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I Need Advice About Some Troubling Symptoms And Labwork. I
Question: I need advice about some troubling symptoms and labwork. I have been suffering from a terrible persistent sweet taste in the back of my throat that sometimes spreads to the rest of my mouth since December of 2019. I have also had bigeminy/trigeminy arrhythmias diagnosed through a Zio monitor recently. I am very symptomatic when this occurs. RUQ abdominal pain that is intermittent and relatively mild to moderate. Intermittent nausea, left shoulder and arm pain, ribcage pain. Recent lab work include vitamin D level (low), calcitriol level (high), albumin level (high), calcium level (mildly high), PTH normal, CBC normal, CMP normal, TSH normal, T3 and T4 normal, ANA normal, sed rate normal. I've had ultrasounds if abdomen that were normal and an MRI of abdomen and pelvis that show possible gallstone and small amount free fluid in pelvis while on menses. MRI of brain last summer negative. Recent possible dx of adenomyosis. Chest x-ray negative.
Medical hx includes hypothyroidism on levothyroxine, depression and anxiety that is adequately treated with medications and therapy.
I do have a hx of radiation exposure from the Chernobyl accident (fallout as I was born in Bulgaria) at 6 months old as well as occupational exposure working as an ER nurse and being in a room with a C-arm without appropriate protection. I have also been successfuly treated for h. Pylori.
I am not getting adequate answers from my doctors. Gi has placed me on ppi and h2 blocker that has not worked despite taking them for weeks. He wants a hida scan completed, but I would like to be very sparing with radiological testing because of my personal history.
Medical hx includes hypothyroidism on levothyroxine, depression and anxiety that is adequately treated with medications and therapy.
I do have a hx of radiation exposure from the Chernobyl accident (fallout as I was born in Bulgaria) at 6 months old as well as occupational exposure working as an ER nurse and being in a room with a C-arm without appropriate protection. I have also been successfuly treated for h. Pylori.
I am not getting adequate answers from my doctors. Gi has placed me on ppi and h2 blocker that has not worked despite taking them for weeks. He wants a hida scan completed, but I would like to be very sparing with radiological testing because of my personal history.
I need advice about some troubling symptoms and labwork. I have been suffering from a terrible persistent sweet taste in the back of my throat that sometimes spreads to the rest of my mouth since December of 2019. I have also had bigeminy/trigeminy arrhythmias diagnosed through a Zio monitor recently. I am very symptomatic when this occurs. RUQ abdominal pain that is intermittent and relatively mild to moderate. Intermittent nausea, left shoulder and arm pain, ribcage pain. Recent lab work include vitamin D level (low), calcitriol level (high), albumin level (high), calcium level (mildly high), PTH normal, CBC normal, CMP normal, TSH normal, T3 and T4 normal, ANA normal, sed rate normal. I've had ultrasounds if abdomen that were normal and an MRI of abdomen and pelvis that show possible gallstone and small amount free fluid in pelvis while on menses. MRI of brain last summer negative. Recent possible dx of adenomyosis. Chest x-ray negative.
Medical hx includes hypothyroidism on levothyroxine, depression and anxiety that is adequately treated with medications and therapy.
I do have a hx of radiation exposure from the Chernobyl accident (fallout as I was born in Bulgaria) at 6 months old as well as occupational exposure working as an ER nurse and being in a room with a C-arm without appropriate protection. I have also been successfuly treated for h. Pylori.
I am not getting adequate answers from my doctors. Gi has placed me on ppi and h2 blocker that has not worked despite taking them for weeks. He wants a hida scan completed, but I would like to be very sparing with radiological testing because of my personal history.
Medical hx includes hypothyroidism on levothyroxine, depression and anxiety that is adequately treated with medications and therapy.
I do have a hx of radiation exposure from the Chernobyl accident (fallout as I was born in Bulgaria) at 6 months old as well as occupational exposure working as an ER nurse and being in a room with a C-arm without appropriate protection. I have also been successfuly treated for h. Pylori.
I am not getting adequate answers from my doctors. Gi has placed me on ppi and h2 blocker that has not worked despite taking them for weeks. He wants a hida scan completed, but I would like to be very sparing with radiological testing because of my personal history.
Brief Answer:
MRCP should be done.Its a non invasive test just splits water contents.
Detailed Answer:
Hi,
Thanks for asking on HealthcareMagic.
I have gone very carefully through your query. Your problem seems to be due to gastritis(Kindly mention the name duration of antacid you are on) or gastroesophageal reflux. Our gastrointestinal tract has a forward propulsive movement (peristalsis) that moves the food material forward as it is digested, absorbed and finally expelled as feces. If somehow this movement gets hampered, food along with the digestive juices would stagnate, stomach acid will reflux into the food pipe and on the other hand the bowel habits would not be proper. Degradation of undigested food in the intestines by the intestinal bacteria.
Second differencial of right sides pain is gallbladder pathology.
HIDA scan is usually not a good one rather a MRCP should be done in which MRI waves are used .This is a highly sensitive and specific test
In order to relieve yourself, you need to do the following:
*Gargle twice with Betafine solution
* Avoid spicy food. Take small but frequent meals. Avoid long gaps between meals.
* Avoid alcohol intake (if it a part of your habit).
* Take plenty of green leafy vegetables as well as other sources of dietary fibers. Take fiber supplements like isabgol/psyllium husk or senna. I would insist you to increase your dietary fiber intake.
* Regular morning walk and exercise to keep the bowel movements proper.
* If I had a patient like you I would perhaps have suggested Prodep (fluoxetine) 20 mg tablet (long term anxiolytic and a prescription drug) once daily for at least 2 months (it may take time for the action to set in). Discuss about this with your treating physician.
* Take curd or yogurt on daily basis. It contains beneficial bacteria and should help.
* Stress reduction has a very important role to play. Yoga and meditation should help.
Revert back with duration potency and name of medicine you are on.
Hopefully that should help.
Let me know if I could help further.
Regards
MRCP should be done.Its a non invasive test just splits water contents.
Detailed Answer:
Hi,
Thanks for asking on HealthcareMagic.
I have gone very carefully through your query. Your problem seems to be due to gastritis(Kindly mention the name duration of antacid you are on) or gastroesophageal reflux. Our gastrointestinal tract has a forward propulsive movement (peristalsis) that moves the food material forward as it is digested, absorbed and finally expelled as feces. If somehow this movement gets hampered, food along with the digestive juices would stagnate, stomach acid will reflux into the food pipe and on the other hand the bowel habits would not be proper. Degradation of undigested food in the intestines by the intestinal bacteria.
Second differencial of right sides pain is gallbladder pathology.
HIDA scan is usually not a good one rather a MRCP should be done in which MRI waves are used .This is a highly sensitive and specific test
In order to relieve yourself, you need to do the following:
*Gargle twice with Betafine solution
* Avoid spicy food. Take small but frequent meals. Avoid long gaps between meals.
* Avoid alcohol intake (if it a part of your habit).
* Take plenty of green leafy vegetables as well as other sources of dietary fibers. Take fiber supplements like isabgol/psyllium husk or senna. I would insist you to increase your dietary fiber intake.
* Regular morning walk and exercise to keep the bowel movements proper.
* If I had a patient like you I would perhaps have suggested Prodep (fluoxetine) 20 mg tablet (long term anxiolytic and a prescription drug) once daily for at least 2 months (it may take time for the action to set in). Discuss about this with your treating physician.
* Take curd or yogurt on daily basis. It contains beneficial bacteria and should help.
* Stress reduction has a very important role to play. Yoga and meditation should help.
Revert back with duration potency and name of medicine you are on.
Hopefully that should help.
Let me know if I could help further.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
MRCP should be done.Its a non invasive test just splits water contents.
Detailed Answer:
Hi,
Thanks for asking on HealthcareMagic.
I have gone very carefully through your query. Your problem seems to be due to gastritis(Kindly mention the name duration of antacid you are on) or gastroesophageal reflux. Our gastrointestinal tract has a forward propulsive movement (peristalsis) that moves the food material forward as it is digested, absorbed and finally expelled as feces. If somehow this movement gets hampered, food along with the digestive juices would stagnate, stomach acid will reflux into the food pipe and on the other hand the bowel habits would not be proper. Degradation of undigested food in the intestines by the intestinal bacteria.
Second differencial of right sides pain is gallbladder pathology.
HIDA scan is usually not a good one rather a MRCP should be done in which MRI waves are used .This is a highly sensitive and specific test
In order to relieve yourself, you need to do the following:
*Gargle twice with Betafine solution
* Avoid spicy food. Take small but frequent meals. Avoid long gaps between meals.
* Avoid alcohol intake (if it a part of your habit).
* Take plenty of green leafy vegetables as well as other sources of dietary fibers. Take fiber supplements like isabgol/psyllium husk or senna. I would insist you to increase your dietary fiber intake.
* Regular morning walk and exercise to keep the bowel movements proper.
* If I had a patient like you I would perhaps have suggested Prodep (fluoxetine) 20 mg tablet (long term anxiolytic and a prescription drug) once daily for at least 2 months (it may take time for the action to set in). Discuss about this with your treating physician.
* Take curd or yogurt on daily basis. It contains beneficial bacteria and should help.
* Stress reduction has a very important role to play. Yoga and meditation should help.
Revert back with duration potency and name of medicine you are on.
Hopefully that should help.
Let me know if I could help further.
Regards
MRCP should be done.Its a non invasive test just splits water contents.
Detailed Answer:
Hi,
Thanks for asking on HealthcareMagic.
I have gone very carefully through your query. Your problem seems to be due to gastritis(Kindly mention the name duration of antacid you are on) or gastroesophageal reflux. Our gastrointestinal tract has a forward propulsive movement (peristalsis) that moves the food material forward as it is digested, absorbed and finally expelled as feces. If somehow this movement gets hampered, food along with the digestive juices would stagnate, stomach acid will reflux into the food pipe and on the other hand the bowel habits would not be proper. Degradation of undigested food in the intestines by the intestinal bacteria.
Second differencial of right sides pain is gallbladder pathology.
HIDA scan is usually not a good one rather a MRCP should be done in which MRI waves are used .This is a highly sensitive and specific test
In order to relieve yourself, you need to do the following:
*Gargle twice with Betafine solution
* Avoid spicy food. Take small but frequent meals. Avoid long gaps between meals.
* Avoid alcohol intake (if it a part of your habit).
* Take plenty of green leafy vegetables as well as other sources of dietary fibers. Take fiber supplements like isabgol/psyllium husk or senna. I would insist you to increase your dietary fiber intake.
* Regular morning walk and exercise to keep the bowel movements proper.
* If I had a patient like you I would perhaps have suggested Prodep (fluoxetine) 20 mg tablet (long term anxiolytic and a prescription drug) once daily for at least 2 months (it may take time for the action to set in). Discuss about this with your treating physician.
* Take curd or yogurt on daily basis. It contains beneficial bacteria and should help.
* Stress reduction has a very important role to play. Yoga and meditation should help.
Revert back with duration potency and name of medicine you are on.
Hopefully that should help.
Let me know if I could help further.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Hello Dr. XXXXXXX thank you for the reply. I am currently taking lansiprazole and ranitidine. I have been taking them for 6 weeks. My bowel habits are regular, and I have no problems there, besides occasional rectal and colonic spasms after bowel movements or during the night. My diet consists mainly of fish, vegetables, dairy, fruits and grains throughout the week. I also take probiotics in capsule form daily and also eat high quality whole Greek yogurt.
As far as my mental health medications: I am sensitive to many SSRI's as far as side effects (neurological problems) and have had genetic testing done regarding medication compatibility. I have tried fluoxetine in the past and had side effects similar to MS. The regimen I am on now so far has worked the best (decreasing incidence of arrhythmias).
I have also been doing meditation and yoga practice, except recently since I injured my shoulder. But I still continue with meditation.
Regarding the high calcitriol level and low cholecalciferol, what is your recommendation? This is not normal and my PCP has not offered any further testing. My calcium and albumin were also mildly elevated, but I know that the high albumin can cause false elevation of calcium. This the adjusted calcium level is in normal range.
Thank you so much for your advice so far! I will certainly ask for an MRCP.
As far as my mental health medications: I am sensitive to many SSRI's as far as side effects (neurological problems) and have had genetic testing done regarding medication compatibility. I have tried fluoxetine in the past and had side effects similar to MS. The regimen I am on now so far has worked the best (decreasing incidence of arrhythmias).
I have also been doing meditation and yoga practice, except recently since I injured my shoulder. But I still continue with meditation.
Regarding the high calcitriol level and low cholecalciferol, what is your recommendation? This is not normal and my PCP has not offered any further testing. My calcium and albumin were also mildly elevated, but I know that the high albumin can cause false elevation of calcium. This the adjusted calcium level is in normal range.
Thank you so much for your advice so far! I will certainly ask for an MRCP.
Hello Dr. XXXXXXX thank you for the reply. I am currently taking lansiprazole and ranitidine. I have been taking them for 6 weeks. My bowel habits are regular, and I have no problems there, besides occasional rectal and colonic spasms after bowel movements or during the night. My diet consists mainly of fish, vegetables, dairy, fruits and grains throughout the week. I also take probiotics in capsule form daily and also eat high quality whole Greek yogurt.
As far as my mental health medications: I am sensitive to many SSRI's as far as side effects (neurological problems) and have had genetic testing done regarding medication compatibility. I have tried fluoxetine in the past and had side effects similar to MS. The regimen I am on now so far has worked the best (decreasing incidence of arrhythmias).
I have also been doing meditation and yoga practice, except recently since I injured my shoulder. But I still continue with meditation.
Regarding the high calcitriol level and low cholecalciferol, what is your recommendation? This is not normal and my PCP has not offered any further testing. My calcium and albumin were also mildly elevated, but I know that the high albumin can cause false elevation of calcium. This the adjusted calcium level is in normal range.
Thank you so much for your advice so far! I will certainly ask for an MRCP.
As far as my mental health medications: I am sensitive to many SSRI's as far as side effects (neurological problems) and have had genetic testing done regarding medication compatibility. I have tried fluoxetine in the past and had side effects similar to MS. The regimen I am on now so far has worked the best (decreasing incidence of arrhythmias).
I have also been doing meditation and yoga practice, except recently since I injured my shoulder. But I still continue with meditation.
Regarding the high calcitriol level and low cholecalciferol, what is your recommendation? This is not normal and my PCP has not offered any further testing. My calcium and albumin were also mildly elevated, but I know that the high albumin can cause false elevation of calcium. This the adjusted calcium level is in normal range.
Thank you so much for your advice so far! I will certainly ask for an MRCP.
Brief Answer:
Follow up answer.
Detailed Answer:
Hi again,
Cholecalciferol is a form of vitamin D which is naturally synthesized in skin and functions as a pro-hormone, being converted to calcitriol while Calcitrol is secreted by parathyroid gland.High levels of anxiety along with many other factors may increase the activity of parathyroid gland.
I would recommend you to consult an endocrinologist for the same(very likely he would ask for a check of parathormone levels in blood). This comes under superspeciality branch and general doctor usually don't know much about it.
Hope i was helpful,
Follow ups are welcome,
Thanks!
Follow up answer.
Detailed Answer:
Hi again,
Cholecalciferol is a form of vitamin D which is naturally synthesized in skin and functions as a pro-hormone, being converted to calcitriol while Calcitrol is secreted by parathyroid gland.High levels of anxiety along with many other factors may increase the activity of parathyroid gland.
I would recommend you to consult an endocrinologist for the same(very likely he would ask for a check of parathormone levels in blood). This comes under superspeciality branch and general doctor usually don't know much about it.
Hope i was helpful,
Follow ups are welcome,
Thanks!
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
Follow up answer.
Detailed Answer:
Hi again,
Cholecalciferol is a form of vitamin D which is naturally synthesized in skin and functions as a pro-hormone, being converted to calcitriol while Calcitrol is secreted by parathyroid gland.High levels of anxiety along with many other factors may increase the activity of parathyroid gland.
I would recommend you to consult an endocrinologist for the same(very likely he would ask for a check of parathormone levels in blood). This comes under superspeciality branch and general doctor usually don't know much about it.
Hope i was helpful,
Follow ups are welcome,
Thanks!
Follow up answer.
Detailed Answer:
Hi again,
Cholecalciferol is a form of vitamin D which is naturally synthesized in skin and functions as a pro-hormone, being converted to calcitriol while Calcitrol is secreted by parathyroid gland.High levels of anxiety along with many other factors may increase the activity of parathyroid gland.
I would recommend you to consult an endocrinologist for the same(very likely he would ask for a check of parathormone levels in blood). This comes under superspeciality branch and general doctor usually don't know much about it.
Hope i was helpful,
Follow ups are welcome,
Thanks!
Above answer was peer-reviewed by :
Dr. Yogesh D
I did request a PTH level from my PCP and it was normal (17). I have also requested a referral to endocrinology, but this has not yet been completed by my doctor.
Can sweet-tasting reflux be due to low acidity stomach acid, gastric ulcer or cancer? I had an endoscopy about 3 years ago because of my history of h. Pylori infection, the results were mild chronic gastritis in one area and biopsy results were negative for h. Pylori. Should I request a second endoscopy?
Can sweet-tasting reflux be due to low acidity stomach acid, gastric ulcer or cancer? I had an endoscopy about 3 years ago because of my history of h. Pylori infection, the results were mild chronic gastritis in one area and biopsy results were negative for h. Pylori. Should I request a second endoscopy?
I did request a PTH level from my PCP and it was normal (17). I have also requested a referral to endocrinology, but this has not yet been completed by my doctor.
Can sweet-tasting reflux be due to low acidity stomach acid, gastric ulcer or cancer? I had an endoscopy about 3 years ago because of my history of h. Pylori infection, the results were mild chronic gastritis in one area and biopsy results were negative for h. Pylori. Should I request a second endoscopy?
Can sweet-tasting reflux be due to low acidity stomach acid, gastric ulcer or cancer? I had an endoscopy about 3 years ago because of my history of h. Pylori infection, the results were mild chronic gastritis in one area and biopsy results were negative for h. Pylori. Should I request a second endoscopy?
Brief Answer:
No need of second endoscopy rather take proper medicine.A mouth swab culture is better.
Detailed Answer:
Hi again dear,
Sweet taste in mouth is a result of infestation by bacteria called pseudomonas.
GERD and acid peptic disorders destroys the normal gut pH of mouth which is alkaline and make it acidic(A Good medium for all bacterias to breed).Hence Suggestion-
Cap PanDSR once daily(to prevent acidity and reflux of acid) in stomach.
Gargle with medicated solution twice.
Hope i was helpful,
Thank you!
No need of second endoscopy rather take proper medicine.A mouth swab culture is better.
Detailed Answer:
Hi again dear,
Sweet taste in mouth is a result of infestation by bacteria called pseudomonas.
GERD and acid peptic disorders destroys the normal gut pH of mouth which is alkaline and make it acidic(A Good medium for all bacterias to breed).Hence Suggestion-
Cap PanDSR once daily(to prevent acidity and reflux of acid) in stomach.
Gargle with medicated solution twice.
Hope i was helpful,
Thank you!
Above answer was peer-reviewed by :
Dr. Yogesh D
Brief Answer:
No need of second endoscopy rather take proper medicine.A mouth swab culture is better.
Detailed Answer:
Hi again dear,
Sweet taste in mouth is a result of infestation by bacteria called pseudomonas.
GERD and acid peptic disorders destroys the normal gut pH of mouth which is alkaline and make it acidic(A Good medium for all bacterias to breed).Hence Suggestion-
Cap PanDSR once daily(to prevent acidity and reflux of acid) in stomach.
Gargle with medicated solution twice.
Hope i was helpful,
Thank you!
No need of second endoscopy rather take proper medicine.A mouth swab culture is better.
Detailed Answer:
Hi again dear,
Sweet taste in mouth is a result of infestation by bacteria called pseudomonas.
GERD and acid peptic disorders destroys the normal gut pH of mouth which is alkaline and make it acidic(A Good medium for all bacterias to breed).Hence Suggestion-
Cap PanDSR once daily(to prevent acidity and reflux of acid) in stomach.
Gargle with medicated solution twice.
Hope i was helpful,
Thank you!
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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