OpenHealth Q&A

Navigating a Web of Health Challenges

At 44 years old, I carry a rather intricate health background. My epilepsy history includes a temporal lobectomy carried out in 2005, which has reduced my seizures to just focal aware types. Significant surgeries I've undergone include a cholecystectomy and gastric bypass back in 2015, followed by procedures for an internal hernia and mesenteric defect in 2020. In 2021, I faced an ectopic pregnancy and a missed miscarriage. Moreover, I dealt with a persistent urinary tract infection from April 2019 until this past June, requiring full-course antibiotics from November 2020 until then. On June 30th, I began experiencing discomfort in my upper abdomen, akin to indigestion, accompanied by nausea and an unusual thirst that led me to consume around 7 liters of fluid daily. The sensation reminded me of the hernia pain I encountered previously. After reaching out to my bariatric surgeon, I was hospitalized for evaluation. Over five days, I underwent various imaging and procedures, including an abdominal CT, an MRI, endoscopy, and colonoscopy. Unfortunately, these tests yielded little information; the only notable finding was enlarged lymph nodes, for which biopsies were taken. Blood tests indicated slightly elevated CRP levels, but they were only marginally outside normal upon my discharge. Despite this initial investigation, my condition didn’t improve over the next 11 days, prompting a second admission for another 10 days. During this time, my surgeon ordered an additional MRI and proceeded with an exploratory laparoscopy. Again, no conclusive cause for my symptoms was identified, leading to further biopsies without any definitive answers. I consulted with an endocrinologist, who advised me to track my fluid intake. Following her guidance revealed that my fluid consumption was accurately balanced with my output, prompting her recommendation to reduce my intake. She also arranged for a brain MRI, which thankfully came back clear. My situation was assessed by a gastroenterologist, who was perplexed by my symptoms. She initiated a treatment plan involving Amitriptyline at a dose of 10mg nightly and Creon three times a day starting from July 23rd, along with a three-week course of sucralfate. Post-discharge, there has been a marked improvement in my upper abdominal pain, occurring only in brief episodes typically after meals; however, the nausea persists in varying intensity—some days it's nearly unbearable requiring anti-emetics, while other days it’s more manageable. I've been consuming between 1,000 to 1,200 calories daily and have shed roughly 10 kg since these issues began. When I brought up the possibility of SIBO, it was brushed aside. I can’t shake the feeling that the gastroenterologist has lost interest in my case, leaving me with the daunting impression that I simply need to endure this. Concerning the findings from my hospital report, it noted a slightly enlarged uterus likely attributed to fibroids, a collapsed colon with possible colitis, and mild swelling in the mesentery of my small intestine, which might relate to mild enteritis or a previously resolved intussusception. Currently, my medication regimen includes: - Keppra 2g twice a day - Calcichew D3 twice daily - Creon three times a day - Amitriptyline 10mg at night - Lenzetto spray twice - Utrogestan 100mg at night - Amoxicillin 500mg three times a day for a sinus infection contracted recently. Any insights or guidance would be deeply appreciated.

Answers (1)

8/27/2025, 1:04:26 PM

OpenHealth AI

Your complex health background and current symptoms understandably place you in a challenging situation. It sounds like you’ve been through quite a lot, and it’s natural to seek clarity and a path towards relief.

You have several health concerns that warrant careful attention, particularly your ongoing abdominal discomfort, nausea, and the extensive investigations that have yet to yield a definitive diagnosis. Here are some key points and actionable steps to consider:

Main Points

1. Ongoing Symptoms and Investigations: You have experienced significant abdominal pain and nausea, with various tests showing inconclusive results.
2. Patient Empowerment and Monitoring: It's crucial to stay informed and proactive about your health.
3. Medication Review and Management: Your medication regimen is complex, and it’s important to evaluate how it aligns with your current symptoms.

Explanation

Given the breadth of your medical history and current symptoms, it is essential to address potential underlying causes while exploring symptomatic relief. The enlarged lymph nodes, elevated CRP levels, and recent abdominal complaints may all suggest possible inflammatory or infectious processes. The persistence of your nausea indicates that further investigation may still be necessary.

Tracking your symptoms similarly may provide useful insights into triggers or patterns that can be shared with your healthcare team. Communication is vital now, especially regarding your feeling that the gastroenterologist has lost interest.

Prioritized Next Steps

1. Keep a Symptom Diary: Record daily episodes of nausea, including timing, severity, food intake, and any triggers. This may help identify patterns and assist in conversations with your healthcare provider.

2. Medication Review: Discuss your entire medication regimen with your prescribing doctor, especially focusing on the interaction of Keppra (for epilepsy) and other medications, which might have gastrointestinal side effects. Some medications can exacerbate nausea, and adjustments may be beneficial.

3. Consider a Gastroenterology Follow-Up: If possible, request a referral for a second opinion from another gastroenterologist who may have a fresh perspective on your case, such as the potential for SIBO, given your gastric bypass history.

4. Nutritional Support: Work with a registered dietitian familiar with post-bariatric surgery patients. Balancing your nutrition while managing symptoms is crucial, especially considering your recent weight loss. They can help tailor a diet that minimizes nausea.

5. Monitor Fluid Intake: Continue to manage your fluid intake as previously advised and ensure it aligns with your hydration needs without overconsuming.

6. Support and Communication: Consider joining support groups for individuals with similar health challenges. Finding emotional and informational support can be incredibly beneficial.

Conclusion

Your situation is multifaceted and can feel overwhelming at times, but breaking it down into clear steps can help provide structure and clarity. You are taking a proactive approach—continue to advocate for your health, and don’t hesitate to seek a second opinion if you feel it’s necessary. Please ensure that you communicate your concerns and experiences with your healthcare providers clearly to work collaboratively towards the best outcomes.