March 6, 2007
Aches and Pains
Question from Melvindale, Michigan, USA:
I’m sure you won’t be able to give me a definitive answer, but maybe help point me in the right direction. I have had type 1 diabetes for 27 years with no complications. I had Rou-en-y surgery in October 2003 so my stomach is no longer “normal,” nor is it in the same place really. I’ve also had my gall bladder (because it was very low functioning) removed as well as my appendix.
For a few months now, I’ve had severe pain in the upper right quadrant of my abdomen. It’s actually right underneath my last rib. When it first started, I was diagnosed with kidney stones, then there were ulcers (you really shouldn’t use NSAIDS post bariatric surgery!). However, the ulcers have healed with the use of Protonix and no more NSAIDS and, at last check, no stones either. I had an endoscopy done Tuesday which showed no ulcers, or anything else for that matter. The doctor took biopsies (including one for H. pylori) all of which came back negative. Over the last few days, if I try to eat a meal (instead of a protein bar, or something similar in size) the pain becomes unbearable, and it’s even caused me to vomit, which I don’t normally do since the weight loss surgery. It was so bad last night, I ended up in the Emergency Room where a doctor suggested it could possibly be a stone or “sludge” in the bile duct, or scar tissue forming around the staple line, or swelling of my liver though he highly doubted that as all my blood work came back normal and my liver enzymes were even a bit on the low side. I’m wondering if maybe we’re not looking in the right place for this answer. While I know what gastroparesis is, I’m not sure of its signs or symptoms, or if maybe there’s something else I’m not aware of that could be causing the terrible pain related to being diabetic. Last night, the doctor prescribed Bentyl and Vicodin e.s. and apologized for not having a better answer.
The surgeon who removed my appendix and suggested the scope also mentioned doing a full pelvic ultrasound if the scope didn’t show anything, but I’m a little confused as to why because the pain is so high in the abdomen. I do know people, especially diabetics, can sometimes have “misplaced” pain, but I think that may be stretching it just a bit. I don’t know; I just know I need to figure this out and soon as I’m really tired of my only choices being feeling “stoned” on the Vicodin or close to tears from the pain.
Answer:
It is difficult to figure out where the symptoms are coming from. As you mentioned, so many things have been moved around. The doctor may need to do a full scan from the chest to the pelvis, rather than just the pelvis alone. The CT scan may look for backed up fluid, dilated bile ducts, swelling around the incision sites, or other abnormalities. Localizing symptoms is probably difficult for both you and your surgeon. Make sure your blood sugars are under good control as this helps with healing. Sometimes these post-op problems work themselves out on their own. However, the longer it goes, the more you need to take medication for the problem, the more you need further investigation to figure out the problem. Other options might include re-exploration to look at the operative site, but you wouldn’t want to do this unless you couldn’t figure out the problem any other way.
JTL
