Resolved question:
Approx4-5 months ago I experienced what felt like an irritation surrounding my lungs that could best be described as a light burning sensation, as well as a constriction on inspiration . This was accompanied by diffuse burning sensations across the upper part of my chest/chest wall- concentrating over my right pectoral area . This burning sensation has been present since - still remains diffused throughout only my right side – has moved to my right side throat, and through my back to the scapula area , and occasionally sensation to my spine., and feels muscular in nature – radiating from chest wall.
I initially consulted Pulmonologist and he took xray of lungs which were clear- as well as clear breath sounds in all areas- did breathing measurement test and breathing was fine. Then Consulted ENT – examined via scope – and throat was clear . He suggested Cardiology as it may be atypical cardiac pain – went to ED …all labs normal (except for elevated CCK, but ruled out as I had tried doing exercises earlier in the day). – including cardiac enzymes, EKG normal , ECHO normal, Chest x-ray normal , Cardiologist indicated pain was strictly chest wall. Referred to Gastroenterologist, paced on high dose of Prevacid, scheduled for colonoscopy, and endoscopy- results for Endoscopy presented with rings in esophagus, biopsy obtained – negative for eosinophilic esophagitis or any other abnormalities, was normal . Colonoscopy revealed some mild diverticulitis, but otherwise normal . Received abdominal ultrasound and hida scan for gall bladder – Hida scan revealed gall bladder working at 5%, gall bladder was removed approx 3 weeks ago. The pain (burning sensation) in Right pectoris and right scapula area continues as well as burning sensation in my throat, that moves up to my ear.( I have noticed a small canker sore on my tonsil arch that is not healing, but not getting larger – Fatigue is present , but I do know my testosterone is low as well – Since the gall bladder surgery digestion is much better but the burning sensation continues and is definitely Muscular and feels as it may have moved to my scapula joints – I ran my own ESR which came back at a 7, and also did a 10 day titrating dose of prednisone , which seemed to make the pain worse. I am at a loss, I know there is something wrong – I’m just not sure which direction to go in –
Medical History- 50 years old, non smoker, non drinker, have lost approx 30 lbs ( planned via eating better, and walking daily ) over the last 4 months . Generally healthy – only hospitalization is when I was 5 yrs old for Reyes syndrome( encephalitis) . Sleep is not effected, pain is 0-1 at start of day – increases as day proceeds.
Thanks ahead of time for your response
Submitted:
4 Days
Category:
Rheumatologist
Hello,
Thank you for asking your query at DoctorSpring.
I can see that you have seen multiple specialists and undergone many investigations for your symptoms. I do understand that it could be frustrating to end up without a specific diagnosis in the end. This syptoms are not suggestive of a Rheumatologic disease either.
From the history and the symptoms it is pretty clear that this is not related to heart, lungs or the GI !. The striking feature is Radiation and Burning sensation which suggests that the origin of pain is in the Nerves. This is a pretty obvious fact and I am bit surprised to see the evaluation has not been carried out in this direction.
Let down my opinion for clarity.
1. The symptoms are non specific. By non specific I mean they do not suggest a single diagnosis, but instead are suggestive of a Nerve related aetiology.
2. This could be due to a peripheral neuropathy or nerve compression.
3. If the pain coincided with the period of weight loss then a nerve compression is highly possible. Fat provides kind of cushioning action to nerves at some place. When there is loss of fat all of a sudden nerves can get compressed. Any unusual activity as in weightlifting or exercise could worsen it.
4. A vitamin B12 / folic acid deficiency can cause peripheral neuropathy and related symptoms. You may take a multi vitamin capsule once a day
5. A symptomatic approach to the pain – NSAID + TCAs ( like Amitriptyline ) are the best option for you. Peripheral neuropathy pain management needs trial and error method and best done by your Doctor with regular followup.
6. I recommend a Neurologist consultation for further evaluation and treatment.
Hope this helps
Please feel free to ask followup questions.
Thank you