My test results
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My test results
Well, I went today to get my test results after having blood work, fecal tests and a colonostopy done. Also, had received a letter in the meantime saying they found something abnormal. Well, today the Dr. says he didn't find anything wrong with me. Not even the microscopic colitis. Now, I'm thinking am I going crazy. He asked me again how many times a day are you going. I told him again at least 8-10 times a day. Sometimes more and sometimes less. He just said that's not good. So he said he would treat me for IBS and gave me a prescription for Bentyl (anti_spasmodic med). Come back in 4 weeks... He told me to stop taking the Welchol since that wasn't helping. So now I don't know what to think.
Hmmmmmm. IBS, is almost always doctorspeak for "I don't have the foggiest idea what's wrong with you", which, of course, he even admitted, and for that I have to give him credit. Also, a biopsy is almost always the difference between a diagnosis of MC, and a diagnosis of IBS.
I apologize, but unlike your doctors, I don't have your records in front of me, so I can't remember if you had biopsy samples taken during the colonoscopy, nor can I remember for sure whether you had a previous diagnosis of MC, based on biopsy samples taken during an earlier colonoscopy or sigmoidoscopy. Also, I don't remember if you are on a GF diet, which could possibly make a difference in a biopsy result.
The difference between the comment that was made in the letter, about an "abnormal finding", and what he said at the appointment, makes me wonder if he actually knows how to interpret a pathologist's report, as far as the markers of MC are concerned. He wouldn't be the first one who misinterpreted a pathology report, simply because he does not understand MC, and it's pathological markers. Also, unfortunately, there are a few pathologists around who don't always recognize the markers of MC, and even though they accurately report what they see under the microscope, the significance of the markers doesn't always "register", so they occasionally miss the diagnosis. The most common problem, though, is the occasional GI doc, who thinks he knows more about the issue than the pathologist, and so he makes his own, (incorrect), interpretation of the pathology report, regardless of the pathologist's conclusions, as stated in the report. It is apparently legal for him to do so, but it results in a grave disservice to his patients. This isn't necessarily a common problem, but among the members here, we have encountered that problem several times, that I can recall.
Do you by any chance have a copy of the pathologist's report, or a copy of a previous pathologist's report, if you had a previous diagnosis of MC, from another doctor. If you have a copy of the pathologist's report, and you will post it, (or PM it to me, if you don't want to make it public), I can tell you whether or not it indicates LC, MC, or whatever. Since I'm not a doctor, obviously, I can't diagnose anyone, but I can certainly interpret the report, and tell you what the indications are.
Tex
I apologize, but unlike your doctors, I don't have your records in front of me, so I can't remember if you had biopsy samples taken during the colonoscopy, nor can I remember for sure whether you had a previous diagnosis of MC, based on biopsy samples taken during an earlier colonoscopy or sigmoidoscopy. Also, I don't remember if you are on a GF diet, which could possibly make a difference in a biopsy result.
The difference between the comment that was made in the letter, about an "abnormal finding", and what he said at the appointment, makes me wonder if he actually knows how to interpret a pathologist's report, as far as the markers of MC are concerned. He wouldn't be the first one who misinterpreted a pathology report, simply because he does not understand MC, and it's pathological markers. Also, unfortunately, there are a few pathologists around who don't always recognize the markers of MC, and even though they accurately report what they see under the microscope, the significance of the markers doesn't always "register", so they occasionally miss the diagnosis. The most common problem, though, is the occasional GI doc, who thinks he knows more about the issue than the pathologist, and so he makes his own, (incorrect), interpretation of the pathology report, regardless of the pathologist's conclusions, as stated in the report. It is apparently legal for him to do so, but it results in a grave disservice to his patients. This isn't necessarily a common problem, but among the members here, we have encountered that problem several times, that I can recall.
Do you by any chance have a copy of the pathologist's report, or a copy of a previous pathologist's report, if you had a previous diagnosis of MC, from another doctor. If you have a copy of the pathologist's report, and you will post it, (or PM it to me, if you don't want to make it public), I can tell you whether or not it indicates LC, MC, or whatever. Since I'm not a doctor, obviously, I can't diagnose anyone, but I can certainly interpret the report, and tell you what the indications are.
Tex
Thanks for your responses. I was first diagnosed 7-29-98 The only thing I have is a Operative Report. It says: Preoperative Diagnosis: Rule out inflammatory bowel disease. Postoperative Diagnosis: Microscopic colitis, redundant colon.
Procedure/Operation: Colonoscopy.
Then under procedure: The scope was introduced in the rectum and gradually advanced to the cecum noticing generalized spasm and redundancy. There are no mucosal ulcerations, polps, masses seen in the entire colon examined. The rectal are revealed some devoidance of submucosal plexus, microscopic colitis in this scenarion cannot be excluded, hence biopsy was obtained in the random section to rule that possibility out.
Then it says regarding the biopsy: Rectal mucosal biopsy: Mucosal erosion with midly active colitis suggestive of Microscopic Colitis.
Now, I've had this done 3 times prior to going to this Dr. and was told the same thing that I had Microscopic Colitis.
This last pathology report says:
Diagnosis:
A - BX Ascending colon
- Benigh colonic Mucosa
- No specific pathologis changes seen
B - BX Transverse colon
- Benigh colonic mucosa
- no acute inflammation seen
- No specific pathologis changes recognized
C - BX Sigmoid Colon
- Benigh Colonic Mucosa
- No acute inflammation seen
- No specific pathologis changes recognized.
Now maybe he didn't give me all of the copies but that is all I have.
Hope you can make heads or tales out of that. I hope I've answered all of the questions you asked me. I sure do appreciate the help.
Oh, I'm not on a GF Diet, but there are many foods that I try stay away from.
I feel to that this Dr. really doesn't know what to do.
Again thanks for your help.
Sally
Procedure/Operation: Colonoscopy.
Then under procedure: The scope was introduced in the rectum and gradually advanced to the cecum noticing generalized spasm and redundancy. There are no mucosal ulcerations, polps, masses seen in the entire colon examined. The rectal are revealed some devoidance of submucosal plexus, microscopic colitis in this scenarion cannot be excluded, hence biopsy was obtained in the random section to rule that possibility out.
Then it says regarding the biopsy: Rectal mucosal biopsy: Mucosal erosion with midly active colitis suggestive of Microscopic Colitis.
Now, I've had this done 3 times prior to going to this Dr. and was told the same thing that I had Microscopic Colitis.
This last pathology report says:
Diagnosis:
A - BX Ascending colon
- Benigh colonic Mucosa
- No specific pathologis changes seen
B - BX Transverse colon
- Benigh colonic mucosa
- no acute inflammation seen
- No specific pathologis changes recognized
C - BX Sigmoid Colon
- Benigh Colonic Mucosa
- No acute inflammation seen
- No specific pathologis changes recognized.
Now maybe he didn't give me all of the copies but that is all I have.
Hope you can make heads or tales out of that. I hope I've answered all of the questions you asked me. I sure do appreciate the help.
Oh, I'm not on a GF Diet, but there are many foods that I try stay away from.
I feel to that this Dr. really doesn't know what to do.
Again thanks for your help.
Sally
Hmmmmmmmmmm. Well, I'm not able to get much worthwhile information from those reports. The endoscopy report from 7-29-98 is very confusing. It consists of remarks solely by the doctor doing the colonoscopy, including the comments on biopsy observations. IOW, if a pathologist evaluated the biopsy samples, his remarks are not included, but are simply "summarized" by the GI doctor.
On the rectal mucosal biopsy, he notes: "Mucosal erosion with midly active colitis suggestive of Microscopic Colitis". Mucosal erosion is a phenomenon frequently observed with ulcerative colitis, but as far as I'm aware, it is irrelevant, as far as MC is concerned. "mildly active colitis suggestive of MC" might possibly be based on facts, but without an actual lymphocyte count, it doesn't mean much. IOW, it sounds as though he might be referring to gross indications, (visable signs), rather than a microscopic examination of the sample.
The last pathology report also appears to be just a summary of the actual report, probably made by your GI doc. Here's what a real pathology report looks like, in it's entirety, (this is the biopsy report on a section of my colon that was removed about two years and eight months ago). Note that it was signed and certified by the pathologist, and also signed by his assistant, (I x'ed out the actual names, for privacy reasons, of course):
If we can believe that report, then it means that you do not have MC, nor any other IBD, and your colon is perfect.
The reason I asked about the GF diet, is because after a long enough healing period, the markers of MC can disappear for some patients, so that could explain a "clean" biopsy report.
If these reports are all that your doctor has to go on, it's no wonder that he's confused, because now I'm just as confused as he is. LOL.
By the way, a redundant colon simply means that your colon is longer than it would have to be, and probably has some extra twists and turns, but this is quite common, and is nothing to be concerned about.
Do you still have your gallbladder?
Tex
First off, I don't see any way that he could possibly have noticed that the rectal area of the colon was somewhat devoid of "submucosal plexus". The submucosal plexus refers to a network of nerve cells located in the submucosa of the colon. The submucosa lies not only below the mucosa, but also below the muscularis mucosae, which is a thin layer of muscle, that separates the mucosa and the submucosa. He would have to have had x-ray vision, (like superman), to actually see that through the scope. He either had his anatomy confused, or his nomenclature confused, or he had a very vivid imagination, at the time. Even if there were some way that he could have actually viewed the submucosal plexus, and noticed that it was inadequate, what would that have to do with microscopic colitis? ...nothing that I am aware of.The rectal are revealed some devoidance of submucosal plexus, microscopic colitis in this scenarion cannot be excluded, hence biopsy was obtained in the random section to rule that possibility out.
Then it says regarding the biopsy: Rectal mucosal biopsy: Mucosal erosion with midly active colitis suggestive of Microscopic Colitis.
On the rectal mucosal biopsy, he notes: "Mucosal erosion with midly active colitis suggestive of Microscopic Colitis". Mucosal erosion is a phenomenon frequently observed with ulcerative colitis, but as far as I'm aware, it is irrelevant, as far as MC is concerned. "mildly active colitis suggestive of MC" might possibly be based on facts, but without an actual lymphocyte count, it doesn't mean much. IOW, it sounds as though he might be referring to gross indications, (visable signs), rather than a microscopic examination of the sample.
The last pathology report also appears to be just a summary of the actual report, probably made by your GI doc. Here's what a real pathology report looks like, in it's entirety, (this is the biopsy report on a section of my colon that was removed about two years and eight months ago). Note that it was signed and certified by the pathologist, and also signed by his assistant, (I x'ed out the actual names, for privacy reasons, of course):
Okay, these guys were looking for cancer, not MC, but the format of the report should be the same. Note that a pathology report normally contains detailed, actual observations, regarding the condition of the tissue in the sample. The "pathology report" that you were given, includes only general disclaimers, that is, nothing remarkable was noted, and it wasn't signed and certified. "Benign Colonic Mucosa" implies that the mucosa is entirely normal, with no lesions, etc. "No acute inflammation seen" implies that no abnormal infiltration of lymphocytes was noted, (IOW, no indications of LC were present). "No specific pathologic changes recognized" implies that your colon checked out impeccably, which is somewhat hard to believe, since in reality, most of us have changes of some sort, once we're past infancy.BRIEF CLINICAL HISTORY
GROSS:
Labeled Sigmoid colon is an approximately 18.0 cm in length x up to 12.0 cm in circumference tortuous portion of colon with attached mesocolon. Both ends are closed with rows of silver colored metal staples. The serosa shows dusky red and purple discoloration, approximately 5 cm from the distal margin is what grossly appears to be an area of adherence and stenosis narrowing to 2.5 cm in circumference. Opening the specimen shows the mucosa is tan wrinkled and velvety with proximal dilatation. There are scattered shallow diverticula. Sectioning shows no grossly recognized ulcerations, perforations or mass lesions. Representatives are submitted as follows: 1A-proximal margin, 1B-distal margin, 1C-D-representatives of diverticulum, 1E-F-representatives from area of stenosis and possible adherence, 1G-proximal mucosa, 1H-distal mucosa, 1I-grossly recognized lymphoid tissue from the dissected mesocolon.
SW/sc
MICROSCOPIC DIAGNOSIS:
sigmoid colon, resection: Acute diverticulitis, focally marked with surrounding reactive mucosal changes and underlying granulation tissue.
Margins of resection are viable.
11 benign reactive lymph nodes.
Microscopic/Diagnostic Dictation performed by
Xxxxx Xxxxxxxxx MD
Electronically signed 11/15/2005 10:58:08AM
Final Diagnosis performed by
XX Xxxxxxxx Jr, DO
Electronically signed 11/18/2005 1:04:15PM
* I have reviewed the pertinent gross findings, any and all microscopic slides, and the resident's interpretation. I have made appropriate editorial changes and have rendered the final diagnosis.
If we can believe that report, then it means that you do not have MC, nor any other IBD, and your colon is perfect.
The reason I asked about the GF diet, is because after a long enough healing period, the markers of MC can disappear for some patients, so that could explain a "clean" biopsy report.
If these reports are all that your doctor has to go on, it's no wonder that he's confused, because now I'm just as confused as he is. LOL.
By the way, a redundant colon simply means that your colon is longer than it would have to be, and probably has some extra twists and turns, but this is quite common, and is nothing to be concerned about.
Do you still have your gallbladder?
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.
Hi Tex,
Yes, I still have my gallbladder. Well, I just don't know now what to think. Do you think it's worth trying Bentyl? Do you think I'm wasting my time with this Doc? I'm almost sorry now that I didn't just go to the University of KY and had it looked at there. (At least I'm hoping they would have good Doctors there).
I just don't know what to do. I don't want to keep talking drugs just to try and see if this will work.
I appreciate all of your help, you sure are very informative. Sally
Yes, I still have my gallbladder. Well, I just don't know now what to think. Do you think it's worth trying Bentyl? Do you think I'm wasting my time with this Doc? I'm almost sorry now that I didn't just go to the University of KY and had it looked at there. (At least I'm hoping they would have good Doctors there).
I just don't know what to do. I don't want to keep talking drugs just to try and see if this will work.
I appreciate all of your help, you sure are very informative. Sally
Sally,
Yes, Bentyl is an antispasmodic and antimuscarinic, which means that it reduces colon spasms and slows down motility. It's usually prescribed for IBS, (not for IBDs), and for issues such as diverticulosis, spastic colon, and bladder spasms. (The term "spastic colon" is sometimes used interchangeably with IBS, but that isn't really accurate, since IBS can sometimes be associated with decreased motility.) If you actually have IBS, then that treatment is probably as good as any.
If you actually have MC, though, (which is likely, but certainly not proven by the test reports that you've been given), Bentyl might slow down the D, (by reducing the peristaltic action of the colon), but it will do nothing to address the inflammation that is source of the problem.
The doctors and nurses who work at teaching hospitals, (affiliated with universities), are much more likely to be aware of the latest techniques, and the newest technologies, related to medicine. IOW, they are early adopters. For recently discovered diseases, (MC was first described only a little over 20 years ago, which is fairly recently, as medical developments go), teaching hospitals definitely offer the best chances of proper diagnosis and treatment.
I really don't know what to think about your doctor. The thing that bothers me the most about the "pathology report" that you posted, is the fact that it makes absolutely no mention of lymphocyte count, (which is essential for determining a diagnosis of LC), nor does it mention any reference to the thickness, (or relative thickness), of collagen bands, (which is essential for determining a diagnosis of CC), for any of the biopsy samples. It's simply a "dumbed-down" summary of conclusions, with no substantiated statements of fact. The truth is, you can't find MC, if you don't know how to look for it, and I get the impression that whoever wrote that "pathology report", (whether what they sent you is excerpts from the original report, or a summary), really doesn't understand how to diagnose MC. Someone who doesn't know how to diagnose MC, almost certainly doesn't understand how to properly treat it. It's a crying shame that out of that many colonoscopies, you couldn't receive a single definitive biopsy report that actually appears to be valid. You've certainly had more than your fair share of "unqualified doctors".
Still, I have to admit, that given the facts you've posted, IBS is the correct diagnosis, by default, (since the pathology report rules out MC), so your doctor is playing by the rules, and I can't really fault him for that. I can fault him, however, for not discovering what is actually wrong with your digestive system, so that you can be properly treated.
The reason I asked about your gallbladder, is that after the gallbladder has been removed, bile is continually dumped into the small intestine, even when it's not needed, which can cause D for some individuals, (a fact that many doctors seem unaware of, or choose to deny).
Okay, I just went back and read your earlier posts, and based on the fact that eating more fiber, (the traditional recommendation for IBS), causes you to have to spend much more time in the bathroom, I have virtually no doubt that you have MC, (since fiber-intolerance seems to be unique to the IBDs). That doesn't carry any weight, of course, since I'm not a doctor, but IMO, if you are ever going to get any relief, (unless you want to adopt the GF diet, and simply treat yourself, like many of us here), you will have to locate a GI doc who actually knows how to properly diagnose and treat MC, and who uses the services of a pathologist who is actually qualified to diagnose MC. IOW, if you want to control your MC with meds, (specificially Entocort, or another anti-inflammatory), you will need to get a correct diagnosis, so that you can get a prescription. If you want to try to treat it yourself, (without a doctor's help), then the GF diet is basically your only viable option. I'm not aware of any research concerning the GF diet and IBS, but I have a hunch that the GF diet may well control the symptoms of IBS, also, since it definitely helps to control the symptoms of all of the IBDs.
Tex
Yes, Bentyl is an antispasmodic and antimuscarinic, which means that it reduces colon spasms and slows down motility. It's usually prescribed for IBS, (not for IBDs), and for issues such as diverticulosis, spastic colon, and bladder spasms. (The term "spastic colon" is sometimes used interchangeably with IBS, but that isn't really accurate, since IBS can sometimes be associated with decreased motility.) If you actually have IBS, then that treatment is probably as good as any.
If you actually have MC, though, (which is likely, but certainly not proven by the test reports that you've been given), Bentyl might slow down the D, (by reducing the peristaltic action of the colon), but it will do nothing to address the inflammation that is source of the problem.
The doctors and nurses who work at teaching hospitals, (affiliated with universities), are much more likely to be aware of the latest techniques, and the newest technologies, related to medicine. IOW, they are early adopters. For recently discovered diseases, (MC was first described only a little over 20 years ago, which is fairly recently, as medical developments go), teaching hospitals definitely offer the best chances of proper diagnosis and treatment.
I really don't know what to think about your doctor. The thing that bothers me the most about the "pathology report" that you posted, is the fact that it makes absolutely no mention of lymphocyte count, (which is essential for determining a diagnosis of LC), nor does it mention any reference to the thickness, (or relative thickness), of collagen bands, (which is essential for determining a diagnosis of CC), for any of the biopsy samples. It's simply a "dumbed-down" summary of conclusions, with no substantiated statements of fact. The truth is, you can't find MC, if you don't know how to look for it, and I get the impression that whoever wrote that "pathology report", (whether what they sent you is excerpts from the original report, or a summary), really doesn't understand how to diagnose MC. Someone who doesn't know how to diagnose MC, almost certainly doesn't understand how to properly treat it. It's a crying shame that out of that many colonoscopies, you couldn't receive a single definitive biopsy report that actually appears to be valid. You've certainly had more than your fair share of "unqualified doctors".
Still, I have to admit, that given the facts you've posted, IBS is the correct diagnosis, by default, (since the pathology report rules out MC), so your doctor is playing by the rules, and I can't really fault him for that. I can fault him, however, for not discovering what is actually wrong with your digestive system, so that you can be properly treated.
The reason I asked about your gallbladder, is that after the gallbladder has been removed, bile is continually dumped into the small intestine, even when it's not needed, which can cause D for some individuals, (a fact that many doctors seem unaware of, or choose to deny).
Okay, I just went back and read your earlier posts, and based on the fact that eating more fiber, (the traditional recommendation for IBS), causes you to have to spend much more time in the bathroom, I have virtually no doubt that you have MC, (since fiber-intolerance seems to be unique to the IBDs). That doesn't carry any weight, of course, since I'm not a doctor, but IMO, if you are ever going to get any relief, (unless you want to adopt the GF diet, and simply treat yourself, like many of us here), you will have to locate a GI doc who actually knows how to properly diagnose and treat MC, and who uses the services of a pathologist who is actually qualified to diagnose MC. IOW, if you want to control your MC with meds, (specificially Entocort, or another anti-inflammatory), you will need to get a correct diagnosis, so that you can get a prescription. If you want to try to treat it yourself, (without a doctor's help), then the GF diet is basically your only viable option. I'm not aware of any research concerning the GF diet and IBS, but I have a hunch that the GF diet may well control the symptoms of IBS, also, since it definitely helps to control the symptoms of all of the IBDs.
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.
Sally,
The GF diet is not easy to do, (old habits are hard to break), but the more you get into it, the easier it becomes, and it eventually becomes second nature. When it starts working for you, it can seem almost like a miracle, to be able to get your life back, just by making a change in your diet.
There's a lot of information on the diet on this site, and whenever you need any help, support, or just want to vent your frustrations, or whatever, please don't hesitate to let us know.
Good luck, and yes, we will appreciate your keeping us updated.
Tex
The GF diet is not easy to do, (old habits are hard to break), but the more you get into it, the easier it becomes, and it eventually becomes second nature. When it starts working for you, it can seem almost like a miracle, to be able to get your life back, just by making a change in your diet.
There's a lot of information on the diet on this site, and whenever you need any help, support, or just want to vent your frustrations, or whatever, please don't hesitate to let us know.
Good luck, and yes, we will appreciate your keeping us updated.
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.
Joan,
No, unless a stone is blocking the cystic bile duct, it will still work normally, and even if the cystic bile duct is blocked, the liver can still deliver bile directly to the small intestine, through the common bile duct. If the common bile duct is blocked, however, all bile flow will be curtailed.
Tex
No, unless a stone is blocking the cystic bile duct, it will still work normally, and even if the cystic bile duct is blocked, the liver can still deliver bile directly to the small intestine, through the common bile duct. If the common bile duct is blocked, however, all bile flow will be curtailed.
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.
Mo
I just don't want to have to learn all this stuff. I need a child's picture book for all this anatomy etc.
I did all the research on breast cancer at U. NE Med Center w/o any back ground. I just can't do it all again. Older and bad computer eye sight.
I thought GF was supposed to help my brain....I'm still waiting..............
I did all the research on breast cancer at U. NE Med Center w/o any back ground. I just can't do it all again. Older and bad computer eye sight.
I thought GF was supposed to help my brain....I'm still waiting..............
