Discussions By Condition: I cannot get a diagnosis.

Please Help!!

Posted In: I cannot get a diagnosis. 51 Replies
  • Posted By: Blackhawkcrewdog
  • June 13, 2009
  • 01:48 AM

Hi this is my first post. I figured i would try another source.

I am a 32 yo male. Blood pressure is a little high (usually about 140/90 or less). I did smoke about a pack or less per day. Drink very rarely. No family of heart disease or strokes.

This all started the last week of April. Wife, Kids and i went out for pizza, i suddenly lost my appetite but this sometimes happens anyways. Only had a couple pieces of pizza and a small salad. Went home and didnt get much sleep, i didnt feel quite right.

Next day started having some abdomen pains in various places. Decided to go to the Urgent care. They said i have some acid reflux problems and gave me some aciphex and sent me home. Two days later i went back to urgent care because the acid comming up would hurt my chest and i got worried. They gave me a GI cocktail and some BP medicine (metoprolol tartrate) because my bp was a little elevated.

The next few weeks were spent going back to urgent care and ER's because the acid was so bad i was thinking i was having heart issues. Had 3 EKG's done and a stress test. All were fine! But i was still not.

Had a Endoscopy done and they found esophogitis. Many blood tests, Ct scan and found Diverticilitus. About 3 weeks into this my back, neck shoulders, arms and hands would tingle a bit on and off. That lasted for about 2 weeks, and turned to mostly pain usually in my ring and pinky finger on both hands. Visited my Doc and refered me to a physical therapist. He suggested herniated cervical disks (no MRI).

Now most of my abdomen pains are gone and so is the acid problem. Still have some lingering heartburn less than once a week.

I am now left with upper abdomen both on left and right sides below rib cage, stabbing pains between shoulderblades and sometimes underneath them and sometimes on them, some chest pain on left side right next to my xyphoid process, neck, back, arm and shoulder stiffness, and some jaw pains. All except the stiffness in my back, neck, arm and shoulder stiffness happens almost ALWAYS when i am sitting down or similar position.

I do not drink and am a light smoker. I do admit that anxiety has been an issue with all this happening. I notice when i am real busy almost all pains are not present. They do sometimes come when i am standing or walking also.

Sorry for the extremely long post. But i am frustrated and my doc now thinks i am a hypocondirac. I am willing to accept that diagnosis if it is truly what is going on. Hope i remembered everything.


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51 Replies:

  • Forgot to mention in the midst of all of this i had frequent, short headaches that have pretty much gone away. Thanks
    Blackhawkcrewdog 54 Replies Flag this Response
  • Anybody? Please!
    Blackhawkcrewdog 54 Replies Flag this Response
  • Okay, let's obtain some clarification. When the performed the CT scan, did they diagnose it as diverticulosis or diverticulitis? Although not entirely unheard of, it's rare for a man of such young age to demonstrate diverticulosis or the complications termed diverticulitis. Although I'm presuming that they fully explained the condition, diverticulosis are small herniations in the muscular wall of the colon that produce small pockets outward from the lumen of the colonic wall. These herniations typically result from increased colonic pressure over an extended period of time. A history of changes in bowel function such as chronic constipation or diarrhea usually accompany's the list of symptoms. Nearly 50% of patients over the age of sixty have some evidence of the disorder and it can sometimes be seen in a few cases over the age of forty. In any case, it rarely presents any symptoms and is often found incidental to identifying other clinical problems. When these pouches become inflamed or infected, we call it diverticulitis and the symptoms most often present as severe left lower abdominal pain, cramping, bleeding and diarrhea in the more serious cases. Loss of appetite does indeed occur as well. As you've probably been told, a diet low in fiber is consistent with persons who develop the disorder and one high in fiber can often bring about reduction in symptoms. Surgery is rarely indicated. So now tell me more specifically about the abdominal pains that you suffered in "various places" and remember that this is the internet, so I don't have the critical value of a direct evaluation. Were the pains sharp or dull, how long did they last, were they mostly located in the lower left abdominal region and did these pains ever awaken you at night? Tell me about the heartburn that you are now experiencing? The recalcitrant pain syndrome and distribution being described is quite common among persons demonstrating intense stress or anxiety and sub-scapular pain in particular is one of the most common complaints being fielded by orthopedists. I would doubt that it constitutes a herniated disk or similar spinal process, however, and will tell you here that physical symptoms as a consequence of anxiety or stress are extremely real and typically accomany intense frustration that no underlying cause can be identified. Also, your symptoms would be inconsistent with any pathology associated with the heart or vascular system. The fact that the pain of the upper ribcage and subscapular pain mostly while sitting down might suggest that your GI disorders are not completely resolved. While proton pump inhibitors work very well to reduce acid, the body's ability to actually heal in cases of esophageal errosion may be more protracted depending upon the circumstances. Also realize that stress and anxiety has a tremendous influence on acid production and relative bowel function. Pain that results from trapped air very often is accentuated when seated because of the natural physical compression that occurs and often this air results from something called aerophagia, or the swallowing of copious amounts of air without realizing it. This is common among persons with anxiety, but in your particular case the pain could be manifesting from the earlier esophageal insult. Realize also that the esophageal sphincter commonly dysfunctions in persons with your condition, wherein the valve located at the junction of the stomach and esophagus malfunctions, allowing chyme from the stomach to enter the esophageal corridor. Patients often complain that they sometimes belch acid into their throat or even the oral cavity. Your symptomatology is not uncommon at all and regardless of whether your doctor believes you to be a hypochondriac should not deter you from seeking whatever extended evaluation that you feel necessary until such time that your symptoms abate and a state of relative normalcy has returned. I would also inquire here about the time period prior to the pizza incident and whether anything significant in your life had occurred such as loss of a job or a loved one or any other emotionally traumatic incident. Realize that in many cases, patients do not make the logical connection between the onset of symptoms such as those described and any type of emotional circumstances due to the fact that the onset of physical symptoms is always thought to be directly related to physical disease. While this is true in many instances, it needs to be reaffirmed that anxiety and stress do result in physical symptoms and in the case of intense health anxiety, produce fears and ruminations that something far more serious may be the underlying cause. Particularly where negative or borderline tests result, patients become more concerned and frustrated that something serious is lurking and cannot be identified in time. My suggestion is that unless you already have a gastroenterologist, that you seek consultation and evaluation until such time that the heartburn and upper abdominal discomfort is resolved. Tests can be performed to determine the acidity level at the esophageal membranes and whether and to what extent treatment is required. I would also suggest that unless you feel that you have a clear and convincing influence over your anxiety that you consider speaking with a professional with experience in treating physical symptoms associated with anxiety disorders, known as somatoform. In general, you'll be fine. There's nothing among your symptoms that would suggest anything catastrophic is lurking. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • My GI doc said it was diverticulosis, with no infections or signs of cancers. The abdominal pains are almost always on the LLQ of abdomen and sometimes a little higher like just below the rib cage on left side. I did have a ultrasound of liver, kidneys, spleen, gall bladder. Just about every blood test has been run on me. I am currently on Metoprolol succinate 50mg 1xday and nexium 40mg 1xday. Was on xanax .25mg as needed for 2 months. I am not taking this anymore. I did notice that as soon as i took a xanax most of my pains would subside. sometimes i have good days and sometimes i have bad days. Thanks for the reply. If you have anymore questions please ask!!!!!
    Blackhawkcrewdog 54 Replies Flag this Response
  • Forgot to mention ultrasound of pancreas also.
    Blackhawkcrewdog 54 Replies Flag this Response
  • Okay. Well, I'm a retired neurologist so if your gastroenterologist said it's diverticulitis, then it's a sure bet. The pain distribution in the left quadrant is entirely consistent with the disorder. Again, however, it's extremely rare in a person your age. Likewise, the subscapular pain, muscle stiffness and joint pain are entirely consistent with anxiety disorder. Xanax is a good choice for short-term use, but you certainly don't want to go through your life on this kind of medication so I would again suggest that you arrange to speak with a professional to help you overcome the effects. There is very likely something in your past which was significant enough to set things in motion. The disorder is very treatable. Since you are taking metoprolol, it's very likely that any elevation in your blood pressure is due to stress hypertension rather than primary hypertension disease. Once the anxiety issues are resolved, you'll most likely find your BP returning to normal in the absence of medication. Beta blockers also have a mild anxiolytic effect, so it will help somewhat with the anxiety and if you are experiencing palpitations it will likely reduce their significance as well. They are, incidentally, harmless in nature. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Thanks for your input. The heart issue has been just driving me nuts at time. I have had consistant heartburn for many years. Really started noticing it about 7 or 8 years ago. I think the thing that gets me the most is all the symtoms come at about the same time so i instantly think HEART ATTACK. I do have an appointment to see a professional in a couple of weeks. I do have a very hard time believing its only anxiety. Right now just sitting here typing this my left arm is achy and some discomfort in my chest. The pains change soo often i get scared. Thanks once again.Mike
    Blackhawkcrewdog 54 Replies Flag this Response
  • I do have one more thing to add. I have noticed from the Very beginning my heart would start racing for no "apparent reason at all". This is the symptom that has scared me the most. This happens almost daily. I am not sure what a normal heart rate would be but when it seems to be racing it is usally beating at about 90-100 bpm. I dont know if this is fast or not. Thanks for your responses Dr. J. Cottle!If you have anymore to add please do so. Mike
    Blackhawkcrewdog 54 Replies Flag this Response
  • An increase in heart rate is not uncommon at all and 90-100 is not even noteworthy. A rate or 100 or below is not even considered sinus tachycardia. Realize that heart rate is extremely dynamic and changes throughout the day and exercise can commonly produce rates of 150 or so with no ill effects or danger to the cardiovascular system. You should focus less on your health. There's nothing wrong with your heart. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Have you been checked for LYME DISEASE?
    jessix 6 Replies Flag this Response
  • Havent been checked as far as i know.
    Blackhawkcrewdog 54 Replies Flag this Response
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  • Blackhawk: That's GOOD NEWS! Find someone who is knowledgable about LYME Disease and get yourself tested. If he/she finds you are negative for Lyme Disease you may get a referral to someone who can put together the symptoms you are experiencing and get your alternative diagnosis. GOOD LUCK! PS ... Make sure the doctor you visit has plenty of experience with Lyme Disease. Many times the receptionist says "yes" to every disease when you call. I would check on-line to find practitioners within your reach and then set up your appointment. LYME DISEASE is a common missed diagnosis and patients suffer progressively worse symptomatology until finally diagnosed, if at all. Often even experienced doctors will miss LYME DISEASE. When doctors start talking "hypochondriac" that means they are stumped and it is time to find another doctor! In your case, your reporting the arthritic-type aches and pains led me to think LYME DISEASE before anything else. Chronic pain patients have similar problems. Doctors treat them with antidepressants claiming chronic pain patients are depressed. Anybody would be depressed if they had undiagnosed and untreated pain 24/7 and on top of that they were being told they were hypochondriacs!
    jessix 6 Replies Flag this Response
  • Well today sucked! I was at work this morning and i really thought i was having a heart attack. Just out of the blue it seemed i noticed my heart going a little fast. Then i felt really weird and then my heart really started going fast! like 140+ bpm. I got really scared then told my boss to call 911. As soon as i heard them coming down the street i all of a sudden felt a little better. They did vitals and ran a ekg and it was fine. Vitals were as follows when they arrived. BP was 180/103 and heart rate was 155 bmp. 10 mins later, bp was 150/101 and heart rate was 113 bpm. 2 hrs later all vitals were normal. I have been having point chest pains, in 3 areas. Right side around left nipple, lasts anywhere from one or two seconds to never more than 30 seconds, left side chest next to sternum on bottom rib. lasts the same as other pain on right side. Sometime i have a pain on left side under armpit very very short in duration. less than 1 0r 2 seconds. These pains are almost aggrivated by sitting down at the computer or in the car. The pains are very localized all the time. Never radiate anywhere. and are always the same intensity. I have had some pain in both arms and shoulders and back. It is more like a muscle pain. I do alot of climing at work and some light lifting. I have had 3 er workups and exercise treadmill stress test. All tests were normal. Had Ensoscopy, ct of abdomen and pelvis( since i have gerd). No murmers or aryitmias of any sort. Docs keep saying anxiety or herniated disks in c-spine. But i really want to know why my heart rate would skyrocket like that? Thanks
    Blackhawkcrewdog 54 Replies Flag this Response
  • Your symptoms were associated with a panic threshold. It's not uncommon and you need to realize that physical symptoms can and do arise in the absence of underlying physical disease. The chest pain in the distribution described would be the consequence of something called DaCosta's Syndrome. It is pain in the chest wall and found commonly in patients with panic disorder. It is also diagnostic that your systolic rate is sustained to some extent while diastolic pressure recedes. This too, is associated with stress and often appears in the context of something we call whitecoat hypertension due to the anxiety demonstrated in some patients when visiting the doctor. When you become vigilent to your autonomic functions, any change detected can cause you fear that something is about to happen to you, resulting in a response known as fight or flight to become engaged. It is a series of physiological processes which generally increase sympathetic nervous cascade. It can make you feel quite strange. The cycle can quickly escalate to a panic threshold because fears are intensified. Once safety is at hand, the body will begin to diminish sympathetic tone and parasympathetic responses become dominant. Heart rate, blood pressure and other autonomic functions begin to subside to normal levels. GERD in of itself can produce symptoms that some patients erroneously associate with an impending cardiovascular event and when the esophagus is inflamed, it can make some patients feel short of breath, light-headed and produce difficulty in swallowing. Even excess gas moving through the lumen of the intestines can cause sensory disturbances that are unfamiliar and worrisome. One of the symptoms which can occur is paroxysmal atrial tachycardia, otherwise known as supraventricular tachycardia, and its believed that irritation of the esophagus can induce its occurrence in otherwise healthy patients. Your symptoms are not associated with any type of heart abnormality or cardiovascular pathology. The tests mentioned would have absolutely detected its presence to even the slightest extent. It's important when you feel odd symptoms taking place to simply pause and relax for a moment, get some water and take a short break. Nothing can happen to you as a consequence of the symptoms you are experiencing and the heart will not suffer any damage nor will it cause you to suffer any type of cardiac event. Incidentally, your symptoms are entirely inconsistent with Lyme Disease. There are a multitude of persons here who all mean well, but become fixated upon certain diseases. Lyme disease is far less common than portrayed on this forum by certain respondants, who feel that a "Lyme Literate" doctor can produce a positive test even if multiple tests conducted were negative. Unfortunately, these persons making such claims are not licensed medical doctors and do not have clinical training or experience. Their heart is most often in the right place, however, and they genuinely want to help. Again, however, your symptoms would not even be remotely suggestive of Lyme Disease. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • How much caffeine do you drink daily and do you drink so called "energy" drinks? Have you been periodically checking your bp and if so, is it ever as high as when you have the panic episodes? Are you taking any medications including OTC meds? Best wishesDOM
    acuann 3080 Replies Flag this Response
  • How much caffeine do you drink daily and do you drink so called "energy" drinks? Have you been periodically checking your bp and if so, is it ever as high as when you have the panic episodes? Are you taking any medications including OTC meds? Best wishesDOM DOM, I have not had ANY caffeine in over 3 months. I did check it everyday up until about a month ago when my DR suggested not to do it so it may help with the anxiety. The highest it has ever been was when i was in the ER and had a horrible attack. BP was 200/101. Heart Rate jumped to about 170 BPM. That was very scary. It was about 2 months ago. This is only the 2nd serious attack i have had but have had numerous others in the past few months. I am currently on Metoprolol Succinate 50mg 1xday, nexium 40mg 1xday and an occasional asprin or two. ThanksMike
    Blackhawkcrewdog 54 Replies Flag this Response
  • Took a long road trip today and the abdominal pains were almost constant the whole time i was driving. Now that we are at our destination the chest pains have begun again. I just think this is absolutely strange that they only happein when seated. As soon as i stood up the pains would almost completely dissapear. I do know when i press on the center of my chest my whole chest hurts alot. The point pains are not reproduced exactly. Could this be costocongritis? My dr told me not to take Ibuprophen due to my acid reflux issues. Once again Dr. Cottlee. Your words have been very comforting.
    Blackhawkcrewdog 54 Replies Flag this Response
  • Dear BlackhawkCrewdog,I have taken an interest in your problem.One more thing you must do. Go for light jogging or brisk walkingand see whether you have the same pains (This is not a treatment for your problem but to ascertain the cause of the sympton.)I may be able to help you. Please e male poodlesamy at live dot com.Best Regards.
    poodlesamy 26 Replies Flag this Response
  • Poodlesamy, I take brisk walks daily and have not noticed these pains. They almost only happen when sitting for any period of time. Sometime the pains are "stinging sensations that feel more superficial than deep inside i guess.
    Blackhawkcrewdog 54 Replies Flag this Response
  • Is it awfully weird that i am having new pains? Sharp left shoulder pain that sort of shoots across the collar bone. This is just getting to be way too weird. Thanks
    Blackhawkcrewdog 54 Replies Flag this Response
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