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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18423
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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This is actually about my 34 year old daughter rather than

Resolved Question:

This is actually about my 34 year old daughter rather than myself, but she's been in so much pain, I've undertaken to try and find an answer for her.
She has had three children, has endometriosis ...and has also now had a hysterectomy.
Since the latter - around August last year - she has had pain under her ribs on the right side.
She has slow transit constipation being treated separately.
She now also has lower stomach pain which she has been told is either related to her bowel or adhesions around the sigmoid colon from her previous surgery.
She also has frequent moderate to severe pain of about 1-2hrs. duration around her lower back. The latter comes on suddenly and she says she feels her back is about to snap.
The pain in her side is there most of the time and is usually an ache - but sometimes throbbing, 'as if from a blow'. This is sometimes on the left too.
She has a cyst on her liver which they say is a simple ongoing symptoms.
She has also had a rash which started at the top of her back but is now over her scalp, arms, legs and tummy. Is like chickenpox for size and does scab, but no pus.
• No infection identified and antibiotics have not resolved;
• Ultrasound and CT scans show nothing;
• Liver function tests proved negative some four months ago;
• Similar with a kidney function test around a year ago;
• Recently, a dipstick showed blood in her urine +3 ...obviously no longer menstrual. She did have this dipstick with similar results during her last pregnancy including protein and it was put down to 'leaky kidneys' then, but not so 'OK' now she's not pregnant;
• Two previous urine dipsticks showed microscopic haematuria;
• Pancreas and gallbladder also scanned, but OK;
• She has had an endoscopy and also a colonoscopy which showed multiple polyps with a fast growth rate - although benign;
• X-rays show no bladder or kidney stones;
• She is due to have a full kidney function test at the weekend (a year or so since the last one)...urine samples are to be given once a week for three weeks to monitor blood...and a high resolution CT scan has been ordered.Really don't think I can give more information, but she really is constantly unwell ...and has been so (totally apart from the endometriosis) for some time.Her own words are as follows:-"I had originally thought the pain was endometriosis, but my gynae (who did the hysterectomy) was adamant that there was no way as there was minimal active endo outside of what was removed totally and he excised that. There were significant bladder adhesions and the ureter was stuck down and had to be freed. He performed an MRI of the pelvis and said there were no signs of endometriosis left. That's when he suggested gallbladder. They will not give me any hormonal treatment as they don't believe it to be the cause. The rash I think relates most to guttate psoriasis. I suffer from eczema but this is different in small spots all over my body and appeared after I had strep throat which I actually now have again a few months later. I had a cystoscopy just after my third child was born due to always having blood in my urine then. It showed a narrowing of the urethra but nothing else. When you say could the pain be psychological my question would be how would I tell the difference? It is extremely real to me and wakes me, stops me picking up my children and doing things I want and need to do...."
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Phil, MD replied 1 year ago.
what meds dose she take now?
Customer: replied 1 year ago.
CITALOPRAM (20mgs.) ... CRUCLOROPRIDE (2mgs.) ... LAXIDO (sachet) both the latter for slow transit constipation and only taken since December last.
Expert:  Dr. Phil, MD replied 1 year ago.
I suppose the key factor would be does the symptoms worsen when you are stressed or depressed?
Customer: replied 1 year ago.'s constant, regardless of mood or stress levels. The depression has been reviewed by her doctor and, although she wants to take her off the Citalopram, she doesn't want to start until the rest of it has been pinned down. She also wonders about the blood traces in the urine...?
Expert:  Dr. Phil, MD replied 1 year ago.
I see.Then I would say it is less likely related to a psychological issue.Also, blood in the urine is common and if the cysto was negative it is likely a benign source
Customer: replied 1 year ago.
(P.S.:- As the time here is coming up to midnight now, we'll both get some sleep and deal with your next response in the morning. OK?)
Expert:  Dr. Phil, MD replied 1 year ago.
sounds good.
Expert:  Dr. Phil, MD replied 1 year ago.
I see
Then I would say it is less likely related to a psychological issue.
Also, blood in the urine is common and if the cysto was negative it is likely a benign source
Customer: replied 1 year ago.
Good morning!
Her concern over the latter is that the cysto was last done in 2013 so, although it was benign then, this (being a 'new' issue' and outside pregnancy) may not be...?
Both my daughter and her husband have also suffered what they term a 'strep-throat virus' in the past month or so and wonder if this could be related to that. Her blood tests over this are due at the end of this week.
Expert:  Dr. Phil, MD replied 1 year ago.
I would repeat the cysto then
Customer: replied 1 year ago.
Well Dr. Phil...I don't think either of us can provide any more information at this juncture. Can we ask what your thoughts are in terms of narrowing it down somewhat please? We all realise that subsequent events may overtake us, but it'd also be quite nice to try and focus in fewer directions than have been suggested - or, rather, NOT suggested - here...?
Expert:  Dr. Phil, MD replied 1 year ago.
Endometriosis is a likely cause. You can get pain all over the belly with this. It is diagnosed with a laparotomy or basically opening up the belly and lookingAlso, it could be adhesions or scar tissue from prior surgery. This is also diagnosed with a laparotomy.Unfortunately that may be the only option at this point.
Expert:  Dr. D. Love replied 1 year ago.
Hello. This is Dr. Love, a different expert. I notice that you have opted out the other expert. There are several comments that are pertinent in this situation. First, ongoing assessments of haematuria should be based on more than a dipstick evaluation. You said that the haematuria was identified by dipstick, but then said that it was called microscopic haematuria. Strictly speaking, that would require microscopic examination of the urine, so is more than a dipstick and may have already been done by her doctor. If there is continued microscopic haematuria, then a repeat cystoscopy and the high resolution CT scan would be the appropriate evaluation. If the dipstick is positive but the microscopic examination does not show red blood cells, then there should be evaluation for muscle disorders, because myoglobin that leaks from inflamed or damaged muscles can cause a positive dipstick for blood. In addition, there is one other test that may help to fully assess the gallbladder. The ultrasound and CT scan of the liver and gallbladder will detect most cases of gallbladder disease, because gallstones are usually present, and these imaging tests are excellent at detecting gallstones. However, a small percentage of people can have gallbladder disease without gallstones, and these people are better identified with a nuclear imaging test called a hepatobiliary scan. If I can provide any clarification, please let me know.
Customer: replied 1 year ago.
Thanks so much Dr. Love...a comprehensive reply. I'll pass it on to my daughter right now and see where we go from there...
Expert:  Dr. D. Love replied 1 year ago.
You are very welcome. Let me know if she has any further questions. Once I have addressed any follow-up questions, please remember to provide a positive rating so that I am credited for assisting you.
Customer: replied 1 year ago.
Hi Dr. Love ...
At last, things seem to be moving on a little. This is my daughter's answer to your thoughts:-
"Ok, will suggest that to the GP. I think she will have to refer me to a urologist for this. I know she did send a sample to hospital after the dipstick but she just said it showed no infection and it wasn't checking for blood. May be worth asking if the kidney route is worth pursuing if the blood tests were normal?"
Expert:  Dr. D. Love replied 1 year ago.
Yes, if there is blood visible on microscopic examination, it is worth pursuing the high resolution CT and the cystoscopy. Normal blood tests of kidney function would exclude certain kidney diseases, but various anatomic conditions can cause bleeding but not adversely affect kidney function tests.
Customer: replied 1 year ago.
Pretty happy with all this so far Dr. Love. Just one more question from her tonight: "Oh ok good. That helps a lot. So I need to have this scan and then perhaps get referred to a urologist, ask the other questions ...and get a cystoscopy?"
Expert:  Dr. D. Love replied 1 year ago.
Yes, referral to a Urologist and repeating the cystoscopy would be appropriate if there is blood in the urine on microscopic examination.
Customer: replied 1 year ago.
Thank you again Dr. Love - have to say we've come further this evening than we had done over this week. It's getting late now for her with two children, so will leave you in peace...but promise I'll get back to you...
Expert:  Dr. D. Love replied 1 year ago.
Very good. I am glad that I could be of assistance.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18423
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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