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Severe abdominal pain in my 12 year old daughter

(66 Posts)
Castlecellar Sat 29-Jun-13 10:11:37

Hi,

I have not used this site before but I am at the end of my tether and am really worried about my daughter, I don't know where to turn!

My daughter is 12 years old and has been having severe abdominal pains. She started her periods in January so knows that the pain is different to the normal period pain (as if that wasn't enough, poor girl!). She has had two episodes, one lasting for 10 days in March/April and a current one which has now lasted a week.

The pain seems to move around her abdominal area and up the back, she describes the pain in her back as a knife trying to stab its way out and the stabbing pain can also come and go in the abdominal area. As well as this, she has an ache in her stomach which gets a lot worse when she is moving. During this current episode she has a lot of pain in her upper back too and around the rib cage on the front, she can't bear any pressure on the ribs or tummy. She is also describing the pain going in her hips and down into her thighs. My daughter is a big eater, she loves her food but is off her food with these episodes. She does drink, only water (when normally it would have to have squash in it!). She is also weak and feels like her eyes are going to close. When she does move around she says she thinks she is going to pass out she is so dizzy.

The first episode started in March, she had to have 2 days off school (most of the time was during the Easter holidays) and this time she has had 3 days off school so far.

The first time she had it I took her to the docs and they treated her for a kidney infection as she had blood and protein in her urine and after 2 days of taking the tablets she was better. This time, there are no signs of blood but there was protein, but it is most definitely the same pain. The docs have said that it is likely to be an abdominal migraine, which I had never heard of.

I took her to A&E yesterday morning as the pain was that bad, they did blood tests and checked kidney, pancreas and gall bladder and everything came back negative.

After doing some research, it says that the these migraines can last for one hour to 3 days but hers are much longer. Has anyone experienced any of this? I am sorry for rambling but I thought best to tell everything.

Thank You!!

Floralnomad Sat 29-Jun-13 10:51:51

It may be worth asking them to rule out coeliac disease , my daughter was diagnosed at 11 after about 2 years of abdominal issues and fainting episodes . Hope she feels better soon and you get to the bottom of her problems .

Pintoe Sat 29-Jun-13 14:38:27

My daughter was also diagnosed with Coeliac Disease at 11 after stomach problems since she was eight. She was sometimes so weak she couldn't walk very far, also was very pale, thin hair, lost weight. She is like a different child now!! Hope your daughter feels better soon.

Castlecellar Sun 30-Jun-13 07:51:57

Thank you for your replies, how did they test for Coeliac disease? We went back to A&E yesterday evening as she was no better. They have prescribed her cocodamol but still don't know what it is. They said these things can go unexplained in children, which I am not happy with. She hasn't been to school, isn't eating and is so dizzy that she stumbles when she is standing!

pollywollydoodle Sun 30-Jun-13 08:07:41

uncommon but it's worth ruling out Addison's Disease

ask your gp for a referral to a paediatrician

Floralnomad Sun 30-Jun-13 09:13:12

Coeliac a is tested for by a blood test followed by a endoscopic biopsy . You do need to be loaded with gluten though so don't be tempted to go gluten free before hand to see if it helps . My mother has Addisons and I would have thought if it was that she would have been more acutely ill IYSWIM. Definitely push for a referral to a paediatrician though . I'd also be cautious about taking too many co-codamol as they can be very constipating which is a whole other problem . Before we were diagnosed my daughter had been misdiagnosed as constipation , appendicitis and mesenteric adonitis also I did get the impression that some medical professionals thought she was putting it on .

pollywollydoodle Sun 30-Jun-13 09:20:18

floral not always. AD is one of those diagnoses that get missed and kids can end up in eating disorder clinics/surgical exploration etc

Floralnomad Sun 30-Jun-13 09:29:12

Fair enough , I only have experience of it from my mother and she was diagnosed in the dark ages but I do know it didn't 'come and go' , she was emaciated , her skin went brown and she literally couldn't stand . I just find it worrying when people are told that things can go unexplained in children , my daughter has CFS now , I have no idea if its related to how long it took to get a diagnoses on the coeliacs , probably not , but we will never know and it has severely impacted on her life and education.

StuntNun Sun 30-Jun-13 09:37:20

My DS2 has abdominal migraines and they're nothing like what you describe, although he could have a mild case I suppose. He gets stomach aches and becomes quite listless; he can't eat, sleep or concentrate until they pass. He is treated with Sanomigran, if abdominal migraine is suspected then she should be treated as it is usually a diagnosis of exclusion. If the medicine works then it is abdominal migraine. Do you have any family history of migraines?

Castlecellar Sun 30-Jun-13 14:05:00

Yes I have head migraines and they started with me when I was going through puberty. I have looked on the Internet though, and as far as I can see they only last for up to 3 days and the pain in abdominal and doesn't go into the back, pelvis and thighs like hers does? We're on day 9 now, every movement is painful for her, even going over bumps on the motorway and round corners! Something is really not right!

notaverynicemum Sun 30-Jun-13 14:14:22

How are her bowels?? My DD was 10 when finally (after 3 years plus) diagnosed with a bowel issue - no real name for it but medication now controls it. Basically her bowel works spoadically.

I have the same/similar condition and can have bouts that are agonising. Affecting my hips and ribs similar to how you describe.

Its worse when I constipated as in seriously constipated. I may be passing stools but I am blocked further back up the colon.

notaverynicemum Sun 30-Jun-13 14:16:59

A simple xray can see how loaded the colon is. So perhaps it may be something to suggest to your GP.

I would suggest if you dont end up in A&E again today then you make an emergency appointment with your GP tomorrow and ask what they think it could be and how they can rule each possibility out. She cannot carry on like this.

Good luck.

intarsia Sun 30-Jun-13 14:21:23

Kidney stones??

Sparrow8 Sun 30-Jun-13 14:37:18

My friends dd ,11, has had abdominal problems for 3 years. They have finally found out that she is fructose intolerant! They are hoping that this has been the issue all along. Her pain would last for a few weeks at a time and then she would be fine. At one point they thought it was a problem with her gall bladder and were thinking about removing it.

Castlecellar Sun 30-Jun-13 14:52:22

I would of been happier for the doctors at A&E to have at least given her an X-ray or ultrasound, then I could have ruled out some of the above that have been mentioned. I am no doctor but I do know my daughter, I have never been a pushy mum on these kind of things but I am quite tempted to take her back once again and demand something more to be done. Cocodamol is just making her fall asleep and masking whatever it is.

Castlecellar Sun 30-Jun-13 14:54:26

Her bowels do seen normal, she is going every day for what she says is normal size.

StuntNun Sun 30-Jun-13 20:23:27

My dad has migraines and doctors have tried to push that diagnosis on me in the past just because there's a family history. It has turned out to be eye strain, teeth clenching and viral encephalitis but never migraine! Maybe they see abdominal migraine as an obvious diagnosis but it does sound more severe than my (admittedly limited) experience of my DS2's migraines.

Viviennemary Sun 30-Jun-13 20:29:33

I think you need to take her back to the doctors and get answers. (Easier said than done I know) But nobody should have to suffer that level of pain. Hope you get it sorted out.

ExcuseTypos Sun 30-Jun-13 20:33:10

Don't worry about being pushy, you have to get to the bottom of it.

I'd go back to A and E tonight or if shes asleep now, in the morning and insist on a scan/x rays. A Dr can't just dismiss that amount of pain as 'unexplained'

RandomMess Sun 30-Jun-13 20:36:05

It could be something like an ovarian cyst too - they can come and go with your cycle and yes they can happen in young girls at the very start of puberty.

dot91 Sun 30-Jun-13 20:36:19

My daughter gets these sore stomachs they started when she was 11 and she still occasionally gets them now. Like your daughter she had lots of tests and it was diagnosed as being brought on by stress. When she was younger it was when she took part in singing competitions although she didn't feel she was worried about it and definately no pressure from us but as soon as she sang the pain went. She has been on omeprazole for her tummy but it didn't work it just needs to ru its course usually a week of very bad pain the most recent one was just before she sat her standard grades .

Castlecellar Sun 30-Jun-13 20:59:54

She is sleepy now but will definitely take her back in the morning and demand to have scan etc. she has been taking omerpazole since Wednesday and that's not helped (although I don't know how long it takes to start working). Looking at the signs for ovarian cyst, that sounds like a possibility, pain in pelvis , back , thigh and ribs. After a horrid couple of hours this afternoon, I am ready to be a very pushy mum. Thank you all for your comments, it certainly makes me feel like I'm not being a neurotic mum smile

ExcuseTypos Sun 30-Jun-13 21:04:21

No you're not being neurotic, mums have to be pushy sometimes.smile

idiot55 Sun 30-Jun-13 21:48:25

I was going to post re ovarian cyst too, I see its been said. Defiantly ask for an abdominal ultrasound, hope you get things sorted xx

RandomMess Sun 30-Jun-13 22:00:59

I know of 1 11 year old in real life and 2 other young girls on here who've had ovarian cysts that were completely dismissed etc. Please please insist on them exploring that avenue thoroughly.

Whataloser Sun 30-Jun-13 22:05:15

I'm not posting to scare you, I'm posting to support you.

But my dd had abdomnial pain and consultants were fobbing it off by saying all adolescent girls have abdoment pain. I said that wasn't a good enough reason.

I had to fight to get scans and exploratory operations as I wouldn't back down. My dd had cancer.

I hope I've convinced that one consultant to take more notice of a mother's intuition in the future.

Tigerblue Mon 01-Jul-13 10:35:18

It might be worth asking her to press on both sides of her stomach. If it's worse on the left, there's a chance it could be her appendix playing up. My daughter was regularly feeling under the weather and one day was noticeably worse with stomach pains which she described all over between her pubic bone and tummy button, and then she produced green sick. We took her into A&E and on examination (tummy being pressed) she was clearly in more pain one side than the other.

Again you (or she) presses on her tummy and it's more painful one side then that could be a pointer to a problem with her ovaries or something else in a similar area.

You know she isn't right. If you are having no look with the doctors, do keep taking her to the hospital via A&E - the time to have her looked at is when the pain is at it's worst.

Castlecellar Mon 01-Jul-13 14:00:22

Got the ultrasound for 3pm on Thursday! They said even if I went back to A&E , they would not see her before then. She keeps trembling now and goes deathly white, she was in the docs when she did it and he didn't seem too worried, I AM! Booked her in for a private ultrasound at 10am tomorrow morning, I think I'll have more confidence in a private hospital now. Although we can't afford to have any more than the scan done. If she goes funny again I will just call an ambulance.

Castlecellar Mon 01-Jul-13 14:01:21

Looking at ovarian cysts, it could be. Probably more so than gall stones which the doctor thought today!

RandomMess Mon 01-Jul-13 17:29:47

OMG why do they not take these things seriously.

Girl I know in RL was a large cyst on the outside of her ovary so no long term complications but it's size was making the fallopian tube twist which was what was causing the excrutiating pain.

It just gives me the rage especially when there could be long term consequences because they refused to take girls more seriously.

ExcuseTypos Mon 01-Jul-13 21:06:49

Castle, I'm glad you've been able to sort a scan out- even if you've had to do it yourselfangry

Good luck tomorrow.

MarshmallowFarm Mon 01-Jul-13 21:15:03

I had several episodes exactly as you describe when I was 14 - appendicitis was always dismissed as the pain wasn't in the right place, but of course that's exactly what it turned out to be - I saw loads of different doctors, umpteen tests then a locum GP decided to check white blood cell count in my blood and somehow diagnosed appendicitis from that. Your description of a knife sticking in is exactly how it felt.

Had a friend of the same age who had similar symptoms and hers turned out to be an ovarian cyst. IME young teenagers are not always taken seriously by the medical profession as everything is put down to "growing pains" or puberty.... please insist on a referral/further tests. Hope she/you get some answers soon x

Castlecellar Mon 01-Jul-13 22:20:22

Sounds awful but I do hope there is something on the scan tomorrow, firstly so it can be treated and make her better and secondly so I can say told you so! I have to say our local GP's have been much more proactive and understanding than A&E. I was relieved this afternoon that the scan was booked, now I'm feeling very very anxious. Need to try to sleep to be strong for her tomorrow

rundontwalk Mon 01-Jul-13 22:21:21

Came back to your thread today hoping you'd be further forward. Am grrrrr on your behalf! Nothing useful to add,but wanted to say what a fab mum you are smile

Castlecellar Tue 02-Jul-13 09:45:35

Back from the scan and it was clear, so not kidney or gall stones or cysts. I'm at a loss! Not sure what to do next. The pain on the car journey so was so intense she was gasping, she's still not eating and is feeling nauseous!

idiot55 Tue 02-Jul-13 11:25:16

That's good news , but wish they could find a cause. Can you phone your Gp?

Floralnomad Tue 02-Jul-13 14:03:19

I think you should push for some bloods to be done ( if they haven't already) if only to check for infection/ inflammatory markers ,so that things can be ruled out .

Madmog Tue 02-Jul-13 14:14:04

I know the pain is over quite an area, but do you know where it radiates from, ie is it worse over one side, in the middle. If it's worse on her left side, then it could be her appendix.

You know your daughter and if you know something really isn't right, then I'd be tempted to take her into a different A&E even if you have to travel.

Castlecellar Tue 02-Jul-13 15:57:59

OMG I am losing the plot! Went back to our local A&E and they were brilliant, gave her morphine got her seen by a doctor straight away. The doctor was the first one to examine her fully and said it was appendicitis. He made her hop on one foot and pushed both sides around her appendix.he also said that the appendix is really the only organ which can bounce around when in a car and cause that amount of pain. Also it was classic that it was treated with antibiotics in April to rear it's head again now! He got her transferred to our local paeds unit on to the surgeons ward.
She has been examined again to be told its not appendix! I am losing the will, just when we thought we had an answer. I just feel like breaking down! The doctor acted like I wanted her to have an operation but of course that's not the case, I just thought we had a fixable answer!

SoggySummer Tue 02-Jul-13 16:01:52

OMG - what an abasolute nightmare. SO where are you now? have they sent you home with no answers?

I would say "OK its not appencitis so tell me what it is please?" or " Tell me what you can test her for now because this extreme pain HAS to be something".

Wish I could do more to help you. Hopefully someone more medical than me or who know the system better can give you some advice.

Castlecellar Tue 02-Jul-13 16:07:56

The doctor at the new hospital said there was no way appendicitis would last 11 days??

ExcuseTypos Tue 02-Jul-13 16:26:53

You poor things.

Is she still in pain Castle? If so I'd take her straight back to A and E and say you aren't moving until someone finds out what is wrong with her.

If you have time, I think I'd be inclined to start a thread in AIBU. Something like 'Please help, I'm so worried about my DD' would gets lots of attention. It might just get someone answering who's been in the same situation.

Castlecellar Tue 02-Jul-13 18:38:31

Yes sent home again. They have done a test for helicopbacter which I will have the results for in 4 weeks with an outpatient appointment. He said send her to school and give her whatever she wants to eat! I'm not evil, she can have whatever she wants to eat , she just can't eat she feels too full up. She can't go to school , she is in too much pain. It's a 40 min drive back from the hospital and now the morphine has worn off she was in tears the whole time. The paediatrician said to prescribe omerpazole, which slightly concerned me as she was already on those and it was on her notes. He said to give it another week. I know these people are experts but out of 6 doctors we have been told, abdominal migraine, mid period cycle pain, gallstones, appendicitis, helicopbacter and acid ggggrrrrrrr

CinnamonAddict Tue 02-Jul-13 20:18:09

Please take her back to a&e if she is getting worse. It sounds an absolute nightmare. Have a brew and keep an eye on her.

ExcuseTypos Tue 02-Jul-13 20:25:21

I agree with Cinnamon, if she gets any worse take her back and insist she is admitted for observation. They cannot keep sending you away without any answers. They've seen her in acute pain they should find out what's causing it.

It's their job!

Found this and thought it might help you. With back, pelvic, stomach and leg pain it could be nerve related.

BlameItOnTheBogey Tue 02-Jul-13 23:33:01

I'd also start keeping a log of who you are seeing, when and what they are saying. And I 'd make it known that you were doing that. It's awful that you have to get arsey to get any answers but you are your daughters only advocate and it doesn't appear that anyone is giving you the time you need at the moment.

Good luck

notapizzaeater Tue 02-Jul-13 23:41:10

I'd take her back, my hubby has appendix and because they didn't believe that's what it was he ended up in a bed for 3 months whilst they kept running test after test, they eventually went in to have a look because it was Xmas and they wanted him out. His appendix had adhered to his bowel ....

Castlecellar Wed 03-Jul-13 06:22:51

What is the AIBU ?

Whataloser Wed 03-Jul-13 06:57:45

AIBU is am i being unreasonable it's a thread subject that has a high flow of traffic so someone will be able to answer.

If anyone thinks its appendicitis say you want to have the appendix removed, that they routinely remove it in boys if they have stomach pains even if no evidence if its not appendix. And once they are in there, if the appendix is not inflamed could they take the opportunity to look in surrounding area to see if they can see the cause.

wannabestressfree Wed 03-Jul-13 07:06:01

I had lots of episodes like this at 11 and throughout my teenage years. I was told I had 'colic' etc.
I was diagnosed with Crohn's disease in my early twenties. It's difficult to see and is better looked at during a flare up. I hope she feels better soon x

SofiaAmes Wed 03-Jul-13 07:21:48

It sounds like abdominal migraines. My ds had several rounds of suspected appendicitis until he got diagnosed with migraines. He had all sorts of other odd symptoms and finally last year we got him diagnosed with Functional Mitochondrial Disease as the cause of all the various issues he'd had for his first 11 years (migraines, cyclical vomiting, chronic fatigue, stomach aches, speech and visual issues, etc) and got him on a treatment of high doses of L-Carnitine and CoQ10 and he is now completely "cured." He'll have to take the high dose supplements for the rest of his life, but since they have absolutely no adverse side effects...and he's been healthy for a whole year, we're not complaining. Here's a fantastic website with information about Functional Mitochondrial Disease. The gp's are only just starting to even know it exists as a disease as it's only a few years that they can even do genetic testing on your mitochondria (my ds was lucky enough to have his done by a colleague of my father's as the insurance would never have paid for it...in USA). Ds' specialist finds that he often is able to diagnose and treat children with "vague" symptoms that other doctors send from one specialist to the next (tummy aches, headaches, chronic fatigue and/or general malaise seem to be common symptoms). Best of luck. I know how awful it can be having a child who is clearly in pain and having the doctors all scratch their head. (Over the years, I had a lot of accusations that my ds' illnesses were exaggerated/fabricated by me and it was so wonderful to get a real diagnosis and name to his disease AND to get a cure for it)

Castlecellar Wed 03-Jul-13 18:49:25

Could abdominal migraines last 12 days? I have had a look online but it seems that most are a maximum of 3 days.
She is still in the same pain today but has felt even more nauseous.
I have decided to book a private gastro doctor , am hoping we can get an appointment tomorrow. If it is abdominal migraine then hopefully we can eliminate some more things with a endoscopy

SofiaAmes Wed 03-Jul-13 19:06:07

Yes! I learned very early on that illness doesn't always follow the instructions. My ds had all sorts of symptoms that the doctors "had never seen before." He went blind for 3 days a few years ago from a migraine. His wonderful neurologist luckily had the sense to suggest that we try to treat it with migraine medicine before sending him to the hospital for a spinal tap (opthamologist's suggestion). I asked her if she had ever seen a migraine like this before and her response was no, but given ds' track record of weird symptoms, she was absolutely positive it was a migraine (and it turned out to be...his vision started coming back within hours of taking the medicines). He had abdominal migraines that lasted a week. And episodes of Cyclical Vomiting Syndrome (a migraine related condition) that lasted 2 weeks.
Please Google Dr. Boles and Cyclical Vomiting Syndrome (CVS) and you will find lots of papers on how he is successfully treating his patients. It may be that the high doses of L-carnitine and CoQ10 might just work on your dd and are so much better than the awful migraine drugs that ds was taking before.

By the way, it's my understanding that migraines start presenting in girls around puberty and they can be exacerbated by hormonal fluctuations. I believe that they are sometimes treated successfully by putting the girls on the pill (I know, not what you were planning for your 12 year old).

CinnamonAddict Wed 03-Jul-13 21:42:00

Castle I'm glad you are still so very much on her case. Tbh I find it odd that one doc definitely diagnosed appendix and the next rules it out again. Rollercoaster.
All the best for you and dd.

SofiaAmes Wed 03-Jul-13 22:22:12

CinnamonAddict, I have had this happen multiple times. The way it was explained to me by the surgeon who did finally take ds' appendix (infected) out. He said that until the appendix is in his hands, he can't tell for sure if it's infected. In ds' case he had some classic symptoms and a few odd ones that were not usual (as ds does) but the surgeon felt that he wanted to operate without doing a scan as no matter what the scan said, he wouldn't feel comfortable that it was correct and he was "95%" sure that ds had appendicitis. This same surgeon had seen ds 2 years earlier when pediatrician had sent him to emergency as he was sure he had appendicitis and the surgeon had not even done a scan because he was confident that he did not have appendicitis. We now know that it was probably an abdominal migraine (ds had not yet been diagnosed with migraines at that point). The symptoms are very very similar.

mumofapirate Wed 03-Jul-13 23:17:00

hope you get some answers tomorrow op. I've heard about abdominal migraine but like you've already said it wouldn't last 12 days

MrsGSR Thu 04-Jul-13 00:02:35

Just to add to whats been said about appendicitis, my sister had it last year. She had bad pain for a few days in January, then it cane back in July, when she had her appendix removed and was told that was the pain she had in January was probably a previous flare up of the appendix, which supprised me as I didn't realise that happened!

RandomMess Thu 04-Jul-13 18:33:04

HOpe you get some answers very soon, your poor dd sad

SoggySummer Fri 05-Jul-13 00:03:16

How is your DD today?

CinnamonAddict Fri 05-Jul-13 14:00:07

Hope your dd is ok.

notapizzaeater Fri 05-Jul-13 20:49:59

Hope you got some answers

Castlecellar Mon 08-Jul-13 20:57:23

Hi, thank you all for your messages. We were admitted to hospital on Thursday afternoon with suspected appendicitis once again. Once again the surgeons came and said it wasn't but they were going to perform a laparoscopy the following day if there was no change. After explaining to her about the procedure they put her on nil by mouth from midnight. At 10am the following morning, after a stressfull night with a very nervous/ scared daughter, they decided to cancel the procedure! They didn't really give me any reasons.
On Sunday she started to feel a bit better and started eating a bit more so we were discharged. She is still in pain and not able to go to school but not too bad. We still don't have a diagnosis, but they have said they will be doing an endoscopy as an outpatient in about 4 weeks time.
As she is still unable to go back to school, we have decided to keep the private appointment with a Paediatrician Gastro specialist to see if they can come up with a diagnosis.
The saga continues........
I will keep you updated

RandomMess Mon 08-Jul-13 20:59:18

Thanks for the update, I have been concerned. When is your private appointment?

SofiaAmes Mon 08-Jul-13 21:28:57

Castlecellar have they tried giving her migraine medicine like Imitrex or Frova? If it is a migraine you should be seeing a neurologist rather than a gastroenterologist. It really sounds like migraines to me. My ds started with headache migraines and would get this glazed look in his eyes (if he wasn't 9, I would have sworn he was stoned) and one eye slightly more squinting than the other. I recognized that his abdominal migraine was just that because although he didn't have a headache and had a sharp stomach ache, he had that "stoned" squinting look in his eyes. Ds thought I was crazy because I was so sure it was a head migraine that I kept asking him if he had a headache and he kept telling me it was his tummy not his head...like I just couldn't seem to tell the difference. Tummy pain went straight away as soon as I gave him the Frova (Imitrex didn't work on ds). A dark room and audiobooks are really helpful and relaxing too. I bought ds an ipad and a subscription to Audible.com when his migraines were at their worst.

FriedSprout Mon 08-Jul-13 23:37:22

Hi Castlecellar, sorry that our dd's problem has not been sorted yet. For what it's worth, my dd got a high temperature, felt sick and was in a huge amount of pain. Out of hours GP checked for appendix issues, but said that sometimes appendix did not present as typical when testing, ie usual external checks would not suggest appendix, but she still felt it may be the cause. She sent her to a&e.

After hours in outpatients, she was admitted because of the pain, but still no diagnosis. Stayed with her overnight and in the morning she was screaming with the pain. They still had no idea what the issue was but decided to do an exploratory op.

They found a burst appendix, one of the worst they had seen, "gunk everywhere" (technical term).

My point, if there is one, is that all of the physical checks they did prior to operating, pressing on area etc. and none of them flagged her appendix other than the degree of pain, sickness and high temperature.

My dd had never presented with any indication of problems prior to that day.

I so hope that you get to the bottom of your dd's problem, don't be afraid to ring for an ambulance if her pain gets too bad. If that out of hours GP had been blinkered to 'non-typical presenting appendix', my dd might have been in even worse trouble.
flowers

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