To think that the Consultant should do SOMETHING to help a woman in pain?

[Blazing88]

Been ill since January. Finally accepted something might be wrong (!) and rang doctors for an appointment. Had to wait 3 weeks. Was then sent for blood tests. Another 3 week wait. Test results back today - allegedly, there is nothing wrong.

Symptoms are:

indigestion, acidity and burping
feeling full
bleeding
feeling tired and breathless
pain, nausea
difficulty swallowing

This is my mother. She's 60 something, normally in good health.

The consultant told her the blood are clear, therefore there is nothing wrong with her.

She is in extreme pain, both sides of her body, to the extent that she can't sleep properly at night. The indigestion/acidity etc, she has been given tablets for, but it's still a painful experience. She has gained weight recently and the doc says it's probably just post menopausal weight gain. (she believes she is eating no differently and the weight is just piling on)

Being a typical bloody 'old' person (she's not old, but she seems now to have turned into one :( ) she is now saying that she is not going to do anything else, as if it was something sinister (ie stomach cancer) it would have shown up in the blood.

Can anyone medical advise? What should she ask to be tested next? What could it be? I think she should insist on a scan, even go private if needs be, but would that be worthwhile?

She is being so stubborn about this (the doctors are always right blah blah) but I think she should insist on a second opinion/more tests. I just don't know what tests she could be asking for!!

The private GP is potentially a good idea and perhaps for diagnostics like a barium swallow and/or therapy if needed, but I would try the NHS for a bit longer for secondary care like seeing more consultants. Otherwise she could end up paying a lot for one consultant appointment when she might need to see a whole bunch of people. However, if she is not improving or getting answers she should request a second opinion and always, always get copies of the letters.

Definitely get a second opinion. But don't panic yet. I had exactly the same problems but it was a hiatus hernia which had pulled my stomach out of shape and acid was coming up my oesophagus and burning my throat. I couldn't swallow, had problems with bloating, blood coming up. I had a fundoplication 10 years ago and have had absolutely no problems since.

I'm going to PM you the name of my consultant, he does gastroenterology and he is absolutely brilliant. He does private as well as NHS, so if you can travel to go private or are in my area may be useful for you.

Without knowing your mum's full history or examining her it is a little difficult to be really sure what to suggest. Her symptoms could be a number of things, some benign, some not. I think the best thing to do would be to seek a second opinion, doesn't have to be private.

Is she bleeding from her rectum or vagina?

If she is bleeding vaginally, she should get a referral to the Post-menopausal bleeding clinic (gynae), I'd probably also want to see results of a pelvic ultrasound scan for endometrial thickness etc (some areas this is done in clinic and doesn't need done before)- further Ix would depend on these findings. CA125 seems to be recommended frequently on mumsnet, but it is pretty non-specific so can be raised for lots of other reasons and is not produced by all types of ovarian ca, so even if negative patient's with PMB should still be referred to gynae.

If she is bleeding from her rectum, even if normal bloods my understanding is she should still be referred for colonoscopy although would not be as an emergency (not a colorectal specialist or GP, so happy to be corrected) and for the upper GI symptoms (nausea, swallowing problems) it may prove to just be simple gastro-oesophageal reflux which can be remarkably painful and can cause swallowing difficulties or even hoarseness. Has she been tested for H. Pylori (stool sample)? This can cause reflux type symptoms and should be excluded before referring for endoscopy examination for reflux/dyspepsia symptoms. If she has real difficulties swallowing- is it with lumpy foods, liquids or both?

I'd also say, in this age group with these symptoms (assuming bleeding is vaginal) endometrial problems is just as likely, if not more so, than ovarian problems.

She hasn't specifically told me where the bleeding is from. I'm presuming vaginal, as I myself have bowel problems so she would have just said if it was that (as in, no embarrassment there, it's like talking about the skin on my arm now!)

She only said she was bleeding because she was supposed to be coming up to help me with the kids and said she couldn't come because she didn't want to miss a doctor's appt. I was a little , fgs, it's just a doc's appt re book it - and then she said no, because she'd been ill since January, indigestion, pain and bleeding. That was all she said.

In the meantime, what dose of anti acid medication has she been started on, for how long? If it has no effect, would the GP consider increasing the dose, and when? The maximum dose I tend to come across is 20mg twice a day but people are usually started on less than that. Also if the pain is worst at night and the GP's hypothesis is gastrooesophageal reflux, the GP might suggest she takes the whole dose at night I suppose, though I'm not a doctor so I don't know. Or they might suggest that she takes Gaviscon Advance as well as the anti acid meds. OBVIOUSLY she should talk to a GP before any dosage changes, starts or stops.

She could also try raising the head of her bed - something like a child's building brick under each of the two legs. So she would still be lying flat, but the whole bed would be slightly tilted, possibly reducing the amount of acid coming up.

There is a silver lining to lots of locums - you don't get stuck with one doctor who never refers for certain things. Also they should write good enough notes that she is not starting from scratch each time, and if she doesn't feel that they are, this is another reason to make sure she is copied into letters.

Raising the bed is a brilliant idea. I've actually got some proper bed blocks that we used to put on the baby's cot! Will send them to her!

And yes, that's a good point about Locums. At least you're not stuck with one doctor who refuses to shift his/her opinion.

OK a few other gastrooesophageal reflux things - does she eat late at night? if she can bear to stop eating 3 hours before bed that could help. Also the things that trigger reflux can be quite individual - chocolate, citrus fruit, spicy foods, coffee?

It has to be said though that the food tube muscle does tend to get weaker with age so it may not be a specific thing.

Definitely go back. I have thyroid issues and if my bloods are 'normal' I still don't feel well. What is normal for one pers l n may not he for someone else. The whole set of symptoms should be treated not solely reliant upon blood work. And as other posters have said - blood work won't show up everything

Something doesn't add up right - unless I've misread things. Did she actually see a Consultant at her hospital? It sounds more like she saw a GP who ordered blood tests and who gave her the results at the GP surgery.

Many locum GPs are good, but I suspect that a practice that relies on locums a lot will be spending money on them, and possibly trying to balance the books by restricting what those locums can do in regards to hospital referrals, referrals for scans, etc.

It sounds as though you need more information, as does your mother. Starting the whole process over again by seeing a GP privately is a good idea. And your mother might feel able to be a bit more assertive if she's paying for that.

send her back, it's probs nothing sinister but it still isn't normal

There's a private gp in Isleham if she's near there.

i think she should be investigated for gastro problems if she is bleeding again , i assume you mean in her stools? id take her to A &E , they will admit and do an endoscopy.

In addition to the advice above , which is excellent, can you go with her and make sure she is not minimising her symptoms when she speaks to the doc?

I know I'm absolutely terrible for doing this. Randomly ended up at the docs with my Dh a little while back and he was really shocked at how I was expressing the symptoms, "well it's just a little...blah blah" I was really downplaying it. Had no idea!

Definitely see a private GP. Blood work alone tells you only one part of the story. She needs a proper gynae and GI work up.

Right. She has said today she will go back to the docs.

Yes, I have misled (not intentionally though). Apparently, Doc had suggested possibly to see a consultant but only on the results of the blood tests. It's the GP that took the blood, sent it off, then read off his screen that the results were normal and there was nothing wrong with her.

As it took her 3 weeks last time to get an appt, she has now said she will walk to the doc's surgery for 8am and wait outside and speak to the desk (rather than trying to get through on the phones)

I think she does realise it needs further investigating. She is going to read through this thread, so thank you all for the very very helpful replies.

I'm so glad she is going back. I hope you get a better plan of action this time.

Sorry – I didn’t mean to imply that you were being misleading, just that the timings didn’t make sense to me, having worked in my local NHS hospital.

It’s good that your mother is going back to the GP. I hope she manages to get an appointment with someone who will take her symptoms seriously. It could well be that her symptoms could be easily resolved, but she does need a definitive diagnosis.

I’m of much the same age as your mother. People of our generation were taught that doctors were gods, and we patients were simply to do what we were told. Definitely no questioning! Also, for some people of my age, it’s not always denial or stubbornness in not going to see a doctor. It’s sometimes a kind of resentment at realising that bits of us are not working the way they used to, and none of us like being reminded that we’re getting older. And that can mean we put up with symptoms far longer than we should.

Best wishes to your mum in getting a proper diagnosis and proper treatment. That is, after all, what she is entitled to.

Hi - another to say your mother just keep asking - it might be her symptoms are not anything serious but she can't go on like this . Yes to going private if she can afford it - definitely x

Wanda You're absolutely right. She's said before that the 'Doctor knows best'. Meanwhile, I'm 40 something, and believe that Doctors are only human like the rest of us!

She wouldn't go back today. She asked me to leave her alone for a few days and stop hassling her. I think she was hoping (thinking) that something would show in the bloods, so the fact that it hasn't has unnerved her. Also, it means having to put herself out there demanding further attention, when, as you say yourself, she doesn't want to cause any fuss!

Anyway. She has listened to a lot of the posts written on here and she is definitely mulling it all over. Fairly sure she will go hopefully very soon.