Melissa in Australia Posted August 18, 2012 Share Posted August 18, 2012 Hi, I need suggestions for this one. My DS is extremely fit, usually rides his pushbike 20 km or more every day, very thin and tall. My DS14 has had a very bad stomach ache for 6 days. He has had no vomiting, or diarrhea, not constipated and can move around. the pain is above his belly button. it is painful enough that the weight of a hot pack is too much and it prevents him from sleeping properly. Eating food neither increases or decreases the pain, though he has no appetite at all and is extremely lethargic. I took him the the GP yesterday, who proscribed paracetamol and Endone ( a morphine derivative). She suspected early appendicitis. and said if the pain is still there the next day go to ER. I didn't fill the prescription for the Endone as I thought if he needed medication that strong he should be in hospital! Today the pain was still there, so we went to the hospital ,and the on call Dr. was visibly shocked that the GP proscribed endone to a 14 year old without doing tests etc. He examined my son and said there is nothing wrong with him , take some mylanta (antacid). My son is still in pain, the paracetamol doesn't do anything, the mylanta doesn't do anything. What would you all recommend? if I go back the the hospital I will get the same Dr who said there is nothing wrong(if I keep going back in he might eventually believe me). the other Dr is a locum and was filling in for the regular Dr. who is away on training or something. I could drive 100 km to the next hospital and get a 3rd diagnosis (leaning towards doing this in the morning). DS has an extremely high pain threshold and when he says he is in pain he really is in pain. Oh I forgot to add that is the weekend here and the local hospital is a very small country hospital that doesn't have pathology on weekends. thanks in advance for all advice Quote Link to comment Share on other sites More sharing options...
kalanamak Posted August 18, 2012 Share Posted August 18, 2012 Did they do a CAT scan of the belly? Abdomens "evolve". It is unusual for an appy (not unheard of but unusual) for an appy to not progress like that, but because of the way the nerves are wired, the early appy pain is around the belly button. It then migrates to the right lower corner. Does he have "peritoneal signs"? When the belly is slowly pushed in and then suddenly released, does he jolt, or bring up the knees. Did they check the stool for blood? Yes, it is bold to give narcotics for an undiagnosed belly. It is a complaint of people in pain in ERs that they aren't doped immediately, but until you have a plan, doping makes any progression of symptoms. Personally, I'd put my kid on clear liquids only, watch him like a hawk (temp every hour while awake and a visual check for restlessness and sweating while asleep) and hourly pulse rates. If the resting pulse is over 100 or 20 points or so above baseline, I'd go back in. If he is in too much pain to sleep, I'd go back in. If it was all the same in 24 hours since last exam, I'd go back in. Any vomiting or diarrhea, I'd go back in. Do you sense a theme? Can you head off to a bigger hospital? :grouphug: Quote Link to comment Share on other sites More sharing options...
Melissa in Australia Posted August 18, 2012 Author Share Posted August 18, 2012 Did they do a CAT scan of the belly? Abdomens "evolve". It is unusual for an appy (not unheard of but unusual) for an appy to not progress like that, but because of the way the nerves are wired, the early appy pain is around the belly button. It then migrates to the right lower corner. Does he have "peritoneal signs"? When the belly is slowly pushed in and then suddenly released, does he jolt, or bring up the knees. Did they check the stool for blood? Yes, it is bold to give narcotics for an undiagnosed belly. It is a complaint of people in pain in ERs that they aren't doped immediately, but until you have a plan, doping makes any progression of symptoms. Personally, I'd put my kid on clear liquids only, watch him like a hawk (temp every hour while awake and a visual check for restlessness and sweating while asleep) and hourly pulse rates. If the resting pulse is over 100 or 20 points or so above baseline, I'd go back in. If he is in too much pain to sleep, I'd go back in. If it was all the same in 24 hours since last exam, I'd go back in. Any vomiting or diarrhea, I'd go back in. Do you sense a theme? Can you head off to a bigger hospital? :grouphug: thank you for your help. there is no cat scan or ultra sound equipment in this small hospital. I am thinking I will monitor him very closely all night (evening here at the moment)and go in the morning to the bigger hospital. Quote Link to comment Share on other sites More sharing options...
Leanna Tomlinson Posted August 18, 2012 Share Posted August 18, 2012 I would go to a facility where they would draw blood work. You could let this wait, but if he develops a fever or the pain increases, I would not delay. If his white blood count is elevated, then he is showing signs of appendicitis or another form of infection. Here are some other questions I have: Does he have rebound pain? - this is when you press on his abdomen and the greatest pain happens when you release the pressure - a classic sign of appendicitis Could he have the beginning stages of mono? The extreme lethargy would point to this. I've know a few teens to present with abdominal pain first. Soon, his lymph glands especially in his neck would start to swell. Blood work would show this as well. I hope you get some answers soon. :grouphug: Quote Link to comment Share on other sites More sharing options...
Melissa in Australia Posted August 18, 2012 Author Share Posted August 18, 2012 I would go to a facility where they would draw blood work. You could let this wait, but if he develops a fever or the pain increases, I would not delay. If his white blood count is elevated, then he is showing signs of appendicitis or another form of infection. Here are some other questions I have: Does he have rebound pain? - this is when you press on his abdomen and the greatest pain happens when you release the pressure - a classic sign of appendicitis Could he have the beginning stages of mono? The extreme lethargy would point to this. I've know a few teens to present with abdominal pain first. Soon, his lymph glands especially in his neck would start to swell. Blood work would show this as well. I hope you get some answers soon. :grouphug: DS says that it hurts more when he presses, not rebounds. What is mono? is it glandular fever? Quote Link to comment Share on other sites More sharing options...
kalanamak Posted August 18, 2012 Share Posted August 18, 2012 What is mono? is it glandular fever? Yes. Also, if he stops passing gas, go in. I'd stick to clear liquids in case he goes to surgery. Clear broth, jello, fruit juice pops (frozen on a stick). :grouphug: Quote Link to comment Share on other sites More sharing options...
Leanna Tomlinson Posted August 18, 2012 Share Posted August 18, 2012 I looked it up, and Glandular Fever is the same as "mono", or more correctly mononeucleosis. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001617/ He is not acting classically for it, but I have seen at least two teens this year present with abdominal pain first, before they developed other more classic symptoms. He also doesn't have to have rebound pain to have appendicitis, and rebound pain can develop as appendicitis progresses. The "peritoneal signs" that Kalanamak mentioned is the same thing. It's a classic sign of appendicitis, but it doesn't always occur. If he worsens at all I would take him back to the hospital and insist that they draw blood to see if he has an infection. Like Kalanamak said: any vomiting, diarrhea, increased pulse, fever, increased pain, and I would take him back immediately. :grouphug: Quote Link to comment Share on other sites More sharing options...
Melissa in Australia Posted August 18, 2012 Author Share Posted August 18, 2012 thanks so much to both of you. You have helped me with things to watch for. thank you Quote Link to comment Share on other sites More sharing options...
juelle Posted August 18, 2012 Share Posted August 18, 2012 Did he by any chance fall off his bike? Could he have hurt his spleen on the handlebars? Could this be a bowel impaction? A scan would be helpful, as would bloodwork. Any chance of gallstones? I do hope you get answers and relief for him soon. And try to take care of yourself a bit. Quote Link to comment Share on other sites More sharing options...
Mommyfaithe Posted August 18, 2012 Share Posted August 18, 2012 I was actually thinking he may have herniated something pushing hard on his bike....or pulled a tummy muscle....My swimmers have had pulled stomache muscles while in training....very painful! Quote Link to comment Share on other sites More sharing options...
kalanamak Posted August 19, 2012 Share Posted August 19, 2012 How is he? Quote Link to comment Share on other sites More sharing options...
Melissa in Australia Posted August 19, 2012 Author Share Posted August 19, 2012 thanks everyone. He tells me that he is feeling much better, he still has some pain, but feels he is on the mend. I have no idea what it was/is and hope he continues to improve :001_smile: Quote Link to comment Share on other sites More sharing options...
kalanamak Posted August 19, 2012 Share Posted August 19, 2012 thanks everyone. He tells me that he is feeling much better, he still has some pain, but feels he is on the mend. I have no idea what it was/is and hope he continues to improve :001_smile: A virus. Isn't that way doctors always say when they don't know? But guts do get them, and they aren't all a "24 hour bug". I recall one bug that gave everyone acholic stools*. I've never seen it before or since, but so many had it at once it had to be contagion. So glad he is better. *They are a cream-grey color .... like the stools of a ghost. Quote Link to comment Share on other sites More sharing options...
Tiramisu Posted August 19, 2012 Share Posted August 19, 2012 A virus. Isn't that way doctors always say when they don't know? But guts do get them, and they aren't all a "24 hour bug". I recall one bug that gave everyone acholic stools*. I've never seen it before or since, but so many had it at once it had to be contagion. So glad he is better. *They are a cream-grey color .... like the stools of a ghost. :lol: I just wanted to check in to see how the OP's ds was, and this made my morning. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted August 19, 2012 Share Posted August 19, 2012 He needs to be somewhere that can at least do an abdominal ultrasound. Could be appendicitis, or gall bladder, or an ulcer. Quote Link to comment Share on other sites More sharing options...
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