Frustrated in CO

[Fletch12]

Here is a quick overview of the last three months of my symptoms:

Lower left abdominal pain, not sharp but dull and achy.  Nothing that disabled me.  I continued to run 40-50 miles per week.  Went to PCP and he sent me to Urologist (I was urinating more frequently).  Negative tests.  Urine OK.  Pain continued.  I went to GI and he ordered colonoscopy after I started to have intermitent fevers.  That test was negative.  Also had endoscopy and uppper GI, all neg.  Had a lower torso CT scan, all negative.  One of my blood tests showed up with a slightly elevated lipase level (400) but it had lowered to 273 a few days later.  I even had my LDH tested, and it was normal.  I had a chest CT scan which was normal. I continue to have the left side pain and now I have a slight loss of appetite.  No nausea yet.  I go from constipation to some diahrrea.  I am still having fevers occasionally (I think...I get warm, but my temp is never over 98.3).  I have had some trouble sleeping recently as well.  My PCP wants me to see an oncologist and also to have another CT of pancreas.

A few questions:
1.  What does a normal LDH reading rule out?
2.  Doe my lipase level dropping back to "normal" signal that the pancreas is ok?  Would pancreatic cancer or pancreitis have higher levels?  My amalayze was normal, by the way.
3.  Could this be IBS?  And could stress create these symptoms? (this past year I have lost my mother, moved to a new city, changed jobs and got engaged- not to mention the fact that I got a DUI)
4.  Any ideas or suggestions?

Thanks in advance.  

Chris in CO

[ayri]

hi, i think you should test yourself for diabetes just to rule it out.

[boron]

Under 2. URINE (above):
- bilirubin
- proteins
- white cells

[boron]

About questions for oncologist:

1. Write down ALL your current symptoms, even if you think, they are not related (bowel habit, stool appearance, temperature, these chest rash etc). Write down your complete medical history from childhood, mention any medications, be honest about alcohol (type and amount of alcohol a week, how many years, so just to feel peace and not thinking on this further), smoking, he will ask about some industrial polutants, asbest and other chemicals.
2. Family history of cancers (exact type, if possible, age of death) of all your 1st grade relatives. Also get info about eventual allergies and gastrointestinal diseases.
3. It's not likely, oncologist will know enzyme levels from the head, but give him results of any test you've ever had (I hope he'll be able to check your medical documentation).
4. Ask (or search online) about these cancers:
- carcinoid
- pancreatic metastases
- lymphoma
- "hormone secreting tumors", like vipoma

Oncologist may order some specific tests for various types of cancers (will search for "tumor markers" in blood), including pancreatic cancer.
http://www.directlabs.com/CancerSafe.php
http://www.emedicine.com/med/topic1712.htm

Answers to your questions:
1. Jaundice is jaundice when you can see it. Yellow eyes, (maybe only slight or in distal corners, day light needed), yellow skin, skin itching, darker and smelling urine - one or many of these symptoms go with elevated blood bilirubin. No elevated bilirubin, no jaundice.
2. Lipase is non-reliable indicator of cancer - I've searched a littke - it wouldn't necessary be high. I believe the same is true for LDH. Increased lipase and LDH are increased either in pancreatitis, or when pancreatic cancer is present with pancreatitis. But cancer may go without pancreatitis, so enzyme levels are not necessary high.
3. Foamy urine may be from bilirubin in urine (which is likely, if urine is darker as usualy) or from  excessive proteins in urine, and this may be due to kidney disease.

Beside thinking on pancreatic cancer, don't forget to biliary tract disease. HIDA scan would give a lot of info about your bile ducts, not about pancreas though, but you have to start excluding possibilities somewhere.

My suggestion about tests, you need:
1.BLOOD:
- bilirubin
- enzyme GGT (it's posible it was already done). GGT is highly increased in any biliary duct disorder (BUT also realy high with even slight alcohol drinking, so ask about this your doctor)

2. URINE

After getting these results, especially if GGT and bilirubin will be high:
3. HIDA scan

4. Whatever oncologist will say.

I would go from 1-4, since oncology test may be expensive, and maybe something other will be find to exclude pancreatic cancer.



- bilirubin
- proteins
- white cells
3.

[Fletch12]

The red skin comes and goes.  When I run I get a mild rash on my chest.  I have awakened to a red line on my forehead the past few days.  I do feel itching a little, but nothing bad.  

No yellow eyes, etc.  Would I know if I had jaundice?  Is it noticeable?

No previous diseases.  Alcohol consumption has been moderate for many years.  Most weekends going out for about 15 years.  Not much during week at all.  

No medications.  

Back to original question, though.  Would my lipase be sky high with pancreatic cancer?  Does LDH levels being normal rule it out?  I am frightened of this.  No pancreatic cancer in family, but both parents and both sets of grandparents died of various cancers.  The dang internet is bad for people like me with undiagnosed stuff.  My stress levels have been very high lately due to this.

Could my symptoms be kidney related?  I have noticed a foamy urine lately.  I have a urology appt. on Wed.  I am trying my hardest to get to the bottom of this.  It has been getting progressively worse for three months.  The loss of appetite just came on Friday.

I have an oncologist appt. tomorrow.  Don't know much about what an oncologist does.  Can you elaborate?  What questions should I bring up?

Thanks so much for your answers.  It is helpful.  My PCP is difficult to get ahold of at times.

Chris

[boron]

Pale stools (from lack of bile) which float (from fat) definitively go with bile flow blockage, probably within biliary tree. If this is from small gallstones, which lodge and release and so on, it is logical that symptoms come and go, lipase rises and falls. Pancreas in this case is not impaired, but disturbed by retrograde bile flow.

I recommend you to have HIDA scan, which shows how bile flows from liver into gallbladder and into biliary tree. They inject a contrast into your vein and monitor its distribution by a special scanner; no endoscopy here.

Loss of appetite and upset stomach and moderate fever go with gallbladder inflammation. I'm still not sure about it. Can you describe red skin a bit? Any previous diseases, alcohol, medication?

[Fletch12]

I am 39 male.  Yes, a few pale stools lately.  A few floaters.  

Lately more loss of appetite and upset stomach.  No vomit, yet.  

And a bit of a reddness on skin at times.

[boron]

1,2. Having LDH and all other pancreatic enzymes back to normal, plus all pancreatic imaging beeing normal, excludes any severe pancreatic disease. Even, if it was pancreatitis, it was slight, and has gone until now. No cancer from these results. Doctor ordered another CT; maybe he thinks there are small metastases from some extra-abdominal cancer. May be a pancreatic (and liver) scintigraphy would show more.
3. If you want to have IBS, you, by definition, need each and every test to be normal, so this isn't IBS.

4. Possible causes of raised lipase are:
- something within biliary tree: a gallstone which has resolved or so. In this case GGT would also be obviously elevated, you don't mention it. This would cause at least occasional right upper abdominal pain.
- gastroenteritis from food poisoning, or from drinking infected water.
- steroid drugs

Have you ever noticed a changed stool color, like pale, foamy, floating or so? How old are you, male/female?