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Posted 6/22/2011 5:37 PM (GMT 0)
I saw my GI yesterday afternoon for a follow-up.  To recap, 10 days ago he took me off all my meds because I complained of very annoying tinnitus.  Tinnitus is a symptom of salicylate toxicity, and since all of my meds are 5-ASAs (salicylates) he took them all away.  He wanted to see me to see how I was doing.

Having been gluten free now for 3+ weeks, I'm feeling really energetic and alert.  But my belly feels only slightly better.  Certainly less gassy.  But the right sided pain and the slow bowel process are still there.  And yesterday the pain started.  Man, I haven't had that pain for a long long time.  I didn't want it back.  The burning, searing midbelly pain. Yikes.  And my knee has been more achy since last weekend.  So he told me to start back the sulfasalazine but hold off on the Pentasa until I get an all-clear from an ENT.  My tinnitus is better but not gone.

I repeated, for the umpteenth time, that I still have right-sided pain. That I can feel "lumps" in my belly around the transverse colon sometimes, and that they stay there unless I move them with my hands.  He said "you're feeling stool" and I said "duh."  No, I didn't, but I thought it.  I did say "why am I feeling stool in my transverse colon?  Why do I feel the urge to defecate under my ribcage and not in my bottom?"  He was kind of stumped and said, in a nice way, "you're weird?"  Ugh.  I said "you're sure it's not a stricture????"  He openED MY CHART.  Hallelujah.

He said "you had an esophageal stricture.....when was the last time we scoped you?"

I don't want another scope unless absolutely necessary and I told that to him.  He suggested a CAT scan.

Will it illuminate my bowels sufficiently to help diagnose this right side pain?  Is it worth the dose in radiation?

Posted 6/22/2011 5:51 PM (GMT 0)
If you can substitute a MRI or pill cam for the CAT scan you could avoid a lot of radiation.
Posted 6/22/2011 5:57 PM (GMT 0)
I think there's a cost/benefit analysis going on here. The pill cam and MRI are pretty expensive, while I think the CT scan is less so. Am I mistaken?
Posted 6/23/2011 3:07 PM (GMT 0)
I'm confused! Esophogeal stricture? Scope? CT Scan? Intestines? Right side pain? Transverse colon pain?

We're all over the map (your body) here. The CT scan can check from the esophagus to the rectum so that sounds like your best bet. In many, if not most areas, the MRIs are still NOT up to date and accurate enough to provide as good results as the CT scans. Scoping would necessitate two scopes, upper and lower, and still leave a vast area uninspected. The pill cam carries a risk if strictures are suspected unless the Agile Patency Capsule can be used first.

In late 2003 I had a CTE at Mayo and I asked about the MRE. I was told they were quite enthused about the MRE's future - BUT - at that time the MRE was equal to or superior to the CTE (I forget which) ONLY at the rectum. That there was much more work to be done before the MRE could provide more accuracy than the CTE overall. BUT they were enthusiastic about its eventual success in the relatively near future. That was 8 years ago so I'm fairly sure that success has most likely been attained for at least a few MR devices around the country but how widespread these newer devices are is an entirely different issue.

Posted 6/23/2011 3:30 PM (GMT 0)
I had a CT scan in 1999, when my regular doctor thought I had acute appendicitis, but insisted that I have an emergency CT scan before they scheduled the surgery. The radiologist came out to see me immediately after the scan and told me, "I have good news and bad news. The good news is, you don't have appendicitis. The bad news is that you have Crohn's Disease in your terminal ileum." The scan clearly showed an inflamed, almost totally closed area in my intestines, in impressive detail. So yeah, the CT scan can help with a diagnosis.

That said, I don't know anything about comparative amounts of radiation--or anything except what I've said above. So I don't know whether it's the best course of action for you.
Posted 6/23/2011 7:32 PM (GMT 0)
CrohnieToo, sorry my post was all over the map. An esophageal stricture is not what I'm worried about now. Believe me when I tell you an esophageal stricture cannot be confused with a stricture anywhere else. I was simply trying to make the point to my DR that strictures are something I'm worried about Crohn's wise. I don't get fistulas or fissures. It took me almost a year to get my [previous] GI to pay attention to my complaints about difficulty swallowing. I'm not in a panic about this right-side pain, just annoyed that I still have it and no reason for it is known.

I've been telling THIS GI for probably 2 years now about pain in my right upper quadrant....last year we went down the gallbladder rabbit hole with nothing to show for it at the end except a low/normal ejection fraction in my gallbladder, therefore not a cause of the pain. My blood work shows no liver problems; I think kidneys are ok too. So what's left?

Thanks for your comparitive feedback about the different imaging options. I am ready to pull the trigger on this CT scan. I'm tired of not knowing what's going on there.

Nawlinscate - so many Crohnies go into the hospital for an appendectomy and come out with an IBD diagnosis. I'm glad your DR was insistent about the scan and saved you an unnecessary surgery. Thanks for your feedback!
Posted 6/23/2011 8:08 PM (GMT 0)
I was simply trying to make the point to my DR that strictures are something I'm worried about Crohn's wise.

Lecithin or phosphatidylcholine was originally extracted from egg yolks and is used as an emulsifier in cooking or as a food supplement to lower cholesterol. No real reason to mention it here except that there are some signs that it may be useful for helping with strictures.

www.lef.org/protocols/prtcl-044c.shtml
Bowel strictures, abnormal temporary or permanent narrowing of the bowel, are characterized by excess deposition of collagen in the intestinal wall. A study was conducted to determine the effect of PPC in the prevention of bowel strictures. Three groups of rats were assessed: a control group, a confirmed colitis group, and a group of rats diagnosed with colitis, but receiving phosphatidylcholine. In conjunction with the study, collagen deposition and collagenase activity in colonic tissue were measured in all of the groups. None of the control rats, but 12 of 16 rats with colitis, developed colonic strictures.

In contrast, only two of 15 phosphatidylcholine-fed rats with colitis showed strictures. Collagen content was much higher in the rats with colitis than the phosphatidylcholine-fed rats with colitis and the control rats. Collagenase activity in colonic tissue was, also, much higher in the phosphatidylcholine-fed rats (Mourelle et al. 1996). Phosphatidylcholine appears to enhance collagen catabolism, restricting collagen buildup in inflamed intestinal tissue and the resulting stricture formation.
Posted 6/23/2011 10:57 PM (GMT 0)
I've had 2 CT scans, one in the ER a couple years ago for acute pain and abdominal distention, and recently a CT Enterography after a long weekend of pain caused by a partial bowel obstruction. When I went to the ER a few years ago, the surgical consult told me if I was any normal person, they'd be taking out my appendix with it looking as it did. But they knew I had Crohn's, so they left it alone, admitted me, and pumped me full of steroids and antibiotics instead. The recent CT enterography was to get a good look at my small bowel, where they already knew from before that I had a stricture. They can definitely see strictures well with the CT, and they were also able to spot a fistula starting to form in another part of my bowel. I would highly recommend getting the test done. My stricture is in the terminal ileum, but the pain radiates up into my right upper quadrant and under my right ribs all the time. I don't have any liver or other organ issues, the stricture pain just refers up that way for some reason. Just because it hurts on your upper right side, that doesn't mean that's the exact location of the problem.
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