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My lipase test is 76 and I have had my gallbladder removed…

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Hi my lipase test...

Hi my lipase test is 76 and I have had my gallbladder removed back at the beginning of the year. I have pain off and on in my lower back and right side above my hip. I had all my blood work done while testing my thyroid but I didn't see anything else out of the norm. Can you give me your thoughts on this?

Doctor's Assistant: Have you had any recent injuries? What seems to make the pain better or worse?

No injuries and it comes and goes through out the month. High fat foods seem to have some connection based on recent flare ups.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I have had four C-sections and I have been experiencing extreme fatigue and a multitude of other symptoms that I thought would be attributed to thyroid but my tsh tested at 1.15.

Submitted: 7 months ago.Category: Medical
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11/20/2017
Doctor: Dr. Arun Phophalia, Doctor replied 7 months ago
Dr. Arun Phophalia
Category: Medical
Satisfied Customers: 38,728
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Doctor: Dr. Arun Phophalia, Doctor replied 7 months ago

You may get an MRI of abdomen. Pancreas should be screened for high lipase. Chronic extreme fatigue is caused by;

Thyroid disease

Connective tissue diseases

Chronic anemia

Neoplastic disease

Chronic infections like Epstein Barr virus

Endocrine diseases (Addison disease).

Chronic fatigue syndrome

Myasthenia Gravis.

You would need following investigations:

Complete blood count (CBC)

Liver function tests

Thyroid function tests

Erythrocyte sedimentation rate (ESR)

Serum electrolyte level measurement

Immunoglobulin M (IgM)/immunoglobulin G (IgG) coxsackievirus B titer

IgM/IgG human herpesvirus 6 (HHV-6) titer

IgM/IgG C pneumoniae titer

Autoimmune panel

Anemia panel.

Other causes of fatigue;

Physiological

Rest and sleep, inadequate or excessive

Diet, excessive or inadequate intake

Environmental factors like heat

Hormonal factors

You may consider following also;

1) Recurring episodes of weakness should raise the question of periodic paralysis.

2) Weakness exacerbated by effort and relieved by rest is characteristic of myasthenia gravis.

3) Proximal muscle weakness suggests a myopathy, whereas distal muscle weakness is more consistent with a peripheral neuropathy or pyramidal tract disorder. Myopathy would be detected by a blood test creatinine kinase.

4) Recurring episodes of apprehension, tremulousness, and palpitations are seen with generalized anxiety.

5) Weakness or fatigue that occur only after work, fasting, or insufficient sleep are most likely explained by normal physiologic mechanisms.

6) All prescription and over-the-counter medications should be considered. Frequently used medications such as antihypertensives, sedative-hypnotics, antidepressants, tranquilizers, and antihistamines are common causes of fatigue.

For your lower back pain and hip pain; you need to be x-rays and MRI of the area.

This can be due to;

1) Herniated/degenerated disc in back

2) Lumbar spondylosis; bone spurs in the back vertebrae pressing on the nerves.

3) Osteoarthritis / age related arthritis of hip.

Following measures would be helpful;

1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

a) Avoid activities which increases the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor

2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants

3) Local analgesic gels or sprays / ointment

4) Hot fomentation

5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

7) Lumbosacral corset or support or brace

8) If obese or over weight, reduce weight for long term benefit.

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Doctor: Dr. Arun Phophalia, Doctor replied 7 months ago

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