Joey Wahler (Host): This is Health Matters, insights from WCH medical experts. Our guest is Dr. David Kim. He's a general surgeon. Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Kim. Welcome.

David Kim, DO: Thank you for having me.

Host: Thank you for being with us. We appreciate the time. So first, talking about abdominal pain. So, what are the most typical causes of it?

David Kim, DO: Oh, if you put in a Google search for abdominal pain, you'd get at least a trillion hits. they can be really anything. It can range from discomfort to upset to something that is new for you, a chronic problem that has a new exacerbation. And then, obviously, on the very far end of the spectrum, it can turn into an emergency. And that can be, again, any number of things that occur in the belly.

Host: I'm going to ask you more about that in just a moment or two. But first, how common is abdominal pain, generally speaking?

David Kim, DO: Well, I'm biased because, in my world, that's the thing that I see predominantly. If you look at emergency room statistics, it's at least a third of the complaints that come into any emergency room in any hospital in this country, give or take depending on what region you're in. But as you and I know as human beings in this earth, abdominal pain can occur at any time.

Host: And speaking of which, since it is so common, how does someone know when it's something minor versus something that needs prompt medical attention? Where would you say that line is?

David Kim, DO: I think that if this podcast were to end right now, the only message that I would want for any of our listeners would be, if you think that it requires evaluation, you should trust your instincts and go get it evaluated. Now, depending on who you ask to evaluate it will differ, but the bottom line is if you think it's an emergency, then I trust you, and I think that it is. And we will evaluate you and treat you accordingly. But the first and foremost would be to trust your instincts.

Now, in terms of adding layers of complexity to what you're experiencing, if you have belly pain that is getting worse or you have belly pain plus or minus other symptoms that are coming up, you're starting to get more nauseous, your abdomen is becoming more bloated, you know, you're starting to feel feverish, a little sweaty, maybe your heart's starting to race a little bit. Those are all signs that your body is telling you something is wrong. And if you feel that it is escalating in any way, that certainly is an indication it might be turning into an emergency

Host: So, you just touched on some possible symptoms. Which ones, which signs or red flags, so to speak, are the main ones that people should never ignore when it comes to abdominal pain?

David Kim, DO: If it's getting worse. A lot of us, try to stay out of the healthcare system, so we'll sit at home and maybe, you know, you give it a half hour, an hour, and it's really not going away. You've tried some of the normal things at home, Pepto, Tums, ice pack, laying down, you know, heating blanket. Certainly our lady friends know or should know the difference between menstrual cramping and something different, because menstrual cramping is something that they're used to from a young age into adulthood. But as a general rule, if it's getting worse, it's probably not going to go away. And then again, if there are other symptoms that are starting to creep up now that you're observing that you're not used to, that certainly is causing concern that's certainly a sign that it becomes a more serious problem

Host: Now, you just mentioned those popular, time-tested, over-the-counter stomach meds, right? They can be very effective for something relatively minor, correct?

David Kim, DO: Yes. A Pepto, Tums, even Pepcid, Alka-Seltzer. I live in the Midwest, a lot of people like ginger ale, those kinds of things. If it's a minor upset, then that will usually take care of it. And if these are experiences that you've had before, and these are modalities that have worked for you, perfect. I think that is something that's safely observable at home. Where it becomes a concern is when those things aren't working and you're starting to run out of options at home is really when you should kind of escalate that further

Host: Gotcha. And so, that being said, when we talk about abdominal pain necessitating an ER visit, what are the symptoms there that mean "Don't wait, get some help right away"?

David Kim, DO: Certainly, if you have abdominal pain that's not generalized, so if it's not all over your belly, but it is in one focal spot, that is certainly a cause for concern for somebody like me. The left side of your belly is different from the right side. It's different from the top bit, different from the bottom, different from the center.

And, you know, these are questions that I get asked very commonly from other patients. And, you know, the question is usually like: What are some things that I should be on the lookout for that tell me that I should give you a phone call? Focality and locality are certainly one of those things, particularly if you and I are somebody who have met before, and I know that you have some other condition.

For example, ulcerative colitis is something that I see semi-frequently. And if somebody has lower abdominal pain, that's certainly a concern for somebody who has a preexisting condition. And then, if other things are coming up now where your bowel habits are really not where they're supposed to be and you're starting to see some blood, or you're now having fever with that abdominal pain, that is certainly a situation in your condition where we're really worried now, and I need you to come in to a place where I can evaluate you or you can be evaluated, and we can figure out next steps for treatment.

Host: Switching gears a little bit, Doctor. Gallbladder problems, appendicitis, those can, of course, sometimes mimic other issues. So, what are some signs people may not realize point to those conditions?

David Kim, DO: Well, gallbladder and appendix live in separate parts of the belly. And so, when you're having an acute problem, for example, gallstones—gallbladder is something I talk about pretty frequently. When you have an acute problem where that gallbladder's really flared up or, heaven forbid, is infected, you're having a stone problem, your gallbladder lives in a very specific part of your belly. So, it lives underneath your right rib cage, sits below your liver. And when it's flared up, you can point to one finger exactly where it is.

Appendix is the same thing. It lives on the right lower part of your belly in a very specific spot. The nerds out there will call it McBurney's point. But it is focal. It is not like anything you've ever experienced before in terms of location and experience and intensity. If that's a thing that's new for you and it's been going on for the last hour or so, and it's not going away, and again, you're having the sweats and the fever and all those other things, it's time for somebody to look at you and get evaluated.

Host: Gotcha. When seeing a surgeon for abdominal pain, what does the evaluation process usually look like, and how do you determine a treatment plan?

David Kim, DO: Generally, when people come to see somebody like me, they've already passed through a primary practice provider, so physician or NPP or a PA, and they've kind of gone through the general screening process of, "Well, where did it start? And, you know, does anything make it better? Does it make it worse? Is it associated with something?" And after the initial interview and evaluation, they've gone through some other imaging process, CT scan, MRI, ultrasound, X-ray, and that kind of guides those patients in a direction of, "Is this something that requires a medical evaluation or a surgical one?"

So by the time people come to see me, I have a fair story of what's been going on. Very rarely do I have somebody who has had abdominal pain, but nobody can figure out what's going on. And in that way, I may be able to provide some insight, mostly because, you know, as a professional surgeon, I see the insides of people's bellies a lot, and so I can maybe offer a thing that hasn't been considered before. But when people come to see me, it's generally because someone else has identified a problem that may require a surgical answer.

Host: Understood. A few other questions for you. First, in terms of treatment, we talked about the over-the-counter pills that people are used to taking at times. Besides that, any other non-surgical treatments out there?

David Kim, DO: Mostly just temporizing measures, you know, position. Avoiding the triggers that may be causing the problem. I like spicy food too. But, you know, if you're going to Taco Bell and having the hot sauce and that's really kind of triggering your belly, it's probably a good time to stop. I mean, my rule for adults is you're allowed to do whatever you want as long as you can accept the consequences. But if your consequences are getting out of control, it's time to exert some moderation.

Aside from that, a lot of people ask me about medication that's used to dissolve gallstones or biliary stones. If you have a gallbladder and you have stones, that medicine really doesn't work. We tried that in the mid to late '90s. We found that it was not very effective. So, medications in kind of specific relation to what I do, I get asked about that gallbladder and gallstone medication a lot. It's not very effective.

Host: Okay, fair enough. And if surgery is needed, what does that typically involve for abdominal pain?

David Kim, DO: If it's an emergency or if it's somebody that I see in the clinic, my motto is always inform the patient and come up with a collaborative decision. So if I'm seeing you in the hospital because you've come in for an acute problem, we sit down and chat about what's going on, what the options are, which include not operating. And I give that option to people who are going to do really poorly without surgery.

But in this day and age, you know, with the availability of information on the computer in your pocket or on the internet at home, the first and foremost thing is to discuss, "This is what's going on. These are what your options are. If you choose surgery or if you feel it's right for you, this is what that looks like, and this is what kind of the remainder of your treatment course might be." Same for people in my clinic. You know, you're coming in, eyes wide open, walking on your own two feet, and you've got an issue that may require surgical intervention. We have the same conversation. "This is what surgery options you have. You can choose to say no. If you proceed, this is what it looks like, and this is what to expect afterwards."

Host: And then, in summary here, Doc, what's the one thing you wish that more people understood about abdominal pain and knowing when to seek care?

David Kim, DO: The abdomen is a very complicated part of your body, and lots of things go on. it kind of falls on the general conversation we're having in this country about misinformation. But I think that when people really start to dive deeply into the belly and all of its physiology and the specifics of each organ, what I really want for the public is to have each individual, if you're diving into that mountain of information, to have a more complete understanding of it. I think there's a lot of people out there who are misleading the public on how certain things work and how other supplements or medications affect your health. You have to understand your body first. I think you have to trust what you're feeling first. Add information to that that's relevant. Be free to be honest about being wrong about certain things. Find a better understanding and answer of that.

But mostly have an open conversation with your providers. And heaven forbid you're in a situation where you're not communicating well with your provider, seek somebody else, and have a good and open conversation about what options are available to you and what treatment options are best for whatever it is you're going through at the moment.

Host: Yeah. Again, it seems your message is simply better safe than sorry. Well, folks, we trust you are now more familiar with abdominal pain and how it can be addressed. Dr. Kim, valuable advice indeed. Keep up all your great work, and thanks so much again.

David Kim, DO: Thanks so much for your time.

Host: For more information, please visit woodcountyhospital.org/surgery. And to make an appointment, please call 419-728-0640. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of Health Matters, insights from WCH medical experts.