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6 month follow up wih gi

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Ulcerative Colitis
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Posted 12/19/2012 3:15 PM (GMT 0)
I am so confused,my gi insists that the colonoscopy and biopsy showed no signs of colitis ,so the little bit of bloody mucus on my bowel movement goes unexplained,she doesn't dispute the 9 years ago findings of proctitis from a previous gi,but does dispute the 1.5 years ago diagnoses of 50cm proctosigmoiditis from yet another gi,said the inflammation and ulceration seen threw the scope and biopsy stating consistent with uc might have been caused by the advil and clyndamicin taken just 2 weeks before the scope.

She said if I had proctosigmoiditis I would have much worst symptoms than the slight blood on feces.

Said she should have seen some scarring or evidence of colitis,but it was a 1.5 year between scopes,I have read of many showing no signs of previous colitis when in remission.

My only symptoms over the 9 years are blood on or around stool,little bit of mucus,never any diahhrea.It's a small amoun t of blood when I was first diagnosed I was bleedind 5-15 per day for about 3 months that has never happened again.

I have been following the scd for 1.5 years just wondering if I am depriving myself of some food for a condition I don't have.

Some insite please? Sorry I know it's a long post

Posted 12/19/2012 5:27 PM (GMT 0)
That is confusing. I don't know what to tell you, except maybe get another opinion.
Posted 12/19/2012 5:39 PM (GMT 0)
Could be internal hemmerhoids creating the blood- if so, good for you- you dont have active UC ... Though he shoukd have seen them.
Posted 12/19/2012 6:08 PM (GMT 0)
I think the GI is offering a medical opinion that you very probably had some other type of colitis/inflammation 1.5 years ago, based on no residual evidence.

Your point that sometimes there is not residual evidence seems well taken. I bet if pressed she migh say only 97% sure of some such.

I think it is good to remember that idiopathic UC is an exclusionary diagnosis, and that maybe not every other type of colitis go excluded 1.5 years ago.

... at least that is how I make sense of what you are reporting
Posted 12/19/2012 6:58 PM (GMT 0)
Probiotic,she did say I had some internal hemrrhoids,but I am not constipated. I read on here that someone was told they don't have uc after ten years they discontinued medication and flared,now I am not on any medication other than I occasoinally use salofalk suppository.
Posted 12/19/2012 7:03 PM (GMT 0)
Do you have copies of all the colonoscopy biopsy reports?

q
Posted 12/19/2012 7:10 PM (GMT 0)
I even asked her how often I need a colonoscopy ,she said" well people with colits after 10 years every three years,"implying as if I don't have it. also I told her I still occasionally use the supp. and she gave me an odd look" You do? I think in a couple of years I will ask for a colonoscopy but by a different gi again,justtto have another opinion. She said she wouldn't prescribe me medication because I don't need it,I am intolerant to the orals and enemas anyway.
Posted 12/19/2012 7:12 PM (GMT 0)
You don't have to have constipation to have issues with hemmies.

I'd also try to get copies of the past c-scopes/biopsies. That's where the real info is.
Posted 12/19/2012 7:13 PM (GMT 0)
do you have copies of all the biopsies results from all of your colonoscopies...including the last one?

That will be the tell.

Every 3 years, I think, would be the least between scopes.

q
Posted 12/19/2012 7:45 PM (GMT 0)
I do

9 years ago-proctitis was seen 12cm of the distal colon

rectal biopsy-acute and chronic inflammation

  comment:the differential diagnosis based on histology alone includes active inflammatory disease,infectious aetiology ad non-specific proctitis. correlation with the endoscopic findings is advised.

This is when I was told I have ulcerative proctitis,I would bleed 10-15 a day ,on its own even when i expelled gas, I was prescribed suppositories,just after one use the bleeding stopped. Over the years I would have a streek of blood here and there ,use a sup. and it resolved.

Sig from 1.8 years

the biopsies of colorectal mucosa show a moderately active chronic proctocolitis,consistent with uc. there is a chronic inflammatory infiltrate,distributed diffusely in the lamina propria with moderate acute cryptitis. there is mild -moderate distortion of the crypt architecture. there is no dysplacia or malignancy.

diagnoses-chronic proctocolitis with moderate activity ,consistent with uc.

this was 2 wees after Advil use and clyndamicin,bloody mucus discharge was my symptoms.

colonoscopy 6 months ago -the colonoscopy today was intirely normal with the exception of internal hemrroids

biopsy-everything within normal limits

Posted 12/19/2012 7:48 PM (GMT 0)
If you had mild to moderate distortion of the architechture, it should have shown on this as well.

Did the biopsy results come from the conclusion or each section? Do you have that breakdown as well...
q
Posted 12/19/2012 7:51 PM (GMT 0)
I'm saying that if you have a little bit of bloody mucus on your stool then you are not 100% in remission. In other words, I wouldn't quit or cut back on anything you have done to get you where you are currently at.
Posted 12/19/2012 8:02 PM (GMT 0)
the specimen consists of fragments of large bowel mucosa showing focal dismal crypt architecttural distortion which is within normal limits of rectal biopsy.there is normal crypt architecture. the thickness of the subepithelial collagen plate is within normal limits. there is no evidence of intraepithelial lymphocytosis.the lamina propria shows mild edema and focal superficial hemorrhage. the inflammatory infiltrate in the lamina is within normal limits. there is no evidence of acute cryptitis ,crypt abscess or granuloma.

diagnose: rectum,biopsy within normal limits.

Posted 12/19/2012 8:07 PM (GMT 0)
Right....and I'll assume the doc put at the top that you have UC.

Being in normal limits "for UC"....not for someone who's never had UC I'm assuming.

Your doc's a dorkette, and she should be absolutely thrilled you're doing well.
She's remiss in taking you off meds totally.

q
Posted 12/19/2012 8:23 PM (GMT 0)
quincy's idea of "normal limits for UC" might make sense of this.

it does sound like there was UC 1.5 year ago, because I thought that the distorted crypt architecture was diagnostic.

I definitely do not have enough histological knowledge to go any further
Posted 12/19/2012 8:33 PM (GMT 0)
Clinic information

rectum intirely normal,history of uc,completely normal mucosa.

impression and plan;

this patient's colonoscopy to the terminal ileum was intirely normal today with exception of small internal hemorrhoids. There was no evidence of active disease and also no evidence of prior disease which we normally are able to identify with loss of vascular pattern.. I have recommended to do a sigmoidoscopy while she is syptomatic to better identify the extent and severity of the disease.

This is the thing I was having some blood just prior to the colonoscopy  ,as well. She is just doubting the spread of the disease and beleived the proctitis from 9 years ago. I think.

Posted 12/19/2012 8:42 PM (GMT 0)
I asked her if I could have been misdiagnosed 1.8 years ago and she said yes, that Advil and the Antibiotic could have caused all that inflammation,she beleives My symptoms would be much worst if I had proctocolitis ,not just little bit of bloody mucus  and it also cleared up without medication within a month, I cannot take orals or enemas,suppositories are my only medication. It might have cleared up faster but I had a terrible reaction to the orals that I was prescribed at the time.
Posted 12/20/2012 8:10 AM (GMT 0)
OK, so yes..it could have been a misdiagnosis with you having the obvious inflammation and cellular structure changes. It would be great if that's what you had and it's now gone.

The only way you'd know is if you went off the supps....and ifyou became symptomatic you get there asap for her to take a look-see with a rectoscope.

The only think that has me not believing the misdiagnosis is that if you did have inflammation from antibiotics and/or advil....the pattern wouldn't have set itself out exactly like UC. You'd have it elsewhere.

Definitely something to consider...but if you also have hemmies, why won't she give you any meds for that?

q
Posted 12/20/2012 12:34 PM (GMT 0)
Quincy- the first 2 exams were sigmoid exams only,she said the whole sigmoid was inflamed,

the 3rd was the only colonoscopy I had-but reading it again ,she only took biopsies from the rectum ,no where else.

I think I will just have to get a new gi,for my next scope and get my gp to prescribe me more supp.

It's just very confusing. She is a young dr.,mid 30s ,maybe not very experienced. But the last one was much older but made lots of mistakes .I guess I was just hoping I still only had proctitis because it's a milder for of uc,but I should be greatful that my symptoms are pretty mild,I was just worried the blood means constant inflammation which is not good.

I don't know why she wont prescibe anything for the internal hemmies. Is there something over the counter I can take? Thank you for your input! Also I though I was symptomatic just a 10 days before the colonoscopy because I was haing bloody stool. Could it have cleared up within that time?

As of this morning there is still little blood on my stool,which I also mentioned at the follow up that I had blood on my stool evey few day and she had no responds.

Post Edited (zdenka) : 12/20/2012 6:01:28 AM (GMT-7)

Posted 12/20/2012 3:23 PM (GMT 0)
I hope it was a misdiagnosis but it makes me wonder if we could all have UC due to something we were doing and maybe someday mine will go away as well :) Wishful thinking... THis illness is so confusing. I think I'd get another opinion just to be sure.
Posted 12/20/2012 4:04 PM (GMT 0)
nssg- I beleive I still have proctitis,I am hoping I don't hae sigmoiditis,the whole sigmoid affected like the sig-showed 1.8 years ago.
Posted 12/20/2012 7:47 PM (GMT 0)
zdenka...you're welcome.  It burns my butt to hear your experience.

Iit's confusing for sure, and a huge neglect on your GI's part to not treat what symptoms you have at this point at the very least!

Yes, you need a new GI to start over. 

Get your GP to prescribe both the Proctomycin hcl supporitories and ointment for now (especially since the GI said you have hemmies).  That will help with inflammation in the rectum anyway...at least to get you through the time before you see a new GI.

Through this link, type in the specialty of gastroenterology and your city/state.  Hope you come up with some promising GIs you can be referred to.  Also check out your doctor to see what others experience as well.

http://www.ratemds.com/search.jsp?country=0

q

Posted 12/20/2012 10:25 PM (GMT 0)
Quincy,Thank you again.

I already checked her out,she has 3.7 out of 5. Last comment is that a woman blames her for her 32 year old husband's death,that she neglected to find his stomach cancer and just kept prescribing him pain pills for over 2 years.

My last gi was terrible too,I had to get screened for heb. b,c and hiv after my sig. scope,do to finding equipment not cleaned properly.

I will reques my gp. to send me to the gi that is rated 5 out of 5,even if I have to wait months and months for an appointment. Thank you again and happy holidays.

Posted 12/22/2012 8:21 AM (GMT 0)
You're welcome...happy holidays to you as well!

Keep us updated.
q
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