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Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 10337
Experience:  14 years as clinician in the field of Family Practice
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I have pain in my abdominal area that radiates upward. Arms,

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I have pain in my abdominal area that radiates upward. Arms, front of neck, upper chest, stomach and middle of my chest. I have been diagnosed with IBS and Acid Reflux. I've had a colonoscopy and Endoscopic exams. Blood work, Urine Test, EKG's, Stress Test, Cardioultra Sound and the Cardio test with injection. (forgot the name). No results were found for heart trouble. What else can it be. I've been told it might be a nerve that's out of whack. Is this possible and if so, what can I do?

Anthony Bray MD :

Hello!

Customer :

hello

Anthony Bray MD :

The pain in the arms/neck/chest may be referred pain from the esophagus but this is too high for this being IBS in my opinion. IBS might also be a factor with your abdominal pain.

Anthony Bray MD :

You could have irritation of the esphogeal wall and this could produce pain. It also may have spasms which can produce pain.

Anthony Bray MD :

If esophagitis related pain then you may benefit to be treated for a good while with an acid lowering med. You may already be on one such as Nexium, Prevacid, Protonix, Aciphex as some common examples.

Anthony Bray MD :

Sometimes adding carafate which is a pink liquid may help to protect irritated areas and this may help.

Anthony Bray MD :

For quick releif and as a diagnostic aid I have often used a "GI cocktail" with a mix of Mylanta and viscous lidocaine. This will numb up sensitive areas and a quick response to this helps to nail down the source of the trouble.

Customer :

Is there anything I can do about this pain? It radiates so strong I can't move at times. Yes I'm taking Protonix. It seems to work at times, and at other times nothing. Where can I get the carafate? Okay, I can find the mylanta, where can I find the lidocaine?

Anthony Bray MD :

The lidocaine and the carafate would need to be prescibed by your doctor.

Anthony Bray MD :

If this is from the esophagus then remember to take it faithfully and also avoid aggravating foods/drinks such as hot spicy dishes, tomatoes, peppers, onions, citrus fruits. alcohol, anti-inflammatory drugs such as aspirin, advil and Aleve (Tylenol is OK) These restrictions should be pretty strict for the first four to six weeks and may be loosened as you have had time to heal.(this presuming that this is the source)

Anthony Bray MD :

Your negative cardiac tests would imply that this is probably non-cardiac pain. (A possible exception might be Prinzmetal's angina >>this is heart related due to spasm of coronary arteries but no fixed blockage so it is possible to have this and still have normal tests. The esophogeal explanation is more likely than this )

Customer :

Okay should I request this test? Is there a test for this?

Customer :

I've had the Endoscopic test and the Dr. found nothing wrong.

Anthony Bray MD :

The diagnosis is based more on the history of the pain and factors which lead to improvement. Prinzmetal's angina may be prevented with a vasodilating med such as Norvasc for example. If you responded to a GI cocktail then this would be strong evidence for the esophagus as the culprit. If you responded to nitroglycerin and/or Norvasc then this may support the possibility of Prinzmetal's. The endoscopy probably would have shown if you had frank esophagitis but some people will seem to be unusually senstive...possibly due to past injury.. so I think the GI cocktail test would still be useful to help with the diagnosis despite the fact that endoscopy was normal.

Anthony Bray MD :

Other possible sourses of chest pain can be musculoskeletal or pulmonary...

Customer :

So I should check with my Cardiologist about the Prinzmetal's thing? First try the cocktail right?

Anthony Bray MD :

Yes I think you should ask your cardiologist about Prinzmetal's and your doctor about the possibility of trying a GI cocktail. These two steps may help to identify your trouble. It is worth discussing at the very least.

Customer :

Okay, thank you very much for your help. Have a great evening.

Anthony Bray MD :

Thank you. I hope you have a great evening too!

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