Question: Hello Doctor,

Hope you are doing good :) .
I am writing to you after a long time again.
You had asked me go through many of the tests. I went to Asian Institute of Gastroentrology Hyderabad.
COlonoscopy and Endoscopy showed no problem.

Amylase,Lipase these tests were fine.(done more 8 months back)

Fecal Fat testing i could not get it done .In India Very rare places they do, and its vety expensive.
I will get it done later.
The liver function tests were fine , Total bilirubin 1.9 mg/dL , direct (0.4) indirect (1.5) , my bilirubin label is consistently marginally high for last 1 and half years.
(i used to take Hepa Merge last year)
I am on VB12 shots (each month one injection) take calcium tablets frequently , so those vitamin tests are fine.

However my acidity problem tends to come back wherevr i give a break to the medication (PIP or antacid)
Night i get up with upper abdomain discomfort at times.I take petril MD at times to have sleep.
Flatulence , constipation (if any fat items , even chicken also at times) ,bloating , hunger pang, i feel pressure in my chest area due to too much of gas pressure.
Lower back pain in the early morning , or night also..whenever my stool is not clear , and i pass smelly winds (even while having loose motion i pass smelly wind).After having food sometimes my stomach starts making sounds.AT times I feel little nauseated after food.Sour feeling in the tongue. And the lower back pain is a very old problem which is related to my motion and gas.

last more than 3 mnths I have been consuming Cyntodac.
And my weightloss is one issue. with slight change in the daily routine , like less sleep or anyting i see good amount of weightloss, i was 65 KG in 2011 now I am
55 kg, and its decreasing. In b/t i had dengue and Tonsil operation.which reduced my weight more.

Do you think IBS patients loose weight normally?
I have been prescribed Ganaton Total , Fluxetine Cap(Neurozac) ,Normaxin .

Before staring Ganaton I wanted your advice.Heard people taking this drug might develop Atrophic gastritis.

The long term usage of Pantoprazol , do they aggravate the Gastritis?

If you think of any other better medication , please suggest.
Or any food diet , for proper nutrition.
For liver related , do you think i should have some more investigation?

I know typical IBS patients have to deal with the symtoms for their life time.But i am little bothered about the weightloss.
Offlate my diet is very plain.

I avoid wheat stuff.Here the tests for Lactose intolerace or Gluten intolerace is not available.Anyway I try to avoid them.
I dnt eat any fat items. even chicken also i have reduced.I Have Tofu and egg white for protein.
There are some fat burner enzymes. do they have side effects , do you think i can try them?

I have Eerectile problem.
And I know taking Neurozac might worsen it, but at this point i m not much concerned about my sexual life. I am homosexual. And have a boyfriend. who lives abroad right now.for a year.

Thanks & Regards XXXXXXX

Hello Doctor ,

Thanks for the reply.
So do you think I should go through any more tests to rule out hyperthyroidism, diabetes, malignancy?

I am taking lactifiber (fiber supplement ) each night before going to bed.
And since i started taking the anti depressant , I feel good. Last night i didnt wake up , after a long time.

Food wise any suggestion ?Things i should avoid ?

Thanks & Regards XXXXXXX

Hello Doctor,

Little panicked now.Last week my weight was 55 kg , and now today i checked its 53 KG.
this unintentional weightloss , i dont know what to do.
What check for malignancy would you suggest? Are they very expensive.

I need some rationalization or explanation for this weightless , otherwise not having peace of mind.

Thanks & Regards XXXXXXX

Hello Doctor,

I am not sure its my anxiety that casing the problem or something else.As u suggested I went to the physician , my weightloss might be due to less sleep and anxiety. since 2011 end till today i have lost 13 KG so far. So he asked me to wait and continue the medication. All my life I was underweight. Then 2009 end to 2011 1st i gained lot of weight , had no stomach problem (after H pilory medication). and now again i am underweight with all the IBS symtomps much severe.

Anyway thing is last 2 days i have throat sore and chest pain.with yellow mucus , which are not coming out.while coughing it pians in the middle of the chest and throat also.
Had mild fever last night and chill, I had little hot milk with little turmeric , and then Tulsi and ginger and clove , later i took calpol and one cintodac cap (i didnt take Normaxin ) , had lacti fiber 2 scoop before going to pin.
night i felt pain in my upper stomach , later around 2 i slept off. I was passing winds.problem is due my sensitive stomach i cant have most of the things like honey or peeper and milk.

Now morning while passing stool , i saw it was whitish yellow in color , and stain of blood on the surface of stool , Little.
I got so much panicked.

But the blood looked like fresh , need to confirm once more whn i go to stool , What do you think about it.God forbidden if it reappears.last week i had colonoscopy , and liver function test also , all were fine.even now i have mild pain in upper stomach.
need your suggestion.I am not much hungry also .
HIV testing i got it done last week , I am negative.

Will get chest xray done today.

Doctor I need some sugestion s to how to deal with this. Should I wait and see ? any food habit. like i know giving little too much of gap between my food intake produces more gas.

Thanks & Regards XXXXXXX

Hello Doctor,

Thanks for your reply.
For my coughing problem i was asked to get CT scan done.

PLAIN CT SCAN -THORAX (chest)

impression: A tiny calcigic focus of about 1 mm is seen across the segment IVa.
Visualised liver , spleen and adrenals otherwise appear normal.

Probable tiny old calcified granuloma across the hepatic Segment IVa.

========================================================
What significance can it have? Do you think I would need more investigation for this , specially considering my weightloss and IBS problem .

Thanks & Regards XXXXXXX

Hello Doctor,

I am sorry .Everytime I think its over , I will not think about it anymore , but something comes up.

Due to my mild fever (just 2 days) , chill , coughing and cough syrup.

And ever since I have started taking the medicine for IBS ( Ganaton Total , Fluxetine Cap(Neurozac) ,Normaxin) , I feel very drowsy the whole day , specially since morning till afternoon .

Since this cold cough and fever started, my motion was not clear.
And today stomach was making lot of noise whole day , specially after having food.
Night just rushed to the toilet with sudden urgency to pass.
It was soft stool , floating , yellow in color, and i saw little red blood once again.

Doctor what would you suggest in this case.

I never saw blood before , 1 and half week back had endoscopy and colonoscopy done.
And after that this is the 2nd time I am seeing blood in stool.That is red and looked fresh.

Thanks & Regards XXXXXXX

Hello Doctor,

One more time , here I am .
I got CT scan of my abdomain done , with contrast .

Impression : No Significant abnormality noted.

everything seemed normal in the result , but it says like below:

"Multiple small subcentimeter sized lymphnodes are noted in the mesentery - ? significance."

With my weightloss and sensitive stomach symptoms of upper abdominal discomfort at night and flatulence , do you find any significance of this report?

Thanks & Regards XXXXXXX