hey achiro

[TopDaugIn2000]

CLEAN OUT YOUR PEEEEM BOX!

[OUDoc]

He went out for his urinalysis. He'll be back.

[OKC-SLC]

GoLytely helps with cleanouts.

[achiro]

Done, when my sponsorship went away, so did my pm space.:(

[achiro]

He went out for his urinalysis. He'll be back.
Did that, cbc, blood chem, and even an H. pylori test last week. I'm all great.:D

[TopDaugIn2000]

you've got mail

[soonerbrat]

you routinely do H. pylori? why?

[TopDaugIn2000]

what the hell is that?

[soonerbrat]

it's a bacteria that can cause ulcers

maybe he's prone to them?

[TopDaugIn2000]

nevermind. wikpedia answered it for me

[soonerbrat]

when i worked at the lab we checked our mice for H. pylori and H. hepaticus by doing PCR on their poop

[achiro]

Not routine at all, I've been having stomach pain recently(in addition to the "normal" gallbladder issues) and needed to rule it out. I am scheduled for a consult with a surgeon for the gallbladder thing next week but thats a whole 'nother story. :O

[achiro]

when i worked at the lab we checked our mice for H. pylori and H. hepaticus by doing PCR on their poop
Thanks to God, all we did was a blood test to rule it out. :D

[OKC-SLC]

H. pylori generally does not cause abdominal pain. It can cause ulcers, which can cause abdominal pain. Ruling out H. pylori doesn't rule out ulcers or other mucosal causes of abd pain.

[achiro]

H. pylori generally does not cause abdominal pain. It can cause ulcers, which can cause abdominal pain. Ruling out H. pylori doesn't rule out ulcers or other mucosal causes of abd pain.
Which is why now, rather than antibiotics, I am under a completely different form of treatment for said ulcer type symptoms.;)

[OKC-SLC]

but do you have ulcers?

[achiro]

but do you have ulcers?
Well since I did't want to start with an upper GI or an endoscope I don't know for sure. Do you have an issue with the fact that we started by testing for h.pylori? 'Cause, you know, it sounds like you do and if you do I would really like to hear why?

[OKC-SLC]

Well since I did't want to start with an upper GI or an endoscope I don't know for sure. Do you have an issue with the fact that we started by testing for h.pylori? 'Cause, you know, it sounds like you do and if you do I would really like to hear why?
I don't have any problem at all, and I'm sorry for giving you that impression. And I have next to no knowledge of your clinical situation, and therefore am in no position to comment on your case beyond the info you have presented here.

But since you asked, the role of using serum H. pylori IgG (which is almost certainly what was performed) as a tool to diagnose abdominal pain is minimal. The reasons are many, and they include the following:
1) H. pylori generally does not cause abdominal pain.
2) H. pylori IgG merely indicates that this patient has had H. pylori--there are some patients who will clear the IgG if the bug is eradicated, but it performs poorly as a marker of ACTIVE H. pylori infection (soonerbrat's stool antigen detection tests or mucosal biopsies/testing are good for that). Incidentally, H. pylori is a carcinogen in addition to its role in development of ulcers, and it always deserves eradication if present.
3) If a patient is having abdominal pain that is concerning for ulcer disease, the presence or absence of H. pylori does not help establish or rule out ulcer disease. There is value in knowing whether ulcers are present versus empirically treating them.


Think of it like this: If a patient has chest pain and one thing I'm worried about is a heart attack, I'm not going to only check their cholesterol. I'm going to check for a heart attack. Even though elevated cholesterol may play a role in causing one of the causes of chest pain (heart attack) its presence or absence does nothing to shore up the diagnosis of cardiac ischemia.

[critical_phil]

as always, i'd recommend an enema.


see you around 8-ish?

[jeremy885]

you've got mail


Did your $1600 mattress not work?

[Jimminy Crimson]

Did your $1600 mattress not work?

jeremy885, FTW!

[achiro]

I don't have any problem at all, and I'm sorry for giving you that impression. And I have next to no knowledge of your clinical situation, and therefore am in no position to comment on your case beyond the info you have presented here.

But since you asked, the role of using serum H. pylori IgG (which is almost certainly what was performed) as a tool to diagnose abdominal pain is minimal. The reasons are many, and they include the following:
1) H. pylori generally does not cause abdominal pain.
2) H. pylori IgG merely indicates that this patient has had H. pylori--there are some patients who will clear the IgG if the bug is eradicated, but it performs poorly as a marker of ACTIVE H. pylori infection (soonerbrat's stool antigen detection tests or mucosal biopsies/testing are good for that). Incidentally, H. pylori is a carcinogen in addition to its role in development of ulcers, and it always deserves eradication if present.
3) If a patient is having abdominal pain that is concerning for ulcer disease, the presence or absence of H. pylori does not help establish or rule out ulcer disease. There is value in knowing whether ulcers are present versus empirically treating them.


Think of it like this: If a patient has chest pain and one thing I'm worried about is a heart attack, I'm not going to only check their cholesterol. I'm going to check for a heart attack. Even though elevated cholesterol may play a role in causing one of the causes of chest pain (heart attack) its presence or absence does nothing to shore up the diagnosis of cardiac ischemia.
OK so maybe I wasn't real clear either. The symptoms I have been dealing with were classic for D.Ulcer. I already needed bloodwork so we just added the test for H.Pylori since it is a simple test and is the cause of an ulcer approx. 90% of the time. It was negative so we decided to go with a PPI for a short time. I have had zero symptoms since starting it BTW. After my surgical consult, and more than likely the removal of my gallbladder, we will determine if more testing is needed.

I am curious though, IYO what value is there really in knowing proof positive that it is an ulcer vs just good old fashioned "heartburn" ? I mean once you've ruled out the need for antibiotics, doesn't prilosec and dietary changes pretty much handle either one?(yes, I know it doesn't heal the ulcer but it helps put your body in a better situation to do it) and if it doesn't what is bad about waiting a couple more weeks before further, more aggressive, diagnostics?(BTW, I mean this in general terms, not for me specifically) Or are you more concerned that if it isn't an ulcer, that it could be something more significant?

[TopDaugIn2000]

Did your $1600 mattress not work?

It has helped with other areas, as in I don't wake up with shoulder and neck pain, etc. I knew it wouldn't "fix" my problem, but I needed a new one and I figured it couldn't HURT my back issues.

MRI is tomorrow morning.

[OKC-SLC]

OK so maybe I wasn't real clear either. The symptoms I have been dealing with were classic for D.Ulcer. I already needed bloodwork so we just added the test for H.Pylori since it is a simple test and is the cause of an ulcer approx. 90% of the time. It was negative so we decided to go with a PPI for a short time. I have had zero symptoms since starting it BTW. After my surgical consult, and more than likely the removal of my gallbladder, we will determine if more testing is needed.

I am curious though, IYO what value is there really in knowing proof positive that it is an ulcer vs just good old fashioned "heartburn" ? I mean once you've ruled out the need for antibiotics, doesn't prilosec and dietary changes pretty much handle either one?(yes, I know it doesn't heal the ulcer but it helps put your body in a better situation to do it) and if it doesn't what is bad about waiting a couple more weeks before further, more aggressive, diagnostics?(BTW, I mean this in general terms, not for me specifically) Or are you more concerned that if it isn't an ulcer, that it could be something more significant?
When we talk about 'peptic ulcer disease' we are generally referring to gastric and duodenal ulcers. In certain parts of the world (SE Asia for one) H. pylori is responsible for as much as 90% of PUD. In the US, it is probably just under half while NSAIDs are similarly responsible for just under half (with other stuff making up the rest).

If you are having dyspepsia-type symptoms rather than PUD symptoms, it is very reasonable to start with PPI trial as you have done.

A few reasons to definitively know if an ulcer is present is the potential malignancy it may represent (particularly with gastric ulcers), the underlying hypersecretory state it may represent, the possibility of having H. pylori-associate ulcer which carries a higher risk of malignant potential, the knowledge of whether certain medications (e.g. NSAIDs or blood thinners) are safe to use, the risk of perforation, etc. If symptoms are typical of PUD (rather than, say, dyspepsia or heartburn) it is generally wise to look for ulcer. If symptoms are of dyspepsia or heartburn, it is generally wise to do a trial of PPI.

Dietary changes don't heal ulcers. PPI's do, eradication of H. pylori does, removal of hypersecretory process if present, etc. Endoscopic therapy does not heal ulcers but rather stops/prevents bleeding from them.

[TopDaugIn2000]

had the MRI this morning. they said to allow up to 2 WEEKS to get the results. WTF?!?!?!?!?!?!?!?!