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.
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.
Thank you.
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
reach
10% in patients above 80 years.
81
D-dimer is also more
frequently elevated in patients with cancer,
82,83
in hospitalized
patients
84
and during pregnancy.
85,86
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.”
ESC GUIDELINES
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.
Check those.
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.
The spleen is also in that area. Did they say anything about the blood work?
I have been told multiple times by doctors that my inability to urinate following iodine contrast is not from the contrast at all. They all tell me that in the absence of kidney disease there should be no issue with it.
(1) If it comes and goes-—you could be periodically ingesting something that collects as a gas in that area-—avoid anything carbonated. Soda is injected w/ carbon dioxide to make it fizz-—carbon dioxide is a gas.
(2) If it is an inflammation-—as several posters conjectured-—you need to up your ingestion of Omega-3’s.
O/3 is usually found in seafood-—but a faster way is to buy flax meal (not flax seeds). Some supermarkets carry it in health food sections.
Flax meal has no taste-—can be added to yogurt and blueberries for a healthful breakfast-—some people add it to bran muffin batter.
Doctors who are knowledgeable about nutrition recommend flaxseed oil doses for those with inflammation attached to allergies.
3) This may sound strange-—but one woman told of being rushed to the ER w/ horrible pain-—her system shut down and she was on IV’s. The cause? She had pigged out on coconut macaroons. Seems when we ingest coconut, it sucks up all body fluids in the process of digestion.
Don't want to get you worried, but he ended up in surgery (not emergency surgery) to have a thick mucus film scraped from his ribcage. The doctor told him it was likely a result of the pneumonia he experienced prior.
He's been fine since. Have you had any episodes of pneumonia or coughing fits from flu or other viral episode?
I hope that helps and wish you a speedy & healthy recovery, whatever it is.
Gas in the Colon – Also known as the splenic-flexure syndrome, excessive amounts of gas trapped in the colon can cause pain under the ribcage. Gas in the colon can trigger pain in the left upper abdomen or the lower left chest. A person suffering from such pain should sit in a chair to rid the colon of the trapped air. Consuming food that causes indigestion can contribute to such gases.
Yipes! What a scolding. I think you’ve been in the ER too long.
Usually that’s correct. Almost nothing in medicine is absolute.
My son-in-law had a similar occurrence about a month ago. It took them three days of tests and observation to find out he had a blood clot in his kidney. Your symptoms sound the same.
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