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911DOC
911DOC, Board Certified Dr.
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Experience:  Emergency Medicine Physician
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Abdominal pain after stopping reflux meds

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Abdominal pain after stopping reflux meds

911DOC :

can you tell me more?

911DOC :

how long has it been hurting?

911DOC :

what medical problems do you have?

911DOC :

how old are you?

911DOC :

male or female?

911DOC :

fever/vomiting/diarrhea?

911DOC :

standing by

911DOC :

are you there?

911DOC :

hello?

911DOC :

I will check back with you when you can answer my questions above.

Customer: Hx of ulcers. Was scoped jun 20 sgowed ulcer chronic gastritis and duodentitis. Was ordered to stop my reflux meds for 2 weeks was just restarted on them. But so far no relief
911DOC :

I see

911DOC :

but can you tell me about the quality of the pain and if it feels like your ulcer/reflux pain... also, any other symptoms at all?

Customer: It feels like reflux just more severe. Its been gradually worsening. I woke up this am almost in tears cuz it hurt so bad
911DOC :

I see

Customer: Its in the epigastric area and its a stabby pain
911DOC :

have you contacted your physician?

911DOC :

because this extreme of pain is worrisome for other possibilities

Customer: I have not contqcted my dr. I see my mayo dr on Wednesday
911DOC :

well two things...

911DOC :

1. the reflux meds do not work right away so this may simply be a time thing

911DOC :

2. we can not be sure that this pain is from your reflux/ulcer disease....

911DOC :

it could easily be any number of other things

911DOC :

and if you have not had a physician look at you with this pain then it is time to get this done

911DOC :

and Wednesday may be too long to wait

911DOC :

do you have a physician you can see tonight?

Customer: I do not have a dr i can see tonight. And tomorrow at 5 am i am leaving town to go to mayo for octreotide scan
911DOC :

I see

911DOC :

what are they looking for with the octreotide scan?

911DOC :

are they concerned you may have a zollinger Ellison syndrome problem?

Customer: I have elevated gastrin
911DOC :

I see

911DOC :

so I do think they are looking for a gastrin secreting tumor

911DOC :

do you have periods of time without pain?

Customer: Not really. I just have periods of less intense pain
911DOC :

would you say that this pain pattern is stable, in other words, you hurt, but you aren't geting worse and worse are you?

911DOC :

and you are not having fever or vomiting?

Customer: Its nor getting worse except when eating. No fever/vomitting
911DOC :

does your mayo doctor know this?

911DOC :

have you told them you are having a really hard time?

Customer: I told him how bad the pain had gotten while i was off the meds. But since arartibg the meds the pain isnt any better. I havent told them that
911DOC :

you should

911DOC :

I think that your case is complicated

911DOC :

that is evident from the tests being performed

Customer: They just cant figure out why i have recurrent ulcers
911DOC :

well I think they may be about to figure it out with the octreotide scan

911DOC :

so the question is how to get you from tonight to Wednesday safely

911DOC :

and with the amount of pain you are in I wonder if going to mayo now or in the morning and showing up at their clinic or ER might not be the best idea?

Customer: Its a 4.5 hr drive to mayo. I start the scan tomorrow
911DOC :

can you at least get checked out at your local ER? they might at least be able to control your pain.

Customer: If you think i must. Im just hoping that the pain will subside
911DOC :

Well the problem is that abdominal pain is notoriously difficult to diagnose (as you know) and prior to giving medicine for pain one needs to be sure that it is SAFE to suppress the pain.

911DOC :

in other words, one needs to understand the source of the pain prior to giving pain medicine because suppressing abdominal pain without knowing this can lead to catastrophe

911DOC :

I wonder if you have a phone number for a contact at Mayo?

911DOC :

Is there someone you can call

Customer: I can send them a message via mayo portal but they wont get it until tomorrow
911DOC :

well, that's something

911DOC :

I wish I could tell you what to do but it really sounds like you need pain medicine and that's not going to happen without an evaluation and in your case it looks like they are zeroing in on the diagnosis at Mayo and if you went locally they would have to try and reinvent the wheel.

911DOC :

so my advice would be to keep taking your current medicine

911DOC :

and if you can't stand the pain I would not hesitate to go to the ER

911DOC :

or if you develop new symptoms, like vomiting or fever.

911DOC :

I wish I could do better for you but you are in a very tough spot.

Customer: Thanks anyways. I hope the scan is normal
911DOC :

Actually, you may want the scan to show something.... Perhaps that would be better than no diagnosis. In any case, I hope you do get answers and a cure for this.

911DOC :

but I am serious about the ER

911DOC :

if you get worse as I mentioned above, you must go.

911DOC :

do you have any final questions for me?

911DOC :

oh, one more thing

911DOC :

I assume you are also trying rolaids or Tums or pepto

911DOC :

you could do this is you wish unless you have been instruced otherwise

911DOC :

standing by

911DOC :

are you there?

911DOC :

it seems you have have stepped away from your computer

911DOC :

I do need to step away too so I am going to switch this to a Q and A session in case you have further questions

911DOC :

if you do not, positive feedback is always appreciated

911DOC :

I hope you get good answers at Mayo, and that you can get some relief from your pain

911DOC :

be well

911DOC :

and thanks for your question

911DOC :

good night

Customer: I tried tramadol but it didnt help
Customer: replied 3 years ago.
I tried tramadol but it didnt help
Sorry

So tramadol is a mild pain reliever

You could try Tylenol with this

The next step are the true narcotics, which would help to some degree, but again, it would require a visit to the ER.

Even though you think the tramadol didn't work, you can take it very 4-6 hours, and you can try Tylenol with it.

Aside from this, I really don't have a magic bullet, though I surely wish I did.

Best
911DOC and 2 other Medical Specialists are ready to help you
Customer: replied 3 years ago.
I sent a message to Mayo
good
hope you feel better soon
Customer: replied 3 years ago.
What else causes elevated gastrin?
Well, even though it is uncommon, Zollinger-Ellison syndrome is one of the causes... it is a tumor that puts out gastrin.

Here is another link that may help.

Basically, your doctor's are likely looking for ZE syndrome. There are other rare causes but now we are getting out of my area of expertise and into the realm of gastroenterology.

best
Customer: replied 3 years ago.
Is it possible the elevated gastrin has no clinical significance
Not likely. You have the symptoms. You are at Mayo. They think your elevated gastrin is part of the problem. My bet is that it is at the heart of your problem.

best
Customer: replied 3 years ago.
Do you think its likely ZE

There is absolutely no way for me to give you an accurate answer on this question. I think that is one of the things they are considering.

 

best

Customer: replied 3 years ago.
My stomach still really hurts

I think it's time to go to the ER or get to Mayo now. My concern is that it's five hours away and becoming VERY ill on the road is a bad idea indeed. I wish I could help you more and I wish you could speak with someone at Mayo but if you can't you need to go to the ER.

 

best

 

Customer: replied 3 years ago.
Im
At mayo waiting to get scanned

Please do not leave there without speaking with a doctor about your pain. Sometimes you come for a scan and go home. Make sure they know you are having great pain in your abdomen and that someone addresses it.

 

 

Customer: replied 3 years ago.
Im suppose to drink mag
Citrate tonight. Is it ok to drink it f i have abdomknal pain
With respect, I can not tell you that. You need to tell the doctor's at Mayo how much you are hurting. Please do that as soon as you can.

Mag citrate is a laxative and I can't see how it would be a bad thing, but you need to let your doctors know the extent of your pain. You need to do that now.

I am not your doctor, though I AM a doctor, and am happy to give my opinions, but I can not, and am not allowed to give medical advice, including advice on whether or not to take medicines.

You are at Mayo. Please let someone know as soon as you can.

best
Customer: replied 3 years ago.
I sent them a messag eyesterday
aren't you there? aren't you at the Mayo clinic? can't you go to their ER?
Customer: replied 3 years ago.
I was there to do the scan. Now im
In my hotel room. I dont know where their er is
then pick up the phone and call the hospital. you can do this.
Customer: replied 3 years ago.
I am fatigued. I drank the mag citrate no results but threw up 3 times
I am going to opt out now because you are simply not listening to what I am telling you. Please go to the ER. Good luck, I hope you do well.