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Old 10-28-2012, 02:12 AM   #1
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Undiagnosed - what would you do?

A bit of back history. Iíve suffered from night time reflux for a couple of years, which I controlled with regular antacids at bedtime only and infrequently a short course of PPIís. Three months ago I took another short course of PPIís, after which I seemed to experience a serious rebound effect. An endoscopy was clear, and the condition is now under control with Ranitidine, and Iíve been reducing from 300mg daily to now 150mg. Feeling much better, but for five weeks now my stools have been much lighter than normal, yellow or sand coloured.

Worried about the stools (which I had mentioned on two occasions to two different docs) I saw the doc last week again and am now having full liver function blood test tomorrow and sheís ordered an ultrasound scan, but because Iím going abroad for a month next weekend, the scan will take place in five weeks time. I said Iíd pay to get it done before we go, (we live in the UK with NHS), but she said that really wasnít necessary as I wasnít jaundiced. She seemed very relaxed about it.

She asked whether Iíd had any upper right quadrant pain. From time to time, and over a long period of time,(maybe five or six years,) without really registering it, Iíve had the occasional mild discomfort behind my ribs, right upper quadrant. Itís usually been a short spell, maybe a couple of hours or so every few months, sometimes longer. During the last month or so, the discomfort has become more frequent, maybe once every 7/10 days, but very brief Ė maybe a couple of hours, and over the last few days, every day. Itís not like a pain, more like a trapped muscle, crampy feeling, which is worse when I sit slouched over my computer, as I frequently do. She examined me, pressed, and I thought I detected some discomfort. So she asked me to breathe in as she pressed on my right side and there was undoubted pain.

Iím worrying about being taken seriously ill whilst on holiday in Europe now, and although we have insurance Iím not keen on dealing with an emergency in a foreign language.

So I have a few questions:

(a) would a liver function test show a gall bladder problem?
(b) If it is a gall bladder issue, and this is the first time the discomfort has been persistent, (over the last three days) how serious is that? Might I easily go another five weeks without the situation becoming significantly worse. Iíve read on this forum of people suffering more serious pain than me for long periods, even having acute attacks of pain that last several hours. Thereís no way I could describe this pain as serious, itís just naggy and worrying. I should also add that it doesnít get significantly worse after eating, nor do I feel nauseous or vomit.
(c) Could regular use of antacids Ė I use the ones with calcium carbonate, magnesium carbonate and alginic acids Ė be the cause of any gallstones. Iíve seldom taken more than 2 tablets a day, but I have taken them fairly regularly because even if Iíve been feeling OK at bedtime, Iíve frequently woken up with acid reflux during the early hours.
(d) During what Iíve called the Ďreboundí period, Iíve lost about 7-8 kg, most of it over a four week period when it was at its worst. This weight loss has now stabilised over the last three weeks. Could a rapid weight loss have caused gallstones?
(e) What would others do about the holiday under these circumstances? I need to make a decision in the next few days, and hopefully having the results of the blood tests mid week will help me one way or another, but Iíd appreciate othersí views.

I should say that I feel perfectly fine otherwise, bags of energy, good appetite even though Iím not eating much, no sign of any jaundice and I look the picture of health.

 
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Old 10-28-2012, 10:18 AM   #2
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Re: Undiagnosed - what would you do?

Hi Minx65. I'm not a doctor, but I do have A couple of thoughts on your post...

Gallbladder issues tend to be episodic, and come and go as stones briefly obstruct bile flow. Large stones can cause a "gallbladder attack", and you'd know it if you'd had one of these. Small stones can cause passing milder symptoms, and generally gum up the works a bit causing symptoms that sound a lot like yours.

Any obstruction of bile flow should show up in blood labs as high bilirubin and/or alkaline phosphatase, BUT due to the episodic nature of the problem, it's possible to have gallstones and normal labs if blood is drawn in between episodes of bile obstruction.

The recent rapid weight loss you describe can aggravate gallbladder issues, BUT can also cause or aggravate fatty liver, which is also consistent with the symptoms you describe. Your positive Murphy's sign (pain on inspiration while doc pressed on liver) is typical of gallbladder problems, but your lack of history of a real gallbladder attack casts doubt into the mix. It may just be fatty liver.

The activity and exercise of a holiday can be good for fatty livers, and your lack of history of acute gallbladder attack reduces the likelihood of one occurring during the next month. In the unfortunate event of having an initial acute attack while on holiday, you might consider most acute attacks pass in a day or two and do not require immediate surgery though there is certainly a possibility this could happen.

If I was facing this situation, I would research home remedies for gallbladder attacks (most involve lemon and/or grapefruit juice, or a tea made from boiling grapefruit rind), and head off on my holiday armed with a plan of action if I ran into trouble. Odds are, you'll have nothing other than a good time, with a possible continuation of your mild symptoms.

If you get some very scary results from your labs, this might be cause for concern, but I'd be surprised if your labs were far out of whack without more substantial symptoms going on.

Regarding the antacids actually causing gallstones, I'm not too knowledgeable on this, but I would think the calcium carbonate would be more likely to cause problems than the mag carbonate. Many gallstones are actually comprised substantially of calcium carbonate! If the mag carbonate works just as well, I'd prefer this over the calcium carb.

Probably good to stay away from the PPI's if you don't really need them. Many people don't realize stomach acid is the bodies first line of defense against food borne illness (food poisoning!), and shutting down stomach acid completely with PPI's greatly increases ones risk for nasty encounters with food borne gastroenteritis.

Enjoy your holiday, but be prepared! Best of Luck to you getting to the bottom of this once you get home.

Last edited by BillinSD; 10-28-2012 at 10:25 AM. Reason: typo

 
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Old 10-28-2012, 10:36 AM   #3
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Re: Undiagnosed - what would you do?

Hi BillinSD, thanks very much for that very concise evaluation - I found that very reassuring. Re the lemon/grapefruit suggestion, oddly enough I've had several cups of hot water with lemon juice today, and the discomfort (I hesitate to call it pain) has been much better. Hopefully I'll have a clearer idea when the initial blood tests come back later this week, but for the moment I'll keep on packing my suitcase then.

 
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Old 10-28-2012, 10:42 AM   #4
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Re: Undiagnosed - what would you do?

Quote:
Originally Posted by Minx65 View Post
Hi BillinSD, thanks very much for that very concise evaluation - I found that very reassuring. Re the lemon/grapefruit suggestion, oddly enough I've had several cups of hot water with lemon juice today, and the discomfort (I hesitate to call it pain) has been much better. Hopefully I'll have a clearer idea when the initial blood tests come back later this week, but for the moment I'll keep on packing my suitcase then.
I have had similar URQ pains all my life, and I'm 48. My ultrasounds always show a clear gallbladder. But my bilirubin is high normal. 1.2 or 1.3
Fatty foods make it worse.
Could be sludge or just a sluggish GB too.
I founds interestingly that Prilosec and those type meds help. I recently had an upper endoscopy which was normal other then a little GERD.

You will find by researching this that URQ pain is VERY VERY common and most people never really can get to the bottom of it.

 
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Old 10-28-2012, 11:46 AM   #5
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Re: Undiagnosed - what would you do?

Thanks for that Hypochondriacyy. (Good name, I like that ) Interesting that PPI's help your URQ pain. I think that's still not enough to tempt me back on them though, as the rebound I had this last time turned into a 24/7 full blown GERD for three months instead of being just a night time issue. But everyone's different, I know a guy who pops Nexium whenever he gets bad, and he doesn't seem to suffer any kind of withdrawal in the in between periods.

Your input has further reassured me, many thanks.

 
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Old 11-08-2012, 07:27 AM   #6
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Re: Undiagnosed - what would you do?

Quote:
Originally Posted by Minx65 View Post
Thanks for that Hypochondriacyy. (Good name, I like that ) Interesting that PPI's help your URQ pain. I think that's still not enough to tempt me back on them though, as the rebound I had this last time turned into a 24/7 full blown GERD for three months instead of being just a night time issue. But everyone's different, I know a guy who pops Nexium whenever he gets bad, and he doesn't seem to suffer any kind of withdrawal in the in between periods.

Your input has further reassured me, many thanks.
Hello I am a newbie here.. i have similar symptoms. pain in the right side of my abdomen, below the rib cage..i am little worried of possible liver and pancreatic disorder, apart from pain i do not have other symptoms,like nausea and vomiting.. no pain after eating.. i could not sleep at night due to worries... but reading this post help me calm down a little....am going to have a full abdominal ultrasound tomorrow praying and praying the it' nothing serious....

 
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Old 11-08-2012, 07:31 AM   #7
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Re: Undiagnosed - what would you do?

Hope all goes well tomorrow. Do let us know what transpires.

 
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Old 11-08-2012, 08:00 AM   #8
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Re: Undiagnosed - what would you do?

Quote:
Originally Posted by Minx65 View Post
Hope all goes well tomorrow. Do let us know what transpires.
Hi,, may i ask what type of pain are u having? i call mine is a real disturbing pain but bearable . it comes when am lying down specially at night.do U have a mid back pain?I have that but it feels like 2 different issues going on... the pain in my side gets milder (almost not there) when i get up and walk around the house..its intermittent . I tried pressing the area if i could feel any pain.. no pain at all.. it just come and go randomly ..no weakness .nausea. among others....bowel movement is fine..thank U for reading i wish U well and have a happy holiday...

 
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Old 11-08-2012, 08:16 AM   #9
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Re: Undiagnosed - what would you do?

I would call it a nagging discomfort, nothing I'd take a painkiller for. I'm better moving about, but its not so much of a problem lying down. Sometimes I think I feel it lower down, towards my waist, and occasionally in my back, but I think it's all part of the same thing, and a lot of tied up with general anxiety. I certainy don't feel anything when I press on it, only when the doctor pressed as I inhaled. It's not too bad at the moment, so I'm able to enjoy my holiday. Will be relieved to get back though and get the scan out of the way. Good luck for tomorrow.

 
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Old 06-10-2013, 12:03 PM   #10
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Re: Undiagnosed - what would you do?

This is what is referred to as health anxiety. The URQ pain is actually sore abdominal muscles.. Most anxiety sufferer's have a location on their body that is the focus of most of the stress they endure.. stop going to the doctor..

 
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Old 06-10-2013, 12:08 PM   #11
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Re: Undiagnosed - what would you do?

Quote:
Originally Posted by Hypochondriacyy View Post
I have had similar URQ pains all my life, and I'm 48. My ultrasounds always show a clear gallbladder. But my bilirubin is high normal. 1.2 or 1.3
Fatty foods make it worse.
Could be sludge or just a sluggish GB too.
I founds interestingly that Prilosec and those type meds help. I recently had an upper endoscopy which was normal other then a little GERD.

You will find by researching this that URQ pain is VERY VERY common and most people never really can get to the bottom of it.

This is what is referred to as health anxiety. The URQ pain is actually sore abdominal muscles.. Most anxiety sufferer's have a location on their body that is the focus of most of the stress they endure.. stop going to the doctor..

 
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