Digestive Disorders / Gastroenterology Expert Forum
SEVERE lack of appetite, etc
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SEVERE lack of appetite, etc


Timeline:

Beginning 3 weeks ago - slight feeling of bloating and fullness after a small meal

Tues, June 3 11:PM - after eating feeling of intense uncomfortable bloating and constipation in lower abdomen

Wed, June 4 - feelings persist, NO appetite - unable to schedule dr appt so I went to emergency.
They took blood and urine tests which came up fine. Gave me magnesium caltrate.

Thur, June 5 - bloating and severe lack of appetite (hadn't eaten anything since Tuesday, June 3 11:pm.
Clearish,yellow mucus or fatty substance in stool.
Went to see primary physician. Blood and urine tests repeated. All fine.
X-Ray reveal no blockage and "unremarkable" amount of gas and stool.
CT Scan later that day of abdomen comes up normal.
Told to repeat magnesium caltrate.

Thursday night, June 5 - Bloating, severe lack of appetite

Fri June 6 - NO appetite. Force fed myself 2 saltine crackers, 2 spoonfulls of oatmeal and a bottle of Ensure.
Later that night, Bloating, and gas pains. Unable to pass gas for relief. Fatty, oily stool.

Sat June 7 - Not as bloated, but feelings or nausea until 2:30pm. More fatty, oily stool.

Symptoms:
1) SEVERE lack of appetite (Feel full). Not able to eat. Must force-feed bits of food.
2) Chronic bloating (expecially at night)
3) Fatty, oily stool (could magnesium caltrate cause this?)
4) Weakness from not eating (5 days without appetite - feel full)
5) No fever

Duration: June 3 to current

Concerns:
1) Stomach cancer?
2) Pancreas?
3) Parasite? (have not been out of the U.S.)

Background: I am 31 6'2" 200 lbs. Excercise regularly. No history of irritable bowel.
Only been constipated or afflicted with painful gas about 3 times in my life.

Diet during last week: Gatorade, Ensure, bites of oatmeal, saltine crackers, chicken soup.

I am very weak, tired and scared. I am planning to return to the doctor on Monday, what are your opinions? What should I discuss with him?

Thanks for your time and attention.
Related Discussions
233190_tn?1278553401
I would further investigate the upper GI tract.  

An upper endoscopy would be most comprehensive test for gastric cancer.  Inflammation of the esophagus and stomach, GERD or an ulcer would also be tested for with an endoscopy.

I agree that H Pylori should be considered, and this bacteria is associated with ulcers and inflammation.

More specialized tests can include esophageal motility studies as well as a gastric emptying scan.

I would also send the stool off for analysis and culture to exclude infection or malabsorption.

This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com
17 Comments
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Avatar_n_tn
I would also, appreciate recommendations on how to handle Sunday (try eating something specific?) and whether or not I should collect a stool sample, etc. Thank you so much for your time on this. It feels good to know I will be getting sound advice.
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Avatar_f_tn
Hi - so sorry to hear of your problems.  Not sure if I can help, but I have been feeling nauseous, bloated and lost my appetite - after 4 weeks of force feeding myself (sometimes just a fruit yoghurt and a banana all day) I went to see my GP 2 weeks ago. As I have Pan Crohn's Colitis (from mouth to anus) with known ulcers/crypt abscesses, and a hiatal hernia which is causing reflux, he prescribed omeprazole, 20 mg a day and after 4 days on it, I have started to feel a bit better. The nausea is less, but still no appetite. I am eating soft food - creamed potatoes, poached or boiled egg for protein, a little tinned tuna mashed with lite mayonnaise, and a couple of crackers with some cheese and chicken broth. Maybe try an omelette?

Your symptoms could be caused by many diverse diseases, so I would definitely take a stool, and urine sample, with you to your doctor and they can start testing and eliminate obvious causes.

You must keep hydrated so drink lots of water or, in my case, I drink non alcholic ginger ale, ginger beer (also non-alcoholic) and occasionally a finger of Stones green ginger wine topped up with lots of ice and ginger ale. For some reason, ginger quells nausea and settles the stomach. I was advised to drink this when on FEC chemo for breast cancer and it did help, along with the anti-nausea meds (granisetron and domperidone) which the Oncology Dept. supplied foc.

When I have a Crohn's flare, my stool floats, looks greasy and has either mucous or blood in it.  However, your symptoms do not suggest Crohn's as usually this presents with diarrhea and severe lrq pain.

I don't think any of us gastro patients can diagnose your problem but can offer emotional support.  I would think you need to see a gastroenterologist rather than a PCP/GP for further evaluation.

Take care - do come back and let us know how you get on - always helpful for other posters.
Liz.
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Avatar_n_tn
UPDATED SYMPTOMS:

June 7, P.M. Bloating and Gas.
June 8, P.M. Morning nausea and acid in stomach.
(Day before I only drank three Ensures and 4 saltine crackers. Only consumed water after 6:PM)

Symptoms seem to have settled at Bloating and Gas at night, Nausea and acid in the mornnig. No appetite whatsoever at any point. Haven't had a bowel movement since last report.

Monday can't get here soon enough.

Thanks for the support, Liz. Good luck with your health.
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Avatar_n_tn
Of course I meant:

June 8, A.M. Morning nausea and acid in stomach.

not

June 8, P.M. Morning nausea and acid in stomach.
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Avatar_m_tn
did they test you for h pylori?
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Avatar_f_tn
Glendon - thanks for the update......I have been out all day doing a recce on an airport for a trip to Spain in late August to celebrate my husband's 80th birthday with 9 friends. Stupidly, when we stopped at a pub for lunch, the roast beef and pork carvery looked tempting, and I ate half my plate.  But...I have paid for it since, with extreme bloating and pain. My problem may be due to two recently MRI diagnosed strictures in my small intestines - a consequence of some 38 yrs of Crohn's adhesions. Must see my gastro, as you also must Glendon!

aak001 - During the 2 hr drive today I was thinking about Glendon's problem and it also occurred to me that he may have h.pylori - which is so easy to fix these days with the appropriate antibiotic. One of my earlier gastros was part of the team that researched stomach ulcers and found the h.pylori bacterium.  Great of you to post and try to help - as we all do on here, when and where we have pertinent experience. Sometimes, people are very upset and scared of their symptoms, and I feel the least I can do is respond to their plea for help, even if I don't have any answers. Thank you for caring and sharing.

Glendon - my husband suffered with severe GERD for years, and difficulty in swallowing at times, when two mouthfulls made him choke, and had to regurgitate his food. He took Gaviscon copiously - sometimes 4 or 5 times during the night. My gastro did an endoscopy on him and found the Schwartzi's (sp?) ring at the bottom of the oesophagus was constricted - he stretched it with the endoscope and he is fine now, although he has cut out all dairy from his diet. We use sunflower or olive oil in cooking and this has made a huge difference for him.

As you may have seen recently on this forum I have just been appointed the first Community Leader for Crohn's, which I am honoured to do, but as a community we do need help from many gastro patients who can give support to people either newly diagnosed, or waiting for diagnosis. Your experiences and information are invaluable.

Glendon - good luck for tomorrow - be proactive and don't let the docs fob you off until you feel comfortable with the tests they are going to do. Most gastros, in my experience are passionate about their work and will help the best they can, but as one gastro said to me 25 yrs ago: "Liz, you can tell me more about your symptoms, than I can tell you about the science." I have learned not to be embarrassed about describing my symptoms to doctors, as after all, my gastro-intestinal system is only one part of my anatomy. I rest my case.

Will be thinking about you tomorrow Glendon.
Take care,
Liz.
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Avatar_n_tn
Thanks for the advice and concern.

I don't believe I was tested for h pylori

Would h pylori lead to bloating? I have been dealing with that again all day today. (Sun June 08)

Still ZERO appetite. I force fed myself some three bites of chicken and rice soup and about four saltine crackers.

The scariest aspect of this is my complete loss of appetite. I've lost several pounds over the last week.
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Avatar_m_tn
I have been getting worse with this for 10 years. Then last year was really bad with many, many, tests.  Finally I had the esophageal motility test and gastric emptying scan that the Dr suggests. Finally a diagnosis!

Had a balloon dilatation for my esophagus problem (achalasia) which worked for food sticking there but lower abdomen still bad. It is gastroparesis. Have been in bed since last July and eat only Carnation Instant breakfast and then Ensure other two meals. Since quit trying any solid foods it is tolerable. A gastric electrical stimulator (Enterra Therapy) is being considered after trying one more new new drug, Lyrica first. So far not working.
Anyone with these problems should check out www.digestivestress.com and then open Home Page.
Good Luck
jnm
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Avatar_n_tn
UPDATE:

Monday, June 09

Dr took several blood tests and stool is being tested. These results should come back hopefully tomorrow maybe Wednesday. I had to basically beg for the h pylori test for some reason. I am still with primary physician. Not sure why I am not yet with a specialist. Perhaps if the blood tests come back negative they will send me. I am with Kaiser Permanente.
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Avatar_f_tn
Hi Glendon - great to hear from you and that testing has started. Did you mention the calprotectin stool assay test? I'm not sure if this is used in the USA (I live in England), as it was first developed in Nottingham, England some years ago. I have it regularly, as it is cheap and easy to do, without radiation problems which my gastro is concerned about as I had 25 days of rads for breast cancer and many endoscopies and colonoscopies, which involve radiation.  

I have not, to my knowledge, ever had h.pylori tests, but guess as I was dx with Crohn's in 1970, the docs know what I have.

I would really suggest you get a referral to a gastro, not just anyone, but one who has had experience in IBD problems. I have had many gastros, leading a peripatetic lifestyle in England and Spain, and some of them just sucked. We have socialised medicine in England, so don't pay for treatment and now I am retired, don't pay for drugs, which could be expensive as I am on weekly chemo (methotrexate) for Crohn's and breast cancer adjuvant drugs.

I do have close friends in the US, in Tampa and Omaha, so know a little of your private medical insurance facilities.  Somehow, I don't think Kaiser is the best, from the experience of some breast cancer sisters.

Whatever, hope you get a proper diagnosis, treatment and meds, for whatever the problem turns out to be.

Fingers and toes crossed that you can get some relief - keep me in the loop?
Take care,
Liz.
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Avatar_n_tn
Yes, your system is much better in many ways. My wife and I must pay $174.00 per month each for medical insurance and we still have to pay a $30 co-pay EVERY time we see a doctor, I had to pay $100 for part of the CT scan. We must pay 20% of all hospital costs, $150.00 for an emergency room trip and any prescripbed drugs can range from $12 to $200 ($180 for my imitrex for migraines).

Kaiser Permanente is an HMO. This means the doctors work for the insurance company. There is obviously a lot of contraversy about that. They are encouraged to keep costs down and this probably explains why they are hesitant to order certain tests quickly. I am forced to use Kaiser because normal insurance companies (PPO) refused to take me because I have a herniated disk in my back.

Our system is very messed up and frustrating.
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Avatar_f_tn
Hi there - I am sure glad I live in England since we pay not a cent for consultations, treatment or drugs.  I do know a little about US medical insurance as I have close friends in Tampa that we have discussed this subject with, particularly when we were staying with them for 2 months in 2003 and I had a severe rectal haemorrhage and was hospitalised for 4 days for IV steroids and blood transfusions - cost $15,000 and my travel insurance initially refused to pay. I fought them for 9 months, and did get them to pay the hospital evenutally.

  To give you an idea...my friend who we were staying with (male, now 79 yrs old) was dx with non-small cell lung cancer 7 yrs ago, stage IV terminal, told to get his affairs in order  - he even picked out a burial plot in a nearby vets' cemetary.  He was under an HMO at the time (don't know which one) and after removal of his lung, was in a hospital bed at home for 6 months. His wife was frantic, and like me, very proactive with our much older husbands' health issues. She got their insurance changed and an appt at the H. Lee Moffitt Cancer hospital in Tampa. There, it was found his cancer had spread to his left kidney, and this + the adrenal gland, was removed 6 yrs ago. He has other issues, like 4 tumours on his parathyroid which are now being looked at.  Last year, routine scans showed his remaining lung had a cancerous tumour and he has just finished stereotactic radiotherapy - only the 4th patient in the US with one lung to have this procedure.  He is doing very well, but considering he has 7 different doctors on his case at a prestigious medical facility, hardly surprising. I believe he has a deduction from his seniors' retirement pension for Medicare, but also has a supplemental insurance for long term disability and drugs. His treatment has cost over $3m and he would not be alive today without his insurance.

I finally bit the bullet Monday and rang my IBD nurse. After hearing of my current symptoms (nausea, no appetite, abdominal pain and bloating) she has got me an urgent appt with my gastro this morning. She said, after dicussing my case with him yesterday, I am probably looking at surgery to widen the 2 strictures in my small intestine but will need either an upper endoscopy or repeat MRI (only one I have had was last Nov when the strictures were found but I was asymptomatic at the time, so no treatment). She also said he will prescribe some nutritional med this morning which I can get direct from the hospital pharmacy.  Hope springs eternal!

Keep positive, as I have always been - it can't cure my bc or Crohn's, but does help living day by day. I have never given up hope, and now that there are so many new drugs for both diseases, I am very optimistic I can live to a ripe old age, wear purple dresses and red hats!

Take care,keep in touch to let me know how you are doing and if I can help in any way.
Liz.
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Avatar_m_tn
i have these exact same symptoms. please shed light on this.
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534146_tn?1213281126
Hey Glendon, I had similar problems you've had, but only relating to being full (dyspepsia). I've been taking peppermint oil (enteric coated) gel capsules - brand is called NOW, orange and white bottle. I've been taking 2 to 3 caps per day and ITS SOLVED MY PROBLEM!!. I was miserable and lost weight because I could not eat! I also had some IBS symptoms and the peppermint seems to have calmed down my IBS. I'm feel very fortunate as I've been to the Gastro... etc and they know very little.

Try it , There is some evidence of it's effectiveness (double blind, plecebo controlled clinical trial, related to dyspepsia and ibs). good luck. Send me an email if its successful. at ***@****
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Avatar_f_tn
Hi - how are you doing? Any results yet on your tests?

I got an urgent appt with my gastro last Wed - he has ordered a CT scan of pelvis,abdomen,liver and pancreas 26 June, then is doing an endoscopy of the upper GI tract under sedation on 9th July. I am hoping the problems relate to the two strictures in my small intestine and can be resolved by stricureplasty.  He has prescribed anti-emetics, domperidone 4 times daily and doubled the omeprazole (anti-ulcer drug px by GP 3 weeks ago) and I do feel a tad better today. Went out for lunch with hubby and friends yesterday and managed 2 slices of roast lamb and two small boiled potatoes - progress!

Take care and hope you get some relief soon.
Liz.
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Avatar_m_tn
I was in error on the website i gave before. It is:

www.digestivedistress.com and then open Website::Homepage

be interested to hear how you are progressing
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