werner@aecom.UUCP (Craig Werner) (02/19/86)
<<<<>>>>> > A up-and-coming liability lawyer is in your office complaining of > alternating constipation and diarrhea, with occasional tenesmus (painful > non-productive bowel movements -- more colorfully described as dry heaves > of the Rectum), occasionally passing just mucus, or just a pencil thin > small stool. There is no gross blood as far as he can tell. He denies any > indigestion at any point, although occasionally says he has some lower > abdominal discomfort associated with the episodes of diarrhea and tenesmus. > His father died at the age of 57 from cancer of the colon, although > the patient denies any concern that this might be cancer -- repeatedly -- > without prompting. > > 1. What does the patient almost certainly have? > 2. What could the patient have, but almost certainly doesn't, but you > had better make sure in light of his profession? To give away the answer right away, the man is suffering from Irritable Bowel Syndrome, which actually afflicts women more often than men, but when it afflicts men, it tends to affect Accountants and Lawyers preferentially. The best description I have heard of Irritable Bowel is the following: "Although there are those who would link Irritable Bowel Syndrome [Spastic Colon] to a generalized conduction disorder of smooth muscle, it is most likely just a pain in the, well, propriety forbids me." It is probably a variant of normal, although not a very pleasant one. The trouble is that normal is defined as whatever is usual for the patient, which is usually anyway from three bowel movements a day to one every three days, despite the propaganda you here on Television from the makers of Ex-Lax. Increasing the amount of fiber in the diet helps some people, although not all. But since it doesn't cause any structural damage, only discomfort, the best therapy is to convince the patient not to worry about so much. Oh, the differential: from one end to the other, the patient could also have a Duodenal Ulcer (although he denies any indigestion), Crohn's Disease (Ileitis), Ulcerative Colitis (Crohn's and UC are both classified as Imflammatory Bowel Disease [IBD] versus the minor IBS. The initials cause as much confusion as the fact that they may initially present with the same symptoms. A simple $3 Guaic test for occult blood in the stool would probably rule out anything major and make the Insurance company happy, but as a form of defensive medicine (against lawsuit) a Barium swallow, a Barium enema, and endoscopy could be performed with similarly (almost guaranteed) negative results at a cost of hundreds of dollars. I mean, you figure this guy didn't become a hot-shot liability lawyer for nothing. -- Craig Werner !philabs!aecom!werner "Sometimes you have to run as fast as you can just to stay in the same place."
hankb@teklds.UUCP (Hank Buurman) (02/25/86)
In article <2270@aecom.UUCP> werner@aecom.UUCP (Craig Werner) writes: > A simple $3 Guaic test for occult blood in the stool would probably rule >out anything major and make the Insurance company happy, but as a form of >defensive medicine (against lawsuit) a Barium swallow, a Barium enema, and >endoscopy could be performed with similarly (almost guaranteed) negative >results at a cost of hundreds of dollars. I mean, you figure this guy didn't >become a hot-shot liability lawyer for nothing. Ahh! The medical mind at work.