Q: I am at my wits’ end with a medical problem and my step-mother suggested I contact you for assistance.
Approximately two years ago I developed right upper stomach pain that moved into my ribs and around into my mid-back. Upon visiting my family doctor he began ordering a series of tests suspecting gallbladder disease. I had X-rays, a HIDA scan, blood work; you name it, I had it done. All the tests came back negative for any gallbladder problem. He then sent me to a GI doctor who looked at all my tests and said that the gallbladder appeared fine but that I should have a colonoscopy. That, too, came back normal.
During the HIDA scan it was noted that my gallbladder emptied slowly and with nothing else seemingly wrong, this was enough for my family doctor to decide to send me to a surgeon for a consultation. The surgeon reviewed all my tests and noted my symptoms and decided I should have my gallbladder removed.
All this took over a year. In the meantime, my life as I knew it didn’t exist. I couldn’t do my routine of walking each day for exercise nor could I stand in the kitchen and cook in the evenings which I so enjoyed. Walking around an art show, shopping, cleaning the house all became too painful. My heating pad was my new best friend. It seemed as if movement, not food, brought on the pain. On occasion eating something did bring it on though. Sometimes the pain was only in the stomach area, sometimes only the back and ribs.
Needless to say, I agreed to the surgery in the hopes that it would help. It was pretty much a routine procedure with the exception of a severe allergic reaction to one of the medications given to me the day of the surgery. My gallbladder, according to the surgeon was twice the size it should have been and was severely inflamed and infected. He said it was very good that I had had it removed. Afterwards my stomach pain seemed to be a little less intense but I assumed the ribs and back pain were just taking a little longer to disappear.
About four months after the surgery the stomach pain intensified and the rib and back pain had never really left. I then started having severe stomachaches, bloating, nausea and weight loss as I could not eat. I ended up in the ER twice. Tests and blood work were repeated. Nothing could be found. My liver, pancreas, lungs, heart, everything was normal. I was sent home and told to contact my family doctor. I did so but he requested that I see the GI doctor again for an endoscopy. I went to second GI doctor because I wasn’t happy with the first (It’s a very long story about being left in the hallway for 2 ½ hours while waiting for him to show up for the colonoscopy). This specialist listened intently to my problems, sent for all my medical records and ordered the endoscopy during which she performed two biopsies. Again, it all came back normal, no cancer, no tumors, no H. pylori, no gluten allergy. She said she is at a loss to help. She suggested since all the tests indicate there is nothing wrong with me but I still have this life-altering pain, that I try pain management and return to my family doctor for muscle relaxers while trying an anti-inflammatory drug such as Aleve or Motrin. I don’t want to start taking medication for a condition that I don’t even know what it is. The GI doctor suggested this could be something I think she called muscular-skeletal.
I am at my wits’ end and am also much poorer as my insurance did not pay for a lot of these tests. I take the following medications and have for a while. OTC Prilosec once a day for a hiatal hernia; atenolol twice a day, amlodipine besylate once a day and benzaepril once a day for high blood pressure which my doctor said is white coat syndrome); Antara once a day for high triglycerides. Besides the above symptoms, I also have on and off stomach pain that moves around, severe cramping as if someone is grabbing me from inside and twisting and about every other month I wake up with flu-like symptoms, chills, a slight fever, hot then cold and feel like I am catching something but am usually good within the day. At first I thought I had a 24-hour flu but it reoccurs so often I doubt that this is what it is. I know this is very lengthy and I do apologize but I don’t know where to turn at this poin and all me doctor have said they don’t know what to do with my any longer. Can you help?
A: My very first thought upon reading your letter was sphincter of Oddi dysfunction. The sphincter of Oddi is comprised of three mini-sphincters that help regulate bile and pancreatic juice. There are two forms: 1) sphincter of Oddi dyskinesia which includes a variety of different disorders that alter the opening and closing pressures of the muscles and 2) papillary stenosis which narrows the sphincters openings, usually due to fibrous tissue buildup.
The condition is fairly uncommon and it is believed that up to 20% of individuals with unresolved pain following gallbladder removal and between 10 and 20% of patients with recurrent pancreatitis have it. Those affected often present with right upper abdominal pain which may radiate to the back or shoulder blades and may cause nausea and vomiting and rarely jaundice, fever and chills.
Treatment depends on the form. The dyskinesia form may be treated with muscle relaxers that affect smooth muscle and certain calcium-channel blockers; however, medication won’t work for the stenosis form. This condition, unfortunately, doesn’t have a high degree of success with only about 75% experiencing relief and nearly 1/3 of all those using the medications experiencing side effects.
Beyond that, there are several surgical procedures that can be used. Each aims to release the pressure of the sphicter to allow normal follow of bile and pancreatic juices to resume. I suggest you return to your GI specialist to discuss the possibility of this disorder being the cause of your discomfort. You may also benefit from an osteopath (a medical doctor [DO] trained to deal with the body as a whole, rather than breaking it up as an MD does).
A final comment on your blood pressure. White coat syndrome is a condition in which the blood pressure rises to above normal when at the doctor’s office, usually due to stress, but returns to normal when home, etc. If this is the case with you, there is no reason for you to be on three blood pressure medications. In my opinion, they would likely lower your BP level to unacceptable levels making normal functioning at home and work nearly impossible. Ask your family doctor about monitoring your BP levels (without medication) while at home once or twice a day for a week or two. If you can show a pattern of normal readings outside the office and only high readings in the office, there is no need for medication. If, however, your numbers are consistently high, resume your medication; you don’t have white coat syndrome.
Readers who would like related information can order Dr. Gott’s Health Reports “Gallbladder Disease” and “Hypertension” by sending a self-addressed, stamped envelope and a $2 (for each report) US or money order to Peter H. Gott, MD Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from our website www.AskDrGottMD.com.
