DEAR DR. ROACH: Could you please explain the difference between irritable bowel syndrome and irritable bowel disease? What is the treatment for each? I saw in a health magazine that there is a blood test to determine which one someone may have. — ES
ANSWER: Although the two names are very similar, the conditions are very different. Irritable bowel syndrome is a common condition, more frequent in women than in men, of abdominal discomfort and bowel changes, such as diarrhea and/or constipation. It is managed by diet (such as the low-FODMAP diet I have recommended several times), stress management and sometimes medications. It can cause significant changes in one’s social life, in addition to pain and discomfort. IBS is a clinical diagnosis, and there is no blood test to confirm it. Primary care doctors manage IBS, and severe cases may benefit from the care of a gastroenterologist.
Irritable bowel disease — of which there are two types: ulcerative colitis and Crohn’s disease — is a potentially life-threatening condition of the GI tract. In ulcerative colitis, there is inflammation that’s limited to the colon, whereas in Crohn’s disease, the inflammation can be in any part of the GI tract, from the lip to the anus, though it is most frequent in the far end of the small bowel and the colon. IBD should be managed by a gastroenterologist, preferably one with special expertise in these diseases. IBD usually is diagnosed by colonoscopy or other endoscopy with biopsy. Many blood tests can be abnormal in IBD, but only the pathologist’s report is definitive. Most people with IBD will need medication treatment, although symptoms and therefore treatment may change dramatically across time.
DEAR DR. ROACH: I went to my ENT doctor in January complaining of muffled hearing and a loud, high-pitched noise in my left ear. He gave me a hearing test, and it showed 50 percent loss. I had an MRI and was told that I have an acoustic neuroma on my left side. This has caused me to go 50 percent deaf in my ear. The ENT doctor wants me to wait six months and see if it grows more, which I don’t want to do because I feel it should be taken out while it is small.
The choices I have are to watch and wait; to have traditional surgery; or to have surgery with gamma knife or cyber knife. I would really like to just get this done and have it taken out before it causes more problems, like affecting my facial nerve, balance nerve or if it gets too close to my brain stem. I also am worried that I may go completely deaf. I am getting a second opinion next month from a neurosurgeon. What are your thoughts on all of this? — B.D.
ANSWER: An acoustic neuroma, also called a vestibular schwannoma, is a type of non-cancerous tumor on the eighth cranial nerve, which is responsible for hearing and balance.
These tumors usually are treated, although some authorities recommend a watch-and-wait approach if they aren’t bothering the patient, if the patient is a poor candidate for surgery or if the patient is otherwise reluctant. None of these seems to apply to you, so I would recommend proceeding with the second opinion, the neurosurgeon, whom I think is likely to recommend treatment. Progressive hearing loss is a clear indication that treatment likely would be beneficial sooner rather than later.
All the treatments you mentioned are reasonable. Cyber knife and gamma knife are ways of delivering radiation to the tumor. Since any of these can achieve the goal of preventing the tumor’s growth and any worsening of symptoms, the choice should be left to the expert.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
(c) 2014 North America Syndicate Inc.
All Rights Reserved