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Dr Khan
Dr Khan, Doctor
Category: Medical
Satisfied Customers: 1183
Experience:  MB, MRCP(UK), MCPS(Medicine)
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severe pain between shoulder blades radiating into rib cage

Customer Question

severe pain between shoulder blades radiating into rib cage . soreness in both lungs on intake and resting
Submitted: 2 years ago.
Category: Medical
Expert:  Dr Khan replied 2 years ago.
Hello and Welcome to JA
Thank you very much for your question and coming to this service
For how long has this been happening?
Do you have any diagnosed past medical issues?
Customer: replied 2 years ago.
7 weeks. the 1st two weeks were severe. phyical exertion would seemto re engere theribcage onthe left side. cough, laughor cough was super painful.now i feel better butstill have symtoms. also have had slow nose bleed sleep on back spit clots occasionally each night.i have taken 81 mg asprin for years now and have never experienced this.
Expert:  Dr Khan replied 2 years ago.
Any shortness of breath or fever?
Any past medical issues like diabetes, high cholesterol or high blood pressure?
Any CT Scan chest or heart work up done? Could not find it in your description
Customer: replied 2 years ago.
upon activity slight shortness of breath but no more than usual for me.i do not have pluracy type pain,but slight sorenessin lungs on breath, mostly at rest or bed.i have diabetes type 2 good a1c though high cloresterol hiatal hernia gerd artheritis occationallystiffness some joint pain high blood press generally feel wore out i have suffered severe muscle cramps all my life its a scourge!
Expert:  Dr Khan replied 2 years ago.
How about heart work up and CT chest?
Any blood tests done?
Customer: replied 2 years ago.
no heart or ct-i have no insurance,pre existing cond so im out of pocket yes blood test dec 22 2011 tc=132,hdl 43, trg 71, ldl,74 non-hdl 79, tc/hdl3.0, i cant find my newer test. x-ray feb 28th showed nothing.
Expert:  Dr Khan replied 2 years ago.
Thank you for the details
Although not classical but there are certain features in description pointing to pleurisy though it may not be the primary process
X-Rays are notoriously insensitive to see details of lungs and only show major structural problems
There are certain possibilities in your case, without pursuing them an exact cause may be difficult to pin point here
Small airway inflammation (Bronchiolitis) is one consideration here
Reversible airflow obstruction or any element of COPD needs to be ruled out
Auto-immune disease involvement of lungs can cause inflammation and bleeding
A comprehensive check including Blood complete, ESR/CRP (Markers of inflammation), ANA levels, CT Chest and pulmonary function testing needs to be considered
Next consideration, once these have been checked would be neuropathic pain coming from spine due to slipped disk or its herniation which can give pain between shoulder blades with radiation. So a spine evaluation would be next step
In patients with risk factors for heart disease like high blood pressure shoulder blade pain may indicate aortic involvement and a basic heart work up with Echocardiogram is needed
I know its a bit labored but all three things including lungs, spine and heart needs to be checked as many considerations here are potentially dangerous, so an exact diagnosis is needed to direct appropriate treatment
You are welcome for further queries
Best Regards
Dr Khan, Doctor
Category: Medical
Satisfied Customers: 1183
Experience: MB, MRCP(UK), MCPS(Medicine)
Dr Khan and 4 other Medical Specialists are ready to help you
Customer: replied 2 years ago.
Helo again, I have seen a doctor and he seems to think its pulled muscules and ordered blood tests to examin me futher, that was on monday the 9th. My symptoms have changed or further developed sence then. The new symptoms started monday night and into tuesday and as of now have not let up. I now have abdominal pain mostly centered and just below my ribcage. I am taking perscription medication for pain. The doctor prescribed pain medication for original symptoms, however medication is needed for both sympoms now. I have to say the pain in my abdominal area is more severe than the back pain at this point. I had my son look up possible diagnosis on computer and he said it came back with possible appendicitis, but symptoms don't fully fit possible cause. I don't have the diarrhea, mild fever, and fequent urination but do have the loss of appetite and nausea. What should i do? Thank you for your help.
Expert:  Dr Khan replied 2 years ago.
Thank you for getting back
Where is this pain exactly located. right or left side below rib cage or on both sides?
How bad is it on a scale of 1-10......10 being worst?
Customer: replied 2 years ago.
Pain is mostly in the center about the same highth of last rib down to about the belly button, so i have to say both sides. The pain is about a 2 to3 but gets worse as it fluctuates.
Expert:  Dr Khan replied 2 years ago.
One more thing
What are your current medicines if you can name them for me?
How would you describe this pain....burning, aching or sharp?
Is this pain getting worse since Monday night or staying same in severity with fluctuations?
Was an EKG done by your physician and if so reported normal?
Customer: replied 2 years ago.
omeprazole 20mg, metforman500mg, terazosin5mg, lovistatin20mg, levothyroxin25mcg, lisinopril hctz20-25mg, proventilhfa,fluticasone50mcg, flovent110mcg, tamsulosin.4mg, fish oil1000mg, d-32000iu, e400iu, asprin81mg, c,multi, b, and potassium gluconate as dosage on bottle. The pain is like when you are feeling sick to your stomach and the feeling you have just before you throw-up, thats how i feel . The pain i have to say is getting worse since monday.
Expert:  Dr Khan replied 2 years ago.
Can you please let me know if your EKG(If done) was normal? Just want to make sure as angina/heart pain affecting lower part of heart can present with pain/discomfort or aching in stomach area so often missed and this specially holds true in diabetics where we do not expect typical symptoms in most
Does your abdomen hurts anywhere if you press it lightly?
What was the pain medicine given by your physician?
Customer: replied 2 years ago.
The pain medicine was given to me by my physician,yes. The ekg was not done. The abdomen does not hurt anywhere when i press down lightly, however i did forget to mention i read high for my blood pressure when i took it today with my home pressure cuff. The reading was 180/100 with a 100 pulse, i did take it a few times and results were about the same every time, sorry i dident mention that before.
Expert:  Dr Khan replied 2 years ago.
Thank you for the details and patience
This area can cause pain due to variety of issues Stomach inflammation(gastritis....very common with pain medicine) or ulcer, stomach flu, inflammation of pancreas,food pipe(esophagus) or liver
And last but not least angina I just wonder that with your initial description of symptoms why was an EKG not done as a part of initial check
My view here is that pain is likely drug induced gastritis (due to pain medicine) which should be better by increasing omeprazole to 40 mg/day(20mg twice daily)
BUT ONLY IF ANGINA/HEART PAIN HAS BEEN EXCLUDED
Your diabetes background,hypertension,age and current high blood pressure readings make me a bit uncomfortable here to pin point stomach issue unless i am confident that your heart has been checked at first place.
Your BP should be cross checked and medicine adjusted accordingly if needed
My professional and honest suggestion would be to get an EKG done now to see if we are not dealing with angina and then take any additional measures like increasing omeprazole or adding some other medicine like phazyme (available OTC for symptomatic relief)
Appendicitis by this time would be much severe(starting symptoms on monday) and cause tenderness in lower right abdomen area with associated symptoms like fever,vomiting and urinary complaints
You are welcome for any further queries
Best Regards
Customer: replied 2 years ago.
so should i go to the emergecy room or should i try and see the previous doctor as soon as possible with the first available appointment? Is there any other signs that would appear if these problems are hart related, if so what should i or my family look for?
Expert:  Dr Khan replied 2 years ago.
An urgent care would do
You can get an EKG from there (whichever you find near)
By getting that done you will have some peace of mind that nothing serious has been overlooked and we can then have our focus directed more towards stomach
As i mentioned that symptoms are always deceptive in diabetics but any development of shortness of breath, palpitation, sweating, dizziness or fatigue and increasing pain would be highly suspicious
Any further queries are welcome
My best Regards
Dr Khan, Doctor
Category: Medical
Satisfied Customers: 1183
Experience: MB, MRCP(UK), MCPS(Medicine)
Dr Khan and 4 other Medical Specialists are ready to help you
Customer: replied 2 years ago.
i have light chain multiple melanoma ihave blood clots in my lungs ihave acooks filter inmy vena cavata i am on 120 mg lovenox 1-day , can i switch to cumadin, what are the good vs bad side affects by comparison? thanks bob
Customer: replied 2 years ago.
when will you answer? i paid 70$ please reply
Customer: replied 2 years ago.
Relist: Other.
I would like to know the differences in the effect and side effect between lovenox and cummidin blood thinners.Currently i am on lovenox for blood clots in my lungs, however i am also diagnosed with cancer (light chain multiple melanoma) with leisions in the bone marrow. kidneys and liver function O.K.What should be my concerns if i were to switch to cummiden?
Expert:  Dr. B. replied 2 years ago.
Both are blood thinning medication , lovenox and coumadin but they work on different clotting factors .
Lovenox (Enoxaparin )is in a class of medications called low molecular weight heparins. It works by stopping the formation of substances that cause clots.It inhibits factor 10 a and 2 a . Lovenox may cause side effects like upset stomach ,fever ,irritation or burning at site of injection , bleeding , if the side effects are persistent ,then you may have to see the doctor . There is also a antidote of lovenox which is called protamine sulfate .

Coumadin works on factor related to prothrombin time , so to monitor its activity your doctor may want to check PT/INR . The antidote for this is vitamin K . The side effects with coumadin which can be seen are hives, rash , itching ,difficulty breathing or swallowing ,swelling of the face, throat, tongue, lips, or eyes ,hoarseness ,chest pain or pressure ,swelling of the hands, feet, ankles, legs , infection ,nausea ,vomiting ,diarrhea. Rash also can be seen . So you can always see the doctor if you get side effects .
Coumadin can lead to bleeding if the person has kidney disease ,so then the doctor may adjust renal dosing of coumadin . He will get a baseline bun , serum creatinine , GFR and then will re test it after 3-4 weeks .
As you mentioned that your kidneys are fine , so at present there should be no concerns but renal function should be monitored at frequent intervals .

Thanks

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