Struggling for Answers: Two Months of Pain, New Tests May Point to Pancreatic Issues
A 32-year-old female, weighing 55.5 kg and standing at 1.74 m, has been battling severe discomfort for over two months. Despite previous assessments suggesting she was not seriously ill, recent tests—including a fecal fat test and CA 19-9 levels—tell a different story. She feels uncertain and seeks direction amidst her ongoing health struggles. Here’s a summary of her current condition: - Chronic pain in the upper to mid-left back, intensifying at night and in a reclined position, but easing when standing or moving. - Ache on the left side of the ribcage and beneath the sternum. - Noticeable weight reduction: 7.5 kg lost since March, decreasing from 63 kg to 55.5 kg. - Persistent fatigue, unrefreshing rest, and frequent dizziness when standing up. - Regular burping, feelings of nausea after eating, particularly with rich or sugary foods. - Sensation of fullness in the upper stomach several hours post-meal. - Softer, buoyant, pale stools—confirmed moderate to severe steatorrhea (21.45 g/24h). - Discomfort and pain while speaking, along with ongoing irritation in the throat and upper chest. - Menstrual cycles beginning a week early, which is atypical for her. **Tests and Imaging Results:** - Abdominal CT scan (conducted on May 21): Results normal, with microcysts identified measuring 5mm. - Pancreatic MRI (performed on May 22): Also normal, revealing one 5mm microcyst in the pancreas, interpreted by Professor Lionel Arrivé. - Endoscopic ultrasound (May 30): Normal pancreatic function, very thin Wirsung duct, minor inflammatory cardia nodule, and benign esophageal nodules which were biopsied. - Upper endoscopy showed mild gastritis and confirmed the presence of esophageal nodules. - Stool pancreatic elastase levels were normal. - Fecal fat test (Eurofins Bioclinic): 21.45 g/24h, confirming maldigestion steatorrhea with undigested fats and proteins noted, normal transit time suggesting possible pancreatic, gastric, or biliary insufficiencies. - A near-infrared spectroscopy analysis indicated 27% fat content (with a normal range of 16-23%). **Blood Test Analysis:** - CA 19-9: 47.9 UI/mL (slightly elevated). - All other tumor markers (CEA, AFP, CA 15-3, CA 125): Normal levels. - Low folate and decreasing iron levels (currently at 24 µg/L). - Echocardiogram (June): Results normal. - Biopsied esophageal and gastric nodules appear benign and do not respond to proton pump inhibitors (PPIs).
Answers (1)
6/22/2025, 2:30:46 PM
OpenHealth AI
I'm sorry to hear about the ongoing pain and discomfort you've been experiencing. It’s understandable to feel uncertain, especially with the complexities of your symptoms and the test results. Let’s break this down into manageable steps to help you find relief and clarity regarding your health situation.
Key Points:
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Symptoms Suggest Possible Pancreatic Issues: Your symptoms, including weight loss, fatigue, digestive problems, and the presence of steatorrhea (indicating fat malabsorption), may point towards pancreatic insufficiency or other digestive issues.
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Test Results and Monitoring: You've had several tests that provide important insights, including a slight elevation in CA 19-9, which needs to be monitored but isn't alone a definitive indicator of serious illness, especially without other abnormal tumor markers.
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Action Steps: Immediate steps should focus on managing symptoms, dietary adjustments, and regular monitoring of your condition.
Actionable Guidance:
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Dietary Modifications:
- Low-Fat Diet: Given your steatorrhea, consider reducing fat intake significantly. Focus on easily digestible foods such as lean proteins, fruits, vegetables, and whole grains.
- Frequent Small Meals: Instead of large meals, try eating smaller, more frequent meals to reduce digestive discomfort and fullness.
- Hydration: Ensure you're drinking plenty of fluids, which can help with symptoms of dizziness and fatigue.
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Monitoring Symptoms:
- Symptom Diary: Keep a detailed log of your symptoms, including when they occur, their intensity, and any potential food triggers. This may help identify patterns or causes.
- Track Weight: Continue to monitor your weight closely. Rapid unintentional weight loss is concerning and should be addressed promptly.
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Manage Pain and Discomfort:
- Positioning: Since you’ve mentioned pain when reclined, try using pillows to find a comfortable position while sleeping or sitting that alleviates discomfort.
- Medications: Over-the-counter pain relief (like acetaminophen) can help manage pain, but consult with a healthcare provider on chronic use.
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Follow-Up Plans:
- Given the complexity of your symptoms and tests, regular follow-ups are crucial. Be proactive in scheduling appointments with your healthcare provider to discuss ongoing symptoms, especially monitoring CA 19-9 levels and the results of the biopsied nodules.
- Consider consulting with a gastroenterologist for a specialized assessment of your pancreatic function and digestive health.
Emotional Support:
It's completely normal to feel overwhelmed with these health struggles. Don't hesitate to reach out to friends, family, or support groups for emotional support. Connecting with others who may have faced similar challenges can be beneficial.
If you have any questions or need further information about specific aspects of your symptoms or management, feel free to ask. You’re taking important steps, and I’m here to support you in this journey toward better health.
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