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I have a pain that feels like a punching feeling under my…

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I have a pain...

I have a pain that feels like a punching feeling under my arm on my left breast on the side. I have had a ultra sound with a mammogram and it was all clear. I do suffer from hers and as of lately for the past 3 months it's been flairing up a lot which has been about the same time I've had this weird pain. I did have open heart surgery 6 years ago but have had no problems aortic valve replacement. I did have a long stay too and nothing. The pain has never woke me up before tonight. It comes and goes during the day alot

Doctor's Assistant: Do you know if your family has a history of heart disease? In general, how would you describe your health lately?

GERD

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Great except the GERD

Submitted: 3 months ago.Category: Health
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Answered in 7 minutes by:
4/2/2018
Health Professional: Dr. Arun Phophalia, Doctor (MD) replied 3 months ago
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 38,717
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer, or further information request.

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Health Professional: Dr. Arun Phophalia, Doctor (MD) replied 3 months ago

What is your age?

Are you taking any medicine for GERD?

Is there any tender point on chest wall or around / armppit?

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Customer reply replied 3 months ago
I had a lung xray and it was clear not long
Health Professional: Dr. Arun Phophalia, Doctor (MD) replied 3 months ago

I am writing the answer for you and will get back to you in 4-5 minutes. If you get a phone call request, you may ignore it as that is an automated site trigger. Thank you.

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Health Professional: Dr. Arun Phophalia, Doctor (MD) replied 3 months ago

Your symptoms can be due to costochondritis which is inflammation of the costal cartilage and rib. Please read about it:

https://www.medicinenet.com/costochondritis_and_tietze_syndrome/article.htm

The other possibility to look for would be mastalgia.

Following is helpful;

1) A well-fitting sports brassiere

2) Relaxation therapy if anxiety is associated

3) Decrease the caffeine intake

4) A low fat diet has been proven to result in a reduction in hormones such as prolactin, believed to be implemented in the cause of mastalgia.

5) Exercise also lowers circulating estrogen levels and this may also be another simple lifestyle modification worth considering.

6) Medications; if significant pain danazol, bromocriptine and tamoxifen are the medications worth considering by your doctor.

You may also consider a mammogram or magnetic resonance mammogram (MRM) for the evaluation, especially if the pain is moderate to severe.

Mastalgia is usually benign, and can be associated with following:

a) premenstrual syndrome,

b) fibrocystic breast disease,

c) psychologic disturbance

Chest wall conditions, like Tietze syndrome, may present as mastalgia.

Lisuride maleate is a new agent recently studied for the treatment. Vitamin E and evening primrose oil also can help you.

I would also consider following for your symptoms, with your history of GERD;

1) Esophageal spasm
2) Esophageal motility disorder
3) Esophagitis.

Following treatment may help you;

a) Calcium channel blockers (diltiazem, nifedipine) decreases the spasm and improves the movements of the esophagus.
b) Relaxation techniques.
c) Noncardiac chest pain in the setting of esophageal spasm and esophageal movement disorder (dysmotility) often shows good response to antireflux therapy, even in the absence of typical gastroesophageal reflux symptoms.
d) Reassurance and control of anxiety is extremely important.

Anti reflux therapy is;

1) antacids; Maalox

2) acid blocker; Prilosec

3) loosing weight, if overweight.

4) avoiding alcohol, citrus fruits and juices, chocolate, and tomato based products

5) avoiding large meals. Eat 5 small meals in a day.

6) wait three hours after the meal before you sleep.

7) elevate head end of the bed by 8 inches.

Following also would be helpful;
Nutrition and supplements;

1) Multivitamin; vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
2) Probiotic supplement
3) Omega 3 fatty acid
4) Avoid; cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.

5) Also avoid; white breads, pastas, and especially sugar, red meats,
6) Eat lean meats, cold water fish, tofu, beans, olive oil

Helpful investigations to establish and confirm the diagnosis are;

1) Esophageal manometry; evaluates esophageal motor pattern.
2) Esophagram / Barium swallow
3) Ambulatory esophageal manometry
4) CT scan of the chest.

5) Upper GI endoscopy.

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 reply replied 3 months ago
I am 61 and in very good health my aortic surgery was due to endocarditis from a tooth. I have had reflux for many years but it has just recently flared up severely.I do have a cardiologist I can check with too. I am not over weight and I don't drink but I do alot of heavy lifting. Its very odd because its almost like the pain makes me feel angry when it comes on. It does feel better when I am wearing a sports bra
Health Professional: Dr. Arun Phophalia, Doctor (MD) replied 3 months ago

Feeling better by a supportive bra means a musculoskeletal origin pain. Tylenol, local analgesic cream, mild massage, deep electrotherapy and acupuncture would help you.

Was this information helpful to you? I would be glad to answer any further questions.

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Customer reply replied 3 months ago
It still flares up with the sports bra but it definitely feels better. I have no trouble breathing could the gerd be causing it? I am going to a breast specialist next week and I will contact my cardiologist as well and have him set up a ct scan as well. Thanks for the info
Customer reply replied 3 months ago
It does hurt when I breathe deep
Customer reply replied 3 months ago
to your question regarding a tender spot on the side of my breast feels bruised
Health Professional: Dr. Arun Phophalia, Doctor (MD) replied 3 months ago

You are very welcome.

GERD can be concomitant to the chest wall muscle disease for inducing the pain. A pain on deep breathing is suggestive of muscles and chest wall issue. Tender spot is very likelihood to be myofascial trigger point. Trigger points may develop after an initial injury to muscle fibers. This injury may be a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. Myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle fascia which is painful on compression. Following would be recommended:

1) passive stretching of the affected muscle after application of sprayed vapocoolant

2) physical therapy

3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation

4) local analgesic patch / ointment / spray

5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)

6) ischemic compression therapy; pressure on the points

7) massage

8) steroid shots

9) acupuncture

Wishing you a speedy recovery.

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Health Professional: Dr. Arun Phophalia, Doctor (MD) replied 3 months ago

Was this information helpful to you? I would be glad to answer any further questions.

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Please let me know if you have further queries or unanswered questions.

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The rating button is on the left upper side of this thread.

You can continue to ask questions after positive feedback.

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Wishing you all the very best in life.

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Stay blessed.

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