Question
QUESTION: Hi, I am a 57 yr old female with pain on my right side which radiates to the right flank area.  I am in stage 4 kidney disease caused by lithium.  I had my gall bladder removed due to chronic pancreatitis (which I still get from time to time), I had a hysterectomy.  I had a hida scan of my abdomen, mri of my back, a ultra sound endoscopy of my abdomen, a upper gi series of my intestines, a colonoscopy, ( they found a polyp in time), and they can find what is causing this pain on my right side which is getting worse every day. I hate going to bed at night because when I wake up it hurts even more. If I move the wrong way, it feels like someone is stabbing me in my flank area. I wake up on my back because my side hurts when I sleep on it. I seen a pain management doctor and he wanted to inject my spine and I didn't think that was the problem.  I have another appoint-
men with another pain management doctor in February.  My amylase and lipase are elevated and they just diagnosed me a diabetic. My
creatinine is 2.43, bun 29 and glucose around 145.  It seems like the pain is moving up in my shoulder.  I am loosing faith in the medical profession.  They keep pushing me off to another doctor.

ANSWER: Terri,
My first thought was that it was gallbladder problems, but you've had your gallbladder out. I'm thinking it could either be another attack of pancreatitis, especially considering that your amylase and lipase are elevated. It also could be a kidney stone. That is where the pain is usually, in the flank. However, with kidney stones positioning doesn't help. It DOES NOT sound like a spinal problem, at least not from the symptoms you've listed. You need to have your primary care doctor rule out kidney stones which is easy to do with a urinalysis. Also, you need to be worked up for pancreatitis, which I'm strongly leaning to. This can be a very painful and chronic condition. If you're under a pain specialist they should treat this as well. Please get back to me if you have further questions, or if I've been unclear.

---------- FOLLOW-UP ----------

QUESTION: I agree with you that this is not a spinal problem!  When they removed the gallbladder, they "cleaned out the bile duct" which caused scar tissue.  They did a ERCP and funnel shaped the duct so hopefully wouldn't cause any more problems.  I have my doubts.  With all the MRI's and ultra sounds, they haven't found any stones. OH, by the way, my uric acid was always very high until they put me on sodium bicabonite.

Thank you very much for response.

Answer
Yes, Terri, yours is a difficult case. But I do not believe it is musculoskeletal. It appears to have something to do with your biliary system, either the pancreas and/or gallbladder. In the meantime look for any discoloration of your urine, pink, dark even a brownish tinge could indicate bleeding, and therefore stones. It is difficult to maintain your independence when surrounded by physicians who each see something different. However, you do have the right to refuse any tests or xrays which you disagree with, or that may cost you too much. And you are very right in that it could be related to scar tissue from previous surgery. The best way to find a good doctor is an common sense, so to speak. You talk to nurses, preferably older nurses who have been around the block a while. See who they recommend or who they see. They'll almost never steer you wrong.