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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34332
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Ok. Story so far... About 40 days ago i got this terrible

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Ok. Story so far...
About 40 days ago i got this terrible pain under the sternum. I have been diagnosed with gastritis 8 years ago so i thought that this was it again. Went to GP and he prescribed me on Nexium 40 mg for 1 month, change of diet and eating habits.

I started eating a lot less, stopped with alcohol, small meals, low fat, avoiding everything that would cause acid reflux.

Pain did not subside, it spread to the left side under my left rib cage. Started feeling nausea, loss of appetite. I also experienced change in bowel movement(used to have it 3 times a day, now hardly 1). Started burping a lot. Even got a dry coughing.

Went to private internist, had abdomen ultrasound, checked liver, gallbladder, pancreas, bile, spleen, thyroid, even prostate and everything looked fine. Found only some air in stomach and little thickening of pylorus. She diagnosed me with GERD, recommended having gastroscopy and to continue with Nexium therapy till the end of month.

After few days, went to private clinic, had gastroscopy, told every symptom to GI and she confirmed that i had GERD due to insufficient cardia. Everything else was fine, no irritation, no ulcers. I was prescribed with another dose of Nexium of 20 mg after finishing of the old one of 40 mg.

For two days everything was fine and then one night had this attack. Woke up from sleep, upper abdominal pain, hardly breathing and nauseated, shaking, feeling cold, weak hands, thought i was going to die. After 20 min, symptoms subsided and i felt extremely tired, went back to sleep. After that, for every 2-3 day, attacks would happen during night. Again, after some time spent sitting, i would get better and just feel extreme fatique and go back to sleep without any problems. Couple of mornings i would wake feeling cold. Started to be afraid of sleep, started to feel really weak and tired during day. Started feeling my left arm, like numbness and pain in all parts of hands. Sometimes shoulder, sometimes lower biceps, sometimes forearm. Also feeling heaviness in both forearms. Because of all of the symptoms i think i developed anxiety and concern of hearth related problem. After that, another attack during evening , shortness of breath, abdominal pain, left arm pain. Went to ER, ECG normal but blood preasure elevated(170/90), heart rate 110. They told me this is probably due to gerd and sent me home. That night felt ok and slept normal.

Went to private internist again, had ecg and complete blood count which came back normal. Had spirometry which showed i had little difficulty but nothing to alarming. She said i will have to do it again in month.

People noticing i lost weight. Started having shortness of breath, first mild, now sometimes it even interrupts me when i talk. Every now and then wake up with abdominal pain, which goes from center to the left side of the ribs. Again, when i wake up, have to sit for an hour for pain to eventually stop and then i just feel tired and crush in bed. Tight feeling in front of neck. Now i can even feel light pain in both sides of my chest, located near armpits and clavicle bone. Lost 14 pounds in 40 days. Abdominal pain is not constant any more but i have this strange feeling sometimes below my sternum. Went to doctor to see about pain in arm, she appointed me for internist who will check this out but she suspects anemia. Yesterday had pain in left arm all day, my left pinky and ring finger went numb. After it all stopped, went for a walk at night, after half hour of walking got this sudden weakness all over my body, started breathing heavily, thought i would faint, went to ER again, again ECG normal, blood sugar levels normal, she listened to lungs and said nothing unusual was there, but blood pressure again elevated 170/80. They gave me something for stomach and 10mg of valium. This was first normal sleep i had for this month of troubles. I wake up, gave blood for further evaluation (anemia), felt fine during morning and then i started feeling extreme fatique again (maybe because of 10 mg of valium from ER). I really dont know what to do anymore. This troubles impacted every aspect of my life. I became depressed, cant enjoy anything, stopped going out with friends and lately thinking that im going to die because i dont know what is wrong with me.

Hello Shane,
I am Dr. Arun and will be helping you today.

What did your following investigations show (if these were done);
Stress cardiac test
Heart ultrasound
Peripheral blood smear
Cholesterol / triglycerides / Lipid profile
Thyroid function tests.

Do you have any significant past medical history / previous surgery or family history?

Were you prescribed any medication for high blood pressure?

Customer: replied 3 years ago.

I only had 3 ecg´s: one normal and two during visits to ER when i thought i had heart attack. They all showed normal reading. Tomorrow ill go to another internist and ill request for stress test and heart ultrasound.


Only had blood test where they tested for heamtrocits, hemoglobin, MCHC, total WBC, granulocytes, lymphs + monos, paltelets. They all come in normal range. What is peripheral blood smear?


Tommorow before going to internist ill get another blood work, i hope my GP included Cholesterol / triglycerides / Lipid profile in it. And for tyhroid, i only got it checked up by ultrasound which showed no irregularities. I suppose ultrasound isnt enough?


I had anemia caused by iron deficiency, had inguinal hernia surgery and gastritis.


I didnt get any medication for blood pressure. I check my blood pressure at home. My systolic is bit higher(from 130 to 145) but diastolic rarely reaches 80. I know for my age that this is still high for systolic but when i mentioned this to my GP, she said this is due to stress. Only times my BP went higher was during this visits to ER. Could this be due to panic?


And if my hemoglobin readings are normal, would that mean that i dont suffer from anemia?


Hello Shane,

I am typing the answer which may take around 10 minutes. Thanks for the patience.

The criteria for diagnosing anemia is not low hemoglobin only. There are other criteria too like iron levels, red blood cell counts etc. Ferritin is a blood test which evaluates for the total iron available in the body. Serum ferritin is the most useful test for diagnosing iron-deficiency anemia. Low serum ferritin (less than 12 ng/mL) is highly specific for iron-deficiency anemia. Please read this resource;

The most common causes of anemia are;

1) iron deficiency (with or without blood loss),

2) chronic disease/inflammation

3) chronic kidney disease

4) deficiencies of folate or vitamin B-12,

5) diseases of the bone marrow

6) hypothyroidism, hypersplenism, and hemolytic anemia

So investigations for anemia entail;

1) Complete blood count (CBC)

2) Peripheral blood film / smear; this is blood spread on a slide and seen under microscope for looking at the size and configuration of the blood cells.

3) Vitamin B-12

4) Folate

5) Reticulocyte count

6) LDH

7) Thyroid-stimulating hormone

8) Serum creatinine and estimated glomerular filtration rate

9) Serum ferritin

10) Serum iron

11) Total iron-binding capacity.


It seems that you had a panic reaction because of the symptoms and also because it is a undiagnosed issue. Since you are taking blood pressure regularly and monitoring it, medication may not be required.


a) Patients with the mild high blood pressure / hypertension do need to restrict table salt which is considered as a prime regulator of the blood pressure. It is advised to reduce sodium intake to no more than 2.4 g sodium or 6 g sodium chloride per day. It is also advised that adequate intake of dietary potassium (approximately 90 mmol/d), helps in reducing the blood pressure.

b) Following dietary and nutrition measure are strongly recommended to bring down the blood pressure;

A diet rich in fruits, vegetables, and low-fat dairy products may lower blood pressure by 10-16 mm Hg.
Oral potassium supplement may lower both systolic and diastolic pressure. Calcium and magnesium supplements, too, decrease the in blood pressure.
Low alcohol consumption lowers the blood pressure.
Stop smoking, if you do and reducing intake of dietary saturated fat and cholesterol benefits tremendously in overall cardiovascular health.
Following reduce and regulate the blood pressure:

1) Garlic

2) Fish oil

3) Herb Hawthorn

4) Coenzyme Q10 (CoQ10).


Ultrasound is not good enough investigation for the thyroid and a blood work for the thyroid should be done for your symptoms. You need to get all the other tests too which we had discussed. Possibilities of the diagnosis in your case can be;


1) Thyroid abnormality

2) Acid reflux

3) Pinched nerves in neck

4) Esophageal (food pipe) motility disorder.

5) Anxiety


Some of these above conditions can be concomitant. I am not worried about an heart condition in your case but I suggested heart tests as these should be done for the cautionary purpose and to categorically rule out heart as a culprit.


Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.


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Customer: replied 3 years ago.

Thanks for reply. Im going to see the internist tomorrow and hopefully get diagnosis from blood work. Thank you for your help.

You are very welcome, Shane.

Good luck.