Skip to comments.ER Visit Last Night
Posted on 12/28/2013 12:27:09 AM PST by MacMattico
Hi all, Last night I spent 8 hours in the ER and am still in pain. I'm also mad about the whole thing. Obviously, though, I'm healthy enough to type on my iPad! Any insight is appreciated.
For the last 3 weeks or so I have had a dull pain right below the bottom of my ribcage on the left side. At times it would become sharp, like a stabbing pain and I would not be be able to take a deep breath during that time. I would cringe in pain during these times. After a while it would go back to a dull ache. This went on, like I said, on and off for the past three weeks. I tried to ignore it (stupidly) because I was so busy and wanted to get past Christmas. Last night about 9 pm the stabbing pain came back and it was unbearable. I had thought I was coming down with something because I was so tired I had left a family Christmas day get together early, came home, and slept 9 hours straight. When I woke up I didn't feel sick so I thought I had just been really tired from the Christmas eve get together we had hosted the night before. That is until 9pm last night.
Amazingly I got into an ER room without any wait. They told me things were really slow. I described my symptoms. I had no fever or trouble using the bathroom. They took blood and urine samples and did a series of x-rays. Within about an hour the pain was back to a dull throb with no pain killers. I try to avoid them because they make me sick.
Hours went by and 3 different doctors came in. They were pressing on my stomach area and it only hurt worse when they pressed directly under my ribs to the far left. I don't have a gall bladder so that definitely wasn't it. My blood pressure has never been high but was high, and they said this was probably nerves although I didn't really feel nervous. The third doctor that came in was convinced it was a stomach issue. I told him it didn't feel like anything to do with my stomach. From then on out all that was mentioned was my stomach.
One doctor mentioned doing a CAT scan. I said go right ahead. Get this-- the doctor says CAT scans are expensive! I said if you've checked my health insurance, you will find out they are covered 100%. I don't know if he really checked my insurance but a nurse came in to tell me I was going to have a CAT scan and be admitted. At this point the hospital was getting busy and I heard a gun shot victim was coming in.
So I laid there for who knows how long, my husband with me, and then a nurse walks in and says I need to take your IV out and you're being released! I said what? The nurse said your X-rays, urine sample and blood tests are all normal. I said the last person in here was a doctor that said I was being admitted! The nurse went and checked with that doctor who told them that I was to "follow up with a doctor specializing in stomach issues". I said I don't even think it's my stomach!
So this morning I had a couple more shooting pains and the dull pain persists. I called the doctor I was referred to and their office said they don't know when they can get me in! I said I was told to follow up today! They said they had no appointments until the end of January and would not see me until then. I hung up I was so mad. I called the hospital and after getting transferred three times was told to come in if the pain got worse, but "they wouldn't have released me if everything didn't look good". I was so mad. I took a high dose motrin and tried to sleep, now I'm up all night with a dull side ache.
Demand the CAT scan and an MRI.
Make it stick, make them do it.
Go for the best technology can do.
Dull pain with intermittent shooting pain?
Something is up!
Make them find it.
Have you lifted anything or slept in a position that might have caused strain on the cartilage between your ribs? I’ve done this a few times and taking a deep breath felt like I was getting stabbed. After a couple of days of not reinjuring it and it was gone. The first time was along the left side of my sternum and my initial thought was a heart attack.
Maybe a blood clot in the lower lung area. Ask about blood thickness, personally my blood is prone to clotting more that most out there so I am subject to a lifetime of blood thinners.
I agree. It could be gall bladder????
I got my gall bladder out 12 years ago in my 20’s !
Do you have a regular primary care physician who will advocate for you? Demand the tests necessary to diagnose your pain. That is what they have the CT and MRI for.
I am afraid that sometimes women are dismissed as hypochondriacs.
It sounds like you might have a duodenal ulcer. It is terribly painful and the symptoms get progressively worse if left untreated. You need to see a gastroenterologist.
Mrs. greedo had it many years ago, they gave her something for it, and it got better.
google it and see if the symptoms match yours.
yours very truly,
I will only ask this...is the pain right below the left side on the rib cage....kinda like you took a tennis ball and squeezed the heck out of it?
If yes? Then, it’s the same thing I’ve had for fifteen years. And early on, with no diagnosis (and still none)...I learned to raise my arms above my head and twist to the left with the whole body. The shooting pain disappears within ten seconds, and doesn’t come back for at least a day or two. Lately, with a different nutritional diet...I haven’t had the pain in six months (less fat, more salad oil, more fruit).
Oh jeez... My dad died from a blood clot to the heart/lungs.
Gall Bladder is located on the right side (I had mine removed).
OP said his pain is on the left side, below the rib cage.
So it is not the gall bladder.
It is right below the rib cage on the left side. It is mostly dull like what I had with my gall bladder, but will then seemingly out of the blue feel like I’m being stabbed over and over. Then go back to dull.
That was my thought...
A blood clot will show up on blood work, any good ER doctor will order a d-dimer test to rule out a pulmonary embolism whenever chest symptoms are present.
Look up Tietze Syndrome and Costochondritis.
I don’t seem to have those symptoms. I’m not nauseous. If I look at a picture of the human anatomy I would say it has something to do with my pancreas. I mentioned this last night in the ER. I guess they don’t think so.
I don’t think so.
Very good call, greedo. Certainly way painful, but they usually wouldn't hospitalize you for it. A quick WebMD descrip: "Pleurisy, also called pleuritis, is an inflammation of the pleura, which is the moist, double-layered membrane that surrounds the lungs and lines the rib cage. The condition can make breathing extremely painful. Sometimes it is associated with another condition called pleural effusion, in which excess fluid fills the area between the membrane's layers."
I've had it a few times. VERY painful.
I was kind of shocked to read about this since I've had my gall bladder removed 20 years ago.
Besides the point, they should have never sent you home without doing further test to determine the problem.
I said that to my husband. Do I have to start screaming for them to listen to me? I had my daughter without pain killers. I’m just not a loud person when it comes to pain.
Here is a search for lower left quadrant pain via Mayo Clinic. http://www.mayoclinic.com/health/abdominal-pain/MY00390/DSECTION=causes
You will see there are several issues that can present on that side. You can rule out some or most but a few should give you a good idea of what is going on and with a bit of extra reading you should be able to get a more specific symptom/cause/issue, at least enough to give the docs more helpful information.
Good luck and don’t let them turn you away.
Under Obamacare this type of thread I will be our new healthcare, should I say, Period!
Do you have a GP or private doctor of some kind? If not, you need to get one.
Yes. I should have called today but I slept as much as I could because I was up all night.
That’s good to know!
You should get a referral to a GI. That is your stomach.
Right where the stomach is.
You have mail.
Besides the point, they should have never sent you home without doing further test to determine the problem.I agree. You need to go back to the hospital. So irresponsible on their part. My mother had pancreatis, and had pain somewhat similar, however, it moved into not being able to breathe well. It's a condition you want to rule out though. And pleurisy I've had as well. It does sound like that from your description. But geeez, you shouldn't have to be on Free Republic to diagnose your condition. Shame on your hospital's employees; I'll be offering up some aves (Hail Marys) for you.
Your gall bladder is on the right.
It could be a lot of things. Please follow up with your doc (horrified by the treatment you got at the hospital!)
In the meantime, check out this link:
Just thought I’d throw in my two cents:
Just because you had your gallbladder out doesn’t mean that you can’t get them in the cystic duct. If that becomes blocked, you can have a ton of issues. (The pain is horrible.)
Another issue that can cause pain in that area is an inflamed spleen or pancreatitis. Stomach ulcers can flare and quiet. I had duodenal ulcers (it’s like acid reflux, but where the stomach goes into the intestine) a few years ago that hurt like hell and yes, the pain came and went. It took months to figure it out.
The problem with abdominal pain is that it can literally be anything and can radiate from anywhere. It’s very difficult to narrow it down.
I’d recommend getting in to see an Internal Medicine dr. Not a family practitioner who also happens to be an IM, one that does IM for a living. They dig harder than anyone else, in my experience.
One easy test is to do 30 days of Prilosec (20mg or one pill a day). If it helps, you’re looking at ulcers (stomach or gut). No, it may not cure the problem, but it does work well for diagnosis.
Follow up with your doctor as soon as you can.
He may recommend the CT. Not that much in Left upper quadrant.
Could be stomach, colon,Lung possible, spleen also in LUQ. Kidney and pancreas less likely.
If you go back to the ER expect to repeat everything, and them probably do the CT. They are not benign. The radiation from an abdominal Ct is 1000mRem. The radiation from a chest xray is 10mRem for comparison. Each abdominal CT increases risk of cancer over your lifetime by a fraction of 1%. And if you are a female of reproductive age there’s a significant dose to your ovaries.
I know its hard to hear this but the fact you’ve had the pain for weeks suggests it’s actually not emergent. Most of the problems we get really concerned about in the Er would not last that long before making you really ill or killing you. Doesn’t mean nothing is wrong, just not an acute process. The job of the ER is to identify those in immediate danger, we can’t diagnose every problem. The most common diagnosis of abdominal pain in the ER is “Unspecified abdominal pain”. We can only do so much in the ER. Trust me I kind of know what I’m talking about here.
Would it not make more sense to listen to the doctor and see the recommended specialist before demanding expensive, somewhat harmful in the case of CT, and possibly unnecessary testing?
The other thing that people don’t realize is that a CT scan isn’t a magic ball that allows a dr to see everything in super high detail.
I’ve had CT scans miss a kidney stone (that I passed the next day) and a massive ovarian cyst that ruptured a couple of days later and nearly killed me from bleeding. (For that one, I had gallons of fluid building up in my abdomen. Not fun.) My son had a CT scan that didn’t show cracked cartilage from his ribs to his sternum.
So many times, it can be a waste of money and, as you said, the radiation is no joke. Most drs that I work with like to go for an ultrasound, blood work, and other tests first.
The ddimer has a high sensitivity and low specificity. That means LOTS of false positive results. You need to identify patients based on age, illness, history, physical exam vitals etc to select the subgroup the test is useful in. If you shotgun the test you end up with a large number of false positives you have to then deal with. That usually means a CT angiogram of the chest which involves a very large radiation dose, and contrast which can shut down your kidneys.
Good ER docs are VERY selective in who they get d dimers on.
Shit...I ain’t no doctor...but i recommend....http://www.youtube.com/watch?v=kkb8xre37F0
I am aware of that. It can catch near 99$ of all PEs and probably 100% of all massive PEs. I had a positive d-dimer and all that was done was a v/q scan. PEs are also very elusive and some say kill over 200,000 people ever year, it should be high on the list whenever anyone comes to the ER with chest pain and pain when breathing.
The single most common diagnosis of abdominal pain in the ER is “unspecified abdominal pain”. We see patients all the time with abdominal pain and can’t come up with a specific diagnosis. I don’t know what labs they ran but probably a CBC, Chem panel, LFTs, Lipase and Urinalysis and an abdominal series xray. If they did those the only additional test I could think of to add would be an abdominal CT. This test is NOT benign. There’s a high radiation dose and IV contrast that affects the kidneys. It takes about 3 hours to do.
People the job of the ER is to identify those in immediate risk, not diagnose everything. We can’t. They didn’t just kick her out, they offered pain relief and follow up with a gastroenterologist. Every set of discharge instructions includes “come back if you feel your symptoms are worse”. Remember this person said the problem had been ongoing for weeks, that makes it less likely to be an acute process.
To all those here who are tossing out diagnosis without getting a history, doing an exam, seeing vital signs, lab results, effects of medication etc etc etc, go try and practice medicine in an ER and see how simple it is.
If you don't have a primary care physician, perhaps you can go to a walk-in clinic and use them to guide you through the process. Try to avoid going from one doctor to another on your own. Have a primary care physician, or nurse practitioner that you can come back to to discuss the situation and decide what to do next.
From my experience, muscle spasms can mimic other more serious problems. While this may have nothing to do with your problem, it is my only thought at the moment.
Years ago, I would have a minor accident, being thrown from my horse. The initial shock went away, but hours later I would have severe pains that would almost immobilize me.
I had two or three such events.
Their is no way to really see or diagnose them. My only relief was to be on muscle relaxant drugs until the muscles stop the spasms
We rarely get VQ scans these days because too many are “inderminate”. You get three choices “high probability”, “low probability” and “inderminate”. Notice low probability does not mean negative. The CT is much more sensitive and specific at detecting PE.
PE is a huge problem in the ER. Yes the ddimer helps IN THE RIGHT PATIENT POPULATION”. The proper way to approach the diagnosis is a careful history, a physical exam, looking at the vitals and selective testing. If you shotgun the ddimer you end up doing a lot of unnecessary CT’s and VQ scans.
“The diagnostic yield of D-dimer relies on its specificity, which
varies according to patient characteristics. The specificity of
D-dimer in suspected PE decreases steadily with age and may
10% in patients above 80 years.
D-dimer is also more
frequently elevated in patients with cancer,
and during pregnancy.
Therefore, the number of
patients with suspected PE in whom D-dimer must be measured
to exclude one PE (also referred to as the number needed to
test) varies between 3 in the emergency department and 10 or
above in the specific situations listed above. Deciding whether
measuring D-dimer is worthwhile in a given situation remains a
matter of clinical judgement.”
Guidelines on the diagnosis and management
of acute pulmonary embolism
The Task Force for the Diagnosis and Management of Acute
Pulmonary Embolism of the European Society of Cardiology (ESC
Diverticulitis or Aortic Anuerysm/Dissection?
I’ve had friends experience both.
They were loudmouths, had great insurance and the ability to write large checks.
I had a score of around 1360 when I went to the ER with palpitations. I had a normal workup except for sinus tachycardia and an IRBBB on my ecg. I am guessing the elevated d-dimer was from my multiple giant cell granulomas in my jaw or my fibrous dysplasia.
If you can, find a concierge medical service, sign up and go see them ASAP.
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