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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What is the cause of indigestion,loss of appetite,weight loss and irregular periods?

Hi, I have been suffering from indigestion and bloating for at least a year now and was not concerned about it as I thought it from recent childbirth. However, it has been becoming worse, I now suffer from loss of appetite from time to time, can not eat large meals, my intestinal area bothers me often, and I suffer from gas continuously, no matter what I eat/drink or do not eat/drink. I have also lost over 10 pounds suddenly and am unable to gain it back. I eat constantly and drink Ensure Plus for extra calories and nutrients to no avail. I have had blood work done, stool samples taken, a CT scan of the spine and abdominal area (revealed several small lesions too small to measure in the liver), an ultrasound of the abdominal area (revealed a slightly enlarged spleen and one small sizable mass in the liver that my doctor says is an hemangioma due to the MRI), an MRI of the abdominal area, an endoscopy, and a colonoscopy and all have come back clean/fine. I was greatly shocked that nothing was seen in the colon as it bothers me the most. Starting today, I have started experiencing some possible fluid backup when belching and that sensation of needing to throw up in the throat (a tightening). My great concern is that I may have linitis plastica since all my scans and tests have come back fine and since it originates in the lining. The abdominal wall was not measured in the scans and the ultrasound did not check for possible ascites. My doctors seem reluctant to do any further testing and yet, cannot give me a diagnosis. I do not know what I should do next. I understand that I have undergone a plethora of tests (and appreciate it) but yet my symptoms persists and grow. I have called the only other place that maybe able to help me (UW Medicine Center for Esophageal & Gastric Surgery) but they are so busy that my appointment isn t for another month and that is with a nurse practitioner. I would go to an ER in a heartbeat if I knew they could help diagnosis me. I fear what I need is a laparoscopy to know for sure. To make matters worse, I fear it maybe affecting my ovaries as I have had 2 irregular periods (VERY unusual as I have never spotted or been irregular before, even with major stressors), am suffering from a hormonal imbalance (when I menstruate, I go on a depression roller coaster that I cannot control, I am currently taking Quetiapine and Latuda, the latter recently started after being taken off of Lithium (no, I am not bipolar)), noticed in December that I am losing more hair than normal, and earlier this week awoke to abdominal cramping in the pelvic area. (Currently not menstruating.) An ultrasound of the ovaries came back clean as well. To add insult to injury, I just recently underwent a single mastectomy for IDC breast cancer with 3 lymph nodes effected. (I underwent a breast MRI, a brain MRI, and the CT scan of spine and abdomen for it.) It is ER+ PR+ HER-. I understand there is a connection between gastric cancer and lobular breast cancer, but I have ductal and my doctors have informed me that it curable. I am unsure of what I can do next to obtain a diagnosis of what is causing my symptoms. I don t understand why I am unable to gain weight and am worried that I maybe right with my possible self diagnosis, hence why I am actually inquiring via the internet. If I am correct, how do I have symptoms if there is no evidence of a cause within the organs (i.e. colon, esophagus, stomach). Please advise.
Thu, 24 Jul 2014
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General & Family Physician 's  Response
HELLO N WELCOME. YOU HV BEEN THROUGH A LOT N I REALLY APPRECIATE YOUR CONCERNS

FIRSTLY. GASTRIC OR ESOPHAGEAL MALIGNANCIES CAN ONLY BE CONFIRMED OR RULED OUT VIA UPPER GI ENDOSCOPY AND BIOPSY.

2NDLY. I WOULD ADVISE A 2 WEEK EMPIRIC AGGRESSIVE TREATMENT FOR YOUR DYSPEPSIA TO OBSERVE FOR IMPROVEMENY. IF SYMPTOMS PERSIST THEN YOU DEFINITELY NEED ENDOSCOPY.
PLZ TAKE
CAP NEXIUM 40 MG BD
TAB PEPZYME TDS
SYRUP BISMOL 2TSF TDS
SYRUP SUCRALFATE 2 TSF TDS

PLZ GET TESTED FOR H PYLORI VIA STOOL ANTIGEN OR UREASE BREATH TESTING.

FOR THE IRREGULAR MENSTRUAL CYCLES U R RIGHT STRESS DOES HV A STRONG ROLE IN DE REGULATING THEM.

I WOULD ADVISE U TO KEEP TAKING CAP DULOXETINE 20 MG OD FOR UPTO 3 MONTHS N DONT TAKE ANY OCPS OR HORMONAL REGULATORS YET IE GIVE IT TIME TO REGULARIZE THEMSELF. IF STILL THE DUB PERSISTS THEN OCPS OR PRIMOLUT N MAY BE STARTED IN CONSULTATION WITH UR GYNAE DOCTOR.

I WOULD ALSO ADVISE SOME INVESTIGATIONS IF U CAN LET ME KNOW UR COMPLETE RECENT BIOCHEMICAL PROFILE AND BLOOD PANEL
CBC
ESR
RFTS
LFTS
RBS
HBA1C
TFTS

PLZ DO LET ME KNOW UR AVERAGE B.P CONTROL AND ALL THE MEDICATIONS WHICH U R USING CURRENTLY SO THAT I MAY MAKE THE PROPER MODIFICATIONS.

HOPE I WAS OF SOME HELP
HV A NICE DAY.
THANX
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What is the cause of indigestion,loss of appetite,weight loss and irregular periods?

HELLO N WELCOME. YOU HV BEEN THROUGH A LOT N I REALLY APPRECIATE YOUR CONCERNS FIRSTLY. GASTRIC OR ESOPHAGEAL MALIGNANCIES CAN ONLY BE CONFIRMED OR RULED OUT VIA UPPER GI ENDOSCOPY AND BIOPSY. 2NDLY. I WOULD ADVISE A 2 WEEK EMPIRIC AGGRESSIVE TREATMENT FOR YOUR DYSPEPSIA TO OBSERVE FOR IMPROVEMENY. IF SYMPTOMS PERSIST THEN YOU DEFINITELY NEED ENDOSCOPY. PLZ TAKE CAP NEXIUM 40 MG BD TAB PEPZYME TDS SYRUP BISMOL 2TSF TDS SYRUP SUCRALFATE 2 TSF TDS PLZ GET TESTED FOR H PYLORI VIA STOOL ANTIGEN OR UREASE BREATH TESTING. FOR THE IRREGULAR MENSTRUAL CYCLES U R RIGHT STRESS DOES HV A STRONG ROLE IN DE REGULATING THEM. I WOULD ADVISE U TO KEEP TAKING CAP DULOXETINE 20 MG OD FOR UPTO 3 MONTHS N DONT TAKE ANY OCPS OR HORMONAL REGULATORS YET IE GIVE IT TIME TO REGULARIZE THEMSELF. IF STILL THE DUB PERSISTS THEN OCPS OR PRIMOLUT N MAY BE STARTED IN CONSULTATION WITH UR GYNAE DOCTOR. I WOULD ALSO ADVISE SOME INVESTIGATIONS IF U CAN LET ME KNOW UR COMPLETE RECENT BIOCHEMICAL PROFILE AND BLOOD PANEL CBC ESR RFTS LFTS RBS HBA1C TFTS PLZ DO LET ME KNOW UR AVERAGE B.P CONTROL AND ALL THE MEDICATIONS WHICH U R USING CURRENTLY SO THAT I MAY MAKE THE PROPER MODIFICATIONS. HOPE I WAS OF SOME HELP HV A NICE DAY. THANX