RLQ Pain for one month

[hmgt]

I am a 25-year old healthy female.  About a month ago I went to the ER with suspected appendicitis (sent by my GP.)  I was vomiting and very nauseous but no fever.  A CAT scan/ultrasound showed negative for appendicitis so I was admitted for 2 days and given Gravol and Demarol.  I was told it was suspected Crohn's or a virus.

I was sent home but pain persisted so I followed up with my GP who sent me for a barium swallow.  He prescribed Motilium but it did not seem to help.  He then prescribed Buscopan but that also did not relieve the pain.

The barium swallow showed negative for Crohn's but showed positive for possible ulcers so I was sent for an endoscopy - where they put a camera down my throat.  That showed negative for ulcers so the GI specialist told me I had IBS.  I don't feel that this is the right diagnosis since I have had no change in bowel movements, constipation/diarrhea etc.  I did have some nausea and occasional vomiting (every few days, an hour or so after eating) for about 2 weeks after I was admitted but that seems to have gotten better.

I am no longer having nasuea but over the past four weeks the pain had remained constant in my RLQ at about my navel level or slightly below, sometimes above.  The pain is sometimes so bad that it radiates down my leg or up my torso but mostly it is just a dull ache.  I have the pain every single day though it seems to be better in the morning and worse in the afternoon and at night (sometimes after eating but not always).  I am finally back at work and am managing the pain with Percoced but obviously this is not a sustainable solution so I am hoping that there is another diagnosis.  I have also been prescribed Motilium and Buscopan but neither seem to help. Finally I was told by the GI specialist to continue on the ulcer meds (Pantoloc) despite the fact that there are no ulcers... I am wondering why?

The surgeon who saw me at the hospital then sent me for another ultrasound and for a HIDA scan which he said he suspected would be negative as he thinks it is "functional."  Today I had the HIDA scan.  My gallbladder did show up but I overheard them afterwards pointing at the screen and saying that they would expect to see more diffusion and saying "could be small bowel."  What would that indicate?

Also if it is IBS what does that mean?  Can I be sure it's not Crohn's.  Do I just live like this in pain forever?  The GI specialist told me I could go to the ER and get pain relief when it got really bad but that seems like an unrealistic solution.  I have lost about 5-7 lbs since this began and cannot really afford to lose the weight.  (I am 5'7 and weight about 125)

I am also trying a new diet over the past few days and avoiding wheat, tea, coffee, refined sugar etc.  It has help reduce  nausea somewhat but I can't say I notice a major difference in the pain

[hmgt]

Gosh thank you both so much for all your support.  I will definitely check out HealingWell.com and will push for another test.  thanks also to kazod who wrote me a very thoughtful e-mail - i've been having trouble accessing my e-mail - overloaded MSN server - but i will write you back tonight.  this has given me lots to think about and i will do some more research over at healingwell.com.  I can usually last until 1 or 2 without the painkillers, but this morning it is really bad and I just took some; unofortunately back at work - all my sick leave is used up.  i find the percocet makes me nauseous and also very grumpy the next day, also slightly forgetful and spacy.  but it is better than the pain.

[without hope]

Hi,
      I searched the internet for a crohn's discussion/support group and I found an excellent site (Healing Well.com).  Of course, I cannot know what you have but if your taking narcotics just to cope with pain it has to be pretty bad.  I questioned whether other people had experienced crohn's disease and NOT had diarrhea.  I was astounded at the number of people who responded and told me that their only symptom was pain--mostly lower right quadrant but even upper right quadrant or just stomach pains.  All of these responses were from people who had actual diagnosis and were receiving treatment.  The point being that the presentations were far from the classic picture given and the variety of symptoms were as different as are people themselves! As a nurse I have had practical experience with the fact that people rarely prsent with "classic" symptoms for many diseases--but it is hard to maintain objectivity when it comes to yourself.  It sound like colonoscopy is the best diagnostic tool but the new capsule endoscopy sounds promising if you can find a doctor in your area who actually performs it (you just swallow a pill that contains a camera that looks at your entire small bowel--no long prep and no pain.  Please feel free to email me as well ***@****.  I completely understand where you are coming from--noone WANTS to be sick but when you are it is the worst feeling being repeatedly told there is nothing wrong when you know there is.  Take Care.

[hmgt]

thanks for sharing - it sounds like i should really push for a colonoscopy then, right? it's getting kind of perverse when i am starting to hope that my test results come back abnormal but i want them to find something in me so i can figure out how to fix it!

i would really appreciate any info you have - are either of you on specific diets?  or have you been on medication?  have you had to have surgery?  i'd love to hear anything you have to say either here or at my e-mail address hil(underscore)bil(at)hotmail(dot)com.

Thanks
hmgt

[without hope]

God your symptoms sound almost identical to mine--that was at the onset 16 years ago!  My question is to the 29 year old female who was diagnosed with crohn's disease--did you have the typical symptoms of diarrhea?  Like this young woman, who also does not present with a change in bowels I have yet to hear of someone actually being diagnosed without the diarrhea as a major symptom.  Thanks for listening again and letting us learn from your experience.  I wish you both the best of health.

[kazod]

Hello,  I just wanted to say that I experienced the exact same thing at the end of October, after many tests and months was diagnosed with crohn's.  I also frequently complain of the radiating burning pain down my leg front and back (along with many other things).  Sometimes it's so bad can't move my leg easily.  Doc said it is because of the inflammation in the bowel but also enlarged lymph nodes putting pressure on a nerve.  If you would like to talk further and need my address, just let me know. I'm female 29.  Take care

[kazod]

Hello,  I did not have diareah, still don't!  I actually lean towards getting constipated if anything.  I know that it is hard to diagnose crohn's (was in my case anyway) wasn't until the colonoscopy that they believed me- as the small bowel follow through, CT and blood didn't show anything.  I remember going through the months before being diagnosed, holding onto hope that it was something minor...like a pinched nerve, hernia, back problem, bacteria etc etc, but honestly knew that it was something big and it needed to be dealt with quickly. My symptoms came on quickly and violently.  I never had a digestive problem or pain like that before and all of a sudden I was extremely limited in what I could eat.  (Still am)  Anyway, feel free to ask any questions at all. Take care

[Kevin Pho, MD]

Crohn's disease can be difficult to diagnose.  Typically, the upper GI series with small bowel follow-through is an appropriate test - but may not determine all causes.  A colonoscopy should be considered if it hasn't been done yet.  

If there continues to be suspicion of Crohn's disease, then capsule endoscopy can be consider.  Blood antibody testing can also be considered to diagnose Crohns - all these tests can be discussed with your personal physician.

Another possibility would be gastroparesis - or delayed gastric emptying.  A gastric emptying scan can be considered to evaluate for this.  

If all the GI tests are negative, then irritable bowel disease can be considered.  Irritable bowel syndrome (IBS) is a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause.  Treamtent can be considered, in the form of increasing fiber intake or antispasmodic agents.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[hmgt]

No, although I have had spinal films done earlier.  The pain down my leg is rare and always seems to center around my abdomen rather than a sort of bone pain.  I also forgot to mention that I had a normal CT scan.

[ozark]

have they done any films of your spine?  the radiating down the lwg may indicate some type of lower spine issue since they cant find anything else.good luck

[hmgt]

Just want to be clear that I have had no diarrhea/constipation - am having normal formed stools.  Also I have only been on the new diet a week and lost weight before that - so this would not be the cause of weight loss (I am ensuring that I get enough protein and carbs.)