General Question

Mariah's avatar

Will you help me decide whether to seek more urgent medical attention?

Asked by Mariah (25863points) February 19th, 2017

Hey guys, sorry to be asking this sort of question. I would just love to have outside opinions.

Ever since my abdominal surgery in November I am having an unfamiliar pain. It has been off and on for these last few months and it has been moving all over my abdominal cavity. Currently it is more severe than it is usually, and it is on both the left and right in the front just under my rib cage. At other times it has been lower and more toward the back. It is a sharp pain that hurts very badly if I sneeze, burp, cough, or even breathe too heavily. At times if I move wrong it will seemingly trigger something and I will get spasms in the painful area. It gets a lot worse right after I eat or if I take Imodium, which makes me wonder if it’s in my small bowel (which is, granted, the part of me that got operated on in November).

My GI can’t see me until 3/1 and I have already had 3 appointments with my PCP about this. She did a chest x-ray and a urine screen (because the pain keeps moving around so much that at one point I thought it was pneumonia or pleurisy and at another I thought it was a kidney stone), both were clean of anything unusual. She wasn’t sure what else to try and seemed to think that it is just part of the healing process from my surgery. The thing that makes me doubt that is that it has not gotten better with time and honestly seems like it’s slowly getting worse.

I am debating whether I should go to the emergency room before my GI appointment. It feels to me like nothing will get solved and my time will be wasted, and that it isn’t really an emergency because it has been going on for awhile, but I am just nervous because I can’t identify this pain. I am used to having things wrong with me but usually I know what they are.

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58 Answers

Coloma's avatar

I’d go, you’re in pain and they will probably do an ultrasound or scan given your recent surgery. Who knows, it could be something completely different like gallbladder pain or???
Given your history it is probably related to your surgery but gallbladder issues do the same thing, tend to have low grade, nagging, sometimes severe pain and often flare up after eating as well. Good luck, let us know!

johnpowell's avatar

Might as well get the last drops out of obamacare while you can.

And yeah, you are awesome and it would be a shame if something happened to you. So ER ASAP.

Do it for Wanda.

funkdaddy's avatar

I asked the wife real quick, she was an ER nurse for a long time and did a lot of the triage up front, when people first come in.

She said it sounds like air that’s still in you from the surgery, but if the pain keeps you from sleeping or doing your normal activities then no one is going to give you a bad time about going in. They may be able to get you some pain medication if that’s something you want. (pain medication is always a weird judgement call, I’m thinking you’ve probably run into that before)... her understanding as “not a surgeon” is the air generally just gets reabsorbed over time. The length of time was her main concern.

The good thing about the ER is they’ll fix what you’re complaining about, but usually just until you can see a specialist. In this case, they’ll check everything out, but you’ll probably leave with pain medication unless they can find something acute.

all the usual disclaimers and the fact that you know your body better than anyone

Jeruba's avatar

[Disclaimer: I’m not a medical professional, and my experience may or may not be relevant.]

Following some lower abdominal surgery when I was in my 40s, I had a sharp pain that increased over time until after 4 weeks I could hardly breathe or stand and was in a state of utter panic. I raced off to my doctor’s office (actually crept, whimpering, and my husband drove), fearing the worst. It turned out that following surgery there was some shrinkage and tightening of the affected tissues, and that was causing the pain. Knowing that, I was able to relax and wait it out.

If you were in my household, I would say start by calling the GI and insisting on an earlier appointment. I think I would have my doubts that a busy ER staffer could figure out what my PCP couldn’t with a handful of tests. It’s your surgeon that you need, don’t you think?

Usually I’m the sort of person who does not want to make a fuss and would never ask for special treatment or demand that an exception be made for me. But on one memorable occasion, when I was in acute, unbearable sinus pain, I was so determined to be seen that I went to the doctor’s office and told the receptionist that I was going to stay put and wouldn’t leave until he saw me. I was prepared to wait all day. He saw me.

johnpowell's avatar

It is massively irresponsible to say “wait it out”... We have been here before.

http://www.fluther.com/30017/ever-have-constipation-so-bad-that-it-hurt-to-move/

Go to the doctor or don’t ask Fluther. Really. Doctor… ASAP. If it is nothing you wasted 15 of their minutes. If it is something you will live.

Cruiser's avatar

No one is more intune with their body than the person that lives in that body. You seem to be more than aware of what is normal or expected and what you describe is anything but. Having to wait another week or so would be unacceptable and untenable in my book so I would bee line to the ER to get checked out. My secretaries husband ignored the fact that he was not having a “normal” bowel movement for weeks that included abdominal pain. This weekend he had a good chunk of his colon removed and next up is finding out what that neglected spot on his liver is all about. Get it looked at! Stat!

johnpowell's avatar

I agree with Cruiser so that means you need to go to the ER and hell has frozen over. Even if it is nothing your mind can be clear…

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Pandora's avatar

Maybe you should stay away from the imodium until this is resolved. You are worry about blockage and imodium does just that.
If the pain is constant and unbearable, get a second opinion but I agree with Jeruba. When I had my tubes tied, after giving birth, I kept having these mysterious pains on and off for months. I believe it was about a year when it finally went away. They never could find out what it was. I imagine it took some time for everything to heal and maybe (like Jeruba) certain parts were getting smaller and shrinking and maybe pulling. Like the way a large skin cut itches when its healing or a bruise. Only this is deeper inside.
But maybe stop the over the counter drugs for now. It could be creating too much pressure that your intestines can’t handle right now.

MrGrimm888's avatar

@Cruiser and I together again LOL. Yeah, go to the ER

Good luck.

Peace n love.

chyna's avatar

I’m chiming in with ER or GI doctor. I’m thinking that if you go to the ER, they will have a GI consult and there you can get the tests you need. Good luck and let us know.

flutherother's avatar

You’ve had the pain a long time and it is getting worse – like everyone else I think you should have it checked out.

canidmajor's avatar

With your history, I vote with the “bug your GI guy to get you in sooner” crew. You, probably more than most of their other patients, have seriously fine-tuned instincts about your gut. Can your maybe get your PCP to advocate on your behalf for an earlier appt?
Good luck with this, Sweetie, please let us know that you’re OK!

jca's avatar

One huge advantage of going to the ER is that any tests you need, for example CAT scan or MRI, can be done immediately. If you go through your doctor, the tests might be weeks down the road. Granted it doesn’t seem like an immediate urgency since your pain has been chronic for a while, but I’d go, if anything to get the follow up tests done same day, which is the power of the ER.

JLeslie's avatar

This is not medical advice, it is only what I think I would do, and you know I have a long history of bad experiences with doctors and I’m tainted.

I would most likely not go to the ER. I think it will be a waste.

I would try to get into your surgeon’s office sooner. First you can try to call and emphasize the pain you are in, and you need to be seen, and remind them you are a few weeks post surgery. If that doesn’t work you can show up at the office. Your face in front of theirs should make a difference. Are you talking to a nurse for the appointment, or just the appointment person? Try the nurse in the phone if you haven’t yet to get an appointment right away.

My gut feeling, no pun intended, is there will be nothing obvious. Nothing easily seen on CT or MRI, and maybe it’s scar tissue adhering organs in a way that is creating pain. That would suck, because the only way to know that is to open you up again I would think, unless there are new diagnostic tools since I had that problem.

Does it feel muscular? Or, in your digestive tract? Because you said it hurts like a sharp pain when you cough, that sounds muscular to me. Do you get any relief after burping or bowel movements?

Since the pain isn’t constant it doesn’t sound to me like it is something awful if it waits a day to be checked, but only you know how much pain you are in. If it’s a metal tool left inside of you, extremely rare, that will show on X-ray, and be ruled out fast. If they left a sponge inside of you, also very rare, you probably would have a very constant symptom.

If you develop a fever I would go immediately to the doctor or ER, short of that I wouldn’t go to the ER. The ER’s main goal is to make sure you don’t die on their watch, and then they send you home saying follow up with your doctor.

I just want to add that it seems obvious to me this is related to your surgery. It might heal over time without intervention, but you should get checked. I only add that because I completely believe this started after surgery, and if your doctor tries to say it’s not related, I’m on your side. :)

ucme's avatar

I’m going to suggest you already knew the right course of action & entirely expected the answers you’ve been given here & sought only confirmation.
That’s all perfectly fine & kind of endearing, shows your commitment to the site & its members.

Mariah's avatar

Thanks all. You guys are sweet. I just woke up and I’m still not sure what I will do. The pain is always mildest in the morning so right now I feel pretty good but as the day goes on and I eat I know it will get worse again.

So 3/1 WAS the appointment I got when I insisted on an earlier appointment with my GI. I was scheduled for 3/20 originally. He’s on vacation this week, there’s no seeing him sooner.

My gut feeling (heh) is that this is new adhesions forming (my last surgery was to remove adhesions that had caused a blockage, and I was full of ‘em) and I’m thinking probably my small bowel is adhering to my diaphragm which is why the pain is so affected by my breathing. If I’m right about this, what I know will happen at the ER is they will give me a CAT scan (they do not do MRIs at my ER except for people who cannot get CAT scans) and the CAT scan will see nothing. And I get another huge dose of radiation into my abdomen which is something I’m already worried about because I’ve lost count of how many CAT scans I’ve had of my abdomen. Unfortunately an MRI won’t see this either, so I literally have no idea how anybody is going to solve this problem for me, even my GI. I feel like I’m just screwed!

I do NOT have an appendix! It came along for the ride with my colon. So that is not something we need to be worrying about, just fwiw.

Still thinking. Thank you for your input. I often have to debate about whether I’m being crazy when I make medical decisions because I am just very “used” to medical drama so I think I don’t panic about various situations as much as I should sometimes.

JLeslie's avatar

Very very bad pain on the right below or just behind the breast is most often gall bladder. But, it usually doesn’t come and go with a sneeze or cough. If you do have gall stones causing your pain that will be seen on ultrasound. I think it’s surgery related though, not your gall bladder, but an ultrasound can rule it out.

Maybe a typical flat X-ray can see if it’s anything crazy like a surgical tool left behind, and very minimal zap of radiation if you want to rule that out?

I had adhesions that adhered my colon to my ovary and caused me pain in my colon and all the way up to me breasts. It felt like pain up in my stomach organ. Once the colon and ovary were separated 95% of my digestive pain went away. Before the surgery I had had a colonoscopy, which showed nothing, except a polyp and my doctor said my colon and rectum looked like a 60 year old and I was in my early 30’s. He did not help my problem, it was my fertility doctor who did surgery and helped my digestive problem.

Mariah's avatar

PCP already did an x-ray. I thought about gall stones the other night when it was really bad and spasmodic but it was on the left that night.

I’m terrified I just have chronic adhesions now. Only surgery solves them but surgery creates them. If I get stuck in a loop where I just have to have biannual surgery or something I’d rather jump off a parking garage.

JLeslie's avatar

I get it! Total empathy from me.

It could just be gas or muscles and work itself out. Maybe try eating foods that don’t create gas, be sure to move around during the day, take some extra probiotics, and take ibuprofen for a few days and see if it helps. Just as a test. Be sure to eat with the ibuprofen and plenty of water. As long as your surgeon is ok with ibuprofen.

Remember you had a big blast of antibiotics for your surgery and if you had laparoscopic surgery they pushed a bunch of gas into your abdomen.

Adhesions usually take a little while to start forming.

ANef_is_Enuf's avatar

I agree with your assessment, sounds like adhesion pain to me. Mine is mild in the morning and progresses throughout the day as I move around/stand/eat/digest. I am not saying this to advise you on what to do, but what works best for me is to have a day or two of liquid diet and, worse case scenario, a bottle of mag citrate. I don’t get constipated, but my surgeon recommended this method because it’s harder and slower to move matter through the intestines that are kinked up – even if there is not a full or partial obstruction, so sometimes it’s helpful to just… reboot.

I also highly recommend a pelvic floor physical therapist. Having to strain to void or move the bowels, or having to do so often (and “holding it” frequently until you can get to a restroom, which was always my biggest issue), can lead to dysfunction in the pelvic floor muscles. You really only hear about it happening to women post childbirth, but it can happen to anyone and people with chronic bowel troubles are higher risk. For me, the more issues I have with my adhesions, the more issues I have with my PFD, and then they seem to play against each other. Between the muscle spasms and upset stomach, it can be pretty uncomfortable at times, but learning to relax the muscles properly helps to alleviate a lot of that. Something to look into.

JLeslie's avatar

@ANef_is_Enuf I think @Mariah had a colostomy.

ANef_is_Enuf's avatar

@JLeslie ah sorry, I’m out of the loop. I’m not sure whether or how that would affect what I said and whether it would still apply (though, I’d imagine learned dysfunction prior to the surgery would still be present and could still cause issues if it isn’t resolved.)

JLeslie's avatar

Just to clarify this surgery wasn’t the colostomy, it was years ago.

gorillapaws's avatar

@Mariah Your surgeon will have coverage when he’s on vacation. I would insist on being seen with whoever that is. Call your surgeon’s office and have them send your records. IMO you should get a surgical consult as early as possible. It’s probably not serious, but I would think a surgeon would be able to make that call and at the very least give you peace of mind that you’re ok. The worst case scenario is obviously to wait if it turns out you have a problem that should be addressed quickly.

You’re only a few months post-op and you have a complex surgical history. I wouldn’t want the receptionist/scheduler (or even MA/Nurse) making that decision for me.

Mariah's avatar

I don’t have a colostomy. I had one temporarily in the past but I poo like a normal person now, except that my small intestine is basically hooked up directly to my anus (it’s a little more complicated than that….. j-pouch). I don’t have a colon or rectum. Strangely I do have to strain quite a lot even though I’ll never have a solid poo again in my life, I think that’s just because I’m missing the strong muscles that the descending colon has to move things along. Not sure.

Do y’all really think I need to be seeing my surgeon for this? Because I could see him, he’s not the one who’s out of town. My gastroenterologist is out of town. I just don’t see the surgeon as being the person with the answers here. He operated on me and could do so again if it were necessary but diagnosing strange abdominal pain feels much more like a GI thing.

JLeslie's avatar

Oh, so that’s my mistake, I didn’t realize the colostomy was temporary.

I think call the surgeon’s office and see what his nurse thinks. I assumed your GI doctor was the surgeon.

BellaB's avatar

I’d probably call the surgeon’s office. Things aren’t going well post-surgery so that would be my first call (taking into account the differences in our medical systems). I wouldn’t expect a g.i. specialist to know as much as post surgery complications as I would the surgeon (or in some cases, someone in their office).

Mariah's avatar

I will do that. That seems like a good middle of the road option for now. Thanks guys.

RedDeerGuy1's avatar

My guess is that they left something in you from the previous surgery. like a piece of gauze . Just a guess. It happens. Keep us updated.

si3tech's avatar

@Mariah Having read some of your posts IMHO you should get checked out soonest.

ARE_you_kidding_me's avatar

Please keep us posted!

jca's avatar

I wouldn’t think of a surgeon as the place to go for an answer to this issue. Surgeons do surgery. I’m not thinking surgery is the answer, just yet, without a diagnosis.

gorillapaws's avatar

@jca Surgeons make diagnoses all of the time. If it is a complication from the surgery a few months back, the surgeon who did the procedure may be the best person to see her. Since her GI is unavailable until next week, it seems like the prudent course of action to speak with the Surgeon’s office.

johnpowell's avatar

@jca My GP tossed me off to a surgeon to look at a fatty growth to the right of my penis. The surgeon said it wasn’t harmful but suggested having it removed. Then he scheduled a operation with general anesthetic in a real operating room to remove it.

So they do actually do the diagnosis.

ANef_is_Enuf's avatar

Did you get through to your surgeon? I hope they have some input and that you’ll keep us posted.

Mariah's avatar

Hi all. Yep got through to my surgeon. Talked with the surgeon himself on the phone, was impressed by that. He thinks anything dangerous would be accompanied by symptoms other than pain (e.g. nausea or fever, none of which I’m experiencing) and he agrees with my PCP that I am just in ongoing healing right now. He said there can still be ongoing changes in the body a year after a major surgery. He said there is no test he would recommend because no scan is going to show anything if I’m just healing. I had read quite a bit about gas in the abdomen after @funkdaddy‘s comment and thought the symptoms sounded pretty similar, especially with the way the pain has moved around, but he was very firm that I would only feel anything from that for 10 hours after surgery.

I still feel weird about it, but I guess I feel convinced now that I’m OK to wait till 3/1. I do kinda hope my GI has more ideas though.

Thanks for the support.

chyna's avatar

Thanks for letting us know. We care!

Mariah's avatar

Last couple of days I can breathe deeply without pain but I feel MOTION and like ???crackling???? in my chest when I do so. Bodies are so fuckin’ weird man.

stanleybmanly's avatar

Yours in particular has been exceptionally tortured. I too had been thinking about the likelihood of gas but since your symptoms are diminished in the mornings, perhaps simply lying down before or while the pain increases might bring you some relief. Have you noticed any ability to alter the severity of the pains through various contortions of your bod?

Mariah's avatar

So the short answer to that question is yes, but not in good ways.

Several weeks ago I was having a very bad night with spasmodic pain on my right side. I kept getting these sharp jolts and then….Pop! Something shifted and then I felt fine. So when something similar was going on last week on the left side, I did some stretches, hoping I could trigger whatever that pop was. Well…I did not get a pop, but after stretching, the pain was like 10x worse and I was awake most of the night with it. It settled down over the course of the next day or two and now I feel like I will never stretch again in my life, lol…

My body’s defective. I want a refund.

funkdaddy's avatar

Good brain though ;)

not minimizing what you go through, just complimenting

ARE_you_kidding_me's avatar

Good heart too.

Mariah's avatar

Aw. Guys :’)

stanleybmanly's avatar

You must know that we are all pulling for you Mariah. I know that I’ve watched you soldier through these horrific ordeals since my arrival here. I don’t usually comment on your travails, because frankly I don’t what to say that can possibly help. But believe me, your courage and persistence breaks my heart.

Mariah's avatar

Sigh. GI appointment was quite useless today. I really wish he could have seen me like 5 days ago when the pain and a very audible popping/crunching type sensation were still present. I’ve been doing a lot better the last few days which is great and all, but it has been on an on/off cycle this whole time so I don’t trust that it won’t come back, and I was totally asymptomatic for the doc today. I attempted to describe it and he decided it didn’t sound like a GI thing (too high up) so he didn’t have much to say about it except “sounds maybe musculoskeletal” and follow up with the PCP if it gets worse again. Blargh.

si3tech's avatar

@Mariah That must be so absolutely freaking frustrating!! Do you have a physician who has actually experienced your exacerbation over months/years?

JLeslie's avatar

That sucks. Next time the pain is bad maybe show up at his office. Although, I doubt it will get you a diagnosis in the end anyway.

stanleybmanly's avatar

Show up at his fkn house.

Mariah's avatar

Right now I’m kinda just hoping it doesn’t come back. I have felt really good, “normal” I daresay, for several days now. Though I told myself I’d stop announcing my recovery to the world because every time I do I seem to have a setback.

My PCP has been the most sympathetic and since I’m not convinced it’s GI I’ll probably go back to her if the pain comes back again. She’s also much easier to get an appointment with.

Unfortunately all of my docs are fairly new to me as I just moved to the area like a year and a half ago. The surgeon especially is new to me; he became my doctor solely because he was the one who was on call at 3 in the morning when I needed surgery (but he’s been great so far). They know my history because they have my records, but until the most recent surgery I had not had any major problems while under their care before. I don’t know them that well yet. And I don’t trust my GI as much as I would like to because he seems mighty eager to get me on a new (expensive) drug that I don’t want to be on, and I have to resist his wishes pretty much every time I see him (he did not bring it up yesterday, for which I was grateful). But he is a respected leader in IBD around here.

Blah. Thanks for the support.

Mariah's avatar

I’ve made a really interesting discovery on my own.

I had 2 hard ciders last night and now I am lying awake with pain where I hadn’t had any yesterday. I also had cider on NYE and had pain on new year’s day. I remember wondering if there was any way alcohol could have triggered something.

I’ve had wine without trouble in the last few months, which would seem to indicate it might not be an alcohol or sulfite insensitivity but rather some other ingredient in the ciders (they don’t contain other ingredients besides fruit juice and sulfites, though…at least according to the label). Maybe carbonation???

I never used to have issues with cider, but I’m obviously going to avoid it now, and when the pain dies down I’m going to do some experimentation with fruit, wine, and other foods that contain sulfites to see if this could be related to a food sensitivity.

I’m really glad I’ve made this connection. Now maybe I can get control of this on my own.

JLeslie's avatar

@Mariah That would be great if you can figure out foods and drinks that give you pain and problems. I definitely think carbonation can be a culprit. As many said above, gas can be very painful and move around. My mom used to be hunched over in pain from salami when she was a little girl, and they decided it was gas related.

I get pain from very sugary things. The pain feels in my stomach organ to me. Like an irritation or ulcer is there.

If I’m constipated I can feel pain all the way up to my chest. Like I could be worried I’m having a heart attack. My constipation is related to raw veggies, iron pills.

My friend with Crohns can’t eat raw veggies. Another friend of mine with digestive problems has a different diet.

ARE_you_kidding_me's avatar

Gas does it to me too, enough that I used to worry it was something serious.

Mariah's avatar

Trust me I know what gas feels like, lol. I’ve had more than my share of that. My GI says the pain is too high to be in my small bowel.

At this point I’m thinking it might actually be heartburn though. I’ve never had upper GI problems so that would be unfamiliar to me. The pain spreads into my collarbone and shoulder in a way that you wouldn’t expect GI pain to, but I’ve recently been reading about how stimulation to the vasovagal nerve can make pain feel like it’s in the shoulder when really the shoulder is totally uninvolved.

Still doesn’t explain why my chest cavity clicks and pops when I breathe though.

My other theory is that I am reacting to foods in an inflammatory way that I never have before. I usually do not eat a restricted diet as I notice no change in how I feel based on what I eat, but the cider thing has thrown me for a loop. Maybe I have developed a food sensitivity. Strange timing with the surgery and whatnot.

Fuck this mystery body, lol.

stanleybmanly's avatar

Have you been able to tolerate other carbonated beverages?

Mariah's avatar

I really don’t drink anything else that’s carbonated. I don’t care for soda or seltzer. It’ll be something I experiment with once I’m well enough to do experiments.

BellaB's avatar

My father has a wide range of gut problems. He’s had to give up everything that fizzes as well as all foods containing onion recently. He has found that sucking licorice lozenges give better relief to shoulder/throat discomfort based on acid reflux than the prescription meds did. Weird, but it works and the specialist told him to keep it up (while the g.p. is freaked out by NO MEDS for this?)

Mariah's avatar

Yeah most people with my diagnosis have trigger foods that they avoid. I’ve never been able to draw any correlation between what I eat and how I feel, except that yogurt and all other probiotics make me feel awful. I’ve avoided soda and other fizzy drinks all my life because I just don’t even like them that much so why consume something unhealthy if I don’t even like it? Only exception was cider, my alcoholic drink of choice. Never had a problem with it till now.

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