Instense Abdominal Pain

[Kristy__0__0]

  I have had a history of stomach pains since 1991 which untill recently had been identified as stress related -- type A personality with compulsive-obsessive behaviors.  It all started when I was in college in Dec-1991.  I woke up one night with intense abdominal pain.  Then nausea and fever set in which lead to vomitting.  Soon I was dry heaving uncontrollably and in unbearable pain.  Diarrhea started too.  The sickness started around 4 am and by 10 am I wanted to go to the Emergency Room.  Nothing could make me feel comfortable.  I know they checked for an appendicitis and food poisioning -- did the rectal exam -- they took urine and blood samples too.  They found no root cause and "marked" it up as STRESS and requested that I see my family Physician the next day. He put me on Tagamet and then sent me to a specialist for an upper GI to check for an ulcer.  The results were null.  He changed my prescription to Zantue.  I was very stressed during this time with school and roomate problems, and I was working 3 jobs during the summer to pay for the tuition increase?
  Then in 1992 I had a second episode which again resulted in the same symptoms.  Again, I found myself at the ER.  The doctors checked me for all of the normal complications and found nothing.  Stress related abdominal pains were what they thought I had? Again, I can say honestly that I was not dealing with stress well and life was very hectic with school and work.
  The abdominal pain surfaced again in 1993.  This time the pain was the most intense yet.  Same symptons as above and again I found myself in the ER.  I think I threw-up over 2 dozen times just waiting to be admitted.  The vommitting lead to stomach like convolsions.  I was hooked up to an IV and catheter.  They checked my gall bladder and appendix.  They took blood and urine samples, ran tests for food poisioning, and did a pelvic/rectal exam.  They found nothing, but kept me overnight.  Again, my family Physician identified this as stress related.  I was dealing with my Grandfathers death that week, working 2 jobs and going to school.
  I then went several years without any problems.  During the summer of 1996 I had another attack.  Same situation, although this time my husband refused to take me to the ER as in the past they did nothing to comfort my pain and never found anything.  So I struggled through the night and went to the doctors the next day (different one then above as I had moved).  Since my family had a history of gall bladder stones he suggested an ultra sound to see if they could detect anything.  They found nothing.  Soon after that episode, I sought counceling for a panic attacks.  During my sessions we talked about my driven need for perfectionism and approval and root caused the stomach pains to stress and demands of my system?  I began reading about relaxation excercises to calm my system.
  During those 4 above episodes, I can not really remember exactly where the pain localized.  I just remember feeling a sharp knifelike feeling above my navel and it turning into an unbearable pain. I started monitoring the pain more efficiently in 1997-8.
  After we moved in April-1997 I had another episode although this time I tried meditative techniques to keep from vomitting as this would usually lead to dry heaves and stomach convolsions.  It worked.  Although I slept next to the toilet, I did not vomit.
  In Feb-98 I had another attack.  More mild than in college, but I did go to the Redi-care, and again I used relaxation excercises to calm my stomach.  I believe the pain to be on the right-hand side as to whether or not it was RLQ I am not sure.  They ran all of the normal tests and my new doctor had me checked me for chronic fatigue and throid problems.  
  Now, I had another attack last week.  I monitored my symtoms carefully.  I had a sharp pain in my abdomin (abdomen) above my navel and felt nauseated around 11 am.  Felt like I was going to throw-up all day.  I felt like I had gas and could go the bathroom but nothing came out.  I went to the doctors at 4 pm.  He sent me to Prolab for blood test.  I went home a threw-up and dry heaved for a while -- mild to above situations.  I ran a slight fever, 100 and felt cold at times and then hot.  Around 7 pm I began feeling better and by 8 pm I had an appetite.  My husband thought this was food poisioning from some chicken I cooked the night before as I reused some marinade from the weekend!!  This episode came on quick and left sooner than before.  My stomach hurt (just tender) for a good 2 days.The next day my doctor called and said I had an elevated white blood cell count and they thought it was my appendix.  They scheduled a meeting with the surgeon to discuss Laproscopic surgery.  He could not say he knows for sure that it is my appendix, he just felt that we should at least do an exploratory to check things out.  
  Please answere the following questions:  1-Could I have had food poisioning this last time, last week?  2-They checked my appendix all 3 times I went to the ER so how could it be my appendix now?  3-Can stress cause the above symptoms or did the doctors just not know what was wrong with me? 4-What other things could be tested to rule out problems?  5-I never heard of chronic appendicits lasting over 18 months? 6-Do you know of a good doctor in the Warren/Youngstown, Ohio area?  I do not feel as if I can trust my current doctors, and I just moved to this area.  I have always been a stress person and I wonder about having surgery when it may not be needed??                
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Dear Kristy,
You raise a number of interesting questions.  Unfortunately, I can not provide the specific ansers that you need.  At present, we do not know the mechanism by which stress affects the gastrointestinal tract, but there is sufficient evidence to conclude that emotions can alter gastrointestinal function.  Whether your specific symptoms are related to anxiety, food poisoning or even acute appendicitis can be determined only by the physicians who examine you.  It is difficult to determine retrospectively what was happening to you.
Appendicitis can be extremely difficult to diagnose.  Although it is possible that all your attacks were related to the appendix, it is also feasible that your current episode is appendix-related and the previous attacks were due to something else.  One word of caution.  There are many conditions that can give an elevated white cell count besides appendicitis.  For example, gastroenteritis can increase the white cell count.
I would suggest that you contact the local medical society or the University and ask for a list of Internists.  Ask friends and co-workers which physicians on your list have a good reputation in the community.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
HFHSM.D.-rf
*keywords; abdominal pain, appendicitis
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