You're young! It's probably nothing! But what if it is?

September 1, 2010 2:48 PM

YANMD. But my choices are ER or wait. Left side pain, fever, blood, etc. What to do?

I've had minor crampy throbby type pain in my lower left side (front, sometimes back, lower - like in the pelvic area) for months. Then, two months ago, I started having fresh blood in my stool. Some in the stool, some on the toilet paper, not a lot, but noticeable. Went to the doctor this Monday, had bloodwork done that showed I'm not anemic and white blood cell count was normal, everything was normal. The doctor figured it was hemmerhoids. Didn't see any external, but thought there might be an internal one, which would explain the blood. OK. Today the lower left side pain feels worse: not terrible pain, but definitely noticeable. I also have a fever that seems to vary between 99.3 - 99.8. At the doctor two days ago it was 99.5. I feel hot, then cold, and clammy. I feel sort of crappy. I guess it could just be a cold or the flu, but I don't know. I feel a little nauseous, not very hungry.

I'm a 26 year old female. I am very healthy and fit - exercise miles daily, eat a pretty good diet with lots of vegetables. I drink coffee daily on an empty stomach - probably not good to do. I would say I feel better when I don't eat foods containing gluten, though, for example, yesterday I ate three slices of pizza and three cookies.

I had STD tests done after my last partner, all negative. Since then I was on two rounds of antibiotics for other things, including a absolutely terrible stomach flu they thought might be bacterial. I have been hanging around a person who has giardia.

I've talked with my doctor's nurse and her suggestion is I come in next week when they have appointments available or I go to the ER now and to definitely go to the ER if my fever doesn't go away or increases. A trip to the ER never convenient for anyone, but it is especially inconvenient for me right now.

I just don't know what to do. I'm scared there's something really bad wrong with me, like cancer or Crohn's or something, but doctors in general just seem to tell me: "You're young! You're so fit and healthy! It's probably nothing!"

posted by anonymous to health & fitness (26 answers total)

ER. Now.
posted by bilabial at 2:55 PM on September 1, 2010

"Probably nothing" is not "nothing." I would go to the ER. Better safe than sorry.
posted by coppermoss at 2:56 PM on September 1, 2010

ER.
posted by dilettante at 2:56 PM on September 1, 2010

None of those things screams "Go to the ER!" to me, but then again, I'm not a doctor. Maybe try an urgent care facility instead?
posted by schmod at 2:59 PM on September 1, 2010

Urgent care if you can find it. Otherwise the ER.
posted by grouse at 3:04 PM on September 1, 2010

ER. The bleeding is probably hemorrhoids, if it is fresh blood but, the pain combined with the bleeding means you need this checked out asap.
posted by SuzySmith at 3:06 PM on September 1, 2010

Don't fuck around with this stuff, if the pain had remained static if I were in your shoes I might wait a bit. However the pain is not static, so go to the ER, pay the higher co pay and get looked at. Blood in your stool and pain is not a symptom of things being ok.

Make an appointment with your primary care for next week as well. Get a copy of any lab work done in the ER to take to your primary doctor. If this were my wife or sister or daughter I would be on the way to the ER with them just for peace of mind.

Why are you still reading down here, you're supposed to be heading to the ER. Since you're stubborn and still reading do not fill your head with worry about what it could be. Totally pointless and will just increase your anxiety, so take a deep breath, call a friend or family member, explain the situation and stop reading metafilter.
posted by iamabot at 3:07 PM on September 1, 2010

If you haven't already, leave for the ER right away. Please let us know how you do.
posted by bearwife at 3:11 PM on September 1, 2010

Time to go to the ER and to ask for a referral to a gastroenterologist. You probably need to be scoped. Not a pleasant experience, but it can put your fears to rest.
posted by Old Geezer at 3:20 PM on September 1, 2010 [1 favorite]

I would follow the nurse's advice, and only go to the ER if the fever persists. An urgent care center is another good suggestion, but be advised that many urgent care facilities send cases off abdominal pain off to the ER.

IANAD, but I do work in health care, and see all sorts of big, bad, and ugly things. This means I tend to automatically assume that any symptom I experience is a sure sign that something catastrophic is happening to my body, so I can well relate to your worries. But let's take a calm look at what's happening here. You have had the same set of symptoms for a couple of months, and saw a doctor about them just a few days ago. So the new factor is the fever, and the nurse gave you advice about that. Try to relax, stay hydrated, rest as well as you can, and keep an eye on the fever. I work in an ER, and it's my personal policy to have my primary care doctor handle as much of my care as possible, because even with the few perks I get as an employee (and they are very few), the ER experience is a long, arduous, often stressful experience that unfortunately often ends with "thanks for coming, follow up with your primary care doctor".

TLDR- try to hold out for an appointment, but if that fever continues to trouble you, head for the ER.
posted by pupperduck at 3:21 PM on September 1, 2010 [4 favorites]

Probably not cancer or Crohns but blood in your stool is never great. When I had that it was a particularly nasty bout of food poisoning that started slow but once it cranked up put me in the hospital for 8 days.

Go get checked. This is your body we are talking about-take care of it!
posted by St. Alia of the Bunnies at 3:23 PM on September 1, 2010

Definitely get yourself to a place that will look into this ASAP. If there is pain, blood and a fever, you do not want to mess around with it. One thing I would certainly do is ask for this to be thoroughly checked out, not just an "I think this is hemmoroids". I tend to agree that it's probably not something horrific, but it's so much better to get it looked at carefully and have it be nothing. Try to relax in the meantime (easier said than done, I know) and stay hydrated. Hang in there!! And please update to let us know how things go!
posted by I_love_the_rain at 3:37 PM on September 1, 2010

I'd be inclined to follow the medical advice you have already gotten, presuming you have reason to believe these people are competent.

As far as the blood goes, bright red blood on your toilet paper is most likely right near the anus; I've had it happen to me when I've strained myself and had no external hemorrhoid. The first time it happened was completely fucking terrifying till I was reassured about it, but they assured me: blood that still is that obviously blood likely came from close to the "exit site." It came and went over a few years and eventually cleared up.

Good luck.
posted by phearlez at 3:53 PM on September 1, 2010

How much reading have you been doing on the internet about this? Every site you go to will probably tell you that you have: cancer, swine flu, or a baby alien inside of you.  It sounds like you may be freaking yourself out a bit, especially if your doctor thinks your ok. 

That said, things can change and if you must go somewhere, I'd try the Urgent Care facility first.  The ER will not be fun, and you will probably wait much, much longer there than you would at the UC. 
posted by Dr. ShadowMask at 4:31 PM on September 1, 2010

IANAD, but it sounds like it might be diverticulitis in the sigmoid colon (though unlikely at your age.) Try putting heat on the area which may help the pain. I agree, if the fever persists, get an antibiotic.
posted by eleslie at 5:13 PM on September 1, 2010

IANYD, but do not go to an urgent care with abdominal pain, that will simply be a waste of your time. An urgent care is for minor complaints like cuts and sprained ankles. They don't have the facilities to evaluate your symptoms.

This could be a lot of different things, so I won't speculate here, but I certainly think an ER evaluation is warranted. This does not sound like the kind of thing that is going to get better on its own. Just go to the ER and bring some books and be prepared that you may have to be there for many hours, because you may need a CT scan and that means a minimum 3-4 hours even if you don't have to wait to be seen, which is always unlikely. and then come back to this thread and tell us what happened, because inquiring minds want to know!
posted by treehorn+bunny at 5:45 PM on September 1, 2010

p.s. you have a fever, so both cancer and Crohn's are unlikely. The money is on something infectious.
posted by treehorn+bunny at 5:46 PM on September 1, 2010

You're a young woman with unexplained abdominal pain. Trust me, you will be taken seriously at the ER (coming from someone your age who just had abdominal surgery). It's better knowing than not knowing, honestly.
posted by timetoevolve at 5:49 PM on September 1, 2010

Just a thought because of the gluten thing... Have you been tested for celiac disease?
posted by Dr. ShadowMask at 6:33 PM on September 1, 2010

I really do not think any of your symptoms suggest a visit to the ER. Your temperature is with in normal limits ( there are substantial variation in normal temperatures), the pain has been chronic with no significant change in durration and intensity. It appears that you have continued to exercise, you are not anemic (therefore no major blood loss), you have maintained some appetite and you have not noted any noticeable weight loss. While it could be something serious your age and the above factors certainly mitigate against it. When someone says that this is not a convenient time for the ER it probably is not an emergency unless they are in denial which does not appear to be your situation. However, if worry/anxiety is making it difficult for you to focus and function effectively there is certainly nothing wrong with going--however-- am not sure you will find it all that reassuring. You may well have a GI problem or other medical problem and should see a physician as soon as is reasonable. I think you are worried which is very very human but only you can decide if it warrants a visit to the ER
posted by rmhsinc at 6:34 PM on September 1, 2010

rmhsinc, you're on dangerous ground telling a person not to seek care based on this little data. It is better to err on the side of caution in any case where a serious medical condition is possible. Based on the information we have, there is no way for us through the internet to rule out a serious medical condition. Although temps around 100 are not an 'official' fever, the fact that she also has subjective fever and chills is suggestive that there is a real infectious process causing the elevation in temperature.

Since she doesn't have any symptoms of a benign infectious process like a cold/upper respiratory infection, we have to assume that the increase in abdominal pain is related to this fever. To be clear, she did state that the pain had increased in intensity. For me, this leaves appendicitis, urinary tract infection, pyelonephritis, intra-abdominal abscess, diverticulitis (though as another poster pointed out, this is unlikely in a young person) amongst numerous other things, on the differential. Given just about every diagnosis connecting abdominal pain with fever requires at least antibiotic treatment, if not further intervention such as surgery, it would be prudent of her to seek ER care since she cannot be seen as an outpatient promptly. If you think that you have to have significant weight loss/symptomatic anemia etc. to have an emergent condition with abdominal pain, then you have not seen enough people trying to write off heart attacks as 'indigestion' and appendicitis as 'just a cramp'. Not everyone who has an emergent condition appears seriously ill at first glance.

I agree with you that having months worth of unchanged chronic pain in the abdomen without other associated symptoms is not a cause for concern. But given worsening pain and fever/chills, the game has changed. Without being able to fully interview and examine this person, I think it is inappropriate to suggest that this is not a big deal. The risks of not seeking treatment for a potential emergency far outweigh the benefits of avoiding an 'inconvenience' or possibly sending someone to the ER who may not have an emergent condition (who cares, everyone else does it!). Picture someone staying home from the doctor based on your advice and suffering appendiceal rupture or massive peritonitis (intra-abdominal infection), for example, because they waited too long to come in. You may reconsider your advice.
posted by treehorn+bunny at 7:10 PM on September 1, 2010 [1 favorite]

A friend with celiacs had lots of pelvic pain, just another data point.
posted by salvia at 9:59 PM on September 1, 2010

From the OP:

"Thank you everyone for your responses. Right before I was headed to the ER, the nurse called back and got me in to see a doctor. They diagnosed me with "middle cycle menstrual cramps". On the one hand, I'm relieved - if that's all it is. On the other hand, I feel weird that it doesn't really explain my other symptoms. I think I will follow up with my primary care doctor as suggested and ask to see a specialist. It makes me feel like a hypochondriac to request stuff like that, but I would rather be safe than sorry. Thank you again!"

posted by jessamyn at 8:09 AM on September 2, 2010

I feel weird that it doesn't really explain my other symptoms. I think I will follow up with my primary care doctor as suggested and ask to see a specialist. It makes me feel like a hypochondriac to request stuff like that, but I would rather be safe than sorry.

Never ever ever ever ever EVER feel foolish to demand more care if you feel like what you have received has not been up to snuff or does not adequately explain your complaints. Even if it is just a matter of your physician failing to explain things adequately to you that is part of the purpose of your physician.

Beyond that - the term for the person who graduated last in their class at medical school is "doctor." If you are uncertain you are getting good care there's a lot of other doctors to choose from.
posted by phearlez at 9:07 AM on September 2, 2010

"treehorn+bunny". I stand by my recommendation. If every medical post is only to be replied to with "see your doctor immediately" or "go to the ER" or "why are you asking" there is very little point in posting medical questions unless strictly informational. I am in no way a physician but I have spent a lot of time with ER personnel, critical care personnel, physicians and have worked in hospitals. Some thing can be extremely serious (which I do not think this was) and not in any way be an emergency. It is often appropriate to go the ER for reassurance--this does not constitute an emergency but is perfectly understandable. It is often necessary to go the ER for things that are not serious (scalp laceration). I trust she sorted out the responses, was able to discern what fit her needs and act on them. It seems to have reached a temporarily resolution and if she remains concerned I would hope she sees a specialist.
posted by rmhsinc at 2:14 PM on September 2, 2010

rmhsinc, I definitely do not endorse replying to every medical post with going to the ER. I'm an ER doctor and so I tend to discourage people from coming here rather than the other way around. I think most people are much too reticent about seeing primary care.

The problem is that we really cannot evaluate in this case whether it was serious, emergent, or not, because we cannot get the full story or examine the patient. If I had seen her, I may not have even ordered blood work on her if her story and exam were very unimpressive. Over the internet though, alll we know is that there is a potential that her pain is serious or emergent. That's all we need to know to refer her to the ER. Our duty is to place the needs of the patient first and not worry about whether she's being a burden on the healthcare system or something like that. I'm glad that she went to get it checked.
posted by treehorn+bunny at 9:16 PM on September 2, 2010