Reply to Bouts of terrible chest and back pain every few weeks (ruled out heart issues)

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]This sounds somewhat similar to a medical mystery I’ve been dealing with.  A few months ago, I woke up in the middle of the night to a stabbing (not squeezing—definitely stabbing) pain that felt like it was radiating from my right breastbone through to my back.  When I shifted in bed, it felt like it was traveling from the back to front.  Every breath was excruciating, and felt a lot like when I had pleurisy a few years ago. While debating a trip to the ER, I realized if I contorted my body just so, there was no pain.  After googling “what feels like pleurisy”, I decided I was having a back spasm, though the intense pain lasted for a week and was only bearable with the max dosage of Motrin.

My PCP, after yelling at me for not going straight to the ER given my history of blood clots and pulmonary emboli, [b]ordered a CT scan and also X-rays of my spine, given a family history of ankylosing spondylitis[/b] and spinal stenosis.  All that those tests showed was mild osteoarthritis in a few parts of my spine. Neither she nor the rheumatologist had much interest in diagnosing the problem once the serious things were ruled out.

I still have a mild version of the pain in my back and sternum when I breathe deeply or sneeze.  I’m thinking it may be costochondritis.  When you meet with your PCP, I’d recommend you ask:

Whether a gallbladder scan makes sense given the family history
Whether it makes sense to get a complete cardiac work up
Whether the symptoms could be from a compressed nerve, back spasms, esophageal spasms, or costochondritis
Whether the symptoms could be related to inflammatory arthritis of the spine
What else the PCP thinks could be causing the pain

If you have been having reflux symptoms, then it probably makes sense to see a gastroenterologist and possibly get an endoscopy.  GERD can definitely cause symptoms that feel like chest pain.

Good luck, and let us know if you get a diagnosis!

[/quote]

You can't rule out ankylosing spondilitis by an X-Ray. You can rule out advanced AS, but not AS in its early stages. Best practice if there is reason to suspect AS is an X-Ray of the sacroiliac joints and, if negative, an MRI using STIR imagery. Only if the MRI is negative can you rule out AS.[/quote]
PP you are responding to.  I did get an X-ray of the SI as well, and the finding was degenerative arthritis.  The rheumatologist seemed confident it wasn’t due to early AS, though, perhaps because my bloodwork didn’t show elevated inflammatory markers? Not sure.[/quote]

I can only say I am surprised if you have a family history of AS that they stopped at an SI XRay. I once spent way too much time looking all this stuff up when a family member finally got dx'ed with with AS. She did have an elevated CRP (34) and a moderately elevated ESR. But I deep dove into AS sites and found people with AS who had neither.

But here is the thing. The doctor she finally saw made a preliminary diagnosis simply through a very thorough hands on exam that lasted at least 20 minutes. There are very specific things one can look for in a hands on exam that point strongly to AS plus self reported symptoms like alternating buttock pain. I fear this is a lost art; her wonderful doctor has retired.

The doctor ran just a couple of blood tests to confirm his suspicions--ESR, CRP, HLA-B27 (a genetic trait associated with AS--negative in this case). Then on to the X-Ray (negative) and MRI (positive). Pretty sure he would have followed this same course even if the ESR and CRP were not elevated, particularly if there had been a family history (not present for my family member).[/quote]

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