You might be surprised to know that one of the hardest things to figure out as a primary care health practitioner is abdominal pain. We often call it “abominable pain” because it is so hard to really know what is going on. So we develop “artful questions” to decipher the cause of their pain and a treatment to hopefully cure the pain.

Here are a few of the questions we might ask:

Where is the pain?
How long
has it hurt?
Is the pain sharp or dull?
Does the pain travel from place to place in the abdomen?
Have you had a fever or chills?

Though these questions do help, identifying the cause or reason for a tummy ache over the phone can be especially challenging. The visual cues help us determine how much pain a person is in and can be very useful.

Pain. Pain is hard to understand from person to person. For example, one patient when asked about his pain level stated he was having 10/10 pain, and delivered that information in a calm voice, sitting still in his chair. I figured he just didn’t know what the rating scale meant.

I explained to him, “Ten out of ten pain is the kind of pain that one might experience if your leg is being cut off with a chain saw.”

“Oh,” He said. “I guess it is about a four, then.”

So when a 75-year-old woman called and said, “I’ve got a tummy ache,” I asked her the “artful” questions stated above. No fever. No nausea, vomiting, or diarrhea. The pain was somewhere in the middle of her tummy, around her belly button. Four out of ten on the pain scale. No exposure to other sick people that she knew of. A little bit of decreased appetite was her only other symptom that might be considered “helpful” in figuring out her pain. I told her to take some Tylenol, drink plenty of fluids, and let us know if she got worse.

I called her back the next day. “How is your tummy ache?” I asked.

“About the same,” she replied. Still no improvement, but no worse. She was concerned that it wasn’t going away, however.

“I think you should come into the office today and see Randi Carter, PA-C. It is too hard to try and figure this out over the phone.”

She agreed and came into the office to see Randi Carter, PA-C. Randi is an amazing practitioner. With more than 20 years’ experience, and much of her time in the emergency room setting and also cardiology, she was well prepared for this nice lady and her “tummy ache.”

During the patient visit, Randi could tell this was no ordinary tummy ache. The older woman was really hurting, and Randi immediately ordered stat lab work and a CT scan of her patient’s abdomen and pelvis. Within an hour, these results were back in Randi’s hands, and the diagnosis made: Acute Appendicitis. The 75-year old woman was rushed into surgery to remove her appendix “just in time” before the appendix ruptured. Had this been missed, she would have had real ABOMINABLE PAIN!