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Ask Dr. Gott 4/3
Mystery blood loss could be fatal
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    DEAR DR. GOTT: I am told I am losing blood all the time, but my doctors don't know from where. I have had several colon and throat studies and all types of blood work. On four separate occasions, I have had veins in my throat banded. I usually have three veins done at a time, but once I had five banded at once.
    I have received blood on several occasions. Once I got 3 pints, the next was 5 pints and just last month I received 2 more pints of blood.
    I have no energy. I have very loose, black stools and have very painful stomachaches all the time.
    I have been tossed back and forth between my primary care physician and my gastroenterologist. Neither seems to know what is going on so sends me to the other.
    I need some answers. I am tired of feeling this way and worry that it may be something serious. Do you have suggestions?
    My medical history includes a stroke, Bell's palsy, a scarred liver and a fall that I was hospitalized for because I was throwing up blood.
    DEAR READER: You appear to have a serious ailment that could be fatal. You need a diagnosis as soon as possible.
    I can only generalize my answer because you don't give your age, gender, current medications, etc. Do you have a family history of bleeding problems? Have you seen a hematologist (blood specialist)? Are you taking Coumadin (warfarin), aspirin or other anticoagulant agents for your stroke? What is the cause of your liver scarring? When did the bleeding start? How long have your stools been loose and black (a sign of internal bleeding)? These are all vital questions that need answers in order for a physician to make a proper diagnosis.
    Since your primary-care physician and gastroenterologist can't seem to find anything wrong, perhaps a visit to a new gastroenterologist or, better still, a hematologist is in order. The specialist can order blood-clotting tests and more to determine whether you have a bleeding tendency, such as hemophilia. A new gastroenterologist will probably order a set of tests including an endoscopy to examine your esophagus, stomach and upper portions of your intestines; a colonoscopy to examine the remainder of your intestines; a CT scan or MRI to visualize your blood vessels; etc.
    The specialist you see first is up to you, but don't delay. If one cannot help you, check with the other. If both fail, it may be time to move on to the superspecialists in a teaching hospital or a facility such as the Mayo Clinic or the Cleveland Clinic. Do not delay in getting help. Let me know how this turns out.
    To give you related information, I am sending you copies of my Health Reports "Blood — Donations and Disorders" and "Stroke."
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