Don't F around with LRQ pain

PSA from a woman with a very sore belly

Like most anxious people, I freak out and start googling "appendicitis” every time I feel a twinge anywhere in my abdomen. Usually, this reassures me that I’m not going to die any time soon, and then the pain passes. Which is exactly what happened when I woke up with bad abdominal pain on Friday night.

When I say “bad,” I mean I couldn’t find a comfortable position to get back to sleep in bed or in a recliner in the living room. But it wasn’t bad like the time in 2014 when a post-surgical adhesion caused a bowel obstruction that sent me to the ER. That was 11 out of 10 pain, the kind where all I could do was lie in the fetal position and weep. (Luckily, it spontaneously resolved before they could get me into the OR.) Friday’s pain also wasn’t bad like a 9 out of 10 migraine, where I can only lie in a dark room and hope to fall asleep. It wasn’t bad like the recurrent abdominal pain that sent me to a zillion doctors in my last year of high school, none of whom could find an obvious cause. (Many years later, I read about abdominal migraines, which might explain that.) And it wasn’t bad like the abdominal pain that made me call an ambulance in the middle of the night when I was about 26. (Again, no obvious cause; the best guess was that a small ovarian cyst might have burst.)

The pain I had on Friday night and very early Saturday morning was between 6 and 7, according to my personal pain threshold. (Have you read Eula Biss’s wonderful essay “The Pain Scale,” by the way? If not, go do that. It’s much more interesting than this.) During that time, I Googled to reassure myself that there was no need to wake up Al and go to the ER in the middle of the night. No fever, no nausea, no vomiting, no 10 out of 10 pain. It felt a bit worse on the right side but was mostly all over. I’m on a new medication that delays digestion, and I figured it was my body reminding me that I cannot eat a big, rich dinner and dessert while I’m on it.

By daylight Saturday, the pain was down to 3 or 4, and I was able to sleep. I didn’t feel great overall, but it wasn’t interfering with my life anymore, so I just had an easy day in front of the TV. The only slightly concerning thing was that it seemed to be completely localized on the lower right. But I still had zero other symptoms of appendicitis, and it didn’t make sense that I’d feel better if that was the problem. (NB, I learned from Dr. Google that sometimes people get pain relief when the appendix bursts—but if that had happened, I would have started having symptoms of infection.)

On Sunday, the pain was better still—0 when sitting still, no more than 2 when moving around—and I figured I’d most likely just done a number on some bend in my intestines (which is not great, obviously, but also not something that requires immediate surgery). I ignored it for most of the day and Googled a few more times to reassure myself the only vaguely concerning thing was the location. The area hurt when I poked at it, but felt better when I stopped, and appendicitis is supposed to hurt more when you release the poke. It just didn’t fit.

Nevertheless, I thought to google “appendicitis stories” to see if it brought up any anecdotes about appendicitis presenting without excruciating pain. There were a few. Then I decided to ask a group chat if anyone in there had experience with appendicitis that looked weird. No one had, but they bullied me about going to the doctor for reassurance. I said I’d think on it. I emailed my GP and described the symptoms, asked her if she thought an ER visit was warranted, given the aforementioned drug and lack of other symptoms. It was Sunday, so of course she didn’t answer right away.

Finally, around 4 p.m., I realized urgent care was going to close soon, and I was driving myself bonkers wondering what this mild but persistent pain was, so I decided I should just go in. I wanted to avoid the ER if I could, and I figured an urgent care doctor could give me a quick reassurance before dinner.

Unfortunately, all she could tell me was what I already knew: it could be a couple different things, and it sure didn’t seem like appendicitis, but given the location, she couldn’t rule it out. Her recommendation was to go to the ER and get an abdominal CT. Their policy was to treat any lower right quadrant pain like it’s the appendix until proven otherwise. Goddammit.

I told Al I wanted to stop for food on the way there, and he pointed out that I shouldn’t eat in case they needed to cut me open. I said I was pretty sure there was no way that was happening, but I guessed I could live without dinner for a couple of hours while I sat there waiting to be told nothing was wrong with me.

I walked into the ER on my own two feet and said, “Hi, I have some very mild pain in my lower right quadrant, and urgent care told me to come here to rule out appendicitis.” For the second of what would be at least 250 times, I ran through the list of other symptoms: no fever, no nausea, no vomiting, no diarrhea. Just pain, and barely that—like a pulled muscle or a big bruise—but in a worrying location.

Apparently, even if you’re walking and talking, the words “lower right quadrant” are a magic key that instantly unlocks the ER. (See also: “chest pain.”) They took me back and ordered a CT scan immediately. While we waited for the machine to become available, a doctor and student asked questions and poked at my gut. I told them I had a hysterectomy in 2013 that took everything but my ovaries, and it definitely felt nothing like a UTI. I told them again that I had no other symptoms, and the doctor pointed out to the student that 80% of people with appendicitis have diarrhea or vomiting.

“What else could this be?” he asked his student.

“Ovary?” said the student.

“Right, yes, that’s one. It could also be a [gallstone] lodged somewhere.” (He actually said “choleosomething stone,” but I don’t know what the exact word was and don’t care to learn.) “Could be colitis. Could be cancer,” he added, throwing a “Sorry, gotta teach the kid to be thorough” smile in my direction. The whole time, he was kneading my gut like a cat.

I had already thought of my right ovary, as well as the possibility that gallstones could be causing pain a little lower than one might expect—especially when the onset of pain was preceded by the aforementioned big, rich dinner. I had not thought of cancer, so that was fun to consider after they left, while I continued to wait for the CT.

I told Al not to bother coming in until we knew more, so I sat there reading Twitter and texting people hospital bed selfies with cheerful captions about how I was just being super-dramatic and only needed a test to confirm there was nothing wrong. Eventually, I got up to go to the bathroom, and when I returned to my room, there was someone there to pick me up for the CT scan.

“You… can walk?” he said.

“Yep!” I said, and followed him down the hall.

A short while later, I was back in my bed, and the doctor came in again.

“Unbelievable, Kathleen!” he greeted me. “They always tell you not everybody is a textbook case, but you are really not a textbook case.”

“Well, shit,” I said.

“I’m sorry, but yes, your appendix is inflamed, and you’ll be having surgery tonight.”

And so I did. With one exception, they just used the same holes from my hysterectomy. The appendix was inflamed but not perforated, so it was all pretty uneventful. Got home yesterday afternoon, sore but fine. Murray is sulky as hell because he’s not allowed to jump on me.

I feel incredibly lucky that I never had to deal with all the typical misery of appendicitis, yet experienced just enough pain to get it checked out before things went really bad. This means, of course, that I will forever be the annoying person who says, “JUST GO TO THE ER!” when people are looking for reasons not to. Thank you to the friends in my group chat who were those people on Sunday.

Don’t fuck around with lower right quadrant pain. This is my message to the world. And now I am going back to sleep, delighted that I will never again have to wonder if it’s my appendix.