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Dr. Andrew Rynne

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Have low BP and abdominal pain. Scan showed cyst. Feeling fatigue and weakness. Any cure?

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Dr. Prasad

General & Family Physician

Practicing since :2005

Answered : 2653 Questions

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Posted on Mon, 24 Dec 2012 in Abdominal Pain
Question: Question for a GP.Hi I am 34 years old woman. Already few weeks I have pain on right side of my abdomen. My GP did a gynecological ultrasound and it actually showed a cyst, but on the left side. The pain started as shooting pain occasionally, now it is more constant, worse when I walk and also started to hurt at my back around kidney area. I had a wisdom tooth extraction under general anesthetics 2 weeks ago but pain started before that. It got worse about a week after the surgery after I stopped antibiotics. I started to have extremely low blood pressure (74/48 pulse 45), chills, fatigue,nausea, problems with remembering staff, overall weakness and dizziness, not stopping headache. I tried to drink a lot that night (3L), had a coffee but nothing was helping to put it up. It is already week that I feel so unwell. My GP did a blood test but it was OK, no sign of major inflammation. My blood pressure is still a bit crazy, sometimes too high (144/88, pulse 100), but most of the time too low (85/50 pulse 50). My normal BP is about 110/60. Still in pain and not feeling well. My GP thinks I am exaggerating. I do not know what to do. I have more problems with migraines and thyroid (Hashimoto, but my hormone levels are OK now), but I already got used to those.I was thinking if it could not be appendicitis (I do not have gallbladder anymore) as the pain is on the right side, but my doctor said as my belly is soft to touch, it should not be that. Also I do not feel like eating at all. I have to force myself to eat. I am suppose to fly next week for 3 weeks to Europe. No idea how I will manage feeling so weak and unwell and what I will do in a plane if my blood pressure drops too low up in the air as I will not be able to even get into a comfortable position there. I am used to pain as a migraine sufferer, so pain is manageable for me, but that dizziness and overall weakness and constant chills are harder for me. I do not know what to do as I am not feeling well at all and my doctor seems to think I am fine. Thank you for your advice.
doctor
Answered by Dr. Prasad 16 hours later
Hi,
I went through the details submitted and I can see you been suffering recently. Though I cannot give you a complete diagnosis without the physical examination, let me list out few conditions which I feel needs attention.

1. Your blood pressure - We do occasionally see patients with a low blood pressure, however your readings of 74/48 is bothering me. Was this recorded at your doctor's office? If it is, then I think you need a full scale cardiac evaluation.

2. Abdominal pain - Radiating pain shooting up to the kidney areas are associated with renal colic. Renal stone and urinary tract infections are 2 conditions that need to be ruled out.
Has your urine been tested?
How about KUB X-ray or Intravenous Pyelogram (IVP)?

3. Under active thyroid (hypothyroidism) following 'Hashimoto' can lower body metabolism resulting in easy fatigability, chills, weakness, a low blood pressure, dizziness, depressive state and other systemic symptoms. I hope the thyroid hormones have been checked recently and are normal.

4. An underlying infection can be causing multiple systemic symptoms including chills, low appetite, headaches, dizziness, nausea, vomiting, weakness and sickness. However the chance of you suffering from an infection is unlikely provided your complete hemogram and other routine test are normal.

The bottom line is - as there is significant overlap among the different entities I presented above, I feel you need battery of test (apart from ultrasound examination) spanning across more than one specialty. I understand you are planning a trip, but it would be better if atleast few of the important organs such as the heart (repeat blood pressure, EKG / Echocardiogram), thyroid hormones (TSH / free T3 and T4), Urine (Urine routine and if needed IVP) and blood (complete hemogram/ESR) are looked upon. A qualified and competent internist (physician) can tailor the aforementioned test on you. Do plan to consult them.

Hope this information suffices. Let me know if you need further guidance.

Thank you and Good luck!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prasad 2 hours later
Thank you Dr XXXXXXX I have seen my GP again today. My thyroid hormones were tested recently and were OK. My blood work was OK. She did quickly urine test and it was OK.I visited cardiologist about 1.5 year ago as I was having tachycardia with slightly low blood pressure. He did some tests and said that he could not find anything wrong and prescribed me Betaloc (50mg) to control the heart rate and asked me to drink a lot of water which I do. I was on it with no issues until now. I have not taken it last few weeks due to very low blood pressure, but when I have days with very high pulse (100) or high BP I take half a pill. As I need to travel overseas I asked my GP if we can at least do an ultrasound to rule out appendicitis or kidney stones as I had gallbladder stones removed in the past. My belly is still tender to touch and much worse when I walk. My Doc mentioned it can be liver area where it hurts the most. She wrote me a request for an ultrasound and CT as well. She asked me to choose if I am willing to go under CT radiation or to do the abdominal ultrasound only. We did gynecological ultrasound previously which showed the cyst but on the left. Reason being that we were going to try to conceive with my husband within next few days. I am only concerned if CT is necessary as she said she thinks it will be negative and she is doing it just for my piece of mind. I do not want to potentially cause a harm to a baby in case I will become pregnant few days after the radiation. Also I have had several CT and MRI scans of my head and spine as part of my migraines investigation in past 2 years, which I know can in total increase my own cancer risk. I was having daily strong migraines. After I have done BOTOX injection that helped a bit with frequency and intensity. Do you think that an ultrasound would be satisfactory to rule out anything serious or you would advice me the abdominal CT scan just to be safe. In terms of under active thyroid I am usually more tired than a normal person, but now I feel overall unwell which is a bit different than my usual tiredness which is pretty common and I do not worry about it that much. I have problem to perform almost any work physically or mentally at the moment. I am used to chronic pain, but what worries me a bit is that I feel overall unwell and weak right now. I am taking multivitamin and magnesium, Vitamin D and fish oil to rule out any vitamin deficiency. I have booked the CT scan but I am a bit stressed about it if I should not go just with an ultrasound. I would not want to increase risks for my baby if we suceed to conceive or my own cancer risks (I have been previously diagnosed with skin cancer( squamous cell carcinoma) on my sculp and had precancerous cells on my cervix removed about a year ago. Thank you for your insight.Kind regards, XXXXXXX
doctor
Answered by Dr. Prasad 3 hours later
Dear XXXXXXX,

Thanks for updating with relevant details. I went through them with diligence and the following are my comments:

1. Blood pressure and heart rate are influenced by hemodynamic forces and normally bears an inverse proportion. A low blood pressure with low heart rate is always sought with concern and hence my earlier concern. Beta-blocker could be a partial cause; however without an opportunity to examine you, I cannot ascertain the heart status.
It is also not clear if the blood pressure and heart rate readings were documented at the doctor’s office, when it was done and if the readings were done in lying down posture. A persistently low heart rate, blood pressure and the associated conditions can very well explain the dizziness and weakness. Therefore discuss with your current doctor and if needed you may consider reviewing with your cardiologist.

2. Now that your thyroid hormones especially the TSH are within limits, we need not worry about underactive thyroid.

3. Tenderness over the liver area is not typical of renal colic’s and therefore my assumption was wrong and it’s encouraging to know the urine report was normal.
A few reports have been published relating gall bladder removal to upper abdominal pain especially after food. I wonder if such factors are the reasons of the abdominal pain.

Besides that, as the pains are much more intense while walking muscular aches, analgesics can be tried for a while.

3. You reported that blood work was normal. I hope hemoglobin levels and liver function test were also reviewed.

4. At this point of time, with no proper explanations for pain, use of CT scan is justified. It would definitely give us more clues to identify the scan.
As you are planning for pregnancy and not yet conceived, CT scan radiation scare is unwanted. The radiations used during the scan do not stay to cause harmful effects on pregnancy. So you can safely proceed to get the scan.

5. I am not sure why the botox injections are used for migraine especially when there are other drugs available for prophylaxis. These preventive drugs have been widely used with good results in many migraine sufferers.

Finally, many a time when symptoms are spread across to involve more than one bodily system and all reports are revealed to be normal, stress / anxiety / depression is a possibility considered, therefore the reason for your doctor's disinterest. I would definitely list this lowest.

To summarize, you can safely proceed with CT scan and I hope it gives us more clues. In addition also consider a review with your cardiologist.

Hope this suffices. I will be glad to assist you if you need further guidance.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prasad 2 hours later
Thank you very much Dr XXXXXXX I like your detailed answer and understand it is very hard to answer somebody without examining the person and knowing exact full history. In terms of migraine I suffer for many years and have tried every possible medication preventive and pain relief, natural remedies, yoga. Even done nerve block injections. I am seeing one of the best specialist on migraines in the country. I did Botox as the last resort as nothing was helping me and I have tried I think 20 different medications over past 6 years many times with terrible side effects and no relief of migraine. I am even on regular physiotherapy program targeting posture and strengthening core muscles, and used to go every 2 weeks to massage therapist and chiropractor before botox. Since Botox I was able to minimize massage and chiropractor treatments needed. I still have migraines, but nothing so sever as it used to be before the Botox injection. I know it is poison, but it was the only thing that gave me some relief. I was on Gabapentin but stopped as we wanted to try to conceive. In terms of the pain I have pain both in the liver section (according to my doctor as I had no idea where liver is exactly), and also kidney area. Now I even have kidney area pain on both sides. I have not done any exercise as I was not well, so it should not be muscle related. I was even thinking if they did not overdose me during general anesthetics as I could hardly walk that day after the surgery I was so dizzy. It was only 2 hours, but still. I do not think I am depressed as I am quite happy, have great husband, just not feeling well.I work part time only now due to migraines, but I love my job. I had a bit intense month but not that major that I could not handle it or feel so bad from it. I guess we will see after the scan. Thank you so much XXXXXXX.
doctor
Answered by Dr. Prasad 4 hours later
You are welcome.

I guess you can continue the Botox for a while.

Liver area is just under the right rib cage where as the kidneys are more on the back adjacent to the spine. The kidney pain sometimes is located on the flanks radiating towards the groin. Occasionally the radiation can be in the opposite direction (ureteric colic).

Since there is a bit of confusion, CT scan of the whole abdomen will definitely provide more clues which can be correlated to the clinical signs to have a better understanding of your problems.

I wish you good luck and hope you are satisfied with your experience on this forum.
I request you to close this discussion if there are no other follow-ups. I would also appreciate your feed backs.

Thank you once again and it was nice discussing with you.

Good luck!!!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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