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Nausea, Nerve Weakness, Sensation Along Spine. Malfunctioning Pancreas Or Perimenopause?
Question: My wife was given 5 days of oral steroids, nasal steroids (around a month) and anti-allergic medicines to reduce her nasal polyps before a sinus surgery. She immediately started feeling nauseous. This was 5 months ago. Through these 5 months, she has had 7 dozes of various antibiotics (for H-pilori, post-nasal-surgery, others), and a megadose of Vitamin D injection + 3 sachets of Calcerol (Her Vitamin D level had fallen to 11, now OK) and also 3 shots of Vitamin B Complex injections.
We have got a CT Scan (Abdomen + Chest), Ultrasound (Abdomen), Endoscopy, Colonoscopy, X-ray complete spine, CT Brain (before sinus surgery) done. All clear. She lost 4 kgs, but then steadied out. She is 49, but not reached menopause yet.
Her nausea has progressively increased. Does not throw up. Appetite healthy, but VERY nauseous 24x7. Weight steady. Hb level steady at 11.5. Thyroid levels fine. Ferratin low. Surge of 'nerve weakness' in upper arms. Sensation along spine travelling up to nape of neck. CD/Colonoscopy detected non-specific thickening of colon walls near cicum and sigmoid.
QUERY:
Can her pancreas be malfunctioning. The net says that not all patients experience pain. But without CT and ultrasound detecting any inflammation, can there be a problem with the pancreas that is causing:
1. Acute nausea 24x7
2. Increase in nausea 1 hour after eating and while lying on the right side
3. Feeling of weakness - especially in arms
4. Fluctuating blood pressure and pulse rate
5. Hb level having come down from her regular 13-14 to 11.5?
6. Ferratin level had fallen to 7.4. Now little better at 10.4?
7. Has become extremely reactive to all drugs - including a simple para
If yes, will a blood test help figure this out? What tests? Does she need to give the blood sample on an empty stomach?
Can we include some other blood tests to figure out some other reasons that could possibly be causing her nausea? Hormones?
CAN ALL THIS BE SIMPLY PERI SYMPTOMS? SUCH ACUTE 24x7 NAUSEA?
We have got a CT Scan (Abdomen + Chest), Ultrasound (Abdomen), Endoscopy, Colonoscopy, X-ray complete spine, CT Brain (before sinus surgery) done. All clear. She lost 4 kgs, but then steadied out. She is 49, but not reached menopause yet.
Her nausea has progressively increased. Does not throw up. Appetite healthy, but VERY nauseous 24x7. Weight steady. Hb level steady at 11.5. Thyroid levels fine. Ferratin low. Surge of 'nerve weakness' in upper arms. Sensation along spine travelling up to nape of neck. CD/Colonoscopy detected non-specific thickening of colon walls near cicum and sigmoid.
QUERY:
Can her pancreas be malfunctioning. The net says that not all patients experience pain. But without CT and ultrasound detecting any inflammation, can there be a problem with the pancreas that is causing:
1. Acute nausea 24x7
2. Increase in nausea 1 hour after eating and while lying on the right side
3. Feeling of weakness - especially in arms
4. Fluctuating blood pressure and pulse rate
5. Hb level having come down from her regular 13-14 to 11.5?
6. Ferratin level had fallen to 7.4. Now little better at 10.4?
7. Has become extremely reactive to all drugs - including a simple para
If yes, will a blood test help figure this out? What tests? Does she need to give the blood sample on an empty stomach?
Can we include some other blood tests to figure out some other reasons that could possibly be causing her nausea? Hormones?
CAN ALL THIS BE SIMPLY PERI SYMPTOMS? SUCH ACUTE 24x7 NAUSEA?
Hi
Thanks for the query
Nausea could be due various reasons such as acidity, medicines taken, pancreatic and liver conditions.
After going through the history, I do feel that your wife is suffering from more of gastric related problems rather than other problems. The gastric problem could be due to increased acid production secondary to the medicines taken (such as oral steroids, calcium tablets, and those medicines to increase the hemoglobin level).
It is very unlikely that it could be because of pancreatitis, as there will be sudden bout of vomiting, abdominal pain, back pain, lassitude and foul smelling loose stools, etc.
1. Yes, acute pancreatitis can induce nausea, which can remain whole day till the infection clears off.
2. Increase in nausea 1 hour after eating is typical of peptic ulcers and more over on lying straight and reduces on lying over the left side.
3. Feeling of weakness in the arms could be related to imbalance of calcium in the body.
4. Fluctuating blood pressure and pulse rate is not related to pancreatitis.
5 & 6. Reduced hemoglobin and ferritin level could be because of bleeding peptic ulcers. The main cause of reduction of hemoglobin and ferritin has to be found out rather than mere correction of the counts.
7. This could be again related to peptic ulcer rather than pancreatic problem, even though this happens occasionally in chronic pancreatitis.
If you want the pancreatic problems to be ruled out it is better to get the following tests done:
a. Serum amylase and lipase levels
b. Serum calcium and triglyceride levels
c. Stool examination
d. Endoscopic Retrograde Cholangio-pancreatography (ERCP)
I would suggest you to encourage her to take plenty of water, avoid coffee/tea, fatty food and take frequent small meals. Also, it is wise to consult a good Gastroenterologist for a thorough examination and further management.
Hope I have answered your query; I will be available for the follow-up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Thanks for the query
Nausea could be due various reasons such as acidity, medicines taken, pancreatic and liver conditions.
After going through the history, I do feel that your wife is suffering from more of gastric related problems rather than other problems. The gastric problem could be due to increased acid production secondary to the medicines taken (such as oral steroids, calcium tablets, and those medicines to increase the hemoglobin level).
It is very unlikely that it could be because of pancreatitis, as there will be sudden bout of vomiting, abdominal pain, back pain, lassitude and foul smelling loose stools, etc.
1. Yes, acute pancreatitis can induce nausea, which can remain whole day till the infection clears off.
2. Increase in nausea 1 hour after eating is typical of peptic ulcers and more over on lying straight and reduces on lying over the left side.
3. Feeling of weakness in the arms could be related to imbalance of calcium in the body.
4. Fluctuating blood pressure and pulse rate is not related to pancreatitis.
5 & 6. Reduced hemoglobin and ferritin level could be because of bleeding peptic ulcers. The main cause of reduction of hemoglobin and ferritin has to be found out rather than mere correction of the counts.
7. This could be again related to peptic ulcer rather than pancreatic problem, even though this happens occasionally in chronic pancreatitis.
If you want the pancreatic problems to be ruled out it is better to get the following tests done:
a. Serum amylase and lipase levels
b. Serum calcium and triglyceride levels
c. Stool examination
d. Endoscopic Retrograde Cholangio-pancreatography (ERCP)
I would suggest you to encourage her to take plenty of water, avoid coffee/tea, fatty food and take frequent small meals. Also, it is wise to consult a good Gastroenterologist for a thorough examination and further management.
Hope I have answered your query; I will be available for the follow-up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Dr. XXXXXXX
A gatroenterologist has done a a complete edcoscopy and colonoscopy. We have also done a CT of the complete abdomen. It is all clear. So peptic ulcers may not be the problem.
She spaces out her food, eats very light food, and has lots of water.
You certainly have a point about the pancreatic problems - even if pain is not there for some patients, she should have had the other symptoms like lassitude and foul smelling loose stools. The question that still remains is whether an individual can have a malfunctioning pancreas when:
1. She has no enlarged pancreas
2. She has discomfort (tingling, glawing feeling) eminating from her amdomen, and travelling up along her back - but without pain
3. She had extreme 24 x7 nausea when given contrast fluid for CT, after being given peglec and sedatives for a colonoscopy procedure - but otherwise her acute nausea comes 5-6 times in 24 hours and lasts 30 minutes to one and a half hour and then subsides.
4. She has a general sense of fatigue, and acute bouts of weakness in her arms with ocassional XXXXXXX inside her arms. Stragely, these symptoms suddenly started a couple of months back.
5. Her nausea/discomfort becomes much less when she takes ajwain (caraway seeds), or a bit of food or a unienzyme tablet with her food. Rubbing Olisan on her tummy and back also helps.
ALTHOUGH YOU HAVE NOT SPECIFICALLY ANSWERED THIS, WE HAVE FOUND BLOGS THAT STATE THAT PERIMENOPAUSE CAN BE EXTREMELY DEBILITATING, AND LOTS OF WOMEN HAVE A LOT NAUSEA AND A PLAIN/DISCOMFORT IN THE ARMS AND BACK. CONSIDERING HER ENDOSCOPY, COLONOSCOPY, AMBULATORY BLOOD PRESSURE TEST, CT, X-RAY AND BLOOD TESTS HAVE NOT SHOWN ANY MAJOR PROBLEM, CAN ALL THIS BE WRITTEN OFF AS PERIMENOPAUSE SYMPTOMS?
A gatroenterologist has done a a complete edcoscopy and colonoscopy. We have also done a CT of the complete abdomen. It is all clear. So peptic ulcers may not be the problem.
She spaces out her food, eats very light food, and has lots of water.
You certainly have a point about the pancreatic problems - even if pain is not there for some patients, she should have had the other symptoms like lassitude and foul smelling loose stools. The question that still remains is whether an individual can have a malfunctioning pancreas when:
1. She has no enlarged pancreas
2. She has discomfort (tingling, glawing feeling) eminating from her amdomen, and travelling up along her back - but without pain
3. She had extreme 24 x7 nausea when given contrast fluid for CT, after being given peglec and sedatives for a colonoscopy procedure - but otherwise her acute nausea comes 5-6 times in 24 hours and lasts 30 minutes to one and a half hour and then subsides.
4. She has a general sense of fatigue, and acute bouts of weakness in her arms with ocassional XXXXXXX inside her arms. Stragely, these symptoms suddenly started a couple of months back.
5. Her nausea/discomfort becomes much less when she takes ajwain (caraway seeds), or a bit of food or a unienzyme tablet with her food. Rubbing Olisan on her tummy and back also helps.
ALTHOUGH YOU HAVE NOT SPECIFICALLY ANSWERED THIS, WE HAVE FOUND BLOGS THAT STATE THAT PERIMENOPAUSE CAN BE EXTREMELY DEBILITATING, AND LOTS OF WOMEN HAVE A LOT NAUSEA AND A PLAIN/DISCOMFORT IN THE ARMS AND BACK. CONSIDERING HER ENDOSCOPY, COLONOSCOPY, AMBULATORY BLOOD PRESSURE TEST, CT, X-RAY AND BLOOD TESTS HAVE NOT SHOWN ANY MAJOR PROBLEM, CAN ALL THIS BE WRITTEN OFF AS PERIMENOPAUSE SYMPTOMS?
Hello again,
I am Dr. Shanthi ( Moderator) from XXXXXXX
I apologize for not being able to convince you with the previous answer.
I have sent across your query to an expert Gynecologist. We shall be receiving her suggestions soon.
Kindly be patient with us. We shall get back to you with the answer from this expert as early as possible and you can view it on your dashboard.
Regards,
Dr. Shanthi
I am Dr. Shanthi ( Moderator) from XXXXXXX
I apologize for not being able to convince you with the previous answer.
I have sent across your query to an expert Gynecologist. We shall be receiving her suggestions soon.
Kindly be patient with us. We shall get back to you with the answer from this expert as early as possible and you can view it on your dashboard.
Regards,
Dr. Shanthi
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Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
Dr. Naveen Kumar Nanjasetty
Otolaryngologist / ENT Specialist
Practicing since :2001
Answered : 2542 Questions
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