[katoka2002]

Chronic RUQ pain

An update would probably be helpful, especially if these symptoms are commonly seen!

I ended up going to Cleveland Clinic in February and met with Dr. Abraham, an anesthesiologist/pain specialist and Dr. Park, a vascular surgeon. Dr. Abraham did a diagnostic celiac plexus nerve block and after a few hours I went for a hard run to try and induce the pain. No pain! Also had a CTA and doppler ultrasound done. Although the arterial velocity of my celiac artery was normal, the CTA showed a minor compression of my celiac artery, such that with the pressure of blood flow with my heart rate high during running, there would be enough pressure on the celiac plexus nerve to cause the pain I’m having.

So the diagnosis is a mild form of MALS, median arcuate ligament syndrome. My treatment options are surgery to release the ligament and sever the celiac plexus nerve or live with it. I’m choosing to live with it right now as the surgery for this is relatively new and failure rate too high for me to take the chance. Most patients with it have pain with eating and nausea which I do not, so pain with running I can handle.

Hopefully this helps others with similar pain!

[katoka2002]

Chronic RUQ pain

I am thin, but not skin and bones skinny. He specializes in low back pain as I couldn’t find anyone that specializes in abdominal pain so maybe he just doesn’t have the experience to do abdominal injections. I’ll ask him next time I see him if he knows anyone that does. I live in northern IL… would you happen to know of anyone in the Chicago, Milwaukee areas or even Madison or Indianapolis?

Thanks again!
Katie

Attached photos… did my best to draw a line where the pain is. Starts under my rib cage and as I run, it radiates down.

[katoka2002]

Chronic RUQ pain

Exactly! That had been my experience with every doctor until I saw the pain specialist. He and I went though all my test results and discussed all sorts of strange possibilities and next steps. He does believe me that the pain exists but he’s said twice now that he was too concerned about injecting me and hitting an organ and causing more problems. Hmmmm…. I’ll ask again. Maybe he was thinking he’d have to go too deep with the injection? How do you typically do it, ultrasound guided?

[katoka2002]

Chronic RUQ pain

Thanks Dr. Goldstein!

Sounds like a possibility! Not something I’ve heard yet so this is exciting… who would I talk to this about? The pain specialist wants me to consult with a different general surgeon than the one I had originally seen, so do I mention the nerve ablation to him? Would it require a diagnostic laparoscopy? Or is this something the pain specialist can do?

In the meantime, I’ve been using Lidoderm patches when I run and they do seen to be helping some, not completely, but an improvement.

Thanks so much!
Katie

[katoka2002]

Chronic RUQ pain

Thanks Dr. Towfigh,

I’ve tried dry needling several times with no success. I’ll talk to my pain specialist about the Botox. After examining me a few weeks ago, he said there wasn’t a safe place to inject me in the area because of all the organs in the area of pain, the lack of a muscle knot to inject and lack of nerve to block. But I think he was referring to lidocaine and cortisone injections, not botox, so I’ll mention that.

Thanks,
Katie

[katoka2002]

Chronic RUQ pain

Thanks Dr. Earle,

Not surprised at all at your response since I’ve heard it from several practitioners… but do you have any idea or can direct me to someone that would have an idea of WHY it happens every time I run? There must be something structurally going on to make me more susceptible than any of my team mates. In order to find a solution, I need a diagnosis. If it’s a muscle spasm (which it could absolutely be based on my symptoms), is there someone who specializes in abdominal muscle spasms in athletes that would be able to help? I already take magnesium several times a week and electrolytes every day during training sessions. I’ve tried IcyHot, but will try Aspercream next week!

Thanks so much!
Katie