GI Issues / Pancreas / Need some thoughts...

[j201215]

Last November while outside the US I developed a low fever and severe diarrhea.   I was treated with antibiotics.  The fever disappeared within 24 hours.  The diarrhea continued.  All blood tests and stool samples were normal.  I was in a developing country and screened for parasites.

After two weeks I returned to a doctor.  He repeated all tests. Everything was normal.  In addition to the blood work, the parasite screen was repeated.    

Over the following months, until I returned to the US, the diarrhea continued.  There was no pain or other symptoms.  I saw several reputable local doctors and was retested with normal results. The only thing slightly elevated at one point was calprotectin.  It was 147 and subsequently returned to normal.  

On several occasions I was put on antibiotics to see if there was an impact.  I was also given a variety of anti-diarrhea meds.    Nothing worked.

After experimenting with my diet I realized the severity of my diarrhea could be controlled by a diet of plain yogurt, rice and boiled chicken.  I lived on this for several weeks and got to a point of almost normal passing.  On one occasion, with an unusually stressful work event, the diarrhea returned within minutes.  It slowed down a day later.  

My weight dropped from 220 to 200 lbs.  The diarrhea was often fatty, but remained normal in color.  I had no fatigue and work out on a daily basis.  

I returned to the US where all tests and blood work were repeated.  My blood work was normal as were stool samples.  The only remarkable abnormality was a severe Vitamin D deficiency.    

A GI specialist ordered a colonoscopy and endoscopy.  My previous colonoscopy had been one year before and was clear.  The results of this test were also clear as were the endoscopy.  

The prepping for the colonoscopy had an interesting outcome.  It seemed to reset my system to normal.  Within a few days after the procedure, I was back to normal with no diarrhea and felt great.  

I usually eat well, after a week of normality, I decided to try some fatty foods to see if I would remain untroubled.  All was fine.  I did not even had a tinge of indigestion.

This continued for three weeks until I ate something that was doused in butter.  Within hours I developed severe indigestion and diarrhea that resolved itself within 24 hours.  I spent the week back on a bland diet and all seemed fine.  

After the week I decided to experiment again.  I ate a very strong cheese.  This put me back to square one with severe fatty diarrhea that was now yellow, but after a few days turned to a normal color.

I went back to my GI who ordered a CT.  Concerned about a CT, I went to my PCP who agreed to start with a HIDA with CCK, along with more blood work.  To clarify, my previous blood work had no abnormality (except for the D def). Bilirubin was normal, white count was normal, glucose, BUN all normal, etc, etc...

As I was going into my HIDA test my pcp called to inform me that my lipase was 155.  Quest's normal range is 7-60 U/L.  I understand what Lipase is, and that it is produced by the pancreas.  

The results to the HIDA came back and my ejection rate is 25 percent.  There are no apparent stones.  The radiologist called it probable Biliary Dyskinesia.      

My PCP has now ordered a CT.  He says my symptoms are troubling and we need to find out what is going on.  He says that in all likelihood I am not looking at cancer.  Somehow, he is not convincing me.  I asked for a rough estimate, and he said “I would guess that the possibility that this is a malignancy is around 15 percent”.  I fear that he is giving me a lower number in his estimate not wanting to alarm me.  

I have no jaundice or other signs of pancreatic issues.  Around 18 months ago I had very severe mid level back pain that went into my legs, which I now wonder if might have been connected.  At that time, an abdominal and spinal MRI was conducted.  All was fine and the pain was attributed to a slight spinal issue manageable with physical therapy.  I now have vague back pain.

Giving it thought over the past days, I have noticed a feeling of fullness in the area just below my right rib cage, though this could be my mind now playing tricks on me. I am otherwise, very healthy and have never had any major issues.  No history of cancer in my family.  My mother has gall bladder removed in her early 40s.  I am in my mid 50s.  I have in fact lost 20 lbs, but again am on a very limited diet and trying to convince myself that the diarrhea matched with limited eating is the cause.

I do not scare easily, but this has really tested me.  I absolutely convinced this is pancreatic cancer, and if not then another form of cancer.  I have become obsessed with this, and finding it difficult to wait for the CT.

With the 155 lipase and HIDA, are there other more common options? My fear is that if there are no gall stones or other obvious reason for a slow ejection rate, and the lipase is high, I am looking at worst case scenario.  


  

[cnoevl21]

Have those levels tested high in multiple blood tests? My levels were high as well, plus my calcium levels were high. Had to get a CT scan (which showde nothing). Upon next test (a week later) pancreas enzymes went back to normal as did calcium. I was in a lot of pain and Tums helped, so I was taking that daily which led to screwin up my levels.
As for dairy causing issues. technically, all humans are lactose intolerant. Cow milk is meant for a calf, not a person. Try switching to almond, cashew, or coconut milk. I guarantee you will feel a difference. But I'd still get checked for food allergies. I got diagnosed with celiac in 01. Started not feeling well a few years ago, went to a food allergy specialist who tested me for all food allergies. Not only am I allergic to wheat (gluten), Im also allergic to squash, bananas, and worst of all RICE. Rice and bananas I was eating on a daily basis.
So get that checked out. Our bodies change every few years, so things you were allergic to 5 years ago you may not be now and vice versa

[j201215]

That has occurred to me.  The fact that milk products (butter and cheese) seem to exacerbate the problem makes me wonder if i have developed some sort of an intolerance.  

Your point about feeling much worse were it cancer has been said by several people.  I am not weak, in fact throughout this I have continued a daily strenuous workout - usually 5 days out of 7 days.  

Acute pancreatitis tends to have a fever associated, which I don't have.  What scares me is the lipase level which is 2X normal according to the test performed by Quest.  Were that not the case, I would assume it was only a standard GB issue.  Someone told me that a 155 lipase is not terribly high and may be the result of the GB as opposed to an actual problem within the pancreas.  

[cnoevl21]

You'd probably feel way worse if it was cancer. Since it comes and goes maybe its acute pancreatitis. It could also be a food allergy. Have you gone to an allergy specialist yet? I would suggest that. If you are fine when you are on the bland diet, it leads me to believe you may in fact have an allergy to something you are eating when off the bland diet.