Ask a Doctor and Get an Answer to Your Medical Question ASAP
Sure--How are things going back home?
Not too bad, thanks. Hope you are well too.
what's up with your abdomen?
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...
I have a pain to the right of my navel.
I have had it before.
Sometimes it seems to be higher up, just under my rib cage. So then I worry about my liver.
But other times it is at navel level.
Liver pain doesn't usually come and go. You've had your gall bladder checked, right?
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.
However, at navel level and/or right upper quadrant, it may be gas trapped in loops of bowel.
When it last flared up badly 3 years ago, I had an ultrasound of my abdomen and everything looked normal.
Is it relieved by anything? Like a bowel movement? Burping?
Gallbladder was checked on u/s.,
It sticks around for a long time.
IBS can surely do that.
good your gb was ultrasounded.
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.
It is very tender from the outside. Even holding something against it feels tender.
Hmmm. Does anti-acid medication help.
And I can also feel gas bubbles if I press near it.
I know you're not drinking as you are still nursing.
I do drink wine, usually when I am anxious.
Try some anti-acid medication like ranitidine if you wish. You're not pregnant again yet?
But not when I am nursing.
No, not yet.
Well, instead of pills, since you're nursing, how about Mylanta type stuff? How often do you go to the bathroom?
What is Mylanta?
I usually go every day, sometimes multiple times if I am anxious.
But when I calm down, the bowel movements are more normal.
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???
Other scary diseases I shouldn't have been Googling?
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)
Crohn's is known as regional ileitis (the terminal small bowel) but can be found elsewhere and is a biopsy diagnosis.
Little bubbles is usually swallowed air MOST OFTEN from swallowing a lot of air with anxious breathing.
Celiac: wouldn't come and go so much if you eat bread and cereals with wheat.
Same with Crohn's?
Does the fact that it went away for a long time make those diseases less likely?
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.
I worry that I have left something festering and getting worse all this time.
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)
How about the floating stools?
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?
Floating stools can be from fat (often leave a grease ring in the toilet) OR
from frequent stools with lots of swallowed air.
Yes, they did biopsies.
(I missed you but that gave my hands time to rest)
And the biopsies didn't come back Crohn's or celiac?
Yeah, sorry to be back again. I bet you were at a loss without all my questions... ;-)
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.
But biopsies were definitely taken.
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
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.
BUT BAD CELIAC is usually found with biopsies.
Damage to the lamina propia of the gut, causing malabsorption of vital nutrients
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?
You had: normal pregnancy. Stress-free time without symptoms.
I also have pain on my right side in my back and hip so I think maybe it's just tension from tensed muscles.
No, it was worse in the latter half of the pregnancy, but higher up, in my ribs.
I would recommend you spending 4 months scrupulously avoiding wheat even in soy sauce etc. and exercising and doing neurofeedback/biofeedback
Abdominal pain in pregnancy is common. With IBS, more common
Always in the same spot?
I recommend blocking you from the internet except this site to ask me questions
I also came across mention of illeococal valve disorder which sounds a likely explanation.
I am doing my best at avoiding the internet!
The common pain in the abdomen is either RUQ or RLQ or LUQ
I have RLQ and RUQ.
Why? You just touched on the RLQ: gas trapped at the ileocecal valve.
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.
That's the thing. Mine doesn't go away. It stays for weeks/months until I decide to stop fixating on it.
Then it fades.
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.
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.
" Mine doesn't go away. It stays for weeks/months until I decide to stop fixating on it." Ahhhh,
if only all diseases, like cancer, would go away once the victim stops fixating.
While I'd like you to try without gluten (wheat), I still think that your phobias and worry are bedeviling you.
So you think it could just be IBS?
I think it is IBS but IBS gets worse for some people with simple carbs and maybe wheat allergies and certainly with worry.
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
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.
Do you take probiotics like yogurt
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.
Did your mum have hepatitis C? Were you tested for B & C as part of the pregnancy panel?
No, it was drug-induced due to long-term antibiotics for UTIs.
Good probiotics help with IBS and most other gut problems
I will try probiotics again then.
Oh--well, that's something you can't inherit, right?
It is. But I worry anyway as I have drunk more than my share of wine at times of anxiety.
Try probiotics, exercise, no wheat, gluten-free, and biofeedback
I really will!
Wine does decrease the risk of breast cancer you know.
I just love the way you look at things. ;-)
The entire country of France should have mal d' foie, right?
YOUR LIVER ENZYMES were normal. YOUR US was normal. Then you were pregnant and so weren't drinking.
You are stretching my memory of high school French!
But I learned something. (I can Google French words, right?? Just not illnesses.)
Then you were pregnant and so weren't drinking.
Correct, of course, but I don't see you point here?
"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!"
Does the fact that my u/s and LFTs were okay even during an episode of the pain mean my liver is okay
The point was, two normal tests and then not drinking so where would the liver damage have come from?
From drinking wine subsequently.
But perhaps it can't happen that fast.
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.
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.
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.
Hard lump that goes away?
A lump you can feel that later in the day is gone?
Yes, I guess
But the pain/tenderness stays
Sounds like ball of gas. Or pooh moving through.
A constant burning either by the navel or right rib.
And my right lowest rib sort of pops if I breathe in deeply and then exhale.
Probable duodenitis (pre-ulcer) from stress.
So antacids then?
Ribs popping are not from cancer--probably from being pushed out by pregnancy or trauma at some point.
Try: antacid, probiotics, no wheat/gluten, exercise, meditation, yoga, having fun (remember that?), bio-neurofeedback. If problem gets worse, get doctor to work up.
Sounds as if your docs were very tolerant at working you up.
Okay, I will try what you suggested.
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.)
I would rather not do any of that again.
Your stress drives you to worry about different parts of your body in rotation.
Remember your focus at first was your heart? You were sure the echo was going to be baaaad?
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.
Try what I suggested: the list above. get your worries under control
Hey, you missed out on the gyno cancer and malignant melanoma before the heart thing. Count yourself lucky! ;-)
Now we are back and hopefully getting settled soon, the options for sorting this all out are right here.
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
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.
Look at your own worries with a humorous eye: Pin the list in your bedroom mirror.
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.....
Annual/pre-pregnancy blood work can include liver enzymes so you will be reassured.
Please don't quote that at me when I bug you in 3 weeks with CJD or some such nonsense.
Stay off: "what horrible illnesses are there left for me when everyone else has the good ones already, the greedy pigs" websites
I certainly will.
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
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.
Thanks again for your patience and reassurance.
You have no idea what a big difference it makes.
IBS = worry
Go get the kids back in touch with their native land. Go through the Chunnel to Euro-Disneyland
But not with mal d'foie!
Yeah, we did Eurodisney years ago before kids. I think Americans pull it off better.
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.
That doesn't sound much fun.
I remember Epcot when I was about 8. I was just desperate to get back to the good stuff with Mickey Mouse and co.
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.
Sounds like she was pretty inspired.
"Go around the world at Epcot, buying tourist trash and eating international junk food."
Yeah, so start reading them about UK history. They love the gory stuff: iron maidens, heads chopped off, etc.
Eek, my kids are a bit sensitive for all that. They don't even like The Three Little Pigs!
Might have to find an abridged version of UK history....would there be anything left without the head chopping, I wonder.
Our kids' favorite purchase at Arundel was a pamphlet on torture
Scared of the wolves?
"Siege and Destruction" included boiling oil
Now my daughter is very politically correct
I hope you kept the play to show her.
Or at least make sure to tell her about it.
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.
It's on lined paper, with drawings of swooning maidens and untrustworthy castle help
Cool. Good for her.
and boiling oil raining down
You should get it published. Give JK Rowling a run for her money.
If you want gentle, travel back in time to the Isle of Wight and dine at the New Inn at Shallfleet.
It's all of maybe 20 pages long
Short but sweet.
And you are very well-travelled!
Sweetened boiling oil?
Leftovers from making donuts
Sounds like a good cure for abdominal tenderness.
and apple fritters.
Would certainly take my mind of it anwyay
Do you feel better now?
Physically no, mentally a million times.
You're welcome. Try the list.
Thanks so much for your time.
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
Have a good evening!
Thank you. And you have a good day,
I am still panicking about my abdomen. :(
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????
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?
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?
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?
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!
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.
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????
Okay, I hear ya. I will forget about Crohn's.
In conclusion then, you think it's a blood vessel/gas/something benign again?
You are great.
I, on the other hand, am useless!!!
Ha ha! I mean with health anxiety. Don't worry - I am not about to start getting other complexes!
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
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.
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?
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.
"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.
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?
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.
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?
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?
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?
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.
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.
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.
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!
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.
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?
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?
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.
Definitely not pregnant.
Okay, if it can be explained by the anxiety, that's fine by me.
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!
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?
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?
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?
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?
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?
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.
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?
"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.
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!