Abdominal Pain: History
Karl | February 24, 2011 19:21Over the past 14 months, I’ve sporadically been quite ill. During the latter stages of getting this investigated, it turns out the cause has likely been responsible for some pain and illness I’ve had for around 4 years, maybe longer.
I decided to write this, partly to document what happened to me, and partly in case any of it is helpful to someone else. It’s wholly from memory, and my perspective on what’s happened.
The first instance I can remember was around the end of 2006, and as that was a bit of a stressful time in my private life, I assumed it was stress related.
I would get a pain right across my chest, just around the level of the bottom of my ribs. Back in 2006 it was uncomfortable, and went within an hour or so, was generally early to mid evening, and so I assumed it was indigestion. I also assumed, as I said, that it was aided by stress, and so took some anti-acid tablets or gaviscon each day and that seemed to clear it up.
The whole episode lasted about 6 to 8 weeks I guess. Not every day, sometimes not every week, but here and there.
As quickly as it had arrived, it went again, and it wasn’t until around December 2009 that it returned. We’d got married, and moved house, and while both enjoyable experiences, the organisation of them is well known to be stressful.
This time, however, the pain came on, and didn’t let up. It started out like indigestion, but gradually concentrated up around the bottom of my ribs. By around 9pm, having tried anti-acid tablets, as well as some pain killers, with nothing touching it, and the pain now unbearable, my wife called the GP practice out of hours number. When they called back, she explained the situation, asked some questions, and then asked her to drive me to the local A&E.
On arrival at A&E, with the pain still there, I was examined by a Doctor. They gave me some codeine which numbed the pain, and some omeprazole, and told me to go and see my GP as soon as possible.
The following morning, with the pain gone, I arranged to see my GP. They examined me, and suggested I was producing too much acid and that this could be stress related. It was suggested that this may have given me an ulcer or the start of one. This seemed to go with my analysis of my situation. The GP put me on 20mg omeprazole for 6 weeks.
While I was on the omeprazole I had no symptoms whatsoever, but within 2 weeks of coming off them, the pain was back; mild and bearable on it’s first visit, but I wasn’t waiting for the full volume of pain I’d bad before, and returned to my GP.
Different GPs were available on different days, and so I saw I different GP by chance. They suggested that I should have been on omeprazole for at least 8 weeks, not 6, and so prescribed 8 weeks of 20mg omeprazole. I also got an appointment to see a nurse to have a blood sample taken to test for helicobacter pylori. The blood test showed negative, and within 2 weeks of finishing the omeprazole, I was back at the GP having had a mild return of pain.
I saw the original GP, who, this time, took a slightly different approach; suggesting I wasn’t as thin as I might be, and that this could be squishing my stomach and pushing acid up into my oesophagus, causing my pain. It was suggested that I could have an endoscopy, but that it’s an unpleasant experience and I seemed to be steered to continuing as we were. There was also a suggestion that the drop off from 20mg of omeprazole’s suppression of acid production was upsetting the stomach, and that a lower dose might be in order. To that end, I was prescribed 3 months of 10mg omeprazole, and I was to take them every other day for the last 2 weeks to try and taper off the end, minimising the impact of ‘normal’ acid production once off of the medication.
I did as instructed, and at the end of the medication, took it one day at a time. All seemed to be fine. I had one very mild dose, but it was a lot more like indigestion, and I’d over indulged a little that day, so I let it slide. All appeared to be going well, and I thought it was all behind me.
However, on Dec 22nd 2010, I had another mild dose of what I thought was indigestion, but it did make me start to think I should return to the GP and push for the endoscopy. I decided to do this between Christmas and New Year, or early in the new year, depending on when I could get an appointment.
My plans were sped up, somewhat, when on Christmas Day, having avoided anything that I though may provoke symptoms, and certainly not over indulged, the indigestion feeling started arriving early evening. By mid evening, it started to become clear that it wasn’t indigestion, and I took some anti-acid tablets. A short while later, I took some co-codamol pain killers as the pain was starting to get unbearable. Around half hour later when the pain wasn’t easing, if anything it was still building, I called the GP out of hours number. They called me back, and after asking me questions, asked me if someone could take me to the local A&E.
A kind neighbour that had not been drinking (it’s Christmas Day, remember), drove my wife and I to A&E and I was seen pretty much straight away. The doctor investigated, and said she would give me some omeprazole. With over a year’s experience, I knew that omeprazole wasn’t going to deal with the pain now it was there, and explained this. They seemed concerned that the co-codamol also hadn’t helped at all. They were concerned enough to admit me to the Surgical Emergency Unit at the John Radcliffe Hospital. The kind neighbour had hung around and took us to the hospital.
There was a short wait once there, but within about 45 mins of arriving I was seen by a triage doctor, who asked questions and examined me. By this point, the pain had been almost unbearable for about 4 hours, and started to subside. They’d taken blood and urine samples for testing, and decided more tests were needed. As it was now around 1am, they kept me in over night. They gave me 40mg omeprazole, inserted a line for a drip, just in case, and I slept for a few hours.
The following morning, Boxing Day, I was in radiology at 6.45am, having my chest and abdomen x-rayed.
A little later, I was told that the doctors were having another look at my x-rays, as they couldn’t decide what additional tests were required, and a short while after this, a selection of people arrived in my room, including the doctor that had examined me the night before. He gave a report, which to my non-medical ears simply contained a lot of the word ‘unremarkable’. Even to my untrained ear, this seemed to indicate they couldn’t find anything wrong, and I worried, briefly, that they would say it was stress, or similar, and send me on my way. After the report, one of the other doctors explained that he suspected I had biliary colic, and that as long as the omeprazole seemed to be dealing with the symptoms for the time being, I would be discharged but must come back to his clinic as an out patient for further tests.
I was overjoyed. Someone had said I had something wrong. My pain was being caused by something. I almost didn’t care what, at that point, just that someone had said something was wrong and needed further investigation.
I have private health care cover, and so I invoked this, to try and speed things along a bit.
In due course, I received an appointment for an endoscopy. I now knew that the person receiving the report on boxing day and suggesting I attend his clinic, was a consultant surgeon, and it was him that was conducting the endoscopy. I’d thought I would be fully sedated, but he explained that this would involve me remembering nothing of the procedure afterwards. He explained that if possible, it’s generally easier to have a local anaesthetic throat spray, and to be fully aware of what is going on. He added that I could be sedated at any time, if it got too much. At all times, what was happening was explained, if something would be a little uncomfortable, such as swallowing the camera, it was all explained well in advance.
The procedure only took around 15 minutes, and I was glad in the end that I’d gone without sedation. I could hear what the surgeon was saying to me, and also to the nurses. A biopsy sample was taken, along with a photograph of the valve leading from my stomach to my duodenum. It showed that I have reflux of bile from the duodenum back up into the stomach. Given I’m on 40mg omeprazole, this isn’t good.
I also received an appointment for ultrasound, and this showed up the main culprits: I have 2 gallstones, 14mm and 16mm, in my gallbladder.
I had a follow up consultation where the situation was discussed. The biopsy result showed mild gastritis. It was explained that the 2 gallstones I knew about, whilst causing the sporadic and unpredictable pain, and by now, an almost constant ache in my back, were actually only part of the problem. To go with them, there will undoubtedly be smaller stones, and there is a risk that these can escape the gallbladder, and get stuck in the common bile duct. If they do, they can block the pipe where it is shared with the pancreas. This can cause pancreatitis. This, in turn, comes in two flavours; mild, and acute. Acute pancreatitis is fatal. 30% of pancreatitis cases are acute. Of course, they could be quiet, and cause me no problems for the rest of my life. There were also a lot of ‘possible’ and ‘could’ in there, but the bottom line was the word ‘fatal’ appeared.
The suggested treatment is to remove the gall bladder via keyhole surgery. This, of course, has risks associated with it, but even before hearing them, I was thinking that as long as none of them had any mention of ‘fatal’ in them, I’d go ahead with the surgery.
As it turns out, the main risk is of injury to the common bile duct, either during surgery, or due to scarring afterwards. Papers suggest it happens in between 1 in 300 and 1 in 500 patients. The obvious question was what was his track record like? He’s done around a thousand, with no occurrences. This is a good track record as far as I was concerned, and surgery was still the answer for me. If it did occur, the symptoms would be unpleasant, and would likely require further surgery to fix, but it’s not a life threatening condition.
There’s also a lesser risk that the body won’t adapt to having bile dripping through from the liver to the intestines all the time, instead of via the gall bladder, however, it’s likely that my largeish stones and diseased gall bladder would be causing an overflow and similar symptoms anyway, and it’s thought I’d adapt. Even if I don’t, it can be fixed with some medication.
So, going with surgery involves:
- Likely removal of re-occurance of pain
- Slight risk of common bile duct injury, but can be fixed, and surgeon has good track record.
Going without surgery involves:
- Chance the pain can return at any time, with no warning. There’s no way to predict it, no foods that avoidance will guarantee freedom from the pain.
- Chance of pancreatitis, together with, however small and unlikely, chance of death.
One of the key things for me, was that if I didn’t have the surgery, I’d continue to get the pain. I’d presumably get used to it, and just go lie down and suffer through it, maybe with some pain killers. This means that one day, I could dismiss the pain as “just another attack” when it could be pancreatitis.
I didn’t need to make a choice right there and then, but even before discussion with my wife and family, it seemed that the sane, sensible choice, was to have the surgery. This was still the case after talking to them.
An appointment was quickly made for the end of the following week. It was at an NHS hospital, rather than the wholy private hospital I’d been to for all my tests, but I’m no private hospital snob, and couldn’t honestly see why I would pick one over the other. It was explained that whilst I shouldn’t need it, the NHS hospital had full A&E as well as intensive care. As I said, I wasn’t bothered either way, and had invoked the private cover to make things go quicker, which they certainly were.
3 days before surgery, I went to the hospital for a pre-operation assessment. This basically involved some blood samples, an examination, and a bunch of questions, all to make sure I was health and fit for surgery.
That night, I had an episode of pain. It was the first time I’d had the pain whilst actually on omeprazole, and frankly, when it escalated to the worst the pain had been, and quite simply unbearable, I called the GP out of hours number. I was frightened. They called back, asked questions, and the trip to A&E was on. The doctor saw me about 45 minutes after I arrived, and I explained the situation. He gave me anti-sickness and anti-spasmodic injections and left me to lie down in an adjoining room for around half an hour. When he returned, I noted that that pain was still as bad, but I didn’t seem quite so bothered by it. I returned home with some Tramadol that I was to take if needed for the pain.
The pain subsided enough for me to sleep, but it was still there to a lesser degree when I woke up on Wednesday morning. I took one of the tramadol tablets and was left with a crampy stitch kind of feeling that lingered most of the day. This was a first as well, and I was glad surgery was just around the corner.
I called the hospital I was due to have surgery at, as I didn’t know if what had happened was important. The surgeon’s secretary called me back a while later and asked if A&E had taken any blood samples. They hadn’t, but apparently a blood sample tested for amylase could have told them if I was developing pancreatitis. There seemed to be some consideration as to whether or not to bring my surgery forward, but in the end it wasn’t. I was instructed to call the hospital if the pain returned prior to surgery.
As it stands, I’m due for surgery tomorrow, Friday 25th Feb.
Tags: abdomen,Biliary Colic,Duodenum,Endoscopy,Gallbladder,Gallstones,pain,Stomach,Surgery,Ultrasound
Categories: Personal Life
No Comments »















Twitter
LinkedIn
Facebook
Youtube
Flickr
LinkedIn