Dear Dr. Pho,
I am a 35 year old male living in the UK. I am normally of good health but very slim (always have been) and have not had any operations etc.
I spend a lot of time sitting infront of the computer and I know my posture is not good. I should also get a lot more exercise.
I will try to describe my symptoms as best I can.
SYMPTOMS:
2 years ago
I started to get air coming up the oesophagus and bouts of nausea that did not last long. The aerophagia seemed to start suddenly overnight and was quite strange for me as I never had it before. It is more voluntary than involuntary - I can bring up air any time I like. The nausea lasted possibly 3-4 hours and then left and seemed to come in cycles of about 3 months.
TESTS:
1 1/2 years ago
I went to see my local doctor and he described the air coming up as aerophagia and possibly I was just swallowing air. I am quite a nervous and stressed person and he put most of it down to my psychology I think. I saw him a few times and I said I would feel better if I had an endoscopy which he agreed to and it was normal.
ENDOSCOPY= Normal
I also had a blood examination and I had very elevated bilirubin levels. Doctor could not see anything else in the blood to be a concern so he diagnosed Gilbert's for that.
BLOOD = High Bilirubin levels
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Fast forward to today:
SYMPTOMS:
1. Aerophagia is still there.
2. Nausea - I now seem to have chronic nausea.. Possibly a few months ago it has gotten much worse and now I seem to have it most days. It seems to be better after I have had something to eat and worse on an empty stomach. It is interferring with my apetite which is normally fine.
3. Upper back pain - Six months ago I had pain in my upper back - middle of the spine area; opposite and slightly above the sternum. The pain then disappeared until recently. Now the pain is worse - it also radiates to the front of the chest too and also to the upper right and sometimes upper left quadrant of the shoulder at the back. Usually the pain is in the back area. I can also feel this same discomfort (which is not bad) at my back when I drink fluids and also when I bring up air in the oesophagus. Sleeping is sometimes affected by it. However the pain is never bad. It seems if I lie on my left side this will help. It does not seem to be affected if I take breaths in or out etc. Normally I sleep like a baby - no problems whatsoever except the last few nights.
4. Skin colour - I have noticed that my skin colour is more tanned than usual - I would not describe it as yellow but a bronzing of the skin in my face - which is quite nice actually :-) I am normally fairly pale. I have not been exposed to the sun lately.
5. Bowels seem ok - constipated some days; sometimes I have bouts of wind and also short anal pain which does not happen at all often. Also I sometimes get a little leakage after urination. I have not noticed any blood.
6. Feel hot sometimes (mornings?) but I generally have a high metabolic rate and higher temperature (always had this)..
7. Recently I have noticed a few dizzy spells, a little faint feeling. Seems to be better when i have a bowel movement.
TESTS:
I went back to the doctor and told him all of the above. I went for the following tests:
1. BLOOD (had haematology, biochemistry, endocrinology screening): All normal except for the following which were flagged:
Bilirubin (high): 78 umol/L (normal = 0 - 20)
Iron (high): 38.0 umol/L (normal = 10.6 - 28.3)
Iron saturation (high): 60% (normal = 20 - 55)
Lymphocytes (low): 1.33 X10^9/L (normal = 1.5 - 4.0)
The high iron could be due to Chinese herbal medicine I was taking 5 days before and doc says to wait until out of my system and then retest blood iron levels to see if they have come down.
The following were all normal:
HAEMOGLOBIN, HCT, RED CELL COUNT, MCV, MCH, MCHC, RDW, PLATELET COUNT, MPV, Neutrophils, Monocytes, Eosinophils, Basophils,
ESR
SODIUM, POTASSIUM, CHLORIDE, BICARBONATE, UREA, CREATININE, ALKALINE PHOSPHATASE, ASPARTATE TRANSFERASE, ALANINE TRANSFERASE, LDH, CK, GAMMA GT
TOTAL PROTEIN, ALBUMIN, GLOBULIN, CALCIUM, PHOSPHATE, URIC ACID, RANDOM BLOOD GLUCOSE (FL), AMYLASE, TRIGLYCERIDES (low), CHOLESTEROL (low)
T.I.B.C., C'Reactive protein
TOTAL THYROXINE
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2. URINE dipstick = Normal except trace of blood (due to running 2 days before?)
3. CHEST X-RAY = Normal
4. TESTICULAR ULTRASOUND = Normal
5. HEART ECG = Normal except late RV depolarisation
6. ABDOMEN ULTRASOUND = Normal
The liver is of normal homogeneous reflectivity. There is no focal intrahepatic lesions and no evidence of duct dilatation. The gall bladder is normal and does not contain any calculi. Gall bladder wall thickness is normal and there is pericholecystic fluid. Both kidneys are of normal size with no evidence of PC system dilatation. No renal masses were demonstrated. The pancreas and spleen are normal. There is no evidence of intra-peritoneal fluid. The abdominal aorta has a normal calibre.
The doctor just seems to think it is all pyschological or stress/posture at computer related. What other tests should I have as I am quite worried and it is on my mind. Being nauseous all the time is not nice. I will be coming to the USA in about a month and think I will continue my testing there as I feel more comfortable with doctors in US (I did my education in USA) Please can you help? Sorry for the long report! :-) Thanks for all your help and time.