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Exacessive bloating with IBS, ENDOMETRIOIS and FIBROMYALGIA.

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Hello My name Joseline I have been diagnosed with IBS, Endometriosis, Severe Chronic Pain and Fibromyalgia, I had 3 surgeries 1 myomectomy, cyst removal, and last labroscopic, and since the cyst removal I have been having excessive bloating to the point I can't fit my clothes, I am a vegetarian, and I don't eat as much my food allergies are very extreme, I don't eat meat, and havent eat meat for 13 years old patientI have cut out mostly everything in my food diet, but still fill excessive bloated, I looked online and find Copper Toxicity could it be that's my problem, cause its to a point that anything I put in my stomach I get excessive bloated, and I have done and Upper and Lower EGD the doctor said my inside looks like an 18 year old, I am 35 years old patientold, please help me I feel that there something inside of me that my body is either producing to much or not producing enough....


Category: Family Physician-GP

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Category: Family Physician-GP
Dr. Mayank Bhargava is online now

Expert:  Dr. Mayank Bhargava replied 4 Days.

Hello,
Thank you for choosing DoctorSpring,
I have thoroughly gone through your concerns and I can say for sure that your symptoms are not due to Copper toxicity. There will be other associated symptoms which for sure are lacking in you. One exception is a condition called Wilson disease which is caused by chronic accumulation of Copper. But again this would not be my first diagnosis or concern when it comes to your symptoms.
What we need to know is whether the bloating is by air or fluid/mass. If the bloating is mainly gaseous it could be from diet or bacterial over growth. Assuming that you have tried various diet combinations and nothing has worked out I am ruling out a diet factor. This leaves the option of bacterial overgrowth. For this I would recommend a probiotic drink or capsule for 3-4 days twice a day. If that is not working / already tried a course of antibiotics like Rifaximin can be considered.
Another cause is hormonal. Low levels of thyroid hormones can cause this too. So if the probiotics and antibiotics are not correcting the problem then I would recommend a step by step approach that consists of a Ultrasound of abdomen, liver, renal and thyroid function tests.
Inorder to consider other possibilities I need some more information from you :
I would like to know how your peroids are now ? Are they regular ?
Are you taking any medications (like birth control pills ?)
Do you pass gas often or is there belching ?
Is there any swelling of your legs ?
You can reply as a followup
Thank you


Patient replied :

I would like to take this time and say thank you for listening to me and blowing me off, how would I know if it's by air or fluid mass. I was tested for thyroid already they didn't find anything in my result, I was also tested for an ultrasound everything is fine, they found a tiny fibroid which they said it's to tiny to be a concern, I pass gas every no and then, and I don't really belch as often. I have taken rifaximin it made me extemely bloated and constipated, My periods are extremely irregular I bleed really heavy for 7 days, I have been on Lupron shots for 6 months i was still bleeding heavy, and birth control pills as well, I was on Nuvaring for a month then it burn inside of my vagina then i stopped, and i have been on several heavy pain meds such as dilaudid, morphine, fentanly patch, oxycoden, oxycotin, hydrocodine, percocet, and my system kicks all those pain meds back after a month i become imune to them, i been on them for several years old patientuntil the doctor gave me methadone then i stopped cold turkey last year after my cyst removal surgery and the doctor fix my intestune since they all were stuck to gether and i. The wro g placed and the doctor cut have of one of my ovaries, then 3 months after my surgery in August ladt year the excessive bloated began slowly and surely, and i dont eat much, i started taking digestive enzymes but then i got bloated mote again so i stopped that was the only medication i was taking i have been fiagnose with SiBO too the doctor gave me meds which didnt work, so you can see i have tried so many diff5 options and i went from 160 to 190 lbs and i eat healthy, since.my.last surgery i was finally able to go to the bathroom on my own without laxatives which i was on for 13 years, so you can see why i am sonpersisted with finding out whats wrong with me, and the doctor said they left me surgery table too long, anf i am left with a dislocsted bone on my lower back excruciating pain, and i refuse to take any pajn meds cause i am tired of the pain the bloating excessivley please help me find out whats wrong with me cause i know its something inside of me that i am either porudcing to much or to.little, and all my food are organic...........often often


Expert:  Dr. Mayank Bhargava replied 3 Days.

Hello.

Thank you for the additional information. I will do my best to help you.
Keeping in view your complete history, the bloating and abdominal distension seems to be due to gas. Fluid or mass causing distension can be felt on examination and will be seen on Ultrasound.

Diet, hormonal changes etc have all been ruled out as causative factors for the bloating. The most likely cause for your symptom is your IBS. Patients with IBS frequently complain of abdominal bloating and increased gas production in the form of flatulence or belching. However, the truth of the matter is that there is usually no excess production of gas. Such individuals have a gut with a heightened sensitivity to normal amounts of gas. This is not a cause for worry.
The good thing is it can be effectively managed.

I have the following suggestions.
-Since you are already on diet control, I am assuming that you are avoiding all gas-producing foods such as cabbage, onions, broccoli, brussel sprouts, wheat, and potatoes. Probiotics should be taken improve the good bacteria in the gut.
-You can try OTC Simethicone, if you haven't already, about 80 mg after every meal to help reduce symptoms.
-In case that doesn't work for you, you can take Dicyclomine 20 mg, orally, up to four times daily as needed in consult with your doctor.

I hope this was helpful. Let me know if I can assist you any further.
Thank you.


Patient replied :

It's not IBS that's what I mentioned in my first question I had a Doctor who was working on me with helping me with this diagnosed and he died, he last told me that it's similar to IBS it's not Chrones disease , it cannot be detected through an ultra sound you only can find it if you're looking for it, that's what the doctor told me, my body is producing too much or to little ofnit, and I fall under 1 and million with this rare disease, and when he was gonna tell him to follow up with him that's when his wife called me and say he had a heart attack and died.....so please take your time and see what other disease falls under similarly not IBS.....and as I mentioned I have tired those medication already and doesn't work makes me worse....


Expert:  Dr. Mayank Bhargava replied 2 Days.

Hello. Thank you for the follow up.
I have gone through all your symptoms again. Just to reinforce most of the symptoms that you described point towards Irritable Bowel Syndrome or Inflammatory Bowel Disease. But since both of them have been ruled out and you have also taken the medicines for the same, other less coomoner causes of bloating can be discussed.
As i mentioned in my earlier reply, it can be due to bacterial overgrowth syndrome in the stomach, and hence i suggested Tab. Rifaximin. I positively feel that Tab. Rifaximin twice a day for 7 days, coupled with probiotics will be helpful in your case. If Rifaximin was not tolerated last time, then you can use Tab. Metronidazole 400 mg three times daily for 7 days, Also in addition in case it is due to parasites, I will advise Tab. Mebendazole 150 mg one dose at night time, followed by another dose after 3 days.
The other causes that can lead to your condition are :Celiac Disease, Parasitic infestations such as Hookworm disease, or Giardiasis. If these are the causes then the medicines i recommended will be helpful.

You mentioned that the doctor said you have something rare, and your body is either producing a lot of it, or very less of it. Since everything else has already been ruled out, may be your symptoms can be attributed to Eosinophilic Gastroenteritis, in case of which, the entire length of stomach is infiltrated by eosinophils leading to severe inflammation, which directly affects the digestion process. A lot of stomach layer is destroyed due to this autoimmune condition. Ultimately the digestive power becomes very weak, leading to varying degrees of malabsorption. The only way to know about this condition is a stomach biopsy without which it can't diagnosed with evidence. This diagnosis is considered after ruling out all other causes, and only if no demonstrable parasites or bacteria can be seen overcrowding the digestive tract. That might be the case for you, which your doctor was working on.
In case it is due to eosinophilic gastroenteritis i will advise you to take Tab. Montelukast twice daily for the next 7 days. I will list the medicines in the end again so that it is helpful for you. The mainstay of the treatment is corticosteroids but it doesn't make any sense to put you on steroids without seeing the biposy report. Hence you can try montelukast and if that doesn't work out then a stomach biposy may be required.
These are the medicines i will advise :
1) Tab. Rifaximin 1-0-1 2 tablets daily for 7 days./ Tab. Metronidazole 400 mg three times daily for 7 days.
2) Tab. Mebendazole 150 mg, one dose at bed time, followed by repeat dose after 3 days.
3) Tab. Montelukast 1-0-1, 2 tablets daily for 7 days.
4) Syp. Sucralfate 2 teaspoons twice daily for 7 days after meals.
5) Probiotic capsules once at bed time for 7 days.
If possible i will advise you to get a CT abdomen done and upload the reports, for a better picture. And also if possible a recent LFT to assess your liver functions.
Hope this was helpful,
Feel free to discuss further.


Patient replied :

The Respond I got back from you I am still not satisfied, because I don't believe you are reading the questions that I have, I specifically explained my symptoms and what I have taken as medications, and what test I have done, everything the Doctor replied too, I have done, I feel as though I am repeating my self over and over again, I am explaining to the doctors that it is NOT IBS but no one is listening to me, This disease I have is rare it is very similar to IBS, I have had the stomach biopsy already, and I have been tested for parasite, and all my test came out to be negative, I have taking all the medications that this Doctor listed for me already and it all made me worse then ever and more excruciating pain, again please help me and listen for the last time it is not IBS, I explained to you that the last Doctor who was on this case died in the process of telling me this rare disease and it was too late, the Doctor was able to tell me that my body produces too much of it, and too little of it, but when it was time for him to tell me this rare disease diagnose he died and had a heart attack....Please listen cause when you think is something IBS for so long you miss all your focus, and aim, look in the listing of disease which I know in fact it alot, to see which is a similarity to IBS, please help I am going around in circle with this and I am tired.....please look into this and take there time and not quickly respond....


Expert:  Dr. Mayank Bhargava replied 1 Day.

Hello.

I apologize if you are not satisfied with the response and we will do the best we can to help you.
Please note that the diagnosis of IBS is NOT being insisted on. It was only suggested in the initial response when you had mentioned being diagnosed with IBS as well as wrote IBS in medical history (not 'IBS was ruled out', please re-check your initial query) and subsequently when you said it is not IBS, it was ruled out in the follow-up answer.
Please do note that it is difficult to get to the diagnosis of another doctor with the limited information available but we will do the best to help you out.

- Please can you please provide details of all the tests and treatments you have received so far?
- Your doctor might have noted down the diagnosis or whatever he was suspecting in your records. Can that be available?
- Was a blood or urine Cortisol level checked for you ?
You have had significant weight gain recently, weight gain can itself cause bloating. One reason for weight gain in the presence of normal diet could be high cortisone levels in blood or Cushing's syndrome/disease where there is excess production of glucocorticoids. Cushing's disease is quite rare with an annual incidence of around 5 to 25 cases per million.

You can upload all the test results in the follow up or email them to info@doctorspring.com.
After analyzing all that, we can proceed further.

Awaiting your response,
Thank you.


Dr. Mayank Bhargava
Category: Family Physician-GP
Experience: 
Fellowship: Gastroenterology, Chotiram Hospital & Research centre, Indore, 2009
Residency: General Medicine, Rajasthan University Jaipur, 2008
Medical School:  MBBS, Rajasthan University Jaipur, 2004
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