Man’s severe abdominal pains continue with no diagnosis

Dear Dr. Roach: I am a 66-yearold white man who is very physically active. Until four years ago, the only real malady I suffered from was a benign enlarged prostate. In March 2016, I went to the emergency room for acute abdominal pain and cramping. It was relieved by intravenous pain medication. Since that initial episode, I have experienced the same symptoms approximately 12 more times. Since the onset of this excruciating pain, I have had two MRIs, an MRA, two CAT scans, a gallbladder test, two colonoscopies, one endoscopy and four hydrogen breath tests. I have been seen by two primary care physicians and two gastroenterologists and numerous emergency room physicians and physician assistants. No medical authority has been able to determine exactly why I have these episodes.

I have been told that I might have Crohn’s disease and irritable bowel syndrome. The latest is abdominal migraine. I’m aware of the information on the first two conditions. Can you tell me anything about abdominal migraine and the likelihood that I may suffer from this?

R.H. I am sure you must be frustrated with the lack of diagnosis and continued symptoms.

Abdominal migraine does indeed cause recurrent abdominal pain, and many people with it have had extensive evaluations before the diagnosis is made. However, migraine of any kind starting in the 60s is uncommon. Abdominal migraine is more common in children. Further, most people with abdominal migraine have other migraine syndromes, such as headache, though it is possible to have abdominal symptoms alone.

The location of abdominal migraine is most commonly around the umbilicus.

Pain often begins suddenly and lasts an hour or more. The pain must be associated with at least two of the following: nausea, vomiting, headache, loss of appetite or pallor (the medical term for the unhealthy pale appearance of a person who is acutely ill).

Often, if the diagnosis is suspected, a trial of anti-migraine medication can confirm the diagnosis if successful.

There are many. Of course, a thorough evaluation for other causes of abdominal pain are mandatory before making the diagnosis of abdominal migraine.

One good place to read more is on Yale Medicine’s webpage for abdominal migraine, yalemedicine.org/conditions/ abdominal-migraine/.

Dear Dr. Roach: I am a healthy 71-year-old woman of normal weight. I had a pacemaker put in back in December 2019 due to heart block. I had a low heart rate of 37, which caused periodic shortness of breath and trouble walking for exercise without becoming dizzy and lightheaded and feeling like I would pass out. Things are much better since the pacemaker was put in, but I still feel like my heart rate goes high quickly with little exertion, such as just walking to the mailbox. My cardiologist says that should improve as I continue to exercise more. Should I be concerned?

P.B. Your cardiologist is very likely correct. People with heart block, like many heart issues, often subconsciously decrease their exertion.

This leads to deconditioning, and a regular exercise program is the correct treatment. If you aren’t getting back to normal, the cardiologist may want to take a look at heart function with an echocardiogram.