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Suggest Treatment For Abdominal Pain And Vomiting Post Hip Surgery

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Posted on Thu, 4 Sep 2014
Question: I have had pretty serious gastrointestinal problems for much of my adult life. I had peptic ulcer disease in my mid 20s. At 39, my GI problems started again with a vengeance, this time requiring hospitalization and frequent ER trips.

During the course of the episode that began at 39, I also developed a lot of joint pain. After 18 months and losing about 40 pounds, things finally began to improve. As my GI symptoms got under control (contemporaneously with xifaxen, possibly because of it), I was eventually left with mostly just joint pain. Eventually, that all cleared too, except for the pain in my right hip.

My hip never got better. After giving it time, PT, and Celebrex, I went to an ortho. On my first visit, I was diagnosed with Ficat class IV avascular necrosis and learned I needed a total hip replacement and soon.

My hip recovery has been great. However, my GI symptoms are back 3 months after hip surgery. I do not have Crohns. Is there possibly something common between these problems? I've not had much for corticosteroids in my life, and I don't have any other risk factors for AVN that we can tell. I also am cold all the time but sweat profusely (mostly lower half of my body) when I sleep.

This has taken enough of my and my family's quality of life. I am desperate to turn this around.
doctor
Answered by Dr. Dr. Klerida Shehu (11 hours later)
Brief Answer:
Please provide more of your medical data...

Detailed Answer:
Hi Jeremycampbellnc,

I am sorry for you current health problems.

Before running into final conclusions, I need to have more of your medical data:

- what were your GI problems that made you go to ER frequently? can you please specify them?
- did you have any trauma prior to being diagnosed with avascular necrosis on your hip?
- what type of medications you used during 3 months of being treated for hip problems (including replacement)? can you specify them?
- have you checked for infectious diseases of GI?
- any other health problem: diabetes, thyroid?

Looking forward to have you data soon for further evaluations!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Klerida Shehu (24 minutes later)
Hi Dr. Klerida,

Thanks for taking the time to respond. Here are the answers to your questions:

- The GI problems that would send me to the ER are non-stop abdominal pain and constant vomiting. I'd wake up rocked with unrelenting vomiting and abdominal pain. My vomit frequently had undigested food in it. (I have a gastric emptying study this Friday.)
- I've never had any trauma to my hip. Also, I'm an executive in my organization, so my job is not physically demanding.
- Leading up to surgery and during recovery for my hip, I took Celebrex, Xaralto, Roxicet, Omeprazole daily. Occasionally I'd also take Promethazine and Ambien. I'm not taking anything now except Donnatal as needed. The phenobarbitol in the Donnatal helps relieve some anxiety when I'm getting sick, but I don't experience much other benefit that I've noticed.
- Regarding infectious diseases of the GI tract, I've been extensively evaluated and would think that my series of university doctors have checked for that. However, I don't know for sure. I had a very high calprotectin test result while admitted to the hospital in January/February of 2013. One of the doctors said I have an inflammatory bowel disease, but the test results have not been repeated in follow-up calprotectin tests... yet.
- I don't have any other substantial health problems that I know of. However, I'm willing to push my in-person doctors for any tests you think might yield useful results. My suspicion is there is a common root cause of both my avascular necrosis and my GI problems, possibly something endocrine. My mood has been a wreck since the GI problems started picking back up again. I'm not sure if it's related to the root cause or a side effect of my currently poor diet and anxiety about the problem returning.
Again, thanks for responding to my question. I hope the additional information is useful.On reviewing some of the risk factors for AVN, I see that gout is on the list. I've had several gout flares in my life, beginning sometime in my mid 30s. My most recent gout flare was slightly less than 1 year before my first ER visit related to non-stop vomiting and nausea. I'm not sure if this information is useful, but I thought I'd share in case it is.
Best,
XXXXX
doctor
Answered by Dr. Dr. Klerida Shehu (9 hours later)
Brief Answer:
Following suggestions...

Detailed Answer:
Hi back XXXXXX,

Thank you for providing more information. They were helpful in raising up some possibilities for your current problems:
- upper endoscopy is necessary to run to exclude upper GI problems
- colonoscopy is advised to rule out large bowel problems
- serological tests for inflammatory diseases are necessary to rule them out
- pancreas function test is necessary to rule out pancreatitis (as it is one of the major causes to avascular necrosis)
- diabetes could be a possible cause that can be ruled out through diabetes testing (fasting blood sugar, post-prandial sugar test, HbA1C test)

If you have already done all these tests; I'd like to have the reports for further evaluation. If you have not done them until now; can discuss it further with your doctor to run these tests.

Dr.Klerida
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Klerida Shehu (41 hours later)
Hi Dr.Klerida,

My last upper endoscopy showed an irregular z-line and hiatal hernia, but no new ulcers or anything like that.
My colonoscopy last year showed hemorrhoids and some potentially forming diverticulosus, but nothing really to account for my troubles.
Type 1 Diabetes does run in my family, but I am not diabetic.

That leaves the test of pancreas function and serological tests. Are there any specific tests you'd recommend? Will my in-person physician know what I'm asking for?

Best, XXXXXXX
doctor
Answered by Dr. Dr. Klerida Shehu (21 hours later)
Brief Answer:
Following specific tests ordered by GI pecialist.

Detailed Answer:
Hi back XXXXXXX

The pancreas function tests are specific tests to evaluate the function of your pancreas :
- Secretin stimulation test
- Fecal elastase test/ fecal chymotrypsin levels
- blood amylase/lipase levels
- abdominal ultrasound
- Endoscopic ultrasound (EUS).

Once again, your GP cannot ask to run these tests as they are very specific. You need to consult with GI specialist first; he/she will advise to run the most appropriate tests for you.

Dr.Klerida
Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Dr. Klerida Shehu

Gastroenterologist

Practicing since :2006

Answered : 2266 Questions

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Suggest Treatment For Abdominal Pain And Vomiting Post Hip Surgery

Brief Answer: Please provide more of your medical data... Detailed Answer: Hi Jeremycampbellnc, I am sorry for you current health problems. Before running into final conclusions, I need to have more of your medical data: - what were your GI problems that made you go to ER frequently? can you please specify them? - did you have any trauma prior to being diagnosed with avascular necrosis on your hip? - what type of medications you used during 3 months of being treated for hip problems (including replacement)? can you specify them? - have you checked for infectious diseases of GI? - any other health problem: diabetes, thyroid? Looking forward to have you data soon for further evaluations! Dr.Klerida