Saturday, June 30, 2012

Recurent Solar Plexus pain

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

I have a recurring solar plexus pain right, almost like I received a punch in the solar plexus. I have tried to be aware of what I eat or if I'm particularly stressed, but have found no pattern yet. The pain usually lasts for a few minutes, growing in intensity, until if quickly wears off and completely disappears. Sometimes it lasts longer though, up to an hour or two. I have stones in my gall bladder, but don't know if that is in any way related to this pain. What should I do?

Gender: Male
How tall are you (feet and inches)?: 6 feet 2.5 inches
What is your weight in pounds?: 243 pounds
How old are you?: 36
How long has this been going on?: More than a month

Check all symptoms you are currently experiencing:
Abdominal Pain

Check all conditions present in your immediate family... :
Cardiac Disease

Please list any medication allergies that you have : : None
When was your last menstrual cycle?: I'm a man, baby!
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Occasionally


What can cause the pain?
Should I be alarmed?
How can it be treated?
___________________________________________

The most obvious answer is that this IS related to your stones in the gall bladder. Curious that you know this, as I wouldn't think to actually look for gallstones unless someone came to see me with a good history and exam for gall bladder pain. My point is that some doctor in the recent past was concerned about your gall bladder and got an ultrasound and found the stoned. Could it be something else? Sure, just not likely, especially at your age. Hard to think of another cause which would produce similar symptoms. Generally, once stones are discovered people are scheduled for a cholecystectomy... a gall bladder removal. My suggestion is that you get with a surgeon and get an opinion on whether your pain is from your gall bladder and, if so, when you can get it removed. The danger of ignoring this is that you could develop CHOLECYTITIS, an infection of the gall bladder, and this is a true medical emergency requiring emergency surgery. Best to get the gall bladder out on an elective basis. It's a much easier and safer surgery.

If you have questions please ask them in the comment section.

Be well.

MDSTAT ER Doc 1


Monday, June 25, 2012

Recurrent Abdominal Pain (absent gall bladder)

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

I have been having horrible pain 4-5 inches above my belly button midline of my abdomen.  The pain is always an achey pain, but then I get attacks of horrible pain that are severe and are similar to previous gallbladder attacks that I had when I had my gallstones years ago. I  had my gallbladder removed in 1995. The pain starts suddenly and intense and lasts from 4 or more hours. The severe pain goes through to my back and up into my chest to the point where I can't take a deep breath because of the pain. I feel like my heart is fast. I have had nausea and occasional vomiting during this time.

I also have been having some floating stools that don't hold their form and are grainy and fat floating in toilet. No light colored stools though. No fevers which I usually don't run a fever due to my hypothyroidism.  I feel full after small amounts of food and the severe attacks usually occur after eating. The first attack occurred while in a restaurant.   I felt immediate abdominal pain, nausea, became very hot and my face appeared flush.  I felt like I was going to die.

I didn't say anything to my husband but he asked me if I was ok and I told him how I was feeling.  I felt better the next day, but it happened again the next month so I went to the ER.  I had another severe attack while there and they admitted me.

They ruled out a heart attack and all other serious problems. I take 24 hour prevacid for stomach pain, levothyroxine, prednisone 10mg a day for back pain (have been taking this for 6 months), hydrocodone 10/660 3x a day prn for back pain, soma 4x a day prn for back pain.   I have had bloodwork, CT scans, and ultrasounds. One of my previous scans showed a dilated bile duct and mild fatty liver.  I have only drank 10 alcoholic beverage in my life and I don' t drink or do drugs. I am scheduled for an ultrasound on Monday to try to find out why I hurt so bad.  Any help would be greatly appreciated!  Thanks!

Gender: Female
How tall are you (feet and inches)?: 5'7"
What is your weight in pounds?: 250lbs
How old are you?: 40
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing:
Vomiting
Nausea
Describe associated symptoms not listed above:  Pain radiating into chest and back. Floating Stools not formed with floating fat. So painful that I can't take a deep breath. Fast heart rate. The pain is a achey pain with  some throbbing pain also. When the severe attacks start it is a severe ache that doesn't let up. I  get full after eating small amounts of food. The severe attacks usually occur after eating.

What have you done so far to remedy this condition? Please include tests and relevant studies here.
I have had CT scans, ultrasound and bloodwork. I will have another ultrasound on monday. One test showed dilated bile duct and fatty liver.
Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): medical problems: hypothyroidism, possible gastritis or ulcer, previous tracheal stenosis of unknown cause, and Degenerative disc disease and arthritis.

Surgeries: Tubal ligation, gallbladder removal, tracheal resection/anastomosis surgery.

Check all conditions present in your immediate family... :
Cardiac Disease
Hypertension
Please list any medication allergies that you have : : N/A

Please list any medications you are currently taking (and dosage if known) :: Levothyroxine 137mcg 1x a day
24 hour prevacid 1x a day
Soma 350mg 4 x a day as needed
hydrocodone 10/ 660 3 x a day as needed
Prednisone 10mg 1x a day
When was your last menstrual cycle?: 3 weeks ago
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Rarely

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible

What conditions could cause the symptoms that I am experiencing?
Could it be pancreatitis?
Can gallstones form after gallbladder has been removed?

__________________________________________

Well, you certainly are having a rough go of it. I am only now able to post your question after a couple of days on the road. Your ultrasound was today. I hope it is diagnostic. This is unlikely to have anything to do with your gall bladder unless you have a reatained ductal stone, and the only way to find that is with a procedure called ERCP (an upper endoscopy).

You are young for intestinal ischemia.... pain in the abdomen due to lack of blood flow to the abdominal organs, usually triggered by eating, though it should be on the list. 

The striking thing to me is the pain's relation to eating.

A couple of things you said triggered something though, and I do not wish to scare you, but there is a rare condition called 'Cardinoid Syndrome' that is associated with some cancers and a rare tumor of the GI tract (intestines). If everyone is drawing a blank you might suggest this. 


Given its rarity I wouldn't mention it at all as it will, no doubt, make you worry, but it does seem that your doctors are trying to knock out all the usual suspects and simply haven't solved this one yet. I would mention this at your next appointment and see if they have already checked for it (they probably have). 



Monday, June 18, 2012

Biliary Colic?

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.


Hello,
I would truly appreciate your help. I have had persistent throbbing pain at a point specifically between the umbilicus and xiphoid process. The frequency of pain began as once every 6 months, and over the course of two years has increased in frequency to once or twice a week. When the pain comes on, it always starts in the evening and lasts for 3 to 5 hours (it's important to note that it comes on while I am sitting up or standing - in other words, not when I'm lying down). Last month I adopted a vegetable + fruit + dairy diet, but then eating wheat bread triggered it. I believe the density of certain foods can trigger it, as may sugary foods (such as apple pie). I have been able to eat creamy foods and not feel pain. I began blending fruits and vegetables and this helped. Sometimes I also have an achy anterio-lateral right sided pain (like at the far edge of my body), which is where my liver is (wouldn't gallbladder pain be between the midline and lateral side?). I was a veg etarian (but ate salmon and shrimp) between the ages 14 and 32. At 32 I began to eat poultry. I'm 39 now.

I had an ultrasound done that showed 7 gallstones. I had an endoscopic exam of the esophagus, stomach, and intestines that came back negative for h.pylori, gluten intolerance, but positive for mild acid reflux on the esophagus. I had a functional CT scan of my upper and lower abdominal quadrants that was negative (stones could not be seen on this scan - I was told because they were not calcified). EKG was negative. Liver enzymes were normal.

Last night I had an attack after eating a piece of pie, and felt feverish, throbbing pain, and vomited for a few hours (did not vomit bile - only pie). I've only had vomiting with the pain once before. Usually I do not feel feverish or vomit with the pain. Thanks so much!!!

Gender: Female
How tall are you (feet and inches)?: 5 foot 6 inches
What is your weight in pounds?: 120
How old are you?: 39
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing: Abdominal Pain
Please list any medication allergies that you have : : None.
When was your last menstrual cycle?: Now
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Rarely

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible

Top three questions...
1. Could this throbbing pain be my pancreas?
2. Could the achy pain be my liver?
3. What could be wrong? What tests would you recommend for a differential diagnosis?

The doctors suggested I have my gall-bladder removed, but I've read that sometimes it's not the gall-bladder. I don't want to have something removed and then still have pain and now even more issues (like having to take digestive enzymes for the remainder of my life).

________________________________________________-

Okay, a quick answer from me. This is, in all likelihood, your gall bladder. It is not your pancreas, as pancreatitis is typically of acute onset and not recurrent with meals. It is true that pancreatitis can be caused by gallstones, but the way you describe your pain and with the testing that has been done you most certainly have BILIARY COLIC. If you click on the blue lettered link you will be taken to a pretty thorough explanation of why you almost certainly have pain from your gall bladder. 

You gall bladder sits with in the liver which is on the right side of your abdomen and just under the ribs. The fact that you have had attacks that now seem to be associated with meals makes this more certain. 

And as to what you have heard about problems after gall bladder removal I am amazed at all the bad information that is out there. The fact is that with the ability to remove the gall bladder laparascopically (without an open incision) that the recovery time and the results of ROUTINE gall bladder surgery today are almost always excellent.

There does seem to be, in a small number of patients, problems with post gall balder pain. Mostly these patients have small stones retained in the bile ducts and a simple endoscopic procedure fixes this problem. In an even smaller group of patients some persistent symptoms of gall bladder pain can occur for months after the procedure. 

However, consider this, since we know you have stones in your gall bladder you would be well advised to have removed at a time of your choosing for two main reasons.....

1. your pain attacks will keep happening and become more frequent and you will find yourself in the ER eventually, and maybe many times. A few ER visits and you have already spent more money than you would in an elective surgery. 

and 

2. If you keep waiting the chances of your gall bladder becoming infected become higher and higher, and when this happens 'acute cholecystitis' it is called, the surgery no longer is elective, it is an emergency surgery and it is life saving surgery. In this way the gall bladder with stones is much like the appendix. In short, you run a much greater health risk by waiting than by having this done as soon as you can and on an elective baasis. 

So, in summary, I would bring your concerns to your surgeon and ask about post-cholecystectomy syndrome and how frequent it is. Your concerns are valid, your surgeon will answer your questions and will be happy to hear them. If he is not then you may have the wrong surgeon.

Please feel free to ask questions in the comment section below. Good luck and thanks for your question.

Monday, June 11, 2012

Achilles Rupture?

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.
MD STAT is an educational service. We do not prescribe medication. We do not enter into a doctor-patient relationship with you. We explain, educate, clarify, and suggest possible solutions to your medical questions. Thank you for your interest.
Gender: Female
How tall are you (feet and inches)?: 64
What is your weight in pounds?: 160
How old are you?: 75
How long has this been going on?: A few days
Check all symptoms you are currently experiencing:
None of these

Describe associated symptoms not listed above: Left ankle and lower leg swelling. Had successful Achilles surgery in 1991. Experiencing pain in the Achilles area and there is a knot the size of a larger pea in the lower Achilles area.

What have you done so far to remedy this condition? Please include tests and relevant studies here.
: Raised leg and iced.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): Achilles surgery 1991
Check all conditions present in your immediate family... :
None of these
Please list any medication allergies that you have : : n/a
Please list any medications you are currently taking (and dosage if known) :: n/a
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Rarely
HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible
Chances of re-rupture?
_______________________________
Obviously this diagnosis is one that can only be made by a physician doing a good exam, and this will likely require an MRI. However, there is a simple test you can do at home to assess the integrity of the Achilles tendon. It is usually called the "Thompson test". Simply lie on your stomach and have a friend or family member gently squeeze your calf muscle. If your foot moves, then you have not ruptured your Achilles tendon. If it doesn't not move, like in this video, then there is likely a rupture. Please see your doctor asap to have this properly evaluated.

Friday, June 1, 2012

Sciatica?

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

MD STAT is an educational service. We do not prescribe medication. We do not enter into a doctor-patient relationship with you. We explain, educate, clarify, and suggest possible solutions to your medical questions. Thank you for your interest.

Gender: Female
How tall are you (feet and inches)?: 5'6
What is your weight in pounds?: 155lbs
How old are you?: 31

How long has this been going on?: More than a month
Check all symptoms you are currently experiencing:
Abdominal Pain
Diarrhea
Bruising or Bleeding


What have you done so far to remedy this condition? Please include tests and relevant studies here. i have been to the hospital and they have said it could possibly be sciatic nerve pain or restless leg syndrome. so far i try to stretch but it hurts more. it hurts when i walk and when i use the restroom.i had have couple surgeries that might cause some symptoms like a partial bowell removel, gall bladder removel,appendix removel.and also i am fixed from having kids so i had a tubal.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): i have anxiety and depression and a little bit of arthritis in my lower back.  i have had a partial bowell removel,appendix removel, gallbladder removel.

Check all conditions present in your immediate family... :
History of Back Pain
Stroke
Please list any medication allergies that you have : : n/a

Please list any medications you are currently taking (and dosage if known) :: gabinpentin, klonapin, prozac,
loxapine

When was your last menstrual cycle?: 2 weeks ago
Are you currently using or do you have a history of tobacco use?: Yes
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Occasionally

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible

what should i do? i have no insurance and no income just got out of a 8 year marriage have 3 kids. been to hospital last week and they gave me a muscle relaxer shot and a steriod shot in butt cheeks.  should i return to the same hospital with the paperwork they gave me and tell them the problems im having again and that no doctors will see me? whats ur opinion on what i might have wrong with my legs.
 
_______________________________________
 
I think we may be missing your main question here.... it did not come through in the form. Can you clarify the question or be more specific in the comment section? To start with, the WORST place for you to get a chronic, non-emergency condition diagnosed and treated is the hospital. The ER is set up for emergencies. If you do not have one they will send you on your way with instructions to follow up with your doctor. If you do not have a doctor this IS a problem as, and again, I think your main question is not asked above, but it sounds very much like you need to be evaluated for low back pain, possibly a herniated disk. An orthopedic surgeon or a good Family Practice doctor is a good place to start. We are standing by for clarification or restatement of your question.