To the ER or wait it out?
April 28, 2010 4:14 PM   Subscribe

Is this worth a visit to the ER tonight just to ease my mind, or should I just wait until I see my doctor again in 2 weeks? Am I crazy for thinking this is all related?

I'm a 25 year old male in reasonable good health.

Here's the back story: In August, I went to a urologist for a symptom unrelated to this issue. While I was there, he checked my testicles and thought he felt something, so he sent me to get a ultrasound. Turns out it was just a cyst - no biggie.

I went back to that same urologist in January for the same unrelated issue, but before I went, I noticed a lump on my left testicle that I'd not felt before. I mentioned it to him when I went back, and he says, "Oh, that's the same cyst. It's just changed a little. No biggie." It was hurting a bit, but I chalked that up me and him prodding at it.

Now it's April. I've got to a different urologist for the same (and hopefully now resolved) unrelated issue. That same lump is still there, and it still hurts once in a while. I didn't really mention it to him when I went to go see him a few weeks ago, because it wasn't really pertinent to my current issue.

So, 2 weeks after seeing my new urologist, I've developed a pain in my lower back. It's been going for about 4 days, it's not very bad, and it isn't consistent. Now, I'm convinced that the thing is actually a cancerous tumor that my last shitty urologist missed and that the back pain means that I've got cancer in my lymph nodes as well.

I've tried to shine a light through the cyst, and it is clear, which most places suggest means that it's a benign tumor, but after poking through the archives and finding this link, which scared the crap out of me, and made me think all over again that I'm dying, and that this is it, because I've let it go too long.

I've expressed this to my wife, who's more worried about my sanity than my testicles. I tend to obsess over medical issues, and the unrelated issue mentioned above has been driving me a bit crazy for the past few months.

I'm going to go to a follow up with my urologist in 2 weeks for the other issue, and I could bring it up then, or I could hit up an ER tonight to make my brain stop freaking me out. I know you're not my doctor, and I'm not looking for medical advice so much as practical advice - would you go to the ER to get the answer to this now? Could they even give me the answer to this now? Or would you wait the 2 weeks to talk to your urologist?
posted by SNWidget to Health & Fitness (26 answers total) 1 user marked this as a favorite
 
I would skip the ER, but call my doctors office tomorrow and ask if you should come in earlier due to needing to have him look at the cyst/lump/mental molehill.
posted by zia at 4:18 PM on April 28, 2010


earlier than planned, that is...
posted by zia at 4:18 PM on April 28, 2010


Could you simply call the urologist's office and ask to speak to your doctor before the actual visit? Tell whoever answers the phone that you have some concerns about some symptoms and you'd like to talk to the doctor to ease your mind.

When I've done this, I usually get a callback in an hour or two. If you're able to do this, he should be able to shed some light on what's happening and tell you it's okay to chill and wait for your appointment (likely) or to go to the ER (much less likely).

Best of luck, and feel better.
posted by rachaelfaith at 4:19 PM on April 28, 2010


As for the urgency (I see that you were thinking of going to the ER tonight) think about the past week. has the back pain gotten any worse? Have any of your symptoms radically changed and made you feel very sick? If not, at least wait 'til morning when you can call the doctor's office.

I absolutely understand the urge to go to the ER just for sanity's sake because I've been there many times, but try to reassure yourself that unless you're really in a dire situation, you can afford to wait until tomorrow morning.
posted by rachaelfaith at 4:22 PM on April 28, 2010


It's very possible that the ER will still make you wait and see a urologist instead of giving you the immediate answer you want. Besides, would you rather see the ER doc, or would you prefer a urologist? Because the ER doc is probably not one.

Can you get your urologist's office to move your appointment up? Tell them you're having some pain and can they please call you if they have any cancellations and can get you in early.

It's unlikely that cancer would change dramatically between tonight and 2 weeks from now, but I totally understand the anxiety. Good luck!
posted by Knowyournuts at 4:22 PM on April 28, 2010 [5 favorites]


I think it's nigh impossible to get a definitive cancer diagnosis at the E.R., even if that's what you had. Tests for cancer are complex and as I understand it, slightly time consuming (as well as invasive).

First off, write your concerns down. Definitely go to your follow up, and bring them all. Don't worry if your doctor thinks you are crazy when you present them.

Also, take heart in the fact that your urologist knows a hell of a lot more about cancer than you could ever want to know. This doesn't mean write it off and stop worrying about your health. You shouldn't have to experience pain or worry, and you have a doctor to help you with those things, but for tonight, rest easy with the knowledge that if your doctor had reason to be as alarmed as you are, biopsies and tests would have been ordered on the spot.

You might see what you can do about getting a follow up appointment sooner than in the two week window, though. To ease your mind.
posted by pazazygeek at 4:23 PM on April 28, 2010 [1 favorite]


Skip the ER and call the doctor tomorrow.

I don't think this is cancer. I think the chances are pretty slim that a 25-year-old guy who happens to have health anxiety would develop cancer that was missed by two different doctors on three different occasions. So I think what you need to concentrate on is how you can manage your anxiety, both in the short and long term. The most important thing is that you do not google your symptoms and do not read anything about cancer. It will only freak you out.

I know this is the standard metafilter answer to everything, but have you thought about seeing a shrink or therapist? I have a good friend who had similar cancer scares, and she's had very good luck with anti-anxiety drugs.
posted by craichead at 4:24 PM on April 28, 2010 [4 favorites]


I neglected to mention -- when I've been in this anxious state over my health before, I have called the nurse hotline on the back of my medical insurance card. Does your health insurance provider have something like that? I have been talked off many ledges by nurse practitioners over the phone before, and I've also been herded into the ER by them. One extremely nice lady once could tell I was having an anxiety attack and suggested I go to the store, get fixings for a turkey sandwich, milk, and baby shampoo to help me sleep. Those numbers are awesome (and wayyy less expensive than an er visit).
posted by pazazygeek at 4:25 PM on April 28, 2010 [1 favorite]


Yeah go call and get the appointment moved. If you don't like your urologist, get another one and ask for an urgent appointment. If you do feel you have a medical emergency, by all means, go to the ER, but there is a third option: move the appointment up to reflect the urgent, but non-emergent nature of the situation, if that is, in fact, how you would classify it.

Is anything bad going to happen between now and tomorrow morning? If not, skip the ER and call the office in the morning.
posted by zachlipton at 4:28 PM on April 28, 2010


Thanks for all the advice so far - I think I've been backed down from the ledge this evening.

To clear up some details: Urologist 1 was the crappy one who sent me to the ultrasound back in August. He's also the same one that felt it up in January and said that it seemed to just be the same cyst, but it's gotten a little bigger.

Urologist 2 is the new one who's only seen me in April, and I haven't mentioned anything about the cyst because I casual mention when he asked if I had any other problem. He hasn't felt/checked it at all.

The back pain started on Saturday, and it's not continuous - it just pops up once in a while. Normally, I'd write this off to sleeping weird, but combined with the cyst/whatever, and some judicious googling of symptoms, I self-diagnosed death upon myself.

Yes, I have anxiety, and I'm on meds for it. The first question my wife asked, in fact, was whether I'd taken my meds this afternoon. I had. This sort of just spiraled out by having too many hours to sit and think.

I'd still love more opinions, but knowing that I possibly won't get a definite yay or nay from the ER tonight has made it a much less attractive option. It'd cost $100 on my insurance, but that's definitely within my "sleep well" threshhold, so money isn't the issue.
posted by SNWidget at 4:33 PM on April 28, 2010


I've had testicular cancer. I'd skip the ER. They'll make you wait forever, you'll probably have an expensive co-pay, and you'll just end up with the same thing you have now - an appointment with your urologist. The ER is for conditions that are immediately life threatening. Everything else, they'll refer out.

While it's important that you get this checked out (again), at this point 2 weeks is not make-it-or-break-it time. I would, however, contact your urologist and see if an earlier appointment has opened up. People cancel or reschedule all the time, so if you explain yourself and call them every couple of days, I'm sure they'll understand.

If it helps you calm down at all, it's unlikely that you have testicular cancer that has metastasized significantly from August if the only symptom on the testicle itself is a small lump. Cancer will tend to take over the entire testicle, making the whole thing larger and harder. Back pain isn't a likely symptom of it metastasizing through your lymph system either - the first lymph node it would encounter is in your groin, and the next is in your chest.

Tell your urologist that the last guy said it's nothing, but you're freaking out and you'd really like a blood test. Testicular cancer it leaves proteins in your blood that are easily detected. In fact, one of them is hCG (human Chorionic Gonadotropin), which is what a lot of home pregnancy tests look for.

(If you want to take a urine-based pregnancy test go ahead, but it's not reliable enough for this. A "pregnant" result means you probably have cancer but maybe not, while a "not pregnant" result means nothing at all.)

And if it turns out you do have testicular cancer, it's one of the most easily treatable cancers, and you're still early enough that you should be fine. You can MeMail me if you want to ask me anything.
posted by CrayDrygu at 4:37 PM on April 28, 2010 [10 favorites]


If you already have an appointment in two weeks, I'd try to stick it out until then, unless the pain in your back gets worse, in which case I'd give the doctor a call and try to move up the appointment and/or get advice. It's far less likely that you have cancer than that you have some sort of urinary tract infection or epididymitis. In the context of a urinary tract infection, back pain could potentially mean the onset of nephritis, a.k.a. a kidney infection, stemming from the initial UTI. I've had this, and it's not very enjoyable (especially when they prescribe you an antibiotic to treat it that you turn out to be allergic to...though that's another story entirely).

Alternately, if you happened to have epididymitis, the testicular pain and back pain could be completely unrelated—the latter could even just stem from the stress of worrying about these various conditions. (You might not be sleeping as well, you might be holding tension in your lower-back muscles, you might be holding tension in your upper-back muscles and your lower back is tightening up to compensate, etc.)

Out of curiosity, though, re: the possibility of epididymitis: Do you have any springtime allergies, and if so, have you been taking any decongestants to treat them? Certain decongestants are associated with infection of the epididymis/testicles, because as the decongestant acts to temporarily shrink down certain blood vessels in the nose, it can also sometimes shrink down the epididymis as well, leading to fluid backups and infection.

It would help to know what the unrelated condition was that you're seeing the new urologist for, as that might help shed some light on any potential connections between your symptoms. It may well all be related—but not necessarily in the way that you think!

Finally, if you're unable to speak to your doctor tonight and still want to take some action, I'd try a heating pad on your lower back—that would help both if the problem's muscular and (to some extent) if it's a kidney thing. (I remember being in the car on the way to the ER with what turned out to be pyelonephritis and feeling a whole lot better just from having the heat cranked up.) And icing your testicles is commonly prescribed for swelling and pain due to epididymitis.
posted by limeonaire at 4:54 PM on April 28, 2010 [2 favorites]


BTW, I only went to the ER the time I mention above because the pain was unbearable—as in, I couldn't sleep, it was so bad. Probably a 7 or 7 1/2 on a scale of 1 to 10, at least initially, though much lower after I warmed up in the car. I would not say what you're describing is enough to merit an ER visit—and I say this as someone who's visited the ER twice for UTIs (the second time was because I was pissing a little bit of blood).
posted by limeonaire at 5:01 PM on April 28, 2010


If anyone's interested, the other issue can be documented in this anonymous question which is now only semi-anonymous. It's been mostly treated, and I think it's been taken care of.
posted by SNWidget at 5:02 PM on April 28, 2010


As a personal rule, I wouldn't go to the ER unless it is immediately life-threatening, extremely ("10 out of 10" i.e. screaming / childbirth) painful, or there is a risk of sub-optimal outcome (scarring, nerve damage, infection) without immediate intervention.* Otherwise, you are probably better off going to prompt care or making an appointment with your GP. Chances are there isn't going to be a urologist on staff in the ER tonight anyway, so my strong suspicion is that there wouldn't be that much they'd do for you besides maybe treating the pain and reassuring you that you're not going to die immediately. Just a guess.

Many GPs and specialists leave room in their schedule for emergency appointments. Just because you have an appointment in two weeks (and, presumably, when you called and made that appointment that was the first opening) doesn't mean that's actually the first free slot. That might be the first opening for a routine appointment, but most GPs I've had or known leave a certain amount of time free to squeeze in people who are in distress and need to have a very specific complaint addressed.

So I would call either your urologist tomorrow and let them know what's up, being specific to tell them that the situation has changed and that you are concerned. They may be able to fit you in (or tell you that it's time to go in for diagnostics) much sooner than you think. Either way, even if they end up referring you to the hospital and you check yourself in for tests, it'll be cheaper than going in through the ER door.

* That's just my personal rule. In general I'm sure there are other cases where the ER is appropriate; e.g. if you have some sort of ongoing or chronic life-threatening medical condition and it changes suddenly for the worse and you know it, obviously that'd be the time to go. (Some people know in advance when they're about to have a heart attack, for instance; it's quite spooky.)
posted by Kadin2048 at 5:18 PM on April 28, 2010


I would call the Dial a Nurse (if you have one) tonight, just to see if you can get some pain tips and reassurance, and then call the doctor's office tomorrow to see what they can do. In going to the ER for something that isn't life threatening, you'd be waiting a looooooong time - and also potentially using up resources for someone else who does come in with a serious injury.
posted by spinifex23 at 5:42 PM on April 28, 2010


I was going to suggest a second opinion, until I reread and saw that you will be seeing a second urologist shortly. Definitely ask him about it then. Two weeks is not likely to make a difference.
posted by megatherium at 7:56 PM on April 28, 2010


To chime in on what other folks (with testicles!) are saying: I recently had my baseline mammogram. It came back with suspicious findings, so I got to go back five days later and have 16 more exposures plus a lengthy ultrasound. I was terrified. The radiologist ordered biopsies on each breast, but they didn't mind that I was not able to come in for a couple of weeks. That, from all my friends-with-cancer experiences, made me pretty sure that I'm being biopsied on Friday as a precaution and not because I actually have malignancies.

You don't say specifically why urologist1 was crappy - it sounds like it's related to your initial complaint and not as much to the cyst, because what he did is pretty much standard procedure. He palpated and sent you to ultrasound. Definitely try to move your appointment up, and plan to explain your concerns; if you only mentioned the cyst casually to urologist2, he may not realize that it's got you tied up in hypochondriac knots (which I totally get - I am so skilled at diagnosing myself with obscure fatal diseases it's not even funny).
posted by catlet at 8:54 PM on April 28, 2010


catlet - Urologist1 sucked because I had another issue (which I linked to in a previous comment), and he basically said it was all in my head, when Urologist2 found something actually wrong with me and treated me with medication. The standard procedure with the ultrasound was fine - that wasn't my complaint.

I'm going to call Urologist2 tomorrow morning and see if I can get in sooner - I should be able to, I can generally get in with them at the last moment if I need to. I'll let him know I'm feeling some intermittent back pain and some testicular pain, and that it's freaking me out. Hopefully, everything will work out all hunky dory.
posted by SNWidget at 9:14 PM on April 28, 2010


I know you're a boy, but I'm a girl, so when I hear "pain in the lower back" I think "cranberry juice."

Pain in the lower back = kidney pain = urinary tract infection. (Boys get those, right?)

You'll want to see a doctor, certainly, but cranberry juice is surprisingly effective against a UTI. If you feel the need to do something tonight, head to the store and pick up a big ol' jug of 100% cranberry juice. I can't see how it could make things worse, and it might help. If only to ward off the scurvy!
posted by ErikaB at 9:14 PM on April 28, 2010


ErikaB - not a UTI. I've actually been checked for that in the past few weeks due to my other issue. Thanks for the idea, though.
posted by SNWidget at 9:49 PM on April 28, 2010


One reason you have a doctor is so you have someone to call, at any time, with an urgent medical question. Your internet friends here as ask.me are good at providing emotional support, and listening, but you can call the doc. You'll get an answering service, and a call back from whoever's on call. Nicer to call at 11 p.m. than at 3 a.m., but if it's urgent, call.
posted by theora55 at 7:28 AM on April 29, 2010


For anyone waiting for a follow-up, I'll say that I made the call this morning to my doctor, and they managed to get me in tomorrow morning at 8am. This is with Urologist2, so I'll count this as my check up for my other issue as well.

I'm trying to come up with a calm way to listing out my symptoms without going, "OMG I'M GOING TO DIE I KNOW IT PLEASE REMOVE MY BALL AND RADIATE MY BODY." So that's going to take some work. I tend to get completely tongue-tied when I talk to doctors, and either leave things out, or not mention certain things.

My back pain is still there - nothing too bad, but it comes and goes. I'm still worried about what it may be, and if it's at all connected, but right now, I feel like I'm hypersensitive to everything that goes on in my body.

I'll post another follow-up when I find out what's actually wrong with me (or if it's just in my head).
posted by SNWidget at 8:23 AM on April 29, 2010


I tend to get completely tongue-tied when I talk to doctors, and either leave things out, or not mention certain things.
Me too. I also tend to minimize symptoms when I talk to doctors, because I don't want to sound like a whiner. It doesn't help that my particular health issues mean that most of the doctors I deal with typically treat people who have much more serious and life-threatening problems than I do.

I deal with this by literally typing up lists. I type up a list of questions, and I type up a list of symptoms or issues I want the doctor to know about. You can read out the list, or you can literally hand it to the doctor. If you list symptoms, be specific: "lower back pain, comes and goes, worse in the morning, usually on my left side but sometimes on my right."

Another strategy, if you can do it, is to take someone with you to the doctor. Give that person a copy of the list of questions. It's the person's job to take notes and to check off questions as they get answered. At the end of the appointment, they can ask the doctor any of your unasked questions. Would your wife be willing to do that?
posted by craichead at 8:46 AM on April 29, 2010 [1 favorite]


craichead sorta beat me to it, but "I tend to get completely tongue-tied when I talk to doctors" is really common.

You should not be embarassed or hesitant in the least to write or type up some bullet points that you want to make sure to go over. That way you won't walk out of the doctor's office and realize that you only ever mentioned two of the five things that you wanted to.

So by all means don't hesitate to make a list of your symptoms / concerns.
posted by Kadin2048 at 8:56 AM on April 29, 2010


So another follow up.

I went to the urologist with my wife yesterday morning. I told him what I was afraid was wrong, he took a look, gave it a squeeze or two, and said that it was definitely a cyst, and that I had another one as well. If it got any more painful, let him know, but otherwise, it was ok. He also checked my back, and pushed around my groin/lower back.

I feel a lot more sane now, and I'm glad I waited it out. My wife went as back up, making sure I got all the info and asked all the questions I needed to not be worried for the next month.

My lower back still hurts, and it feels like it's getting worse, so I don't know what to do there. But that's for another AskMe, I guess.

Thanks everyone for the advice!
posted by SNWidget at 11:35 AM on May 1, 2010


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