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6 months of pain and weight loss = no diagnosis


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Old 04-01-2016, 09:01 AM   #1
workathomedad
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6 months of pain and weight loss = no diagnosis

I apologize for the long first-time post. I'm hoping someone can help me.

I'm 46-year-old man who has never smoked, never drinks, generally healthy and thin my whole life. Last summer I weighed around 175 (I'm 5' 10.5" tall). In August, I had a strange symptom where my skin on my right side under my arm and around the front and back became sore like a sunburn, even though there was no rash or redness. I went to my GP, who put me on a course of Prednisone, which seemed to fix it. A few weeks later, in September, I called to complain to the GP that I was very constipated (like 5 days since a BM) and food I ate kept coming up (like regurgitation) and I had heartburn. He told me to take Miralax and Prilosec OTC (20mg/day) and referred me to a Gastro specialist.

The gastro did full blood tests (all good), an upper endoscopy, which came back clean. However, he upped my Prilosec to 40mg/day. He also did a gastric empty study which came back negative. By this time it is November and I've lost 15 pounds and while I had no heartburn at all, food continued to come back up, usually 2-4 hours after eating and it was undigested. Around this time I started to have nausea and actual real vomiting that took place daily, along with pain in my RUQ which wrapped around to my back. The increase in Prilosec didn't help so I went back to my GP and he took one look at me and said it was my Gallbladder. Ultrasound showed no stones but I failed the HIDA test at 17% for gallbladder function. So they removed it and promised I would feel like a new man in a week. That was in January, and now it is April and there has been no improvement at all.

Since then I've had a Colonoscopy (came back clean), and CT Scan (clean). I'm still on the 40mg of Prilosec and my gastro admits he is out of ideas. I'm down to under 150 pounds, so nearing 15% loss of my body weight. I still have RUQ pain and food readily comes back up.

I have an appetite, and an intense desire to gain the weight back, but am punished if I eat anything more than rice and applesauce and cream of wheat. The nausea is nearly always present now. I try not to be a hypochondriac, but I'm starting to worry they've missed something. I've never had jaundice or floating stools, so I'm probably a fool for worrying about pancreatic cancer, but my gastro has suggested exploratory surgery to look for anything that might be causing a problem. (He mentioned adhesions from the gallbladder surgery, not tumors).

I'll take any advice of any kind (feel free to be blunt). My doctors are out of ideas so I'm desperate.

Thanks,

Mike

 
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Old 04-01-2016, 10:03 AM   #2
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Re: 6 months of pain and weight loss = no diagnosis

Mike,

You said you were thin your whole life but according to your weight and height, your BMI was 24.8 which is far from thin. 25 to 29.9 is overweight. Were you a body builder back in August of last year? If so, maybe the extra weight was muscle?

If you were trying to build muscle or trying to lose some weight, it's possible that you might have taken some supplement/formula that caused your skin to become sore. If you did start taking something different, it might have triggered an allergy.

Try to think back to what you were doing in August that might have triggered such an unusual reaction. Perhaps it was a change in your diet or a different supplement.

Did your blood test check for vitamin deficiency or excess?

Last edited by JohnR41; 04-02-2016 at 12:25 PM.

 
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Old 04-01-2016, 10:11 AM   #3
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Re: 6 months of pain and weight loss = no diagnosis

Ok, you got me - I wasn't thin. And no, not a body builder but decently muscular (I did some bench pressing) Yes, at 175, I did have a bit of a middle-aged spare tire. I was always happier at 165-170 lbs, so I was indeed a little overweight. I just don't know how I went from the constant struggle to lose those 5-10 pounds to now fighting for every pound.

I will try to look back in my memory, but no, I can say for sure I don't take supplements and never had, except for a standard multivitamin. I don't know if that sunburn feeling had anything to do with the rest of my symptoms or not, I just mentioned it because it is roughly in the same area as my gastric pain.

I will try to find out about my blood tests. They said they tested for everything but to be honest I never checked.

Thank you for your thoughts!

Mike

 
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Old 04-02-2016, 01:29 PM   #4
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Re: 6 months of pain and weight loss = no diagnosis

Unexplained chronic-nausea could be the result of electrical dysrhythmias (not to be confused with cardiac dysrhythmia). This is a neuromusclular disorder of the stomach.


Another cause could be gastroparesis. Have your doctors ruled out these possibilities?

Last edited by JohnR41; 04-02-2016 at 01:49 PM.

 
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Old 04-02-2016, 01:53 PM   #5
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Re: 6 months of pain and weight loss = no diagnosis

Thank you for your additional thoughts. I did have a gastric emptying study performed early on, like 5 months ago. They never mentioned gastroparesis, but that is what I found when I googled the test. The description of gastroparesis sounds EXACTLY like my problem, as food just sits in my stomach. However my test came back negative. I have considered asking for another attempt at that test since my problems are worse now.

I have never heard of electrical dysrhythmia. Is that a heart condition? That has never been mentioned or tested. I will say my BP is commonly low (100/60) and my fitbit commonly reports a resting heart rate of around 54. I just assumed that was normal for my current low weight.

Thank you again. I'm currently waiting on my lab results from NY doctor so I can check for what they have tested.

 
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Old 04-04-2016, 01:46 PM   #6
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Re: 6 months of pain and weight loss = no diagnosis

Perhaps I should have said "gastric dysrhythmia". To diagnose this problem they would need to run an electrogastrogram (EGG). Doctor Kenneth Koch M.D., chief of gastroenterology at Wake Forest Baptist Medical Center developed this non-invasive test. It sounds like a fairly recent development so I don't know whether other doctors have this device yet. Or maybe they have other ways to test for this problem.

It's not a heart condition. Evidently, electrical impulses come from somewhere, perhaps the brain, and send signals to the stomach's muscular pump. And it seems this system has its own built in pacemaker which can be too fast or too slow. So the EGG device records the electrical impulses to see how it's working.

Maybe your "pacemaker" has been gradually slowing down over a period of several months. As you mentioned, getting retested for gastric empting might be a good idea.

Last edited by JohnR41; 04-04-2016 at 02:05 PM.

 
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Old 04-04-2016, 06:19 PM   #7
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Re: 6 months of pain and weight loss = no diagnosis

Thanks for the excellent explanation. It sounds like gastric dysrhythmia may be another possible cause for a slow emptying stomach. I have had several people suggest I go to a big facility like Cleveland Clinic and let them try to figure it out. Maybe I can inquire about the EGG test before I go that route (if I do).

A friend who is a pharmacist (and professor) has suggested that the 40mg of Prilosec I have been taking could be causing my slow emptying stomach. He doesn't understand why they didn't have me drop or lower it after my gallbladder surgery in February. So I'm considering tapering down that.

 
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Old 04-06-2016, 12:48 PM   #8
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Re: 6 months of pain and weight loss = no diagnosis

Quote:
Originally Posted by workathomedad View Post

A friend who is a pharmacist (and professor) has suggested that the 40mg of Prilosec I have been taking could be causing my slow emptying stomach. He doesn't understand why they didn't have me drop or lower it after my gallbladder surgery in February. So I'm considering tapering down that.
In my first post (on this thread) I spoke only about what might be causing you to have sore skin. I thought it might be an allergy and I was reluctant to go any further because I figured some of your other symptoms could be the result of medication side-effects. But I didn't mention my doubts because I figured your doctors would have known if the other symptoms were medication related.

I'm glad your pharmacist friend brought up this possibility. I hope cutting back on Prilosec proves to be helpful.

BTW, the reason I got the idea of an allergy is because I'm somewhat allergic to eating spinach. If I eat too much cooked spinach, the following day I get extremely itchy on one side of my face. But there's never any rash or redness.

Last edited by JohnR41; 04-06-2016 at 12:51 PM.

 
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