Pancreatic Cancer worry

[Mai1994]

Hi all,

Firstly, apologies if topics of this nature are not allowed, or if I am in the wrong forum. If so, please feel free to delete this topic.

I’m 25, male, don’t drink or smoke, not overweight. Since March, after having a takeaway meal, I have been experiencing on and off IBS like issues. Initially felt nauseous and had a reduced appetite along with occasional loose-ish floating stools light brown in colour. No real pains, but do have gas now and then, especially if I have a spicy or very fatty meal.

As I have a family member with coeliac disease, my GP recommended I had a blood test for it and a general full blood count. I should add that my previous FBC came back all good in April 2018.

By chance, I was suffering from a suspected sinus infection at the time of having the blood test and was taking plenty of paracetamol and decongestant tablets.

Anyway, received the results a few days ago. White cell count and ESR slightly raised, Vit D deficiency and raised liver markers of which ALT and ALP were just under twice the upper limit. Coeliac test came back negative and all other blood work was spot on.

I do suffer from health anxiety to an extent, so this has got me worried. My ongoing jumpy stomach and the liver tests have got me fearing pancreatic cancer. My GP doesn’t seem concerned and has requested a repeat FBC in a few weeks time. I generally look and feel fine, no tiredness or signs of jaundice.

However, should I be pushing my GP for an ultrasound scan? I do think my stomach issues have been exacerbated by my worrying but I have lost around 1-1.5kg since March. Typically though, I have always struggled to gain weight and as such, my weight hovers around the 66/67kg mark. At the moment it is at 65/66kg.

Apologies for the long post.

[PCUK Nurse Jeni]

Hello Mai,

Thank you for your post, and apologies that we have been unable to respond until now.

I am sorry to hear that you have been having some health concerns of late.

You seem to have a good overview of when your symptoms appear, and what triggers them - which is good. Also, good to hear that you don't drink or smoke - which is unusual for a male of your age - good for you.

You indicate that since the take away meals, or fatty/spicy food, they you get the symptoms. Can I ask, other than when you eat these foods, are you symptom free? For example, if you eat food which is not takeaway, fatty or spicy? And are your bowel habits "normal" during these times? And do you still suffer from the gas, or is this again only associated with such foods?

Your gp sounds proactive which is good, and sensible to test for coeliac disease, as it can cause some of these issues, along with anemia. Positive that this was normal.

Mai, in terms of the raises ESR, then this could be accounted for by the sinus infection certainly, so nothing untoward to worry about there.

What has the gp said about the Vitamin D deficiency? Have you been started on any Vit D supplements? Or what is the plan? Do you know your exact levels at all? This does need addressing, because we know that if a person has some form of malabsorption issue (not saying you have, but you mention the floating stools, so better to be vigilant), then they can lose Fat soluble vitamins, one of these being Vitamin D. A long term Vitamin D deficiency can lead to reduced absorption of calcium, which is needed for healthy bones. Do ask your gp about this Mai, and what needs to be done.

With regards to the liver function, this does also need to be rechecked in 2-3 weeks time, to see if this is normalised or consistently high. With regards to the paracetamol and decongestant, did you check that the decongestant didn't also contain paracetamol? And did you stick to the recommended dose for paracetamol? Too much paracetamol can sometimes affect the liver function, so be wise to just double check you weren't taking too much. Hopefully, the repeat test will be OK. If the FBC was OK, then its the liver function tests which need repeating, maybe also the vitamin D levels depending on how low they were.

In terms of the stools and digestive issues after certain meals, then perhaps talk to your gp about maybe checking your absorption levels - a stool test can be done called Faecal Elastase, which will tell if you are malabsorbing or not. Sometimes, there isn't a reason for this per say. Worth having a chat about.

You don't mention any pain or anything which is positive. Or significant weight loss - you have quite sensibly pointed out that your anxiety can cause weight loss, which is true. I don't think an Ultrasound is needed at this moment Mai, but if the bloods come back abnormal again, then yes. It could be that your sinus infection affected everything.

In the meantime, try eating foods rich in Vit D. You can have a look here:

https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/

Of course, most of this comes from sunlight, and I fear we are not getting enough of this at the moment.

I hope this helps?

Should you wish to contact us further, please dont hesitate to email us - address below.

Kind regards,

Jeni.

Jeni Jones

Pancreatic Cancer Specialist Nurse

Support Team

Pancreatic Cancer UK

email: nurse@pancreaticcancer.org.uk

support line: 0808 801 0707

[Mai1994]

PCUK Nurse Jeni wrote:

> Hello Mai,

>

> Thank you for your post, and apologies that we have been unable to respond

> until now.

>

> I am sorry to hear that you have been having some health concerns of late.

>

> You seem to have a good overview of when your symptoms appear, and what

> triggers them - which is good. Also, good to hear that you don't drink or

> smoke - which is unusual for a male of your age - good for you.

>

> You indicate that since the take away meals, or fatty/spicy food, they you

> get the symptoms. Can I ask, other than when you eat these foods, are you

> symptom free? For example, if you eat food which is not takeaway, fatty or

> spicy? And are your bowel habits "normal" during these times? And

> do you still suffer from the gas, or is this again only associated with

> such foods?

>

> Your gp sounds proactive which is good, and sensible to test for coeliac

> disease, as it can cause some of these issues, along with anemia. Positive

> that this was normal.

>

> Mai, in terms of the raises ESR, then this could be accounted for by the

> sinus infection certainly, so nothing untoward to worry about there.

>

> What has the gp said about the Vitamin D deficiency? Have you been started

> on any Vit D supplements? Or what is the plan? Do you know your exact

> levels at all? This does need addressing, because we know that if a person

> has some form of malabsorption issue (not saying you have, but you mention

> the floating stools, so better to be vigilant), then they can lose Fat

> soluble vitamins, one of these being Vitamin D. A long term Vitamin D

> deficiency can lead to reduced absorption of calcium, which is needed for

> healthy bones. Do ask your gp about this Mai, and what needs to be done.

>

> With regards to the liver function, this does also need to be rechecked in

> 2-3 weeks time, to see if this is normalised or consistently high. With

> regards to the paracetamol and decongestant, did you check that the

> decongestant didn't also contain paracetamol? And did you stick to the

> recommended dose for paracetamol? Too much paracetamol can sometimes affect

> the liver function, so be wise to just double check you weren't taking too

> much. Hopefully, the repeat test will be OK. If the FBC was OK, then its

> the liver function tests which need repeating, maybe also the vitamin D

> levels depending on how low they were.

>

> In terms of the stools and digestive issues after certain meals, then

> perhaps talk to your gp about maybe checking your absorption levels - a

> stool test can be done called Faecal Elastase, which will tell if you are

> malabsorbing or not. Sometimes, there isn't a reason for this per say.

> Worth having a chat about.

>

> You don't mention any pain or anything which is positive. Or significant

> weight loss - you have quite sensibly pointed out that your anxiety can

> cause weight loss, which is true. I don't think an Ultrasound is needed at

> this moment Mai, but if the bloods come back abnormal again, then yes. It

> could be that your sinus infection affected everything.

>

> In the meantime, try eating foods rich in Vit D. You can have a look here:

>

> https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/

>

> Of course, most of this comes from sunlight, and I fear we are not getting

> enough of this at the moment.

>

> I hope this helps?

> Should you wish to contact us further, please dont hesitate to email us -

> address below.

>

> Kind regards,

>

> Jeni.

>

> Jeni Jones

> Pancreatic Cancer Specialist Nurse

> Support Team

> Pancreatic Cancer UK

> email: nurse@pancreaticcancer.org.uk

> support line: 0808 801 0707

Hi Jeni, thanks very much for your detailed response, much appreciated. Apologies for the late reply, after a few days of my original post I thought that nobody would respond so I forgot I had posted it!

I am still getting bowel symptoms but they have improved somewhat. It is quite unpredictable. Some days my bowels are fine even if I eat a large, fatty meal. Other days I pass a lot of wind and get bloated occasionally. It may be that my bowels are ‘getting used to’ fatty meals again after being upset from a bug. I should add that frequency of bowel movements has not changed and I still empty them once per day usually around the same time.

However, in recent weeks I have tried to eat a bit more in an effort to gain some weight. Unfortunately, although I haven’t weighed myself much, I haven’t really gained anything. The last time I checked, I was almost 67kg but I feel I should be more than that. I do tend to worry about my health and have become obsessed about my weight. A few people have mentioned that I look as if I have lost weight. So there still could be some form of malabsorption going on and I will discuss this at my next GP appointment along with the Vitamin D.

With regards to my blood tests, the repeat test I had showed that the liver enzymes ALT and ALP had fallen back into range. However, another enzyme called GGT was slightly raised (wasn’t tested for this originally), so I will be having a third test. My GP isn’t too concerned and the thinking seems to be that whatever infection I had sent my liver into a bit of a loop for a while.

My appetite is pretty much back to normal and I don’t have any tiredness, exhaustion or abdominal pains.

[PCUK Nurse Rachel R]

Hi Mai,

Thanks for your reply, I'm Rachel - one of the other nurses. There are numerous reassuring things here which is positive.

Perhaps if you wish to chat further with one of us then please do give our support service a call or send an email.

It's good that your GP is continuing to see you and doing a recheck of your liver function tests.

Do feel able to contact us if needed - details are below.

Kind wishes, Rachel

Rachel Richardson

Pancreatic Cancer Specialist Nurse

Support Team

Pancreatic Cancer UK

email: nurse@pancreaticcancer.org.uk

support line: 0808 801 0707