[54M] With gastrointestinal and neurological symptoms

Patient Description

A 54-year-old male presents with frequent heartburn, loss of appetite, constant bloating, indigestion, and frequent burping. He feels full after eating a small amount of food and has been experiencing excessive fatigue for about a month, significantly impacting his daily life. The fatigue came on suddenly and is accompanied by poor sleep quality. He reports persistent abdominal pain for about three weeks, rated as 9 out of 10 in severity, located above the belly button and extending across the abdomen. This morning, he noticed blood in his stool, described as maroon and darker with stringy dark clots on the tissue, but no blood in the toilet. He also experiences lightheadedness and unsteadiness, rated as 9 out of 10, and has fallen a couple of times. Additionally, he has dull, pounding headaches that throb, rated as 7 out of 10, occurring after dizziness. He reports some weight or muscle loss in his arms and legs, but his abdomen is distended and solid. He has had dark stools but not tarry, and has experienced nausea and vomiting a couple of times. He has not been taking any NSAIDs, blood thinners, or other relevant medications, and has not had any recent dietary changes or travel. His family history includes his mother who died of lung cancer and his grandmother who died of colon cancer. He has a history of bipolar disorder, extreme depression, and anxiety attacks, and is currently taking Latuda, Lamictal, Temazepam, Sertraline, Seroquel, Ropinirole, and Quetiapine.

Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential diagnoses that could explain your condition. It's important to remember that these are just possibilities, and you should seek care from a real health professional for a formal diagnosis and treatment.

1. Gastrointestinal Bleeding

Rationale: The presence of blood in your stool, especially with dark clots and maroon coloration, suggests gastrointestinal bleeding. This could be due to several conditions, including peptic ulcers, diverticulosis, or colorectal cancer, especially given your family history.
Typical Treatments/Testing: Your doctor may recommend a colonoscopy or endoscopy to identify the source of the bleeding. Blood tests to check for anemia and other related issues may also be necessary.

2. Gastroesophageal Reflux Disease (GERD)

Rationale: Frequent heartburn, indigestion, and regurgitation of food are common symptoms of GERD. This condition occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus).
Typical Treatments/Testing: Lifestyle changes, such as diet modifications and avoiding lying down after eating, can help. Medications like proton pump inhibitors (PPIs) or H2 blockers may be prescribed. An upper endoscopy might be performed to assess the esophagus.

3. Functional Dyspepsia

Rationale: Constant bloating, feeling full after a small amount of food, and frequent burping can be symptoms of functional dyspepsia, a chronic disorder of sensation and movement in the upper digestive tract.
Typical Treatments/Testing: Dietary changes, stress management, and medications to reduce stomach acid or improve stomach motility may be recommended. Your doctor might also perform tests to rule out other conditions.

4. Anemia

Rationale: Excessive fatigue, lightheadedness, and unsteadiness could be signs of anemia, which can result from chronic blood loss (such as from gastrointestinal bleeding) or other underlying conditions.
Typical Treatments/Testing: Blood tests to check your hemoglobin levels and iron studies can diagnose anemia. Treatment may involve iron supplements or addressing the underlying cause of blood loss.

5. Possible Cancer

Rationale: Given your family history of colon cancer and the presence of blood in your stool, it's important to rule out colorectal cancer. The distended and solid abdomen could also be a sign of an underlying malignancy.
Typical Treatments/Testing: A colonoscopy is essential to screen for colorectal cancer. Imaging studies like CT scans or MRIs may be needed to assess for any masses or abnormalities.

What you can do

Gastrointestinal Bleeding

Seek immediate medical attention: Blood in your stool is a serious symptom that requires prompt evaluation. Go to the emergency department or contact your healthcare provider immediately.
Avoid NSAIDs and blood thinners: These medications can exacerbate bleeding.

GERD and Functional Dyspepsia

Dietary changes: Avoid spicy, fatty, or acidic foods that can trigger symptoms. Eat smaller, more frequent meals.
Elevate the head of your bed: This can help prevent nighttime reflux.
Over-the-counter antacids: These can provide temporary relief from heartburn and indigestion.

Anemia

Iron-rich foods: Incorporate foods like lean meats, beans, and leafy green vegetables into your diet.
Follow up with your doctor: Ensure you get the necessary blood tests to diagnose and treat anemia.

General Health

Track your symptoms: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
Stay hydrated: Drink plenty of water, especially if you're experiencing nausea and vomiting.
Rest: Ensure you get adequate rest to help manage fatigue.

What you should look out for

Given the severity of your symptoms and the possibility of life-threatening causes, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:

Severe abdominal pain: If the pain becomes unbearable or is accompanied by fever, vomiting, or a rigid abdomen.
Increased bleeding: If you notice more blood in your stool or if you start vomiting blood.
Fainting or severe dizziness: Especially if it leads to falls or injuries.
Unexplained weight loss: Significant weight loss without trying can be a sign of a serious underlying condition.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have any more questions or need further assistance, feel free to continue the conversation.