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What Does My Ultrasound Scan Report Indicate?
Question: I am a nurse, and my best friends 19 year old son underwent T-3 thru L4 fusion for severe Schorman's Kyphosis (82 degrees humped) with one re-do due last year to loose loose hardware and fusion failure at L-2, so they ended up stabilizing down to L-4. (both surgeries over 2 year period) At this point he appears overall well healed with of course the limited mobility. But the ongoing concern today is a 3 mo hx of extreme nausea/explosive diarrhea, vomiting when he eats just about anything. Greasy foods are the worst, but just about any food makes him feel horrid. He has a clear upper and lower GI with contrast, Today Ultrasound of panc/Gallbladder and duct are normal. No Chrone's (with with biopsy), no parasites, no h-pylori, no evidence of celilac, barrettes esophagus, no blood in stool or vomit. He is in malnutrition, and is in muscle wasting according to his labs. He's currently at 147 lbs and dropping at 5'11' (normal wt 174) wt loss and abdominal pain below the belly button and slightly to the right are incapacitating. He's on Lexipo for 2.5 weeks, Zofran, amytriptaline for one week, and Nexium, and something that starts with a "B" for abdominal pain. He is depressed but he is able to work and go to college most days, and is becoming weak from inability to eat. He is super tight to the point of almost contracture in most of his major muscle groups (back/legs) and was pre and post surgery to a level the therapist and MD has never seen anyone this rigid. This kid is in trouble right now, and his MD's are at a loss. There is a psych/depression component with the obvious change of life style this once athletic kid has undergone. Could there be some type of neurogenic spine syndrome going on here that affects the GI? He was pretty severely hunched and tight and in pain when they made him rod- straight without any Physical therapy directly after surgery. He was in extreme spasm for over a year after surgery and still deals with bad spasms. Physical therapy hasn't at this point been able to help with tightness or spasm pain. He does not have any neuro deficits, other that inflexibility and pain. My friend and I are at a loss at this point to know where to turn next to figure out the origin of the ability to hold down food, and wt. loss. WE are not sure if we should be consulting and ortho or GI Md again at this point
Brief answer:
There can be many possibilities
Detailed answer:
Hello,
Thanks for choosing HealthcareMagic for your query,
I have gone through all your details and I appreciate your concern.
Initially I would give you a briefing about things you might be already knowing but its required as every thing can be inter related to each other in this case.
Scheuermann's disease is a self-limiting skeletal disorder of childhood.The cause is not currently known, and the condition appears to be multifactorial. The most likely cause of this disease is faulty gene, However none of the research done till date is conclusive. So genes typically involved in this this disorder are not yet known. In lay man's language we can say that we still don't know the cause of the disease we are dealing with. So million dollar question is when we don't know the cause How can we treat?
So while there is no explanation for what causes Scheuermann's Disease, there are ways to treat it. For decades there has been a lot of controversy surrounding treatment options. As we are treating the patient without knowing the cause. The aim of surgery and other treatments are to provide relief from limitations(Non curative treatment therapy).
Now lets come to your question,
See there can be many possibilities as per the details given by you. So lets see them one by one.
Recurrent Loose stools and nausea increased by taking Fatty food is highly suggestive of recurrent gastroenteritis. He is on a number of medications from many years. Continuous use of antibiotics without probiotics causes good bacteria's of intestine to die leading to problems like severe indigestion along with nausea and vomiting. However it can be due to recurrent Gastroenteritis also.
As explained earlier human gastrointestinal tract is colonized by bacteria of 400 different species and subspecies. They are responsible for proper digestion of food. Depletion of this flora due to repeat antibiotic therapy and infection has lead to severe digestive problems in your case.
Intestinal flora are types of microorganisms known as probiotics that live normally as part of the intestinal tract. These organisms have several functions that help the body. The most plentiful and important bacteria in the small intestine is the Lactobacillus species. Lactobacillus helps ferment indigestible carbohydrates. It also helps to stimulate the digestive process and aid the absorption of nutrients, as well as increase the motility of the gastro intestinal tract. I would suggest you to keep taking a good probiotics like Econorm thrice daily for few months .Probiotics are live bacteria and yeasts that are good for digestion.
As all the tests like colonoscopy endoscopy etc are normal I would suggest you to give him a probiotic three times a day. Drink cleaner water.
A stool test can be done to see if there is bacterial or protozoal infection.
This was all about Gastroenterolgy part,
As per your second question yes severe tightness in abdomen can be there as a late complication off surgery. As we are dealing with a structure surrounding spinal cord(main nerve), it can be a possibility that a nerve arising out of it is damaged or infected as a result of multiple surgeries. Whole body Positron emission test can be planned top see if all nerves are functional.
Third possibility is that as the exact cause of this disease is not known. There are possibilities that all these problems are increasing gradually due to a particular syndrome or gene(Any rare syndrome under research)leading to shutting down of different organs gradually.
Take home message from me-
Take him to a quaternary care center where four specialties Genetics, Neurology, Endocrinology and Gastroenterology are there under one roof. Request them all to discuss this case. They are very rare cases and need extensive investigations and expertise on part of treating doctors. I would suggest you to take him to a Medical school or Hospital and request the researchers and Professors of various specialty to come together and discuss all possibilities taking your son as a Case and not just as a Patient.
I hope I answered your query well,I case you need any other explanation feel free to ask.
Thanks.
There can be many possibilities
Detailed answer:
Hello,
Thanks for choosing HealthcareMagic for your query,
I have gone through all your details and I appreciate your concern.
Initially I would give you a briefing about things you might be already knowing but its required as every thing can be inter related to each other in this case.
Scheuermann's disease is a self-limiting skeletal disorder of childhood.The cause is not currently known, and the condition appears to be multifactorial. The most likely cause of this disease is faulty gene, However none of the research done till date is conclusive. So genes typically involved in this this disorder are not yet known. In lay man's language we can say that we still don't know the cause of the disease we are dealing with. So million dollar question is when we don't know the cause How can we treat?
So while there is no explanation for what causes Scheuermann's Disease, there are ways to treat it. For decades there has been a lot of controversy surrounding treatment options. As we are treating the patient without knowing the cause. The aim of surgery and other treatments are to provide relief from limitations(Non curative treatment therapy).
Now lets come to your question,
See there can be many possibilities as per the details given by you. So lets see them one by one.
Recurrent Loose stools and nausea increased by taking Fatty food is highly suggestive of recurrent gastroenteritis. He is on a number of medications from many years. Continuous use of antibiotics without probiotics causes good bacteria's of intestine to die leading to problems like severe indigestion along with nausea and vomiting. However it can be due to recurrent Gastroenteritis also.
As explained earlier human gastrointestinal tract is colonized by bacteria of 400 different species and subspecies. They are responsible for proper digestion of food. Depletion of this flora due to repeat antibiotic therapy and infection has lead to severe digestive problems in your case.
Intestinal flora are types of microorganisms known as probiotics that live normally as part of the intestinal tract. These organisms have several functions that help the body. The most plentiful and important bacteria in the small intestine is the Lactobacillus species. Lactobacillus helps ferment indigestible carbohydrates. It also helps to stimulate the digestive process and aid the absorption of nutrients, as well as increase the motility of the gastro intestinal tract. I would suggest you to keep taking a good probiotics like Econorm thrice daily for few months .Probiotics are live bacteria and yeasts that are good for digestion.
As all the tests like colonoscopy endoscopy etc are normal I would suggest you to give him a probiotic three times a day. Drink cleaner water.
A stool test can be done to see if there is bacterial or protozoal infection.
This was all about Gastroenterolgy part,
As per your second question yes severe tightness in abdomen can be there as a late complication off surgery. As we are dealing with a structure surrounding spinal cord(main nerve), it can be a possibility that a nerve arising out of it is damaged or infected as a result of multiple surgeries. Whole body Positron emission test can be planned top see if all nerves are functional.
Third possibility is that as the exact cause of this disease is not known. There are possibilities that all these problems are increasing gradually due to a particular syndrome or gene(Any rare syndrome under research)leading to shutting down of different organs gradually.
Take home message from me-
Take him to a quaternary care center where four specialties Genetics, Neurology, Endocrinology and Gastroenterology are there under one roof. Request them all to discuss this case. They are very rare cases and need extensive investigations and expertise on part of treating doctors. I would suggest you to take him to a Medical school or Hospital and request the researchers and Professors of various specialty to come together and discuss all possibilities taking your son as a Case and not just as a Patient.
I hope I answered your query well,I case you need any other explanation feel free to ask.
Thanks.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you, will take your suggestions and act!
Brief Answer:
Thank you and wish him a fast recovery.
Detailed Answer:
Thank you and wish him a fast recovery.
Thank you and wish him a fast recovery.
Detailed Answer:
Thank you and wish him a fast recovery.
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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