst part of this whole thing was the prep, and then overhearing something getting diagnosed with Lynch syndrome right before I went into the procedure room sad I feel really bad for this person.

I'll post more results when I get them
34 year old male
Life long asthmatic
Chronic hives
URQ pain since Dec. 2016 (unresolved still)

Posted By : (Seashell) - 6/6/2017 9:43 PM
Jklue:
Three cheers for making it through with the colonoscopy. People often cringe at having a colonoscopy and avoid or delay having the procedure. Now you can be an advocate for your friends as they approach the need for a baseline scope.

Thank You for taking the time to update your thread. Once someone posts with a concern, the members here genuinely care and take a vested interest in hoping that a positive resolution to the presenting concern is actualized. People that you may never meet in person care about you and want the best for you.

Now you know what the inside of your colon looks like. Scattered diverticuli and scattered internal hemorrhoids. That's good that he was able to remove the polyp. Flat polyps can be difficult to resect. You'll be in good steed as you age having this baseline colonoscopy at age 34.

You're correct to feel a twinge of emotions for the individual identified with Lynch Syndrome. Understanding that other people are enduring their own health challenges does help place one's own miseries in perspective.

Since you may be recirculating to the gall bladder as a source of your symptoms and woes, do talk with your gastroenterologist about Sphincter of Ode dysfunction. Here the valve to the gall bladder spasms intermittently - resulting in gall bladder occlusion type symptoms.

You may also want to explore clarification of the superior mesenteric artery (SMA). This is a fairly rare disorder and requires an astute physician to make the diagnosis. Intermittent blockage of the SMA causes pain radiation similar in distribution to your narrative. People affected are fairly miserable with transient episodes of pain and limited ability to eat. The condition is successfully treated by surgery to respect the segment of SMA affected.

I am sorry to hear that your mother has been diagnosed with Addison's. I have Addison's myself. It can be a challenge to find the optimal dosing and timing for replacement hydrocortisone and Florinef. MDJunction has a fairly active online support forum.

I hope that you and your gastroenterologist are able to narrow the focus of possible conditions. In the meantime, "go easy" on greasy meals and coffee which have aggravated symptoms in the past.
- K -
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Posted By : Jklue - 6/7/2017 2:22 PM
Seashell:

Thanks again for following up. I agree with you-- I have read many post in which the original poster never follows up.

I will be waiting on the biopsy results from the polyp, but the doctor didn't seem to concerned when he came in after the procedure. My memory is a bit fuzzy, but I remember him saying he removed a small flat polyp and to eat more fiber. I blame the diverticulosis and hemorrhoids on my fast-food midwest diet growing up. Since I met my wife 5 years ago it has been fresh fruit and veggies-- going to stick with this.

One thing that was strange is that I starting running a low fever just before the procedure. I still feel it today and wonder if it was from the prep/dehydration, or simply my immune system getting run down from dehydration/no food. If it continues I plan to call the doc.

My mother suffers from a long list of ailments, Addison's being one of them. She basically has no immune system left (CD4 count stays around 200), and she has been on steroids so long that her bones are starting to break (including the spine). Resting blood pressure around 210/110. Over the past 10 years doctors have been unable to find the cause, some saying carcinoid syndrom, others saying autoimmune. Her struggles has put my "small" issues into perspective....
34 year old male
Life long asthmatic
Chronic hives
URQ pain since Dec. 2016 (unresolved still)

Posted By : (Seashell) - 6/7/2017 11:29 PM
Jlklue:
A low grade fever presenting BEFORE the colonoscopy would likely be attributable to dehydration caused by the colon-cleansing prep.

Be certain to rehydrate your body with high quality clear liquids or the electrolyte packets available (ex. Emergen). Avoid high sugar sports drinks (Gatorade. sport drinks (Gatorade, Power Ade).

Experienced gastroenterologists have a good ability to visually identify a polyp as benign or malignant one. That your gastroenterologist is unconcerned should ease worries as you wait for final microscopic biopsy results.

Which leads you back to considering your gall bladder. Also discuss Sphincter of Odi and intermittent occlusion of the superior messenteric artery (SMA).

Addison's is a serious, life-altering condition. I am sorry that your mother has so many health complications stemming from corticosteroid use. I am in a similar predicament. The corticosteroids that keep me alive are also eroding my body and organs. It is a surreal experience.
Finding an endocrinologist with pituitary and HPA axis speciality has been key for me. I wish your mom well. It's a difficult course with Addison's.

We are here for you however you may need.
-k -
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Posted By : straydog - 6/9/2017 6:46 AM
Karen is right about getting hydrated well after a scope. I have crohns & UC & have had more than my fair share of scopes. I too am thinking you have a possible gall bladder issue that is rearing its head. Stick with your current diet.

Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums

©1996-2017 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer