Solve the Medical Riddle: She Has Intermittent Severe Pain in Her Abdomen, and She Saw Blood in Her Urine, Third Week

By Marie Savard MD

Editor’s note: Welcome to our thirdAGE feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.  

The first week of this riddle, the patient reported her symptoms to her PCP. The doctor proceeded with the examination using the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

Last week, Barbara learned the results of her urine test and CT scan. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“My mother takes a statin – Crestor, not Lipitor like Barbara, but the same idea. My mother has what the doctor calls ‘statin toxicity’, with muscle pain, myoglobin protein in the urine, and dark urine. The doctor says that’s because of muscle breakdown. The medical term is myoglobinuria. It’s a severe side effect of statins. Maybe that’s what’s going on with Barbara.

— Lily M.

“Barbara might have acute cystitis and a kidney infection. Cystitis can cause reddish dark urine and can travel to the kidneys to cause back pain. I know from experience! However, Barbara didn’t report painful urination or a fever, so my guess is probably not correct.

— Susan G.

“I’ll bet I know what’s wrong! She’s dehydrated and she takes a lot of Tums, which are practically pure calcium. That’s exactly what I was doing before I was finally diagnosed with calcium kidney stones. I thought that only men got those, but I was wrong. Barbara says she thinks her father had urinary problems, so maybe she is in the dark about women getting kidney stones. Her father’s generation probably didn’t talk about the details of urinary problems. Mine didn’t and I only found out years later that he had calcium kidney stones. Anyway, I passed my stones, but I had to go to the hospital. That was the worst pain of my life – worse than labor! Now I don’t take Tums and I drink plenty of water even if that means wearing disposable diapers to guard against leaks. I’m 70 and I do have some incontinence.“I’ll bet I know what’s wrong! She’s dehydrated and she takes a lot of Tums, which are practically pure calcium. That’s exactly what I was doing before I was finally diagnosed with calcium kidney stones. I thought that only men got those, but I was wrong. Barbara says she thinks her father had urinary problems, so maybe she is in the dark about women getting kidney stones. Her father’s generation probably didn’t talk about the details of urinary problems. Mine didn’t and I only found out years later that he had calcium kidney stones. Anyway, I passed my stones, but I had to go to the hospital. That was the worst pain of my life – worse than labor! Now I don’t take Tums and I drink plenty of water even if that means wearing disposable diapers to guard against leaks. I’m 70 and I do have some incontinence.

— Georgia L.

“I hope Barbara doesn’t have kidney or ureteral cancer. From what I know, because of my sister-in-law’s condition, the cancer would have showed up on the CT scan. Still, I’d have a second scan just to be absolutely sure if I were Barbara.

— Rochelle S.

“My aunt had a leaking abdominal aneurysm. Barbara might have that. We learned that her pulses were all strong on her exam, but we don’t know if there were sounds of blockage or turbulence when the doctor listened over the arteries with a stethoscope, and at the abdominal and groin area. We know that Barbara’s blood pressure was normal but we don’t know if she has a history of vascular disease or diabetes. I’m guessing she didn’t since the doctor said the physical and the history were both normal. I’m really curious to learn what the actual diagnosis will be!

— Virginia B.

To be continued . . .

Come back to thirdAGE.com next Thursday when the doctor will reveal the actual diagnosis and treatment plan.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.