The cause of a girl’s abdominal pain should have been clear to doctors

April 1, 2013
Solving a medical mystery

As I read “The girl who cried pain” [March 26], I thought, “Here’s someone else who has been through what my wife, Julie, has been through for the past 10 years.” When I got into the middle of the article, I was thinking we could have changed the names here and written it ourselves — the symptoms, frequency of attacks, mixed multiple diagnoses.

In my wife’s case, during a period of some 10-plus years, there were medications prescribed for anxiety, antacids, pain and nausea, diagnosis of appendicitis (and removal), several endoscopies and colonoscopies, an HIDA scan, all with negative results) and finally the removal of a healthy gallbladder because “that’s pretty much all it could be.” Then, another attack, and a couple of months later, another. We were finally referred to a surgeon who did an exploratory abdominal laparoscopy. He found a rather severe abdominal adhesion involving a loop of small intestine that had adhered to the abdominal wall.

As it turns out, there are no diagnostic scans or tools that allow physicians to see and diagnose this problem without exploratory surgery. More GPs, and especially gastroenterologists, should be aware of and investigate this condition before prescribing the removal of healthy organs.

Tim Gardner, Monrovia, Md.

The article left me flabbergasted. The details of the pain and other symptoms immediately and forcefully indicated to me that everything needed to be done to check for gallbladder disease. It is true that the fact that the patient did not have gallstones significantly decreased the chance of gallbladder disease, but it did not come close to eliminating it. In one fairly large study, one in six pediatric patients requiring removal of the gallbladder for disease did not have stones but rather had biliary dyskinesia, as did the patient in your article.

Although I am a retired physician, I did not do clinical diagnosis of patients while practicing medicine. What I learned about such diagnosis was done half a century ago and has long since faded. The fact that I (with my meager diagnostic skills) immediately focused on the correct diagnosis in this case is not a testament to my brilliance but rather is an indication of professional failure on the part of the many doctors who failed to diagnose the patient’s problem.

Dennis K. Heffner, Annapolis

It seems extraordinary that in an age of phenomenal computing power, the correct diagnosis of a rare medical condition would depend (over a decade of failure) on the competence, experience and memory of physicians. A properly designed computer program would surely have come up with biliary dyskinesia as a possibility given three clear indicators: a family history of gallbladder disease, pain in the upper right quadrant of the abdomen and the absence of gallstones.

Why does the medical system continue to rely on the judgment of busy and not infallible physicians when a “universal diagnostic algorithm” (I’ll call it) could quickly and cheaply take most of the guesswork and mystery out of identifying a difficult condition? Tests could then follow to confirm the algorithm’s suggestions.

Julian Blackwood, McLean

No rehab for me

Regarding “New method makes hip replacement easier” [March 26]: In the past 18 months, I’ve had both hips replaced by the anterior approach. In both surgeries, I didn’t have to go to rehab or physical therapy.

I’m 68 years old, and since last Thursday I have played six tennis matches of an hour and half each. (I don’t recommend that much play, but it doesn’t bother me, and friends needed subs.) In each case, I walked out of the hospital on my own, and I haven’t looked back.

Mary Troutman, Laurel

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