Bad stomach pain, scheduled to travel to California. What to do?

July 13, 2022 2:43 AM

I've been experiencing recurring stomach pain for about a few months. Had a x-ray, an ultrasound, a MRI taken with no abnormal results, and an upcoming upper edonscopy exam in August. Ended up going to Urgent Care about 3 weeks ago because I was having sharp pains. Was given medicine. Took it briefly, stopped because the pain went away. Having a bad flare-up now, I got vacation plans literally today. What to do?

YANMD.

As the description says, this stomach pain has been recurring. It's this really odd pain that has a heaviness in my stomach, kind of like there's rocks in there. Initially, it would come and go, but was minor, kind of like a "burst" every now and then. I got those aforementioned screenings, but they didn't show anything odd. This was in addition to blood and urine tests, as well as a stool test earlier this year. All tests/labs came out fine.

I have an upper endoscopy scheduled in August, because they couldn't figure out what was wrong after all those, and the MRI.

Three weeks ago, the pain was pretty bad; the "bursts" kept coming and going rapidly (every 5 minutes or so), and the pain extended to my lower back and hips. I ended up calling off work early and went to Urgent Care, which ultimately wasn't really able to do much, other than prescribe Dicyclomine and Pantoprazole. That did the trick; I took the meds briefly after my visit for a couple or so days, but stopped because the pain had gone away. The "bursts" came and went sporadically every few days, but were very mild and manageable/ignorable. I planned a family vacation in California, with my flight departing today. Everything was fine.

Until last night. Out of the blue, I got this really bad flare-up of the "bursts" (same as 3 weeks; every 5 minutes or so). I tried drinking warm water and chamomile tea to help soothe my stomach, and eventually slept. Unfortunately, I was awakened at 3am because of sharp "bursts" going on in my stomach. The pain was almost unbearable when the "bursts" came. I took some Pepto Bismol, which did help a bit, and recently took Pantoprazole, and will take Dicyclomine during the day.

My grave concern is this: I'll be 3,000 miles across the country. My parents' home is about an hour away from the nearest Kaiser center. This flare-up was really bad, and still continues to be (still waiting to see if the medicine kicks in). I'm not sure if I should go to Urgent Care this morning, because to be honest, the last time I went, it was kind of a waste, other than getting the meds. It was ~3 hours in total, only to be told in the end that there was honestly not much that can be done because I have the upper endoscopy scheduled already. However, currently, the "bursts" are really annoying, and the pain is extending to my lower back and hips. When the "bursts" come, it kind of knocks me out, and I have to pause what I'm doing. When the "bursts" vanish, I'm completely normal again. It's so baffling and confusing. No rhyme and reason to it. I don't think there's any specific food triggers or patterns or whatever.

Not sure if it's related, but I noticed during the time of "bursts" that I have a hard time passing gas, and going pee also takes considerable effort/patience/time. For a while now (~2 months), my stools has been mostly soft/diaherra-like, and sometimes I have to go 2-3 times a day to feel completely cleaned out.

I'm just at a loss right now. This is rotten timing. My brother is on a solo trip up the PCT in California, and I really want to see him, as well as my family. I had this vacation planned, I need it. It's been a stressful and hard year, and it's the perfect time because work is slow right now, and I got the perfect flight deals, everything was working out.

YANMD, but what do I do? How do I make this go away? I'm going to take the meds as prescribed 3 weeks ago, but I'm afraid that won't be enough, and I'm afraid I'll have an emergency in California. What could be the matter? Why haven't the doctors found anything? It's so perplexing. Again, YANMD, but any clues? I can ask Kaiser, but they're pretty much just waiting until the endoscopy, so thought I could ask for ideas here.

Any suggestions would be appreciated. I need help navigating this super stressful situation that is happening at the worst possible time. When in pain, it feels like a personal hell, and it's really hard to tolerate. Thanks.

posted by dubious_dude to Health & Fitness (18 answers total)

I had abdominal pain that I also felt in my back and hips etc but it ended up being a very upset appendix that they just took out after ruling everything else out and it didn’t stop hurting in the emergency room. My appendix was covered in scar tissue so I think I had previous flares and in the final hospital visit it was probably getting ready to burst. They couldn’t see anything on an ultrasound or x ray. Didn’t have an mri.
posted by catspajammies at 2:52 AM on July 13, 2022

Because my pain was mostly in my lower back previous doctors had assumed kidney stones etc and given me anti inflammatories and antibiotics which had probably calmed down my appendix a couple of times but now my appendix is out I’ve never had the problem again.
posted by catspajammies at 2:55 AM on July 13, 2022

I have Crohn's disease. I travel for work, and I used to routinely travel from California to DC. When I am having a flare up, I do not get on a long flight. Altitude can amplify gastrointestinal signs and symptoms (pressurization and altitude can get your digestive tract gurgling, and gas can become more painful as it expands and contracts in response to pressure changes). I get that you need a vacation, but in the absence of a diagnosis and treatment that you know reliably helps you, I don't see how a minium 8 hour excusrion by commercial airliner is setting you up for stress relief. I also don't know if trekking up to the PCT would be wise (unless you're just meeting at a waypoint that you can get to and from relatively easy). If you think you may need urgent medical care, please do not hop onto the PCT!

I don't know if there's a quick resolution to your dilemma, but have you explored the psychological side of your situation? The stress and anxiety I used to feel (and sometimes still feel) about my health problems absolutely cause or manifest as physical pain and discomfort. There have been long periods where taking more medication(s) are contrindicated so the second-line treatment has been controlled breathing, meditation, ACT-type approaches to managing pain, managing my circumstances, and generally structuring things so I avoid putting myself in flare up-triggering situations to the greatest extent possible. This isn't to say you're not going to figure out what's going on! In the meantime, though, if you're going to be traveling it may be helpful to download some controlled breathing-meditation-etc. apps or YouTube videos before getting on the plane.

Not sure if it's related, but I noticed during the time of "bursts" that I have a hard time passing gas, and going pee also takes considerable effort/patience/time. For a while now (~2 months), my stools has been mostly soft/diaherra-like, and sometimes I have to go 2-3 times a day to feel completely cleaned out.

Hm, I wonder if there's a muscle/nerve component here, rather than something exclusively GI. If dicyclomine helped, I'd be curious about what kind of gastric motility disorder screening(s) you've been through. Any other injuries, nerve damage, hormonal changes in the recent past?
posted by late afternoon dreaming hotel at 3:24 AM on July 13, 2022

Response by poster: I forgot to mention that I also had an abdominal CT scan taken last October, in addition to the abdominal ultrasound taken earlier this year and the MRI taken a couple of months ago. I believe they all scanned my appendix and didn't see any issues, but appendicitis is definitely a possibility that can't be ruled out. No nausea or vomiting so far, though.

I also don't know if trekking up to the PCT would be wise (unless you're just meeting at a waypoint that you can get to and from relatively easy)
Definitely planning to meet my brother at a waypoint, not actually hiking.

I don't know if there's a quick resolution to your dilemma, but have you explored the psychological side of your situation?
I honestly very much doubt it's psychological. The "bursts" come literally out of the blue, when I'm not even thinking about them at all. I'd be fine, relaxing and doing my thing, and wham bam, bursts.

Altitude can amplify gastrointestinal signs and symptoms (pressurization and altitude can get your digestive tract gurgling, and gas can become more painful as it expands and contracts in response to pressure changes)
That's a good point. My first (connecting) flight is a relatively short one, about 2 hours. When I land at the connecting point, I'll see how I feel and go from there. I'm also hoping that the combination of meds and water will help. I did fly last December, though, and had some mild stomach issues then, but didn't run into any issues. I guess we'll see.

Any other injuries, nerve damage, hormonal changes in the recent past?
Not that I know of.
posted by dubious_dude at 5:45 AM on July 13, 2022

My friend was terribly, terribly sick and in pain for a few months with symptoms similar to what you are describing, plus vomiting and fever as time went on. She was in a lot of pain but was masking that pain and/or attributing it to other things like PMS or whatever -- and she just had her gallbladder out after going through a gallbladder emergency. A lot of the pain was from gallstones being lodged in her bile duct. If the gallbladder has not been ruled out definitively, I would look into that. The consequences of a gallbladder emergency that go untreated are not great, and my friend ended up in the hospital for about five days and off work for another five. She's now working from home but still pretty restricted on what she can do since the surgery. I would not fuck around and find out with this.
posted by Medieval Maven at 6:23 AM on July 13, 2022 [1 favorite]

This bit of the above comment rings very true to me: When I am having a flare up, I do not get on a long flight. Altitude can amplify gastrointestinal signs and symptoms (pressurization and altitude can get your digestive tract gurgling, and gas can become more painful as it expands and contracts in response to pressure changes).

I had acute sinusitis once and got on a long-distance plane. I experienced some of the worst pain of my life, even during the short first section of the flight. It did permanent damage to my sinuses. Based on that experience, if I were in your position, you wouldn't find me getting on a plane even if I had a trip planned.
posted by aniola at 8:54 AM on July 13, 2022 [1 favorite]

+1 gall bladder. Your description of symptoms is pretty close to the symptoms I had. My primary care doc ordered an ultrasound which found nothing. When the symptoms persisted, and felt like a legit EMERGENCY every time they happened, I pressed her. She ordered a HIDA scan which is specific to gall bladder function. Findings: 100% blockage, and oh there were also two good-sized stones not seen on other imaging. It happens.

Another possibility: Ulcer or other gastritis. I assume that's why they gave you the Pantoprozole? I've had non-ulcer/non-specific gastritis. I thought it was an ulcer, because it was definitely stress-related.

It doesn't seem like urgent care is useful for what's ailing you. And that the pain is bad enough that it could become an emergency or is the signal of an emergency. If it were me, I would avoid travel until after the endoscopy because I wouldn't want to be that far from an ER near my home.
posted by ImproviseOrDie at 9:42 AM on July 13, 2022

Response by poster: @Medieval Maven and @ImproviseOrDie, I was told that my gallbladder was not detected in any of the imaging tests, and that it most likely was removed when I was at a young age. Does that make a difference?
posted by dubious_dude at 10:28 AM on July 13, 2022

Can your parent(s) vouch for the fact that your gallbladder was removed when you were kid? That just seems extremely strange. I think if you can't verify with your parent(s) that such a thing was done, I would push for better imaging. I would just be surprised; gall stones in children are not especially common.
posted by Medieval Maven at 11:18 AM on July 13, 2022 [6 favorites]

IANAD, but from my limited med tech experience, abdominal pain is usually appendicitis, diverticulitis, cholecystitis (gallbladder), a UTI, or good old constipation. This sounds intestinal and has gone on too long to be regular gas/constipation, so I'd be inclined to place my index of suspicion on diverticulitis. Diverticulitis can also be chronic (diverticulosis). And antibiotics can treat mild cases. But who knows. Maybe I'm totally wrong and this is something more along the lines of Crohn's, Celiac, or IBS. Kind of wild this is also affecting your urination though.

I would try to get another CT done, since the last one was in October, and you said your symptoms didn't start until a few months ago. I don't know a lot about ultrasound but my impression is that it is not quite as good a diagnostic tool as CT. Good luck, sorry you are going through this.
posted by coffeeand at 12:09 PM on July 13, 2022 [2 favorites]

Having a medical emergency when you are hours away from help is an avoidable disaster for you right now. How much will you be able to enjoy a trip if you are in this much pain? What happens if there’s turbulence and you aren’t able to access the bathroom for your entire flight? What happens if you need to access the ER while on your trip?
posted by Bottlecap at 12:55 PM on July 13, 2022 [2 favorites]

If Pantoprazole helped, try some Pepcid or similar. This could be acid reflux and PPIs (the -zoles) need time to build up in your system.
posted by Threeve at 2:31 PM on July 13, 2022 [1 favorite]

Nthing coffeeand about getting another CT scan. Family member had similar symptoms to yours that went on for a few weeks while traveling. She thought pain was improving in between bouts. A CT scan, not an ultrasound, identified it as burst appendix wrapped around her colon when the pain resumed, again during travel. A bigger pain was getting this all taken care of away from home--not fun. She had major abdominal surgery that required inconvenient recovery in a motel room. This is just one data point, but having a medical emergency away from home adds to the misery. She couldn't go back home for weeks and had to be driven there by car since it was inadvisable to fly. Sorry about your situation.
posted by Elsie at 5:09 PM on July 13, 2022 [2 favorites]

I think traveling right now would be a really bad idea. You're in the middle of your worst flare-up ever and you don't know which way this is gonna go. I don't want to alarm you, but for all you know you could end up with something bursting while you're on an airplane or miles from a hospital. You really don't want whatever this is to suddenly get dangerous while you're traveling.

It doesn't sound like anybody has talked about a colonoscopy, which is kind of surprising. With difficulty passing gas/peeing, loose stools, and a feeling like you have rocks in your stomach, it seems like your doctors really need to check your colon.
posted by Ursula Hitler at 6:03 PM on July 13, 2022 [3 favorites]

Popping back in to ask OP: Did a gastroenterologist order the endoscopy, or your primary care (or other) doc? A gastroenterologist will be doing the endoscopy, I assume. If the endoscopy finds nothing, I'd want to be under a GIO doc's differential diagnostic eye for this, not a non-GI specialist who didn't do a residency in gastro.

Also nthing the person who said receiving emergency care & surgery far from home is a giant pain the ass. I broke my leg in a spectacular way far from home. Sure, I had access to a perfectly fine hospital and surgeons in Brooklyn, but I live in Baltimore. I had to spend a week in the hospital, away from friends/family who could help or bring me stuff from home I wanted, and then I had to get home with my post-operative shattered leg outstretched. It was really difficult. I don't recommend it.
posted by ImproviseOrDie at 5:14 AM on July 14, 2022

I'm not one to ask for a followup, but did you go? Were you okay on the plane? The answers here have me nervous for you.
posted by kimberussell at 10:51 AM on July 14, 2022

Response by poster: Good morning!

Update: Due to the last minute nature of this, and following my gut, I ended up flying to California. Went very smoothly; made sure to eat light and took meds. All worked out fine, no issues. The pain was almost completely gone. I'm continuing to take the meds as needed, and trying to take it easy. Still have the occasional "bursts" but they're very minor in scale of pain and timing so far, so hoping that means they'll slowly go away like they did last month.

I asked my mom if I had my gallbladder removed, and as it turns out, nope. I have emailed my doctor, because all three tests (CT, MRI, and ultrasound) showed my gallbladder as "not visualized", so there could possibly be something blocking it.

I'm going to see how the rest of the vacation goes, but I do have the address of the nearest Kaiser ER and Urgent Care center, and shared them with my parents (who I am staying with) in case. Just going to hope for the best, but I'm confident so far. *fingers crossed*

Did a gastroenterologist order the endoscopy, or your primary care (or other) doc?
My primary care doctor.

It doesn't sound like anybody has talked about a colonoscopy, which is kind of surprising. With difficulty passing gas/peeing, loose stools, and a feeling like you have rocks in your stomach, it seems like your doctors really need to check your colon.
Good idea, I'll ask.
posted by dubious_dude at 11:28 AM on July 14, 2022

Response by poster: Final update for those of you still following this thread:

Had no issues at all, but unfortunately on my last day in California, I had the same annoying stomach pain. I addressed them with both medicines referenced to in the OP, which mostly helped, and flew back home without any serious issues. I'm home again.

I do notice a pattern, though, that might be the culprit: drinking alcohol. Before both the pre-vacation episode and the almost-post-vacation episode, I had alcohol to drink. Perhaps that's it? Let's see what the doctor and endoscopy says.
posted by dubious_dude at 6:09 PM on July 26, 2022 [1 favorite]