Left Flank Pain

My condition may be described as follows: Feeling of pain, discomfort and heat in the lower left flank abdominal region which spreads upwards and outwards and then down both arms. Causes dizziness, heat sensation and tingling in arms. From the onset of an episode, the symptoms generally last about 20-30 minutes then pass, but residual tingling and heat sensation in arms remains for a longer period. Sometime episodes occur several time per day, then diminish to once of twice per week. This condition has persisted for more than one year.

I have had an MRI, CT Scan, CTU Scan, Colonscopy, Barium enema imagery and full blood screeing. All tests were negative and blood work normal except slighty elevated cholestoral levels. I have consulated a consultant neurologist, had af ull heart evaluation with a heart specialist, full endocrinology evaluation with endocrinology specialist. All these evaluation produced normal results and no specific medical issues relating to the specific area of expertise of the consultant. Currently evaluated by Gastric Consultant and taking Nexium, Liblan and Cuplaton. This medication eases the pain but does not cure the condition. However, none of the doctors are able to diagnose the condition and seem at a loss to give any pointers as to further evaluation.

My question to two-fold. Is it wise to continue taking medication when the underlying cause of the condition has not been diagnosed? Where do I go from here to obtain a correct diagnosis.

John McPhail

[Kevin Pho, MD]

Many of the major GI diseases would be ruled out with the tests that you have done thus far.  More specialized testing can be considered, like sending the stool out for fat analysis (to exclude malabsorption).  Blood tests can be done to evaluate for celiac disease.  

If negative, irritable bowel disease can be considered as well.  

Medications like Nexium and Liblan can be used to treat dyspepsia/GERD or IBS respectively.  They are reasonable medications in light of the negative testing.  

Other IBS treatment can be considered with tricyclic antidepressants and Rifaximin as well.  

These options can be discussed with your personal physician, or in conjunction with a GI opinion at a major academic medical center.

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.

Kevin, M.D.
www.kevinmd.com

[JohnMcphail]

Dear Dr. Pho,

Thank you for your response. It is reassuring to know that the prescribed medication is a reasonable course of action given the negative results. However, I still seem to be no closer to identifying a possible cause of the condition. I am not convinced that the problem is gastric illness as all the doctors I have spoken to find the combination of symptoms to be very unusual, i.e. the dizziness and tingling sensation in my arms stemming from abdominal pain doesn't quite fit with any known gastric illness. Endoscope examination, colonscopy, barium enema, and other imaging technique show no evidence of gastric illness.

Prior to the sudden onset of the condition, I had not experienced any gastric related problems. I am 62 years of age, male and retired with very little stress in my life, living comfortably in a tropical environment. I eat a very balanced and varied diet, lots of fruit and vegetables and alcholol consumption is at most a few glasses of wine per week. I have systematically tried elminating certain foods from my diet as I thought it might be food sensitivity, but to no effect. I did a full parasite cleanse, just in case this was caused by a parasitic condition. Again no impact on the condition.

The upshot is that the combined knowledge of four specialists, Neurology, Cardiac, Endocrinology and Gastric, plus my GP cannot determine a cause. Basically they all tell me there is nothing wrong, but then why do I continue to have such "attacks" for want of a getter description? I have been "round in circles" twice being referred from one doctor to the other. The good news is that they have eliminated a whole range of serious medical conditions. The worrying thing is not knowing what is the cause and trying to cope with a condition which at times is debilitating.

Could this condition be caused by spinal injury or deterioration? i.e. the tingling sensation in my arms would suggest pressure on nerves emanating from my neck or upper spinal region. Do I now need to consult an orthopedic specialist?

John McPhail