Marie A Savard MD

Solve the Medical Riddle: She Has Intermittent Severe Pain in Her Abdomen, and She Saw Blood in Her Urine, First Week

Editor’s note: Welcome to our third AGE feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

We’ll start this week by letting you know what the patient told her PCP and how the doctor proceeded with the examination. Next week, the PCP will continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!

The Patient Reports Her Symptoms

Barbara, age 62, is worried because she has pain in her abdomen and back that comes and goes, and she saw some blood in her urine.

As always in thirdAGE Medical Riddles, the doctor uses the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

This week, we’ll learn what Barbara told the PCP:

pain in abdomen “For several weeks I’ve had pain off and on in my abdomen in the pelvic area, and sometimes one the right side of my mid and lower back. The pain can be very intense to the point that I can hardly stand it – definitely a 10 on a scale of 1 to 10. But at other times, it doesn’t seem so bad. I’ve also been nauseated every now and then. That’s why I’ve been putting off making an appointment to see you. I just kept praying that whatever was wrong would go away. Wishful thinking, I know! Anyway, what finally pushed me to come here is that yesterday I saw blood in my urine although the pain is now completely gone. Besides that, my urine looked kind of brownish. I freaked out! I’m a high school English teacher with a winter break coming up in February. My husband and I have a trip planned to Disney World with my daughter and son-in-law and the grandchildren. I dread the thought of having something serious wrong with me that could spoil our vacation. I hope you’ll have good news for me so I can look forward to enjoying time with my family!”

statinsThe doctor took a complete history and asked specific questions about prior urinary tract infections (UTI’s, cystitis), family history of genitourinary tract problems, and what medications Barbara takes, including over-the-counter products. Barbara said she had never had UTIs, but that her father may have had some urinary problems. The doctor already knew that Barbara is on Lipitor, a statin drug that can occasionally lead to brown urine from muscle breakdown and myalgia (muscle pain). The doctor had previously prescribed the Lipitor for high cholesterol. TumsHowever, Barbara also told the doctor that she takes a lot of Tums for indigestion. She takes a multivitamin every day.