Wednesday, March 20, 2013

Multiple Medical Problems and Chest Pain


Did 100 reps with 30 lbs 2 days ago (not sure if its important or not) Have had a sinus infection for almost 3 wks (dr appt in 2 days) I have back problems and have t4 and flexeril for it. I took them last night in hopes of sleeping better since sinus has been keeping me awake and restless sleeps. When meds kicked in, I got bad chest pains that kept me up all night and had a hard time breathing for 1/2 night. Today it's still sore and sensitive. Area is solar plex/between breasts.. Had this before and dr said was acid reflux. If so why does it happen only occasionally (once every 2 or 3 mos) and cause such pain for 24 hrs ?? I am overweight, had pituitary tumor, have hypothyroidism, celiac (found out in jan), low magnesium. I have had 3 kids as well.

 Gender: Female
 How tall are you (feet and inches)?: 5'3
 What is your weight in pounds?: 186
 How old are you?: 31
 How long has this been going on?: More than a year

 Check all symptoms you are currently experiencing:
 Abdominal Pain
 Difficulty Breathing
 Chest Pain

 Describe associated symptoms not listed above: The difficulty breathing part felt like someone was sitting on my chest.. I know it wasn't the side effect of the meds as I have been on them for a while

What have you done so far to remedy this condition? Please include tests and relevant studies here.
 : I was given reflux meds for a couple wks. That seemed to help at that time as I was getting the pains repeatedly. But now 3 mos later it's back.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): I have a pinched nerve in my lower back as well as arthritis. I can't take anti inflammatories as they caused major weight gain and stomach probs..  I have hypothyroidism, celiac disease, and low magnesium (taking vitamins)Had a pituitary tumor but it seems to be under control, not on meds for it anymore. I have had breast reduction 17 yrs old, surgery on my knee after skiing accident (15yrs), surgery on my armpit as breast tissue left  grew (28yrs),tonsils removed (16yrs), adnoid removed (8yrs)

 Check all conditions present in your immediate family... :
 Asthma / Lung Problems

Please list any medication allergies that you have : : Penicillin - throat swells
Please list any medications you are currently taking (and dosage if known) :: Cytomel 1/3.5 & synthroid 50mcg compounded in one pill .. I take 3.. I also take Tylenol 4 and Flexeril10 mg. I also take daily vitamins, including vitamin b 100 complex, kelp, omega 3-6-9, vitamin c 1000mg, digestive enzymes, vitamin d 25 mcg, magnesium glycinate 600 mg ..and occasionally iron 300mg ( was deficient last yr)

 When was your last menstrual cycle?: 3 weeks ago
 Are you currently using or do you have a history of tobacco use?: Yes
 Are you currently using or do you have a history of illegal drug use?: No
 Please describe your alcohol consumption :: Occasionally

The pain causes, what other things it could be ?

Ma'am, with respect, you have so many issues going on at once here I can't really tie this up nicely. The fact is that your symptoms could be coming from reflux, could be from gallstones, or it could be your heart. There are other possibilites, but these three are top of the list.

The point I guess I would make with you is that in order to GET the diagnosis more work needs to be done.

For instance, withn the chronicity of this, reflux is a likely cause. But you need to be checked for ulcers and you may need to have an upper endoscopy (camera exam of inside of esophagus and stomach).

You are also at the right age for gallstone disease. An ultrasound of the gall bladder is probably needed in your case.

Finally, even though the odds are against this being your heart, it is certainly worth looking at your heart with an EKG and, perhaps, a stress test.

Your other medical problems DO muddy the waters, so perhaps the best advice I could give would be to make sure your doctor is comfortable AND competent to manage a complicated medical patient such as yourself.

There are many unanswered questions in your case. I wish I could help more, but there is much that is yet to be done.

If you have any questions please do ask them below in the comments section.


Anonymous said...

I have had a stress test done on my heart and an ultrasound on my gallbladder. But those came up clear. LoL I know what u mean about complicated, I have been so unwell for a while and feels like there's always something new showing up. I even joked with my family that God must want me overweight, I keep "getting " things that make it impossible to lose! I gained 30 lbs just taking anti inflammatory for 2 mos and nothing in my diet changed. But now with the celiac diagnose I seem to finally be losing weight. Wondered if it has/had anything to do with the stomach pain? What about a pulled muscle? Could that cause spasming pain? Pain feels like it builds up quickly and then stops and finally drops back down again.. Almost similar to labour! (Definitely not)

space doc said...

Dear Anonymous:

Certainly a compicated picture!

1) you mentioned 100 reps with 30#--If these were bench presses they could cause some discomfort in the chest--not likely to be persistent or recurrent.

2) Back pains--on T4? and flexeril. Flexeril can cause some symptoms of gastro-intestinal upset.

3) You said the pains were still sore and senitive--was this an external feeling on pushing on the chest or an internal sensation. Surface tenderness woould suggest muscle or cartilage irritation. Internal discomfort could be acid reflux (possibly cardiac also.

4) You said the doctor said you had acid reflux. Was a barium x-ray or an endoscopy done to make the diagnosis?

5) Even though your ultrasound was normal, there could still be some stone or occasional blockage of the gall bladder or pancreatic ducts. This would be diagnosed by EGD (esophago-gastro-duodenocopy)
which is a more complete endoscopy visualization
which could check on the ducts as well as confirming any acid reflux problems.

6) How was the pituitary tumor diagnosed? A regular MRI can miss small tumors and it may be necessary to do a special MRI (called a sellar-specific MRI)

7) I wonder if the hypothyroidism was due to the pituitary or just from the thyroid itself. (The pituitary controls several hormones including thyroid, adrenal, LH & FSH sex hormones, growth hormone and Prolactin).

8) Was the diagnosis of celiac disease made with upper and lower G.I. x-rays or with a biopsy?

9) The low magnesium could be from poor absorption due to celiac dis. It often goes along with poor absorption of calcium--I'm sure your blood tests would have picked this up.

10) I do think that the endoscopy (or EGD) would be a good place to start to checkout the reflux and double check for any stones etc, that could be causing a lot of your symptoms.

Good Luck!! Keep us posted !

Space Doc.