GP or A&E for this?

[ibdpatient]

Just some background I have ulcerative colitis (IBD) which isn’t in a flare up as I have had my large bowel removed 10 years ago after a peroration, leading to a stoma bag and then a reversal surgery, so I no longer have the bag but am missing my full colon. I had a flexi sig a few months ago and all looked ok, though I do still have ‘microscopic colitis’

My stools are normally loose but still ‘enough’ and I go around 3-4 times per day.

I have also had my gallbladder and appendix removed and have scar tissue on my lung from it collapsing in 2011. I had a C Section 4 years ago. Just so you have enough info!

Last night I randomly had an awful feeling of anxiety with palpitations - randomly and over nothing, and about an hour later I started experiencing intense pain in my jaw leading all the way down to my upper abdomen. It was a crushing pain that made me want to vomit (I didn’t) and also radiated all up my upper back. It lasted about 45 minutes. I’ve experienced this pain once before last year which lasted about 10 minutes so I never bothered looking into it. It was absolute agony & I was unable to do anything than curl up on the sofa. It passed at about 2:15am and I slept until 7:30am.

Ever since I woke up I have had explosive diarrhoea that is just water consistency, I’m going roughly every 30 minutes at the moment. I’m getting abdominal pain and sweating with the bowel movements. I’ve felt like I’m going to throw up all day (I haven’t, it’s rare that I ever throw up from nausea) and have had no appetite. When I stand up or walk even to the bathroom my head is dizzy and feels almost like it’s spinning, so I’ve been out of action all day which is a bit rubbish as it’s Mother’s Day.

I’m feeling really rubbish but I know GPs and hospitals have the 48 hour rule for any sickness/diarrhoea. I’m still able to get up to make a drink etc and I’ve been awake all day, just unable to do anything else.

Because of my history I do get more anxious about bowel related things, but at the same time know it’s maybe just a stomach bug. But it’s the mix of the pain last night paired with the symptoms today that’s making me question what to do. I’m sitting just now and my head feels wavy even doing nothing.

Any advice? I do have anal fissures so the diarrhoea is also causing a lot of pain down there.

A&E because it could be heart related

Me A & E with your history, unless you have an exceptional GP.

sounds absolutely awful, I hope you feel better soon!

Is there an adult at home with you?

@CatsLikeBoxes What makes you say that?

Call 111 and tell them everything that you have said here. They can arrange an urgent GP appointment for you or send you to A&E.

@SpringSprungALeak Yes my partner is at home with my. My local hospital I have a really negative history with (bowel perforated due to medical negligence, law suit involved) so I worry I’m just going to be laughed out of there. Next nearest hospital is 45 mins away and we had a young DS.

Jaw and back pain could well be cardiac pain and you should have an ECG.

You don't say how old you are? Agree with PP - go to A& E and get yourself checked over. This could be cardiac pain. Better safe than sorry.

@Couchpotato3 Sorry - I’m 29.

Chances are it's not cardiac then, but it's not impossible, and you do have a pretty complicated medical history. Please do get some real life medical advice this evening - don't sit at home and just wait for something to happen. Hope you feel better soon

I'd try 111 first too, as I'd hate to be sitting in A&E for ages with explosive diarrhoea, which would increase my anxiety ten-fold. If they say to go as they think it could be cardiac related, then you can go and will hopefully be triaged quickly as a result.

111 for sure

Doi - Consultant surgeon . Go to ED and get checked out .

try 111 or straight to a&e.

Don't be surprised if they send you an ambulance.

Is it still bad now? I think you should go to A&E too with those symptoms from last night, but would also worry about making it to hospital and sitting for hours airing with diarrhea, not sure what yours is like but there’s only one toilet in our A&E and it’s usually busy. How far away is the hospital?

I’ve called 111 and they didn’t seem very concerned. They kept asking me which symptom I wanted to focus on (I get they have to do that), I said it was a combination but in the end chose the diarrhoea. They’ve said I’ll get a call back from a local care provider within 1 hour and if I don’t get s
call call back to chase.

I think the problem with 111 is they can't just listen to the whole story of how you're feeling, they following an algorithm... Like a flow chart. You can see how it works if you access 111 online and fill it in yourself. If you pick diarrhoea as your main symptom it won't flag up as too concerning. If you chose chest / back / jaw pain as your primary issue it might trigger an ambulance. Cardiac problems obviously less likely at 29 than 59 but no one can tell you it's definitely not that, so you should get checked out. I hope you feel better soon

Hope you’re doing ok OP, let us know what they advised on the call back 🙂

Agonising pain which prevents you doing anything - head to A+E

(DOI I’m a GP)

A&E. the jaw pain you are describing could be heart related, or a pulmonary embolism. You can have diarrhoea associated with anything if the systems are messed up. If the jaw pain ti shoulder comes back again before called back then go to A&E if not left already.
any chance you could be pregnant and have an ectopic pregnancy?
The algorithm is rubbish and they won’t prioritise diarrhoea but they will cardiac sounding chest pain

A and E. Don’t ever discount what could be heart related issues based on age etc.

Crushing pain in chest and radiating jaw pain is A&E without a doubt.

Nurse here - I would be flagging the jaw pain as possibly cardiac and would want you checked out.

A&E where you have access to the testing and expertise that you need. Take care and good luck.

What does the acronym DOI mean in this context please? @Mannikin @olympicsrock

Declaration of interest. Meaning they may be biased (for various reasons) in this instance.