Solve the Medical Riddle: She Has Intermittent Severe Pain in Her Abdomen, and She Saw Blood in Her Urine, Fourth Week
Editor’s note: Welcome to our thirdAGE 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.
The first week of this riddle, the patient reported her symptoms to her PCP. The doctor proceeded with the examination using the classic S-O-A-P notes as follows:
S=Symptoms or Chief Complaint
A=Assessment or Analysis
P=Treatment Plan or Recommendation
Last week, we let you know what some people had suggested as possible diagnoses. This week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!
The Doctor Reveals the Diagnosis
Thumbs up to Georgia L. for guessing the correct diagnosis! Barbara did indeed have calcium kidney stones. The tip off was high calcium in the urine, often from a type of kidney leak of calcium that is hereditary. Georgia is correct that Barbara’s father’s generation often did not discuss personal medical issues in detail with family members. That’s a big mistake, since family medical history can help with diagnoses of family members’ medical issues.
Also, Georgia is right about the fact that plenty of people think that only men get kidney stones, even though women can get them as well. In Barbara’s case, the family predisposition to the calcium stones was precipitated by her dehydration and her intake of Tums, which are almost pure calcium. Dehydration leads to calcified urine sediments or crystals that solidify, enlarge, and then drop through the tiny part of the ureter called the lumen. The sharp, crystallized stone “cut” or irritated Barbara’s ureter on the way down, leading to severe pain and eventually microscopic or even “grossly visible” blood in the urine. Her pain finally stopped after the stone passed on its own into the large bladder.
Fortunately for Barbara, the blood in her urine was a sign that she needed to be checked out even though the pain stopped. Some people may have microscopic blood in the urine and not even know it!
The doctor advised Barbara to avoid dehydration by drinking lots of fluids throughout day. He told her to get dietary calcium from yogurt, milk, and cheese because she needs calcium to help prevent bone loss, and she loses calcium in her urine due to her hereditary condition. He prescribed Hydrochlorothiazide (HCTZ) 25 mg daily to stop the renal leak of calcium given her history and family history of stones. He also told Barbara NOT to take calcium supplements or Tums.