How to address ongoing stomach issues with doctor

May 4, 2016 9:39 PM

I have a doctor's appointment tomorrow, and I'd like to go in with some way to talk intelligently about my symptoms and perhaps an idea of what I should be tested for. Symptoms within...

During the past month or so, I've been having ongoing stomach issues in terms of bloating and feelings of gassiness and heartburn. I believe at least a portion of it might be stress related, as it flares up worst at work, right after eating lunch. At home, after eating dinner, for instance, I rarely have any symptoms. Or, if I do, I don't really notice it. I have been taking Prilosec, which seems to help, but I still have a lot of really loud gurgly noises throughout the day and feeling like I have an urgent need to go to the bathroom but when I get there, it's almost always gas.

An ulcer is the first thing that comes to mind. I've never had one that I know of, so I don't know what it feels like. Heartburn is another possibility. Does anyone have any more ideas about what this could be? Thanks.

posted by Forty-eight to Health & Fitness (9 answers total)

Go and talk to the doc. It can be any number of things. FWIW, I literally just did this with my doctor with similar symptoms. We are still figuring it out but the first test was eating no dairy for two weeks then eating a ton of dairy to see what happens. Then the doctor had me do three weeks without any gluten and then after that eat a lot of gluten and see what happens. They put me on a proton pump inhibitor now and I'm trying that for 30 days to see if it's an acid problem. They also did some blood work. Anyway you'll work out with your doctor what steps to take. Just explain all your symptoms and when they occur to your doc.
posted by FireFountain at 9:43 PM on May 4, 2016

List all your symptoms, questions, and concerns before going in on a piece of paper. Don't be afraid to literally read from it and take notes.

I agree that it could be something you're eating or acid problems. What are you usually eating at work? Are you drinking coffee? It's notorious for stomach issues and pooping.

They'll likely hear your symptoms then decide what tests or medications to try.

If they want to keep you on Prilosec ASK FOR AN RX! (In my youth - as a poor college kid no less - I had a doctor that just told me to buy it OTC for a few weeks before a test and I must have spent like $120 in a month because he wanted me on double when it's only like $6 for an RX.)

Ask to be checked for H. Pylori just to be safe. It's a simple blood test.

Then, follow their advice and go from there. Keep a food, medication, and symptom journal. There may be more tests later on but this should just start with the basics.

Oh and if they brush you off and say it's "IBS"or "Acid reflux" without doing more tests or following up, get a new doctor.

Queen of stomach issues since birth here. Had all the tests, been scoped up and down, and one less gallbladder now.
posted by Crystalinne at 10:09 PM on May 4, 2016 [2 favorites]

I would leave out your thinking it is stress related. It sometimes is a place Doc's like to stop at without exploring other causes. It might be stress related and it may not. Don't throw yourself under that bus.
posted by cairnoflore at 12:25 AM on May 5, 2016 [8 favorites]

Have you been actually feeling a lot of stress lately, enough to twist up your guts? Unless you're experiencing a lot of stress, don't mention stress as a possibility. Doctors are a little too ready to assume you're just knotted up from stress.

Your poops make a big difference in the diagnosis of a situation like this. Be prepared to discuss their frequency, color, size and consistency. Tell him what's normal for you, and if anything has changed recently. Ask him if he thinks a test for occult blood is in order. (That's a pretty routine and totally non-invasive test, don't panic.)

If there are foods you already don't eat because they give you problems, mention those. They may give your doctor some idea of the kinds of things you can't tolerate.

The pains you're experiencing at work may be connected to being stressed there, or it may be the timing of your daily digestion. If (for example) you have a problem digesting eggs and you're having them for breakfast every day, it may be that that problem is kicking in when you just happen to be at work. If you're eating anything every single day, try skipping it to see if that helps.

Have you tried Gas-X, Milk of Magnesia, Alka Seltzler, etc? In my experience when you're feeling really bad (like, ER bad) that stuff doesn't help much, but if you're feeling just kind of cruddy it can make a big difference. Try some Gas-X at the first inkling of cramps. I've also found that I can sometimes almost immediately help bad heartburn with a spoonful of yellow mustard. It seems very counter-intuitive, but it really has worked for me on multiple occasions. For me it can sometimes be more effective (and it's much less gross) than Milk of Magnesia.

(Source: Not a doctor, but a colon cancer survivor with a history of IBS and all sorts of other hideous gut stuff. I've seen too many doctors.)
posted by Ursula Hitler at 2:18 AM on May 5, 2016 [1 favorite]

Try keeping a food diary to take with you. You might find there's a food type you only have at lunch at work. eg. If you take sandwiches for lunch but don't eat bread/wheat at other times

I have a friend with a similar problem and we were talking about it and she rarely has bread or pasta at home, only at work.

also, nthing not mentioning stress. IMO don't self-diagnose at all, just give the doctor your symptoms and let them do their job.
posted by missmagenta at 4:26 AM on May 5, 2016

I hope your problem is minor and nothing serious. This is what happened to me and I hope, that just maybe this info will help you or others.

For 2 1/2 - 3 years I was having very troubling stomach pains/gas/bloating. First thing my doctor said was stop drinking. I drink, but not a lot and only ale/beers. I stopped for 6 weeks, no better. Then I stopped eating dairy. No change. Almost three effing years I put up with the pain etc and doctors didn't have a clue what was wrong. I'd wake feeling fine, eat some breakfast, take my meds, still feeling fine, then about 9:30 the pain would kick in and last all day. Nothing helped it. My doc was useless and I was beginning to think I had stomach cancer.

So one morning I'm sitting at my desk, in pain when I noticed what I was sort of unconsciously doing: putting another piece of gum in my mouth (I take meds that make my mouth dry, so it's sugar free gum and mints, a lot of gum and mints). I wondered, could this be causing all the pain? Did a google and low and behold, artificial sweeteners can cause stomach problems and gum chewing can cause air to get into stomach resulting in bloating etc.

Haven't had any gum/mints in three weeks and my stomach is like brand new.
posted by james33 at 5:03 AM on May 5, 2016 [1 favorite]

Seconding keeping a food and symptoms diary. There are apps for this now, if that's easier for you. If there's any new food or beverage you've added to your diet in the past few months, try cutting it out. (Splenda can be a trigger for some people, for example, so if you've recently launched a Coke Zero habit, there's one suspect.)

Beyond that, tell the doctor exactly what's going on, being as specific as possible. So not "I feel tired" but rather "I'm going to bed half an hour earlier and I still wake up feeling exhausted. I'm also drifting off during meetings and while watching TV."

Be explicit about how many times you feel the need to use the restroom and what comes out while you're in there.

Mention all symptoms, even if you figure there's no way they could possibly be related to this.

Do not mention stress -- doctors are good enough about ascribing symptoms to stress without your help.

In addition to reflux and an ulcer, they'll probably also check you for celiac (blood test) and run some standard parameters like a complete blood count. They may want to do stool tests to sample for parasites (e.g. giardiasis; have you been in the woods or drunk any questionable water in the past couple months?). They will ask about any travel you've done. They will then wait for those tests to come back.

If the tests all come back negative and you're still having symptoms, you will probably need to be the one to follow up -- if you don't, they'll assume you're doing fine. So follow up with them. Ask for a GI referral (if it's not already a GI you're seeing). The next step would typically be an upper/lower endoscopy to check for inflammatory conditions (celiac -- the blood test isn't 100% accurate -- and IDB) and other possible causes.
posted by pie ninja at 5:43 AM on May 5, 2016 [1 favorite]

Regarding what Criytalinne said, yes, ask for a prescription for Prilosec if that's what the doctor wants you to try, but be prepared for your insurance company to refuse to cover it because it's available OTC. That is what happened to me.
posted by FencingGal at 6:22 AM on May 5, 2016

Doctors can be really awful about stomach issues, I didn't get help at first because I "didn't look too miserable"! Definitely don't mention stress or that it might be something you ate. Before they send you for horrible invasive tests like a colonoscopy, ask for an abdominal ultrasound (which is quick and painless) and might detect huge gallstones. You can have a diseased gallbladder that looks normal on scans and there is a test for that too (HIDA scan) plus pills you can take that if you do a lot better on them it usually means you have a gallbladder problem (ursodial). There is also a tiny camera you can swallow to check for ulcers which is painless. Don't let them just send you for the big one (colonoscopy/endoscopy) and then shrug at you if nothing alarming. Good luck!
posted by meepmeow at 7:13 AM on May 5, 2016 [1 favorite]