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Verbal Diagnosis--Push For More Testing?


Kerceli

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Kerceli Newbie

Hello!

I'm posting in need of some advice. I have been mostly gluten free for years now (and now strict gluten free since my recent problems..to be explained). I would always take bites of non gluten free things here and there if I wanted a

taste and never worried about contamination, but probably within the last 6 months I noticed I could no longer take little bites of things with gluten because I got horrible stomach aches and headaches. In August, I went out for dinner with friends and it was family style. I was stupid and didn't speak up about my needs so I ended up eating a lot of gluten containing food thinking oh well I'll just bear the stomach ache (this was the most non gluten-free I had had in a longggg time). Well it made me so horribly sick for a week. I couldn't eat at all. I was nauseas 24/7, had C and D, depression, anxiety, cloudy head, body aches.... Just overall felt like HELLLLL.

I called my doctor asking for a blood test. It came out negative. I then asked for a endoscopy. My doctor said I would have to eat gluten for two weeks in order for anything to show up regarding celiacs. I told him the sickness I endured was so horrible I couldn't do it again. He said there is no other option for testing though. He placed 'celiac disease' in my medical record. I am now living as a celiac... Worried about contamination, checking labels feveriously... I have found since being more careful, I react to contamination issues now, which is a first. I feel like I have all the symptoms of celiacs, but do I just go about my life saying I'm celiac when I don't really know for sure?? Any advice or thoughts would be helpful. Thanks so

much guys.


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ravenwoodglass Mentor

Your doctor has confirmed you are celiac and it is in your medical record plus your body tells you clearly when you eat gluten. IMHO you have a great doctor. Make sure he does a vitamin and mineral panel on you to check your levels and do urge 1st degree family members to get tested.

Takala Enthusiast

You can at least call yourself severely gluten intolerant. You could also opt for over the counter genetic testing, if you were curious to see if you do indeed have the official genes which go along with celiac. That doesn't prove anything, but can put you in the class of celiac disease being the more likely probability. You could say your diagnosis is based on a gluten challenge failure. But the "celiac" in the medical records will in some regards help you in the future if you develop related conditions, because then there is an official "reason" to test you or suspect that you may have said related conditions, because you are at higher risk. And it also means that when you undergo any medical procedures or get a pharma prescription, you have a reason to tell them to be sure you don't come in contact with gluten. Be sure to put this information in at anywhere you get prescriptions filled, also, under the "allergic to" warnings- to avoid gluten, wheat, rye, barley.

If your relatives and friends take it more seriously with the "celiac" label, then that may also be a factor in what you chose to use.

DavinaRN Explorer

My blood test was negative (my endocrinologist ran it for me because I would feel sicker once I ate to raise a low blood sugar than I did with the low). She explained that the test wasn't 100% accurate, but there really is non-celiac gluten intolerant. She offered referral to GI for further testing if I needed diagnosis. I opted not to and have been gluten free almost 10 weeks; feeling better than I have in a very long time. With research, I'm thinking I have had issue since late teens possibly. Wondering what my primary doctor will have to say.

Kerceli Newbie

Hey guys thank you all so much for your responses and advice. Takala i didnt think about putting in my med record an allergy to wheat, rye, barley, etc. thanks everyone this community is invaluable!

gatita Enthusiast

I agree you have a very advanced doctor. Because I don't have the word "celiac" in my record, I'm having a hard time getting a GI referral that my insurance will cover. It's very frustrating....

So it sounds like your diagnosis is a good thing that may help you get any additional testing you need.

Kerceli Newbie

Hi gatita, my doctor told me there is nothing more that can be done if I don't want to have gluten for two weeks and then go get a endoscopy. So I guess other than signaling doctors of my "allergy" (at the least) its good. But I wish I could actually find out. I need to check out the over the counter genetic testing.


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ravenwoodglass Mentor

Hi gatita, my doctor told me there is nothing more that can be done if I don't want to have gluten for two weeks and then go get a endoscopy. So I guess other than signaling doctors of my "allergy" (at the least) its good. But I wish I could actually find out. I need to check out the over the counter genetic testing.

Please do keep in mind that genetic testing is only a small part of the diagnostic process. There are folks with the celiac associated genes that don't develop celiac and there are diagnosed celiacs that don't carry one of the two most commonly tested for genes. In the long run it is your bodies response to gluten that is the best diagnostic tool we have at present.

Madagascar Rookie

i had the genetic test run by prometheus labs - they test for 2 genes. the one that came up positive was the "A" gene. interestingly, we were going to have my DH tested by Xterra (not sure if i have that name right, but they do a cheek swab for $150) and discovered that they don't test for the A gene, only the B gene.

in other countries they test for up to 23 genes. so . . . genetic testing can be helpful, but it's not everything.

also, Prometheus labs said i was not likely to have celiac disease based upon where on the genetic strand my gene was, but i clearly have it. i think there is value in having the genetic test done if you have children, but there is obviously so much room for error that you can't go solely on it. i also had the antibodies done and my only positive response was in the TTG that came in at 29 with a positive diagnosis at 30. the Prometheus lab test for antibodies and genes cost . . . dun dun dun $940. i didn't know before i requested it how much it would cost, but because i have 3 young adult kids, we wanted to know. don't know yet how much the insurance will cover, but through me getting tested and learning i do have one gene, my brother and his kids have all gone gluten free, and my 3 kids have all gone gluten free. we all had some signs, but not all the same (some skin, some digestive, some mental). everyone is feeling better, so it was worth it.

the gold standard test, however, is how one responds to the gluten-free diet. so with or without a diagnosis, if you feel better, go with it.

kerid Newbie

you can get the stool test. since the bowels are where the damage is being done, it makes sense to test there. on the website, they even say that you don't need to eat gluten first, as that can cause devasting effects to the person, and the antibodies are usually there for a while. here's the link to read up on it: (excellent read!!!) we are all getting the test done in january.

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Kerceli Newbie

Thanks guys!!!! :)

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    • trents
      Certainly, it would b wise to have a gene test done if your physician is open to it as it would provide some more data to understand what's going on. But keep in mind that the genetic test for celiac disease cannot be used as to diagnose celiac disease, only to establish the potential to develop active celiac disease. About 40% of the general population possess one or both of the primary genes known to be associated with the development of active celiac disease but only about 1% of the population actually develop active celiac disease. So, the gene test is an effective "rule out" tool but not an effective diagnostic tool.
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      Had Quaker gluten-free oatmeal last night and my stomach is a mess today. NO flu but def stomach stuff. Anyone else?
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      So you would be good with the diagnosis and not worry to check genetics etc etc? Appreciate your words!
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    • Scott Adams
      For those who will likely remain gluten-free for life anyway due to well-known symptoms they have when eating gluten, my general advice is to ignore any doctors who push to go through a gluten challenge to get a formal diagnosis--and this is especially true for those who have severe symptoms when they eat gluten. It can take months, or even years to recover from such a challenge, so why do this if you already know that gluten is the culprit and you won't be eating it anyway?  Approximately 10x more people have non-celiac gluten sensitivity than have celiac disease, but there isn’t yet a test for NCGS. If your symptoms go away on a gluten-free diet it would likely signal NCGS--but those in this group will usually have negative tests, or at best, elevated antibodies that don't reach the level of official positive. Unfortunately test results for celiac disease are not always definitive, and many errors can be made when doing an endoscopy for celiac disease, and they can happen in many ways, for example not collecting the samples in the right areas, not collecting enough samples, or not interpreting the results properly and giving a Marsh score.  Many biopsy results can also be borderline, where there may be certain damage that could be associated with celiac disease, but it just doesn't quite reach the level necessary to make a formal diagnosis. The same is true for blood test results. Over the last 10 years or so a new "Weak Positive" range has been created by many labs for antibody results, which can simply lead to confusion (some doctors apparently believe that this means the patient can decide if they want more testing or to go gluten-free). There is no "Weak Negative" category, for example. Many patients are not told to eat gluten daily, lots of it, for the 6-8 week period leading up to their blood test, nor asked whether or not they've been eating gluten. Some patients even report to their doctors that they've been gluten-free for weeks or months before their blood tests, yet their doctors incorrectly say nothing to them about how this can affect their test, and create false negative results. Many people are not routinely given a total IGA blood test when doing a blood screening, which can lead to false negative interpretations if the patient has low IGA. We've seen on this forum many times that some doctors who are not fully up on how interpret the blood test results can tell patients that the don't need to follow a gluten-free diet or get more testing because only 1 of the 2 or 3 tests done in their panel is positive (wrong!), and the other 1 or 2 tests are negative.  Dermatologists often don't know how to do a proper skin biopsy for dermatitis herpetiformis, and when they do it wrongly their patient will continue to suffer with terrible DH itching, and all the risks associated with celiac disease. For many, the DH rash is the only presentation of celiac disease. These patients may end up on strong prescriptions for life to control their itching which also may have many negative side effects, for example Dapsone. Unfortunately many people will continue to suffer needlessly and eat gluten due to these errors in performing or interpreting celiac disease tests, but luckily some will find out about non-celiac gluten sensitivity on their own and go gluten-free and recover from their symptoms. Consider yourself lucky if you've figured out that gluten is the source of your health issues, and you've gone gluten-free, because many people will never figure this out.    
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