When is it being confident that something is wrong, and when is it just paranoia?

[BurningBridges]

Well, I suppose I mean how can anyone tell if they have health anxiety - I think I don't and I need some perspective.

I've been having stomach pain going through to my back and flu like aches and pains in my arms since August last year. It started with a pain like a stitch, now I feel something heavy inside pressing against my stomach and back - its like being pregnant with the baby's head up in your ribs if that helps to describe it. I also lost a couple of stone initially.

GP prescribed PPIs (to stop stomach acid) and said it was indigestion. I refused to go quietly, and eventually as I had private insurance she referred me via that to gastroenterologist. He did ultrasound and endoscopy and said it was an ulcer, come back in 6 weeks. So I did, then he said he didn't know if it was an ulcer, probably costachondritis (inflammation of the ribs). He also refused to examine me - i.e., he wouldn't touch my stomach which I thought was really odd. So again, using my insurance, my GP agreed to refer me to another gastroenterologist, and he was a really nice guy, spent ages with me, went through lots of ideas, did a colonoscopy. Nothing. As first consultant had confused the issue around ulcers, second consultant ummed and ahhed and said ok try rheumatology.

Congrats if you are still with me, unlike my insurance which ran out at this point. Back to GP who I've been seeing every month since August 2011. She is now considering NHS rheumatology referral, just had thoracic x-ray and more blood tests. Am going back in a couple of weeks to get results. I don't think rheumatology consultant will be able to help, particularly if I have to wait 3-6 months to see someone.

So the point of my post is: I think its something serious - let's name the C word - I think it could be cancer. This odd vague pain, deep inside, the general flu feelings. She thinks I have health anxiety and generally starts my referral letters as such "this lady has many anxieties". She also says my 2 stone weight loss cannot be taken into account as I could do with losing a bit more. She reckons cancer patients are normally very thin. (My weight is stable now by the way).

How far should I pursue this? I truly believe this is something serious, GP thinks I am mad. "D"H agrees with GP when he says look you've seen all these people and had all these tests if you had cancer if would have shown up. But I think not, I think many cancers can be missed at a critical stage, and I have this feeling that won't go away that something is very badly wrong. So am I a sad middle aged hypochondriac, or an empowered patient taking responsibility for my own health?

I should point out that my mum died of cancer at 55, I am nearly 50 - I am adopted so we weren't blood relations, but of course the experience means I know that life isn't always great and that bad things can happen. It also means that my GP can say well in that case of course its health anxiety!

By the way, I very much prefer the GP's ideas to mine, I'd rather be anxious than facing a life threatening illness.

You can be anxious and ill. The two are not mutually exclusive!

However, I think it is worth stepping back and reflecting on why you are still frightened about cancer. Stomach pain and weight loss which has now stopped don't sound particularly cancerish. It is good that your GP has not dismissed your fears, she has been making the referrals, you have had blood tests, x-rays, colonoscopys, ultrasounds and endoscopy. And nothing has suggested cancer to your GP or either of the consultants you have seen. It sounds like the main reason you still feel frightened are a) you still feel unwell (that is important but given all the tests you have had it is more likely to be linked to something benign but obscure than to cancer) and b) that you have frightening memories of someone dying of cancer.

Could you try booking a double appointment with your GP and writing down in advance all of the things which are contributing to your ongoing anxiety and then asking her to discuss them with you fully. Has anyone explained why the test results are good so far? You need this information before you can start putting your fears to rest. Bland reassurance alone is not enough.

Assuming you do feel that this full information is adequate you might want to ask for a clinical psychology referral to help you address the anxiety. There is a really good page on health anxiety here and why most health anxiety is founded in reasonable fears that we all have about our health. You don't need to dismiss yourself as a middle-aged hypochondriac if you do decide that some of your distress is founded in anxiety. Your anxiety matters too.

I was not thin when I was diagnosed with cancer. I was a normal healthy weight.

Thanks PPP - I have booked a double appt., for 2 weeks time, but I know she will say look you have had all these tests and 2 consultants say you are ok. I mean of course it might not be cancer, it could be anything, but no one knows and rather than her saying right what's next to look into, she throws her pen down, general eye rolling, v. theatrical etc. and any unexplained symptom she puts down to age or being overweight!

Thing is I have had all sorts of counselling over the years I'm not adverse to laying it all out in front of someone and having it professionally rummaged, but this doesn't feel like anything I've had before, I really don't want to talk about it other than to say hey, do you really think I am making this up, I have two DCs and a business to run, loads of good things in my life I'd rather get on with, but I also feel its my actual responsibility to take care of myself and find out what the problem is.

Sorry to hear about your diagnosis Udderly, are you well now? And yes, how can everyone with cancer be thin? That's madness! I thought overweight people were more at risk anyway?!

Can you change your GP? If she is dramatic that doesn't sound helpful, mine is always very calm and rather reserved which I find reassuring.

The bottom line is of course you have health anxiety. You are frightened that you have cancer and it is affecting you day-to-day. Most people do not feel that way. The question you want an answer to is is your anxiety justified? I don't know the answer to that because I do not know if you have cancer or not, so the key question you need to answer is what do you need to know to feel reassured that all reasonable steps have been taken to check you do not have cancer. It isn't mad or irrational to be frightened of having cancer particularly if you lost your mother to the illness when she was still young. Tell your GP you need to understand the decisions made about your care so far in order to feel reassured. Ask her to explain how confident she is about the results of the different diagnostic tests you have had and importantly why. After this you can reappraise your anxiety.

Having health anxiety is not the same as madness, hypochondria or making it all up. Nor does it mean you are not ill too. Have a look back at your two posts and think about how you keep framing is as either/or. Either I'm a hypochondriac or I'm empowered, either I have cancer or I'm making it all up. From your GP's point of view I doubt it seems like that. You have physical symptoms which may well be rooted in physical disease which could be treated, but these are overlaid with your fears about serious disease and that can make it hard to disentangle what is going on here. GPs often know a lot about health anxiety from the inside because they get it themselves (as you would if you spend all day trying to figure it when tummy ache and bloody stools mean stress and when they mean bowel cancer).

Hope you feel better soon. Be gentle on yourself.

PPP thanks for taking the time and trouble to write all that, I have cut some bits out and pasted it into my notes for next appointment - I like the idea of asking how she feels about the results so far (particularly the no-touch-feely consultant's vague endoscopy notes).

I still think a lot of cancers are missed at an early stage when they could be treated and knowing this has definitely added to my anxiety! If GPs are waiting for blood and wasting before they do a referral, its normally too late by then. But being dismissed by GPs (and any practitioner to be honest) is a problem that we can all face at some point in our lives; a different thread for a different day.

Appreciate another perspective on it, thank you.

BB, sympathies - worrying about health, regardless of the reason, is no fun and seriously impinges on peace of mind/normal life.

Just to add, yes its true many cancers are missed early on but that is mostly because they cause no pain or other symptoms.

Personally, I found approaching 50 (in spite of being healthy, happy, with two scarily young kids - or maybe because of it?! - and having healthy parents in their 80s) brought up all sorts of vague, mortality related anxieties.

I do think a nagging worry about something physical warrants good investigation, and I also think that blood tests, colonoscopy and endoscopy and maybe an ECG would cover most of the sensible check-up stuff related to the stomach pains.

And speaking as a veteran of the following, I would add that aches/fluey feelings in arms can also be from middle-aged backs and twingey nerves - do the aches feel worse at the end of the day, or any other times when you're likely to have a tense back? Just a thought...

Wishing you well with regaining peace of mind, either way

Sorry you're having such a rough time. I think having your Mum pass away at a such a young age (and you approaching the same age) is a big factor in the anxiety element of all this. My Mum died of throat cancer and my dd (who was 18 at the time) was/is really panicky about anything she has wrong with her being cancer. She will phone me saying she has this or that pain/feeling/mole/spot, and do I think it's normal (ie do I think it's cancer). The anxiety definitely stems back to her Grandma's illness and death which is totally understandable.

Your GP sounds really unhelpful. A doctor absolutely should not pen slam or eye roll. That is so dismissive, not to say downright rude. Is there anyone else at the practice who is any better or could you change GP? I think to not feel as if your GP is on the same side as you and is trying as hard as they can to work out what is going on, would make you feel really vulnerable. I would hope that all the tests you have had done so far would have revealed something by now if it was cancer or something major, but you need reassurance and understanding and a discussion about what to do next because if you still have this pain and other symptoms then clearly they need to think what is the best thing to do now.

I really hope you get some answers soon.

Thank you to everyone for your support, that's nice. I was expecting some people to tell me to get over myself. But I know from other MN threads there are many people on here struggling to get a diagnosis or support from their GP

I don't want to change GP as its a nice 4 doctor practice, the children see a different doctor and she's great with them, but the GP I see is the head of the practice along with her partner (and then two other doctors). So they are all friends and colleagues, they are hardly likely to start gainsaying each other.

I called today for my blood tests (latest ones) and the receptionist said its marked "to be discussed at appointment" so something must have shown up, but sounds like its not anything particularly major. Am now waiting for chest x-ray results. I have my big make or break appointment on the 18th May I've booked a double appointment and got DH (albeit reluctantly) to come along.

Yep, answers, that's what we need!

Good look for 18th. Let us know how you get on. Hugs.

I hope the fact that none of us think you need to 'get over yourself' makes you feel more confident. Good luck.