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CorpsmanUp, Former U.S.Navy, Hospital Corpsman
Category: Health
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Experience:  Over 4 years of providing direct, clinical medical care.
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Appendix Stone and overall health

Resolved Question:

Keep in mind that there are 4 MD's in my doctor office, and most times I see a different one everytime I visit. I am concerned that something is being overlooked and I am not feeling so confident about a current diagnosis therefore, I am looking for some answers or opinions.

In early March 06 I went to the doctor due to some pain in my upper right abdomen and rib cage area, adominal bloating, nausea and overall bad digestive health. I also was fighting an upper respitory infection at the time. The doctor prescribed an antibiotic for the respitory infection, but also assumed my gallbladder may be going bad and ordered a blood test. He informed me that the blood test came back normal, and if I continued to experience abdominal pain to come back to the office. I continued to feel bad but assumed it was due to the virus and would eventually clear up.
In later March 06, I returned to the doctor due to the fact that I was still feeling pretty bad, my digestive health and the shooting pains were not going away. In addition I felt ill after most meals and I was beginning to experience pain in my chest area (like my food was not going down), I also was experiencing regurgitation of food. The doctor I saw at that time ordered an upper GI, I was informed that the results were normal. Please note at this time, my temperature was taken by the nurse who informed me that I had a low grade fever (99.8) and noted it on intake. The doctor did not mention the fever and I never inquired further.
I went back in early April for a pre-scheduled appointment with regard to MRI results for some bone spurs I have in my neck. At that time the nurse took my temperature and mentioned again that it was (99.9). I still was not feeling the greatest and was experiencing a lot of pain in my back and rib cage area. The doctor informed me that it was due to the compressed nerve in my neck from the bone spurs and prescribed antiinflammatory and muscle relaxors.
About 2 weeks later the pain continued, even though I religiously was taking the medicines prescribed. I went back yet again and saw one of the other docs, who explained the pain in my back was muscle spasms and put some sort of injections in 5 of the muscles in my back and suggested physical therapy. The nurse took my temp again but never mentioned to me what it was.
At the end of April I went on a business trip. I became violently ill for one evening with vomiting and diarreah. I was also experiencing horrible shooting pains in my back.
I passed this off as the flu or something I ate. However I continued to feel shooting pains, bloating, etc.
At the beginning of May I woke up one morning and began having severe colicky pain in my lower right abdomen, just below my waist line. The pain was very colicky and intense, I could not stand or sit. It felt similar to child birth contractions. The pain felt like it was "inside" and actually radiated to my rectal area. I was considering going to the emergency room, but is slowly subsided and dissapeared in about 40 minutes. There was no vomiting or digestive issues associated with this episode. It concerned me, but honestly I didn't want to go back to the doctor yet again with another symptom that was going to be brushed off. About 3 days later, I woke up again with a similar attack in the same location but not as severe. I made an appointment that day and went to the doc. The nurse on intake again noted a low grade fever. I saw yet another doctor who informed me that it was classic symptons for kidney stones and he highly suspected it. He did a urinalysis while I was in the office. He informed me that the results indicated blood in my urine and an elevated white blood cell count which confirmed his suspicions. He prescribed me some pain meds and told me to drink a lot of water. He also told me to schedule a cat scan and he would contact me with the results. I received the cat scan results yesterday. The doctor informed me that he saw no kidney stones but did find a stone in my appendix. However, the appendix is not distended and there is no infection. His diagnosis was that I did have some kidney stones which I must have passed. We will take a wait and see approach to the stone in my appendix. If I have any fever, vomiting or additional pain to go to the emergency room. I explained to him that I continued to have shooting pains on my right side and around my belly button area since the last attack, I have had a daily headache that will not go away with advil, and I have been extrememly tired. He basically brished this off and said just wait and see. When I questioned the low grade fever and WBC he never really answered me. I took my temp last night when I got off the phone with him and it is 99.5 Granted my temp in the past before all of this started was in normal range. I have never ran a higher temperature and it has been quite awhile now that it has been above normal for "me".
At the present time, I am still getting the shooting pains, aching in my hips and legs, a fever at 99 and horrible headaches. I am beginning to feel nauseous from the headache.

I am looking for answers or opinions on the following items:

A) Why would my temperature and WBC count be elevated? Doesn't this indicate an infection somewhere?

B) Is it normal to have an appendix stone without appendicitis? And is it gauranteed to lead to appendicitis or will it just stay there?

C) Can a CT scan be read incorreclty, have appendix stones been mistaken for something else?

D) Do I now panic everytime I feel nauseous? I feel this way often. Do I run to the emergency room?

E) The daily headache, fatigue and overall ill feeling is really starting to effect me. Any other suggestions of what these symptoms might reflect?

F) Can these symptoms I have indicate that an infection might be present that the doctor cannot see?

G) Can they just remove the stone? Why wouldn't my doctor suggest this considering how I have been feeling?

Finally, do you think my doctors office is being through or just brushing me off? What kind of doc should I have re-evaluate these problems?

Sorry its so long, I just feel the need to be very through at this point. Thank you.
Submitted: 8 years ago.
Category: Health
Expert:  CorpsmanUp replied 8 years ago.
These are my answers to your questions:

A. Yes. An elevated WBC and temp are common signs of infection. Though they really don't pinpoint an infection, it does give the doctor clues that there might be one.

B. Appendix stones are the leading cause of appendicitis. This stone is made up of fecal matter and in every case that I have researched, it eventually causes a blockage which leads to infection.

C. CT scans are extremely accurate. Though your doctor may read them, they are also read by a radiologist who is a specialist at reading CT scans, x-rays, and MRIs. I would highly doubt that the appendix stones would be mistaken for something else given your symptoms and general history.

D. I wouldn't panic. This will probably do more harm to you than good considering what I can only imagine your stress level already is. If you feel extremely nauseas, start vomiting, or have a high temp(greater than 101.5) you should go to the ER just in case.

E. It is possible that you may be having some psychological changes as well. Since this has been going on so long, this can cause your symptoms to be overstated. I don't doubt that you feel this way given, again your general history with this problem, and also the feeling of being brushed off.

F. I think that it is very possible that these indicate a chronic infection. I will talk more about this after I finish your questions.

G. Your doctor should send you to have surgery. The surgeon will most likely remove your appendix also with the stone.

Overall: I think that you should go back to see the doctor, get another CT scan, and if the stone is still there, request surgery to remove it. As stated above, the surgeon will remove the appendix also. Your symptoms do go along with appendicitis but the time frame doesn't go along with anything that I know of or have researched about appendicitis. My suggestion is get the CT scan, request to have your appendix removed. Before having the surgery I would also request a lower GI endoscopy along with biopsy of mucus material from the lower GI and also from your stomach just to rule out an infection such as H. Pylori. It is possible that your doctors are just not giving you their upmost attention with this. They may just not know where to go from here. Since you have been to 4 general doctors already, I suggest seeing an internal medicine doctor about having the surgery and the GI scopes. I hope this helps. I am by far no expert yet on something this advanced but I have answered your questions based on my past experience with patients and also medical research. If this answer helps please hit the accept button. If you have any other questions or if you need me to explain any of my answers feel free to ask. Thank you.

Customer: replied 8 years ago.
Reply to James's Post: Thank you for your response, just a few more questions/clarifications. Actually, quite a few, sorry.

I just had the CT scan last Friday, you think I should request another one this soon? Are you sugesting this because there is a possiblility that the stone in my appendix can pass? Is there even a possibility that it can just pass on its own? I guess what I am trying to understand is, is this something like a kidney stone or is it something that almost always will lead to appendicitis and I should have the surgery. I guess I am confused due to my doc's response just wait and see versus all of the horrible stories I hear about appendicitis and that it can be painful and life threatning. In addition, since I have been feeling crappy for so long now, I just want to feel better again. I also have some travel for business and pleasure coming up and would hate for something to happen while I am on the road.

The other part of my confusion is as you said the time frame of my symptoms. I bet this is what is confusing my doctor as well. I tried to find information with regard to Appendix stones and all that consistently comes up is appendicitis leading me to believe this is always the case. However, I did find the following information...Although recurrent appendicitis is uncommon, data confirm that it does occur. The condition should be suspected in patients with a history of severe right lower quadrant pain that recurs frequently and resolves spontaneously. If careful history taking, physical examination, and the use of modern radiographic methods implicate the appendix as the culprit, surgery can be curative.

Actually there were quite a few medical articles with regard to reoccuring appendicitis.

Alright, so you are suggesting I go see an Internal Medicine doctor? I suppose I should bring copies of the cat scan report and films I just recently had. Is there anything else I should communicate that you feel would be important in receiving a proper diagnosis?

Last but not least, please advise on the following:

A) The cat scan I recently had was of the abdominal and pelvic region. No dye. Should I suggest having one with dye? Does that give a doc more information or is it pretty much the same thing?

B) I had an upper GI about a month ago that was normal. Could the radiologist have saw the appendix stone at that time? Or does an upper GI just reflect the upper abdominal area only? The appendix is in the lower abdominal area correct?

C) The endoscopy that you are suggesting, what organs does the doctor see then? Is this a better picture or a different picture of a different area not viewable on the cat scan.

The reason I ask and am trying to understand what these tests reflect and what areas are connected to this general area that the doctor may not be seeing.

Thanks so much for your help, I know I am compeltely taking advantage of your knowledge.
Expert:  CorpsmanUp replied 8 years ago.
I have a few questions before I answer yours. This will help me a lot in confirming what I think is going on.

Do you sometimes have burning with urination?

Have you had to urinate more frequently than normal?

Does it feel like your pain moves around to different areas of your abdomen and below or does it mostly stay in one spot?

Write back and I will help you more with this. Thanks.

Customer: replied 8 years ago.
Reply to James's Post: No Burning.

Yes I am urinating more often, however I have been drinking a lot more water in recent months due to the heat here in Vegas and since the original diagnosis of the kidney stones and the doctors instruction.

The 2 severe colicky-child birth-wave attacks of pain I had recently were in the same exact area lower right abdomen down low (below the waistline). The pain I have had since then and prior to the attacks is a shooting type of pain between my belly button and the area where the attack occured. In addition I have a sharp pain that occurs on the same side near my rib cage, further up.

Expert:  CorpsmanUp replied 8 years ago.
Alright, I assumed that it had been a month since your last CT scan. Since you have had one not too long ago I don't see the point of getting another one just yet. Your symptoms go along with 2 possible causes.

1. An inflammed appendix. I doubt that you have appendicitis just based on the length of time this has been going on but it should still be ruled out. I have never heard of appendicitis going on this long without turning into a severe infection with the risk of the person dying. I have researched this and found that in rare cases appendicitis can resolve itself in some people, the chance of a recurring infection is highly likely though. The right lower quadrant pain, pain around the bellybutton, elevated WBC, and slight fever are all indicators that the appendix may be inflammed.

2. Kidney stones: I didn't even grasp the fact that some of your symptoms go along with kidney stones also. Your answer today also comfirmed that this should be ruled out. The frequent need to urinate (even though you have increased your water intake), pain in your back or flank area, blood in the urine, and slight fever might indicate a presence of kidney stones. The doctor said that a stone was found in the appendix. In my experience, I have learned that when dealing with x-rays and CT scans, it is possible to mistake an object as being higher or lower than it really is because it is hard to verify the internal organ landmarks thus sometimes not being able to verify the depth of an object. Using a dye with a CT scan just makes the scan clearer for the doctor to read.

Personally, I still suggest seeing an internal medicine doctor. He/she will be able to spend more time on finding out what is wrong and they have a strong knowledge base of internal conditions that a general doctor may not have.
I have to take back my statement about the lower GI endoscopy for right now. This procedure looks at the large intestine and can find ulcers and inflammation, but I think that there are more tests that need to be done first.

Ask your new doctor to order an ultrasound of your abdomen (covering your appendix area as well) and of your urinary tract to rule out kidney stones. This procedure gives the doctor an image of the organ(s) that are in question and can be taken from different angles to get a 'full" view. The doctor may want to take an x-ray of your abdomen and lower abdomen also. If a kidney stone or an appendix stone show up, the doctor can use this as a landmark of where to focus most on the ultrasound.
I think with these 2 tests the doctor should be able to find out what is causing your pain and if not then kidney and appendix problems can be ruled out making it easier for the doctor to narrow down his/her focus on your symptoms. The doctor may also re-order blood work and a urine test to check for changes since your last tests. Make sure to bring everything that you have had done and your doctor's notes. If this answer helps please hit the accept button. Thank you.


CorpsmanUp, Former U.S.Navy, Hospital Corpsman
Category: Health
Satisfied Customers: 911
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