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Irritable Bowel Syndrome.

Resolved Question:

Hello.

I just turned 40. I would say i am fit, i excercise a lot, eat reasonably healthy (salads, rarely eat red meat), and i do yoga, running, and body weight excercises. I did have IBS in years gone by, but rarely if ever get it any more.

I have never had high blood pressure in my life. However, last monday night, i started a juice fast with fresh vegetable and fruits, rather too quickly and rather too intensely.
On Tuesday I continued although I had a little tuna and a couple of eggs at the end of the day, because i didnt want to be too serious. I felt great.

I continued on Wednesday too, except this time I ate a steak in the evening not to big. (Insane looking back now, but that was what my body was telling me). The next morning, i felt good until i went the toilet, and suddenly I noticed redness in the stools. From that moment, until today, I have had a continous stress response, and bowel movements, like IBS, except they were particularly noticable in the sigmoidal colon when walking. This sent me catostrophizing for 2 days about colon cancer.

That evening i went to a cardiologist because i couldn't calm down. When i got there i did calm down, and even though my heart was high 110/min my blood pressure was only 130/80. He told me there could be an inflamation, but not to take anything for the high heart rate, just relax. I did feel better shortly after.

Friday I continued juicing and was better I went to Yoga, but in the evening the stress response came flooding back.

The next day I went to see a doctor. I told him about the juice fast although forgot to mention the steak (not purposely). I had sensations all over the body by this time, especially lymph nodes and I was asking him about colon hydrotherapy to help with the fast. He found my heart rate normal but my blood pressure high now. I think 150/80 (if I remember correctly). He told me to keep monitoring both until my juice fast was ended. We discussed the redness in the stool, and he agreed this could be the litres of beetroot I had drank. He checked the anus, thoroughly, and found no problem (so presumaby no swollen prostate).

My colon continued to clean, and i could feel every movement.

I ended my juicing that afternoon, and started reintroducing fruit and vegetable a little bit at a time. This caused severe IBS reactions. That evening walking in the park (i've been walking and drinking water for 4 days non - stop in an effort to return to normal), I noticed the lymph nodes in the chest and the head started swelling. ( I put this down to the juice fast, the body was now cleaning the upper lymph system after doing the legs).

Sunday was similar with only temporary respite from the stress response. I continued to go from colon cancer panic, to every other type of panic.

When I woke up this morning, i finally felt a bit bit better. The lymph was not swollen so much.

However, it wasn't long after i had to start eating and i've had hard difficult bowel movements all day, causing more stress responses and again raising my blood pressure and lymphatic swelling from the neck lymph nodes is still there now, and i can tell my blood pressure is still high now.

This afternoon, I had a very strong sharp pain across the chest, just for a second, but it felt more like a lymphatic thing.

Right now, my blood prssure feels high, and my lymph system is still swollen. Bowel movements continue strongly and IBs pills (disputalin) won't help.

Please advise. Do you think I have an infection? bacterial?


Category: Family Physician-GP

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Category: Sexually Transmitted Diseases(STD)Specialist
Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello,

Thank you for choosing DoctorSpring.

I have gone through your medical history and I understand your concern.

First of all let me assure you that there is no symptoms or signs that are suggestive of any kind of cancer (or any serious disease) as matter of fact. The onset set of symptoms was rather sudden with a known precipitating factor (the diet modification) .

This is more likely to be a functional bowel disorder - similar to IBS, but not exactly like IBS. This is usually precipitated by an infection - viral or bacterial (possibly in the vegetables or fruits or tuna) or irritant food. Diputalin (Mebaverine) is a gut relaxant and will not help you here.

I am not sure whether your Lymph nodes are really inflamed or not. Unless you have a real disseminated infection (or inflammation) you will NOT get lymph nodes enlarged in location other than the site of infections. If the swelling persists you can get in examined by your Doctor.

The approach to this is simple. First step would be to take a normal MIXED diet. Do not experiment. You can take an OTC Pepto-Bismol tablet twice a day. Add a probiotic capsule or drink once a day for 3 days.

The symptoms should resolve in 2-3 days. If not the reason could be a bacterial infection and you will require a course of antibiotics like Rifaximin. Resolution of the gut symptoms will help you with you blood pressure and fast heart rate. Try to stay relaxed.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

Thank you Dr Deepu, that's good to here. Just to finalise I would like to add a little information just to give you any stray details, which might not be details.

I have been googling medical facts non-stop for over 4 days now so forgive me for being forward with medical terms.

Your diagnosis and treatment somehow feels right. I do feel that if the bowel disorder would go things would get better blood pressure wise.

However, in addition to the symptoms I do feel an 'intracranial pressure', and optic margins do seem distorted. to the far right and far left. Vision does have that blurry effect to it.

Also there is pains in the chest. Only short pains, at the moment on the left side, near the heart but not in the centre of the chest.

Could I presume that all of these are caused by my high blood pressure?

I will try to relax.

One more thing, after reintroducing fruit and veg, I finally moved to Kefir which has had a marked improvement on the stomach, and arguably blood pressure too - 137 over 83 and 137 over 86 consecutively. Thats lower than earlier readings today.

if you could reply i would appreciate it.

Thank you.

Richard


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello Richard,

The fact is that you cannot 'feel' intracranial pressure. Instead raised intracranial pressure manifest as blurred vision, nausea, vomiting etc. The blurred optic disc manifestations are actually seen on the optic disc when examined using an Opthalmoscope. I do not see any reason or any connection on why the bowel symptoms should cause a raised ICT. You need not worry about this at this point of time. For the time being I would just categorize this as a non specific symptom. (When I say non specific I do not mean that the symptom is not significant, just that it is not specific for a diagnosis). The chest pain is also non specific. It is sure a non cardiac chest pain.

I feel you are bit anxious and worried. So the most likely cause of your raised blood pressure could be the anxiety ( increased heart beat is also suggestive). Most likely you are getting occasional palpitations too. And when you are at your Doctors office the blood pressure can further shoot up due to white coat hypertension.

So it is better to have a couple more BP readings(preferably in a relaxed setting). If the BP still reads I high I would recommend a baseline evaluation including a Thyroid function test and ECG.

Milk, fermented milk products like Kefir is not something I would not generally recommend. BUT there is a good amount of individual variation. Some individuals tolerates these products much better. If it works for you then no issues.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :

HI Dr Deepu,

Your diagnosis was probably very goood.

However, today was the first day I didn't totally panick. Yesterday I ended up in the hospital for infections, as I summised that I might have a brain infection. I summised this on the basis of my confusion and mental state, w

hich was probably due to the panic/anxiety in the 4 days since my infection.

I was given some pretty heavy calming medicine, hydroxizin hidroklorid.

This has helped. I've also been undergoing acupuncture.

It seems like my whole bowel system went off line, and came on line again, except this time, with a range of confused signals to the brain.

However, the neurologist said he thought I'd caught a viral infection in the whole body which had caused sensitivity. The brain was diagnosing one catastrophe after another, and that was sending me into panic, worsening stomach problems.

My blood pressure is coming down. Each day there seems to be some slight progress.

However, it's like I'm teaching my body, manually how to digest and relax. This all used to be done completely manually.

Please give me some good news......will I ever get better, will I ever get back to normal. I still feel pscyhologically the world looks different. I guess that could be me still recovering from anxiety/panic disorder.

I still have a permanent tension headache, which as you know I thought was swollen lymph.

Please help, give me some good news, that this will all resolve again one day.

Today I ate fruit in the morning, and walked drinking water. Then cabbage and potatoes in the afternoon.

This is frightening, but I am relaxing, listening to music.

Richard


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Hello Mr.Richard,

There is of course good news. The good news is that there is no 'bad news'

. I will explain.

A major part of your symptoms are psychosomatic. And among other symptoms there are NO danger signs or symptoms. There appears to be no major organic illness which can do any permanent damage to your body (or in other words there is no bad news). And you have been adequately evaluated.

As a clinician I see this as very important and positive news. You symptoms are more functional in nature, which means they can be corrected. You SHOULD consider Psychiatric care for the anxiety and panic attack. This should be your first priority. Let the bowel settle down on its on. Just go for a very regular diet.


Hope this helps
Thank you.


Patient replied :

Thank you Doctor,

So finally, please can you tell me, what you mean by psychiatric care for the panic attacks. I feel I can relax more now as I am no longer looking for solutions to this, and i can concentrate on treating my FBD. They gave me tablets for calming me down if I need them.

My second question is. What about the neurological symptoms that persist. The stiffness up the back of the neck, the general headache, sensitivity to noise, olfactory sensations from time to time, and most of all blurry vision and traces.

These were many symptoms I just didn't list as I had been concentrating on the main painful ones, the stomach, and occassional shooting pains in chest and elsewhere.

Why do i feel, that some neurological changes took place in my body over the last 4 days?

FBD doesn't really explain that.

Richard


Expert:  Dr. Deepu Sebin Sebastian replied 1 Day.

Hello Richard,

As I said your symptom pattern is suggestive of psychosomatic symptoms. By Psychiatric care I mean a Psychiatric consultation for anxiety and stress. You might need medications like SSRI or SNRIs which can help with these symptoms. Once this is addressed there will be resolution of many of your symptoms.

Hope this helps
Thank you


Dr. Deepu Sebin Sebastian
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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