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Ask Dr. D. Love Your Own Question

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17666
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Love i got in touch with you in december last year but had a

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Hi dr love i got in touch with you in december last year but had a problem with my phone and have only been able to get the emails to respond to you. The symptoms i get are pains of various type across my stomach and up to the left side of my chest and down my left arm sumtimes mild but sometimes very severe , the doctor at my practice even called an ambulance for me because she thought i was having a heart attack. I have been to the hospital in an emergency a few times now but they give me morphine and do my ecgs and blood test to check if i have had a heart attack but say i havent and send me back to see my doctor to see what specialist or test i can have next. I also feel quite unwell regularly and feel bloated and feel like i am full of wind which i cant get rid of. I dont go to the toilet that regularly then sumtimes i get chronic wind which really smells bad too. Ive had various tests including a gastoscopy which showed i had reflux. A manometry test which was clear. A barium x ray which showed slight dystmotility which isnt the cause of my problems. I have had a chest ct scan which was clear. Loads of ecgs which are always good. I did a running machine stress test which was gud. I had a echocardiogram which was clear. I had an angiogram which showed no blockages of my arteries or anything. And i have also had a heart mri scan which was good too.i also went to pain management where they said its something i might have to just live with a few doctors have said this but i am not excepting it and then prescribed me oromorph which is no good to me im an engineer and work on complex machinery. So nothing has been found yet and i think my doctor doesnt have a clue whats wrong or what to do next im at the end of my tether with it and need some help to get diagnosed and then hopefully treated. Hope you can help me or point me in the right direction thanks andy moffat
Submitted: 4 months ago.
Category: Medical
Expert:  Dr. D. Love replied 4 months ago.

Hello again.

Have you been taking a medicine for the reflux seen on the gasstroscopy?

If so, what are you taking?

Have you had a follow-up gastroscopy to see if the reflux has improved?

Have you had a CT scan of the abdomen?

Customer: replied 4 months ago.
I have had various types of esomprazole tablets for my stomach even a year and a half before i was sent for the gastroscopy none of them changed the symptoms. The reason i mentioned the esomomprazole was because i seen two gastroentorologists and the one i seen through bupa said that was the best and prescibed 40mg of it in the morning and for a few weeks at night aswell. Its made no difference so i have stopped taking that. In fact i have stopped taking all the wonderful and weired medication i have been prescibed over the past few years and i dont feel any worse for it even though i still feel unwell and pained regularly. Theres been no mention of a follow up but i will ask my doctor as soon as i get an appointment. And as for the ct of my abdomen i was goin to speak to the specialist at bupa about having an mri of my abdomen which i can get quick through bupa what do you think. Is there anything else i can do if my doctor doesnt know where to turn next or anything you can think of
Expert:  Dr. D. Love replied 4 months ago.

Thank you for the additional information.

I would note that there is much overlap when considering the cause of pain felt in the upper abdomen and lower chest. Conditions in the abdomen can cause chest pain and conditions in the chest can cause abdominal pain. However, you have had a very thorough evaluation for chest conditions, so while I am going to talk about further evaluation of the abdomen, this is because you have already had a more extensive evaluation for chest conditions that can cause pain.

Reflux, or more properly, gastroesophageal reflux disease (GERD), is a common cause of abdominal or chest pain, which can radiate to the side or back. The esomeprazole is a great medicine for GERD, but there is no medicine that works 100% of the time in controlling GERD. If someone has persistent symptoms despite taking esomeprazole, then either it has helped the reflux or this may be one of the small minority of people in which the medicine will not work. If the former, then we should be looking for other causes of the pain, which I will discuss further below. But if the latter, we would need to consider more aggressive care for the reflux, such as augmenting the esomeprazole with a medicine that works by a different mechanism or consideration of surgery for the GERD. A repeat gastroscopy would be the usual method for identifying the persons with persistent reflux despite esomeprazole.

As for evaluation to look for other possible causes, the usual next test that I would consider would be a CT scan of the abdomen. An MRI of the abdomen can be better for certain organs, such as the liver or spleen. But for overall assessment of the abdomen looking for conditions that can cause pain, a CT scan would usually be the preferred test. If there are findings on exam or other tests that raise concern about the liver or spleen, then a corresponding MRI would be appropriate, but you do not mention any such findings thus far.

If you have not had a colonoscopy, this also can be considered. From your description of symptoms, a colon problem would be less likely. But the colon does wrap around the abdomen and if there is no other cause of pain that can be found, it would be appropriate to consider a colonoscopy.

If I can provide any additional information, please let me know.

Customer: replied 4 months ago.
Thanks thats a very thorough answer. I have also had blood tests which showed a fatty liver but the test i had recently showed it was better by 1% and also i have had ultrasounds of my stomach which last year showed an enlarged spleen and at the time the doctor said they might take it out but in seeing the hameotologist he said it may be its just the size for me coz every1s different and im 6ft tall rugby type build so he said get another test 6 months later which was 2 months ago and showed my spleen had shrank slightly. I was told i had possibly some underlying infection and that is possibly why it was enlarged in the first place. And as it happens i have asked for a colonoscopy which i am getting next month. As i say the doctor was at a dead end and asked my thoughts and recently i had been researching my symptoms on reputable nhs websites and that would possibly be my next test. It cant harm and may show someting up. So you think i should ask for another gastroscopy to find out if my reflux is any better?and if its not as for the esomaprazole and taking another medicine to help it what would that be or would i have to discuss with my doctor? After mentioning my spleen and liver do u think a ct of my abdomen is a good next step or do i ask for to have an mri of my abdomen? Im wondering have you ever came across these symptoms i have got and did you get to the bottom of it and find out what it was in the end? I also seen a locum doctor at my surgery as my usual doctor is on holiday. He has sent me for another blood test because he thinks i might be lacking in some viramins what do you think about that
Expert:  Dr. D. Love replied 4 months ago.

Yes, a repeat gastroscopy would be appropriate. if the reflux is persistent, I usually add an H2 antagonist, such as ranitidine, to the esomeprazole, although there are other similar medicines.

I would still usually check a CT scan since the fatty liver and the spleen seemed to be getting better. Since you ask about any prior cases, there actually was a specific case of a patient in which the CT scan found the cause of chronic recurrent abdominal pain. I live in a part of the US in which there is a large population of retirees, and several years ago I had an initial visit with a newly retired women that had been having chronic recurrent abdominal pain. She had just retired from a hospital associated with one of the top medical schools in the US and had undergone a very extensive evaluation without having found any cause. I reviewed the tests that had been done and the only test that had not been done was an imaging test of the abdomen and I ordered a CT scan. The CT scan showed a soft tissue tumor behind her intestines. She ultimately wanted to return to the hospital from which she had just retired for her surgery, as she had a good relationship with a surgeon there, and when she returned she like to tell how the surgeon like to joke with the medical team that she had to retire for a community doctor to find the problem that had not been detected by his colleagues. It is not that a CT scan will commonly find the cause of pain, as a soft tissue tumor is not common, but it is appropriate to consider a CT scan when the usual tests fail to detect the cause of pain.

Customer: replied 4 months ago.
Thanks for the reply you have gave me plenty to think about i appreciate all you have said. I do have a small lump down the right of middle in my abdomen which is painful sometimes and theres mixed opinion what it is but seems to have been skipped over do you think that could b afactor of my pains. I was also wondering about what you said last year about going to a training school if i had explored all avenues and got nowhere. Is there such a training school that looks at medical problems in england i live near newcastle and do you know how i could sort going to one of these training schools
Expert:  Dr. D. Love replied 4 months ago.

It would be unusual for a small lump to cause the extent of pain that you describe. There certainly are medical schools in England, as there are centers for training new doctors and for doing research, although I am not familiar with specific facilities. When I search on the internet, there is a School of Medical Education at Newcastle University (see http://www.ncl.ac.uk/mbbs/ which is oriented towards student, rather than patients). There are apparently several hospitals associated with the Medical School, so it is not clear which would be the best to be at for a patient with persistent abdominal pain, but it looks like the primary hospital is the Royal Victoria infirmary. You can contact them directly to determine how you can get an appointment.

Customer: replied 4 months ago.
Yeah thats what i thought too its a different pain to what i get normally so i can agree with you there , i still would like that sorted though sometime but its on the back burner at the minute. I was wondering what type of specialist would look at the ct abdomen results ? Is it a gastroentorologist or is it something my doctor discusses with me because im just wondering if there is any other type of specialist i could see with the symptoms im getting just to give an idea to my doctor so she could organise me seeing someone or if its someone i can see through my private cover because im feel im running out of options especially when my doctors seems to have
Expert:  Dr. D. Love replied 4 months ago.

A Radiologist will read the images, but your GP or Gastroenterologist will correlate the CT scan findings with the other clinical findings. The Gastroenterologist would be the appropriate specialist for this type of pain. If a higher level of specialist is required, that would usually mean a referral center Gastroenterologist rather than a community Gastroenterologist.

Customer: replied 4 months ago.
Well thanks very much for your great advice i have alot to think about and sort out hopefully i can get to the bottom of it soon. Its a shame you dont live near me as i would definitely wouldnt hesitate to come and see you. You have definitely lifted my mood a bit knowing that more can be done and i dont just have to live with it
Expert:  Dr. D. Love replied 4 months ago.

You are very welcome. I hope that everything goes well and you get to the bottom of this soon.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17666
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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