Evaluation of First Visit

I received a copy of some of my medical records the other day. This blog entry is to discuss what the Physician’s Assistant stated and what I recall from the first visit.

The date of the first visit was September 9th 2005. I of course had gone in due to increased frequency of stools, accompanied by blood. In the record it uses the acronym ‘brbpr’, apparently that is easier to write than ‘bright red blood per rectum’. I had no real diarrhea at the time, just the increased stools, not watery or anything like that. Unfortunately I hadn’t been lucky enough to have done any foreign travel recently, although later they would sometimes insinuate that this was something I picked up in Mexico 10 years earlier.

Along with the bloody stools, I was experiencing an increased need to urinate. I would not urinate as much as I normally did, but would feel the need to urinate just a few minutes later. No burning or real pain accompanied this, it was just that uncomfortable ‘time to go pee’ feeling.

I did have a history of several years of diarrhea when I ate large amounts of certain junk foods, such as on long car rides. I also had a several year history (not mentioned in the doctor’s notes) of diarrhea when I drank something really sweet such as apple juice or especially white grape juice.

I had some abdominal pain upon palpation of the lower abdominal quadrants, blood in stool, poor appetite and rectal bleeding (doesn’t blood in the stool include that). I did NOT have heartburn, gas, constipation (had never had that in my whole life), diarrhea, nausea, vomiting, stomach cramps, polyphagia (excessive hunger or eating), abdominal swelling or jaundice (yellow skin). I should mention here that a digital rectal exam was not performed at this time. (You know, when they put the gloved finger where you don’t want them to.)

The record states that I denied cold intolerance. I don’t recall being asked that. Not having grown up in a climate as cold as Idaho, I have been one to get purple nail beds easily and don’t tolerate or appreciate the cold very well.

I had no aphthous ulcers (canker sores). Nor did I have a Virchow’s node. A Virchow’s node is an enlarged lymph node above the left clavicle on the neck. This can be a sign of cancer or serious infection. I also did not have an umbilical node. This would be an enlarged lymph node on the abdomen (umbilicus means belly button).

The conclusion made by the Physician’s Assistant was that this could be as simple as IBD (Irritable Bowel Syndrome) with hemorrhoids. He also states that this could be cancer (one of the ‘C’ words I learned to hate). A colonoscopy was ordered as were stool WBC (white blood cells), stool O&P (ova (egg) and parasite), stool C&S (culture and sensitivity), stool Giardia antigen, C difficile toxin (a toxin produced by clostridium difficile). You’ve probably heard of Giardia (giardia lamblia). Clostridium difficile is hard to grow in the lab so they test for a toxin it produces.

In short I had to go to a lab and get blood drawn and poop into a sterile container. Then I had to await the results and was scheduled for a colonoscopy - the test people don’t exactly line up for. I knew they weren’t as bad as people think. As a medic in the Air Force I had seen colonoscopies performed. The worst part is the prep you have to drink. Next to that the IV is the hardest part. After that you go to sleep and don’t remember anything (unless maybe your doctor doesn’t like you enough to give you enough medication). But seriously people shouldn’t be afraid of getting a colonoscopy. Early detection of colon cancer by colonoscopy saves thousands of lives every year. Unfortunately it could save many more (think about what that means).