Have Pots Syndrome. Colonoscopy, CT Scan Done. Urine Analysis Normal. Reason For Weight Loss?

Posted on Mon, 13 May 2013

Question: Hi My name is XXXXXX- I have P.O.T.S syndrome Postural Orthostatic Tachycardia syndrome. The same time I started to have POTS symptoms I had GI symptoms, a very gurgly stomach after I eat and boughts of Diarrhea/constipation. I went to the Dr. and had MANY tests done. There are it so far:

Colonoscopy showed "Acending Colon Sessile Serrated Adenoma-" which really scares me because I do not smoke or drink, and I have no history of colon cancer in my family. But I am glaf they found it but being only 26 and female this is worrisome

my EGD showed- "Consistent with Reactive Gastropathy, with no H. Pylori , duodenal Mucosa- shows no significant pathologic abnormalities

I had MANY stool samples with one thing positive
1+ Fat in stool
I have lost 20 lbs since November without trying. and I go back and forth from constipation .
I also had a CT of the abdomen and pelvis done today- showed this "adrenal glands kidneys, uterers, and the urinary bladder are not remarkable . The uterus is retroflexed otherwise Normal. in appearance, as are the ovaries, and no extrauterine masses or free fluid found. The liver and spleen are normal. There is a small accessory spleen. The gallbladder and bililary tree , pancreas, and retroperitoneal structures are not remarkable and there is no lymphadenopathy. There is no ventral wall hernia. There is a spondylolsis of the posterior neural arch of L5. although the lumbar vertebral bodies and disc spaces are normal in height. The bases of both lungs are clear.
Impression: CT findings most consistent with obstipation but no acute abnormalities

todays lab work as follows
BUN- 17
Creatinine 1.0
NA 136
K 3.4
Chloride 102
CO2 29.0
Glucose 85
Total Protein 8.2
Calcium 9.0
bilirubin total .40
GOT 17
GPT 38
cALCULATED osmolarity 273 - marked as low?
Globuilin- 4.3
A/G ratio 0.9
Amylace 43
Lipase 97
HCG Quant- <1.0
Albumin 3.9
Glomular filatration rate 71.23
WBC 6.2x1000
RBC 4.32x10*6
HGB 11.8- marked as low
HCT 37.3
MCV 86.2
MCH 27.4
MCHC 31.8 Marked as low
RDW 14.7 marked as high
Platelets 294x1000
MPV 8.3
Lymph % 36.4
Mono % 6.2
Seg % 57.4
Lymph Count 2.3x1000
Mono Count 0.4x1000
Seg count 3.6x1000

Urinalysis normal
chest Xray Unremarkable
I have also seen an immunologist - she tested my Tryptase Levels they were 3.3
IGG was slightly high
XXXXXXX 1:80 speckled- Rheumotologist undergoing other studies

so my question is this I have lost 20 lbs since November when pots started- and LOTS of belly issues- Dr. states I have a malabsorption issue, and obviously there has to be some kind of motility issue too- because after I eat my stomach gurgles like crazy and then they tell me now for the 3rd time im "obstipated" My gi doctor- today on the phone told me hes cluelesss so im looking for another specialist

Could I have like small bowel overgroweth?????

Other problems is I get sick a lot I had strep a month ago put on antibiotics didn't work real well was put on prednisone helped a little but 3 weeks later have a left slightly swollen tonsil still and 1 lymphnode in my neck that is about MAYBE 1cm big very soft. movable. ENT says im fine......

what could be causing my weight Loss ?!? why am I so sick all the time?!? ever since POTS. I don't know what to do from here.

Answered by Dr. Shanthi E (7 hours later)

Hi XXXXXXX

I have read your query with diligence. There is a solution to every problem; we shall discuss them here.

Firstly, POTS - You know all about it. I think I need not discuss about it here.

Second, Colonoscopy showed "Ascending Colon Sessile Serrated Adenoma" - when was this diagnosed? Relax; it can be managed without any worries. If it is a single sessile adenoma, it can be excised and removed completely. Later on, a histopathological examination of the Adenoma can be performed to check if it is cancerous.

About the Consistent Reactive Gastropathy - You may be put on antacids, or proton pump inhibitors, diet changes. These will take care of the stomach.

1+ Fat in stool can be safely neglected.

The CT scan largely appears to be normal except for the spondylosis of the posterior neural arch of L5.

Accessory spleen exists as a normal variant; nothing needs to be done about it.

Lab works: Calculated osmolality is normal, although the value is marked as low.

Hemoglobin 11.8 is considered normal clinically. MCHC and RDW are also normal.

Coming to your question:

Could I have like small bowel overgrowth?????

There is a Sessile Serrated Adenoma in the ascending colon, not in the small bowel.

You have lost 20lbs without trying. That is definitely a concern. I am suspecting Tuberculosis here although the chest x-ray is normal. It is possible that there is intestinal Tuberculosis or the sessile serrated Adenoma by itself can be tuberculous growth.

My suggestion to you would be to get the Adenoma excised, and study it under the microscope for tuberculous pathology.

If it is proven, you will largely benefit by taking anti-tubercular treatment.

You may consider getting a Mantoux test done too.

The lymph node in the neck could be due to Tuberculosis as well. You may also consider taking a lymph node biopsy to confirm the cause.

Tuberculosis as a rule causes drastic weight loss. Your immune system is down, that is why you are sick all the time.

Eat high protein food with eggs and milk. Take light organic food. Avoid meat. Change your diet pattern to more lighter food, more of vegetable salads and fruits.

You are just 26 years old. I am pretty sure you will recover quickly and get back to healthy life.

Please do write back, we shall discuss again.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shanthi E (7 hours later)

THank you . I am going to see the allergist/Immunologist today and discuss what's been going on and update her on findings . (she does not yet know about the strep I had , being sick a lot , and the biopsy report) . she knows my IGG is high and states "something has set off your immune system but I don't know what"

Atleast this puts me at another possibility. Thank yoU! its been 5 months since the POTS and belly issues started. & it hasn't been a fun ride. oh I forgot to tell you they did get rid of the adenoma thru a "polypectomy?" . but its been 3 weeks now im not sure if they will still have it...

Answered by Dr. Shanthi E (16 hours later)

Hi XXXXXXX

Thanks for writing back.

Great - the adenoma is excised. Yes, it is a polypectomy. The hospital would still have the sample. In addition, it would have been studied already under the microscope, post the surgery. Please request for the HPE (Histopathological Examination) report. It would give a conclusive impression.

Please go ahead with the doctor's appointment and discuss about Tuberculosis as a possibility.

I empathize with you. I agree it's not a fun ride for a 26 years old, like you. However, all will be fine soon. Believe in it.

Keep me posted about the doctor's visit.

Get well soon.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shanthi E (6 hours later)

Well doctor , Crazy things do happen . All of my problems started with the birth of my baby preterm , 2 weeks later I got POTS and digestion issues. I never mentioned to you I had a positive XXXXXXX 1:80 speckeled. it was concerning enough with my symptoms that my Primary wanted me to see a rheumatologist. so after a month wait I got in to see her. After I got out of the allergy appointment yesterday (and my doctor said yes possibly tb , and I was also going to have a CT of my sinus's and test for MONO and some other virus she mentioned I Don't remember the name) but after I got out of there I got a call from the rheumo. I tested completely positive for Lupus! now RA runs in my family.. not lupus but I suppose anything is possible. The rheumatologist said this might answer all symptoms since the birth of my baby (symptoms are flu-like feelings, some achiness in the joints especially the back sometimes ribs, low grade fevor off and on and then as well as easy infection, swollen glands and lymphnodes) she said all of that is probably the lupus..... Then I asked her if lupus could cause malabsorption- she said its not common, but she DOES have patients with it- but gets better with treatment. She also said since I have POTS- I could very well have a mobility issue with my gut on top of the lupus causing malabsorption... does that sound right to you? I am going to pick up my labs today from her. and still going to see a GI doctor that also specializes in POTS - so does all of this kind of click together? As much as I hate a lupus diagnosis, im a nurse and I know we have come far with it.... thankfully my kidney function is normal- I had a recent chest xray that was normal, and CT of belly and pelvis normal too, so doesn't sound like any organ involvement, just Nervous about being on Plaquinil due to the "eye issues" that come with it.. since I already have stigmitisms. not sure if your allowed to reply one more time but it would be great if you could replay regarding all of this. Can all of the symptoms I have really be related to Lupus?

Answered by Dr. Shanthi E (17 hours later)

Hi XXXXXXX

Sorry for my late response. I am glad you wrote back.

How did you test completely positive for Lupus? I see that your XXXXXXX was at 1:80. Was an Anti dsDNA antibody test done?

RA and Lupus are both autoimmune diseases. Both can co -exist within families.

Lupus does not usually cause weight loss, especially 20lbs. I agree with your Rheumatologist that most of your symptoms are due to Lupus but not necessarily the weight loss.

Lupus can cause the reactive Gastropathy, and colon inflammation, and cause malabsorption.

Yes, I am glad too that your kidneys are normal. Plaquenil does cause retinopathy. You will need to undergo eye examination every 6 months for it. You know well, every drug has a side effect. Hence, please weigh the risk benefit ratio.

I am happy that you are a nurse.
My only concern is that Lupus would not cause heavy weight loss rapidly. However, note that you may put on weight, if you are started on steroids for the management of Lupus.

You can always recharge this query to ask me queries.

You may ask me directly at this link too.

WWW.WWWW.WW
Keep me posted.

Wish you good health :)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar