Doctor Speak
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Doctor Speak
I need someone that knows doctor speak to translate please:
Hi,
The images are too small to read, but I managed to open them with an image processor so that I can get an image large enough to easily read. Unfortunately, I have to get ready to attend a funeral, and I may have to work a while afterward, so I won't be able to write a detailed description of my observations until later.
The first thing that I notice, however, is that your doctor only took a single biopsy sample each, from your ileum, and your colon. That's not anywhere enough samples to reliably diagnose or rule out microscopic colitis.
More to follow.
Tex
The images are too small to read, but I managed to open them with an image processor so that I can get an image large enough to easily read. Unfortunately, I have to get ready to attend a funeral, and I may have to work a while afterward, so I won't be able to write a detailed description of my observations until later.
The first thing that I notice, however, is that your doctor only took a single biopsy sample each, from your ileum, and your colon. That's not anywhere enough samples to reliably diagnose or rule out microscopic colitis.
More to follow.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Fascinating test! I wish I knew what all those items meant. Regarding your biopsy, I don't understand how they can say there are "abundant lymphocytes throughout the lamina propria" and then say there is no evidence for LC. Whaa?? I think they saying Ulcerative Colitis because of the cryptitis, which is usually not seen in LC/MC. The presence of eosinophils is interesting, and may suggest some IgE food allergies, as opposed to IgA mediated food sensitivities. You may have a mixture of both. Do you have any known food allergies?
1987 Mononucleosis (EBV)
2004 Hypomyopathic Dermatomyositis
2009 Lymphocytic Colitis
2010 GF/DF/SF Diet
2014 Low Dose Naltrexone
2004 Hypomyopathic Dermatomyositis
2009 Lymphocytic Colitis
2010 GF/DF/SF Diet
2014 Low Dose Naltrexone
The GI told me after the biopsies that I had MC. Then after the blood tests changed it to UC.
I ordered the Enterolab test this morning and one of the questions was the type of MC and I cannot tell from the doctorese.
I am glad I asked for copies of the tests, but it is of limited use because I don't understand a lot of it.
I ordered the Enterolab test this morning and one of the questions was the type of MC and I cannot tell from the doctorese.
I am glad I asked for copies of the tests, but it is of limited use because I don't understand a lot of it.
OK, I'm back. In my haste, I misread the report — your doctor did take 2 biopsy samples from the ileum, and an undisclosed (but multiple) number from the colon. So please disregard what I said in my previous post.
Looking at the report, your ELISA autoantibody result is elevated, as is your vascular endothelial growth factor (VEGF). It's certainly not surprising that someone who has an IBD would show a positive autoantibody result. The elevated VEGF simply implies an increased rate of new blood vessel creation and development. This can be a marker of cancer, or other issues (such as bronchial asthma or diabetes), but in your case it is surely associated with all of the inflammation in your intestines. It's a sign that your immune system is trying to heal the damage (but as we know, with IBDs, healing gets stuck in the first stage, and cannot progress). And of course if the amount of VEGF is far in excess of needs, then disease can result.
On the second page of the report, under Microscopic Description, the pathologist mentions that "the lamina propria is free from eosinophilic infiltrates". On the last page, he says:
OK, with that as background information, what does all this mean? Eosinophil numbers are elevated with both Crohn's disese and UC, but not with MC. Nor did your biopsy samples show any other markers of either Crohn's or UC, such as gross (visible to the naked eye through the colonoscope) lesions, crypt abscesses, architectural changes, etc.
I dispute this claim by the pathologist, however, "There is no evidence of lymphocytic colitis . . .". Why? Because from the first sentence on the last page of the report:
Furthermore, I see no evidence that the pathologist even considered the possibility of collagenous colitis, because nowhere in the report does he even mention the thickness of of the collagen bands in the lamina propria. An elevated lymphocyte count in the lamina propria in the absence of an elevated lymphocyte count at the surface of the mucosa is often associated with CC (but of course a measurement of the collagen band thickness would be necessary to verify the degree of thickening that would be diagnostic of CC).
In my strictly unprofessional opinion, it appears that the pathologist was trying to rule out UC, and only considered LC in passing. IOW, the pathologist failed to use due diligence in searching for MC, and therefore improperly failed to diagnose it (IMO — I'm sure that he or she would dispute that). Of course, the door was left open for interpretation, because the diagnosis was for "unspecified" active colitis, which can be interpreted to imply MC. Apparently the pathologist felt kind of wishy-washy that day. Maybe he or she isn't very familiar with MC.
I hope this helps.
Tex
Looking at the report, your ELISA autoantibody result is elevated, as is your vascular endothelial growth factor (VEGF). It's certainly not surprising that someone who has an IBD would show a positive autoantibody result. The elevated VEGF simply implies an increased rate of new blood vessel creation and development. This can be a marker of cancer, or other issues (such as bronchial asthma or diabetes), but in your case it is surely associated with all of the inflammation in your intestines. It's a sign that your immune system is trying to heal the damage (but as we know, with IBDs, healing gets stuck in the first stage, and cannot progress). And of course if the amount of VEGF is far in excess of needs, then disease can result.
On the second page of the report, under Microscopic Description, the pathologist mentions that "the lamina propria is free from eosinophilic infiltrates". On the last page, he says:
Basically, granulocytes are a category of white blood cells that are characterized by granules in their cytoplasm. They include neutrophils, eosinophils, basophils and mast cells. Neutrophils are the most common of the granulocyutes. White cells of this type are also known as polymorphonuclear leukocytes (PMNLs, or simply PMNs). They are labeled this way because of the fact their nucleus usually contains 3 segments or lobes, which distinguishes them from mononuclear white cells, which contain only a single-lobed nucleus. Mononuclear cells are also known as agranulocytes, and examples of them include lymphocytes, monocytes, and dendritic cells.Examination reveals actively inflamed colonic mucosa with moderate numbers of PMNs and eosinophils intermixed with abundant plasma cells and lymphocytes throughout the lamina propria. PMNs are seen within the surface epithelium; however, there is no evidence of ulcerative exudates. The glandular epithelium shows widespread reactive changes with increased cell turnover and focal cryptitis; crypt abscesses are not seen. Glandular architectural disarray is not demonstrated. There is no evidence of lymphocytic colitis, pseudomembranes, ulcers, parasites, viral inclusions, or epithelioid granulomas. There is no evidence of malignancy.
OK, with that as background information, what does all this mean? Eosinophil numbers are elevated with both Crohn's disese and UC, but not with MC. Nor did your biopsy samples show any other markers of either Crohn's or UC, such as gross (visible to the naked eye through the colonoscope) lesions, crypt abscesses, architectural changes, etc.
I dispute this claim by the pathologist, however, "There is no evidence of lymphocytic colitis . . .". Why? Because from the first sentence on the last page of the report:
the phrase that constitutes the last half of that sentence, "intermixed with abundant plasma cells and lymphocytes throughout the lamina propria.", is clearly suggestive of lymphocytic colitis. IOW, while the first half of that sentence is certainly not diagnostic of UC, it doesn't necessarily rule out UC, either. The last half of the sentence however, indicates a diagnostic marker of LC.Examination reveals actively inflamed colonic mucosa with moderate numbers of PMNs and eosinophils intermixed with abundant plasma cells and lymphocytes throughout the lamina propria.
Furthermore, I see no evidence that the pathologist even considered the possibility of collagenous colitis, because nowhere in the report does he even mention the thickness of of the collagen bands in the lamina propria. An elevated lymphocyte count in the lamina propria in the absence of an elevated lymphocyte count at the surface of the mucosa is often associated with CC (but of course a measurement of the collagen band thickness would be necessary to verify the degree of thickening that would be diagnostic of CC).
In my strictly unprofessional opinion, it appears that the pathologist was trying to rule out UC, and only considered LC in passing. IOW, the pathologist failed to use due diligence in searching for MC, and therefore improperly failed to diagnose it (IMO — I'm sure that he or she would dispute that). Of course, the door was left open for interpretation, because the diagnosis was for "unspecified" active colitis, which can be interpreted to imply MC. Apparently the pathologist felt kind of wishy-washy that day. Maybe he or she isn't very familiar with MC.
I hope this helps.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
thanks Tex, that part about the lymphocytes is exactly what I thought the 2 statements seemed to disagree.
The colonoscopy itself didn't show any signs of anything. The GI told my husband everything looked fine and he had only taken the biopsies for the purpose of checking for MC. I didn't have any visible problems.
The dx of UC on the blood tests also confuses me. Does that mean I am genetically inclined or that I already have it? Can MC advance to UC? Could I have both?
Guess the treatment is pretty much the same other than UC involves bleeding and MC does not?
The colonoscopy itself didn't show any signs of anything. The GI told my husband everything looked fine and he had only taken the biopsies for the purpose of checking for MC. I didn't have any visible problems.
The dx of UC on the blood tests also confuses me. Does that mean I am genetically inclined or that I already have it? Can MC advance to UC? Could I have both?
Guess the treatment is pretty much the same other than UC involves bleeding and MC does not?
Prometheus Labs claims that test to be quite accurate, but since the algorithm used for "diagnosis" was based on a somewhat limited number of subjects, I doubt that it is as accurate as they would like for us to believe. It certainly implies that your test results are consistent with results for patients who actually have UC. Without histological evidence though (based on biopsy samples), I doubt that your GI specialist would be confident of such a diagnosis.nerdhume wrote:The dx of UC on the blood tests also confuses me. Does that mean I am genetically inclined or that I already have it
Some "authorities" claim (without proof) that it can. Personally, I doubt that it's very likely. The fact of the matter is that until proven otherwise, we almost surely have the same chance of developing UC as anyone in the general population — no better and no worse. And yes, it's possible to have both.nerdhume wrote:Can MC advance to UC? Could I have both?
Correct. In fact, I can recall at least one member who has UC (but not MC) who controls his UC symptoms entirely by diet changes. He hasn't posted in years, but at last word, he was doing fine.nerdhume wrote:Guess the treatment is pretty much the same other than UC involves bleeding and MC does not?
Here are links to a few of his posts, if you are interested. Look for posts by NJ in these threads.
http://www.perskyfarms.com/phpBB2/viewtopic.php?p=66509
http://www.perskyfarms.com/phpBB2/viewtopic.php?p=75712
http://www.perskyfarms.com/phpBB2/viewtopic.php?p=76643
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.