To ask for medical advice

[FoxInABox]

Before anyone flames me (donning my hard hat!) I just want to ask the opinion of those with medical training in here please. I will of course speak to my own Gp but I would like a few opinions so I know if there’s anything I need to ask specifically, or if I shouldn’t be concerned. I have done my own research but I know Dr Google can be a bit of a rabbit hole.

My teenage DD has had bloods done after 2 years of stomach pains, all across her stomach area. We have been back and forth the doctors in this time, and she has tried IBS medication with no joy. It doesn’t affect her bowel movements and she says they’re normal and there’s no pattern with the pains. There doesn’t seem to a pattern related to any particular foods or pain after eating- it is fairly random. She has recently started feeling full quickly also and not being able to finish meals.

The blood results have come in today. Everything was normal - but one seemed the very low end of normal. The serum ferritin was 17.1, with normal range marked as 13.7-78.8. She is 5’6 and I’m pretty sure has finished growing so I think the adult range is a better indicator, I believe the low end of the adult range is 15? It just seems very low to me at 17.1. Everything else seems comfortably within the normal range however.

For those with a medical background, is this something that would be a concern? Are there any further tests or anything specifically I should be asking about? At the moment I feel like we don’t really have any answers about why she is having these pains. I would really appreciate any advice.

coeliac? the tests would be IGA TTG tests if they'd been done as part of the bloods.

Is she vomiting OP?

@ElfridaEtAl No vomiting at all thankfully

@LordFarquart38 they did IGA came back as 2.150 so looks well within normal range ?

Is the pain always there? Or are they like episodes that come on and then abate? If it’s episodes, how long do they last roughly? Are there other associated symptoms like nausea / vomiting etc when the pain is there? What does the pain feel like? I.e. sharp, achy, stabbing etc?

There's good advice below in relation to blood and stool tests that should have been done to exclude other causes, & other considerations, e.g. diet, anxiety.

https://cks.nice.org.uk/topics/irritable-bowel-syndrome/

The ferritin concentration suggests your daughter's iron stores are low, consider her diet, & her menstrual flow, if other tests are within range/negative. There's some evidence that ferritin levels at the low end of the range should be treated with iron supplements to raise levels to a minimum of 50-70

https://www.bda.uk.com/resource/iron-rich-foods-iron-deficiency.html

@PostItInABook it isn’t always there, it comes and goes, when it is there it’s often for at least a few hours, but can range from half hour to a few hours a day. She does seem to get it most days, but can have a few days with no pain at all. She describes it as a harsh ache, just below belly button but right across, sometimes lower.

no other symptoms- no vomiting, no diarrhoea or constipation.
the feeling full quickly is quite new- that’s only been for the last two - three months.

4 things to raise with GP. Could it be…..
Low iron stores
GERD
Gastroparesis
Chronic appendicitis, (rare but I had it as a teen and it took 4 years of going back and forth to the GP to finally have it removed), though with no vomiting it’s probably not this tbh.

@Rosebud21 thank you I will read through those links.
I called our Gp surgery but the receptionist told me that GP had marked them as normal and no call needed. I have to call back tomorrow morning to request a follow up.

she did a stool sample a while ago which was normal. GP did request a new one but she hasn’t yet given me the sample- being a typical teenager she is trying to put that one off as she finds it very embarrassing.

I'm not a clinician. Extensive experience of bowel problems and pursuing investigation.

GP will tell you that level of ferritin ( iron storage marker) is fine. I'm on an iron protocol group onFB and they heavily criticise current markers used for most nutrients including ferritin levels. Most would say this isn't optimal at all. This level might indicate an issue from heavy periods to malabsorption or just diet low in iron. Trying to raise iron levels would be the first thing advised - whilst secondly looking at issues impacting ( e.g possibly the stomach problem).

There's a raft of roads you can go down regards the bowels. If it has been going on a long time now and not getting anywhere, I'd look at further investigation. Some is invasive though.

First thing might be requesting a stool sample - GP can process I think and they test stool for inflammation levels ( feacal calprotectin)

An MRI can be requested, with contrast to look for bowel inflammation or structural issue like diverticulitis.

Next stage might be a colonoscopy - bit invasive but they can take small samples ( biopsies).

If this is a problem of motility ( bowels moving too fast or slow) it won't show on an MRI or stool sample. It can be very painful though. A swallow camera pil is excellent for measuring speed of transit and it takes photos all the way through. You then poo it out. You have to push for this usually as if the above are all normal they will often go down the ' anxiety' road, particularly with young women.

I went through all this. Everything normal then I pushed for a camera pill test , ended up doing it privately. That did show exceptionally fast motility as a result of Autonomic dysfunction. I also have Ehlers Danlos Syndrome which impacts how the bowels move food through.

Other possible areas for investigation could be allergies/ sensitivity. I think the tests for this aren't that accurate though. If willing, trying dairy and gluten free for a while might really help.

Some people try antihistamines for the gut to see if it is an excess histamine problem - famotidine is an H1 blocking antihistamine that might be worth a try.

Again it all depends how bad things are,how long it's been going on. It's worth investigating based on low ferritin though.

Sorry to add she does often complain of feeling dizzy - often on standing. Not something I have linked to her pains before, but I guess this could be down to low iron?

This is not the place for medical advice.

You have no idea who is answering you - some will be honest about who they are, others will not.

If you have concerns go back to your GP. If they have said they are normal, why are you questioning this? You can ask for a second opinion if you have reason to distrust the original GP - most services will have another one you can speak to.

@PostItInABook thank you I will look those up.

This is definitely a low iron symptom. Stretching a bit here but autonomic issues can affect the motility of the bowel ( gastroparesis) and also how the vessels pump blood upwards against gravity. I have POTS. Appreciate there may be lots of reasons for this.

Iron protocol group on FB gives good advice in my view. Iron supplements can be really uncomfortable on the stomach so if she can increase through diet that would be good.

If she can stomach it, drinking a pint of electrolyte water as soon as she wakes up might help the dizziness. It might also give you an idea if blood volume is low.( I think volume is the correct term here.)

Any chance it isn't her stomach but gynae related?

@Pantaloons99 thank you that’s really informative. I’m sorry you had such a nightmare fighting to get answers.
The histamine is interesting as she has chronic urticaria and takes anti histamine for that but it’s been stable for a while so she is only taking when needed. That does make me wonder if her histamine levels are naturally high though and could contribute to her pains.

Has she been checked for POTS?

@Hankunamatata quite possibly as she started her periods the same year the stomach pains began, but we haven’t been able to pinpoint any kind of pattern related to her cycle. She doesn’t complain about them being heavy.

Definitely don't worry about ferritin of 17, my dc's was down to 3 once and other than prescribing iron supplements no one was remotely concerned.

If all other bloods are fine I'd try not to worry. Is she very anxious generally? That can cause people to breathe fast and it may be something simple like trapped wind. So lots of good diet, exercise and calming apps may help.

No medical expertise but when my sister was 15-18 she has reoccurring stomach pains went down the ibs, dietary causes, stress etc. frequently in a &e for morphine and gas and air to get her out of pain. Her GP and a and e staff were starting to put her down as a drama queen when she turned up in a and e with sepsis and 50:50 odds of surviving the night. She was diagnosed with acute pancreatitis. It took 3 days for her to get scans due to issues with the lifts during which time she was accused of being an alcoholic. The scans revealed gallstones and which had migrated to the pancreas. She had an operation to remove the stones from the pancreas and once she recovered she had her gallbladder removed. She's struggles with high fat foods but otherwise she hasn't had any further issues since the surgeries.

Document everything, if you are needing A and e try to follow it up with GP appointments. I think the issue my sister had was no one was joining up all the dots. The people in a and e only looked at why she was turning up at a &e, the GP only looked at why tests they had ordered. The consultant only looked at how she responded to the medication they had prescribed for the IBS. No one looked at the big picture until that a and e trip. It took 3h to persuade her to attend a and e that day as she was afraid of the suggestions she was making it up.
Whether or not gallstones fit your daughter symptoms I would say this would ensuring there's someone looking at her as a whole person is crucial

@hagchic thank you and i will be discussing it in full with our GP, but I have seen this forum be extremely useful for others when they have had similar queries - and there have been lots of really helpful replies. I will of course execute caution and won’t be starting her on anything without discussing with her GP first.

@Pantaloons99 thank you that’s really useful.

@ChazsBrilliantAttitude that’s quite interesting as a few of those symptoms are things she has experienced. She hasn’t been tested for that

@Janiie no not anxious at all. I have discussed that with her as that was something I was thinking of initially. Oh wow 3 is literally on the floor!
i think im just worried it indicates malabsorption and trying to think why- particularly with the stomach pains for so long now.

@Superscientist it sounds like your sister had an awful time of it. I’m glad it got sorted in the end but it’s a real concern it took so long for her when she was in so much pain. I think that’s my worry that potentially things are being missed, we often see different doctors.