Need Some Help from the Medical Braintrust
 

My 20 year old grandaughter (who I have raised and has lived with my wife and I for 10 years) has been really struggling for over a year. She has been on a daily regimen of Miralax from constant constipation. Daily nausea, stomach pain, dizziness and feeling tired to the point of being unable to get out of bed. Despite this she goes to school, works near full time, takes dancing and pilates classes and is 3/4 thru a program to become an instructor. In her free time she pretty much functions has head of household to her 2 younger sib's. She is a great young lady and it pains me greatly to see her conflicted like this.

She has been to GP, GI, internal medicine - all the best our county has to offer. Nothing, no prognosis, can't find anything. Obviously, a 20 year old should not being feeling this way. It is causing a great deal of anxiety to say the least. We are about an hour and a half north of L.A. I'm thinking seriously of calling UCLA begging and pleading for someone to see her.

1. Any thoughts on a diagnosis or suggestion on how best to proceed.

2. Any suggestions on how to get her to UCLA for a look.

Thanks in advance for any help, guys and gals, it is sincerely appreciated.

Mental health issue. Ht/wt would be helpful to know. If she is severly underweight, she is demonstrating classic anorexia. Bulimia and laxative abuse are the same thing-just different ends involved. High achiever, very responsible, over scheduled, exercise to exhaustion. Just my guess.

She goes to school, works near full time, takes dancing and pilates classes and the docs said they couldn't find any reason for her to be so tired she can hardly get out of bed? I'm no doctor, but I'll bet if she does get to UCLA the first thing they'll say is get some rest. She is under too much stress.

What's her caffeine intake??
It's truly amazing what kind of effect a sustained high level of caffeine can produce.

CrowBob ... She is 5'4" about 140. Certainly not underweight. She eats really weel, healthy ... soy milk, lots of salads, fish. No soda, no candy. The excerise to exhaustion is certainly close to her sit.

To hhi944
 

Almost no caffeine intake ... no coffee, no energy drinks

Sounds like stress/overexertion. I'm no medical professional but I'd tell her to slow down. Something like meningitis would kick her butt at this stage....

Why is she on daily Miralax? Has she ever had an intestinal blockage? If so, it might be time for her to see a gastrointerologist.

Might be a good idea regardless. Ask me how I know.

No, don't ask me... long story; you don't wanna hear it and I don't wanna tell it.

There are numerous possible etiologies for your granddaughter's chronic constipation. There could be diet-related, a true GI motility issue, a pharmacological issue (if she's chronically using/abusing certain meds), or (hate to say it but possibly) some psychological component, as well. Obviously, if multiple practitioners in your town haven't been able to nail down a diagnosis, it might not be simple or common explanation.

Other than taking a good history, exam and some routine bloodwork, there are some more invasive specialized studies that can be done for work-up, depending upon what the working diagnosis is. Endoscopy (either from above or below), upper GI swallow studies, manometric pressure readings, Sitz marker studies, barium enemas, defacography, tissue biopsies, etc. that can be done. What study gets performed will depend upon the story she gives and what the doctor suspects might be the problem.

If you feel like you've exhausted all your local medical resources and really want to go to a university center (whether it's UCLA or USC), it's not a difficult thing to schedule an appointment. Just look them up (either the GI or colorectal service) and give them a call. All the staff have private offices, in addition to the county facilities they cover. That's where your granddaughter will be seen. It'll be like any other doctor visit. A resident might or might not be there, but it'll be the attending physician you've chosen who will see your family member--it won't be a resident clinic, for example.

Food/water allergy? Inflamed appendix? Hemmeroids? If there is a physical blockage, that should be the first thing they'd be able to find.
I would change everything in the daily routine and see what happens.

Ask her PCP for a referral, they are not likely to take you at UCLA without one.

What tests have already been done, specifically, what did the GI guy do?

i'm no physician and i didn't stay at a holiday inn, but has she been checked for anemia, even though that doesn't jive with the constipation. and is it possible to become addicted to constipation medicine, messes up the periwinkle or something like that.

Could it be a true case of Celiacs?

Got nothing to add here except to stress how important it is to drink lots o'water.

I do, lots and lots. Well over a gallon a day on average, more when it's hot or under exertion. I really think it makes a huge difference.