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Gastroenterology (Expert Forum)
Referred pain to left shoulder after eating. Has cancer w/ mets.
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Referred pain to left shoulder after eating. Has cancer w/ mets.
by BarTay, Apr 12, 2005 12:00AM
I hope you might be able to give us some suggestions in addition to my husband's oncologist and GI specialist.
A brief synopsis:
My 54 year old husband was dx’d w/ Islet Cell cancer of the pancreas in 2000 w/ no lymph node involvement, had 2/3 pancreatic resection and did well for almost 3 years other than developing diabetes which is well controlled. He has been seen regularly by his oncologist with CT scans and blood work every three months.
In 2003 he had surgery again and then 6 months of chemo after metastasis to area around the aorta was found. He refused radiation after that. Within 6 months, there was mets to liver, increase in mass in remaining pancreas with bile duct obstruction and has had bile duct stent placement and replacement 4 times in the past year. His last CT showed mesenteric vein clot and is now on Coumadin. Yes, all of this is pretty sad and now he is on Duragesic pain patch and other meds for breakthrough pain.
Over the past four days he has had severe sharp pain in his left shoulder area that "travels" from his abdominal area, but no pain in the abdomen. This occurs immediately after eating most things. Last night he ate popcorn w/o any pain. He has had this same sort of pain in the past with out any etiology ever being determined. He has a portacath in that left shoulder area as well that is functioning well and had never been a problem since inserted in 2003. He has lost 40 punds in the past year.
Yesterday his stool was “yellow” diarrhea and described as “oily”. I will be calling his GI doc today since I believe this might be related to his hx of bile duct obstruction. A reinforcement stent (a smaller stent plced inside the permanent stent) was placed last in March. His GB has been OK. He now does have some lymph enlargement in his abdomen and I certainly suspect mets there as well. He is on Ursodiol and Aciphex. Hyoscyamine sometimes helps relieve the severe left shoulder pain.
My questions:
1. What is the most likely origin of this pain after eating? He has it w/ eating fruit alone as well so I don’t think it is totally about fat intake.
2. Do you have any suggestions about anything that might make him more comfortable?
3. I am interested in online support groups for the caregiver and would appreciate any suggestions.
Thank you in advance. I have read through the archives here and see where you provide helpful information. Although I realize our situation is grave, I would like to do everything possible to prevent my husband’s pain.
BT
A brief synopsis:
My 54 year old husband was dx’d w/ Islet Cell cancer of the pancreas in 2000 w/ no lymph node involvement, had 2/3 pancreatic resection and did well for almost 3 years other than developing diabetes which is well controlled. He has been seen regularly by his oncologist with CT scans and blood work every three months.
In 2003 he had surgery again and then 6 months of chemo after metastasis to area around the aorta was found. He refused radiation after that. Within 6 months, there was mets to liver, increase in mass in remaining pancreas with bile duct obstruction and has had bile duct stent placement and replacement 4 times in the past year. His last CT showed mesenteric vein clot and is now on Coumadin. Yes, all of this is pretty sad and now he is on Duragesic pain patch and other meds for breakthrough pain.
Over the past four days he has had severe sharp pain in his left shoulder area that "travels" from his abdominal area, but no pain in the abdomen. This occurs immediately after eating most things. Last night he ate popcorn w/o any pain. He has had this same sort of pain in the past with out any etiology ever being determined. He has a portacath in that left shoulder area as well that is functioning well and had never been a problem since inserted in 2003. He has lost 40 punds in the past year.
Yesterday his stool was “yellow” diarrhea and described as “oily”. I will be calling his GI doc today since I believe this might be related to his hx of bile duct obstruction. A reinforcement stent (a smaller stent plced inside the permanent stent) was placed last in March. His GB has been OK. He now does have some lymph enlargement in his abdomen and I certainly suspect mets there as well. He is on Ursodiol and Aciphex. Hyoscyamine sometimes helps relieve the severe left shoulder pain.
My questions:
1. What is the most likely origin of this pain after eating? He has it w/ eating fruit alone as well so I don’t think it is totally about fat intake.
2. Do you have any suggestions about anything that might make him more comfortable?
3. I am interested in online support groups for the caregiver and would appreciate any suggestions.
Thank you in advance. I have read through the archives here and see where you provide helpful information. Although I realize our situation is grave, I would like to do everything possible to prevent my husband’s pain.
BT
Doctor's Answer
by Kevin Pho, MD, Apr 13, 2005 12:00AM
, Apr 13, 2005 12:00AM
To answer your questions:
1) Possible causes can include gallbladder disease, including the bile duct obstruction, as well as various causes of dyspepsia - GERD, an ulcer, or inflammation of the upper digestive tract. Of course, the pancreas can lead to pain in that area as well.
2) Finding the cause of the pain will help. If all the GI diseases have been ruled out with the appropriate studies, efforts can then be focused on pain relief - including adjusting the dose of the duragesic patch.
3) I cannot quote specific online support groups, but there may be others that can comment here that may be able to help.
I would discuss these diagnostic options with your personal physician.
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.
Kevin, M.D.
kevinmd_b
1) Possible causes can include gallbladder disease, including the bile duct obstruction, as well as various causes of dyspepsia - GERD, an ulcer, or inflammation of the upper digestive tract. Of course, the pancreas can lead to pain in that area as well.
2) Finding the cause of the pain will help. If all the GI diseases have been ruled out with the appropriate studies, efforts can then be focused on pain relief - including adjusting the dose of the duragesic patch.
3) I cannot quote specific online support groups, but there may be others that can comment here that may be able to help.
I would discuss these diagnostic options with your personal physician.
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.
Kevin, M.D.
kevinmd_b
Member Comments (1)
by BarTay, Apr 13, 2005 12:00AM
Thanks for all the information. Greatly appreciated. Today the GI doc started Reglan before meals. We are hoping that might help. He was concerned about gastric emptying problems.
