What’s wrong with me, hospital clueless

If they want to discharge you without coming to a conclusion or say it was something that you don't feel is right, can you not invoke Martha's Rule to request an independent second opinion? I'm not sure how you do that, but there's supposed to be information about it in every NHS hospital now, isn't there?

No worries! It can be tough on threads like these that have a lot of updates. OP posted her gallbladder scan was clear at 10:55 today.

Hey sorry, we cross posted. I think we’re saying the same thing and wording it differently, or that I’m still misunderstanding? I’m sorry about that; normally I can understand these things. To me, that is a diagnostic test - if it’s positive, then they can consider a possible blood clot (and yes, possible other others). If it’s negative, then a blood clot isn’t possible. I think maybe this is the part I’m misunderstanding: so a blood clot is possible without a raised d-dimer? And yes, unfortunately, had a few “raised but okay” D-dimers, which is maybe why I’m confused (and sorry about this @elm26 - it wasn’t my intent to derail the thread and I really appreciate @Greybeardy and @JulietteHasAGun sharing their knowledge with me. ♥️

May have missed it but where does it say she has had a scan of gallbladder?

I think you’re misunderstanding me? Yes, a raised D-dimer may indicate other things, but it IS used as the first diagnostic test for a clot - if it is positive, THEN they will do more testing, like a CTPA or a Doppler test. If it is negative, then they are not going to perform any additional testing for a clot, which is why I asked OP about blood tests. I have been through this several times in my own life, unfortunately - D-dimer is not specific only to clots, that’s true, but if it is raised, only then would further testing be performed, according to my consultant (I had a tough time in hospital this past February). But! Maybe there’s something I’m missing? I know going through it as a patient is not going to make me as educated about it as a medical professional, so I’m fully aware maybe I’m still missing something here.

yes, you have misunderstood. A negative d-dimer excludes a clot. A positive d-dimer could be due to a whole number of things, including clots, but also lots of other things (including inflammation, infection, pregnancy, cancer, post surgery, haematoma's outside the vascular system etc etc). If someone scores low on the risk predictors then doing a d-dimer may be useful in confirming that there isn't a clot. If they score highly they should have imaging. What happens in real life more often than not is that someone thinks they're being helpful by doing the test and actually make things more complicated when it comes back mildly positive for other reasons.

Could be ovarian torsion! Where the ovary twists on itself. It’s apparently agony but not very easy to spot. Push them on this and explicitly ask ‘how do you know for certain it is not ovarian torsion?’. I tend to find approaching things in that way ‘tell me how you know it is not x thing’ is usually really useful as it makes them wonder how they would defend their decision making if they got it wrong and they have to admit they don’t know for sure meaning they will keep looking.

Anyway nothing that the OP has posted screams blood clot to me. No chest pain or breathlessness. No leg pain or swelling. Dd had a PE and the chest pain was severe. But she didn’t have back pain or shoulder pain. Nor could she not pass urine.

But her pain hasn’t been dismissed. She’s had three scans (including of her gallbladder). Women are often dismissed but the OP has had a lot of imaging in a short amount of time which has not shown a cause for her pain, that is not the fault of the clinical team.

Nope. A raised d dimer does not diagnose a clot. It can indicate there may be a clot but lots of other things can cause a high level, muscle strain, pregnancy.

a ctpa or a vq scan will diagnose a PE and a doppler scan will diagnose a dvt

Hunh? Maybe I’ve drastically misunderstood all the tests I’ve had? My understanding and Google seems to agree: A D-dimer blood test IS the test for diagnosing DVT and PE; high levels indicate a clot but not where it is.

Actually both are true. Shoulder tip pain is usually caused by irritation to the phrenic nerve, usually from blood (such as from a ruptured ectopic), or air (from some gynae procedures). It’s also common following caesareans where they don’t pump you full of air. 😊

You might have passed a small stone but ureter can stay in a prolonged spasm. Another possibility intermittent ovarian torsion or nerve irritation.

blood clots are not diagnosed using blood tests. They can sometimes be excluded using a blood test, but that's probably not appropriate in this scenario. Fortunately the doctors looking after the OP will know that.

My money is on a kidney stone

Thought the same!!

Have they mentioned if your blood infection markers are normal? Low stats can be an infection. Blood clots should show on a blood test, but I don’t know if it’s on the routine ones. But this all needs to be discussed because you can’t leave the hospital and care for the children, especially a baby and a toddler, until you have a solution for the pain. It sounds like it’s only manageable right now on Oramorph and codeine.

I'm sorry you're still none the wiser. I hope the surgical team can help tomorrow.

So, a couple of related possibilities.

How many periods have you had if you’re six months post-partum? Was this your first? I find it incredibly suspicious that you had a heavy period and then this happened. Right after your period would be when your uterus is at its thinnest, and I’m wondering if you have previous adhesions from either your endo or your laparoscopies themselves, and you essentially “ripped” one of their adhesions.

Unfortunately, and I’m sure you know this, it’s very common to not know the extent of endo until surgical exploration. But I would not be surprised to discover that you had/have something pressing on the “neck” of your bladder, which stopped you weeing - whatever it is has possibly shifted a bit to allow you to wee now, but you’re still not well enough to go home, and unfortunately, it means you could lose the ability to wee again. Have they palpitated around the (tiny) scars from your previous laparoscopies to see how that corresponds to the pain?

Please discuss the possibility of adhesions, from endo itself, pregnancy, or past surgeries with the surgical team tomorrow. I hope they would not send them to see you just to tell you, “Oh well, good luck.”

Back and shoulder pain and low blood pressure? Have they checked you for pulmonary embolism or a blood clot?

If they're encouraging you to eat do try to eat something to see what that does to the symptoms.

Also try walking around the bay / ward - to see if you can / how much it hurts.

Try a shower if you can - warm water might help the pain, being less hot and sticky should feel good. If it doesn't help you have more info for the doctors.

Talk to the nursing staff about whether you need laxatives to go with your morphine - don't add constipation to the problem list.

I would have agreed with you before experiencing endless dismissal of my own similar symptoms. “As bad as labour pain” = you must be very anxious as a first time mum. No actually, I’m in pain. 1-3 in 100 women need their gall bladders removed in the year post partum according to the literature, and not one medical professional considered it for me until I self diagnosed and found someone sympathetic enough to give me scan.

The medical profession dismissing women’s pain is also well documented.

to me sounds like Gallstones