To ER or not to ER
March 12, 2017 7:10 AM   Subscribe

I've had mostly mild, mostly intermittent lower left, lower right, and lower middle abdominal pain for more than a week but that seems to be sort of getting worse/more constant. I don't have a GP I trust or an urgent care clinic nearby. Way too many details inside.

For a little over a week, I’ve had tearing/cramping pain in my bilateral lower abdomen and general naval area. The pain comes and goes throughout the day, but when it starts, it usually goes from the naval area, to the lower right abdomen, to the lower left abdomen, and then sometimes back to the right side. Although it seems to be left-sided more than right-sided, it tends to be more sharply painful and shooting when it hits the right side. Overall, I sometimes feel like a balloon is expanding in random localized areas, and then deflating. I've never felt anything like it before.

When the pain originally started for the first time, it doubled me over. I was going upstairs and had to sit down on one of the steps. That was the only time it was so bad I had to stop moving, and it only lasted a few seconds. It’s been rather general and mild since then, except it woke me up at 3:30 a.m. this morning. I went back to sleep.

All week, today included, I’ve had unusually clammy hands, episodes of cold sweat and chills, episodes of nausea without vomiting, a near-constant urge to defecate (although I’m still doing so at my regular time with my normal consistency of poop – no diarrhea or anything), and an increase in gas (which I can pass). All of this seems to be worse today, including the abdominal pain. The abdominal pain has been constant today but more localized in the lower left side, sometimes with sharp, shooting pain in the lower right side. It’s nothing that stops me from moving around.

Other unusual symptoms: My appetite has also been depressed but not absent. I’m not getting major urges to eat, but I can and do eat, only less than usual. For example, I had a couple of pretzel chips and hummus for lunch today, and I’m full; totally not normal. I’ve also had unusual amounts of vaginal discharge that smells unusually strong. I don’t know if that’s related. I've had weird right-sided muscle tenderness near my supraspinatus muscle for a week. My temp has been in the 98's; I usually temp around 97. I've also been extremely tired all week.

I get that I need to see a doctor about this. My GP does. not. listen. and has completely bungled two major medical conditions for me in the past three years. I’ve been meaning to get a new GP; the one my endocrinologist recommended isn’t taking new patients, and I never followed-up on finding a different one. Totally stupid, I know.

So, from my perspective, this is a decision between taking some time and finding a decent family doctor, or spending some money at the county ER for what might be absolutely nothing. (I’m rural with no nearby urgent care clinic.) On one hand, this stuff is mildly annoying, and I feel like it's not a big enough deal to go to the ER. On the other hand, this stuff is totally not normal, isn't going away, seems to be getting a little worse, and it could be a big deal.

Is this something that sounds like it needs medical attention right damn now, or is this something that sounds like it can wait a week or two while I find I decent GP? No one here is my doctor. No one here is giving me medical advice.

I’m 30 years old, female, cheap, and stubborn. I am hypothyroid s/p a complete thyroidectomy ten years ago, with PCOS, a history of miscarriage, and pre-diabetes secondary to the hypothyroid (thank you, GP). I’m on thyroid pills and Metformin.

Anonymous because of all the medical stuff and stuff about poop/discharge.

Thanks.
posted by anonymous to Health & Fitness (22 answers total) 1 user marked this as a favorite
 
Intermittent but bad pain over the course of a week that might be worsening? Yeah, I'd go see a medical professional. Could be a kidney stone, could be an infection, could be a pulled muscle or ligament, could be cancer, could be you have one of those weird reversed bodies where your appendix is on the "wrong" side, you don't know.

I understand being frugal, but what's going to happen is you will indicate where you have pain, they'll do a manual exam, and most likely they will give you a CT or something, and that will hopefully tell them something.

If you are worried about expenses you can look at what locations your medical plan covers for CT scans or whatever and if there is a cheaper imaging location you can get referred to, and ask that you be sent there.
posted by gryftir at 7:23 AM on March 12, 2017 [2 favorites]


Do you have accessible records that establish a history of low basal temperatures?

It sounds like you have been running a low-grade fever, and possibly have an infection going on. But if you show up to an ER with a temp of 98.4, they won't take you seriously as they should.

I have the same problem; mid 96 is normal for me, and by mid 98 I am miserable and definitely sick, but only my primary care place gets that.

Your symptoms sound like an infection (appendix, bowel) or ovarian cyst that could easily get very bad fast, even though you don't sound strictly emergent at this moment. It's something I'd seek very good care for quite soon, and if you don't have other good care options, the ER might be the place.
posted by Dashy at 7:36 AM on March 12, 2017 [2 favorites]


If you set up an urgent appointment with your GP you might end up seeing someone else in the same office, an NP or another doctor. Were your bad experiences limited to the doctor or was it the whole practice? I would try that before the ER.
posted by lydhre at 7:40 AM on March 12, 2017


Does your local emergency room have a number you can call to talk to a nurse? If so, call. Is there a Planned Parenthood clinic in your area? If there is, call them. This doesn't sound like something you want to mess around with. Some of your symptoms sounds similar to those of an ectopic pregnancy, any chance of that? I hope you get some care and feel better soon.
posted by mareli at 8:21 AM on March 12, 2017 [2 favorites]


You don't need to choose THE doctor. You can always change doctors again later, when you have the luxury of time to do research.
posted by rakaidan at 8:56 AM on March 12, 2017 [9 favorites]


You've done an excellent job of writing up a description and history of your symptoms for this post. Print it out and take it with you when you go for care (wherever you wind up going).
posted by heatherlogan at 10:16 AM on March 12, 2017 [1 favorite]


Write down the symptoms like you've done here and make an appointment with a doctor. Don't wait around to find a new GP first. I would either call your GP's practice and ask for an appointment with the next available GP or make an appointment with Planned Parenthood or go to an emergency walk-in clinic.

Sometimes doctors do better when they have a very specific, concrete problem to solve, like, "Is this abdominal pain an emergency situation or not?" than they do with trying to do something like diagnose long-running complex health problems. Which is why I think you should call your GP as a first step, even if he or she hasn't been so helpful in the past.
posted by colfax at 10:48 AM on March 12, 2017 [2 favorites]


Hello! I am an emergency doctor (but not your emergency doctor). I deal with undifferentiated lower abdominal pain every day of my working life. I can't really rule out ectopic pregnancy or a host of other life-threatening gynecologic and/or intra-abdominal problems on the basis of what you're telling me. You know who can? Your local ED. Two or three hours in an ED bed and you will likely arrive at an answer, or at minimum be reassured that there is nothing serious going on (and probably get some symptomatic treatment also). Further testing is certainly warranted ASAP.

If you are concerned enough to write up this question, you're concerned enough to go get things checked out.
posted by killdevil at 12:26 PM on March 12, 2017 [20 favorites]


Do you have a Planned Parenthood nearby? If not, I would go ahead with the current GP just to make sure you don't have an infection - sounds like maybe a kidney thing or possibly BV. You need to get that taken care of quick so it doesn't get worse. Even a crap Dr. is going to be able to treat something like that. Then you can spend some time getting a better doctor, and go to the ER for sure if the pain escalates.
posted by ananci at 12:28 PM on March 12, 2017 [1 favorite]


I'm a doctor (not your doctor), and I second what killdevil said. The combination of progressively worsening lower abdominal pain + atypical vaginal discharge + nausea warrants investigation ASAP.
posted by basalganglia at 12:42 PM on March 12, 2017 [2 favorites]


I am not a doctor, but because reasons I've had more than my share of ER experience from the patient side over the past 60+ years. Often I've had occasion to chat with the various med staff while I've been waiting for results of one kind or another, and pretty much anyone I've ever talked to has said "everybody waits too long" before calling or going to the ER. Myself included, even though by now I should know better.

I second the suggestion to call the ER and ask to speak to a nurse. Let them help you decide whether a physical visit is necessary.
posted by qurlyjoe at 2:07 PM on March 12, 2017


I acknowledge all of the above guidance BUT rule out constipation first!!! take something that will make you go and then review your pain levels and symptoms.

constipation can have major effects....
posted by Wilder at 2:44 PM on March 12, 2017


As a fellow emergency doc, I would mainly add to what killdevil said by saying that abdominal pain generally cannot be dealt with at an urgent care/walk in clinic, except very few circumstances (like a UTI). At least a GP can do imaging tests like ultrasounds or CTs and follow up on them, urgent cares don't typically have those tests available.

Calling the ER is not usually a useful thing to do because we cannot give medical advice over the phone. I've listened to the other end of hundreds of these phone calls as the secretary repeats "I'm sorry sir/ma'am, we can't give medical advice on the phone. All I can tell you is that if you think this is an emergency you should come in to be seen."

Temp of 98 really isn't a fever though. It's an objective definition. Not to say that you couldn't have an infection with a temp of 98, but 98 will never be a fever even if you have data to prove that your temperature has always been documented at 96.
posted by treehorn+bunny at 10:29 PM on March 12, 2017


Also 2-3 hours is very optimistic. I've worked in about 10 different ERs so far and visits for abdominal pain routinely run up to 6 hours, and that's only counting the 'treatment time' (once you get into the room), not counting the wait time prior to being roomed. If you have a choice about when to go to the ER, try to get there before 11am - after that it just gets busier and busier through the evening and into the late hours.
posted by treehorn+bunny at 10:31 PM on March 12, 2017


Fellow cyster here. I currently have a large-ish cyst on my left ovary and I cramp and experience mild pain from it that feels like it's in my intestines, but obviously it's on my ovary. I know about the bastard because I just had a CT and an MRI for lower left-sided pain and cramping (the fear was bowel cancer). I've had cysts rupture in the past, and it was always intense. I would be laying or sitting curled up in pain, agonizing pain, sometimes accompanied by gas for about 30 minutes. Then I would have what felt like IBS attacks for a few days or even a week thereafter. So because you have PCOS, I'm wondering if you aren't just having a flare up or if one of your cysts has ruptured. When they rupture they can tear things up in there and cause bleeding. You should have your blood tested to see if you're anemic. I think you need to see a doctor soon. I wouldn't waste time agonizing over how crappy your GP is, just schedule an appointment with them and be seen. When you make your appointment stress that it's urgent and that you're either coming in within the next day or two or you're heading to the ER, they should be able to squeeze you in. You can still research new doctors in the mean time and find one with great reviews, one who will listen to you and give a thorough damn, but right now you need to worry about the immediate issue- that being, you have no idea what's going on with your bowels/ovaries and that area of your body is acting totally funky. I would also look into establishing care with a gynecologist, you won't get good and proper PCOS care from a GP. Don't wait weeks to be seen, just see your current GP or go to the hospital. If you're bleeding internally you could die from it. You could also have something totally unrelated to PCOS like an infection of the intestinal lining or appendicitis.
posted by Avosunspin at 1:52 AM on March 13, 2017


After having witnessed two AskMe questions from people with worrisome abdominal pain who never came back to update, I have made it my policy to tell anyone with abdominal pain asking if they should go to the ER that YES absolutely please go to the ER. There's a lot of important stuff in there and it's better to be safe than... not. Yes. Please go to the ER. And then please come back and update to let us know you're OK! (ETA: Just noticed this is anon, please let the mods know so they can update. After you are back from the ER with a clean bill of health.)
posted by rabbitrabbit at 9:11 AM on March 13, 2017


Mod note: This is a followup from the asker.
The pain localized to a deep ache in my right lower quadrant last night. It kept me up for a few hours. When I woke up in the morning, I had some bad pain there, got ready for work, couldn't button my pants that had fit perfectly fine on Saturday, looked in the mirror, and told myself to make the phone call to the GP's office.

I called into work and got into my GP this morning (and by GP, I mean the office staff; I haven't seen the MD in years). They suspected appendicitis and sent me to the county hospital with orders for labs and an abdominal CT. Everything came back unremarkable - except for a lot of ovarian cysts.

The nurse at the GP's office called me and said all the issues I'm having are because of those cysts and because I might be ovulating. Silence. I was waiting for "and what we're going to do is..." But nope, just silence. I asked her what to do about the symptoms, and she said, "Oh, just call back if you keep having them." Well... They never went away, I was having the symptoms the entire time I was at the hospital, and I had half the mind to hang up and call her right back with, "Hey, I'm still having symptoms."

I just took a deep breath and had a tearing pain in my navel area. My lower abdomen still aches and stabs. I am getting an OB/GYN today and am thinking about making an early appointment with my endo, but, really, it's time for an OB/GYN. And a GP I don't second guess all the time.

Thank you all for the concern and advice. I am glad I went and had it looked at. You're all the best!
posted by cortex (staff) at 10:36 AM on March 13, 2017 [1 favorite]


I have had issues with ovarian cysts in the past. Definitely a good idea to see an OB/GYN, but in the meantime, I would recommend a high dose of naproxen which is an anti-inflammatory and will also help with the pain. I've always been given a prescription-strength dose of that for ovarian cysts, and it does help (I think it's 2 or 3 times the dose on the over-the-counter bottle, so easy to do without a prescription). It will also help to get on hormonal birth control if you aren't already and if there's not some other reason that you can't be on it. Sorry your GP was of no help!
posted by rainbowbrite at 10:43 AM on March 13, 2017


I'd go the an emergency room with these symptoms.
posted by SLC Mom at 12:57 PM on March 13, 2017


Just read you update. Did you actually SEE a doctor? The tests they did are close to worthless unless you have been examined. If you didn't actually see someone, a trip to the ER is still in order.
posted by SLC Mom at 1:00 PM on March 13, 2017 [1 favorite]


So the nurse thinks you've been ovulating for over a week? Glad you're seeing a gynecologist soon.
posted by basalganglia at 10:24 AM on March 18, 2017 [1 favorite]


Mod note: From the OP:
Some resolution, for anyone who comes here looking for their own answers.

My new gyno did two different kinds of ultrasounds and two physical exams; everything came back okay. She suspected stress and/or a food allergy. She got me into a gastroenterologist, who reviewed my films and confirmed that everything looked okay. He suspected IBS and recommended a number of things, including anti-spasm medications, which did nothing; a FODMAP diet, which, eh, I'm not giving up avocados, broccoli, and apples, but you can have my bread and milk; and IBGard. IBGard is magical, fancy peppermint oil that has completely changed, calmed, and regulated my digestive life. I think the IBS diagnosis is accurate.

I also think it was stress, which I tend to be rather blind to, following two prior jobs that were constant, all-day, every-day, take-it-home Stressapaloozas. My current job is usually laid back and relaxed, but, in early March, I was in the middle of my first semester of a graduate program, and I'd just had giant, flaming mess of a giant, important report land on my desk at work. I didn't really feel stressed out or strung out or anything, but I think I was probably losing it somewhere in my brain. After a particularly nasty episode of the abdominal pain on the day that report was due, the symptoms pretty much went away.

Per WebMD, there are studies out there that link stress and IBS; some have shown that stress triggers the immune system to trigger IBS. So, that's my very expensive answer: stress and IBS.

Thank you all for all the advice, thoughts, and help on this.
posted by Eyebrows McGee (staff) at 7:14 PM on June 11, 2017 [3 favorites]


« Older which Borges story is this?   |   Worried about my car insurance... Newer »
This thread is closed to new comments.