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Gastroenterology (Expert Forum)
Any Clues
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Any Clues
by muxy, Aug 05, 2003 12:00AM
HI
33 years old
5'11 217lbs
white male married happily
NKDA
no medical history
For the past 25 months I have been experiencing the following symptoms; burning skin, I have white dots on my forearms, legs, torso and neck,the dots are hypopigmented but burn, especially after eating a large meal. The burning starts 5 minutes after waking then become more intense after a meal. The skin becomes mildly flushed, in the face, neck forearm, thighs and torso.
THE FOLLOWING NIGHT AFTER I drink alcohol I experience a thumping heart with increased rate with activity,difficult catching a deep satisfying breath,myoclonus at the point of sleep, dry mouth. I feel as if I have an increase in my metabolism. IT IS IMPOSSIBLE FOR ME TO SLEEP due to the feeling of a thumping in my heart, the feeling of having to stretch my muscles, and nocternal myoclonus. I know I am in for a tough night when I get that feeling like my bones are achy and my muscles need to stretch. I am guarenteed a night of jerks.
Also after drinking I will have no appetite the following day and have multple BM's but not loose just frequent.
Lately, the past 6 months, I have had chest pressure daily and have had the inability to grab a satisfying breath. This causes me to yawn about once every 3 min. I am not suffering from shortness of breath, I just can't get a satisfying one.
Also recently I have been getting occasional abd bloating especially when I drink alcohol. And I have been belching more frequently but the belches are so deep and thick it is disgusting. I also have some mucous in my stool especially the day after alcohol. [very small amount but usually when bloated.]
BTW I drink about once every 2 months-almost as if testing myself.
I have had the following tests :
HOLTER MONITER TESTING which showed increased HR ater drinking but no arrythmias.
2d ECHO [weightlifting 16years]"the LV is at the upper limits of normal Wall thickness is also at the upper limits with septum and posterior measuring 11mm.
urine 5HIAA negative x 2
CT abd neg
EEG neg
urine metanephrines neg
24 hour creat neg
thyroid OK
cbc ok
ONLY ABNORMAL TEST was a red cell folate with normal hgb [Dr. said it was erronious]
ESR 1 [-10]
ceruloplasmin and copper neg
My main worry is the burning skin, the inability to catch a satisfying breath and the responce to alcohol which leads me to believe I may have an enzyme deficiency or a a hormonal/endocrine problem such as carninoid possibly esophageal of bronchial [neg CT Abd] I occasionally get a wheeze with my first couple breaths upon waking as well as the chest pressure and difficulty getting a satisfying breath.
My internist says I may have an autonomic glitch that I will have to live with. It may show itself as something in the future or just go away. He feels I am healthy and should just deal with my changing body. I feel this is something I should pursue further. What are your thoughts and should I continue the search for an answer?
33 years old
5'11 217lbs
white male married happily
NKDA
no medical history
For the past 25 months I have been experiencing the following symptoms; burning skin, I have white dots on my forearms, legs, torso and neck,the dots are hypopigmented but burn, especially after eating a large meal. The burning starts 5 minutes after waking then become more intense after a meal. The skin becomes mildly flushed, in the face, neck forearm, thighs and torso.
THE FOLLOWING NIGHT AFTER I drink alcohol I experience a thumping heart with increased rate with activity,difficult catching a deep satisfying breath,myoclonus at the point of sleep, dry mouth. I feel as if I have an increase in my metabolism. IT IS IMPOSSIBLE FOR ME TO SLEEP due to the feeling of a thumping in my heart, the feeling of having to stretch my muscles, and nocternal myoclonus. I know I am in for a tough night when I get that feeling like my bones are achy and my muscles need to stretch. I am guarenteed a night of jerks.
Also after drinking I will have no appetite the following day and have multple BM's but not loose just frequent.
Lately, the past 6 months, I have had chest pressure daily and have had the inability to grab a satisfying breath. This causes me to yawn about once every 3 min. I am not suffering from shortness of breath, I just can't get a satisfying one.
Also recently I have been getting occasional abd bloating especially when I drink alcohol. And I have been belching more frequently but the belches are so deep and thick it is disgusting. I also have some mucous in my stool especially the day after alcohol. [very small amount but usually when bloated.]
BTW I drink about once every 2 months-almost as if testing myself.
I have had the following tests :
HOLTER MONITER TESTING which showed increased HR ater drinking but no arrythmias.
2d ECHO [weightlifting 16years]"the LV is at the upper limits of normal Wall thickness is also at the upper limits with septum and posterior measuring 11mm.
urine 5HIAA negative x 2
CT abd neg
EEG neg
urine metanephrines neg
24 hour creat neg
thyroid OK
cbc ok
ONLY ABNORMAL TEST was a red cell folate with normal hgb [Dr. said it was erronious]
ESR 1 [-10]
ceruloplasmin and copper neg
My main worry is the burning skin, the inability to catch a satisfying breath and the responce to alcohol which leads me to believe I may have an enzyme deficiency or a a hormonal/endocrine problem such as carninoid possibly esophageal of bronchial [neg CT Abd] I occasionally get a wheeze with my first couple breaths upon waking as well as the chest pressure and difficulty getting a satisfying breath.
My internist says I may have an autonomic glitch that I will have to live with. It may show itself as something in the future or just go away. He feels I am healthy and should just deal with my changing body. I feel this is something I should pursue further. What are your thoughts and should I continue the search for an answer?
Doctor's Answer
by Kevin Pho, MD, Aug 09, 2003 12:00AM
, Aug 09, 2003 12:00AM
One consideration would be the carcinoid syndrome. Carcinoid syndrome is the term applied to a constellation of symptoms caused by the release of chemicals from carcinoid tumors.
Episodic flushing is the clinical hallmark of the carcinoid syndrome, and occurs in 85 percent of patients. It primarily involves the face, neck and upper chest, which become red to violaceous or purple, and is associated with a mild burning sensation. Severe flushes are accompanied by a fall in blood pressure and rise in pulse rate.
Most flushing episodes occur spontaneously, but they can be provoked by eating, drinking alcohol, defecation, emotional events, palpation of the liver, and anesthesia.
I would suggest that your physician evaluate for this disease. A 24-hour urinary excretion of 5-hydroxyindoleacetic acid (HIAA) would be an appropriate first test.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Sataraman. Diagnosis of the carcinoid syndrome. UptoDate, 2003.
Episodic flushing is the clinical hallmark of the carcinoid syndrome, and occurs in 85 percent of patients. It primarily involves the face, neck and upper chest, which become red to violaceous or purple, and is associated with a mild burning sensation. Severe flushes are accompanied by a fall in blood pressure and rise in pulse rate.
Most flushing episodes occur spontaneously, but they can be provoked by eating, drinking alcohol, defecation, emotional events, palpation of the liver, and anesthesia.
I would suggest that your physician evaluate for this disease. A 24-hour urinary excretion of 5-hydroxyindoleacetic acid (HIAA) would be an appropriate first test.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Sataraman. Diagnosis of the carcinoid syndrome. UptoDate, 2003.
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I find the smaller my meals the less symptoms I have. Also I have dropped about 15 lbs in the past 25 months. Some of this may be from my dietary changes but I always ate pretty good.
And Yes I do consume aspartame.probably more than I should.
Love this website.
Muxy
Thanks,
Kevin, M.D.
My skin burns when I wake and is worened by a meal. There are white dots associated with the burning. I don't know if the white dots cause the burn or are hypopigmented areas that are created where the burn is. The areas spread starting in the forearms and now is a full body thing except at the pelvis.
Thanks again.
I apologize for not realizing you already had the 5-HIAA reading. The story continues to be suspicious for carcinoid, and there are other tests if the 5-HIAA is not revealing.
The first would be chromogranin concentration. Neuroendocrine tumors have been associated with increased concentrations of chromogranins and this can be measured.
Determination of the whole blood serotonin concentration is often helpful when urinary 5-HIAA testing yields equivocal results.
Other tests would be provocation tests. One would be the epinephrine provocation test. Epinephrine is administered and the he patient is observed for flushing, hypotension, and tachycardia, which appear between 45 to 120 seconds after an injection and last for at least one minute in a positive test. The test is stopped after the first positive response.
Another similar test would be the pentagastrin provocation test which works in similar ways.
If all those tests are negative, then carcinoid can more or less be ruled out and other causes be continued. Until then, I would still consider carcinoid (even with negative 5-HIAA levels).
Thanks,
Kevin, M.D.