Chapter 12

As classical as it can get

  • (Age: 65 years, female)

    To my knowledge, I did not have any symptoms of celiac disease as a child or as a young teenager.

    In first-year university, when I was 18, I went to give blood at a Red Cross blood drive. It took me ages to recover my energy. When I went to the next blood drive they would not accept my donation because the iron content was too low. They suggested that I not give blood in the future.

    After that time a number of doctors prescribed iron pills, which I took for more than 40 years. During that time I would have periods of exhaustion, when just walking up the stairs would necessitate my stopping at the top to let the muscle pain disperse. I also had periods where I felt much better.

    In the 1970’s, a doctor started me on a series of intramuscular iron injections. I finally developed an aseptic abscess on my hip and the injections were discontinued. The doctor suggested that I start a series of blood transfusions, but I refused (and in retrospect, I realize that I might have saved myself from an even worse fate).

    One problem I had during the summer, for many years, was swollen ankles, but this usually righted itself in the cooler weather.

    Although I did not recognize it at the time, I suffered from steatorrhoea for many years, and of course had very smelly feces. I tended always to wait until the family had left home in the morning before I went to the bathroom. If I were in a public washroom, I would always choose the toilet that was closest to the exhaust fan. Of course, I regarded all of this as normal and would never have discussed it with anyone in the family or the medical profession. I did once mention to the doctor that my stools were very large, but there was no discussion about this.

    In the early 1980’s, a doctor found that my folate levels were exceptionally low and prescribed folic acid supplements, which I took for a time. In the mid 1980’s, as part of my ……… study on the impact of dietary salt on calcium excretion in seventeen post menopausal women, my 24-hour calcium excretion (on all six tests) was approximately ten times lower than the rest of the women in the study. My serum albumin levels were also very low. But the doctors involved did not identify these as a concern.

    In the late 1980’s, I went to the doctor with exhaustion and terribly swollen ankles. My iron and folate levels were very low. I had upper and lower barium examinations, tests for liver, kidney and heart function. I had a low thyroid function and was put on thyroxine.

    I finally went to an internist who after five minutes of questioning thought I likely had celiac disease.

    I was biopsied on …, 1989 and just from visual examination of the specimen, the doctor said I had celiac disease.

    I have had two bladder repair operations and wonder if they might be related to connective tissue deterioration. I am developing osteoarthritis, which might be related to old age (heaven forbid) rather than celiac disease. Last year I had a non-malignant tumor removed from my colon.

    I discovered two years ago that at 78 years of age my father developed severe diarrhea (two years before his death) and was put onto a gluten-free diet, which helped his condition. I am not sure that he was definitively diagnosed with celiac disease. My brother died of cancer of the intestine when he was 44.

    My sister thinks she has celiac disease, and follows a strict gluten-free diet, although she was not biopsy diagnosed.

    My husband and I had three boys. They are very healthy, and I now realize how fortunate we are that they did not have neural tube defects, or any other complications. One of our sons (now 32) has just been biopsied for celiac disease and has shown no flattening of the villi. Another of our sons (now 33) has also had a blood-screening test for celiac disease, and it too was negative. But both have digestive symptoms from time to time and I have a suspicion one or both might develop celiac disease in the future, but I hope not.

  • Clinical Pearls

    In iron or folate deficiency anemia, think of celiac disease.

    Peripheral edema in celiac disease is due to hypo-albuminemia secondary to the protein losing enteropathy.

  • Individuals with celiac disease can develop osteoporosis from malabsorption of calcium and vitamin D. In patients with osteoporosis, celiac disease should be considered as a diagnostic possibility.

Copyright © 2007 by Mohsin Rashid
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