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Infectious Diseases

What kind of Doctor to see?

06/29/2004

Question:

I have a really bad pain in my right side below my ribs. I need to go to a Dr, but I don`t know what kind to see and I`m tired of tests my family dr orders that show nothing. I have been told to see a pain specialist b/c one of my dr`s thinks it is post herpetic neuralgia, but I only had the shingles on my face and I had the pain a long time before I had the shingles. My family dr`s always order gallbladder ultrasounds (I`ve had 3 or 4, the last one hurt so much that I`ll never have another) and I had a HIDA scan showing everything to be normal. The only things that make the pain worse (it comes and goes) are certain exercises and eating when the pain is present. I get nausea, diarreah, really ba gas, and a little reflux when the pain is at its worst (now). I am so frustrated because I keep getting different suggestions from family doctors, but no answers, and the pain just keeps getting worse (I have had it on and off for 5 years now). Do you have any suggestions for what kind of Dr to see?

Answer:

Some more history would be in order before a firm recommendation could be made as to whom you should see.  For instance your age, other medical history, medications, what the pain is like (such as deep, or burning, or cramping), the presence or absence of fever, and weight loss would all be important pieces of information.

It sounds as though gallbladder disease has been excluded.  The fact that you have had the pain for so long and have had diarrhea associated with it suggests irritable bowel syndrome.  Your description of the pain worsening with movement suggests a musculoskeletal disorder.

My recommendation would be that you go back to your family doctor and explain your frustrations and ask for a further opinion.  Failing that, a gastroenterologist would be a logical step.

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Response by:

Peter Grubbs, MD
Assistant Professor
College of Medicine
University of Cincinnati