What additional tests should I ask the doctor for?

January 31, 2013 4:28 AM

I went to my doctor because I could feel a mass or swelling in my abdomen just to the right of my belly button. The doctor could feel it too and called it a mass or a "feeling of fullness." Slightly gross details inside.

The doctor tested my urine and found blood and protein. Then he sent me for an ultrasound but the technician didn't see anything. The technician did say that my bowel is right where the swelling or mass is, and she wasn't able to see behind my bowel.

I'm concerned that when I see my doctor for the ultrasound results, he'll dismiss me without investigating further. Is that fair enough, or should I ask for more tests? Are there any particular tests I should request?

I'm still waiting for results from blood tests for kidney and liver function, and my blood count came back as normal and I was told I have no infections. My blood sugar is a little high (prediabetic). Since then, I have seen the protein in my urine and also noticed that's a little rust-colored which I think is blood. It's definitely not menstrual blood as I don't have periods since having a Mirena coil inserted. Oh and I'm forty years old.

I know you're not my doctor and all the usual disclaimers will apply to any ideas you can give me.

posted by hazyjane to health & fitness (12 answers total)

I'm concerned that when I see my doctor for the ultrasound results, he'll dismiss me without investigating further.

I would just say that based on recent experience with medical tests, your doctor is unlikely to just dismiss this-- they might refer you to a specialist, but they shouldn't just throw up their hands. And if they do, you should get a new doctor. Best of luck.
posted by jetlagaddict at 4:34 AM on January 31 [2 favorites]

You're peeing blood, the doctor is not just going to dismiss you (and if he does you should get a new doctor!)
posted by missmagenta at 4:50 AM on January 31

Doctor: So, I'm going to go ahead and dismiss you without investigating further.

You: I'm actually kind of concerned about this, and I'd like to get to the bottom of it. What is the next step, diagnostically? Is there a specialist you could refer me to?
posted by Rock Steady at 5:13 AM on January 31 [3 favorites]

You haven't been waved out of the office, far from it. You're waiting for test results. Quite a few test results, actually. Tests that are important to taking the next steps in your case. I know waiting for test results is hard, but please don't let your worry system kick into overdrive.
posted by seanmpuckett at 5:24 AM on January 31

You'll get more imaging. External US is a great place to start (noninvasive, kinda 3d, cheap, you can push on the target in real time) if you have a clear line of sight, but as you've experienced sometimes the view is blocked by a pocket of bowel. If your MD shrugs his / her shoulders get a new one.
posted by a robot made out of meat at 6:08 AM on January 31

Let's just say he dismisses you. Protest a little and then if he insists, see a different doctor.

That said, at this stage, try not to worry. Blood in your urine together with a mass you can actually feel is not something your doctor will take lightly or dismiss, based on his medical training. Doctors are trained to be aware when tests don't show positive results even when they should. This is termed the sensitivity of the test for a certain condition.

Even if your ultrasound doesn't show much, your doctor will send you for further imaging studies (maybe an MRI or CT depending on the results of your other tests).

Most likely your doctor wanted to save you some money by sending you for an ultrasound first instead of a full-on CT or MRI. Ultrasonography is generally the cheapest imaging modality. This won't be the end if it comes out inconclusive. Don't worry.
posted by rozaine at 6:12 AM on January 31 [1 favorite]

Jerome Groopman's book How Doctors Think point out that doctors, like everyone, can get trapped into going with their first instinct and may not take the time to consider alternative diagnoses. Your job as a patient is not to diagnose yourself, but to prompt the doctor to apply his or her knowledge and skills as effectively as possible. He suggests asking questions like:
-What else could it be?
-Is there anything that doesn't fit? and
-Is it possible I have more than one problem?
posted by Mr.Know-it-some at 7:09 AM on January 31 [9 favorites]

Your doctor was trying to see if they could use a less-expensive, no radiation/noninvasive test to diagnose you - the ultrasound. Unfortunately, no luck. There is no diagnosis so far, and they are unlikely to give up. I also suspect the next thing you will talk about will be CT or MRI.

I like Mr. Know-it-some's questions for the doctor too - those are great even if your physician does tell you exactly what further testing/referral you need.
posted by treehorn+bunny at 7:31 AM on January 31

That being said, I should add one of the best things about the questions Mr. Know-it-some posted is that they allow you to have a dialogue with your doctor about why they're thinking what they're thinking, without doing things like asking for specific additional tests. Asking for tests is not really a great thing to do, in general - people asking for tests tends to result in overtesting. Despite what I noted above I'd hate for you to come away from this Ask thinking "I'm demanding an MRI from my doctor! I'll accept nothing less!" - we're just strangers speculating on the internet and your doctor knows much better what the proper plan should be - if you're not happy with what they say, asking for a second opinion or a referral are better courses of action.
posted by treehorn+bunny at 7:35 AM on January 31

Thanks for the reassurance, everyone. I'm nervous about just being dismissed because the first doctor I saw did dismiss me, saying the mass that he and I could both feel was my "six pack". I thought this was ridiculous because it's only on one side and I haven't been exercising or anything. This first doctor never gave me a urine test or anything.

The second doctor thought this was ridiculous, saying "no offense but you don't exactly have the most well-developed abdominal muscles I've ever seen." So hopefully this second doctor won't dismiss me based on just the ultrasound, because I'm rapidly running out of doctors in my small rural town.
posted by hazyjane at 7:46 AM on January 31 [2 favorites]

Well, I followed some of the advice in this thread. I almost, almost got dismissed but finally the doctor agreed to schedule a non-urgent appointment with "a surgeon" to examine me. Not sure an exam by a surgeon is the best way to go instead of an MRI, but I suppose it's better than nothing. I still have the swelling in my abdomen but don't think I have the blood in my urine anymore. I ordered some test strips off Amazon to make sure it's gone, though. All my other test results came back okay except low calcium and slightly high (prediabetic) blood glucose. The doctor said I should be "highly reassured, and I'm still relatively young and unlikely to have stomach cancer." So now I'll wait for my surgeon's appointment but just go on the basis that I'm okay. I do love the NHS but frankly sometimes it can be frustrating! Anyway, thanks everyone for responding, much appreciated.
posted by hazyjane at 10:55 PM on February 11

hazyjane: I do love the NHS but frankly sometimes it can be frustrating!

Oh, hmm. I didn't realize you were in the UK when I first answered this question, and while my advice still applies, you may want to be clear about your location if you ask further questions about navigating the health care waters, as there might be specific NHS-focused advice that we denizens of Forprofitmedicinelandia are not aware of.
posted by Rock Steady at 8:02 AM on February 12