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Abdominal Pain – NYD

NYD – Not Yet Diagnosed.

To most physicians, this acronym is either the dear favorite or the arch nemesis of acronyms.

Psychiatry uses it a lot… They like it.
Psychosis – NYD.
That’s fine.
Why?
Because regardless of the cause, you will treat it all the same.  You can treat the acute situation and time some time to find the underlying cause.  And if you never find the underlying cause, it might not matter all that much if you are controlling the symptoms well.

Medicine, well they don’t use it much.  NYD = not trying hard enough to find the cause.
You won’t seem many internists or surgeons using this acronym, at least not for long.  And if they do, then the patient really has them stumped.  Even if something is delineated NYD, you can still treat the symptoms, but you will never actually make the patient better until you discover the cause.

And here I sit with that wonderful diagnosis: Abdominal pain – NYD

I was forced to go back to the emergency room on Tuesday because I was, again, in excruciating pain.  As I anticipated, all investigations were normal.  However, my abdominal exam was considered “non-contributory” because I had so much voluntary guarding.  NO KIDDING – I HURT.  DON’T TOUCH ME THERE!  This third emergency physician, while very nice, really peeved me off even more than the one who lied to me; After all investigations came back normal (actually the ultrasound was inconclusive because they couldn’t find my appendix), he had the “maybe this pain is just a manifestation of all the stress you’re under” talk.  He then flippantly offered me a surgical consult, “if I wanted.”  He was only offering it to me because I know the system and he probably thought that’s what I wanted.  I turned it down, mostly because I didn’t want to be “that patient.”

I *know* people may think that my pain is a psychogenic problem.  It is frustrating, however, when the very people who are supposed to be figuring out the problem try to turn it around and come up with an explanation that makes them feel better about the fact that they are sticking an NYD on the end of their final diagnosis.  Yes, I am a medical student in my final year.  Yes, I am a parent to two kids under 4 years old.  Yes, I just applied for residency positions.  But, none of this is new and I’m feeling less stressed out about my life now than I did even a month ago.  It just doesn’t add up.  Regardless, emergency physician #3 is convinced that this problem will go away on its own.  Short term solution: take some dilaudid and wait it out.
Yesterday I forced my way in to see my GP and we talked about everything.  We did some brain storming and we made somewhat of a plan.  Unfortnately, that means that I have to still endure this pain for as long as it decides to hang around.  The plan also still involves dilaudid, for when the pain is intolerable and to prevent me from landing the the emergency room again.  She also gave me a note excusing me from my clinical duties for the rest of the week (and then vacation starts).  She had no extra answers for me, except that she found trace blood in my urine, called her urologist friend, who looked at my CT scan from the weekend and assured her that he didn’t see anything concerning from a kidney/ureter/bladder point of view.  One extra thing off the list, but further away from a diagnosis.  The biggest part of the plan: referal to general surgery.  I don’t know about you, but I smell a diagnostic laparoscopy in my future… and I’m willing to bet it will come back NORMAL.
I am now the beginning of a sad, sad story: A woman who’s daily life had been disabled by NDY abdominal pain requiring narcotics… There is really nowhere good for this to go.  In a few weeks, I’m sure we can add “unnecessary abdominal surgery” to make the story even more sad.

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