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DR RANDALL
DR RANDALL, Doctor
Category: Health
Satisfied Customers: 85
Experience:  GENERAL SURGEON/SURGICAL INTENSIVIST
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Whenever I swallow, I receive a pain on the right side of my

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Whenever I swallow, I receive a pain on the right side of my chest cavity. It is difficult to know where its origin is. But after an EKG, heart pace test, and CPA scan, my doctors remain baffled. While they remain baffled, the pain has progressed and seems to have spread, so that now it is continuous, but low grade. One of my doctors thought it might just be helico bactor that causes stomach ulcers and recommended a single two-week course of Biaxin, which improved the problem about 50%, but did not fix it. What could it be, and what further should I do about it?
Submitted: 5 years ago.
Category: Health
Expert:  DR RANDALL replied 5 years ago.
Customer/p>

 

have you had an upper endoscopy?

have you had a cat scan?

have you had a chest xray?

any surgical history for your chest or abdomen?

any medication?

Customer: replied 5 years ago.
have you had an upper endoscopy? [Yes, showed a small area of inflamation near the bottom of my esophogus. [The doctor said if the pain persisted he would give me a rather strong antibiotic to fix the problem, but when I went back to him, he said it should go away on its own. It did not.]

have you had a cat scan? [Yes, that is what we call a CPT-Scan takes 3d pictures of the heart. It came back "unremarkable."]

have you had a chest xray? [About a year ago. It too was perfectly normal.]

any surgical history for your chest or abdomen? [Appendix taken out in April 1995]

any medication? [listed above: lysinepril, Nexium, Metformin 500mg/day, Gabapentin (800mg/day), and various vitamins and mineral supplements]
Expert:  DR RANDALL replied 5 years ago.

Ok

 

Your first answer is what I wanted because quite frankly the first thing that came to mind upon reading your question is esophageal pathology. Pain is rarely a cancer compliant

early on so infection, erosions or ulcers is most common. The reason the Biaxin gave you some relief lead me more to an infectious etiology. Diabetes puts you at risk for opportunistic infections.

Neurontin is not normal medicine for diabetes. So I hope you have some neuropathy to justify its use.

 

The heart scan is not a cat scan of the chest. Pain with swallowing is either neck or chest pathology. A scope can see the inner lumen but the cat scan can see all structures and their surroundings. Unless they also read the heart scan as if it was a chest CT then you did not get what I think you need. MRI is also a good option.

 

The appendectomy is not an issue.

 

I am worried that the GI doctor has dismissed you because that discipline hold a significant key here?! Rescope is often needed and probably should be done. Biopsies !!! Wow these need to be done. Especially for H pylori, what if you have a resistant strain or you need treatment longer than the usual 14 days? Endoscopy could help. How about increasing the dose of nexium? Many times I find standard doses with this class of drug is insufficient.

A cat scan could evaluate neck structures & your mediastinum ( around the heart).

 

Now I will add this warning ---> As a surgeon I have had to chase the complaint for several months before the cause actually grew big enough to see.

I am not sure what else to tell you?! You need your doctors ( a doctor) to step up....

 

Customer: replied 5 years ago.
This is all first class advice, because my GP tried first to increase my Nexium dosage, but the insurance would not authorize it. She suggested that I augment the Nexium with some over the counter equivalent, but did not specify. Maybe you could recommend something.

Oh, on the neck structure, I have long-standing tennis injuries in the neck area c2-c6. They have fused on their own, and currently do not seem to be giving me trouble. However, I do know that the pain in my chest sometimes (especially in the mornings) gets more intense with abrupt neck movements. Somehow, even in my own untrained mind, there seems to be a correlation between my old neck injury and the pain in my chest.

Many thanks for this first class advice. Maybe I should take it to my GI doctor?
Expert:  DR RANDALL replied 5 years ago.

The only over the counter medication like nexium is prilosec.

Also know that the drug class we are talking about has unique properties in that some of them work some do not. All you can is try. Insurance is another issue. Again the gastroenterolgist could help here...

DR RANDALL, Doctor
Category: Health
Satisfied Customers: 85
Experience: GENERAL SURGEON/SURGICAL INTENSIVIST
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