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Pain in right side


Badrabbit
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8 minutes ago, Sheryl said:

Maybe also look at the position you usually sleep in, could it be straining the right side?

 

I say this because (1) You have already had pretty thorough work up including CT and ultrasound which showed nothing and (2) you describe it as an ache rather than sharp pain.

 

With right sided abdominal pain the important things to exclude are gall stones/inflammation of gall bladder, liver mass or inflammation, appendicitis, chronic pancreatits; and very rarely, pancreatic tumor. The tests you have already had, should have revealed these if present assuming the CT and ultrasound were of the whole abdomen.  If you want further assurance without much expense, could get these blood tests if not yet done or not done recently: ALT, AST, bilirubin, CBC, amylase, lipase, CA 19-9.

Thanks, I'm going to Hospital tomorrow as its bad this morning, pain killers not working now, feeling despondent about it all, I will suggest Kidney and Liver check.

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1 minute ago, Badrabbit said:

Thanks, I'm going to Hospital tomorrow as its bad this morning, pain killers not working now, feeling despondent about it all, I will suggest Kidney and Liver check.

I don't see any reason to look at the kidney. Liver, gall bladder, pancreas, appendix and just possibly colon would the the likely places to look. You might like to consult a GI specialist instead of the kidney specialist you have been seeing.

 

Have you had a colonoscopy in past 5 years or so?

 

 

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3 minutes ago, Sheryl said:

I don't see any reason to look at the kidney. Liver, gall bladder, pancreas, appendix and just possibly colon would the the likely places to look. You might like to consult a GI specialist instead of the kidney specialist you have been seeing.

 

Have you had a colonoscopy in past 5 years or so?

 

 

Never had this or any other exploratory procedure.

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2 minutes ago, Badrabbit said:

Never had this or any other exploratory procedure.

Maybe ask about it if everything else still comes up negative. (if you are 45 you should have one every 2 years anyhow for routine screening)

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3 minutes ago, Sheryl said:

Maybe ask about it if everything else still comes up negative. (if you are 45 you should have one every 2 years anyhow for routine screening)

Okay I'll see what happens tomorrow at Mission Hospital, I will stress to them that I have already had tests at a Private Hospital, maybe get them to get the treatment record from the Private Hospital so as to check what has been recorded.

I'm worried about huge cost using OPD my insurance only covers 2500 per visit, I can't afford to lose my savings on something that might be difficult to find, I might in the end be forced to go inpatient.

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3 minutes ago, Badrabbit said:

Okay I'll see what happens tomorrow at Mission Hospital, I will stress to them that I have already had tests at a Private Hospital, maybe get them to get the treatment record from the Private Hospital so as to check what has been recorded.

I'm worried about huge cost using OPD my insurance only covers 2500 per visit, I can't afford to lose my savings on something that might be difficult to find, I might in the end be forced to go inpatient.

Mission Hospital is also private, just not for profit.

 

They will not be able to get your records, you have to do that.  It is easily enough done, just go to the medical records dept with our passport, hospital number and dates ((or date range) for the records you want. In the case of the CT tell them you want it on CD, they may sen d you to the Imaging Dept for that.

 

Then bring it all with you.

 

Is this Mission Hospital in Bangkok or in Phuket? If in Bangkok I recommend you see Dr. Nick Walters (American GP) to coordinate the overall diagnostic process.

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2 minutes ago, Sheryl said:

Mission Hospital is also private, just not for profit.

 

They will not be able to get your records, you have to do that.  It is easily enough done, just go to the medical records dept with our passport, hospital number and dates ((or date range) for the records you want. In the case of the CT tell them you want it on CD, they may sen d you to the Imaging Dept for that.

 

Then bring it all with you.

 

Is this Mission Hospital in Bangkok or in Phuket? If in Bangkok I recommend you see Dr. Nick Walters (American GP) to coordinate the overall diagnostic process.

Mission in Phuket, I'll go to Private Hospital and get the records today.

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At Mission, ask for GI specialist. Or if things get really bad during the evening/night, go to the ER.

 

As the pain has gotten worse, may need to revisit issue of appendicitis. Sometimes it is hard to diagnose initially, even with CT. This would mean a repeat Ultrasound (even though you had one before - things can change and if there is continuing inflammation of the appendix it might be visible now when not visible before). Also will need at least a new CBC (blood count to see if white blood cells are elevated).

 

Although the pain is on the right side and thus not typical of gastritis, they might nonethless do a trial injection of a PPi (medication to suppress gastric acid) to see if that relieves the pain. Not expensive and if it does work, suggests an entirely different course of action/treatment.

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46 minutes ago, Sheryl said:

At Mission, ask for GI specialist. Or if things get really bad during the evening/night, go to the ER.

 

As the pain has gotten worse, may need to revisit issue of appendicitis. Sometimes it is hard to diagnose initially, even with CT. This would mean a repeat Ultrasound (even though you had one before - things can change and if there is continuing inflammation of the appendix it might be visible now when not visible before). Also will need at least a new CBC (blood count to see if white blood cells are elevated).

 

Although the pain is on the right side and thus not typical of gastritis, they might nonethless do a trial injection of a PPi (medication to suppress gastric acid) to see if that relieves the pain. Not expensive and if it does work, suggests an entirely different course of action/treatment.

I have had bad problems with Acid Reflux in the past not sure if that is important, 4 visits to Emergency plus seeing a specialist who suffered himself with Reflux they did not diagnose it, a friend told me to take tablets that his daughter used after suffering many years with Reflux, my next bad attack was cured by these tablets, not suffered since.

Records have been requested from private Hospital.

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15 hours ago, Sheryl said:

If they said Gallbladder clear they will have visualized the liver.

 

I am wondering if it could be a muscle ache. 2 hrs a day walking is a lot. Have you tried resting a few days to see if it makes a diffetence?

Sounds like a muscle strain of some sort. 

 

 

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29 minutes ago, mommysboy said:

Sounds like a muscle strain of some sort. 

 

 

This was my original thought but not consistent with the severity he reports today.

 

Ruling out appendicitis is first priority, even though prior scans did nto show it picture may have changed. Failing that a trial of PPI will indicate if it is gastritis (not the usual location for such pain but can happen). If not then may need to again evaluate for possible gall bladder, liver, pancreatic disease and if none of these maybe colonoscopy.

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45 minutes ago, Badrabbit said:

I have had bad problems with Acid Reflux in the past not sure if that is important, 4 visits to Emergency plus seeing a specialist who suffered himself with Reflux they did not diagnose it, a friend told me to take tablets that his daughter used after suffering many years with Reflux, my next bad attack was cured by these tablets, not suffered since.

Records have been requested from private Hospital.

Not really relevant as reflux is regurgitation of stomach contents into the esophagus/pharynx.  Whereas gastritis is inflammation of the lining of the stomach and/or duodenum.

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5 minutes ago, TropicalGuy said:

May we know this “Specialist” Doctor Name to avoid ?

 

I have no idea what you refer to, nowhere in this thread is there negative review of any specialist.

 

in any event, Thai defamation laws would prohibit posting such information.

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9 minutes ago, Sheryl said:

Not really relevant as reflux is regurgitation of stomach contents into the esophagus/pharynx.  Whereas gastritis is inflammation of the lining of the stomach and/or duodenum.

Okay, when I go to Mission I will request Appendix check, records from Private hospital does not include Ultra sound even though I did have one so will request that also.

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1 hour ago, Sheryl said:

This was my original thought but not consistent with the severity he reports today.

 

Ruling out appendicitis is first priority, even though prior scans did nto show it picture may have changed. Failing that a trial of PPI will indicate if it is gastritis (not the usual location for such pain but can happen). If not then may need to again evaluate for possible gall bladder, liver, pancreatic disease and if none of these maybe colonoscopy.

Can gastritis be an emergency situation, pain that bad? i know when i had it, it was nowhere near that, maybe ulcers would be more painful

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8 minutes ago, scubascuba3 said:

Can gastritis be an emergency situation, pain that bad? i know when i had it, it was nowhere near that, maybe ulcers would be more painful

It can be extremely painful, in fact can mimic a heart attack. But it can also be more mild.

 

It is not usually localized to the upper right quadrant such as he indicates, but that is possible.

 

Pretty easy to rule out with a trial of PPI which can be given as injection. If this is the sort of pain, injection will bring noticeable relief.

 

 

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17 minutes ago, Sheryl said:

It can be extremely painful, in fact can mimic a heart attack. But it can also be more mild.

 

It is not usually localized to the upper right quadrant such as he indicates, but that is possible.

 

Pretty easy to rule out with a trial of PPI which can be given as injection. If this is the sort of pain, injection will bring noticeable relief.

 

 

Sheryl I need to plan for tests, I can't just say "do whatever you need to do money is no object"

What tests should I get in order of priority, when I go next week 5k will be all I want to spend I can do the same each month if that is needed, my OPD insurance is 2500 per visit 30 days in one year which I would rather not use.

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By way of suggestion only because nobody else has mentioned it, I wonder if it may be a case of appendicitis.

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14 minutes ago, Badrabbit said:

Sheryl I need to plan for tests, I can't just say "do whatever you need to do money is no object"

What tests should I get in order of priority, when I go next week 5k will be all I want to spend I can do the same each month if that is needed, my OPD insurance is 2500 per visit 30 days in one year which I would rather not use.

CBC (complete blood count) and repeat ultrasound would I think be priority to rule out appendicitis. IF the doctor thinks there is a high index of suspicion for appendicitis or gallstones/liver issue and Ultrasound was inconclusive then he might recommend repeat CT. If so I would seriously consider it, especially if you have good impression of the doctor's skill. Putting a cost limit in my be more expensive in the long run. But this only if doctor tells you he believes it is important.

 

Other labs that might be useful are as I listed previously: ALT, AST, bilirubin, amylase, lipase, CA 19-9 - unless these were done quite recently (as in, not more than 30 days ago).

 

And ask about a trial o PPI injection, costs very little. Works only if you are having noticeable pain at the moment they inject, as you need to see if there is a dramatic improvement after injection.

 

I think the blood work plus ultrasound and PPI shot would probably not exceed 5k. CT would of course be much more but, given that you had one already with no findings,  consider it  only if the doctor strongly suspects something that the US does not sufficiently rule in or out.

 

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On 12/4/2021 at 10:58 AM, BritManToo said:

I've always thought MRI as a pointless exercise, but extremely profitable for the hospital.

good looking out - they should be mandatory then - - we don't want these private hospitals going out of business - what would we do then? 

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40 minutes ago, Sheryl said:

CBC (complete blood count) and repeat ultrasound would I think be priority to rule out appendicitis. IF the doctor thinks there is a high index of suspicion for appendicitis or gallstones/liver issue and Ultrasound was inconclusive then he might recommend repeat CT. If so I would seriously consider it, especially if you have good impression of the doctor's skill. Putting a cost limit in my be more expensive in the long run. But this only if doctor tells you he believes it is important.

 

Other labs that might be useful are as I listed previously: ALT, AST, bilirubin, amylase, lipase, CA 19-9 - unless these were done quite recently (as in, not more than 30 days ago).

 

And ask about a trial o PPI injection, costs very little. Works only if you are having noticeable pain at the moment they inject, as you need to see if there is a dramatic improvement after injection.

 

I think the blood work plus ultrasound and PPI shot would probably not exceed 5k. CT would of course be much more but, given that you had one already with no findings,  consider it  only if the doctor strongly suspects something that the US does not sufficiently rule in or out.

 

I don't have any of the symptoms accociated with the Appendix, I know test costs could spiral out of control I'm very worried about that, all I can say for certain is that I have this pain for such a long time, twice it became unbearable needing a rush to the ER, the 1st time it  cost 27,000bht for pain relief injection, Blood test, Urine test, X Ray, Ultra sound, CT scan with contrast only to be told " can not find anything" the 2nd time only cost 1300 for Pain relief injection plus pain killers, I told the Doc about the tests I already had so no point in repeating them, as long as something life threatening can be ruled out I could live with the discomfort.

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Appendicitis can certainly be life threatening and can present with a wide range of symptoms. Including yours. 

 

Lab results and ultrasound results are not static. As I explained before,  with time the picture on ultrasound can get clearer.

 

As per my last pist unless repeat CT is necessary costs of new work up unlikely to exceed 5k.

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2 minutes ago, Sheryl said:

Appendicitis can certainly be life threatening and can present with a wide range of symptoms. Including yours. 

 

Lab results and ultrasound results are not static. As I explained before,  with time the picture on ultrasound can get clearer.

 

As per my last pist unless repeat CT is necessary costs of new work up unlikely to exceed 5k.

Okay thanks.

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12 hours ago, Badrabbit said:

I don't have any of the symptoms accociated with the Appendix, I know test costs could spiral out of control I'm very worried about that, all I can say for certain is that I have this pain for such a long time, twice it became unbearable needing a rush to the ER, the 1st time it  cost 27,000bht for pain relief injection, Blood test, Urine test, X Ray, Ultra sound, CT scan with contrast only to be told " can not find anything" the 2nd time only cost 1300 for Pain relief injection plus pain killers, I told the Doc about the tests I already had so no point in repeating them, as long as something life threatening can be ruled out I could live with the discomfort.

Here in Australia I had similar experience with mid right hand side pain. The pain instantly commenced when I got out of bed and was so severe I called emergency services. The hospital gave me morphine and anti inflammation injection, the pain subsided. Doctor couldn't diagnose cause and provided some opiate pain killers.  Doctor informed me possible to have recurrence, which so far hasn't happened in four months elapsed.

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