Monday, January 9, 2012

Chest Pain? Abdominal Pain? What Gives?


On Saturday I was carrying in some groceries, when I noticed a strange pain at the bottom of and/or slightly behind my ribcage on the right side. – immediately to the right of my sternum.  I wondered if I had pulled some nameless muscle, although it did not feel like a muscle pull (having been an athlete I am very familiar with muscle pulls), but I thought it may have been some deep "core" muscle that gives a different sensation when pulled. But over the next 24 hrs as I tried to locate the offending muscle group it became clearer to me that it was not muscular because it seemed "tender" to the touch - a feeling half way between a runners "stitch" and a soreness due to inflammation.  It kind of felt like maybe some gas trapped in an odd place.

On Sunday eve the pain was about the same, maybe a tiny bit greater, I was getting a wee bit concerned because I figured a stitch was out of the question, and I was seriously doubting a sore muscle pull.  At some point my 5 yr old hit me right in the old solar plexus – not really, but he hit me right on the money spot below my ribs, it was a fairly typical 5 yr old playful punch- not much force.  The pain was so sharp that I yelled so loud that it sent my son screaming for mommy, and it even surprised me.  This is no muscle pull.  About 3 hrs later I started experiencing a very sharp pain when trying to breath deeply.  Also only on my right side but about 2 inches below my nipple (too high for any gastro-intestinal pain I am assuming) that was, once again similar to a side stitch -  the kind that hurts to breath deeply,  but about 2 -3x more intense and after a few hours it is still here. 

The pain is way to intense to “fight through the pain”, if I try to complete a breath, the pain is so sharp that my body reacts reflexively and forces me to stop.  I don’t mean a reflex like when your knee is tapped, I mean it is as if tried to keep your hand on a stove as it slowly got hot, at some point you will take your hand away no matter how much you try to will yourself not to – your body just takes over.

When I push straight into my stomach (liver? kidneys? gall bladder? Isles of Langerhans? gut? Whatever is located at the bottom of the rib cage) just below the rib, the pain starts about 1 inch to the right of my sternum and ends about 5 inches to the right of the sternum.. As I push it feels as if something is bloated, and if as I push into my body I angle my fingers up underneath the rib cage that seems to be the locus of the pain, maybe about an inch or 2 up from that lowest rib.

Also if I try to arch my back (not while inhaling) I feel both the sharp pain near my nipple and the “tender” achy bloated-y pain near the bottom of my ribs.

Could this be an old debate-team injury manifesting itself 30 years later?  Or is this merely mean I have to talk to my wife about her “cooking”?  Seriously though, I would like know if this is the beginning of appendicitis or pleurisy that me be a symptom of some underlying and serious condition, or if this is something I can ride out for a few days.

Thanks and Happy New Year

Update on the breathing pain.  I awoke this morning and found that lying on my back or left side gave me pain breathing with shallower breaths, and it just hurt to be in those positions.  When standing or sitting, only pain with deep breaths.  At 3pm I took a deep breath without the stabbing pain.  It is now 345 and still no more stabbing pains. But when I breath deeply I can feel a very mild pain where the sharp pain was, and I can feel a small to medium increase in the "tenderness" pain at the bottom of my ribs. It is wonderful to be able to breath, yawn, cough, sneeze without stabbing pain. BTW, any movement that is even slightly jarring Running dancing, twisting quickly) brings on a small to medium increase in the pain at the bottom of my rib cage.

Oh I was googling stuff last night and I realized in may be relevant that I have been having headaches quasi-regularly for about the last 3 weeks.  I rarely get headaches and almost never take pain killers but I have taken pain killers 3 times in the last 3 or so weeks.

Thanks again
Gender: Male
How tall are you (feet and inches)?: 6' 1
What is your weight in pounds?: 215
How old are you?: 50

How long has this been going on?: A few days
Check all symptoms you are currently experiencing:
Abdominal Pain
Difficulty Breathing
Chest Pain

Please list any medication allergies that you have : : None
When was your last menstrual cycle?: I'm a man, baby!

Given that the sharp pains have subsided what should I do?

You need to proceed directly to the ER. You have two if not three potential life threats. The comments below are very good, but basically I am very concerned about the possibility of this being a blood clot in your lungs. It could be pain from your heart... it could be a collapsed lung.... it could be a lot of things. But, as long as the pain is as you describe all guessing is pointless. You could be in grave danger tonight. You need to go to the ER now. Now. Stop guessing about this pain and go get it looked at.


Dr. J said...

As a lurking emerg doc I will chime in on this one:

You are a 50 year old man with sudden onset chest pain associated with breathlessness. As is typical for a 50 year old man in generally good health you are minimizing your symptoms, you need an answer in the next few days? Seriously?

Let me be straight with you, you need an answer today. Your symptoms could represent a catastrophic medical condition. Although it is possible that there is some benign explanation everyone is concerned. When ou walk into any emergency room in the country and tell this story you are going to get a work-up for pulmonary embolism, and some cardiac work-up.

You need to go to the hospital now. Look at your 5 year old son, think about how sad he would look without a Dad to punch. Tell your wife to stop cooking dinner and take you to the hospital.

Good luck.

Dr. J

space doc said...

I agree with Dr. J. that you realoy need to be seen by an M.D.

It's possible that you you might just have an intercostal (between the ribs) muscle pull &/or upper abdominal muscle strain, but there could also be a developing pleursy or even a little air escaping form the lung (pneumothorax). These can be checked out by an M.D. listenimg and and if warranted getting a chest xray.

The recent headches may be related-- if there were a viral infection getting started which could also be related to a viral pleurisy.

The heart as well as the lungs should definately checked.

If it turns out to be a mild pleursy &/or muscle strain
all you may need to do is take an anti-inflammetory medication such as advil or aleve.---but

you definitely should be checked by an M.D.

We'd be interested to see how this turns out.

Good luck and keep us posted.

Space Doc

MDSTAT_DOC_7 said...

Aaaaannnnnddddd - a third opinion is that yes, you should go get this checked out now.
Granted, the fact that it has been going on a couple of days now PARTIALLY rules out some of the immediate concerns, there are still some ugly possibilities. I believe they are mentioned above, but to reiterate...
Cardiac pain (less likely, since it hurt when your kid punched you)
Lung pain, as in a collapsed lung - very possible, and WOULD hurt when your kid punched you
Blood clot in the lung - again, less likely to hurt with the punch
And last on my list of probable serious causes would be a gallbladder gone bad.

I hope by the time I posted this you had already sought medical attention in person! Please let us know if this turned out to be a pulled muscle or a surgical issue or worse! Hope all is well now - and that your 5 year old has not been too traumatized! :)

Anonymous said...


You guys & gals* are awesome!!! There is a doctor in my neighborhood who I am close enough to that, upon receiving these grave warnings, I went to see him rather than a trip to the ER. He gave me a physical exam (listened to heart, lungs, poked a few areas, and I was able to ask some questions since I was armed with some specific info from you all (embolism in particular). This resulted in prompting him to ask a few more questions (such as "Any leg pain?" and "How bad is your wife's 'cooking'?" - as you can see, my sense of 'humor' has unfortunately returned). Bottom line... he felt we had ruled out all life threatening stuff enough to "stay at home but watch it, but call me in the middle of the night if you are concerned or things get worse". After seeing him my general feeling of malaise increase slightly over the next hour, but then began to subside (esp with some NSAIDs). I awoke this AM with, and pain / concern had been replaced with ... joie de vivre. Due, in part to MD Stat! (But mostly due to lack of pain). So if I may ask, what the #$%& could it have been? (The discomfort at the bottom of the rib cage is 85% gone)? Can Pleurisy come and go that quickly and occur in 2 places with very different types of pain? Could my Islets of Langerhans be in revolt? (I am overusing the Islets, comedically, but is the only thing I remember from Biology - besides the krebs cycle, of course). Finally, can I forget about this or do I need to be aware that this was the 1st shot across the bow of some serious ailment lurking in the grass requiring me to go get an ekg, or cut food out of my diet, or something esle that will make me finally realize that I am no longer 25 yrs old? Thanks again!

PS Re my 5 yr old, all is well, he merely "Hates daddy" which is a condition that usually passes with a small dose of self prescribed, over the counter tickling.

* "guys & gals" is meant to be respectful, I hope my informality does not offend.

MDSTAT_ER_DOC_1 said...

dear anonymous,
thanks for your sense of humor. since you mentioned it, yes, pleurisy can be very acute and can move around and should resolve.

islets of langerhans? you must be some kind of special non medical type to remember THAT from biology.

but, in the spirit of humor, let me tell you this. make sure that you never piss off a witch-doctor. a voodoo curse is always on the list and can not be ruled out except by a voodoo priestess.

and now in all seriousness, thank you for your question. come back anytime.