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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18762
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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, I have been experiencing a barrage of waxing and weaning

Resolved Question:

Hi,
I have been experiencing a barrage of waxing and weaning symptoms which are causing me some concern.
I am getting pain in the left hand side of my rib cage, to the extreme left almost to the point its reaching around my side, not as far as my back. The pain is reasonably high up at around 4" from my arm pit. This can also often spread to the boney section of cartilage at the borrow of my sternum and is often accompanied by a lot of random mild bowel pain.
I do get a degree of neuropathic tingling and twitching in my face, arms etc, which come and go. I can often experience some dizziness and a general feeling of pressure in my head which makes me feel slightly "Dizzy" also. My stool is often quite greasy and a very slight slight yellow tinge, which typically floats. This does vary from time to time to "normal".
The bowel pain seems to vary in location and on some days can even seem to affect my perineum when sitting for long periods. I had a swollen uvula and tonsils a few months ago, which persisted until my Dr decided to take them out. I feel this has been more reactive than curative and I'm concerned I may have some sort of bowel condition. I also get heart palpitations and racing pulse. I think this is more prevalent after meals, but I am uncertain.
I have had a number of tests done previously, including a whole body MRI (Covering all major organs, including the pancreas, liver, heart, bowel-external, prostate and general abdomen and pelvis. I have been screened for Testicular cancer, all okay, I have had a gastroscopy back in October, which was okay. I also had a resting EMG and Echo which showed very good heart function and structure etc. This was at Rest only. I do notice a rather rapid increase in heart rate when attempting to exercise, however, due to often extreme lack of energy, Exercise has been more of a problem lately. My focus and cognition is also waxing and weaning with symptoms.
I have also had these feelings of head rushes at random times, which feel like rushes of electrical impulses through my head and face accompanied by a feeling of almost lost consciousness...OR a surreality feeling. Note, I have had an EMG and Nerve conduction test to rule out any neuromuscular disease, all of which was normal. Please note I am a 30 year old Male, working in an office, as an engineer/Project Manager.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Hello from JustAnswer.
It will help if you could provide some further information.
When you are having the pain in the rib cage, is it tender to press on the area of pain?
Does it hurt to take a deep breath?
Do you have the details of what blood tests were done?
Have you had any tests done on the stool when the stools are greasy?
Customer: replied 2 years ago.

Hi, its not sore when I take a breath nor when pressed. When I get inflamation in the area below my sternum (the small lump of cartilage) this seems inflamed, or the area under it perhaps.

I had full blood count, full LFTs, various others (I'm afraid I don't have full details). I have not had any testing done of the stools.

The symptoms come and go, and I'm concerned with a few things -

My Bowels, could pain from bowel radiate to left hand side of Rib cage? Other pains in bowels can be on right and left side and as well as general and all over. Could this be gluten intolerance of some kind? Im concerned about IBD, but have no diarrhoea which I have read isn't a mandatory symptom, I do have pain etc and was wondering if the twitching and neuropathy could be nutrient related?

My Pancreas - could this be pancreas related? I have no Jaundice etc.

My Heart (Ive had a lot of at rest tests done) but no stress testing (this is lower on my list of concerns).

Expert:  Dr. D. Love replied 2 years ago.
Do you remember whether your doctor said that any of the various other blood tests were tests of inflammation or the pancreas?
Tests of inflammation include a sed rate or C-reactive protein.
Tests of the pancreas include amylase and lipase.
Customer: replied 2 years ago.

Hi there,

My C-Reactive Protein was normal. No rests on Amylase or Lipase which I can see. Alanine was high, Albumin was slightly elevated, Aspartate was very slightly elevated. All have since returned to normal, since December (the period of the above referenced tests). Perhaps worthy of note, an Abdominal MRI states - "Pancreas is normal, with no Billary or pancreatic ductal dilatation".

Could this emanate from Bowels or is this unlikely.

Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.

There are several comments that are pertinent in this situation. I am sorry that this took so long, but it is a complex situation.

Yes, it is possible that any condition of the upper to mid abdomen can cause pain that is felt in the chest. The perception of pain in the body can be very imprecise. For the same reason that someone with a heart attack may have pain in the arm, a person with a condition affecting an abdominal organ can cause pain that is felt in the chest.

So, when someone presents with chest pain, we will first think of conditions in the chest, but if there are no apparent chest conditions, it is appropriate to consider abdominal conditions.

If there were tenderness when pressing on the rib cage, then that would be more indicative that the problem is of the rib cage. If there is no tenderness, then the pain could be a deeper musculoskeletal problem, within the chest cavity, or from the abdominal cavity.

Of the conditions within the abdominal cavity, the evaluation that you have had would exclude many of the possible conditions, but the condition that would be most worrisome would be a problem with the pancreas. The MRI is excellent at detecting anatomic problems with the pancreas, such as tumors or cysts, but it is not as good at detecting inflammation, particularly mild inflammation, and it does not detect pancreatic insufficiency.

The most sensitive tests to detect acute inflammation of the pancreas are the blood tests of the pancreas, the amylase and lipase noted above. For chronic inflammation of the pancreas, another test to consider would be an endoscopic ultrasound, which can get much better views of the pancreas.

One reason that there is concern about pancreatic insufficiency is the intermittent greasy stools. If the pancreas is not releasing digestive enzymes into the small intestine, then the gut does not digest and absorb fats from the diet, and fats that pass through the gut into the stool would be perceived as greasy stools. There are tests that can be done on stool to look for fat, but these apparently have not been done.

It is important to note that the imaging studies that you have had are limited in the ability to detect inflammatory bowel diseases, but normal blood tests of inflammation would make inflammatory bowel diseases much less likely.

So, at this point, I would be next concerned about pancreatic disease. The next steps would be blood tests of the pancreas, if not already done, and tests of the stool performed when the stools appear greasy. The formal terms for the tests are tests for fecal fat and reducing substances.

If I can provide any further information, please let me know.
Customer: replied 2 years ago.

Doctor,

Thank you for your comprehensive response.

To clarify one final point, would it be true to say that if digestive enzymes aren't being readily excreted by the Pancreas then this could cause vitamin deficiency based neuropathy?

Equally, given that I do not have any indications of tutors etc as detailed in the MRI, would it be fair assumption that its "unlikely" to be a cancerous or tumour condition at this time?

I shall request the referenced blood tests and pursue this with my Doctor.

Expert:  Dr. D. Love replied 2 years ago.
Inadequate digestion and absorption can lead to vitamin deficiency symptoms, but it is more common to first have symptoms related to poor digestion and absorption of the major nutrients - carbohydrates, proteins, and fat.

Yes, the imaging studies that you have had would make it unlikely that there is any cancer or tumour. An imaging study is not the best test at detecting cancers within the stomach or colon, but once the cancer has progressed to the point that it would be causing all of these symptoms, there would typically be some changes on the MRI.
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