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Dr. David
Dr. David, Board Certified Physician
Category: Medical
Satisfied Customers: 45993
Experience:  Experienced Physician trained in New York City. I'm ready to help.
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Me: * Male * 37 years old * 5' 11" * 150 Lbs * Healthy: Run

Customer Question

* Male
* 37 years old
* 5' 11"
* 150 Lbs
* Healthy: Run ~20 miles per week, bike 10. Resting heart rate ~50bpm. Blood pressure 115/75ish. "Healthy" diet ("What does that mean?" Too much to type here, but serious thought/research goes into it; not an “extreme” diet; balance of animal protein and greens; low glycemic.)
My questions upfront are (but please read details):
1) Could a kidney cyst smaller than a marble really be causing substantial discomfort and develop quickly? I’ve passed full turkey dinners through my ascending colon that were way less uncomfortable than this.
2) If not a kidney cyst, what else could it be?
3) What questions should I be asking my phsyician and nephrologist?
5 or 6 Weeks ago: Started to feel a slight pressure at the tip the 10th and 9th rib, on my right hand side like someone constantly had two fingers resting there. The pressure is constant, and does not change when eating, bowel movement, hydration, etc.
3 Weeks ago: Pressure became more noticeable, with defused pressure (not yet pain) noticeable in abdominal muscles. The pressure is constant, and does not change when eating, bowel movement, hydration, etc.
2 Weeks ago: All previous symptoms, but now notice it in the back muscles on the right hand side of the spine. The pressure is constant, and does not change when eating, bowel movement, hydration, etc.. Movement in certain positions makes the pressure more noticeable. Flex lower back; feel it there. Bend over, feel it in the 9th/10th rib. My 45-minute commute home is starting to get fairly uncomfortable; feels like there is a baseball sitting behind my 9th/10th rib. Sleeping in certain positions is now uncomfortable. 200MG of ibuprofen doesn’t touch it. Time to go see doc.
1.5 Weeks ago: Went to doc. X-ray negative. Physical pressure exam by doc. He says he doesn't feel anything; I don't feel any extra pain with him poking into my ribs and back. Says x-ray shows I might be a little constipated. Asked about BMs. One a day, but maybe a little less regular than normal. Prescribed Miralax; said if I don't feel better to get an ultrasound of upper right quadrant (gave me a referral.) Took Miralax for 5 days. Day 4 and 5, stool is getting pretty loose and almost diarrhea, and I feel empty, but that pain/pressure at the end of my ribs, abdominal, and in back didn't change one iota. Also doc ran tests while I was there (CBC, urine test, and serum test). Truncated results at below (was told nothing was abnormal.)
4 days ago: Ultrasound.
Today: Report received from ultrasound as follows--Liver and Pancreas have homogeneous echogenicity. Gallbladder physiologically distended without abnormal gallbladder wall thickening, pericholecystic fluid, or gallstones. Common bile duct measures 3mm. Right kidney measures 11.1 cm in length, containing an interpolar cyst of 1.2 cm x 1.1 cm. Visualized upper abdominal aorta and inferior vena cava are within normal limits.
I was referred to nephrologist for follow up, which will happen in the next 5 days or so.
Test results (full test results available upone request)
WBC 5.1K/uL
RBC 4.60M/mm3
HGB 14.3gm/dL
HCT 41.0%
MCV 89.1fL
MCH 31.1pg
MCHC 34.9g/dL
RDW 39.6fL
A/G RATIO 2.0mg/dL
GFR BLACK/WHITE >60mL/min/1.73m2
Blood, keytone, bilirubin: Negative
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. David replied 8 months ago.

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

Expert:  Dr. David replied 8 months ago.

usually kidney cysts don't cause pain

sometimes heavy workout and exercise can strain and stress your diaphram muscles.

your gall bladder is distended. you could be having some gall bladder dysfunction causing distention of your gall bladder and pain there.

you may benefit from a HIDA scan to check your gall bladder function which may not be ejecting properly and could be causing your pain.

I would ask your doctor for a HIDA scan to check your gall bladder function and ejection

Customer: replied 8 months ago.
I had not eaten for 12 hours prior to the ultrasound test, as instructed before most abdominal ultrasounds. I was told a gallbladder distention is normal; meaning not contracted. The only thing found remarkable on my ultrasound by the doctor was the renal cyst.
Expert:  Dr. David replied 8 months ago.

I doubt your renal cysts are causing your pains

renal cysts are very common and dormant and stay there and don't cause pain.

do you have pain when your doctor presses down into your abdomen deeply below your right lower ribs?

Customer: replied 8 months ago.
No, Sir. Digital pressure to the abdomen, under the lower ribs, or into the back causes no noticeable change in pain.
Expert:  Dr. David replied 8 months ago.

have you tried any NSIADs like advil or naproxen sodium to see if these help with the pain

often times inflammation of the rib or cartilage can cause costocondritis pain which usually respond and get better with advil or naproxen

Customer: replied 8 months ago.
As I stated in my initial description, 200MG of ibuprofen doesn't touch. I've tried this maybe 3-4 times. Has no effect. The pressure is constant, not matter time of day, what I eat, or what medicine I take.
Expert:  Dr. David replied 8 months ago.

200mg of ibuprofen is only one pill, you should really try 400-600mg of ibuprofen with food in your stomach twice a day and see if it helps the pain.

Customer: replied 8 months ago.
Correction: 400MG of ibuprofen has not effect.
Customer: replied 8 months ago.
2 pills, as you stated (thought it was 100MG, but 200MG per pill is correct.)
Expert:  Dr. David replied 8 months ago.

have you tried any stomach acid reducing medicaitons

I would try zantac and prilosec for 1-2 days and seeing if decreasing stomach acid would help your symptoms

if they help, then your pain could be due to inflammation of your distal stomach or duodenum,

excessive stomach acid is very common.

Customer: replied 8 months ago.
I have not tried that; I will take this under advisement. Thanks.
Expert:  Dr. David replied 8 months ago.

you are welcome

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