Constant Gnawing Pain Under Left Shoulder Blade - MDs Provide No Clear Answers. Looking for Guidance & Reassurance.

Me: 38/F, 125lbs, 5'2", Half Hispanic and half Ashkenazi Jew

Meds: 40 mg Pantoprazole 2x/day, Xifaxan 550 mg 3x/day (I'm on last day), Sucralfate, 200 mg/Spironolactone, 15 mg Meloxicam 1x/day

Non-prescription Meds: Digestive enzyme, magnesium, multivitamin

Current diagnosis: IBS, SIBO, Functional Dyspepsia

Current symptoms: Month of gnawing pain under left shoulder blade. Hurts worse laying down or on side. Awful in the morning after an evening of laying down. Occassional tenderness pain in upper left abdomen and left ribs. Pretty sure it is not muscular skeletal and it is GI related. I have full range of motion. Stool is orange, floating, skinny, fuzzy looking.

Medical History/Background: I historically have had decades of gastrointestinal distress. Historically this has presented in constipation and large hard stools which would cause anal fissures and a mild prolapsed hemorrhoid. In 2020 my bowl movements transitioned from hard, large, & brown to being green to yellow with much smaller caliber slightly softer. I sought out a GI doctor who conducted an endoscopy & colonoscopy in 9/2020. Both were normal. I was diagnosed with general IBS.

Since 2020 I have developed nighttime reflux. Every day I wake up with nausea and a sore throat. Doctor said to take omeprazole which I did. I also purchased a wedge pillow. Reflux continued to get worse. Fast forward to May 2023. I had about 4 drinks in the course of several hours one evening. I woke up the next morning vomiting with diarrhea, nausea, abdominal pain. I also felt super hungover like I drank a whole bunch the night before which I didn't. My friend and I had the same food so it wasn't food poisoning. In fact she spent the night and was extremely concerned given that we had drank the same drinks and ate the same food. I went to urgent care and they said they suspected I had gastritis. I set up an appointment with my GI doc and he prescribed me pantoprazole at the max dose. Abdominal pain subsides, however nighttime reflux and morning nausea persist. Basically I don't feel like the pantoprazole has done anything.

November 2023: I start having these vague abdominal and back pains. I end up in the ER because I couldn't tolerate it anymore. Labs and CT scan were performed. All generally normal.

December 2023: Out of an abundance of caution I purchase a full body MRI. (I know docs hate these). Came back normal.

December 2023: GI doc orders hydrogen breath test. I do test positive for SIBO. Doctor prescribes an antibiotic which I didn't start taking until this month. I'm on the last day and nothing has improved as a result of the antibiotic.

After xmas 2023: I drank a big glass of red wine with my husband. Afterwards I started to feel ill. About an hour later I started throwing up and having diarrhea. I took some spare ondasetron that I had to put the kibosh on the nausea. I feel stable immediately afterwards.

January 2024: GI doctor performs endoscopy and finds nothing.

February 2024: I randomly start having this gnawing back pain under my left shoulder blade that has increased in intensity. Much worse than what I had before. This is also a persistent constant pain that I have. It's almost been a month. I started the sibo antibiotic in hopes its related and will help. Pain gets worse. Poop is now straight up orange. My primary prescribes me a muscle relaxant and meloxicam and it's done nothing. I went to the ER where they tested my lipase and it's normal. They refuse to do more imaging and prescribe me another anti-inflammatory.

I pushed GI doctor and he scheduled me for an MRCP. I'm feeling scared & frustrated because I have no clear diagnosis and I'm on a bunch of pills none of which have made anything better. I continue to get worse. Starting to be scared that it's something bad like cancer or organ failure.

I'm practicing meditation to try and bring myself back from the edge, but it's hard for me to push through all the pain and irregular bowel movements.

Question:

  • Besides the MRCP are there any other tests, imaging, labs I should get?
  • Is it unlikely theMonth of gnawing pain under left shoulder blade. Hurts worse laying down or on side. Awful in the morning after an evening of laying down. Occasional tenderness pain in upper left abdomen and left ribs. Pretty sure it is not muscular skeletal and it is GI related. I have full range of motion. Stool is orange, floating, skinny, fuzzy looking.
  • Given the location of this recent pain and my symptoms I'm afraid it's my pancreas. Is there other conditions that might have been missed that could be causing this type of pain and symptoms (bad reflux, orange stools, worse laying down) that isn't a death sentence?

This pain is making it hard for me to work and to parent. I'm in a bad mood all of the time.

Labs in the last year: Fecal elastase, giardia, parasites negative. H. Pylori negative.

Recent Labs: Comprehensive panel, hormones, CBC normal - except for RBC 3.86 x 10E6/uL, Hemoglobin 11.2 g/dL. Lipase normal at 43 u/L.

SIBO 12/23: Positive. Never got the lab report so I can't provide #s.

Imaging:

Colonoscopy & Endoscopy 9/20: Normal.

CT Abdomen & Pelvis 11/26/23 - Nothing significant, subcentimeter hypodensities too small to characterize on liver. Small splenule on spleen. Mild thickening of bladder without surrounding stranding.

MRI 12/23 - Nothing significant

Endoscopy 1/24: GI doc observed some inflammation on stomach. Biopsy was taken and pathology report found nothing remarkable.