I guess a little history of my GI tract is in order.
When I headed off to college, about 14 years ago now, I developed IBS-D. IBS is often triggered for the first time by a stressful event. I spent a long time learning to manage it through mostly diet. About 5 and a half years ago, right before my wedding, I got a really bad pain right below my belly button. I went to urgent care twice before I was sent in for a CT scan. I was told the CT showed enlarged lymph nodes and it was a virus that would resolve. It resolved like clockwork. Later I found out that is called mesenteric adenitis.
About a year later, I developed fairly typical symptoms of gallbladder issues. I had an ultrasound and HIDA scan that didn't show any dysfunction so the GI doctor put me on Nortriptyline to calm the nerves in the gut. Over a year, I was increased to the maximum dose they would give for that type of treatment. My primary care physician finally had me rescanned and my gallbladder had negligible function. I had a cholecystectomy.
After that, I had a good two years. I could eat reasonable amounts of fats in my food without being in pain for a day and my IBS was well controlled with daily probiotic capsules.
Then December of last year, I started to feel this occasional pressure in my right side. It was hard to pinpoint, but I always kind of generally referred to the love handle area when telling people about it. I am used to feeling weird sensations in my gut. As the days went by, it became pretty constant. I thought maybe it was postural and tried to sit with my core engaged. By mid January, it became painful and started slowly shifting depending on what position I was in. Standing: love handles, sitting: ribcage/shoulder where gallbladder used to hurt, laying on my back: like kidney pain. My doctor didn't have any appointments, so I went to urgent care.
The urgent care doctor checked my urine, did a CBC, and did all the tests to check for acute appendicitis (things like moving your leg around or pressing in specific spots and seeing if it hurt more). With my urine and CBC clear, she had them schedule a CT scan. When I was called with the results, they said it looked similar to my scan from 5 years ago with a large appendix and slightly enlarged lymph nodes. What? Nobody told me 5 years ago my appendix looked enlarged! She didn't seem to think that meant anything since it hadn't changed much in 5 years so I ended up having a pelvic (including transvaginal) ultrasound which was deemed unremarkable. I was told to follow up with my primary care provider.
I sent a direct message to my primary care provider and was granted one of their secretly open appointment slots. She looked at everything that had been done, decided my pain was more right upper quadrant than right lower quadrant, and referred me back to the GI doctor I had seen with my gallbladder issues.
The GI doctor I have seen most is actually a physician's assistant. PA's are pretty great, but they are better for treating cases that fall within the normal range of a defined illness. Literally her first suggestion was to go back on Nortriptyline then she took a good look at the medicines I was on and said I was pretty high risk for peptic ulcers. She had a lot of other suggestions too, including chronic appendicitis. She thought the pain could be from a duodenal ulcer, so I was scheduled for an upper GI scope. I actually had one of these back when I started having gallbladder issues too. I guess when something doesn't seem typical, they like to just go in and have a look-see. The endoscopy, performed by the physician she is the assistant to, was also unremarkable.
When I went back for a follow-up with her 3 weeks later, she started throwing ideas around again. I had been doing research and I wondered about SIBO (small intestinal bacterial overgrowth). She didn't think the pain was typical of SIBO but she was totally cool with me taking the non-systemic antibiotics for it as well as trying a low FODMAPs diet. At first I felt great, but then the pain came back like an attack only now it wasn't radiating as much. Now you could really feel it if you pressed in that area where it's supposed to hurt when you have appendicitis. Now I was getting really nauseous a lot of the time. On top of that my bowels were irritated from the antibiotics, like they do. After some more messaging, I was referred to a surgeon.
The surgeon's nurse was really diligent in finding out why they suspected my appendix and calling the radiology place for my old scans. The surgeon was great too. He looked at my history going back to before the gallbladder was out. He also told me the most important facts: It's hard to get a good image of the appendix. It's normally like pulling teeth to get the radiologist to mention it when you're looking for it. Mine was really big. He also said he didn't used to believe that chronic appendicitis existed, but he'd seen it. He couldn't guarantee fixing my pain, but the benefits outweighed the risk. My appointment was on a Friday morning and he had his nurse find an OR for Monday morning. Longest weekend ever.
Not much I can say about the surgery. It was pretty normal outpatient, laproscopic stuff. Home in 3 hours feeling the best I ever have after that kind of thing. I was told I could resume normal activity as I felt like. I was back at work in a week.
My follow up with the surgeon was short. Yes, under the microscope it was appendicitis. A normal appendix is about 6mm wide, mine was 1cm. Your entire pinkie finger would be a good visual of the general size of it. Despite seeing chronic appendicitis again, the surgeon still declared it to be weird.
