very worried abou slightly elevated alp and back chest pain..is it bone cancer? Doctors response would be appreciated

[Mark2929]

I am a 40 year old male, a non smoker 5'11 190 pounds. I suffer from depression, anxiety, and panic attacks. I have Asthma, IBS, Gout, Fybromyalgia & acid reflux. The medicines I take are alluporinol (Gout) Ventolin, Prevacid, Flovent, Serevent. Celexa and ativan as needed for panic attacks. I have a benign fatty liver confirmed by Biopsy 5 years ago, which causes elevations in GGT ALT AST ALP.

Recently about 3 weeks ago I started having mid-chest & back pains and thought I was having a heart attack. I have had allot of recent tests including a chest x ray followed by a chest and Abdominal CT scans both with contrast and they were normal. Numerous normal blood workups including,  CBC, Calcium, Magnesium all lytes, PTH, TSH T4, CPK, LDH ESR, Creatinine, Albumin, cholersterol, INR, Billirubin Lipase Amylase. Unrinalysis was also normal.  

In addition while having chest pain on different days I have also had  3 normal ecg's with heart blood panel.  The Stress test was normal,  Gastrocopy was okay

I am concerned because of the back /chest pain and the slightly high ALP of 145 (lab says up to 129 u/l is in the normal range) and what I have read about bone cancer on a few sites. My calcium and PTH are normal and my doctor is says he is not concerned about bone cancer. My family doctor says I have had a very thorough workup and enough tests and that I don't need a bone scan, which is more radiation. Because the ALP is just above normal and is likely liver related because of the ast alt ggt elevations caused by my benign fatty liver (Isoenzymes a couple of years ago showed the alp was increased to liver). He also says that the chest and abdominal CT scans with contrast are quite accurate and look at everything including bone, ribs, thoracic and lumbar spine and everything in between such as lungs liver pancreas spleen gallbladder etc.  He says that my anxiety, depression, Fybromyalgia, IBS  & fixating on the pain make is worse

[Mark2929]

to clarify I had a chest abdominal and pelvic CT scan with contrast

[Mark2929]

Thank you very much for answering Dr Juing, as I feel like a complete basket case the past few weeks.

If I could please ask you one last question. Would a chest x ray and then an abdominal ct scan with contrast take a good look at the chest bones ribs and thoracic/lumbar spine to pretty much rule out cancer as the cause of my mid chest and back pain?  I am so worried about bone cancer. I know and accept that the CT scan looks at all of the organs like lungs spleen liver etc. and rules out cancer which is a relief but I am worried about the bones/spine. My doctor says the ct is through in this regard and I shouldnt worry about bone cancer. He also says that my calcium and PTH would likely be markedly elevated with bone cancer. Those blood tests were normal. Lastly he told me that primary bone cancer in that area at my age is very rare and it would usually be mestatized from the lungs or liver in the area I am complaining about. My lungs and liver were fine on the ct scan sao he says I should stop worrying.

My psychiatrist who I had seen for years left my area a year ago and is returning at the end of June. My doctor is referring me to him as soon as he is back and says I need my meds  and maybe try some new ones, as well as being able to talk about my problem with cbt. My anxiety and depression are bad and have a hypochondria type effect when I get pain that doesn't go away I think cancer and become highly anxious and depressed. I was also wondering if a pain management clinic might help with nerve blocks to the middle of my back.

Thanks again for responding to my last question and I would be much appreciative if you could answer this last question so I can try to slowly relax until I am able to see my psychiatrist at the end of June.

[J T Junig, MD PhD]

I agree with your doc completely on this one.  You have a couple of anxiety disorders;  you are going to fixate on the worst possible outcome because of those conditions.

Your situation is an example of the limitations of medications.  You will only become tolerant to the ativan;  the celexa should be pushed to the highest dose you can tolerate, and if you are still having panic consider changing to an SNRI like effexor.  But if these things don't make a big difference, consider psychotherapy.  I think you would likely benefit from either CBT (where your thoughts are examined and you are given assignments to work toward changing your thoughts) or psychodynamic psychotherapy, where you attempt to gain insight into your unconscious fears so that you gain some control over the anxiety they produce.  

There are different kinds of therapy, but I think one of those would be best for your symptoms.  If you have trouble finding a therapist, feel free to check out my telepsychiatry page-- www.telemedpsychiatry.com .  I do psychodynamic psychotherapy by telepsychiatry and have patients scattered across the country, using a webcam.  It actually works very well-- after awhile it seems that we are in the same room together!

But as your doc said, the multiple tests that you have had are sufficient to find a malignancy if you had one.