a vexing set of symptoms

Since beginning the new year on January 1, I have lost 19 lbs (today is January 16), going from 267 lbs to 248 lbs (I am 6'2" tall). I also have a rapid onset of stomach fullness when eating even relatively small amounts of food, and frequent, liquid diarrhea. Truth be told I don't have much appetite, and I am recovering from a bout of flu that lasted from 1/4 until about 1/11 (cough/cold, sinus pain/pressure, and generalized malaise/body aches). Concurretn with the flu, I also had an outbreak of oral herpes, for the which I took Valtrex, 2 gm Q12H x 1 day (4 gm total) and used a Zovirax ointment on the cold sores.

This past week I tried to eat lots of high-fat, and fattening foods (pizza, doughnuts, burgers, rotisserie chicken) to see if I could abate or even reverse some of the weight loss, but I could not - in fact, I lost an additional two pounds. My mouth "feels funny" - dry and tingly, for lack of better descriptors, and I get really sleepy after eating.  I drink only about 15 oz of coffee each day, in the morning. I eat pretty much everything, but have recently tried to limit my beef intake out of concern for BSE/vCJD.

I am a 40 year old caucasian man. I take the following medications: Zoloft 200 mg/day (depression), Lisinopril 20 mg/day (hypertension), Singulair 20 Mg/day (extrinsic asthma), Clonazepam 0.5 mg BID (anxiety), Valtrex 1 gm PRN (oral herpes), Ambien 10 mg HS (insomnia), Tylenol #4 PRN for headache pain (taken infrequently). During my flu and herpes outbreak, I took 400 mg Ibuprofen QID for achiness and fever, which I have now been able to discontinue. I also take Claritin-D as needed for seasonal rhinitis. Ive been taking all these meds in these amounts for at least a year - none of them are new to me.

Needless to say I'm afraid to go to my doctor - sounds foolish, I know - but I'm very concerned that this might be cancer, or diabetes, or something worse. I am my family's sole support - I have a small son and a stay-at-home spouse, and the thought of a serious illness scares me.  The weight loss is really the scariest thing to me - I know at 6'2" and 267 I needed to lose weight, but I'd been roughly that weight for more than a few years, and I'm a terrible dieter - I cheat constantly.

I'd love feedback as to what this might or might not be. Sould it be Hepatitis? A yeast infection of some kind? Other possibilities? Parasite?  Something...worse?

Lastly I just had to change insurance from an open plan to a HMO - and this is just the sort of thing that scares me about HMO care - I don't want some doctor just shoving Immodium at me and waving me off - it seems like this might be serious. How do I bring appropriate gravitas to bear on the medical equation in an HMO environment?

Thanks - peace and love to all of you, and I welcome your feedback.

[Kevin Pho, MD]

The symptoms you describe are pretty general.  Weight loss, stomach fullness, change in bowel habits, diarrhea can be caused by a variety of GI disorders.  Malabsorption, inflammatory bowel disease, irritablbe bowel disease, infectious causes (either bacteria or parasite) or cancer are all possibilities.  

I work for an HMO, and any responsible physician should not just "brush you off with Immodium", whether you go to an HMO or not.  

In any case, with the bloating, weight loss, and diarrhea, endoscopies (bother upper and lower, or an upper GI series and lower endoscopy) would be a reasonable place to start.  Tests for your pancreas, stool tests for malabsorption, and blood tests for celiac disease should all be considered.  A simple non-GI test to consider would be a blood screen for thyroid disorders as well.  

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.

[dumbguy]

I forgot to mention borborygmus - so loud at times that my spouse can hear it from across the room - it's one of the ways I know diarrhea is on the way. Just this afternoon at 12:00 noon I ate a bowl of borscht for lunch, and promptly crapped it out by 3:00pm - what seems to me to be a fairly rapid transit (and I know it was the borscht because it was the only purple thing I ate in the past week).  Thanks!  Sorry I forgot to include this in the original posting.

[surgeon]

unexplained weightloss, fullness, increased borborygmi -- it is highly likely that there is a specific and easily diagnosable cause. Tumor is high on the list, but not the only thing. To speculate about it online is only educated guessing; whatever it is needs an answer, which you'll only get by seeing your doctor. If it's serious, the sooner it's diagnosed and treated, the better. If it's not so serious, you'll be relieved. In any case, it's time to see your doctor. Soon.

[nanuqtom]

My friend had similar symptoms and it was diabetes.  Get checked or die. My friend almost died and is now left with no feelings in his feet, not to mention other problems.  If he had gone in 3 yrs earlier when the problems started he'd be in much better health today.  good luck.