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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 7959
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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Almost a year ago I started having some symptoms arise without

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Almost a year ago I started having some symptoms arise without any injuries at all. I started having a lot of what my doctors call trunk pain (felt like pain in my sternum and pain in my lungs) and was experiencing constant light headiness and occasionally (2-3 times a day) I felt so dizzy that I felt like I was going to pass out. I started seeing a doctor and he kept putting me on a bunch of different medications that in my opinion was a attempt to cover up the issue as we weren't getting anywhere with a reason for these symptoms, and none of the medication helped at all. I did go see a ENT, a Pulmonologist and a Optometrist, and all said they did not see anything that would cause pain or dizziness. Once again he started experimenting with medication so I decided to go to a new doctor as I wasn't there to get drugs or to be drugged up all the time, I simply wanted to know what it was and what to do about it. If we found the problem and then medication would help, then fine, however, we weren't to that point yet.
In between leaving one doctor and seeing the new doctor, I started having pain in my left shoulder blade which sends sharp pain down my left arm to my elbow and then my thumb, index finger and middle finger started tingling. So now with my new doctor, I have seen him like 3 times now (mainly because he was waiting for paperwork to be sent over from the other doctors. He has now scheduled a appointment with a Orthopedic doctor to see if a MRI is needed and a Cardiologist. Appointments coming up next week. My doctor is thinking maybe a pinched nerve(s) or arthritis in my spine. But wants to rule out a arrhythmia with the Cardiologist. I understand that a pinched nerve can cause the shoulder blade pain that sends the pain down my arm and the tingling in my fingers, but my question is can it also cause trunk pain and dizziness? Also what questions should I ask these doctors once I get there as I have been in and out of the ER and from doctor to doctor and I am tired of explaining these symptoms. I am not sure if I am describing them wrong or have I just had bad doctors?
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 1 year ago.
Hello from JA
Any heart problems in the family?
Customer: replied 1 year ago.

My mother's mom died of a dnr heart attack in the hospital after suffering 4-5 heart attacks over time and at least a dozen strokes (she was in her mid 70's). My father's mom died of a single massive heart attack in a retirement home (she was in her mid 80's). Not sure of my grandfather's as they were not in the picture. My mother passed from septic shock and multiple organ failure (she was 60). She also had rheumatoid arthritis real bad. My dad passed away in his apartment alone sometime over night and no autopsy was done (he was 71). Death certificate says heart attack however my brother and I think it was diabetes that did him in. He refused to see a doctor so we don't really know. My brother and I both have diabetes (type 2). And are on Metformin for it. I have had 2 stress tests done with both coming back fine and xrays of my chest with nothing showing. All the tests in the ER comes back negative for any heart issues.

Expert:  Dr. Thomas, MD replied 1 year ago.
OK
Quite an extensive question.
Arthritis in the neck would have to be very extensive and severe to cause all of your symptoms.

Heart work up should also proceed.

OK. If you have further questions or details, use reply to expert.

Customer: replied 1 year ago.

I understand that a pinched nerve can cause the shoulder blade pain that sends the pain down my arm and the tingling in my fingers, but my question is can it also cause trunk pain and dizziness? Also what questions should I ask these doctors once I get there as I have been in and out of the ER and from doctor to doctor and I am tired of explaining these symptoms. I am not sure if I am describing them wrong or have I just had bad doctors?

Expert:  Dr. Thomas, MD replied 1 year ago.
As I said above..no, I think it is more than just neck.
You need a cardiac stress test in my view and should ask the doctors about this.

OK. If you have further questions or details, use reply to expert.

Customer: replied 1 year ago.

I'm sorry, I thought I had put this in my original statement but I have already had 2 stress tests done (last was done January 1, 2013). The last one I did I wasn't able to hit the target heart rate due to the dizziness, however, the hospital said that I was within 10 of the targeted heart rate so they are pretty sure the results would be accurate and the results came back with nothing wrong. The only thing I have noticed (and not sure if this happens every time since I obviously don't seek medical assistance every time I feel dizzy) is that my blood pressure is high when I get really dizzy, to the point where I feel like I am going to pass out. My blood pressure is normal any other time yet I still feel somewhat light headed, so not sure if that helps at all. Last time I feel over here at home, my wife called 911 and it take the ambulance about 20 minutes to get here and after that time and getting hooked up in the ambulance, my blood pressure was 210 over 120. I understand that it is hard to diagnose someone over the computer without seeing them and running test and what not, however, your not in the dark about anything that my doctors have. Like mentioned, if you know the tests that the er doctors run in the er, all those come back normal. I have diabetes (my glucose runs on average of about 150 - 160 and I am on Metformin). I have high cholesterol and I am taking simvanstatin for that. Other than that, I have not been diagnosed with anything else and that is what concerns me as these things would not cause my issues. My current doctor is shooting in the dark as well by sending me to a cardiologist and orthopedic doctors. I am just wondering if you can maybe give me some sort of ideal as to what all it may be (as a second opinion to my current doctor which I like and trust, however as we all know, never hurts to seek other advise as well). Like I said before, the pain in the arm I believe could be just a pinched nerve, yet wasn't sure if it could cause the other issues, and you say no. So what else do you think it could be. I know you won't know as a absolute without seeing me and doing tests as stated before, however, I am under a lot of stress here considering I recently lost both parents and all my medical problems have seemed to come on so suddenly. I believe my doctor said that the reason he is sending me to the cardiologist is to see if they may want to put me on a at home ekg machine to see if when I have these episodes that I am not suffering from a arrhythmia that I and the doctors are not catching. Does this make sense to the condition? When you respond, can you please be more specific and more descriptive? I know your a busy person and I appreciate your time, but it does me no good if I don't get a complete answer.

Expert:  Dr. Thomas, MD replied 1 year ago.
I am sorry but I am going to opt out of the question.
When I do, it will alert all experts to your question.
Please do not post or it will lock back to me.
Expert:  Dr. Rick, MD replied 1 year ago.
I see that your expert has opted out and is no longer available to assist you.

I have reviewed your post and above conversation. How may I help?
Customer: replied 1 year ago.


Can you see all the above posts with the other doctor?

Expert:  Dr. Rick, MD replied 1 year ago.
Yes. I can see the posts that are part of this thread.
Customer: replied 1 year ago.


Well without absolute yet, my pcp believes the pain in my shoulder blade and arm is result of a pinched nerve. I have a appointment with a orthopedic on Thursday for that issue with the hopes from my doctor to do a MRI. But the trunk pain and dizziness seem to be a different issue all together. As I have stated in previous statements we have tried certain things but nothing as of yet. I am going on Friday for a holter monitor for 48 hours to see if there is any palpitations per a er doctor from the last time I went to the hospital (I went to the er 2am Monday morning because of a episode with dizziness and a racing heart). Then I have another appointment set up for the 9th to have some more tests ran. So I am wondering if someone can give me some ideals as this has been going on for some time now and no one seems to know what it is. This is the first time that I have gotten a doctor that is sending me to a cardiologist. But was wondering is that the right move or should we maybe look in a different direction and if it is the right way to go, what questions should I ask the cardiologist and how do I explain to them what's going on as it is so difficult to describe?

Expert:  Dr. Rick, MD replied 1 year ago.
It seems like this has been going on for quite sometime now and you have been running all over to a doctor here, a doctor there....yet no real solutions have been forth coming. Does this sound like a true statement to you?

I think it might be time for you to take a very difficult, and bold, step to see if you can get some relief. It seems obvious to me that your current doctors have reached the bottom of their bag of tricks and, yet, you are still having these problems. Is this something that I'm going to be able to figure out using "chat" as my only diagnostic tool? Of course not....

At this point I think the best thing for you to do would be to gather up copies of all your medical records and travel to a large University Teaching hospital. At an institution like that you could be evaluated and treated by a team of sub-specialists who are at the cutting edge of their respective fields. The best thing about these large teaching hospitals is that consultations are available with Professors and leaders in their field by just walking a few steps down the hall.

The Mayo Clinic in Rochester, Minnesota is an excellent example of just such a place as this. That being said there are many excellent teaching hospitals all across the country and I am sure that there is one near you.

If you could tell me what large city you live near and how far it would be possible for you to travel in seeking treatment I would be happy to give you some names. Of course, you could also ask friends and associates or check the internet yourself. Let me know what you would like to do.

Of course, you could wait and see what these specialists you already have lined up have to say, and if they can't figure things out and make you feel better, then you could head to a place like the Mayo Clinic.

How does this sound to you?


I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I’ve earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

Customer: replied 1 year ago.

Yes this has been going on for a while. Started with the trunk pain and the dizziness originally. After going to the ER a few times with it and them not doing anything, I decided to find a PCP. I couldn't go to the place I use to go to because they weren't accepting any new patients and since I hadn't been to that place for over 2 years, I was considered new. So I went somewhere new. And unfortunetantly for me, this doctor was one who wanted to continue to experiment with different medication instead of finding out what the root problem was. For a example, he had me on such medication like medication for GERD because of the chest pain and meclizine for the dizziness. And this was on the first visit. I told him I really don't think it's heartburn but to no avail. After being on it for a couple weeks with no relief he would try different medications. All along he did no tests on me. To explain what kind of doctor this was, I had a episode while up in Chicago at my father's funeral where I got real dizzy and fell forward off the couch right before new years. My sister called 911 and I went to the hospital there and they admitted me for observation and a stress test the next morning. During this visit they noticed my glucose level and asked if I was diabetic, and I said not that I was aware of. He said in his opinion I was so when I got back, to have my doctor run a A1C test to decide the proper treatment. So when I got back, I went to see this doctor and said the doctor in Chicago said in his opinion, I had diabetes and wanted him to run a A1C test and my doctor said I don't see any reason to do that. I said that I was just passing on what he asked me to pass on and he said he thinks I just had that test done in the ER about 3-4 months ago. I said I would feel alot more comfortable if you would do the test and he said ok fine. So the nurse came in, drew blood and about 30 minutes later my doctor came in and said ok, you have diabetes. I said so the count was higher, he said yes. I said how much higher was it, and all he would say was higher. He never explained to me what type I had nor how to treat it or the diet changes or anything, just told me to take Metformin everyday. I found out my brother also had diabetes and thankfully he told me alot of what to do and where online to find some answers when I had some.


 


So that was that doctor. After that, I started looking around. I went back to the original doctors office I wanted to go to and luckily they are the only place in my surrounding area that has a diabetes class, so since I now had diabetes, that got my foot back in the door there.


 


There was a 30 day wait to get over to the new doctor for a appointment. in this time is when I started having the shoulderblade pain that shoots pain down my arm and makes my thumb, index finger and middle finger tingle. So when I finaaly saw my new doctor for the first time, he said I seemed to have 3 main issues. The trunk pain, the dizzimess and the arm pain. He asked where all I have been to with these issues and asked for me to sign a release so he can see what they have already done as it would do no good to repeat tests and get the same results, and that it will also help eliminate certain things as well. But he said his opinion, is that since the arm and the dizziness seems to bother me more he will tackle those 2 first. And rescheduled me 2 weeks out. Unfortantely, these other doctors are taking their time to send him all the paper work, so the last time I went to see him after having to go to the ER again, he said well. let's schedule you for a cardiologist for you dizziness and see if maybe they want to fit you with a holter monitor and get that going while we wait and a orthopedic and see if he thinks it might be a pinched nerve and maybe order a MRI to confirm that.


 


So that is where I am at right now. I did have to go to the ER again because my doctor told me to try to pay attention to when I get light headed like I do, to see if there is anything else I can feel or see happening as I never paid attention. He said especially a change in heart rate. So when I had a episode Monday morning at 2 am, I sat up and started feeling my pulse but didn't feel anything weird. Luckily (or unluckily) it happened again and I noticed that my pulse started racing. Too fast to count. Lasted about 5 seconds or so and slowed down. Then about 5 minutes later it happened again with the same result with the pulse except this time my pulse stayed up around 100. He said if I noticed anything like that or if it ever happened more than once, go to the hospital if they were closed. So I did. In the ambulance, my BP was 154 over 98. The reason I say this is because the last time I went by ambulance, the first reading in the ambulance was 210 over 120. I have noticed a few time my BP has been elevated but it does go back down within some time. So no one has ever made a big deal about it. Now I am not sure if it is anxiety causing this or if it is a problem of it's own and maybe this is what is causing the dizziness. So the ER doctor this time tole me to get a holter monitor for 48 hours and see if that will help reveal anything. Which I will get on Thursday. Orthopedic on Friday and cardiologist on the 9th (as stated before)


 


So as you can see, it's not really my current doctor that is the problem per-say, it is that my condition in my opinion seems to be worsening while I am having to wait for all these doctors that may not even be the right doctors to go to. I don't blame my doctor for this, it just tales time and the way insurance companies are now, doctors have to answer for why they admit you to a hospital now that no one wants to take the bold step to do so. Which I believe if I could be admitted, with all the doctors there, someone could figure something out and a lot faster. Would ease my mind a lot. This is putting my wife threw hell and not to mention the effects it is having on my poor kids. And myself. What ever happen to the good ole days where if you went to the ER and they couldn't figure it out, they would admit you. And before you left the hospital, you knew what was wrong. I am not asking for the hospital to treat me, just figure out whats wrong so that my doctor and I can get a plan together to treat it.


 


And that is it in a nutshell. But to answer your question, the closest teaching hospital that I am aware of is UVA (University of Virginia in Charlottesville, VA). And your not the first person that has suggested to go there, however, it is a hour and a half away and in all honesty, I can not afford the gas to go to the ER there for them to just turn me away like my local hospital. If I knew I could go there and they would admit me and before I left, I would know something, then I wouldn't give it a second thought. It is a great hospital. If I was 1 county north, I could call 911 and they would take me there. However, once again, if they just turn me away with doing the normal ER tests, my wife would have to drive that far to come get me and once again the gas would put a hurting on us. We are both unemployed now and I can't get back to work with all this going on and she is trying, and I am on medicaid which limits where I go for doctors as well.


 


But again, any help with this is greatly appreciated. You are right to assume that I am at my wits end with all this. I keep trying to tell myself it can't be anything major or it would have killed me by now or someone would have caught something, however, I have seen where people have had problems and nothing was detected until after something major happened (or death) then the doctors say oh well, that's what it was. Meaning I didn't think of checking that.

Expert:  Dr. Rick, MD replied 1 year ago.
Thanks for that extra information. I can understand the difficulty in getting to a hospital 90 minutes away and, I agree, the ER might there might just send you home saying that you are no sick enough to be admitted.

That is why I don't think you should go through the ER but rather contact the internal medicine department, gather all your medical records, and be seen in the outpatient clinic. This way the Professors will examine you and start doing the tests you need.

And I can tell you from experience, they will not limit their workup just because you are on medicaid as the doctors in a University setting get paid the same no matter what type of insurance,or no insurance, you have.


It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 7959
Experience: 20+ years as a doctor. Internal Medicine Internship in NYC
Dr. Rick, MD and 6 other Medical Specialists are ready to help you
Customer: replied 1 year ago.


Also do you have any contacts at UVA that you might be able to contact to assure a productive visit?

Expert:  Dr. Rick, MD replied 1 year ago.
I wish I could but, as I live over 1,500 miles from UVA I don't personally know anyone there.

You could call the local medical society for a name or ask friends, relative or your local GP if she knows anyone.

If you get a chance, drop me a note and let me know you things turn out.

Take care and have a good day.

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