As doctors sometimes we start to become somewhat cynical when a patient comes in with a complaint without any obvious cause. Recently I had a patient who presented with a straightforward case of a kidney stone that was treated appropriately with pain medication until the stone was given a chance to pass (which it didn't until a procedure was done to remove it). However after this, he continued to have ongoing pain in his back and abdomen which seemed initially for all the world like another kidney stone.
I reevaluated him and gave him ongoing pain medication to relieve his symptoms until this thing could be figured out. Imaging testing, however, failed to show he had a kidney stone. Pain seemed to worsen and worsen. His depression turned into more anxiety and the patient required increased anxiety medication. Before long he was using fairly large amounts of powerful and potentially dangerous medications.
He was referred to urology, general surgery, and gastroenterology all without any success in diagnosing his pain. After two or three months of thing dragging on, all of his physicians (even myself somewhat) began to think his anxiety was getting the best of them and increasing his level of pain. He needed a psychiatrist which in rural America just wasn't going to happen.
As we continued to work this pain up, the patient had an abdominal ultrasound performed which showed he might have a stone in his gall bladder too. Desperate for an answer, the surgeon took him to the operating room and found that not only did he have significant gall stones, but the gall bladder was infected and he also had appendicitis! He is certainly the only patient I have ever had to have had kidney stone, gallstones, and appendicitis all at the same time.
I saw him a few weeks after the surgery and he had a big smile on his face, not a pain in the world, nor a worry. Sometimes there really is something wrong when the patient says so.
The Country Doctor
I reevaluated him and gave him ongoing pain medication to relieve his symptoms until this thing could be figured out. Imaging testing, however, failed to show he had a kidney stone. Pain seemed to worsen and worsen. His depression turned into more anxiety and the patient required increased anxiety medication. Before long he was using fairly large amounts of powerful and potentially dangerous medications.
He was referred to urology, general surgery, and gastroenterology all without any success in diagnosing his pain. After two or three months of thing dragging on, all of his physicians (even myself somewhat) began to think his anxiety was getting the best of them and increasing his level of pain. He needed a psychiatrist which in rural America just wasn't going to happen.
As we continued to work this pain up, the patient had an abdominal ultrasound performed which showed he might have a stone in his gall bladder too. Desperate for an answer, the surgeon took him to the operating room and found that not only did he have significant gall stones, but the gall bladder was infected and he also had appendicitis! He is certainly the only patient I have ever had to have had kidney stone, gallstones, and appendicitis all at the same time.
I saw him a few weeks after the surgery and he had a big smile on his face, not a pain in the world, nor a worry. Sometimes there really is something wrong when the patient says so.
The Country Doctor