Introduction

In a terrifying turn of events, a 68-year-old woman from Long Island found herself once again battling severe abdominal pain that had begun a week earlier. As she lay in bed, a visiting nurse insisted she return to the hospital. Describing the distressing scene, the woman’s hair was unkempt, her face pale, slick with sweat, and her moans filled the room as she desperately tried to find a comfortable position amidst the tangled sheets.

Initial Hospital Visits

Despite the ongoing pandemic, she had made her way to the emergency room twice already, yet her condition was worsening. The first visit left her feeling reassured but ultimately unsatisfied. The doctors attributed her discomfort to gastritis – an inflammation of the stomach lining – after conducting tests that returned normal results, yet she was certain that the searing pain was much more severe than her past experiences with gastritis.

Family Support

Her son, living in California, made the long journey back home, concerned for his mother’s deteriorating health. Unfortunately, when he arrived, it was clear the medications prescribed were ineffective. Four long days spent in silence and discomfort followed, during which she could neither eat nor drink properly, reinforcing the urgent need for medical attention.

New Hospital Admission

In an agonizing car ride to a new hospital, NYU-Langone Long Island, every bump felt like a knife in her gut. This time, a compassionate physician assistant took the lead in her care. She attentively listened as the patient detailed her symptoms: stabbing pain exacerbated by movement or eating, intermittent vomiting, and extreme leg weakness. The assistant conducted various tests, revealing alarming abnormalities in her white blood cells and blood chemistry.

Medical Complications

What added complexity to this case was her medical history of severe osteoarthritis and the presence of a spinal-cord stimulator, which although intended to alleviate her chronic pain, seemed to be contributing to her gastrointestinal distress rather than alleviating it. A CT scan showed unusual findings, raising concerns about inflammation in her blood vessels, potentially indicating vasculitis, a serious and often dangerous condition characterized by blood vessel inflammation.

Further Investigations

The potential connection between her gastrointestinal symptoms and vasculitis led to further examinations and imaging of other areas including the brain, neck, and chest. Despite some concerning findings, the full extent of her condition remained somewhat elusive initially.

Treatment Decisions

While high-dose corticosteroids are a common treatment for vasculitis, her osteoporosis raised concerns about the associated risk of bone density loss. After a thorough consideration, doctors decided to proceed with high-dose intravenous steroids.

Recovery

In a remarkable turnaround, her condition began to improve almost immediately. She regained her appetite, and for the first time in nearly two weeks, she could eat without the overwhelming pain that had plagued her. However, even after returning home, she continued to experience weakness in her legs.

Conclusion and Current Status

Additional investigations later confirmed the diagnosis of severe osteoarthritis in her hips, prompting hip-replacement surgery that would alleviate some of her long-standing joint pain. Intriguingly, despite extensive testing, the underlying cause of her vasculitis was never identified; however, she has not experienced a recurrence in the four years since the onset of her severe abdominal pain.

Today, she continues to manage her ongoing osteoarthritis, finding ways to cope with the daily discomfort, while the haunting memory of her previous abdominal agony serves as a reminder of her resilience and the importance of seeking help in times of medical crisis. This case highlights the complexities of diagnosing abdominal pain in older adults and emphasizes the need for persistent healthcare advocacy, particularly in the midst of an ongoing healthcare crisis. Will other patients gain the courage to seek medical help early, or will they suffer in silence like this woman?