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Lot of pressure and discomfort in my upper abdomen. Really

uncomforable, pressure, gets tight and...
lot of pressure and discomfort in my upper abdomen. Really uncomforable, pressure, gets tight and hard there. I feel shaky inside. Had x-ray at emergency all clear, digestive enzymes good in liver, gallbladder etc. miserable. Some burping, just mostly pressure and discomfort
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Answered in 2 minutes by:
11/4/2009
Dr. Muneeb Ali
Category: Medical
Satisfied Customers: 8,341
Experience: MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
Verified
Hi,
Im sorry to hear about your symptoms, id like to ask a few questions

Any past medical history?
Have you had an ultrasound of the abdomen and an EKG done?
Any bad taste in mouth, do the symptoms get worse at night?
Any Altered bowel habits? Any change in stool colour?
Any relation of the symptoms with intake of food? does it get worse or better?
Any sweating or shortness of breath?
Exact location of discomfort...is it just below the sternum in the abdomen?
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Customer reply replied 8 years ago
Medical history, I take armour thyroid for low thyroid funtion. Have had gassy stomach most of my life, but with the diet change it took that away, until around 2 weeks ago. Had an ultra sound a year ago to check gallbladder, it was all clear, no stones and the sharp pain I had in that area left. Off and on my stomach would act up, that is one reason I changed my diet to gluton and diary, elimated alot of sugar, too. Bowels normal, were light in color for a while but normal now. No bad taste in mouth, but gets dried out, but I drink alot of water daily. Pressure there even when I don't eat. It's there most of the time. I do get anxiety and that could be menopause symptom which I am on hormones for that but getting retested this week. I do have alot of sweating, but like I said, menopausing and get that with that. Not really shortness of breath, but harder to breath when the pressure is there. It is below the sternum right in that upper abdomen area, feels full when I push on it, but does not hurt, just uncomfortable.
Well It seems to me that you have GERD/Heartburn....all the symptoms are clearly indicative of that. Also another differential would be that of Peptic ulcer disease which can cause similar symptoms.

Also i would recommend you get your thyroid function checked out as well to see wheter you need an adjustment for your dose of armour thyroid. Sometimes with worsening thyroid function this disease can get worse.

The best solution for your current problem is getting a endoscopy done which is long scope via which the doctors can see any problem in your stomach and esophagus, if that comes back normal 24 hour ph monitoring can diagnose the problem.

However instead of undergoing very expensive tests, another option is to start taking Nexium which helps a lot in these cases alongwith the diet control that you already are on. Also elevating the head of the bed at night alongwith taking the last meal 2 3 hours before bedtimes helps as well.

I hope i have been helpful, if you have anymore queries please let me know
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Customer reply replied 8 years ago

Thank you, ***** ***** regards ***** ***** I don't have acid coming up in my throat, I just have the pressure that comes in that upper abdomen area and I can feel movement sometimes in my rib cage on the left side, when I push on it, it moves like air. Can anxiety cause stomach trouble like heartburn, where you have that air up in your chest but it's not burning pain? I get that, too. Will the tablet of Betaine HCL help after meals? Nexium can stop the acid, but I have heard that sometimes people don't have enough acid and therefore can have problem, thats why I thought to take the Betaine HCL, what do you think of that. I don't want to start on anacids if possible, that can be a long term thing and sometimes cause more problem even with the liver. It uncomfortableness stays in that upper area and can go in my chest but NOT up in my throat or esophagus.

Well the chest pain you experience can be the acid moving up in your esophagus but limited to the portion in the chest.

In regards ***** ***** question about stress causing heartburn, yes increased amount of stress can cause these scenarios where increased acid is released and can cause similar symptoms.

Taking betaine hcl will definitely help with the digestion but it can aggravate an underlying condition such as dyspepsia (non ulcer) where increased acid is produced or even an ulcer.

I can understand your reluctance to start Nexium or antacids but i would recommend you discuss this with the your GP and consider a short trial say for 3 - 4 weeks and see if that doesnt help. If not Nexium you can try OTC antacids before your doctors appointment and see if that doesnt help. The side effects with Nexium occur ina very low percentage of the population and many patients take the drug without ever experiencing any side effect at all. Although its good that you dont want to be dependent on many drugs at once, so best option would be trying OTC antacids then discussing further options with your doctor.

If you have anymore questions please feel free to ask me
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Customer reply replied 8 years ago

What type of OTC antacids would you recommend if I were to try that for the suggested 3-4weeks? I never take them so I would not know. Is prilosec one that would be good for that short period of time. I heard that it takes 3-4 days for it to kick in if it is going to help idyspepsia, is that true. I am under alot of stress and like I said going through menopause and therefore the hormone thing is always an issue even though I take bio-identical cream for that. I am getting re-test for my thyroid levels.

I have to say I took an HCL tablet after my lunch and my stomach calmed down quite a bit, but still when I sit I feel the pressure and air in there, would that abundance of air and pressure still be considered a GERD issue? Just want to cover all my bases before I close out our conversation.

its true that it takes normally approximately 2 weeks for complete benefits of the therapy to occur although ost patients can easily feel the benefit within the first week.

Prilosec does contain omeprazole and it is a good drug in this scenario.

The abdominal fullness that you feel or even bloating can be considered a dyspepsia issue but not GERD as you rightly pointed out before that you do not have refulx symptoms. During my emergency practice and later on in the clinics as well i have seen numerous patients with such a presentation who get better on drugs like prilosec and antacids.

I hope i have been helpful
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Customer reply replied 8 years ago

So, you are saying that in many cases when some have taken prilosec and antacids the situation can go away, it does not have to be a continual course of taking these meds for a long period of time, which is what I want to avoid. I would also like to avoid the possiblity of having to have that scope down my throat if possible. This is the first time I have had this issue and have it last for 2 straight weeks, it's just so uncomfortable.

What was your recommendation for antacids, didn't see that in your last response.

Thank you very much.

No in many cases, a short course of 4 weeks or so does help a lot of patients and they dont need to go on long term treatment however that can only be determined after a trial of the treatment and the tests i have written above.

Im sorry i must have missed the antacid, i would recommend you try any one of these

1)Gaviscon (Syrup)
2) Prliosec OTC (Capsule)
3) Maalox (Syrup)

But prilosec has interactions with many other drugs so that should be started under the supervision of a physician

Also you havent mentioned whether you got an EKG done or not, sometimes a heart issue disguises itself with similar symptoms, so its better to get that done and have that ruled out. So that why i would recommend you to discuss this with your physician as well
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Customer reply replied 8 years ago

I have not had an EKG. They put me on a monitor at the hospital and watched my heart

and BP etc and said my heart was strong, but not sure that is enough. This is scary for

me, I have to say, not fun to go to a bunch of dr. (though I am thankful for you all) to rule out "stuff". Sometimes wonder if menopause is the real issue in most of this since I never had any real issues with anything before I began that journey a couple of years ago. It can make your heart race, BP go up and down, especially in stressful times and it can cause sweats, anxiety etc, I'm sure you are aware of this. So, it's hard to know. I'm just curious how heart issues could cause stomach issues?

Well sometimes when a patient has a heart attack, im not saying you had one...just to allay your fears :), it presents with pain and similar symptoms nin the region of the abdomen that you describe, this is due to the fact that the nerves supplying the heart can refer the pain to that area of the body. This does not occur always but since they put you on a monitor thats good enough because thats essentially a continous EKG.

And yes im sure its frustrating to go to different doctors for ruling out these problems, but as you know practical medicine is quite different from that we see in books, many a time a patent will have symptoms which do not correlate with his diagnosis.

Youre right menopause does cause all the symptoms that you have written down...and to be sure its probably that causing the rapid heart beat etc in your case.
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Customer reply replied 8 years ago
Yea, I have a BP cuff and take my BP everyday several times because of Menopause. It has been like 108 over 88 or 127 over 72 and sometimes it goes high like 153 over 90 but comes down. It's just my heart rate has been so fast like 85-90 area and it just makes me feel miserable, any suggestions to calm that down? I am just hoping that once I complete my next saliva test to re-check hormones some of this may be corrected.
Well the first two readings are good....but 150/80 is definitely high...now the imporatnt thing for you to do in this is keep a complete record of your bp readings over the next week so that we can have a complete record of how many times your bp is high and at what times.....a single reading doesnt constitute the criteria for starting any anti hypertensive medication. So do nothing for that except for monitor your BP, thats the best option at the moment if it consistently remains high then we would have to put you on medication and a low salt diet.
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Customer reply replied 8 years ago

It's mostly my heart rate just being so fast...my pulse, I guess. The minute I get anxious or stressed over something it goes up and then back down. I also know it can go up when your upset or in pain, that's pretty normal. It's just this heart rate of mine basically right now, not normal for me to have it going so fast.

I do watch my salt intake, and don't eat processed foods much if at all. Are there natural ways to lower BP with out drugs? I know those drugs can cause other things to occur. Would like to a void that if possible.

Example: Right now sitting here at the computer stomach is not bloated but feels kinda hard like a muscle would when I bend at the waist it's like something is in there, understand what I mean, can air just do that and then push up in your chest?

there are natural ways to do that by reduing the salt in your diet also if you feel your heart rate is very raised you can simply do a vasalva procedrue...which is closing your nostrils with your hand and trying to blow air out of it. Also you can try carotid massage, just massage your carotid artery about 4 - 5 cm below the hard part of your throat (cricoid cartilage). Although carotid massage shouldnt be done in patients who have carotid plaques!!!!

Apart from decreased salt intake you can try exercising, and a low cholesterol diet which you already are on

Actually the sensation you describe is that of fullness, its not necessary that you have air in your stomach although burping can occur even without it. Although to answer your question, yes its entirely possible that happens.
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Customer reply replied 8 years ago

So, to try and end this for you. What is the fullness feeling if it is not air? Sometimes I can feel air going up into my rib cage, mostly on my left side, it can feel pretty strange. So, tell me again, what can take away that "fullness feeling"? Is it just antacids then, is fullness acid, seems strange it would be that, feels more like air. Someone suggested a hernia, but not informed enough about that.

I have it come right away in the morning, it's not even food related it seems.

Hopefully this will be the last of my constant questions to you.

I still strongly feel you have dyspepsia which can be taken away with use of antacids that i have described above. I know its hard for you to believe that the fullness is acidity, however the sensation youre describing is consistent with dyspepsia....im sure you feel its air and as i mentioned before this is a sensation pretty common with many patients.

A hernia is unlikely as it difficultly in breathing ...i assume someone mentioned a hiatal hernia which is the protusion of the stomach through the diaphargm into the chest and it would show up on a simple chest xray.

Dont worry i dont mind these questions, it is my job to answer any and all of your questions, as long as i dont get a call from the ER, i can answer all your questions...:)
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Customer reply replied 8 years ago

Wow! You have been great! The hernia sounded scary, but my husband just said he asked the ER dr. if that could be it and he said no, I guess from his view of the x-rays. He suggested seeing a GI dr. and I probably will if the suggestions you have given me don't work or help.

I did get on line and read up, prior to our conversations, on dyspepsia and there is natural things that can be done, so I may look into that now that you have strongly suggested that is probably what is going on with me, whether it is menopause related, nerves/anxiety it's still there.

Thank you so much again. Well, worth the time and cost.

No problem happy to have helped you out :) , do let me know once you get a diagnosis ...so i can better help other people with similar symptoms to you
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Customer reply replied 8 years ago
What is the best way to let you know my outcome?
You can leave me a post on my private inbox....there is an option for that or you could email me at syed.muneeb.ali ..... thats a gmail account.
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Customer reply replied 8 years ago
Thank you again so much.
youre welcome
Dr. Muneeb Ali
Category: Medical
Satisfied Customers: 8,341
Experience: MBBS, MD, MCCM. Currently working in Critical Care Medicine with 10 year experience in Medicine
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