Listening Leads to Accurate Diagnosis

After 30 years as an insurance executive, Carol McDougal was forced to retire in 1990. The pain she began suffering in her left hip area was so excruciating, it left her disabled. The Kansas City, Missouri native went to physician after physician looking for answers, but never got one that satisfied her.

Photo by Jordan Pysz.

After years of suffering, Carol’s pelvic pain is finally gone.

“I was in so much pain,” she shares. “I couldn’t work. I couldn’t concentrate to do my paperwork. I couldn’t follow up on anything. Often, my pain was a ten on a scale of one to ten.
“The doctors couldn’t diagnose me, though. I’d go in and say I have pain in my left hip area, and they would give me pain pills. They thought it was an orthopedic issue, so I saw an orthopedic doctor and had an MRI and a whole work-up done. I got the same result.
“I came to Florida in 1991, and again, I would explain my symptoms. The doctors here also thought it was orthopedic, and they gave me more pain pills.”
Carol suffered with her pain for more than 27 years, but in 2017, she experienced a serious intensification of her symptoms, leaving her in even greater agony.
“It started with spasms in my colon that went on for three days and three nights,” she relates. “When they finally calmed down, I got worse spasms in my bladder for two days and two nights. They were intense spasms, so bad I couldn’t sleep. My bladder thought it was full even when it was empty. That’s what sent me to my primary physician.
“The physician assistant I saw at my doctor’s office told me I needed to see a urologist. I was reluctant, but she said she knew somebody who was very good. She recommended Dr. Miranda-Sousa, and I said I’d go and see what he had to say.”
Though reluctant, Carol’s decision to meet with Alejandro Miranda-Sousa, MD, of Urology Experts in Fort Myers proved to be her first step along the road to recovery. She immediately got a good feeling from the doctor, describing him as very nice and professional. She especially liked that Dr. Miranda-Sousa was caring and sincerely concerned about the pain she was suffering.

A Fresh Start

“Carol came to me complaining of urinary symptoms, including frequency and urgency, as well as pressure on the left side of her pelvis,” recalls Dr. Miranda-Sousa. “I initially suspected a urinary tract infection, but the testing came back negative. I also did an evaluation of her bladder, and that was normal.
“When I examined her, however, I noticed an area of pain and tenderness in her left pelvic region. As I touched the area, I perceived what felt like a mass. I ordered an ultrasound and discovered a cyst on her ovary. After additional imaging studies, I referred Carol to a gynecologic oncologist to have the cyst removed.”
The cyst proved to be the root of Carol’s pain.
“The ultrasound showed that the growth on my left ovary had flopped over my colon and bladder,” Carol explains. “That’s what was causing the pain. The growth had actually attached itself to my colon and left massive scar tissue there when it flipped over to my bladder. It left scar tissue on my bladder when it flipped to go somewhere else and do the same thing. This is what had been going on since 1989.”

Listen and Learn

“Pain is complicated,” Dr. Miranda-Sousa explains, “and in many cases, it is difficult to determine its source. To do so, it is critical to listen closely to patients when they describe their symptoms. In general, the patient will tell me eighty percent of what I need to know to make an accurate diagnosis. That’s how I knew what to look for in Carol’s case. Good doctors are good listeners.”
In addition to listening, the physician also needs to ask the right questions, Dr. Miranda-Sousa notes.
“I have a mental framework of what I need to know and ask, so this usually goes fairly quickly,” he adds. “The questions help me rule out and pinpoint diagnoses, and also help guide me in ordering the appropriate imaging and tests. Physicians must answer all of the patient’s questions as well.”
Carol, like many pain patients, went from one physician to another and was frustrated by their findings. She never got a definitive diagnosis, nor did she experience any improvement in her symptoms, until she met Dr. Miranda-Sousa.
“What can happen with these patients is the new physician reviews the previous physician’s notes and is guided to the same conclusion, which does not satisfy the patient,” the doctor explains.
“I try to avoid relying on previous physicians’ notes and interpretations of the patient’s problem. I review the imaging and test results but not the final comments, so I have an unbiased opinion going in. I prefer to make a fresh start, and that starts by listening to the patient.”

“Learning to Live Again”

Carol was relieved when the cyst on her left ovary showed no signs of cancer. She was even more relieved when the mass was finally removed. She was amazed by how quickly after the surgery she began to feel better.
“The surgeon cleaned out the scar tissue on my bladder, colon and other areas that were affected,” reports Carol. “There were massive amounts of old scar tissue. Within two days, I was released from the hospital, and I never felt so good.
“Now, I have no pain. From one to ten, it’s a zero. Before surgery, it was up to ten many times.”

“Dr. Miranda-Sousa really paid attention to me and listened closely. He was careful and took time with me. He listened and found the problem – and the solution.” -Carol

Without the constant pain, Carol is returning to activities she hasn’t been able to do in years. She feels rejuvenated and renewed, like she was when she was much younger. Carol says she is exhilarated and “learning to live again.”
“I’m active again,” she enthuses. “I’m on a walking program. I can make it all the way around the block. It’s rebuilding my body. I’m out working in the yard. I’m driving and running around taking care of business that should have been taken care of a long time ago.
“I have freedom now. I feel like I’m twenty-one years old and can live another fifty years. I feel like I can take on the world.”
Carol’s glad she was referred to Urology Experts and Dr. Miranda-Sousa because he took a different approach to evaluating her condition. She believes that approach is what led to her successful diagnosis and treatment.
“Dr. Miranda-Sousa really paid attention to me and listened closely,” she states. “He was careful and took time with me. He listened and found the problem – and the solution.”

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    • Urology Experts

      The team at Urology Experts is dedicated to providing exceptional healthcare and personalized treatment plans. They offer a number of different urological services and specialties that will help any patient restore their quality of life.... Read More

    • Alejandro Miranda-Sousa, MD

      Alejandro Miranda-Sousa, MD, is a board-certified urologist by the American Board of Urology. Dr. Miranda-Sousa graduated from the prestigious Universidad Peruana Cayetano Heredia School of Medicine in Lima, Peru. He also completed his r... Read More