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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

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Suggest treatment for back pain that radiated to the stomach

Answered by
Dr.
Dr. Rakesh Madhyastha

Nephrologist

Practicing since :2009

Answered : 4360 Questions

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Posted on Tue, 23 Dec 2014 in Medicines and Side Effects
Question: My husband , 74, years old, healthy and slim, non smoker, had non fever fluish symptoms for over a week. This past tuesday he had an attack of pain in back, radiating across flank towards stomach. Taken to ER, they observed him, did CAT, ultra sound, ER doc said maybe kidney stone..a little blood in urine and they thought there was stone in tube. CAT scan also said enlarged prostrate, little cyst in kidney and a bit of diverticulitis. Released, my husband went to his "new" county health dept doctor who sent him back to ER for a "contrast CAT scan. The 2nd ER doctor , consulted on phone with health dept doc, but said he thinks it's shingles. (my husband had experienced stress over past weeks) and 2nd ER doc did not want to do contrast scan because he said based on health of my husband's kidneys, he thought there was a chance of damaging them. My husband agreed. There are as yet no shingle blisters. Also 2nd ER doc said their urine tests and ultra sound showed no blood in urine, and he didn't see any stones on previous CAT or ultra sound.
My husband is in significant pain. Skin VERY sensitive to touch but says pain is like a bad pulled muscle. On scale of 1-10 pain is usually a six, although this morning it was a 3 and went back to a 6. He's weak, bloated, belching all the time. Not eating much and hard to get him to drink enough fluid, although I'm very aware of it. Pain meds: Percoset, 2 every 4 hours although my husband is doing 1 every 2 hours generally and a nausea med that he took just once or twice. On wed, after ER on tuesday, he vomited often, but not since. I would say it hasn't become worse, it's just bad. No fever. We don't know if it's kidney stones or shingles and don't want to go back to ER unless necessary. My husband will now find a good primary care physician. Based on what I've told you can you give an opinion?
doctor
Answered by Dr. Rakesh Madhyastha 1 hour later
Brief Answer:
Need more info

Detailed Answer:
Hello

Thanks for the query

Based on the history you have given me I would like to confirm a few things for better clarity and understanding

1. Is the pain in the flank related to either food intake or urination?
2. Is there burning while passing urine?
3. Did the ER doctor run some tests to rule out pancreatitis ?
4. Please tell me which part of the abdomen is sensitive to touch? upper, middle, lower back to the right or left, etc
5. There was blood in urine this time, could you please attach the report if possible?
6. Is he able to walk without discomfort?
7. Mention all his medications as some of them can cause pain abdomen

Please get back to me. My next reply to you might be 4-6 hours from now, I am getting ready to go to the hospital. I reply after my morning rounds of the in-patients

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 16 minutes later
1. no
2. no
3. not that we know about
4. lower back left - flank
5. 2nd ER visit, no blood in urine and not sure about first ER visit
6. no. but at noon I applied DMSO to the area and miraculously the pain has subsided completely. It is now 5:30 pm pst.
7. He takes no medications usually but now is taking Percoset for pain for this condition only.
doctor
Answered by Dr. Rakesh Madhyastha 6 hours later
Brief Answer:
Infected cyst

Detailed Answer:
Hello

From the history you have given me it looks like the source of the pain could be from the kidney and more so because it is in the lower back and there is cyst in the kidney however what goes against it is that the pain disappeared for a while after you applied DMSO.

Here is how you should go about it

1. If I were to be your doctor I would have started him on antibiotics like Levofloxacin once a day for 5 days. It is a good drug to be given for urinary tract infections
2. A repeat urine routine and a complete blood count is essential at the moment.
3. If that is normal then I would like him to undergo a CT spine to see for slip disc. I have had two patients who presented with similar complaints which turned out to be slip disc.
4. Give him plenty of clear fluids
5. Continue to apply DMSO if he gets symptomatic relief with it
6. Watch out for fever, especially fever with chills and rigor.

Please approach a primary care physician with my suggestion.

I hope I was of help, if you have any further queries please get back to me

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 13 hours later
Thank you, Dr Madhyastha, difficult holiday/long weekend here in the US for a medical emergency. Doc not available yet and after 2 stays in ER, not inclined to do that unless necessary. (fever etc. and he has no fever.) He talked on phone to his local doc who just retired, this morning, and like you, doc thinks it may be muscular/skeletal. (maybe slipped disc) And because it's so hard/painful for my husband to lift his legs onto the bed, I'm beginning to think so too since I had slipped discs and know what it feels like. Will go to doc #1 on Monday with your suggestions and see if he wants the antibiotics/tests. Thank you for those excellent suggestions. Pain continues to be helped by DMSO. He is not drinking enough, eating very little and no bowl movements for 4 days though I'm trying to deal with that with prunes, magnesium etc and constantly talking about fluids, but he feels nauseous ( took a pill for that awhile back.) Old doc recommends 600 mg ibuprofen every 6 hours and I hope that will contain pain because that percoset/oxycodene seems like bad stuff. (I wonder if cannabis wouldn't be a better approach.) Again, thank you and if you have any further thoughts they'd be appreciated. XXXX
doctor
Answered by Dr. Rakesh Madhyastha 12 hours later
Brief Answer:
Constipation because of oxycodene

Detailed Answer:
Hello

Thanks for getting back and I am glad I was of help

1. Oxycodene is known to cause constipation. So if you cut down on oxycodene it will help relieve his constipation. Tab acetaminophen can be given instead of it, however it is a weaker analgesic
2. Coming from a Nephrology background I wouldnt recommend Ibuprofen every 6 hours, it is nephrotoxic. I recommend every 8 hours instead
3. Continue to apply DMSO. I suggest Local analgesics like diclofenac or aceclofenac gel intermittently as well.
4. All these analgesics causes severe gastritis which is causing the loss of appetite, I recommend Tab omeprazole once to twice a day on an empty stomach to improve his appetite.
5. Continue to give fluids
6. Cannabis is a good option, it is not available in XXXXXXX so I dont have much experience with Cannabis as a pain killer.

I am sorry for the short delay in my reply. There was a 1 year old child I had to do acute peritoneal dialysis for, it took a while and I just got free.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakesh Madhyastha 7 hours later
Thank you very much. Pain on flank & back has disappeared. Has stopped ibu and all meds as of 3am. Would Motrin be better if he needs it? Will continue DMSO. Much better today, but still belching and bloated. Fleet enema yesterday had little result, but then he'd eaten little until this morning when he had big bowl of soup. Will see doc tomorrow for further tests.

Only questions left: Can he have his favorite black XXXXXXX tea? (I think tea, coffee is dehydrating, but it would make him happy.) Would another fleet enema be ok to get things moving?

I do hope your little 1 year old patient does well. She is fortunate to have you for her doctor. With best wishes, XXXX
doctor
Answered by Dr. Rakesh Madhyastha 1 hour later
Brief Answer:
Follow up

Detailed Answer:
Hello

He can go ahead and have the black XXXXXXX tea but it might cause increase in bloating and gastric discomfort. The best way to go about it is to have it along with some solid food like biscuits, etc.

Tab Motrin is fine, better would be acetaminophen.

Why dont you just give him 10 ml of oral laxatives like Syrup Duphalac instead of enema? When one does not eat much a bowel moment can take as long as 3 days, I do not recommend an enema at this moment.

My little patient is doing well and off ventilator Thank you so much.

I might not be physically present but I am your doctor as well and you can get back to me anytime

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