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What Causes Nausea With Abdominal Pain And Metallic Taste In Mouth?

Posted on Mon, 23 Jun 2014

Question: Hi, I'm a 29yo male and have been having trouble lately. I have twice been tested and have positive P/Q VGCC Antibodies at 10X over normal limit. I had a negative PET Scan in March. Lately, I've been very nauseated, pain in the left side of my abdomen, left side of my back and have a very metallic taste in my mouth. I tried Ensure drink but vomit them and also I see bright red in my vomit. What could this problem be?

Answered by Dr. Ashish Verma (9 hours later)

Brief Answer:
looks like acute gastritis

Detailed Answer:
Hi,

Welcome to HealthcareMagic.

Autoantibodies directed against voltage-gated calcium channel (VGCC) also are known as anti-voltage dependent calcium channels or anti-LEMS (Lambert-Eaton myasthenic syndrome).

It is important to recognize that anti-VGCC antibodies are present in 76% of LEMS patients without detectable tumors. This could be the reason that your PET scan was negative.

In addition, anti P/Q type antibodies are observed in up to 7% of SCLC (squamous cell lung cancer) without LEMS. But your PET scan should had shown that, so that is also unlikely.

But your symptoms are very muck like that in gastritis, maybe due to the amount of stress you are taking about your disease. And the blood you saw in your vomit could be due to a bleeding peptic ulcer.

So i would suggest that you start on a ppi tablet like pantaprazole or omeprazole and get an endoscopy done to identify the point of bleeding and its management.

Hope i have been helpful.

Regards,
Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ashish Verma (10 minutes later)

i also wanted to add that I have not been diagnosed with LEMS as my EMG came back clear. I do have weakness in the legs and other muscles in my back. I have been to the Mayo Clinic in XXXXXXX and as I also have PTSD, they're trying to pawn all of my symptoms off onto the PTSD. I've been in contact with others who have a diagnosis but also a clear EMG, but they are on 3,4DPAP, and it has helped them but my neurologist won't sign off on it as my PET & EMG are clear. what's my next step?

Answered by Dr. Ashish Verma (33 minutes later)

Brief Answer:
repeat scan after 3-6 months

Detailed Answer:
Hi,

Presence of VGCC autoantibodies confirms the LEMS diagnosis, due to the very high antibody specificity.

As per the recent guidelines by European Fedration of Neurological Society (EFNS), once a diagnosis of LEMS is suspected, start the search for a SCLC. Smoking markedly increases this risk, but nonsmokers should undergo the same diagnostic program. Extensive imaging is necessary, and if necessary including PET. If the initial search is negative, the screening should be repeated after 3 months, and then every 6 months up till 2 years after LEMS debut.

You may be in very early stage of the disease, as though your EMG is clear, but still you have weakness in the legs and back muscles. So maybe its a little early for it to be picked up on EMG.

So i suggest that you need following it up as per the above mentioned guidelines.

And i could not get what is 3,4DPAP, so please tell a bit details about it so that i can be of more help.

Regards,
Dr. Ashish Verma

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Ashish Verma (51 minutes later)

thanks again. Drug: 3,4-diaminopyridine. Jacobus Pharmaceutical in New XXXXXXX has been doing positive trials and also "Compassionate" trials to those who aren't near one of their centers. It's a medicine specifically for LEMS. I appreciate the help, I'm just trying to figure out how to talk to my Neuro doctor at mayo again because they've had a hard time listening and I'm not sure what else to do.

Answered by Dr. Ashish Verma (1 hour later)

Brief Answer:
I can't help with that

Detailed Answer:
Hi,

I know about DAP, but I am unaware of DPAP. Sorry about that.

But the thing is the people at Mayo work following their own treatment protocol which is very strict. And as per them you are not suffering from LEMS. So no chance of prescribing a drug for that.

So either you consult somewhere else for a second opinion or you follow up with them till you show a convincing sign.

Regards,
Dr. Ashish Verma

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Above answer was peer-reviewed by : Dr. Prasad