Chronic but sporadic upper stomach pain

[DJ__0]

  Sorry for the lengthy "book" that follows.  I know it is important
  that you have enough background info to help in understanding what
  is going on with my stomach... 9/10 years of fighting this is
  beginning to wear on me and I just need some confirmations and/or
  suggestions.
  About 9/10 years ago I was diagnosed with cervical fibrositis to the
  extent that at times I had very limited movement of my head/neck.
  My doctor prescribed an anti-imflammatory (which helped tremendously)
  and I went through physical therapy several times over the next few
  years (which also helped).  Unfortunatley, the anti-inflammatory
  worked so well, that I took it a little too frequently for a couple
  of weeks and sometimes with only a few crackers or the like.  As
  such, I began having stomach problems.
  My doctor changed the anti-inflammatory to one that dissolves in
  the intestine rather than the stomach and put me on Zantac and
  Carafate (for a limited time) and greatly restricted my diet. I
  gave up colas and caffienated beverages for good and after a
  couple of months was able to resume my normal diet.  I have since
  stopped the anti-inflammatory use with the help of Norpramine
  (150 mg daily - also helps with sporadic bouts of depression)
  and Soma which I take as needed, but have dramatically reduced
  the use of in the last two years with the help of the Norpramine.
  My stomach problems come and go. At one point about four years ago
  or so, my stomach bothered me to the point that the smell of food
  nauseated me to the point of not eating (I could tolerate bananas
  and vanilla and tapioca pudding) and lost a great deal of weight.  
  Carafate and Tagamet helped me get thru that spell.  I have since
  been taking 800 mg of Tagamet daily (think I got down to 400 mg for
  a few months, then had to bump it back up).
  In the last six months or so, I have been having a lot more stomach
  pain/discomfort.  It occurs at the base of my sternum and pressing
  on the area, is very painful at times and aggrevates it.  At times,
  it feels as though there is a band around my stomach just below my
  rib cage and the "band" tightens and is very discomforting although
  the "band" feeling is not painful, just the spot below my sternum.
  The painful stabbing is always located at the top of my stomach, just
  below the sternum.  It causes some nausea, but never vomitting, and
  blows my appetite.  Being 41 years old, 5'8" and only 116 lbs., I
  can't afford to loose much weight and have a hard time putting weight
  on.
  I had an upper GI in '97 and my doctor still says it is gastritis.  
  He is a very thorough doctor and keeps close tabs on me (I've also
  had a lower GI, a sigmoidoscopy, and colonoscopy in the last several
  years that all looked good).
  Two weeks ago, because my stomach was very tender, my Dr. stopped my
  Tagamet and put me on Prilosec, 20 mg once/day.  About five days later
  I experienced major stomach upset and pain.  I awoke during the night
  with a "bear-hug" crushing feeling in my chest and pain, took Titrilac
  (a terrific antacid that usually works wonders on me and most everyone
  we've ever told about it) to no avail and finally went to the ER uncertain
  of the cause.
  Blood work and an EKG came back normal.  The ER Dr. diagnosed it
  as GERD and told me to increase the Prilosec to twice/day. The
  next morning, I contacted my Dr. who instead stopped the Prilosec
  and put me on Prevacid, 30mg, twice/day for 2 weeks (just starting
  week 2).
  The first few days, my stomach seemed fine (as it did when I started
  taking the Prilosec).  The last couple of days, the pressure/pain
  has started again in the same area, just below my sternum, and causes
  nausea which makes it difficult to eat, even though I know I need
  to get food in my stomach.
  When I begin to feel discomfort in my stomach, I cease eating
  foods I know will aggrevate it (fried/greasy, chocolate, spicey,
  acidic, minty, most fruits, onions, salads, etc. - gave up citrus
  several years ago), which doesn't leave much left to eat.  I primarily
  drink ginger ale, which never bothers me, and ice/ice water.  I
  smoke on average 1/2 pack/day, down somewhat in the last couple of
  months (I know I need to quit, but it greatly helps me cope with
  stress) and have quite a bit of stress between my job (mostly just
  lately and should ease up in the next few weeks), my part-time
  business, undergrad classes (just 4/year), and remodeling of our
  home (almost finished).
  Sometimes, like yesterday and last night, the stabbing stomach
  pain causes my upper abdominal muscles to involuntarily contract
  and stay that way as though trying to suck them in to press
  against my stomach to ease the discomfort (hard to describe).  
  I very rarely get heartburn, pain/discomfort in my throat, or
  lower abdominal pain associated with this.  I sometimes get a
  "sour" taste in my mouth along with the stomach discomfort/pain
  which can come on at any time of the day or night regardless of
  whether or not or what I've eaten.  It usually lasts at the very
  least, 24 hours and most often a good 2-3 days.
  I also take Naprosyn Sodium 400mg twice/day for about a week every
  3-4 weeks (beats female surgery), but am careful to take it with
  food.  I take Fiorecette as needed for severe headaches, sometimes
  several times/day or week (also try to take with food), then at
  other times 0-2 over a 2-4 week periods.  I do not take Ibuprophen
  or any other pain relievers on the market with the exception of
  acetomeniphen (will sometimes relieve my headaches w/out Fiorecette).
  None of the scripts I take seem to correlate with my stomach woes,
  however, unless I've taken too many without food.
  So, does this sound like gastritis or GERD?  Does my Dr. seem to
  be on the right track?  And when taking Prevacid, I do not always
  know when I am going to eat, so it can be difficult to take as
  recommended - 1 hr. before eating - but I cannot find anything that
  tells me that I must eat w/in an hour of taking it.  So, is it
  that they want me to take it on an empty stomach, or should it
  only be taken when I know I will eat w/in an hour?  If I don't
  take one before I have dinner, is it ok to take it 2-3 hours
  after eating or better to take it as soon as I know I'm going to
  eat, even though it's not an hour prior to eating?  They really
  don't explain this in any literature I've received or found and
  our new, young pharmacist didn't know much about the drug when
  I asked.
  I am getting very tired of battling this and it is rapidly
  becoming another major stressor (that I really don't need) in
  my life.  I'd really appreciate any information, hints, tips,
  etc. that you, or anyone who takes the time to read this "book"
  and has battled the same and overcome it, can pass along to me.
_____________
dear DJ,
Reading your letter i was impressed by the chronicity of your symptoms, the reasons why you might have gastritis (nonsteroidals) and the evaluations that you have had.  My main suggestion is to exclude gastroparesis as the cause of your symptoms.  Delayed gastric emptying, which can be easily treatred with a prokinetic agnet such as Propulsid, can cause many if your symptoms.  Also, in view of your low weight, malabsoprtion should be excluded.
If you continue to require nonsteroidal agents, ask your doctor about trying Cyototec, a prostaglandin compound, that protects the gastric mucosa from damage.
This information is presented for educational purposes.  Always consult your personal physician for specifci medical questions.
HFHSM.D.-rf
*keywords: gastroparesis, gastritis, malaborption
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