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Gastroenterology (Expert Forum)
Concerned
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.
Concerned
by jgrossi, Sep 14, 2005 12:00AM
I have posted in the past, but am still having problems and appreciate your input.
I am 30 y/o male, smoker. 4 years ago my normal weight was 158 lbs. then I got sick, ran a fever for just under a couple weeks and nothing was found, at that time I lost about 11lbs., about 9 months after that (still not feeling myself) I started having upper back discomfort and weird feelings in my legs (had needles put in legs/MRI of spine everything was ok.
Soon after, I started having discomfort in my upper left abdomen, had a abdominal CT and Chest CT (11/03), everything checked out fine except for a couple of liver cysts.
During this time I started gaining lots of weight, peaked up to 188 lbs.. Still had abdominal discomfort and leg feelings, more so in my left leg just above the knee (mainly when lying down or sitting), I was told it was RLS.
My concern now is that starting in February I noticed I was loosing some weight and to now I weigh 177 lbs., about 11 lbs. lost in a 7 month period. I have been having constant stomach noises, my stool is occasionally streaked with bright blood and on toilet paper. I have alternating normal stools and then constipation. I still have persistant upper and middle left side back discomfort and upper and lower left abdominal discomfort.
I have for several years suffered from Acid Reflux.
I have had several test done, and seen many doctors (2 neurologist, 1 gastro, 2 infectious disease specialist, family doctors).
Abdominal CT 12/03 - Normal
Chest CT 12/03 - Normal
Abdominal CT 04/05 - Normal
Liver MRI 11/04 - Normal
Abdominal Ultrasound (12/03) - Normal
Abdominal Ultrasound (11/04) - Normal
Colonoscopy - 2/04 - Normal
Endosocopy - 2/04 - Normal
Small bowel series - 03/05 - Normal
EKG - 5/05 - Normal
Chest x-ray - 5/05 - Normal
SED Rate - Normal
5-HIAA - Normal
Serontonin - Normal
Liver Funtions (Multiple) Normal
CBC - Normal
Serum Total protein - Normal
High Cholesterol
High Triglycerides
Normal BP
Immunofixation, Serum (No monoclonal protein detected)
Pancreatic enzyme test - Normal
Kidney functions - Normal
As you can see I have had a pretty good work-up and nothing, which I am thankful, but with continuing issues, I can't help being concerned, especially about things like Cancer. What could doctors have missed, if anything. All of my docs are saying there is nothing wrong, which makes me feel good, but I am the one who on a daily basis does not feel right. Could I be causing these symptoms on my own? I don't understand how I went from being a thin person to gaining 30 lbs in three years, then start to loose weight, despite a relatively normal appetite, while there are times where I could care less whether I eat or not. Any thoughts would be appreciated. As far as the blood streaked stool, would the colonoscopy of caught anything there or the endoscopy?
I am 30 y/o male, smoker. 4 years ago my normal weight was 158 lbs. then I got sick, ran a fever for just under a couple weeks and nothing was found, at that time I lost about 11lbs., about 9 months after that (still not feeling myself) I started having upper back discomfort and weird feelings in my legs (had needles put in legs/MRI of spine everything was ok.
Soon after, I started having discomfort in my upper left abdomen, had a abdominal CT and Chest CT (11/03), everything checked out fine except for a couple of liver cysts.
During this time I started gaining lots of weight, peaked up to 188 lbs.. Still had abdominal discomfort and leg feelings, more so in my left leg just above the knee (mainly when lying down or sitting), I was told it was RLS.
My concern now is that starting in February I noticed I was loosing some weight and to now I weigh 177 lbs., about 11 lbs. lost in a 7 month period. I have been having constant stomach noises, my stool is occasionally streaked with bright blood and on toilet paper. I have alternating normal stools and then constipation. I still have persistant upper and middle left side back discomfort and upper and lower left abdominal discomfort.
I have for several years suffered from Acid Reflux.
I have had several test done, and seen many doctors (2 neurologist, 1 gastro, 2 infectious disease specialist, family doctors).
Abdominal CT 12/03 - Normal
Chest CT 12/03 - Normal
Abdominal CT 04/05 - Normal
Liver MRI 11/04 - Normal
Abdominal Ultrasound (12/03) - Normal
Abdominal Ultrasound (11/04) - Normal
Colonoscopy - 2/04 - Normal
Endosocopy - 2/04 - Normal
Small bowel series - 03/05 - Normal
EKG - 5/05 - Normal
Chest x-ray - 5/05 - Normal
SED Rate - Normal
5-HIAA - Normal
Serontonin - Normal
Liver Funtions (Multiple) Normal
CBC - Normal
Serum Total protein - Normal
High Cholesterol
High Triglycerides
Normal BP
Immunofixation, Serum (No monoclonal protein detected)
Pancreatic enzyme test - Normal
Kidney functions - Normal
As you can see I have had a pretty good work-up and nothing, which I am thankful, but with continuing issues, I can't help being concerned, especially about things like Cancer. What could doctors have missed, if anything. All of my docs are saying there is nothing wrong, which makes me feel good, but I am the one who on a daily basis does not feel right. Could I be causing these symptoms on my own? I don't understand how I went from being a thin person to gaining 30 lbs in three years, then start to loose weight, despite a relatively normal appetite, while there are times where I could care less whether I eat or not. Any thoughts would be appreciated. As far as the blood streaked stool, would the colonoscopy of caught anything there or the endoscopy?
Doctor's Answer
by Kevin Pho, MD, Sep 15, 2005 12:00AM
, Sep 15, 2005 12:00AM
There has clearly been a comprehensive workup. With the negative testing, cancer would be unlikely.
For the stomach symptoms, you can consider more specialized testing like a 24-hr pH study with esophageal motility studies, which can uncover previously undiagnosed GERD or esophageal dysmotility which may contribute to the symptoms.
As for the weight loss - you can consider evaluating the thyroid via blood thyroid tests, as well as malabsorption - with blood tests for celiac disease or stool tests looking for fat malabsorption.
Irritable bowel syndrome can also be considered with the alternating constipation and normal stools. Anti-spasmodic agents as well as increasing the amount of fiber in the diet can all be considered for treatment.
These options can be discussed with your personal physician.
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.
Kevin, M.D.
http://www.straightfromthedoc.com
For the stomach symptoms, you can consider more specialized testing like a 24-hr pH study with esophageal motility studies, which can uncover previously undiagnosed GERD or esophageal dysmotility which may contribute to the symptoms.
As for the weight loss - you can consider evaluating the thyroid via blood thyroid tests, as well as malabsorption - with blood tests for celiac disease or stool tests looking for fat malabsorption.
Irritable bowel syndrome can also be considered with the alternating constipation and normal stools. Anti-spasmodic agents as well as increasing the amount of fiber in the diet can all be considered for treatment.
These options can be discussed with your personal physician.
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.
Kevin, M.D.
http://www.straightfromthedoc.com
Next -- how about diet and exercise? Are you eating and eating well? Making wise food choices? Do you get an hour of exercise every day? You can split it up but daily exercise can do wonders for the constitutional complaints as well as stress management.
It is frightening when we do not feel well and noone has a pill to cure it. But many times it boils down to relaxation, daily exercise, and a good sensible diet. So much easier to recommend to someone than to follow myself :) Good luck!