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khagihara, Doctor
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Severe Lower Right Side Abdominal Pain/Female

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I am 31 years old with PCOS, Hypothyroid Disorder, Fibromyalgia and Chronic Fatigue. Twelve days ago I started feeling more wide spread aches and pains than normal and I was running a low grade fever around 100. I immediately thought I must have had a cold or the flu, however the following day my lower right side of my back began to hurt mildly so then I thought it must be a kidney infection. The next day I was unable to walk with out assistance due to sever lower right abdominal pain and lower right back pain. Most of whom I consulted thought I must have a kidney stone. I went to the doctor the next day, still in horrid pain in both lower right abdomen and lower right side of my back and they ordered a urine test which showed a urinary tract infection. They put me on Lortabs for the pain, Cipro for the infection, and Mobic for inflamation. (Prior to these meds, I am on Levoxyl for my thyroid, klonopins for anxiety, adderall for my fatigue and advil for my fibromyalgia.) Two days following, my doctor had a CT done which showed my right ovary inflamed and a small cyst. Just yesterday I went to an OB doctor who said the cyst was too small to cause the pain, ordered a blood count test, did a pelvic exam, and sent me home. The blood count test came back normal. From the day that of my first symptoms I went 6 days with out a bowel movement and even with laxatives and an enema my bowel movements have been difficult (constipation and very hard stool). I get nauseated from the pain, I eat maybe once a day (usually fiber bars), I have very excessive flatulence, intermittent fevers, constant lower abdomen pain (both front and back), and extreme fatigue. I want to get this fixed, but with out medical help to figure the problem out, I don't know what to do and my doctors are unable to help. More background information: I have had 3 ovarian surgeries to remove cysts and to remove scar tissue. My falopian tubes, I have been told, are collapsed. My last ovarian surgery was in 2006 and I was told that I had very small spots of endometriosis on my uterus (nothing to worry about at the time). I had pre-cancer cells of the cervix in 2005 which only took one treatment of cryotherapy to correct. Other than the female reproductive issues (PCOS), hypothyroid disorder (which was finally leveled this year), fibromyalgia, chronic fatigue, chronic sinusitis and being over weight, most of my health has been favorable. I have never had issues with my digestive system, I have healthy blood pressure, strong heart and lungs, etc. With all this information, is there any thing that I can do to help my doctors correct this current issue with this awful stabbing, twisting, and pinching pain in my lower abdomen? Thanks for your help.
Exactly where is the abdominal pain? On a scale of 1-10, what is it? Does it radiate to anywhere else? Which is more painful when you press in or let go? When did it start? Is it constant? Is it getting worse? Does anything make it better? Does anything make it worse?
Do you have abnormal vaginal discharge?
Do you have a severe pain during periods, intercourse, pelvic exam, urination, or bowel movements?
What color is your urine? Is it cloudy?
Any other bowel problem?
Do you have any other symptoms?
Are you aware of anything which might have brought this on?

Are you taking any medications including OTC pills and herbs?
Any family medical history?

Customer: replied 6 years ago.
The abdominal pain is on the lower right side, just above my pelvis by 1 inch at best. My belly is very round from being over weight and bloated, so the best way to help you with the location is to measure from the center of my pelvic bone. From the center of my pelvic bone to just below the pain is about 3-4 inches, and about 1-2 inches just before the bone curves, then up about 1 inch.
The pain with out the pain meds is very close to a 10, to the point of making me nauseated. The pain with the pain meds is very close to a 6, but at least I am able to function with less assistance. The pain is also in my lower back just below my kidney and about an inch above my buttocks. The pain hurts worse left untouched than when pressure is applied, however, if you were to press directly on the spot... it is piercing. Compression (a girdle, etc) has helped with the pain in a way, it enables me to be a bit more mobil, however if I compress for too long it actually makes it worse. The pain is at its worst when I have to change position from laying down, to sitting up, to standing, walking up stairs, bending over, etc. I am unable to raise my right leg to change clothes or get in and out of a vehicle. The pain does not radiate far from where it hurts the most (down to my hip), it is mostly localized. The pain started Sunday October 17, 2010, but my fever started Friday prior. The pain is constant (minus the relief I get from the pain meds). The pain is at its worst when I first wake in the morning, it stabs so much that I can not even roll over with out assistance. There is no abnormal vaginal discharge. The pain is unchanged during my (very frequent) urinations and bowel movements (when I am finally able to pass a movement), nor was the pain changed during my pelvic exam. Other than this abdominal pain, during my O.B. exam I did notice that my uterus was extremely tender. Sexual intercourse is rare at the moment due to my fibromyalgia pain (which feels worse than the flu 24/7). My cycle starts around the 1st of the month, so I am unable to answer that question. However, my menses have always been painful but short (3-4 days max), slightly heavy, and I miss my menses from time to time. My urine is cloudy and a dark yellow. My bowels, when finally released, are extremely hard or tightly packed. I am not aware of anything that might have brought this own. Prior to this, despite my fibromyalgia and chronic fatigue, my habits were unchanged and I can not think of any thing that would have brought this on. Other than the medications I previously listed, and prior to my taking Lortabs, I would take advil. As far as having other symptoms, I have a loss of appetite, my stomach is bloated, and I have heartburn/indigestion. Family Medical History: My mother had a hysterectomy at the age of 35, chronic sinusitis, and also had a heart attack in 2006. My father has degenerative disc disease (11 back surgeries and 2 neck surgeries), (which I inherited) and he has also in 2006 had a massive heart attack with a quad bypass and pacemaker (he had high blood pressure and cholesterol). Every aunt and uncle that is blood related to me, and my grandparents has had mild to massive heart attacks. Other than heart disease, I am unaware of any other information regarding my extended family medical history.
It is very difficulty case. Urinary tract infection still exists because of the cloudy urine. The pain could be due to stones or appendicitis. But they could be shown in the CT scan. A laparoscopy that doctors look into the pelvic cavity through small holes would help for the diagnosis.
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Customer: replied 6 years ago.
The CT showed no signs of gallbladder or kidney stones, as my doctor and I first suspected. I have had kidney infections, bladder infections, and even urinary tract infections through out my life and they only hurt when I urinated. This pain that I have hurts none stop, almost like I am all twisted up some where in that area. My OB doctor did not do an ultrasound. At present, the only tests done were a blood cell count, a urine test, and a CT scan. My OB doctor, after our exam, scheduled for a follow up 4 weeks from now, and advised me to see my family doctor if the pain persists. If my OB doctor will not do an ultrasound, then I am certain that laparoscopy would be out of the question. Wouldn't a blood cell count test be affected by antibiotics that I have been taking for 5 days prior to the test? Is it not odd that I have been in this kind of pain for 12 days? Are there any other tests that I can tell my doctors (family doctor and OB doctor) about, that I think that was possibly overlooked? If my doctors are no longer helpful, what should I do then? A side note: I have had hypothyroidism since I was a teenager, lost my insurance for over a year and since then I went through 11 different doctors and 9 years to finally get my levels right, which happened just this year. I added that because I do not want to be passed around to different doctors and wait several months to years with this kind of pain, for a diagnosis. I am struggling financially and my insurance does not cover all these visits and tests they request. Thats why I came here. I want to stop the passing of the buck and get this fixed right now. If money were no issue, I would have just gone to the E.R. from the start. My insurance only pays for E.R. visits if I am admitted to the hospital.
I am sorry about your situation.
Yes, if you are taking antibiotics, the white blood cells in the blood tests could be normal. Is the antibiotics decreasing your symptoms? How long are you supposed to take the antibiotics?
Customer: replied 6 years ago.
The antibiotics are not decreasing my symptoms. I am on Cipro 500mg, 1 pill twice a day for 10 days. I am not sure that I mentioned this, but when they did the white blood cell test my results were normal.
Do you mean that the result was before taking antibiotics?
Customer: replied 6 years ago.
No the results were taken 4 days into my already taking the antibiotics. I now only have 2 days left.
Do you still have a pain or burning sensation with urination?
Customer: replied 6 years ago.
Actually, I never had any pain or burning when urinating with this actual case of my urinary tract infection. Which led me to believe that it must have been discovered early or was a mild infection. I actually have had blood work done recently (other than the White blood cell count) on 10/14/10. ACTH 24; Sodium: 141; Potassium 4.5; Chloride 107; Carbon Dioxide 28; Anion Gap 6L; Glucose 117 (but had eaten); Urea NIT.,Blood 10; Creatine 0.6; EST GFR-Caucasian >90; ES GFR Non-Caucasian >90; Calcium 9.1; Cortisol 13.8 (ug/dl); Estradiol 59 A (UNK pg/mL); Free T4 1.0; Follicle Stimulating Hormone 5.2 (IU/L); Luteinizing Hormone 12.1 (IU/L); Prolactin 6.8 (ng/mL); Total Testosterone 95; and TSH 0.345 L
These test were run for my Thyroid check as well as other hormones...I am not sure if this will help.
You may not have UTI. Take a home urine test. If it is appendicitis or gallbladder infection, the antibiotics should help the symptoms. Actually it doesn't help. It could be due to endometriosis. Try birth control pills. You should also take abdominal x-ray to rule out the intestine problem.
Customer: replied 6 years ago.
I had a CT done of the abdomen, would that have shown an intestine problem?
You had CT scan. You don't need to have abdominal x-ray. I was thinking about intussusception, a serious disorder in which part of the intestine — either the small intestine or colon — slides into another part of the intestine.
Customer: replied 6 years ago.
Would a CT show intussusception? Blood work? or an MRI? Ultrasound?
Taking images of your abdomen with an ultrasound, X-ray or computerized tomography (CT) scan may reveal intestinal obstruction caused by intussusception. One of the symptoms is stool mixed with blood and mucus. You don't have it.
Customer: replied 6 years ago.
I hate to keep asking so many questions. I am just ready to put this in the past. Does a CT scan show any issues with endometriosis or uterine fibroids? The CT scan showed a cyst ( I can not remember the size) less than 4 inches in diameter, no free fluid in my abdomen, and that my right ovary was inflamed. Is there blood work that can help rule things out or is an MRI or Ultrasound my best options at the moment?
CT scan can show fibroids (if it is degradated, it causes a pain. Otherwise, no pain), but not endometriosis and the adnesion except ovarian endometrial cysts and endometriosis of uterus (adenomyosis). If it is close to 4 inches, it is a big cyst. It could twist, which causes a severe pain. You should remove it.
Blood work doesn't help rule out possible diseases. MRI and ultrasound don't help the diagnosis. CT scan is good enough.
For diagnosis and treatment, laparoscopy would be a best option.