Seeking Guidance for a Medical Dilemma
I’m reaching out for advice regarding a friend from Canada who is struggling with persistent gastrointestinal issues. She is a 35-year-old woman, measuring 5'3" and weighing 170 lbs. For the last couple of years, she has been dealing with severe stomach problems that have not improved despite numerous interventions. Initially, there was suspicion surrounding her gallbladder, leading to a surgical removal; however, this did not alleviate her symptoms. Her family physician referred her to an allergist, but she faces a frustrating one-year wait for that appointment. Additionally, she has made countless trips to the emergency room, relying on medications like Pink Lady for temporary relief and, occasionally, Codeine—despite being allergic to it—because the discomfort is bearable compared to her intense pain. She has eliminated both dairy and gluten from her diet, yet nothing seems to make a difference. To date, she has undergone a gastroscopy with biopsies, several ultrasounds, and she has a CT scan and MRCP scheduled for September. When her symptoms flare up, she experiences excruciating pain rated at a 10 out of 10, often leading to syncope, severe vomiting, and periods of incoherence. Notably, during these episodes, her liver enzymes spike to alarming levels: - ALP: 137 - ALT: 233 - AST: 108 - GGT: 242 In her urine tests, despite resembling a bladder infection, the results show: - Leucocytes: 250 - Blood: 5-10 - WBC: 21-50 - RBC: 6-10 She has been denied a colonoscopy since she is under 40 and maintains normal bowel movements. Unfortunately, her family doctor has refused to provide further referrals, and even the general surgeon she approached declined to assist her. Considering exploring options in the United States, she discovered her insurance would not cover those expenses. Is there anyone out there who has faced a similar situation or can offer insights on how she might navigate this challenging path to see a specialist? What steps can she take next?
Answers (1)
8/10/2025, 8:40:53 PM
OpenHealth AI
I'm sorry to hear about your friend's challenging situation with her gastrointestinal issues. It's understandably frustrating to deal with ongoing pain and uncertainty, especially after so many interventions. Here’s an overview of the current situation and actionable next steps.
Main Points
Your friend is experiencing severe and persistent gastrointestinal symptoms despite several medical interventions. She has undergone various tests, including gastroscopy and imaging, which returned inconclusive results. Her symptoms lead to significant distress and elevated liver enzymes, indicating potential underlying concerns.
Explanation
Her symptoms and history suggest a complex condition that may involve multiple factors. Chronic abdominal pain, syncope (fainting), severe vomiting, and fluctuating liver enzymes can stem from different gastrointestinal disorders, such as bile duct issues, functional dyspepsia, or even complications related to the gallbladder surgery. The delayed referral system can add to the frustration, and it's concerning that she is using medications she's allergic to for pain relief.
Current test results indicate potential distress in her urinary system, but with normal bowel movements and a history of food eliminations, further investigation remains essential.
Next Steps
Here are prioritized actions your friend should consider:
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Symptom Diary: Advise her to keep a detailed diary of her symptoms, including the timing, duration, severity (on a scale of 1-10), and any food intake or medications taken. This documentation can be crucial for future medical consultations.
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Seek a Second Opinion: Although she has faced refusals for referrals, encourage her to seek another healthcare provider, emphasizing her severe symptoms and previous treatment failures. Look for a gastroenterologist who specializes in functional gastrointestinal disorders, even if it means exploring practitioners outside her immediate area. Some hospitals have specialty clinics which might facilitate faster appointments.
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Emergency Care for Severe Episodes: Given her level of pain and the risk of syncope, she should feel empowered to return to the emergency department for evaluation during severe flare-ups. It’s critical to communicate the severity of her condition and previous medical history during these visits.
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Research Visual Capture: If a colonoscopy remains inaccessible, she may inquire about alternative imaging studies that can provide additional insights into her gastrointestinal route, such as a small bowel MRI or specialized studies to assess her pancreas and bile ducts.
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Explore Telehealth Services: Since she's considering out-of-country specialists, she might benefit from telehealth consultations if any US-based specialists are open to virtual visits. This might provide timely insights and recommendations without immediate travel.
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Nutrition Consultation: A targeted consultation with a dietitian experienced in gastrointestinal issues could identify any dietary patterns that may be contributing. They can suggest alternative therapies or elimination diets based on her specific symptoms.
It's important for her to remain persistent, advocate for herself, and know that further options exist, even if it currently feels limiting. This journey is undoubtedly tough, but with systematic documentation and proactive steps, she may find the relief and support she seeks.
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