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Dr. David
Dr. David, Board Certified Physician
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I have had right lower abdominal pain with severe nausea and

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I have had right lower abdominal pain with severe nausea and don't feel like eating. I went to ER last week, but each time they do a CT scan on me they can't see my appendix at all on it which I really thought it was. So, since I have history of ovarian cysts they now each time I go to the ER with right lower abdominal pain which was worse when the let go after pressing down, the doctors no matter what say it is due to my ovarian cyst. I never had my appendix taken out before in my life, so why is it that everytime I have a CT Scan it doesn't show my appendix and do you think it could be my appendix. I also, feel extremely tired and run down, but my WBC is normal.
Submitted: 10 months ago.
Category: Medical
Expert:  Dr. David replied 10 months ago.

Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

Expert:  Dr. David replied 10 months ago.

usually the appendix can be seen on CT scan

sometimes, in some patients, the appendix is too small to be seen.

ovarian cysts which are inflamed can cause pain and loss of appetite and cramps

I doubt you have had appendicitis for this long.

how old are you? have you had any constipation or hard stools?

Customer: replied 10 months ago.
I am 42 and I haven't had any constipation or hard stools.
Expert:  Dr. David replied 10 months ago.

I see.

still mostly your left ovarian cysts causing your pains.

it sounds like you are worried about appendicitis

appendicitis is not very common at your age.

and the CT scans didn't show any appendicitis.

Customer: replied 10 months ago.
is it true what my father said who is a doctor and some of our neighbors about the appendix it is better to take out no matter what if have symptoms but even thought doesn't show up to take out a healthy appendix rather than one that is inflammed or infected.
Expert:  Dr. David replied 10 months ago.

it depends on how severe your symptoms

if your symptoms are coming from your right ovarian cysts, it make more sense to remove your right lower ovaries which may do more to help your symptoms.

Customer: replied 10 months ago.
is there an email that I can email you the latest CT Scan of pelvic that says size of left ovarian cyst that was done on 10/19/2016 and email the one from July 1, 2016 before I had surgery. It looks like from the CT on 10/19/2016 I wasn't sure I know I had one ovary taken out it look like by that it was the right. And if you compare the two reports if you can let me know by reading them if on the newest one on 10/19/2016 if my left ovarian cyst got larger and if right lower quadrant pain can stem from left side ovary. And they want me to follow back up with the GYN surgeon, do you think I will have to go under sugery again to have left ovary removed, the reason he wanted to keep one in is because I am only 41 he wanted to let me have some hormones so I didn't have to take hormone replacement, but do you think he will decide to take out the left ovary if it gotten bigger quite a bit larger since July and till now in October.
Expert:  Dr. David replied 10 months ago.

usually an enlarged left ovary or left ovarian cysts should not cause right lower quadrant abdominal pains.

you could have scar tissue or adhesions causing your right lower quadrant abdominal pains

have you tried going on birth control pills? this can help level out your hormones and can help with ovarian cysts.

ask your surgeon if you have scar tissue in your right pelvis

you may need a surgery called lysis of adhesions to help break up scar tissue in your abdomen and pelvis to help decrease your pains.

Customer: replied 10 months ago.
I am going to attach the older radiology report from July and the updated one from 10/19 so maybe you can tell or let me know from your opionion if the left ovarian cyst got larger, and if it seems like the right ovary was removed. I have had problems with cysts on my ovaries since 2001 so I had issues with them for many years.
Expert:  Dr. David replied 10 months ago.

it looks like the left ovarian cyst did get a bit larger from 3.9cm to 4x1.7cm in size

you are not on birth control pills?

Customer: replied 10 months ago.
I was tried birth controls when I first starting to have problems with ovarian cysts back in 2011 but it didn't help, it didn't make me feel good.
Expert:  Dr. David replied 10 months ago.

you have some fluid in your pelvis

I'm not sure what is causing your right lower quadrant pain.

something is irritating your pelvis.

it may not be the left ovary causing the pain.

Customer: replied 10 months ago.
I had a pelvic ultrasound yesterday. My primary care doctor got report he said that the report said I refused the vaginal,part which isn't true. I told the ultrasound tech I am willing to go through vaginal part but, she said the cyst seems to far up that she would have to insert probe so far in and she didn't want to try that to hurt me. Then when she got finished just doing ultrasound over my abdomen she went and showed images right away to radiologist while I stayed there lying down and she came back after a few minutes and said I was good to go.But ultrasound my primary doctor said showed complex cyst on left ovary which has gotten bigger he didn't say how much bigger.What are complex cyst. I saw a GYN surgeon in July and had tubes and I think right ovary removed because he wanted to keep one ovary since I am only 41 to still have some hormones. My doctor recommends that I go back to GYN what do you think would be required treatment this time do you think another surgery to remove left ovary.And can you explain what exactly complex cysts are.
Customer: replied 10 months ago.
Did you get my message from earlier about the Ultrasound I had done? Which the report says I refused the vaginal part which I didn't I said to the tech doing the Ultrasound that I am willing to go through the vaginal part. But it was her that decided the cyst seemed to high up, and she didn't want to insert the wand for the vaginal part that far up to try and hurt me.But the Ultrasound showed on my left ovary complex cyst and my primary care doctor said it even got bigger or larger, however he didn't say how much larger it got.So he wants me to follow up with the GYN surgeon that did my surgery in July that removed right ovary and tubes.Can you explain to me exactly what complex cysts are and do you think the GYN surgeon will recommend another surgery again to remove now my left last remaining ovary. Because last surgery he wanted to keep one ovary in since I am only 41 so I can still have some hormones left in me.So, if you could respond to let me know these two things to explain what comlex cysts are and are they dangerous or serious and do you think I will have to undergo another surgery to remove left ovary.
Expert:  Dr. David replied 10 months ago.

complex ovarian cysts are cysts which which are partly filled with fluid and part of it are solid.

but even left complex cyst should not cause right lower quadrant pains

are you still having right lower quadrant pains.

There is a 70-80 percent chance of finding ovarian cancer in a postmenopausal woman with a complex pelvic mass and an elevated CA-125.

but you are not post menopausal

and you haven't had a CA-125 level checked

Customer: replied 10 months ago.
I am attaching to here for you to read what it says what the ultrasound that I had on 11/9/2016 says about the left ovary and left ovary cyst. Do you think that what it says should be concerning that I might have to have another surgery again to either remove the cyst or remove my last remaining ovary from what the ultrasound report says. Because there are some big words in the report I don't understand which makes me worried. Like hydrogeno whatever all those different terms used. Do you know what they all mean.
Expert:  Dr. David replied 10 months ago.

no, it is not concerning

how is your right lower abdominal pains, is it still there, has it gotten better?

hypoechogenicity means that the left ovary is not sending back ultrasound signals, because part of the ovary is solid. that is not a sign of cancer

Customer: replied 10 months ago.
I don't have pain in my right side any more. However, I don't know if it could be related to the cyst or the ovary I do have exterme and more pain now then ever before on my left side towards pelvic or lower abdominal region. Will that make a difference in the GYN Surgeon making a determination for the best treatment for me.
Expert:  Dr. David replied 10 months ago.

that is good you don't have right lower abdominal pains anymore.

yes, left lower pelvic pain is most likely due to that complex ovarian cyst on the left side.

have you tried ibuprofen or aleve? these could help the temporary ovarian cyst pain for the time being until it gets better

going on birth control pills could help decrease the pain as well.

Customer: replied 10 months ago.
In my Ultrasound I submitted to you that I had done on 11/8/2016 what does it mean in report choelic septation of ovary or if referring to the cyst. I started over the weekend to feel extremely nauseated and more pain in left pelvic especially when lying down in bed at night. Is that a sign that the cyst or ovary is getting worse off.
Expert:  Dr. David replied 10 months ago.

your pain symptoms could be a sign of more inflammation and cramping from your complex left ovary cysts.

echoelic sepations are separations and walls inside of the cyst separating the solid and liquid (cystic) rooms in the cyst.

if the pain gets worse, you may have to have your left ovary removed as well like you had the right side.

going on birth control pills could hep you regulate your hormones and decrease ovarian cyst pains

let me know if you have other questions.

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Customer: replied 10 months ago.
How do I know if the ovary cyst is becoming twisted. Because I have more severe pain now, pain in lower back and in upper left thigh I have pain. And difficult sometimes having a bowel movement and a lot more nauseated that I suggested to my mom last night for dinner instead of the pork loin she took out to have scrambled eggs since I know that is a bit easier to tolerate sometimes when nauseated.
Expert:  Dr. David replied 10 months ago.

your last pelvic ultrasound didn't show the ovarian cyst or ovary to be twisted.

you would need another pelvic ultrasound to see if you have new ovarian cysts or torsion of your cyst.

Customer: replied 9 months ago.
I saw the GYN surgeon this past Monday that did the surgery at the end of July because I was having pelvic pain again. I attached to one message to you the ultrasound report from 11/8/2016. I finally was able to get from the GYN surgeon the report and pathology report from the surgey in July to give to my primary care doctor that wanted report so badly. My primary care doctor reviewed the report, he said I thought all along he took out the right ovary, actually my primary care doctor said the report showed what was called hemorgaic cysts on both ovaries. So he removed at least the blood right cyst as well as both of my tubes.Are hemorghapic cysts to be of concerned, and since in the ultrasound report I had on 11/8/2016 it says the left ovary cyst has changed. Is it possible for the hemorghaic cysts to burst and if so how would I know if it has burst what symptoms would I have, like vaginal bleeding even though in 2011 had a hysterectomy so no longer have periods or what other symptoms would I notice if I still have that type of cyst if it does burst. And would that be considered if it does burst an emergency situation.
Expert:  Dr. David replied 9 months ago.

sometimes hemorrhagic cyst can rupture but it would be rare. usually this would cause a lot of pain in the left lower quadrant abdomen and pelvis.

a burst cyst is not an emergency situation. but it can be painful