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jbmd
jbmd, Board Certified Physician
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Experience:  Board Certified physician in Internal Medicine - 30+ years experience
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For JBMD, please. Can I ask you about stomach/abdominal

Customer Question

For JBMD, please.

Can I ask you about stomach/abdominal issues?
Submitted: 4 years ago.
Category: Medical
Expert:  jbmd replied 4 years ago.

jbmd :

Sure--How are things going back home?

JACUSTOMER-esroey8x- :

Not too bad, thanks. Hope you are well too.

jbmd :

what's up with your abdomen?

JACUSTOMER-esroey8x- :

I know you are probably going to tell me my symptoms are due to anxiety, and I know you are probably right. But here goes anyway...

jbmd :

Yes. Fine.

JACUSTOMER-esroey8x- :

I have a pain to the right of my navel.

JACUSTOMER-esroey8x- :

I have had it before.

JACUSTOMER-esroey8x- :

Sometimes it seems to be higher up, just under my rib cage. So then I worry about my liver.

JACUSTOMER-esroey8x- :

But other times it is at navel level.

jbmd :

Liver pain doesn't usually come and go. You've had your gall bladder checked, right?

JACUSTOMER-esroey8x- :

I last had it bad about 3 years ago. It gets worse in pregnancy and seems to get higher up in pregnancy as if an organ is being pushed upwards by the baby.

jbmd :

However, at navel level and/or right upper quadrant, it may be gas trapped in loops of bowel.

JACUSTOMER-esroey8x- :

When it last flared up badly 3 years ago, I had an ultrasound of my abdomen and everything looked normal.

jbmd :

Is it relieved by anything? Like a bowel movement? Burping?

JACUSTOMER-esroey8x- :

Gallbladder was checked on u/s.,

JACUSTOMER-esroey8x- :

No.

JACUSTOMER-esroey8x- :

It sticks around for a long time.

jbmd :

IBS can surely do that.

jbmd :

from stress.

jbmd :

good your gb was ultrasounded.

JACUSTOMER-esroey8x- :

I also had an endoscopy 3 years ago. They found mild inflammation in the duodenum which is about where I get the pain by the navel. The doc said it would come and go with anxiety, which I have certainly had a lot of lately.

JACUSTOMER-esroey8x- :

It is very tender from the outside. Even holding something against it feels tender.

jbmd :

Hmmm. Does anti-acid medication help.

JACUSTOMER-esroey8x- :

And I can also feel gas bubbles if I press near it.

JACUSTOMER-esroey8x- :

Haven't tried.

jbmd :

I know you're not drinking as you are still nursing.

JACUSTOMER-esroey8x- :

I do drink wine, usually when I am anxious.

jbmd :

Try some anti-acid medication like ranitidine if you wish. You're not pregnant again yet?

JACUSTOMER-esroey8x- :

But not when I am nursing.

JACUSTOMER-esroey8x- :

No, not yet.

jbmd :

Well, instead of pills, since you're nursing, how about Mylanta type stuff? How often do you go to the bathroom?

JACUSTOMER-esroey8x- :

What is Mylanta?

JACUSTOMER-esroey8x- :

I usually go every day, sometimes multiple times if I am anxious.

JACUSTOMER-esroey8x- :

But when I calm down, the bowel movements are more normal.

JACUSTOMER-esroey8x- :

Oh, that's the other thing. My bowel movements float and sometimes have little bubbles coming from them in the bowl. Is this a sign of malabsorption? Celiacs???

JACUSTOMER-esroey8x- :

Chrohn's?

JACUSTOMER-esroey8x- :

Other scary diseases I shouldn't have been Googling?

jbmd :

Mylanta/Maalox: the old fashioned liquid anti-acids sold otc. Can be magnesium based (so not for those with frequent bowel movements) or aluminum-based (so not for those with constipation)

jbmd :

Crohn's is known as regional ileitis (the terminal small bowel) but can be found elsewhere and is a biopsy diagnosis.

jbmd :

Little bubbles is usually swallowed air MOST OFTEN from swallowing a lot of air with anxious breathing.

jbmd :

Celiac: wouldn't come and go so much if you eat bread and cereals with wheat.

JACUSTOMER-esroey8x- :

Same with Crohn's?

JACUSTOMER-esroey8x- :

Does the fact that it went away for a long time make those diseases less likely?

jbmd :

But it might help you try to stop eating wheat. There's some evidence (perhaps not totally convincing) that the genetically enhanced wheat of today causes problems.

JACUSTOMER-esroey8x- :

I worry that I have left something festering and getting worse all this time.

jbmd :

Celiac, true celiac, shouldn't come and go. Crohn's can but it usually has diarrhea often with blood and can occur at the anus as well as the terminal ileum (where the appendix is, so it's usually right LOWER abdomen pain)

JACUSTOMER-esroey8x- :

How about the floating stools?

jbmd :

What you have sounds like IBS from stress (SURPRISE!) but I would still try a wheat-free diet for a while and see if better. Did they biopsy your inflamed duodenum back then?

jbmd :

Floating stools can be from fat (often leave a grease ring in the toilet) OR

jbmd :

from frequent stools with lots of swallowed air.

JACUSTOMER-esroey8x- :

Yes, they did biopsies.

jbmd :

(I missed you but that gave my hands time to rest)

jbmd :

And the biopsies didn't come back Crohn's or celiac?

JACUSTOMER-esroey8x- :

Yeah, sorry to be back again. I bet you were at a loss without all my questions... ;-)

JACUSTOMER-esroey8x- :

No, but the doctor said they wouldn't necessarily show celiac. I didn't ask about Crohn's. As usual this conversation happened not in English so it was all a bit hazy.

JACUSTOMER-esroey8x- :

But biopsies were definitely taken.

jbmd :

It's now believed by some that there is another form of wheat allergy, not celiac, with problems with wheat but not the dire consequences of celiac

jbmd :

The diagnosis of celiac is by blood tests and biopsy is the final test--but it can still be suspected. The ultimate thing is a gluten-free diet for about 4 months or more.

jbmd :

BUT BAD CELIAC is usually found with biopsies.

jbmd :

Damage to the lamina propia of the gut, causing malabsorption of vital nutrients

JACUSTOMER-esroey8x- :

So would you recommend a blood test (given I have Hashis, another autoimmune disease) or do you think the fact that it comes and goes means it's just the inflammation that was spotted on the endoscopy?

jbmd :

You had: normal pregnancy. Stress-free time without symptoms.

JACUSTOMER-esroey8x- :

I also have pain on my right side in my back and hip so I think maybe it's just tension from tensed muscles.

JACUSTOMER-esroey8x- :

No, it was worse in the latter half of the pregnancy, but higher up, in my ribs.

jbmd :

I would recommend you spending 4 months scrupulously avoiding wheat even in soy sauce etc. and exercising and doing neurofeedback/biofeedback

jbmd :

Abdominal pain in pregnancy is common. With IBS, more common

JACUSTOMER-esroey8x- :

Always in the same spot?

jbmd :

I recommend blocking you from the internet except this site to ask me questions

JACUSTOMER-esroey8x- :

I also came across mention of illeococal valve disorder which sounds a likely explanation.

JACUSTOMER-esroey8x- :

I am doing my best at avoiding the internet!

jbmd :

The common pain in the abdomen is either RUQ or RLQ or LUQ

JACUSTOMER-esroey8x- :

I have RLQ and RUQ.

jbmd :

Why? You just touched on the RLQ: gas trapped at the ileocecal valve.

jbmd :

People come in the ER with it all the time thinking they have appendicitis and while sitting around waiting for all the heart attacks and strokes and gunshot victims (this is America, after all) to stop wasting the doctors' time, the pain goes away and they feel better.

JACUSTOMER-esroey8x- :

That's the thing. Mine doesn't go away. It stays for weeks/months until I decide to stop fixating on it.

JACUSTOMER-esroey8x- :

Then it fades.

JACUSTOMER-esroey8x- :

I wake up every morning with a knot on the right side of my belly and a feeling like something is there that shouldn't be.

jbmd :

RUQ: the colon starts at the RLQ with the ileocecal valve, goes up the right side abdomen the goes across the top, with a gentle downward loop and then back up to the LUQ where it descends in the "descending colon" Air rises, so it gets trapped at the upper areas and doesn't easily go down.

jbmd :

" Mine doesn't go away. It stays for weeks/months until I decide to stop fixating on it." Ahhhh,

jbmd :

if only all diseases, like cancer, would go away once the victim stops fixating.

jbmd :

While I'd like you to try without gluten (wheat), I still think that your phobias and worry are bedeviling you.

JACUSTOMER-esroey8x- :

So you think it could just be IBS?

jbmd :

I think it is IBS but IBS gets worse for some people with simple carbs and maybe wheat allergies and certainly with worry.

jbmd :

Don't say "just IBS" as it is a painful and annoying condition and we doctors are not sure of the cause but biofeedback helps you unhook the symptoms

JACUSTOMER-esroey8x- :

And I shouldn't worry about my liver? My LFTs were normal 2.5 years ago and my liver normal on u/s 3 years ago when I was experiencing the same pain. Liver disease is another big fear of mine as my mum had bad hepatitis originally diagnosed as liver cancer.

jbmd :

Do you take probiotics like yogurt

JACUSTOMER-esroey8x- :

No, I don't at the moment. I have in the past. Diet is a bit erratic at the moment with all the moving around.

jbmd :

Did your mum have hepatitis C? Were you tested for B & C as part of the pregnancy panel?

JACUSTOMER-esroey8x- :

No, it was drug-induced due to long-term antibiotics for UTIs.

jbmd :

Good probiotics help with IBS and most other gut problems

JACUSTOMER-esroey8x- :

I will try probiotics again then.

jbmd :

Oh--well, that's something you can't inherit, right?

JACUSTOMER-esroey8x- :

It is. But I worry anyway as I have drunk more than my share of wine at times of anxiety.

jbmd :

Try probiotics, exercise, no wheat, gluten-free, and biofeedback

JACUSTOMER-esroey8x- :

Will do.

JACUSTOMER-esroey8x- :

I really will!

jbmd :

Wine does decrease the risk of breast cancer you know.

JACUSTOMER-esroey8x- :

I just love the way you look at things. ;-)

jbmd :

The entire country of France should have mal d' foie, right?

jbmd :

YOUR LIVER ENZYMES were normal. YOUR US was normal. Then you were pregnant and so weren't drinking.

JACUSTOMER-esroey8x- :

You are stretching my memory of high school French!

JACUSTOMER-esroey8x- :

But I learned something. (I can Google French words, right?? Just not illnesses.)

JACUSTOMER-esroey8x- :

Then you were pregnant and so weren't drinking.

JACUSTOMER-esroey8x- :

Correct, of course, but I don't see you point here?

jbmd :

"Sickness of the liver"--the usual excuse for non-performance when you don't want to say "I didn't do it because...puff, puff...I am FRONCH!"

JACUSTOMER-esroey8x- :

Does the fact that my u/s and LFTs were okay even during an episode of the pain mean my liver is okay

JACUSTOMER-esroey8x- :

?

jbmd :

The point was, two normal tests and then not drinking so where would the liver damage have come from?

jbmd :

Pretty much.

JACUSTOMER-esroey8x- :

From drinking wine subsequently.

JACUSTOMER-esroey8x- :

But perhaps it can't happen that fast.

jbmd :

The problem, my dear, is in your brain's little worry treadmill. Of course, you can have something wrong with you sooner or later but you yourself said the best thing ever: Something will happen sooner or later and then I'll regret having wasted my life in useless worry.

jbmd :

But after the tests you spent 9 months preggers and then have been nursing SO even if you had some liver problem, it would have healed/regenerated by now.

JACUSTOMER-esroey8x- :

I know you are right. But when there are real symptoms like this hard lump in my belly, I can't help automatically thinking tumour.

jbmd :

Hard lump that goes away?

jbmd :

A lump you can feel that later in the day is gone?

JACUSTOMER-esroey8x- :

Yes, I guess

JACUSTOMER-esroey8x- :

Moves around.

JACUSTOMER-esroey8x- :

But the pain/tenderness stays

jbmd :

Sounds like ball of gas. Or pooh moving through.

JACUSTOMER-esroey8x- :

A constant burning either by the navel or right rib.

JACUSTOMER-esroey8x- :

And my right lowest rib sort of pops if I breathe in deeply and then exhale.

jbmd :

Probable duodenitis (pre-ulcer) from stress.

JACUSTOMER-esroey8x- :

So antacids then?

jbmd :

Ribs popping are not from cancer--probably from being pushed out by pregnancy or trauma at some point.

jbmd :

Try: antacid, probiotics, no wheat/gluten, exercise, meditation, yoga, having fun (remember that?), bio-neurofeedback. If problem gets worse, get doctor to work up.

jbmd :

Sounds as if your docs were very tolerant at working you up.

JACUSTOMER-esroey8x- :

Okay, I will try what you suggested.

JACUSTOMER-esroey8x- :

Thank you.

jbmd :

If necessary, you can go through another scope, US, blood work, or get a good dose or radiation with a CT scan (but I wouldn't do this yet, pls.)

JACUSTOMER-esroey8x- :

I would rather not do any of that again.

jbmd :

Your stress drives you to worry about different parts of your body in rotation.

jbmd :

Remember your focus at first was your heart? You were sure the echo was going to be baaaad?

jbmd :

then lungs.

jbmd :

now abdomen

JACUSTOMER-esroey8x- :

I don't think any of those tests are beneficial if not indicated as they just feed the anxiety all the more. I just need a good doctor like you who I can meet in person and who can conduct a physical exam and then talk things over. Not someone who will refer me for a test at the drop of a hat.

jbmd :

liver.

jbmd :

Try what I suggested: the list above. get your worries under control

JACUSTOMER-esroey8x- :

Hey, you missed out on the gyno cancer and malignant melanoma before the heart thing. Count yourself lucky! ;-)

JACUSTOMER-esroey8x- :

I will.

JACUSTOMER-esroey8x- :

Now we are back and hopefully getting settled soon, the options for sorting this all out are right here.

jbmd :

I was listing but you typed in the meantime and, much fun as it can be, I hate to beat you up with your own whip

JACUSTOMER-esroey8x- :

I just feel that this abdominal/rib problem is my last stumbling block to relaxing a bit more about my health, which is why I wanted to get your opinion on it.

jbmd :

Look at your own worries with a humorous eye: Pin the list in your bedroom mirror.

JACUSTOMER-esroey8x- :

If I can relax about that, then I can move forward with the other steps. No other fears on the horizon, and I tend to run through the same things so I think I am pretty confident there.....

jbmd :

Annual/pre-pregnancy blood work can include liver enzymes so you will be reassured.

JACUSTOMER-esroey8x- :

Please don't quote that at me when I bug you in 3 weeks with CJD or some such nonsense.

jbmd :

Stay off: "what horrible illnesses are there left for me when everyone else has the good ones already, the greedy pigs" websites

JACUSTOMER-esroey8x- :

I certainly will.

jbmd :

As long as you are trying to make progress at getting over your worries, I will be as patient as a grain of mustard seed

JACUSTOMER-esroey8x- :

I think my husband might have to instal a parental lock on my computer so I can only visit websites for buying men's gifts.

jbmd :

Good idea!

JACUSTOMER-esroey8x- :

Thanks again for your patience and reassurance.

JACUSTOMER-esroey8x- :

You have no idea what a big difference it makes.

jbmd :

IBS = worry

jbmd :

Go get the kids back in touch with their native land. Go through the Chunnel to Euro-Disneyland

jbmd :

Just kidding

JACUSTOMER-esroey8x- :

But not with mal d'foie!

jbmd :

No foie

JACUSTOMER-esroey8x- :

Yeah, we did Eurodisney years ago before kids. I think Americans pull it off better.

jbmd :

We took the kids to Epcot and the grands took them to Disneyland. In Epcot I felt as if I'd been confined to a plastic purgatory.

JACUSTOMER-esroey8x- :

That doesn't sound much fun.

JACUSTOMER-esroey8x- :

I remember Epcot when I was about 8. I was just desperate to get back to the good stuff with Mickey Mouse and co.

jbmd :

But when we visited Corfe Castle in UK, our daughter went home and age 8 wrote a play, "The Siege and Destruction of Corfe Castle" with illustrations.

JACUSTOMER-esroey8x- :

Oh wow.

JACUSTOMER-esroey8x- :

Sounds like she was pretty inspired.

jbmd :

"Go around the world at Epcot, buying tourist trash and eating international junk food."

jbmd :

Yeah, so start reading them about UK history. They love the gory stuff: iron maidens, heads chopped off, etc.

JACUSTOMER-esroey8x- :

Great slogan.

JACUSTOMER-esroey8x- :

Eek, my kids are a bit sensitive for all that. They don't even like The Three Little Pigs!

JACUSTOMER-esroey8x- :

Might have to find an abridged version of UK history....would there be anything left without the head chopping, I wonder.

jbmd :

Our kids' favorite purchase at Arundel was a pamphlet on torture

jbmd :

Scared of the wolves?

jbmd :

"Siege and Destruction" included boiling oil

jbmd :

Now my daughter is very politically correct

JACUSTOMER-esroey8x- :

Haha.

JACUSTOMER-esroey8x- :

I hope you kept the play to show her.

JACUSTOMER-esroey8x- :

Or at least make sure to tell her about it.

jbmd :

Our punishment for allowing them to be free-thinkers. Yes, we have the play. She is bizarrely proud of it and shows it to people.

jbmd :

It's on lined paper, with drawings of swooning maidens and untrustworthy castle help

JACUSTOMER-esroey8x- :

Cool. Good for her.

jbmd :

and boiling oil raining down

JACUSTOMER-esroey8x- :

You should get it published. Give JK Rowling a run for her money.

jbmd :

If you want gentle, travel back in time to the Isle of Wight and dine at the New Inn at Shallfleet.

jbmd :

It's all of maybe 20 pages long

JACUSTOMER-esroey8x- :

Short but sweet.

JACUSTOMER-esroey8x- :

And you are very well-travelled!

jbmd :

Sweetened boiling oil?

JACUSTOMER-esroey8x- :

Why not?

jbmd :

Leftovers from making donuts

JACUSTOMER-esroey8x- :

Sounds like a good cure for abdominal tenderness.

jbmd :

and apple fritters.

JACUSTOMER-esroey8x- :

Would certainly take my mind of it anwyay

JACUSTOMER-esroey8x- :

Yum

jbmd :

Do you feel better now?

JACUSTOMER-esroey8x- :

Physically no, mentally a million times.

JACUSTOMER-esroey8x- :

Thank you.

jbmd :

You're welcome. Try the list.

JACUSTOMER-esroey8x- :

I will.

JACUSTOMER-esroey8x- :

Thanks so much for your time.

jbmd :

Go have fun in the fresh air now. If you have a sitter, walk with your husband, if your area is safe. share one donut. (they upset me--don't eat fried things much. But you're English. Chips and Plaice and All

jbmd :

Have a good evening!

JACUSTOMER-esroey8x- :

Thank you. And you have a good day,

jbmd and 2 other Medical Specialists are ready to help you
Customer: replied 3 years ago.

I am still panicking about my abdomen. :(


 

Expert:  jbmd replied 3 years ago.
Of course you are. But taking steps to fix the situation will make you feel more in control and will move things toward resolution.

Have you found a bio/neurofeedback place yet?

Customer: replied 3 years ago.

Not yet.


 


I have spotted something new. It's about an inch or two above my belly button. If I stand up from lying down or slouching, I notice a small lump sticking out. I put my fingers on it and it pulsates a few times and then sinks deeper into my abdomen. What the heck is it????

Expert:  jbmd replied 3 years ago.
If it pulsates with a regular beat, it's a blood vessel in your abdominal wall that might be sticking out because the muscles were stretched apart in pregnancy. If it's not regular, it might be a bit of bowel that might be sticking out because the muscles were stretched apart in pregnancy.

Does cancer pulsate? No.

On the other hand, don't re-watch "Alien" with that scene of the alien popping out of the guy's torso. You might worry about that.
Customer: replied 3 years ago.

Is that true about cancer? I thought one marker for cancerous lumps was that they have their own blood supply, or some such rubbish I read on Dr Google. Is that not right?


 


How about aortic aneurysm?


 


Hernia?

Expert:  jbmd replied 3 years ago.
Well, anything that goes through or partly through the abdominal wall IS a hernia of sorts--just not necessarily one that needs fixing. So the bowel protruding to where you can feel it would be partly herniated but NOT a fixed hernia (one that doesn't go back in).

Aortic aneurysm in someone your age without significant hypertension wouldn't be likely AND an abdominal aortic aneurysm is located behind the abdominal cavity itself in the retro-peritoneum. It can't herniate up to be a little lump above your belly button. The NORMAL aorta can be felt in thin people often. but you need to press gently down and it doesn't go away.

Cancers DO have their own blood supply but that's a tangle of little vessels. If it were a cancer of the abdominal wall, it wouldn't sink back in. If it were a cancer on the bowel, it probably wouldn't reliably be in the same place unless it had stuck itself and the bowel to the abdominal wall and then the first thing would apply.

If you went to med school, you could get money for the knowledge you're gaining, you know. meanwhile, have the doctor examine your abdomen and do appropriate tests the two of you decide on if the exam doesn't end your worry.

And find the therapy! For your family's sake.
Customer: replied 3 years ago.

Do you think I do need to get it examined then?


 


Or do you think it might just be the normal aorta protruding slightly through my split abdominals?

Expert:  jbmd replied 3 years ago.
See, I can think or explain all I want but for reassurance you need someone to lay hands on. Do I think you need to get examined? Well, I don't think you'll quit panicking or searching the Internet either way but maybe a doctor you trust there will calm you down a bit.

For some reason (returning to England???), your stress and worry seems to have increased. Why is that?
Customer: replied 3 years ago.

I don't know that the stress has increased exactly. But we are stressed with lots of work and the task of finding a new home. The pains in my stomach have been going on for a few weeks.


 


Before we left England last time, I mentioned to my GP that I was worried about my right-sided rib/abdominal pain. We didn't go into all the detail that you and I have because the main reason I was visiting him was about my migraines and wheeze, and he was pushed for time, but he did feel my abdomen and said all was okay.


 


Do you think I need to go back and specifically mention this weird lump or do you think he would have spotted anything really wrong?

Expert:  jbmd replied 3 years ago.
I would hope he would have spotted anything really wrong. You left England when? If it's been a few years and before your last pregnancy, this might be something that the pregnancy's separating your rectus muscles brought to light and another feel might satisfy you.

An ultrasound of the abdomen might put your worry to rest.

Stress has increased in your life: finding a new home when you have small children and things are expensive is stressful. One of the ways your devious little mind seems to deal with stress is to convert to symptoms and worry and obsession with physical problems. Fortunately they deal with your body and not your kids. I had a bit of this when my daughter was very tiny--worrying about her health when I was on pediatric rotation. Our pediatrician kept me from making her a crazy toddler by teasing me until I was embarrassed about my obsession.
Customer: replied 3 years ago.

Sorry - I haven't been very clear. We actually came back to England in July but then left again for a few weeks in mid-August. So it's been no time at all since that physical exam.


 


Would a physical be enough based on what I have told you? I would rather not have the stress of an u/s if I don't need it/


 


I can see your method with me is much the same as the ped who teased you into being embarrassed! ;-)


 


Apologies if I am slow responding. MIL has just got back and haven't seen her for 2 months so must socialise!

Expert:  jbmd replied 3 years ago.
I think asking the doctor if he feels his exam would have found that or revisiting with specific thought of checking out the lump would suffice.

To be honest, I was born to a family of teasers. You could say anything you wanted (within reason) as long as the majority of the family laughed. If they didn't, you'd better start running. So, I've always used humor in my profession, depending on if the person was capable of handling it and the situation wasn't serious. However, I DO think your worry is serious and perhaps I should stop teasing you until you find getting your medical obsession under control by making it a priority to find a therapist who does what I suggested. Don't say you lack the time: you're finding the time to research abdominal aortic aneurysms.

Ask MIL to babysit so you can attend medical school.
Customer: replied 3 years ago.

I will try asking him if I can get to see the same person.


 


But basically you would not be alarmed, right? You think it's the aorta or a blood vessel?


 


I don't mind the teasing. My family tease too. It helps to lighten the mood at least.


 


And I will find a therapist. No excuses. I just want to find one in the area we will be living so that I can have some continuity in seeing the same person. So it needs to wait a week or two as we won't be settling here in inlaw-ville.

Customer: replied 3 years ago.

Oh, also, I read this:


 


Crohn disease may present with sausage shaped mass on the right lower quadrant. The sausage shaped mass appears to be palpable and tender.


 


This is something else I felt the other day when poking around, but assumed it was just stool in the intestines. Which is correct????

Expert:  jbmd replied 3 years ago.
Did it go away? If it went away, most likely stool.

What bad writing: "...sausage shaped mass...appears to be palpable..."

If it is a mass you find, it's palpable. And it can't "appear to be palpable," it either is or isn't.

As you said, one day you will have something that medical science can find. In the absence of bloody diarrhea, shelve the Crohn's research until you visit your GP.
Customer: replied 3 years ago.

Okay, I hear ya. I will forget about Crohn's.


 


In conclusion then, you think it's a blood vessel/gas/something benign again?

Expert:  jbmd replied 3 years ago.
Yes.
Customer: replied 3 years ago.

Thank you.


 


You are great.


 


I, on the other hand, am useless!!!

Expert:  jbmd replied 3 years ago.
"I, on the other hand, am useless!!!" implies deeper issues, you know.
Customer: replied 3 years ago.

Ha ha! I mean with health anxiety. Don't worry - I am not about to start getting other complexes!

Expert:  jbmd replied 3 years ago.

Remember that the additional pregnancy you desire might further separate your abdominal muscles. If you become like that Duggar woman, you won't need ultrasounds or CT scans. You'll be a living anatomy lesson.

 

Something new for you to consider: http://www.today.com/health/researcher-finds-way-calm-fears-during-sleep-4B11214946

Customer: replied 3 years ago.

Good morning.


 


So today I had a BM and noticed an oily residue coming from it into the water. It was clear, not orange. But it reminded me of what you said about greasy stools and celiac. I don't know if this is the first time or not.

Expert:  jbmd replied 3 years ago.
Also, IBS gives you extra mucus, the normal substance that protects the colon from scratching/irritation by stool and substances in it. It's not diagnostic of anything. In greasy stools, they float and leave a grease ring in the toilet like in the tub when you bathe if you have been working hard and sweating.

Customer: replied 3 years ago.

So the grease that shows pancreas cancer or liver problems would be orange and not clear?


 


I am so worried today, I can hardly breathe.


 


I have also noticed something interesting. My stools always float EXCEPT when I have an upset stomach (frequent bowel movements, thinner stools, softer consistency). Then they sink. So normal for me is floating, upset stomach causes sinkers. Does that give a clue as to the cause?

Expert:  jbmd replied 3 years ago.
Not necessarily. I want to ask if you have other symptoms of pancreatic or liver problems but don't want to give you any hints of symptoms to adopt.

No, the only color of interest would be bloody. With liver failure the stools get clay-y white, the urine dark.

The life-expectancy of pancreatic cancer is only a few months untreated. By now you'd have massive fluid in your abdomen and otherwise be wasting away, weak, perhaps unable to get up from bed.

I don't see how you could be made worse by an exam and US so go get them done.

Have you found a therapist yet for neuro-biofeedback? If not, do or I might need to cut this off. No sense circling the same obsessions.
Customer: replied 3 years ago.

I have to wait until we get to where we're going to be living in the UK before finding a therapist. Like I said, I want to find someone and stick with them.


 


I have some back pain and pain around my navel. Plus floating stools all the time - for years now. And a lot of gas at the moment, including belching.


 


Please don't cut me off. Your advice helps to talk me down from a panic.

Expert:  jbmd replied 3 years ago.
Well, for years is NOT pancreatic cancer. For years with normal pregnancy is NOT serious liver disease or serious nutritional deficiency. It is possible to have malabsorption and problems with digestion with foul-smelling, greasy stool that floats or it just might be IBS with a lot of swallowed air from anxiety. Your stool can be tested for fat. You can try a gluten free diet and see if it helps. Often with IBS eating fewer free carbs, especially highly processed carbs, can alleviate some of the gas from fermentation of carbs in the gut.

I know you said that you had to relocate before therapy except that, if it's going to be a while, months and months, you might at least discuss with your local doctor or get started with a therapist and see if they can then refer you to another in a new location OR pick the location relative to the possibility of therapy (I've heard that you can move over the county line and get or not get services relative to another county). This constant level of anxiety can't be good for you and your family.
Customer: replied 3 years ago.

"For years with normal pregnancy is NOT serious liver disease or serious nutritional deficiency."


 


Do you mean that the pregnancy would have had problems if I had had serious liver disease or Crohn's etc?


 


Can the floating just be normal for me or do you think it indicates celiac again?


 


If you were my doctor, what tests would you tell me to do? Not to set my mind at rest, but to set your mind at rest that it's only my anxiety causing all of this?


 


I am going to look into finding a therapist next week. Even though we won't be settled, we will be in the same county as where we eventually buy a house.

Expert:  jbmd replied 3 years ago.
The odds are that SERIOUS liver/pancreatic/bowel disease would cause malabsorption and therefore poor nutrition in the fetus.

I'd do:
A fecal fat test
AGA (antigliadin antibodies)-IgA
AGA-IgG
tTG (anti-tissue transglutaminase)-IgA
EMA (anti-endomysial antibodies)-IgA
Total serum IgA
Serum lipase
US abdomen
Expert:  jbmd replied 3 years ago.
Liver enzymes
CBC
Vitamin D
Iron
Folate
B12
albumin level
Expert:  jbmd replied 3 years ago.
The best test for wheat allergy/intolerance is strict gluten free diet. Helps IBS too.

(sorry for the multiple posts but if I try to edit, it removes the line spacing and then everything runs together if I don't go back and hit return over and over again.)
Customer: replied 3 years ago.

And those tests would be to set your mind at ease? Not mine?


 


Seems a big leap from what we discussed until today. Why are you suddenly alarmed?

Expert:  jbmd replied 3 years ago.
I am not alarmed. You asked what I'd do to make sure--if I had a patient as obsessively concerned as you are with different disorders, I'd nag them to get to therapy. Then I'd also nag them to try diet. However, in the case of someone not able to handle well waiting and trying diet and putting off seeking therapy and, despite my saying over and over that they have an obsessive concern with diseases and spent too much time researching new diseases, if I needed proof for them (after seeing that a good echo made them able to deal with things for a while, heart-wise) and myself personally having a massive ego as well as a great hatred for being proven wrong in any aspect of my life when I've been insistent that I know what I'm saying for sure, I'd do the tests.
Expert:  jbmd replied 3 years ago.

And I might in my practice start them on medication like an SSRI or SNRI for obsessive worry, but then they said they were nursing and wanted to get pregnant again, I'd really be backed into a corner.

 

I am a patient person who loves helping people but I do like to see progress.

Customer: replied 3 years ago.

Okay. So really the tests would be more for my benefit because you think it would help alleviate my worry, right?


 


Not because you think something is seriously wrong?

Customer: replied 3 years ago.

Also, can you please tell me why you would test for albumin and liver enzymes if you think a liver problem is unlikely?


 


And why serum lipase if you think my pancreas is okay? Do you think it could be pancreatitis?

Expert:  jbmd replied 3 years ago.

No. I have said multiple times now I think it is your obsessive worry. I would simply be trying to head your research online off at the pass. What else/how else would you have had me frame this?

 

I've said you don't have this and don't have that and it's your worry and please stop researching and go to the doctor and find a therapist. Give me a hint of what would reassure you.

 

I am trying to help you and avoid opting out but every avenue to get you for help is blocked, isn't it?

Customer: replied 3 years ago.

I guess I just am still worried about the floating stools, that's all. I like to have a reason for things. But maybe there isn't a reason beyond IBS caused by stress.

Expert:  jbmd replied 3 years ago.
As I've said, you're smart. You are interested (!) in medical matters. Let's pretend you went to medical school. What would you say to someone like yourself, who has now gone through 4 or 5 organ systems, sure you have something drastic?
Customer: replied 3 years ago.

That it was anxiety, of course.


 


But the fear remains that one time I will be right.


 


Once I can explain a symptom away, I feel better.


 


So wheezing = allergies.


Mad TSH = Hashimotos


Abdominal pain = IBS


 


Floating stools = ????


 


This is my problem. I still fear the cause as the internet seems to say floating stools is bad, especially if it's all the time and not just a blip.

Expert:  jbmd replied 3 years ago.
Very good, doctor!

At 12:57 today I wrote: Well, for years is NOT pancreatic cancer. For years with normal pregnancy is NOT serious liver disease or serious nutritional deficiency. It is possible to have malabsorption and problems with digestion with foul-smelling, greasy stool that floats or it just might be IBS with a lot of swallowed air from anxiety. Your stool can be tested for fat. You can try a gluten free diet and see if it helps. Often with IBS eating fewer free carbs, especially highly processed carbs, can alleviate some of the gas from fermentation of carbs in the gut.

So, testing with blood work and a simple stool sample for fat (you're not saving your stool for any other reason are you? I mean, you could donate it to the lab without worry) and a diet trial would be what I'd recommend, though swallowed air from anxiety requires some intervention with the anxiety.

I've said it's anxiety with allergies/Hashimoto's/IBS. All symptoms of real OR imagined disorders are worse with anxiety.

Should I convince you that the problem with this is anxiety, would you not go on to something like, "I have another migraine or maybe it's..." or my knee hurt after a hike, could I have rheumatoid to go with my Hashimoto's?
Customer: replied 3 years ago.

See that's why I'm worried still about celiac/pancreatitis -- because you say I should do a fat test and have bloodwork. Seems like there can't be an innocent explanation for floating stools.

Expert:  jbmd replied 3 years ago.
I gave you an innocent explanation: swallowed air from anxiety. Fermentation from carbs in the gut with IBS. You didn't accept innocent explanation for floating stools and still don't. And you say then that you need to accept a reason for a symptom and for that you need some proof of lack of a disorder that you've carefully researched. So THAT is why I suggested the tests.
Customer: replied 3 years ago.

It's because the floating stools have been going on for years and it's all the time, apart from when I have an upset tummy. That's why I didn't think it could be the excess air swallowed.


 


But I didn't spot your reason about fermentation of carbs - sorry.


 


Okay, if that is a possible explanation, then I am happier.


 


So the pancreatitis/celiac stools are different? Larger and greasy, right? And the fact that I had a normal endoscopy means no celiac? And a normal u/s of the pancreas 3 years ago (when I had floating stools) also a plus point? Not clutching at straws here, honest!

Expert:  jbmd replied 3 years ago.
Of course a normal endoscopy showing no swollen gut lining is good and normal US of the pancreas is good, as is now years of not getting worse and having a normal pregnancy. But obviously you know "nothing found" is good and yet it doesn't completely calm you down. So what will, short of "autopsy with no abnormal findings?"
Expert:  jbmd replied 3 years ago.
You are wasting another evening worrying about your health.
Customer: replied 3 years ago.

Another day...another week. I know you are right.


 


I am going to see a GP on Friday to have them check my abdomen. Then I will find a therapist next week.

Expert:  jbmd replied 3 years ago.
Good. And try the no-wheat, low processed carb diet for gas. Remember there is no reason that you can't be allergic to wheat even without celiac.

Don't answer--go read a good book or cuddle with your hubby or even watch television.
Customer: replied 3 years ago.

Hello. Only me. I am going to pay a bonus to give you more compensation for your time today, don't worry.


 


One niggling question: in the context of what you know about me, would a few kilos of weight loss in the last few months concern you? Or would you put it down to anxiety?

Expert:  jbmd replied 3 years ago.

Do you honestly think I'm worried about compensation amounts? Does a few kilos of weight loss concern me? It could be from gut pain and lack of appetite or it could be from anxiety. How tall are you, what did you weigh and what do you weigh? What have you been started on?

Expert:  jbmd replied 3 years ago.
(I can't discourage paying or correspond without pay as the site takes half--they need to pay for this being available, both workers and equipment and services--If I did so, I might be kicked out!)
Customer: replied 3 years ago.

I am 170cm. Prior to pregnancy in March 2011 I was 55.7kg.


 


Due to moving around, I haven't been using the same scales consistently.But immediately post-pregnancy I weighed 64kg, and then in May this year I was 58kg.


 


When I started using my current scales in July, I was 55kg and now I am 54.


 


I am feeling nausea and some lack of appetite for the past few days and I had an upset tummy for about a week 2 weeks ago.


 


Does anxiety cause weight loss? Is it just getting back to my pre-pregnancy weight?


 


This also happened after my 2nd pregnancy. 55kg prior to pregnancy, 64kg at the birth, 3.5 kg lost in first 5 months pp, then a sudden loss of 3kg in the next 4 month and even more sudden loss of 2.5kg in 3 weeks after that back down to 54.5. This last loss was also at a time of nausea and high stress.

Expert:  jbmd replied 3 years ago.
It could be either anxiety or your body's return to what is normal for it. This goes for the nausea, too, though, but please do a pregnancy test to be sure that's not an issue. (You're nursing but that works for populations only, not an individual).

Discuss with the doctor when you see them this week and make a game plan for if it continues to go down.
Customer: replied 3 years ago.

Definitely not pregnant.


 


Okay, if it can be explained by the anxiety, that's fine by me.

Expert:  jbmd replied 3 years ago.
You were fine a few weeks ago after the echo but if your weight continues to go down, you need to continue working on a cause/cure, whether for anxiety or something else.

My husband used to say that my highest emotion was nausea. It was how I reacted to everything. Then I controlled that and now my pregnancy weight is still about me, 30 years later.
Customer: replied 3 years ago.

A cure for something else? What do you mean?


 


Also, that weird lump above my belly button is on the move this evening! If I lean back in my chair and wait a few seconds, I see it stick out. Then it travels up an inch or so and disappears (without being pressed on). It's like watching a baby's limb move when you're pregnant.


 


Do you still think this could be a blood vessel or hernia? It throbs if I press it, so could it be the normal aorta being visible through my split abdominals? Even my husband thinks it's freaky and he is never usually phased by anything!

Expert:  jbmd replied 3 years ago.
A baby gas bubble! The delivery is easier than with a real baby but those around you are less likely to celebrate.

"cure for something else"--are you trying to trick me into thinking you'll cease worrying about everything under the sun?

The aorta doesn't move. It would have to be your muscle moving out of the way.
Customer: replied 3 years ago.

But it is always in the same place and it's there any time of day and always moves in the same way. It feels hard and pulsates. Can that really be a bubble of gas?

Expert:  jbmd replied 3 years ago.
Yes. Certain parts of the gut are fairly fixed in position but are only felt when a gas bubble moves through because otherwise they're soft and flat. The doctor checking it might help.

Customer: replied 3 years ago.

Could it be diastasis recti causing the lump? I know I have this to an extent - maybe 2 fingers. Does this cause the intestines to sort of protrude and then go back in again?

Expert:  jbmd replied 3 years ago.
I tried to post this twice, will try again: Yes. Certain parts of the gut are fairly fixed in position but are only felt when a gas bubble moves through because otherwise they're soft and flat. The doctor checking it might help.
Expert:  jbmd replied 3 years ago.
Let the doctor do an ultrasound so you can see your normal aorta and normal liver and normal pancreas and maybe you'll feel better and stop fretting.
Customer: replied 3 years ago.

GPs here won't do ultrasounds at the drop of a hat.


 


Do you think it could be a hernia? Or just diastasis causing my intestines or aorta to be visible?

Expert:  jbmd replied 3 years ago.
That would be low for a hiatus hernia. The diastasis creates what could be regarded as a hernia--the abdominal wall is thinner without the muscles in the way and so what doesn't usually appear or be able to be felt now can. Regardless, unless the lump got stuck, which it hasn't, it goes back in on its own and doesn't cause problems.

Except for worry on your part.
Customer: replied 3 years ago.

Would it not be the exact place of an umbilical hernia? Or is it too high for that?


 


And what would be the movement I see, if not a gas bubble? Is it that something protrudes and then goes in again when the muscles tense and relax?

Expert:  jbmd replied 3 years ago.
An umbilical hernia would be right under the belly button--you said this was above?

Your muscles, if moved to the side by diastasis, aren't tensing in the area. A muscle belly that didn't move out of the way could cause this but it would more slowly relax and would twitch differently. Again, have your doc lay her/his hands on your belly.
Customer: replied 3 years ago.

It is above. Where a "supra-umbilical hernia" would be (sorry, I Googled).


But would a hernia remain visible all the time?


 


And if it's not muscles, then we are back to intestines or blood vessels and nothing to worry about?

Expert:  jbmd replied 3 years ago.
You can call hernias by all kinds of names by location. A difference in name doesn't mean a different diagnosis. No, hernias can come and go as they slip through spaces.

I think gut. I think HAVE DOCTOR FEEL AND STOP GOOGLING AND WORRYING.
jbmd and 2 other Medical Specialists are ready to help you
Customer: replied 3 years ago.

The difference to me is that I thought what you said the other day meant it would be a hernia that didn't need surgery, but umbilical hernias seem to be potentially dangerous.


 


I will ask the doc on Friday.

Expert:  jbmd replied 3 years ago.
Umbilical hernias only need fixing if they get stuck. They are commonly fixed because people don't like having their belly button protrude through their clothes--they often come out with the pressure of pregnancy.

Hernias only need to be fixed IF: they get stuck (strangulated) or cause pain or interfere with the action of an organ.
Customer: replied 3 years ago.

Thank you!


 


I do have an outie belly button since my first pregnancy, but I assumed this is just normal. Presumably it's not always due to an umbilical hernia?

Expert:  jbmd replied 3 years ago.
An outie belly button can be considered a hernia. If you were having lump that was an umbilical hernia, your outie belly button might get really big. Then you would have it fixed, though throughout the ages people have just had them--unless they get stuck.

Pregnancy is hard on your body.
Customer: replied 3 years ago.

"Pregnancy is hard on your body."


 


Ain't that the truth!?


 


Have a good day -- no need to reply. I have taken up way too much of your time already.

Expert:  jbmd replied 3 years ago.

You're the one going for another baby. My husband wanted another and I said, "How wonderful! Who with?"

 

I can't wait for you to see your doctor--no reply--it bounces back to me!