Right flank pain; right hip pain; left shoulder pain; etc!

Hi all.  I am a 30 yr old woman, recently diagnosed with diabetes (fasting glucose was just over 100; a1c was 6.8), metabolic syndrome (based on fasting glucose, BP 156/95 and last 3 visits have been high, and obesity), a fibroid, and a recently ruptured ovarian cyst (right ovary).  My FNP also said that, based on ALK/PHOS bloodwork (level was 182), he believes I have a fatty liver and probably a fatty heart, yet has not sent me for further bloodwork or other tests.  Last month, I was told I had a urinary tract infection, then told it was a kidney infection, based on urinalysis levels of leukocytes and a slight amount of blood in my urine.  The pain from this sent me to the ER over that same weekend where a CT was performed and that's when I was told I had the ovarian cyst and fibroid, but no infection present based on bloodwork and urine dipstick.  I went to an OB/GYN, and the cyst had ruptured by this time (2 weeks after ER visit) and my menstrual cycle had begun again (it was absent for 6 weeks after I expected it to be coming).  So I was told the right flank pain I had been experiencing since January 2010 was due to the ovarian cyst, yet I've still been experiencing the pain.

The right flank pain is at it's worst (most of the time) when I'm lying in bed, getting so bad that when I want to turn over, the pain wakes me and I have to sit up to switch positions.  The pain is not always at a constant, but I am always aware of the discomfort it causes.  It is located mostly on the back, below my right rib, above my hip but sometimes feels like it is in my hip as well.  I also have extreme fatigue, sleeping in until 11am-1pm everyday, yet feeling like I can't get enough sleep!  I've recently developed a mild headache (about 5 days ago) that I just can't seem to get to stay away.  It goes from the top front of my head all the way around to the back, into my neck, also causing neck pain.  And I also have been combating pain in my left upper clavicle, about the middle half of it out to the top of my shoulder bone.  

What is going on with me?  The FNP that I see, well, let's just say I don't believe he is taking me seriously, yet I know the pain I feel is real.  And this is a very small town I live in, so there are not many options as far as medical professionals unless I drive over an hour away, which I am willing to do.  I truly hope that someone can offer me some helpful advice.  Thank you so much for taking the time to read this.

[Tuckamore]

Hello Ms. Smith,

You present some complicated symptoms. I am sorry for your continuing pain. It is so frustrating when we are brushed off by our medical care providers.

My first suggestion would be to make an appointment with a urologist and follow up with an good GYN. Flank pain can be from many causes. In fact statistically low back pain is one of the leading causes of physician visits in the US. Although Nurse Practitioners are fine medical providers for simply things they cannot replace a physician when things become more complicated.

Depression can play a part in fatigue as can headaches. Please don't think I am saying that your symptoms are all due to depression. In my opinion too many health care providers use that diagnosis to dismiss medical symptoms and things can get missed. I am just saying that it can play a role in fatigue.

Another thought would be if the urologist and GYN are unable to come up with any answers that you find acceptable request a consult with a rheumatologist. Sometimes they are able to diagnosis generalized pain the better than other specialities.

You are your own best health care advocate. Be assertive and make that drive to obtain good health care. I wish you the very best and hope that you will let us know how you are doing.

Take Care,
~Tuck