Suggest Treatment For Left-sided Abdominal Pain
A week ago, she was seen by a gynecologist and had a pelvic exam which indicated nothing significant. This was followed by an ultrasound of the abdomen area, with no apparent issues. Her pain continued, as she is studying for semester tests, taking the SAT tests last Saturday and going to soccer practices and playing full games several times. The pain continues in spite of prescribed Tylenol 3 at night. At least, she can sleep then,) and up to 800 mg. Ibuprofen during the day, which does not eliminate the pain. She had been on SPIRONOLACTONE, 50 mg/day and MINOCYCLINE, 100 mg/day(generic/Minocin) for acne, for a couple months. The last doctor has suggested to discontinue them for 3 days to see if the pains could be a side effect of them. No other meds. She is not able to see a doctor for intestinal bowel exploration until May 20. MY QUESTION, FINALLY IS: COULD THERE BE SCAR TISSUE OR SOMETHING ELSE relating to the removal of the ovary and cyst in 2008, involved in this scenario? Would it have shown up on the ultrasound? Who would be the best person to contact other than what we have done, so far. (The pain seems chronic, except for the nighttime since being on Tylenol 3; no difference if she is or when she isn't playing soccer or at home or school, etc.)
She claims her pain level to be about "6" most of the time, but much higher to cause her to double up at times. She feels she's been to the ER in the past, such as with her abdominal pains when she was nine, when no one there nor her pediatrition here could identify the huge cyst. At Ryle (sp?) Children's Hospital in XXXXXXX 8 years ago, her ovarian cyst was discovered and removed and determined to be benign. Unfortunately, it was entwined with the ovary, which had to also be removed. She has had a cyst removed from the thyroid this past year, non-malignant, and ankle problems, although no broken bones, so has a very high level of pain endurance, according to her doctors. One of the doctors told her she seems prone to developing cysts, so when I read about your "scar tissue" information, I wonder if there could be some connection?
Can you help determine the next, and hopefully, less-expensive step, other than checking for IBS or other bowel issues? She has no vomiting, only occasional nausea, no constipation, no blood in the stool or urine, no bladder infection; otherwise, she eats well, sleeps well since the Tylenol 3, has incredible energy to keep up with her studies and activities, considering the pain. She says, "If I could just get rid of the pain!" Hopefully, we can find a solution.
I have not seen any "Terms and Conditions" to agree to accept. Where do I find them?
Thanks for taking the time to read this somewhat lengthy "health question". I figured you would need some background information. I look forward to your diagnosis/suggestions. XXXXXXX @ YYYY@YYYY
need to add strong painkillers, and see Gastroentrologist
Detailed Answer:
Welcome at HCM
I am Dr Saad Sultan and will be answering your query. I have read and understood your health concerns.
As far as scar tissue is concerned , I don't think it is relevant here in your case history. Normally after surgery , scar tissue presents with signs of intestinal obstruction ( vomitting, constipation , abdominal distension)which are not present in your case.
Since there is no other associated problem like constipation or blood in stools etc , so one should not worry about it much.
In my opinion , she should be seen by Gastroentrologist once for proper clinical correlation . As ultrasound appeared normal , the next step is to get the CT scan of abdomen with contrast to pinpoint the pathology if present.You may also need to get full blood count with ESR, liver function and kidney function tests. He will also assess you for peptic ulcer disease.
Possible differentials include muscular pain, IBS and mesenteric vessel abnormality.
Pain management on the other hand needs to be addressed. There is need to add other painkillers like tramadol to relieve symptoms.
Stay calm and engage in healthy physical activities.
Feel free to ask any time.
Regards
Dr Saad Sultan