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Old 02-13-2013, 13:09   #1
Smokin Joe
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My Odd Chest Pain

The first incident:
Started on or about 10/25/12 low grade fever all day around 100-101.
Chest pain radiating from mid line over the heart area. Pain increased with shift in position. Pain was sharp and would shoot up the neck when ever I bent over or stood up. Pain felt like is was related or traveled via vascular i.e. my carotid artery up to the bottom of my chin and would stop there.

Went to the ER they gave 3 I/V’s full labs, ruled our PE and chest X-ray all neg. Exist diagnosis was possible pleurisy.

Follow up with my PCP the next day, stated the symptoms were classic pleurisy which was odd because he had never seen a “classic symptom case” another round of labs and X-rays all negative. Gave Percocet for pain and advised to take motrin for inflammation. Pain was a 4 or 5 and tolerable for 2 days, then on the third day pain shot up to about a 7 or 8 out of 10. Pain subsided after about 4 days on Percocet.

Fast forward 7 weeks, pain is mild and manageable with motrin, but still vaguely present. No Percocet for almost 6 weeks at this point.

The Second Incident:
January 7th, 2013 pain comes back like a freight train and is more prevalent then ever. Go back to PCP. He says “I don’t know” but at this point its not pleurisy. However he puts me on Voltaren and Prednisone and refers me to a pulmonologist

January 11th, 2013 relate all info to the pulmonologist. She orders CT-A and Echocardiogram, plus additional labs.

By this time the pain has subsided and it feels like the Voltaren and Prednisone are working. CT-A and Echcardiogram come back clean and clear, only thing showing is my venacava artery is slightly dilated compared to the others.

January 30th, 2013 I feel great, no pain, back to 100% pulmonologist says she thinks it was pericarditis but has no proof to back that up as all labs and test show no abnormalities.

The Third Incident:
February 8th, 2013 shortly after lunch on set of pain in the upper left side of my abdomen, at first if feels like gas pain but within 24 hours the pain radiates across my entire chest. And stays centrally focused on the midline of my body consistent with previous incidents. By the 10th the pain has increased to a 7 or 8 out of a 10.


February 11th, 2013 I saw the pulmonologist who examined me and said there is no way it is your heart or lungs as she had a cardiologist review everything and my heart and lungs are clear. As such she further stated she was totally out of answers and believes I needed to see a GI doc. Later that day I followed up with my PCP for a second opinion who confirmed that if it is not the heart and lungs then the next step is a scope with a GI doc.

February 12th, 2013 I saw a GI Doc who examined me and stated that any GI issue would be a real stretch but of course it had to be ruled out. I have a gallbladder ultrasound set for Thursday and a Scope set for next Tuesday.

Consistent symptoms throughout this ordeal when this (whatever it is) is aggravated or the pain is “on” have been: Mild pain on day one (like a 4 out of 10) escalating to a 8 or 9 out of 10 by the third day, Night sweets, what feels like a fever as far as feeling hot, then cold, followed on by chills at night, chest pain that even when medicated is a 4 or 5 out of 10. Unmediated feels like at 8 out of 10. It always escalates the same, with mild pain in the lower center of the chest, really bad night sweats and what feels like a low grade fever that night, next day pain will increase in area and level. Pain increase until it spans the entire chest and the pain is steady 8 out of 10. Controlling pain with Percocet 10-325 every 6 hours. After 4-5 days of pain management pain will drop off for a couple of weeks then come back hot and heavy.

Here is what I am consistently seeing, 1) Docs who have no answers 2) A pain that is not presenting in a typical fashion that would lead to a quick and or easy diagnosis. 3) I feel docs are ignoring the fever / night sweats as every time I bring it up they are dismissive of it. 4) This is a cyclical occurrence.

Would anyone here care to jump in and add your knowledge and expertise, as it seems I am stumping everyone else I am running into. I am so frustrated at this point that I would just love an answer so it can get treated and I can move on with life. I have a newborn, 5 year old, work, and a spouse that I have been neglecting due to this craziness. ETA: Pain is aggravated by deep breaths, coughing, hiccups, or burps.

And NO ADAL you CANNOT sink a needle into my heart for training purposes…. You wicked witch doctor. ☺ Sorry for the long winded post and TIA for any help.
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Last edited by Smokin Joe; 02-13-2013 at 14:22.
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Old 02-13-2013, 17:41   #2
Eagle5US
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Looks like you are doing all the right things and seeing all the right people.
Try and keep the faith through your frustration. Probably the WORST thing that could happen would be for a bunch of folks on the internet to start sending you "ideas" because it really muddles the picture for your health care team.
Understand too, that they are ruling out all the BAD things (i.e. things that can kill you) and during that time they too know you are still suffering.

No one goes into medicine because they want to say "Damn, I dunno. Looks like you are SOL" They want to help you. Us giving you bright ideas without the benefit of a physical exam, imaging, and labs would more than likely be somewhat detrimental.

All that having been said. I too hope you feel better soon.

Please keep us posted on your progress and prognosis. It could be a good learning thread for our Deltas.
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Old 02-13-2013, 18:09   #3
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Shall do Sir.

I will also see if I can get a copy of my CT-A and Echo + lab results for your eyes. I know me just spewing my frustration with out labs and without an exam only gives you an incomplete picture. But I'm all for learning and I think I have a real head scratcher here. I hope it will help someone down the road.

This one Delta I talk to a lot only wants to stab me in the heart because "it couldn't hurt" was the last excuse I received . Prior to that was, "it will be fun" and "Its really good training".

Thanks for the response and encouragement.
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Old 02-13-2013, 18:43   #4
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I'm not a doctor, and not a Delta, nor did I sleep in a Holiday Inn Express last night. However, I do hope this gets resolved quickly and satisfactorily for you, Smokin Joe.

Hang in there...
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Old 02-13-2013, 18:53   #5
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Ask your PCP to ultrasound your gallbladder. Is the pain related in anyway to your diet? Fried or fatty food make this worse? Pain associated with cholecystitis usually manifests in the midline of the upper abdomen, but can radiate like heart attack pain. Your work up seems to have ruled out pericarditis (my first thought) and pleuritis (you didn't describe pain on respiration so I didn't think this was a likely Dx). I am betting on the gall bladder. Interesting an ECG abnormality (S-T interval elongation) is associated with gall bladder disease. No explanation.

Disclaimer: I am not an MD, but I did stay at a Holiday Inn Express

Seriously, have the gall bladder ultrasound.
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Old 02-13-2013, 22:23   #6
adal
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On a serious note, the needle to the heart needle would only be diagnostic. (and fun training )
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Old 02-13-2013, 22:58   #7
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Originally Posted by Smokin Joe View Post
Prior to that was, "it will be fun" and "Its really good training".
Just practice up on your bleat.
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Old 02-13-2013, 23:59   #8
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I agree with Eagle; it could be a lot of things. Do you have difficulty swallowing? A gastro-intestinal series, including esophageal manometry may pinpoint the issue since your doctor has ruled out a heart problem ... the excessive sweating may be indicative of a number of issues not related to the chest pain. While the Internet offers a lot of information, in the final analysis it's hands-on diagnosis that's going to resolve this. In any event keep involved with the process ... you'll fare better if you take an active role in medical decision-making.

I certainly hope that you can identify and overcome the problem.
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Old 02-14-2013, 07:48   #9
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Quote:
Originally Posted by Trapper John View Post
Ask your PCP to ultrasound your gallbladder. Is the pain related in anyway to your diet? Fried or fatty food make this worse? Pain associated with cholecystitis usually manifests in the midline of the upper abdomen, but can radiate like heart attack pain. Your work up seems to have ruled out pericarditis (my first thought) and pleuritis (you didn't describe pain on respiration so I didn't think this was a likely Dx). I am betting on the gall bladder. Interesting an ECG abnormality (S-T interval elongation) is associated with gall bladder disease. No explanation.

Disclaimer: I am not an MD, but I did stay at a Holiday Inn Express

Seriously, have the gall bladder ultrasound.
There might be something to this, I am getting an ultrasound this morning and my pulimonologist did mention a very small abnormality in my t wave when I went to the ER back in October. However, she was very dismissive of it and made a very passing comment about that, and other EKG's did not show this.


Thanks everyone for the info, and I get a scope down my throat on Tuesday, I will update you all when I know more.

And I will work on my bleat and four legged run.
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Old 02-14-2013, 11:16   #10
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Originally Posted by Smokin Joe View Post
There might be something to this, I am getting an ultrasound this morning and my pulimonologist did mention a very small abnormality in my t wave when I went to the ER back in October. However, she was very dismissive of it and made a very passing comment about that, and other EKG's did not show this.
That is a key differential diagnostic indicator that most internists and cardiologist even dismiss. With your episodic sever pain as you describe it, pain on inhalation (not exhalation), clear heart and lung pathology - I'll bet you a donut that you have gall bladder removal in your near future. The ultrasound will tell all.

PS: Don't f'around with this. Can lead to pancreatitis if I'm right and you don't want to go there.
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Old 02-14-2013, 11:59   #11
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On a serious note, the needle to the heart needle would only be diagnostic. (and fun training )
Let me know if you need me to hold him down so you can stick him.......
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Old 02-14-2013, 12:19   #12
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That is a key differential diagnostic indicator that most internists and cardiologist even dismiss. With your episodic sever pain as you describe it, pain on inhalation (not exhalation), clear heart and lung pathology - I'll bet you a donut that you have gall bladder removal in your near future. The ultrasound will tell all.

PS: Don't f'around with this. Can lead to pancreatitis if I'm right and you don't want to go there.
I tell you what, the ultrasound sound today hurt like a motherf-er, and I pressed the ultrasound tech as hard as I could and she was tight lipped which I get. I didn't see anything in the ultrasound that jumped out at me like an alien in my chest but that doesn't me anything.

Also, I monkey F'around with this on the front end for a couple of weeks, thinking it was no big deal. Now (the last few weeks) I have had a change of heart and am being very aggressive about this and I am really leaning on the docs for answers and results.

The Scope is on deck, hopefully between these two tests we can figure this out.
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Old 02-14-2013, 14:37   #13
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I didn't save a lot on my car insurance nor did I stay at a Holiday Inn last night. Not really my lane and I agree, Charlie mike with the docs; however, reading it, I did wonder about travel. Have you been out of the country (TB) or to Cali (Valley Fever). It does kind of sound like some sort of pleural effusion whether pneumococcal or what have you, heck maybe even a little like endocarditis. If you have good docs and they are truly stumped, they'll do what good docs do and bounce it off colleagues. Surely someone somewhere had a pt who had the same! Only so much is book learning. The rest is ojt. Anyway, see your doc. Don't listen to advice on the 'nets and most importantly, Feel Better Soon!
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Old 02-14-2013, 15:32   #14
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Let me know if you need me to hold him down so you can stick him.......
I'm just gonna pass over this, as there is nothing smart nor productive I can say to make this go away. Please don't stab my heart with a big fucking needle until I'm dead or dying.

Quote:
Originally Posted by Mismed
I didn't save a lot on my car insurance nor did I stay at a Holiday Inn last night. Not really my lane and I agree, Charlie mike with the docs; however, reading it, I did wonder about travel. Have you been out of the country (TB) or to Cali (Valley Fever). It does kind of sound like some sort of pleural effusion whether pneumococcal or what have you, heck maybe even a little like endocarditis. If you have good docs and they are truly stumped, they'll do what good docs do and bounce it off colleagues. Surely someone somewhere had a pt who had the same! Only so much is book learning. The rest is ojt. Anyway, see your doc. Don't listen to advice on the 'nets and most importantly, Feel Better Soon!

No travel, Valley Fever was ruled out too with all the labs and by the pulmonologist.

The only pattern I can establish is that this comes on easy with mild chest pain, then within 2 days hits like a freight train encompass the chest, and goes to 8 or 9 out of 10. Manageable with a truck load of Percocet. Then after 3-5 days on Percocet it subsides for several weeks, only to come back and repeat.

Update New change in meds:
10-325mg Percocet as needed for pain (currently been off of them for 16 hours and I only have only very slight discomfort. Deep breaths do cause significant pain in the front mid line of the chest. Normal resting breaths = no pain.

20mg of Omeprazole X2 a day
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Old 02-14-2013, 15:39   #15
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On a serious note, the needle to the heart needle would only be diagnostic. (and fun training )
You are so bad Adal......but the truth is an endocardial biopsy may be in play if there is any evidence of cardiomyopathy. Also, have they done a stress test to try and bring on the pain so that it can be captured on ECG or echo when it happens? The GI guy may also need an UGI to check for esophageal spasm which can hurt like a heart attack.....

You're too young for this garbage!

ss
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