Poor MD Problem Solving With GI Problems

[londonflo]

30 plus years ago, I had a lot of 'gut' pain problems. Would go into the hospital and was just basically ignored or had gastrograffin enemas. I was told it was a psych problem. I went to Mayo. The Mayo GI department told me the majority of their patients are told their problem is psychiatric.  All the psych RXs in the world did not help. My job threatened me with termination.

A couple of decades later, one night I had the same  abdominal pain with vomiting happen again. Same symptoms, I worked the same full day. It came on without notice.  . By this time I was married. My spouse said "let's go the hospital". I explained "You don't understand...they will say it's in my head." Eventually we went in (after  4 HOUR wait) and after a CT, I had a volvulus. Why do you have to get old to get good diagnostics or have a spouse who can demand better care?

[JBMmom, MSN, NP]

So sorry for all that you experienced in the past. Thank goodness you experienced a spontaneous improvement in symptoms all those years ago with no negative effects. Being told that something is "all in your head" can be so defeating, especially when it feels like you're not being taken seriously. Did they ever do any diagnostics in the early years? It's possible that they did not have the same technological capabilities then, or they just weren't using the same methods. I hope that your care this time around brings you relief from symptoms. 

I do think there is something to young women's symptoms being much more readily attributed to psychiatric issues and potentially overlooked. And GI symptoms can be particularly challenging to diagnose when the symptoms are diffuse or nonspecific.

Hope you're feeling all better soon!

[londonflo]

41 minutes ago, JBMmom said:

Did they ever do any diagnostics in the early years?

Only obstruction series X-rays that were at one time positive. 

42 minutes ago, JBMmom said:

It's possible that they did not have the same technological capabilities then, or they just weren't using the same methods

 A CT would have shown I was actually obstructed, The gastrograffin enemas only fixed the problem in the short term. I was diagnosed at an early age that I had 'a redundant colon;'. I just had another colonoscopy where I had 3 tubular adenomas removed. So glad that that colonoscopies and the prep is actually better than in 80s.

I just wish that when a physician cannot find an actual cause it would not be interpreted as "it is in their head".  But I did find that having  a husband got me better efforts to help me in the health care system. .. 

[MunoRN, RN]

I would agree the terminology is problematic, but despite that your previous episode worked out as well as it could have given that even just a couple of decades ago they were quicker to do surgery for this sort of thing, it's now more commonly accepted that surgery should be avoided in these cases.

I agree it's not accurate to call sub-clinical abdominal issues a "psychiatric" issue, but it's not inaccurate to describe the issue as being primarily one of pain and discomfort rather than an imminent medical emergency.  That doesn't mean it doesn't justify treatment of the pain and discomfort, but it's technically correct that it's "in your head", brains perceive pain and discomfort.

[londonflo]

8 hours ago, MunoRN said:

That doesn't mean it doesn't justify treatment of the pain and discomfort, but it's technically correct that it's "in your head", brains perceive pain and discomfort.

IT was NOT in my head... but in my abdomen. Then when you live with it ....you can tell me about it and it's sequalae  that included an an incarcinated  hernia 

[MunoRN, RN]

12 minutes ago, londonflo said:

IT was NOT in my head... but in my abdomen. Then when you live with it ....you can tell me about it and it's sequalae  that included an an incarcinated  hernia 

Your brain is actually in your head.  I realize that term connotes a disinterest in the problem and frequently when people say "it's in your head" they are indeed not interested in your problem.  But when medical intervention offers more harm than benefit then often the best treatment is to look at how to mitigate how someone perceives the pain and discomfort if that's the priority intervention required.

An incarcerated hernia is not sequalae of a volvulus, those are two unrelated conditions.

[londonflo]

1 hour ago, MunoRN said:

I realize that term connotes a disinterest in the problem and frequently when people say "it's in your head" they are indeed not interested in your problem

Yes, I found out that many health care professionals were not interested in the problem nor in truly investigating whether if there was a problem there at all. I was just a 'GOMER'.

[londonflo]

On 12/18/2021 at 1:59 AM, MunoRN said:

An incarcerated hernia is not sequalae of a volvulus, those are two unrelated conditions.

Of course I know that. 

On 12/17/2021 at 4:38 PM, MunoRN said:

I agree it's not accurate to call sub-clinical abdominal issues a "psychiatric" issue, but it's not inaccurate to describe the issue as being primarily one of pain and discomfort rather than an imminent medical emergency.  That doesn't mean it doesn't justify treatment of the pain and discomfort, but it's technically correct that it's "in your head", brains perceive pain and discomfort.

And what the heck is someone left to do? Go to the "Brain MD and say I have abdominal pain?   And with what you are saying I was left "to deal with it", on my own, despite follow up and more subsequent visits , left to deal with it "on my own."  My point was when you are a woman and on your own, a lot of actual problems are diagnosed as "in her head". I don't think you get that.

When going to the ER another time with the same problem, this happened....When I am in pain I sweat profusely, (as many people do). I ended up totally dry and confused the next day. When I returned to the ER with the continuing  pain and now an electrolyte and fluid problem, that got some attention. . That was something they could put a number and name to, and actually got treated for. I still left with abdominal pain, no future plan except for an appointment with a psychiatrist and a definite feeling of abandonment by a health care system I had trusted.

[Guest 1152923]

So sorry for your bad experiences with the medical community.  I strongly agree that many patients are left to their own devices and frequently fall through the cracks. It seems that when the etiology of a patient's pain or condition remains unknown after traditional, diagnostic algorithms, they are sometimes referred to psychiatry (as you were), and labeled with some vague diagnosis-I.e. 'Somatoform Disorder', 'Conversion Disorder'...  Sadly, we have to be vigilant advocates for ourselves and our loved ones when we interact with health care professionals and my heart breaks for those without support or who have no health literacy.  I can't imagine being unable to understand or navigate my way through a very complex (and very broken) medical system, but this unfortunately is the lived reality of many.

[londonflo]

20 hours ago, MunoRN said:

terminology is problematic

I did not go to the ER for problematic terminology. I did not go to be a GOMER. 

21 hours ago, JBMmom said:

Thank goodness you experienced a spontaneous improvement in symptoms all those years ago with no negative effects.

I did not have a spontaneous improvement in symptoms and I had plenty of negative side effects. Finally had the surgery for a volvulus that I experienced on and off for many years. My secret  at that time for preventing additional episodes?  I don't know...I did limit my eating and went to under 100 pounds. OMG another psych problem!!

Here's is my point. I had a recurrent volvulus for several years,  Sometimes it resolved via the Gastrograffin enemas  which probably restored the colon to it's natural position but never fixed the problem.  Finally in my 40s I had a GOOD diagnostic workup that showed a volvulus. By the time of getting into an ER bed, having a CT etc. I was being marked for a colostomy. 

My whole point for this topic is if are a woman, and alone the ER can't rush you out the door fast enough. I also think the appropriate diagnostics were NEVER used until I was in my 40s. Same symptoms, same pain over several ER visits but an obstructive series on XRay  was not actually a good diagnostic tool (although one XRay was positive for obstruction, one for a fistula). With the fistula, the MD actually asked me if I had something on my hospital gown that provided that imaging. I NEVER had a fistula! This was the GI doctor that totally complained about me going to MAYO.

here is the thing,...when you are alone, you will get easily dismissed as a neurotic,,,,,But having a S.O, with you will get your complaints actually  credited as something that needs attention. 

And Munro .....what the heck is sub-clinical and what should that be dismissed as a psych problem?

[nursej22, MSN, RN]

I am sorry for your problems  and the length of time it took for an accurate diagnosis. No one should have to endure that. 

I will add that ER is not the only setting where a woman, especially if alone, will be brushed off or missed diagnosed. I went to my primary care for almost constant heartburn, despite H2 blockers and over the counter PPIs. I also had some tenderness on palpation and bloating. This lead to an assumption that I had cancer, resulting in several pelvic exams, an elimination diet,  lady partsl US (so painful), CT, MRI and an endoscopy. At each consult, clinicians would mention that a prescription PPI might help, but it was never prescribed. That is, until after the endoscopy showed GERD. So after thousands of dollars in co-pays and deductibles, two months of pantoprazole my pain was gone. 

Oh, and yeah, antidepressants were offered before pantoprazole.

 

[JBMmom, MSN, NP]

5 hours ago, londonflo said:

I did not have a spontaneous improvement in symptoms and I had plenty of negative side effects.

I apologize I misunderstood this point in your original point. I was under the mistaken impression that without treatment a volvulus would end up leading to necrotic bowel. The fact that you have dealt with this for so many years without proper diagnosis and treatment is a very sad illustration of some of the clear shortcomings in our medical systems. I'm glad you've finally gotten the appropriate care.