Dr. Amol Kumar Wasudeorao Diwan
Allergy Specialist
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a 52-year-old male. I am an athlete and health-conscious, No drugs. Rarely drink (on holidays) and eat pretty healthy and clean. My current issue is weight loss 10 pounds from last year. It is hard to keep weight on, major debilitating fatigue, burping a lot, fullness under right rib cage when I breathe in. Rib cage muscles feel sore and right under right pectoral muscle. When I breathe in, it feels full and the ribs ache sometimes. I also notice I have a lot of sticky sputum when I exhale that is stuck in my neck (no cough or fever). Doctor did a full blood panel, including testing for multiple myeloma and everything total normal, thyroid or no diabetes. An ENT said, I have GERD and reflux, but everything else looks normal.
I went to two GI doctors for my ill-feeling, weight loss and oily bowel movements and they did work up and it showed fat in stool, retest had no fat in the stool. Then was tested for pancreatic insufficiency was 288, then slightly insufficient at 178, put me on Creon made me ill. Then they ordered a EUS of my pancreas, and everything looked normal. I still feel fatigued. Some days I feel a little better. Not sure what to do, sometimes I feel like I need to go to the hospital because I feel that crappy.
So went back to PCP 30 days ago because I had a fullness feeling in my chest and breathing felt funny and warm in the chest (no pain). For as long as I can remember I have had clubbed fingers. But last year, the nail beds have gotten more swollen and red. See images (especially middle finger right hand). So to be safe PCP did x-ray of fingers and x-ray and CT scan of chest is normal. The cardiologist did stress test and the echo was normal. So PCP is sending me to a pulmonologist and rheumatologist because fingers are also feeling very numb and cold at times. The challenge is because of COVID-19, everything is shut down, and because I do not feel well, and I do not know what is going on diagnosis-wise.
Do you think that the normal CT scan of lungs rules out lung cancer? Because online, it says clubbing is 90% of the time due to lung cancer, pleural effusion. I also was wondering with all the gastro issues, fats in stool, clubbed fingers, if I should pursue a sweat test for cystic fibrosis. I am trying to figure it out before it's too late to treat.
Below are other tests.
Hello,
Welcome to icliniq.com.
After going through your description, I learned that you are an otherwise healthy lifestyle man with good nutrition and no significant addictions. The investigations and tests done so far regarding the lung and abdominal complaints are normal, and there is no need to worry significantly about it. So I will not go into the details as everything appears normal.
Now, coming to your concern regarding feelings of malaise, fatigue, and a slight cough, it appears to be functional rather than due to any organic cause. Such complaints are due to many factors like faulty posture, faulty food, irregular food habits, and lack of exercise. So after having all the reports normal it is very difficult to pinpoint any chest or abdominal disease. So there is nothing to worry about any grave diagnosis in the absence of typical symptoms. As you said, you have long-standing clubbed fingers, and in most cases, it is asymptomatic clubbing without any underlying disease. All the differentials you mentioned are chronic conditions with symptoms at least for more than a year, and in your case, it is very unlikely.
Most of the time, it is physiological clubbing, and there is nothing to worry about (with normal CT scans and absence of chronic symptoms). Cystic fibrosis is more common in the pediatric group of patients, and it is diagnosis very obvious on chest x-ray. As your x-ray and CT scans are normal, there is no need to perform a sweat test. Also, there is no pleural effusion. So most probably, you are suffering from dyspeptic symptoms due to indigestion. So it would be advisable to continue GERD (gastroesophageal reflux disease) treatment for a month and take OTC muscle relaxant tablets for pain relief. Similarly, give attention to the body posture, type of food taken, and maintain regular food time. Include more of green leafy vegetables, salad, fruits in your diet, and avoid fast food.
I hope this helps.
The Probable causes
Differential diagnosis
Treatment plan
Preventive measures
Patient's Query
Thank you doctor,
I think my concern was apart from the incredible fatigue and not feeling well and noticing more clubbing and finger widening (especially in my middle finger right hand).
Also, everywhere I read online said 90% of the time clubbing is due to lung cancer or other serious lung conditions which added to the anxiety. Do you think it is safe to rule that out based on report, or should I get my sputum (sputum cytology) checked which I seem to, have a lot in my throat? I will plan on trying what you prescribe with medicines and continue with my healthy eating and workout lifestyle.
Hello,
Welcome back to icliniq.com.
I can understand your anxiety regarding clubbing, but most of the time, it is physiological and nothing to worry about if major investigations like a chest x-ray and CT scans are normal. As I answered previously, clubbing of fingers is a common finding in general practice, and in the majority of cases, there is no cause found even after detailed investigations. Also, clubbing is seen in lung cancer and chronic lung disease, but it can be due to other cardiovascular, GIT (gastrointestinal tract), and liver diseases.
Assuming normal lung tests, respiratory causes are ruled out, and we should focus on other possible etiologies to find out the probable cause. There is no harm doing the sputum cytology, but none of the symptoms or imaging tests point out lung malignancy. If you are in doubt, you can proceed with the cytology test. More information can be given upon actual physical examination. So it is advisable to consult a specialist for getting a detailed history and thorough physical examination once the lockdown is over. Until then, you can continue the same medicines.
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Allergy Specialist
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