Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
156 Doctors are Online
Ask a Urologist   »  

Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine?

User rating for this question
Excellent
Answered by

Internal Medicine Specialist
Practicing since : 2005
Answered : 507 Questions
Question
Hi I was having pain in my lower right and below my ribs on the right side as well. The pain got so bad one day I went to my doctor, that day I had no pain sometimes it would come and go. I layed down on the doctor's table and he felt where my liver is and said my liver was ok, he did not take any blood tests or urine test to my surprise. Advised me next time it happens I should go to an emergency ward, I did as for ultra sound, he said the hospital can do that there. When pain returned I went to emergency ward at hospital and they found pus in my urine, gave me medicine to cure my pain. They gave me MacroBID 100 mg for 7 days. The pain went away, but two days after I finished the medicine the pain returned. My own doctor said to see him 48 hours after finishing the MacroBID for further blood test and urine. During that day my back on the right side very sore, felt like I was kicked by a horse. My doctor examined the new test and gave me another medicine it was Novo-Norfloxacin 400 mg. This medicine took away my pain but pain returned two days after but after another two days pain was gone. I seem to be alright no pain now. My own doctor told me I a e loci in my urine. Why did the first medicine MacroBID 100 mg not work. Please can you explain and respond, thank you.
Posted Fri, 23 Aug 2013 in Urinary and Bladder Problems
 
 
Answered by Dr. Omer 1 hour later
Hello,

I am Dr.Omer and I am here to help you with your query.

I am sorry to hear about your problem.

As you have said that you are 66 year old female , presented with right abdominal pain ( right hypochondrium ) , diagnosed as kidney , with pus on urine test , treated with nitrofurantoin 100 mg for 7 days , and now with norfloxacin 400 mg.

Urinary tract infection are very common in females , due to short urethra , proximity with vaginal orifice.

Urinary tract infection are more common in post menopausal period , due to less immunity of the individual.

Mostly the organism which is known to cause these problems in females are
E. coli, S. aureus, Enterococcus, Klebsiella, and Enterobacter , all these bugs are easily treated with nitrofurantoin with 10 14 days course.

Norfloxacin also covers these bugs , but famous to treat gonorrhoea infection.

In females the urinary tract infection is sometimes multi drug resistant , and may require more than 1 antibiotic.

The best plan of action after seeing pus in urine would be the culturing of the particular organism and then seeing that which antibiotic is most sensitive to that organism , and then we would have given you that antibiotic.

The reason you were not successfully treated with nitrofurantoin would be.

1. Short duration of antibiotic , that is 7 days , usually we give it for 10-14 days , if the patient is responding , and you responded well.

2. The organism by which you are infected is not completely covered by that antibiotic.

The kidneys are located near your back , so when you have infection of kidneys your back hurts a lot.

I would recommend to continue the nirfloxacin for 10-14 days , if you get fine , that would be great , if not get a URINE CULTURE SENSITIVITY test.

Hope this helps and clears your doubt.

Feel free to ask any further questions.

Take care.
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 2 hours later
I thank you for replying to my health question, if my own doctor would have taken a urine and blood test at the beginning, the length of my infection would not have been as long as it was, I thank you again.
 
 
Answered by Dr. Omer 8 hours later
Hello again

YES you are right that if your first ( own ) doctor would have taken the urine and blood test your infection would not have been that long

Doctors are also human , and mistakes/error can occur

Nothing to worry about , as any other doctor like me , or that ER doctor would have done the urine and blood test

Never the less , continue on norfloxacin , and your urine infection with right hypochondrium pain will go away

Just follow what i said

Hope this helps

wishing you health with speedy recovery and happiness

Take care


Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 42 hours later
I am still getting pains lower right side, I am tired of these pains, I am going to contact my doctor tomorrow. I have taken two round of medicine for the infection, and find this disappointing of the return of this pain. When I get the return pain I take a Tylenol 3. We were took our dog for obedience listens and the duration of the lessons was about 3 hours, was standing but mostly sitting, with the steady pain in my side. When I got home I took the Tylenol 3, it took about an hour and a half for the pain to stop, can you give me anymore advise for my problem, thank you.
Hi, forgot to let you know that I took the second medicine for 10 days and the pain has returned.
 
 
Answered by Dr. Omer 17 hours later
Hello again

As you have said that you still have that nagging pain in your lumbar area( right lower abdomen ) , already taken 2 rounds of different antibiotics , but no relief.

As I have told you earlier that if your nagging pain stays , then you definately need to do following 2 tests.

1. Ultrasound kidneys and ureter to check for any concretion/ abnormal anatomy or small stone .

2. We dont know which organism is causing your E.Coli , we gave the antibiotic , but not much improvement

Kindly re-visit your doctor and discuss this with him , and also about the tests

For now you can take tylenol , with a gap of more than 6 hours and water intake of 4 liters/day , till you visit your doctor

I last thing i want to tell you about MDR( multi drug resistant) organism infection which is common in females , so females need more urine culture sensitivity test

I hope this explains your query

Feel free to ask any further questions

Take care

Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 6 hours later
Thank you for replying to my questions, I went to see my doctor today and he order Urine Senitivity Test, I forgot to add the word Culture but I am sure it is one in the same test. The ER doctor gave me an Unltrasound test, and there was no change from the one I had 8 or 9 years ago. I did have endrometreous, can't spell, in 1976 had left ovary removed had cyst on it, still have womb and right ovary. The ER doctor only did ultrasound because I had endrometreous many years ago. The ultrasound was only from the hips down, I asked are you going to cruise the kidneys, she said the doctor did not request that. Whenever I had the other ultrasounds, the technicians would always say now we will cruise the kidneys, I am sure it would have not cost my Manitoba Medical that much more. The longer this pain goes on, I am certainly getting concerned.
 
 
Answered by Dr. Omer 14 hours later
Hello again

I am really happy that your doctors are now finally on that path , that i told you in my previous messages.

Urine culture sensitivity test , will show us , what kind of organism you are having.

Ultrasounds are of three types when ordered by a specialist

1. U/s abdomen

2.U/s KUB for kidneys

3.U/s for uterus + ovaries


What you are describing is that he did ultrasound from hips down , these includes kidneys+ureter area , so i think he must have seen the kidneys and ureter , but didnt mention it in your report.

Its a good thing that your doctor wants to check the uterus + ovaries to, infection can be present there?.

Just follow your doctor , as he is on the right pathway , as your right ovary is there too, left oophorectomy + endometrosis, has no relation with your right sided pain

Discuss with your doctor next time , that if you have seen my right ovary+ uterus, what if my kidneys could be scanned with ultrasound

I hope this helps

Take care



Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 4 hours later
You did mention with my ultrasound exam that my kidneys must have been scanned, but my doctor did not mention the results of the kidneys than you say my kidneys should be scanned. I requested on my own from the time I saw my doctor for more blood tests, that I am requesting for a kidney scan. I am presently waiting for an appointment for that scan. You did mention that they must have been scanned with the first scan, but did not advise me of seeing the kidneys, please explain, please respond thank you
 
 
Answered by Dr. Omer 37 minutes later
Hello again,

First of all , nothing to worry about , please try to understand.

I assumed that this time they(ER doctor+radiologist) MAY have checked your kidneys by Ultrasound, though now i know that they didn't scanned for kidneys.

You are saying that the ER doctor did advised the ultrasound , because you were having a history of endometriosis , so he just checked only for endometriosis and did not check for kidneys.

You did an excellent job by asking for ultrasound kidneys and they gave you an appointment , you should also have told them about the pus in urine test?.

You have completed the course of norfloxacin for 10 days , i hope you are not taking any other medications NOW?

In the end i assure you that you just have a pain due to UTi ( urinary tract infection/kidney pain).

And in my experience a female of 66 years old will have normal ultrasound kidneys on your fore-coming appointment.

More important test will be awaiting urine culture sensitivity test , i hope they find the culprit in your urine.

I hope this helps.

Take care .
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 1 hour later
Thank you again for your help, when I was sick with pain the last thing I was thinking of is to tell the ultra person that I had pus in my urine, she still would have said the doctor did not request ultrasound of the kidneys. I think this doctor did not do a through medical review and exam. I really think I did fall through the cracks. If there was pus the doctor should have ordered an ultrasound of my kidneys no matter what. ERs are just a marry-go-round, I waited for 6 hours and did not have a through exam and tests. Do I have to collapse in pain at home to be taken seriously!!!
 
 
Answered by Dr. Omer 20 hours later
Hello again

I like the sense of humor you have, and this is the most important part of your treatment, diseases come and go, just stay positive as you are always.

I think you should have told it to your radiologist doing ultrasound, that you just had a test of urine and it showed puss , then he for sure examined your kidneys.

Anyhow you an discuss this with your recent (new) doctor. If you cannot then your fore-coming ultrasound kidneys will solve this problem.

What medicines are you taking currently, after complete course of norfloxacin??

Every-one is taking you seriously, its just they want to rule out other causes of right hypochondrium/lumbar pain.

Just wait for your for-coming test , if you have severe pain , go again to ER and discuss a simple question : I have puss in urine , and I have a poor response from 2 antibiotics , do I need an ultrasound kidneys?

Trust me, this time they will listen you.

Hope this helps.

Take care
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 4 days later
The reason I am still addressing this issue is that I am still having pain. Saturday 13, and Sunday 14, had pain in my lower right side. In front below my ribs and at my back right side. I received a letter that I am scheduled for an abdomen ultrasound test for this coming Sunday. My question is why am I getting these pains over and over, when they start it is for 4 – 6 hours and when I lay down the pain goes away a bit. The pain starts when I am sitting. I was laying on my left side last evening and my side was sore by my ribs on the right side and I could hear a girgling sound like air or bubbles in my intestines, did not last long. Then this Sunday had the repeated pain lower right side, front by my ribs and sore right back. I am puzzled and tired of the repeating pain. I have thought about a hernia, for the soreness on my right side. All my doctor asked is to I feel a lump, I did have an operation for endemetriosis, and have scar tissue, he did not even examine me at all, I guess I am patient and examiner. This is totally upsetting, the pain seems to come again when I am sitting as I said earlier, please help, thank you. In the medical field there must be someone else who has had similar problems that they can compare it to, I know testing must be done.
 
 
Answered by Dr. Omer 13 hours later
Hello again

As I have come to know that you still havving pain on your right side ( starting from right side of the ribs and downwards , extending to back

There are four 5 organs on our right side of abdomen ( liver , gall- bladder , kidneys , intestine , right ovary).

There is no liver enlargement , as your doctor examined that so budd chiari syndrome is out. But chronic cholecystitis ( with stones ) is a possibility.

You are a known patient of endometriosis , but endometriosis is rarest in post menopausal females as ovaries are knock out .

Incisional hernia , could be reason , can you sent the picture of your abdomen( whole of it covering the scar mark) , cause it can cause all your symptoms in almost all positions have less pain when lying striaght.( when the pressure on scar XXXXXXX is the lightest , what is your weight ?)

Hernia pain increases with posture causing a stretch on the scar XXXXXXX ( especially when you are sitting.

Fibrous band do form after any operation of abdomen/pelvis like after 5-30 years , and then these bands can cause volvolus of the intestine ( rotating around the band).

Girgling sound from tummy is normal when turned around on bed due to air in it.

May be you had an incidental finding of pus in urine , and you already have taken 2 rounds of antibiotic taken still no relief , then post operative complication of adhesion bands , fistulas , volvolus will require you to undergo CECT abdomen with video laproscopy and obviously basic steps like through medical examination and ultrasound of- course , with special mentioning of all these possible causes.

I have told all the possible causes besides UTI in your case.Do you have any bowel complaints , like constipation , losse stool ?.

Hope this helps

Dont stop replying , continue till your problem solves.

Take care
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 8 hours later
Hi everytime I start typing I lose the typing screen. My weight is 152, and have no constipation or loose stools, I am regular. I am still having a sore back on the right side. My side is still sore not as bad as Saturday and Sunday, I took 2 Tylenol, did not have to take Tylenol 3, pain went away. This evening had to go out to the store and sat in my car and could feel a slight pain on my right side. I did have the operaton for endometriosis in 1976, my third son was born in 1978. Than I had my right ovary tube tied a few years later, the doctor could have done a laproscopy, but did not because there would have been scare tissue. As I am sitting typing to you I feel sore on my right side, it feels uncomfortable. My doctor took more urine tests last week and I phoned for results, the two test including Urine Culture Sensitivity Test both tests showed no abnormal growth of bacteria. My ultrasound test is on this coming Sunday. This pain is lasting too long. I thank you for your patience and understanding.
 
 
Answered by Dr. Omer 12 hours later
Hello again

So your urine sensitivity test came normal with no organism growth , that is a good sign.Urine culture sensitivity test can come normal in many patients with renal colics.

Your ultrasound is comming on saturday , so that will solve the problem.

In my last reply i told you about the differential diagnosis of your symptoms, and I think UTI with renal colic is my first diagnosis.

The things you are telling that you have a nagging , uncomfortable pain on right side with sore back , all this leads to right renal colic.

Ultrasound of abdomen will also show us the stones in ureter causing back pressure and hence hydroureter + hydronephrosis.And my gut feeling is that you may have this.

Incisional hernia is ruled out as you have said that There is no scar XXXXXXX , besides your weight is normal.

Just wait for the ultrasound and that will tell us the cause of your right sided abdominal pain , and keep on taking tylenol , not more then 4 tablets / day.And if that comes normal A CT scan of kidneys + abdomen will be helpful.

There are no other causes of your symptoms except for kidneys problem.

Hope this helps

Take care
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 3 hours later
My ultrasound is for this Sunday, when I had my endometrosis operation the doctor cut into me so there is scare tissue and a second time when they tied my right ovary, you must have misread me. The ovary operation they did not do a did a laroscopy because of scare tissue being there from my endometrosis operation. Today no pain until I sit down. What is ULT renal colie, thank you for your help.
 
 
Answered by Dr. Omer 23 minutes later
Hello Again

Yes, I think I misread it , if you have that scar tissue due to endometriosis , and present on the right side of belly button line , then there is a probability of incisional hernia , as your symptoms aggravate on stretching or sitting.

I think you need to be evaluated for incisional hernia as well , and not in all cases there is a bulge of lump from incision place when you push out your tummy , usually we dig deep during endometriosis operation , and fibrous band can form inside the scar XXXXXXX deep , causing stretching of pain nerves ?.

I would like you to get a surgical review if the ultrasound comes normal too , UTI with renal colic means kidney spread.

Hope this clears up our doubts

Regards



Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 4 hours later
My doctor has ordered a Abdominal Ultrasound, you did say there are 3 ultrasounds, 1. abdomen 2. KUB for kidneys 3. uterus + ovaries. I am assuming that the abdomen ultrasound will include the kidneys, correct. My first payment of $15.00 expired a few days ago, and they recharged me another $15.00, even though I was to have until Aug 6, 2013 to ask questions on the same related illness. So by the time I have my ultrasound is done this file will be expired!!
 
 
Answered by Dr. Omer 17 hours later
Hello again

Yes , I have told you the types of ultrasounds , but if he has written abdomen , then some radiologists do the Ultrasound KUB ( kidney ureters and bladder) with abdominal ultrasound and some doesn't. So I would like that you can discuss your problem with any of the doctor and he will see your kidneys.

Well I don't think so this conversation will be closed till your ultrasound report , But you can get more help about using your current conversation duration from XXXXXXX customer help center.

I hope this helps.

Wishing you health , as always.

Take care

Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 3 hours later
Thank you once again, I did not have pain on my lower right side, back a little sore on back and under the ribs, did not take any pain medicine today.
 
 
Answered by Dr. Omer 20 hours later
Hello

Thats a good news that you didnt have to take pain killers todays.

Wait till your ultrasound and will clear our doubts about differential diagnosis I gave you.

Take care
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 2 hours later
Today I have no lower right side pain, just tender on my mid back right side. I am just wondering that my bladder infection was so bad, that is why I am having all this trouble. After my ultrasound test, when I see my doctor, I will give him a list of all of your suggestions. I will just say I was looking online for help information. I do hope there is an end to all my health issues, thank you again. I will let you know of the results of my ultrasound, thanks again.
Last afternoon and evening had a very bad back pain, I put heat on it, today to my surprise I seem to be pain free, do not know how long it will last, I can only hope and pray.
 
 
Answered by Dr. Omer 2 days later
Hello

Yes you are right that you should discuss all the differentials I gave; you can say you googled it , he won't mind.

Well I hope and pray for you too that you get pain free as soon as possible , do these home remedies , they seem to be very helpful in alleviating your pain.

And I am also praying that your radiologist finds the cause.

Wishing you health and happiness.

Take care
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 17 hours later
Went for my ultrasound today, explained where I am usually sore. Yesterday we went to a friends party, after a few hours of being there sittiing, I became sore below my ribs, and my lower right side. In total it lasted 4 to 5 hours, two hours at the party and the rest of the pain when I came home. I took a Tylenol 3, and went to lay down. I explained to the ultrasound person that maybe I could have a hernia. After the ultrasound she said a CT scan would be better to check for a hernia and to have something else checked for, can't remember what she said. I don't think she saw anything on the ultrasound, I did not ask if she saw anything. On Friday I had no pain at all was able to clean my house and wash my floors. Today I have no pain, with my husband and our dog, went to the dog park, beautiful day. Ultrasound person said it will probably take 2-3 days. When I had my other ultrasound test when I went to the ER, my own doctor had the results the following day.
 
 
Answered by Dr. Omer 4 days later
Hello again,

As you have said that you didnt ask him about the ultrasound test nor did she said anything after ultrasound , so I think your ultrasound would have come NORMAl.This is a good news , at the same time you are pain free nowadays.

Ultrasound reports delivery time is different in all hospitals , some give it the same day , while others take couple of days , in any way I THINK YOUR ULTRASOUND REPORT IS NORMAL.

So the next plan of action would be that you observe yourself , if the pain is mild comes and go , then we can wait for further investigations.May be the pain will go away.

If it comes again , with discomfort then further investigation could be CT scan abdomen without contrast with a consultation of Internist, as ultrasound is not capable to see deep.

As you have said that your report will come in 2-3 days , I was waiting for that and that led to delay in reply , my sincere apologies for this delay.

Hope that you will remain pain free , always.

Wishing you health.

Take care.
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 19 hours later
Went to my Dr. this morning, two days ago had pain in my back, laid on the floor and told my husband to push his elbow on my back where it is sore. Yesterday sore under my ribs, today sore on my lower right side. Results of my ultrasound:
US Abdomen Complete:
No calculi are identified in the galbadder. The bilary tree is not dilated. Echogenicity of the liver is consistent with fatty infiltration. The liver otherwise appears unremarkable. Spleen normal. Visualized portions of the pancreas unremarkable. Kidneys normal. My doctor as ordered a scope of my intestines, and gave me a hema-screen kit, I had one in 2010, please respond thank you. What does liver and kidneys appear unremarkable?
 
 
Answered by Dr. Omer 6 hours later
Hello again

Okay so we got the results of your ultrasound , seems to me PERFECTLY normal .Youur ultrasound rules out pancreatitis , cholecystitis (Gall bladder infection with stones) , kidney problems , normal spleen size.

The only thing important in your ultrasound is Fatty Liver.

Fatty liver means fat infiltration in your liver , though it can be normal or it can produce the symptoms of pain under the ribs raditaing to back and right area of abdomen.When fatty liver is there sometimes liver function test could be abnormal or can be totally normal.

When fatty infiltration is high a disease known as NASH( non-alcoholic steatotatic hepatitis) occurs. Biopsy is done to confirm the diagnosis . Do you drink ? , or checked for hepatitis B and C?.

But fatty liver or XXXXXXX is usually a diagnosis of exclusion , meaning when other causes of right side under the ribs have bbeen ruled out.

Your doctor has given you heam -screen kit(HS) to check for any hidden , small amount of blood in your stool that is not visible , but gets detected by HS kit.

Colorectal Carcinoma and diverticulitis is the most common cause for occult blood in stool , but you shouldnt worry as it will come negative for you as you have no other symptoms of colon or intestine.But do the test advised by your doctor.

Colorectal carcinoma and diverticulitis ( finger like projection of intestine) peak age is usually 60-70 years , but has bloody stool , bloating , colitis etc.Do you have a family history of Colorectal carcinoma.

Liver and kidneys unremarkable means that the are totally normal in size and shape.

Follow and let me know the result of HS kit.Then we will proceed further.

Hope this helps.

Take care


Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 2 hours later
Thank you for responding, took my husband to the hospital on Wednesday was very tired on Sunday and on Tuesday he opened the hood on his Highway Truck about 6 times, and since than has had a very sore side and back, just like myself. The hospital did a EkG and blood tests, and 6 x-rays. Everything came back normal. Today he went to his doctor was still very sore on right side of chest and very sore back. His doctor noticed a rash front and back and advised him he has Shingles. The only reason I am mentioning my husband is his pain is so similar to my. My bladder infection I really think I got it when I had my bunion operation and after surgery my oxygen levels were low so they kept me overnight. They wheeled me to the bathroom on a commode chair over the toilet, which had no space between me and the toilet. I am pretty sure that is how I got my bladder infection. My right side and right back could be Shingles as, but I have no rash, maybe I had a rash but not now. The systems between my husband and myself are very similar. I do have pain on my lower right side as well, it comes and goes. My back is quite sore steady pain. Thank you for your help and understanding.
To answer your question if I drink, I am not a drinker. We go to a restaurant and I have Ice Tea. A Social Wedding function I may have one or two drinks and I have a soft drink after, I do not like getting headaches. Most people now do not even drink, it is too expensive. At home I drink tea, some coffee, hot chocolate and milk which I prefer.
I have not informed my doctor that my husband has Shingles, not that it matters but it might be a connection. My doctor closes on Friday afternoons. He is ordering a intestine check with a scope by a doctor that specializes in that area.
 
 
Answered by Dr. Omer 21 hours later
Hello again

Your husband had shingles , with rash on back and extending forward and right side of the body.His doctor is righ.

Shingles is actually activation of the dormant herpes varicella zoster, your husband has the typical rash of this viruses.

Shingles is not contagious as shingles , so if you had shingles and your husband cannot have shingles instead will have primary zoster infection known as chicken pox, in your country especially age above 60 years, shingles is very common as well as the PHN.

So your husband just had shingles with rash and pain, not from you.

You have exactely diagnosed yourself right by saying you got the infection(UTI) from commode+hospitaliztion so this clears the source of your urine infection.

Bunion operation ( big toe extra bone) or any operation in which you have to be admitted shows immunocompromised period with stress , all this lead to activation of zoster as shingles.

In many patients the rash is pathogonomic but in others there is no rash at all only pain that is known as ( post herpatic neuralgia PHN ), the pain usually follows typical pattern , i am sending the link to the picture , kindly identify your region.Because if your pain follows that picture then we can have high surity , that you are suffering from PHN POST HERPATIC NEURALGIA.

I would stronglyyy recommend to discuss with your gastroenterologist who will do the colonoscopy or your T10 etc)

Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 7 hours later
Thank you for your help, the link would not open, but I typed in dermatomal distribution of shingles pictures. The pictures show the T8, T9, and T10 on the left side. My pain is in all of those areas but on my right side. Last night my pain felt a bit better, but today I have it back again, and it is a steady strong pain in all those areas on my right side and in front under my ribs. I can honestly say I am not well. I feel so ridden with pain. If not for my husband getting shingles, and having the same pain in the same areas, I would not have even thought about the possibility of maybe having shingles. My bunion surgery on my left foot went well, the Dr. also did remove some bone on my right foot over my arch, I did not like that bone because when I would sit and cross my leg that bone would just stick out. The Dr. is a different doctor than my family doctor, he had to redo the surgery on my right foot because it did not heal right, or he did not take enough of the bone off, there was a lot of fluid under the stitches and bone was still there. He put a needle to try and take the fluid out, but not would come, so he redid the surgery, and this time he removed the bone that should have been done the first time, and I was put under again. I just feel I have fallen between the tracks of medical help. My back is so sore I feel like someone hit me on my back with a board.
I am phoning my doctor's office and advising them, that I am coming in on my own without an appointment. I will let my doctor know my husband has shingles and to test my blood for the shingles virus. Even though I do not have the rash I have all the systems, I do hope that I can have this solved. The medicine my husband is taking is (Valacyclovir 500 mg), he is taking 2 tablets three times a day. His rash has gotten worse but the pain is gone. If he is too busy to see me I will be prepared and have a letter for him to read, when he takes his coffee break!!!. I am just wondering why, that if I do have shingles, why with all my blood work done, the shingles virus was missed, or was that the shingles virus test was missed. I do hope there will be an end to my suffering and that you can have a break from all my complaining, thank you again. During the night I went to the bathroom and checked my chest for any rash, none but I did have a mosquito bit or hive, in the morning it was gone, could have been an insect bit, we do have mosquitos in Manitoba. May I just ask, where are you located, what country are you in. It seems I have to go to the ends of the world for medical help, I am lost for words.
 
 
Answered by Dr. Omer 19 hours later
Hello again

As you live in canada , there is predominant shingles.Valacyclovir is taken for 2-3 days for acute shingles with rash and pain, it wont be helpful to you.

I have high probability that you had minor attack or rash or no rash , and now you are having PHN ( post herpatic neuralgia) .I wish, I could examine you and would have solved your mystery pain.

You are most welcome , I am from Pakistan , lahore , working in defence hospital.

You don't have to come so far , just follow what I am trying to tell you , you need to get this to your doctor with the HS kit test for blood in stool , when that will be negative + no family history of colorectal carcinoma he wont do the colonoscopy test.

There is no test to detect herpes zoster infection except in chicken pox which occurs in child hood, The maximum you can do is a Nerve conduction study(NCS) of T8 ,9,10 nerves , that can show the neuropathy but not the virus.

Plus you have all the risk factors for getting PHN , age and operations.

The treatment for PHN is pregabalin or gabapentene. These are very effective.

Get a CT scan abdomen , if that's normal then PHN is the diagnosis.

Hope this helps.

Waiting for your reply.


Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 18 hours later
A CT scan will give 500 times the amount of a normal x-ray that is what the ER doctor said when my husband was in the hospital when I explained my pain. He was not there to discuss my health issue only my husbands, he was very polite, he did not say he would not discuss my issue, but did not elaborate. Only that a CT scan there is 500 times of radiation more than a normal x-ray. I thought that shingles is a form of the herpes virus and a blood test could be done for that, please reply.

How is the Nerve conduction study(NCS) of T8 ,9,10 nerves done, that can show the neuropathy but not the virus. What exactly is post herpatic neuralgia), you gave me the website but it does not explain well, can you please explain, thank you. The T8, 9, 10 is where the shingles pain is in the area where the shingles pain is right.

I went to my doctor's office with a letter to give to my doctor to read, I phoned first that I was coming in. The receptionist said she will give it to the doctor to read, this is what the content of the letter read, written my myself:

I took my husband to the ER Thursday morning, as I mentioned to you on Friday, he had very sore right chest and pain on his right back, they took an EKG, blood tests and 6 x-rays. All tests came back normal. On Friday afternoon he went to his own Doctor, because of extreme pain, his doctor noticed a rash on his chest and back, which he did not have in the morning. His doctor advised him he had shingles and gave him a prescription for his pain (Valcacyclovir 500 mg blue pill) two tablets 3 times a day. My complaint of my pain seems all to similar. I would never have thought shingles might be my problem. I spoke to the doctor online, I am not trying to doctor myself, but I feel helpless. The online doctor advised me if I have shingles my husband did not get it from me. I explained about my bunion operation and he advised me I exactly diagnosed myself right by saying I got my bladder infection from commode & hospitalization. Bunion operation or any operation in which a person has to be admitted shows immunocompromised period with stress, all this lead to activation of zoster as shingles. I also had to be reoperated because my operation was not successful the first time, the bunion was on my left foot which heeled well, but the right foot had a bone over the arch that stuck out when I would cross my foot, and had thickened skin over the bone. The right foot did not heel, and an infection formed, the bone seemed to be still raised. It was a mess to see, so I was reoperated again. I had pain in my back and right chest all weekend long. On Saturday at bedtime the pain was quite back and to sleep I had to roll my pillow and go on my knees to try to sleep.

The online doctor said in many patients the rash is pathogonomic but in others there is no rash at all only pain that is known as (post herpatic neuralgia PHN, the pain usually follows typical pattern, he sent me a picture of areas where pain is concentrated. He is most certain that I am suffering from PHN POST HERPATHIC NEURALGIA. He also says if my HS kit test comes back negative that a colonoscopy is not necessary. I have two more specimens to take for the HS kit test.

He thinks there is a high probability that I had a minor attack of shingles with mild rash or no rash, and now I am having PHN (post herpatic neuralgia). This doctor is from Pakistan, Iahore, working in a defence hospital. He advised me there is no test to detect herpes zoster infection except in chicken pox which occurs in childhood. The maximum that can be done is a Nerve condition study (NCS) of T8, 9 and 10 nerves, that can show the neuropathy but not the virus. He also said I have the risk factor for getting PHN, age and the operations I had.

Treatment for PHN is pregabalin or gabapentene, these are very effective. He also said to get a CT scan (abdomen), if that is normal then PHN is the diagnosis. A CT scan gives 500 more times of radiation than having an x-ray, so to have a CT scan is not to have just for the sake of having it unless it is the last resort. The ER doctor at St Boniface when I was there with my husband advised me about the strength of radiation of the CT scan.

My doctor has not phoned me, I was pretty sure he would not be contacting me, he probably does not like to be cross checked, but this is my health, I will wait and see if he will contact me, I can wait it out, I have had this pain for a long......time.

 
 
Answered by Dr. Omer 29 minutes later
Hello again.

PHN defination is this:

Varicella-zoster virus (VZV) is the causative agent of varicella, or "chickenpox XXXXXXX and herpes zoster, or "shingles XXXXXXX Most cases of acute herpes zoster are self-limited, although the pain can cause significant suffering, particularly in the elderly. Symptoms may be severe enough to interfere with sleep, appetite, or sexual function. In addition, a variable percentage of patients may continue to experience pain for months to years after the resolution of the rash (postherpetic neuralgia or PHN). PHN can be quite difficult to treat.

PHN traditionally has been defined as the persistence of pain for more than one month after the disappearance of the rash. We prefer a more recent classification system:

Acute herpetic neuralgia refers to pain preceding or accompanying the eruption of rash that persists up to 30 days from its onset.

Subacute herpetic neuralgia refers to pain that persists beyond healing of the rash but which resolves within four months of onset.

PHN refers to pain persisting beyond four months from the initial onset of the rash.


In one study 334 patients 60 to 69 years of age who developed herpes zoster, PHN occurred in 6.9 percent. In contrast, among 308 patients age 70 years or older who developed herpes zoster, PHN occurred in 18.5 percent.

The major risk factors for PHN are older age, greater acute pain. In patients who develop PHN, advanced age is associated with increasing severity and persistence of symptoms.

PHN most often represents a continuum of pain that never resolved following an acute episode of herpes zoster. However, PHN rarely has been reported to occur in patients months to years after resolution of the initial event. These episodes occurred in the same distribution as the initial rash and were precipitated by a specific event (eg, a surgical procedure, tooth abscess)

Ct scan does cause radiation level to about 500 x-rays , but new ct scan machines in developed countries like canada exposes to less than 250 xray film radiations , in any case one CT scan is not that harmful , but if your Ultrasound is common and you still have pain around tummy area than Ct scan is the next step as you dont have any other symptoms.

T8 , 9 ,10 are same as left or right side.Thoracic (especially T4 to T8), cervical and trigeminal nerves are most commonly affected

I would request to be humble with him as like any doctor he wants you to be healthy asap.But doctors are very busy , even if he doesnt call you can XXXXXXX him in next appointment may be he will answer then.

I hope this helps.

Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 4 hours later
I respect my doctor, I am not a person that will charge at him, and demand answers. I am not a type A personality. Went to his office respectfully and his receptionist, advised that she will give the letter to my doctor. Doctors are busy, but when there is a person like myself with continuation of pain, I think I could have had a phone from him at the end of the day. Doctors do not phone they want a office visit so they can earn more. I am not trying to belittle my doctor by saying I have talked to a doctor online, I do not want to have a battle of doctors over my pain. I want no pain. My pain was not too bad this morning, but the pain started again, very intense, used a heating pad, still sore. My husband said he will take me to the ER, I said what help will that do, I am not ready to sit in an emergency department for 5-6 hours with this pain. Over and Out.
 
 
Answered by Dr. Omer 9 minutes later
Hello

Thankyou for understanding

Go to ER , you will XXXXXXX a new doctor , he will get your pain relieved by pain killera ( oral or injectable ) , Get a full sensory system examined at the place of your tummy that hurts.I think its a good idea to have a visit to ER.Rest is upto you.

And I also hope that you get a call from your doctor.

Take care
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 1 hour later
Sounds like a good plan to go to the ER, if my doctor calls when I at the ER, I will check my messages and if he calls advise his receptionist I am at the ER. My daughter-in-law is a nurse and has not heard of pain killera, she mentioned something else. She does know of an oral or injection for pain. Maybe you said pain killera as a more simple terminology for me. I will go tomorrow one more day of this pain is the norm. I will take the letter that I gave to my doctor, so I will not have to talk too much, because I am at a loss for words. My husband has to work tomorrow and I don't want to drag him with me to the hospital.
It is not my tummy that is given me the most pain, it is my back. I guess at this point, it doesn't matter tummy....back!!!
Not going to ER this morning, by back is not sore. It starts later in the day and is with me until I fall a sleep. I put a heating pad the one that has jelly in, very good. After use you need to boil it so it comes back to clear, after use the jell hardens. Once clear you put it away, when you want to use, you click a medal circle inside and it activites the heat, very good product the heat lasts a long time. You need to put a towel around the pad as it is very hot. My husband phoned his doctor yesterday for a cream for his rash, the doctor says he knows of no cream for shingles, now that is surprising. He wants him to come in so he can look at the rash again, now that is funny he just wants another office visit for payment. My husband has an earache no problem he will go in. The doctor did not know about the earache. Why does my pain get worse mid day and into the night. My husband saw his doctor for his earache the doctor gave him antiseizure medicine for his earache. For his rash I told him to buy Calamine lotion, the doctor said that is good. I have known about this lotion all my life and the doctor did not know a medicine or lotion for shingles, same lotion as for chicken pox.
My doctor's receptionist called my this morning and that my doctor wanted to talk with me. He looked for a rash, no rash, checked my breathing sounded fine. He ordered a chest x-ray. I do pull my dog on a leash, not of late, she is quite a puller. I have been getting in and out of my son's pick-up truck we borrowed because we were getting the transmission fixed in our vehicle, it is quite high to get in and out of. My bladder infection was the most intense pain and my right chest and back pain started with the walks with my dog. She is a mid-to big dog Rhodesian Ridgeback and part Whippet. The pain I had was so close to my husband's that I may have thought I had shingles as well. My doctor will have the receptionist of the results of my x-ray. My doctor is so calm, he make me feel comfortable, his receptionist is a real XXXXXXX I will let you know of the x-ray results, thank you.
 
 
Answered by Dr. Omer 2 days later
Hello,

Muscular spasm of back and in right lower zone of your back is totally possible due to the stretch of the dog pull , but that pain goes away maximally in a month.

Happy to know that you getting good advice from your doctor with an xray to see the chest.

I hope he had examined and saw the place where it hurts.

I think your xray will be completely normal , I pray that.

Take care
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 3 hours later
My x-ray came back as being normal, today though my back is sore, started mid afternoon. I phoned my doctor, spoke to the receptionist, asked if he could prescribe muscle relaxler. She spoke to him and he said over the counter Robotoxin should help. I will purchase it and booked an appointment with a physiotherapist. My doctor is going on holidays for two weeks, there is another doctor in charge. I took in my stool samples in today, advised my doctor was going on holidays and my doctor could have results as early as tomorrow. I am not going the bug the replacement, with Robotoxin and physio, my back just might surprise me and stop hurting. The pain is real and when my husband got shingles I thought my aches and pains were over. This is just like a soap opera saga!!! After supper I rested my back and the pain eased a little, did not put heat on it. When I put heat (I have a jell pack which is very good) on my pack the pain will stay away for a day or so, I guess I should put heat more often. I have never had this problem before. I have not been pulling on my dog leash, my husband does the leash holding. I am not looking for a serious problem, just want this pain to vanish for good. My lower right side seems alright now, no more pain. It seems maybe the bladder infection made my kidneys tender and inflamed, could that be. Thank you for listening to me.
 
 
Answered by Dr. Omer 2 days later
Hello again

Physiotherapy and muscle relaxant is also a good alternate , try it and i think your pain will go away since your pain relieves as you put heat on it.

I think putting heat vanishes the pain so kidney pain will be unlike right now , but muscle sprain is at high probability even highr than PHN.

Hope this helps.


Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 28 hours later
I was looking on line and it seems it is possible to get shingles without a rash. I sent an email earlier but it does not seem to be on file I am sending again. These are comments of other people with systoms like myself, list of comments, I am trying very hard to be an adult but it is difficult, list of other peoples' comments.

I just got back from the emergency dept suffering from pain and burning sensation on left side. The doc diagnosed "shingles" even tho there is no rash. He prescribe anti viral and I'm off work until futher notice. So yes shingles does happen without a rash.

hi yes i have all these symptoms but no rash.. my doctor told me if i got the rash it was shingles...4 days on and i still have no rash but the pain is terrible and i'm so tired..
he did give me prescription for the anti-viruals but i'm not sure if to take them or not as he said take them when the rash appears...
thank you everyone

I had Shingles without a Rash in 1992 and dosed up on L-Lysine. Got rid of it after 4 weeks.
I now have it again some 16 years later and still no rash. Am taking L-Lysine tablets and Cod Liver Oil tablets. Hopefully will go soon as the pain is horrible


I have had excrutiating pain on the left side of my face extending to the back midline of the skull on and off for about 4 years. Not one doctor could figure out what was causing it. I was starting to think I would just have to forget about doctors and put up with this pain. I saw a new doctor today and he said he believes it is shingles (even though I don't have a rash) affecting the cranial nerves. He's the first doctor that didn't look at me like I was crazy. He put me on antiviral and prednisone. Hopefully this will work and I won't feel like I'm losing my mind any more.

I am 56 yr. old female who has a reoccurance of rashless Shingles. I had them 5 yrs. ago and went to the ER in NYC and they diagosed me with Shingles. Now I recently felt the same pain on my left side under my rib cages that went around to my back, it spread to my left breast and left sholder blade. I went to an urgent care unit in XXXXXXX and they put me on Valtrex and increased my Lyrica to twice a day. This is day 3 and I still have the pain but no rash. Hopefully this will subside in the next few days so I can return to work. I was lucky that both doctors knew what this was and did not go through the test some of you have experienced.

Shingles with a rash is called Zoster sine herpete. Defined as pain and paresthesias along the dermatome ... Acyclovir with and without prednisone for the treatment of herpes zoster....see WWW.WWWW.WW

My husband has this five years ago and also developed PHN (postherpetic neuralgia, pain that persists for longer than 1 month following the shingles episode) He has been going to a pain clinic for five years and the Dr has tried everything he knows. I followed up on the internet and see he's been most thorough. Over the years he has tried about 30 nerve blocks, they don;t last long enough and really only one has hit the sweetspot where he was pain free for over a week. He felt so good he built me a rock sidewalk.

Has also tried Gabapentin (Neurontin), Pregabalin (Lyrica), Hydrocodone, Marinol, Lydocaine patches, Fentanyl patches, Tricyclic antidepressants (amitriptyline) and Capsaicin are a few I remember, the Fentanyl that came as a sucker was the most effective, just as we found this, my job changed insurance and Blue Cross would not cover it, as it was several hundred dollars we couldn't afford it. Better luck and best wishes to everyone who is hurting. It is had to see your family like that and there is nothing you can do

Shingles with a rash is called Zoster sine herpete. Defined as pain and paresthesias along the dermatome ... Acyclovir with and without prednisone for the treatment of herpes zoster....see WWW.WWWW.WW

My husband has this five years ago and also developed PHN (postherpetic neuralgia, pain that persists for longer than 1 month following the shingles episode) He has been going to a pain clinic for five years and the Dr has tried everything he knows. I followed up on the internet and see he's been most thorough. Over the years he has tried about 30 nerve blocks, they don;t last long enough and really only one has hit the sweetspot where he was pain free for over a week. He felt so good he built me a rock sidewalk.

Has also tried Gabapentin (Neurontin), Pregabalin (Lyrica), Hydrocodone, Marinol, Lydocaine patches, Fentanyl patches, Tricyclic antidepressants (amitriptyline) and Capsaicin are a few I remember, the Fentanyl that came as a sucker was the most effective, just as we found this, my job changed insurance and Blue Cross would not cover it, as it was several hundred dollars we couldn't afford it. Better luck and best wishes to everyone who is hurting. It is had to see your family like that and there is nothing you can do

My husband who is 61 has been in a lot of pain for 14 weeks in the area of his stomach around the naval. We have been to 3 different doctors, has had colonoscopy, CT scan, blood work, EKG, etc. Nothing found. He has also been to the ER three times. Why is it that doctors do not know anything about shingles with no rash? Actually, a psychiatrist mentioned the fact that it could be shingles with no rash and I began doing a lot of research and found that it is more common that one thinks. My husband has been using ice packs on his stomach. It helps some. He was given anti-inflammatory drugs, etc. - no help. It is very frustrating not to be diagnosed. Also, if this is a problem with older adults, should the "physician" community not advise the shingles shot if it would help? Apparently, we have to research ailments to get answers. Thanks for the posts. At least, we know that we are not alone.
Blank
 
 
Answered by Dr. Omer 36 minutes later
Hello

Atleast I insisted online as much as i can without seeing you , and i thought it could be shingles with no rash , our medical data also suggests the same , secondly shingles with and without rash is common in your country and north XXXXXXX

I already strongly suggested to use gabapentene, amitryityline for PHN , you cannot use prednisolone + acyclovir as it is late now. Get a doctor who can prescribe you this and knows shingles pain without rash

Best of luck.

Take care
Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 2 hours later
I will take your advise, my back is so sore it feels like a bruised rib! You have been very patient and kind, I thank you very much for all of your advise. My husband put cream on my back MYO-MED and RUB A535, two different creams if I had ten different creams I would put them all on. I heated a bean bag in the microwave, and have taken my second tylenol # 3, one in the morning and one at bedtime. My doctor is on holidays for two weeks. There is another doctor looking after his patients, I do not have the energy to keep complaining about myself let alone to another doctor. If this continues as I know it will, I will certainly go to the ER. I thank you again.
Is amitryityline an anti depressant, because I was given it once and I had rapid heart beat. I am currently taking Citalopram and Lorazepam, should have mentioned the medicine I am taking. My mother died sometime ago suddenly and I found her. My depression was not mental but physical, suffered for many years before my doctor who I have now prescribed Citalopram. I am only advising you because of the amitryityline. I am sure you have other people who need your help, I will forever be greatful for your time.
 
 
Answered by Dr. Omer 18 hours later
Hello again

As you have said that you are taking citalopram , a SSri for mood stabilization.

Amitryptaline is a nerve stabilizer + antidepressant , so helps in pain control.

Keep on doing the home remedies with OTC creams for the pain.

Wait for your old doctor , and if the pain increases ER visit will be required.

Low mood can also cause somatization , meaning converting mental stress to physical pain . So discussion on this required.

Amitryptaliine can cause fast heart rate , by anticholinergic effect , a side effect , there are so many other medicines which are nerve stabilizer + anti depressan like gabapentine , topiramte , opioid tablets and so on .

Citalopram is not famous for these actions except for antidepression.

Hope this helps.




Above answer was peer-reviewed by
 
Follow-up: Having pain in lower right and below ribs. Ultrasound of lever came normal. Took Norfloxacin, MacroBID. Correct medicine? 2 hours later
Thank you again, I will not be continuing with the paid sessions, I will be forever grateful for your understanding and knowledge, thank you and wishing you the very best!
 
 
Answered by Dr. Omer 7 hours later
Pleasure is mine.

You could use this service anytime you want to.

Thanks and take care!
Above answer was peer-reviewed by
 
Share on Facebook
Share on Twitter
Share on Google+

The user accepted the expert's answer

Ask a Urologist

© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor