Hi RLR,

Just a quick post to see if you can shed any light on my current symptoms please.  Back in September I wrote about very fast beats waking me up in the night.  Since then I've had it happen a few times day and night. Eventually I went to the doctors about 4 weeks ago and had an ECG done.  This came back as normal.  My doc said that the fast beats were of no concern and if they got any worse I could have a 7 day monitor.

Since then I started to have very bad burning in my chest and stomach which started weeks ago with a mild burning sensation in my right chest area.  This came and went occasionally but eventually it was all over my chest and I was burping constantly.  I then developed back pains under my right shoulder blade and then into the centre of my back.  I went back to the docs and he said I was suffering from Acid indigestion which I haven't suffered from before on this scale.

He prescribed Omeprazole which I only took two tablets over two days and the following night I thought I was having a heart attack.  I had pains, shivers sick feeling in my stomach I could not sleep every time I fell asleep I was jolted awake feeling terrible and my heart was racing all night.  The next day I went straight back to the doctor who said it was probably side effects of the tablets so put me on Zantac which I decided not to take in case of further side effects.

After another week I was still having continuous back pains and feeling unwell so I returned to see another doctor on Monday who once again thinks this is just Acid reflux.  He examined me thoroughly listening to heart chest etc and doing a very thorough abdo examination. He could feel my aorta in my abdomen and although not unduly worried has now ordered an ultrasound to check it out.  I had blood tests done 3 weeks ago which came back normal. My BP was 147/95 which I thought unusually high but the doctor was not concerned??

My main concern is that I am still having chest pains, not much burning anymore but the main concern is my back.  Almost constant pain under right shoulder blade and upper central back.  I have lost my appetite and also lost over 10lbs in weight in 3 weeks!  My legs feel shaky a lot of the time and I am so worried that I have something seriously wrong with me.

To me this is not Acid reflux.  My concerns are that it could be heart related?  Or an aneurysm?  Why would the doctor order an ultrasound because he can feel my pulse in my stomach.  I have always been able to feel it, is this normal?  Please can you shed some light onto all this.  By the way the pain in my back seems to lessen when walking. Also I went on a 5 mile bike ride last night and really pushed it but had no pain at all under exertion.

Thanks for reading and any comments will be very helpful as always!

Best Regards

Rich

Hi Rutherford,

Very nice to hear from you.  Thank you for responding to my post as always!  Very good to hear your diagnosis and something that I hadn't realised is that the medication can take weeks and that the symptoms can get worse in that time.  All of your explanations are very logical and make me feel a lot more reassured.  

I have the blood results back and the chest x ray.  The chest x ray is normal and no action required but the bloods have a low lymphocyte reading of 0.8.  Is this anything to be concerned about.  The doc wants me to have another blood test in a month to see if they have gone back up.

Can you tell me if it is normal to loose the amount of weight that I have lost over such a short time?  I have now lost some more weight even though I am eating a normal diet, less the extras!  I do feel very sick most days and have a full feeling in my sternum.  But everyday I either way the same or I have lost another pound!  

The pain in my back is sometimes very intense and it wakes me at night.  It comes and goes but it is there everyday.  This is the main symptom.  I am currently not taking any medication for this as I didn't want any side effects.  I have been prescribed Zantac, Hydroxyline to help me sleep and even bixoprolol beta blockers to calm my heart down!  I've also been advised to take paracetamol for the pain and gaviscon to aid the indigestion.  Surely I cant take all these together can I?  

Could this have become chronic because of not taking the medication and worry concerning what it is?

Thanks again for all your advice and time you take here with all of us.
How are you by the way?!

Kindest regards

Richard

Well, it can't be "every day" because a 10lb weight loss over 3 weeks, or 21 days, is slightly less than a half-pound per day and not too surprising or even considered remarkable in the midst of GI difficulties of the type being described.

I think one of the overriding concerns is that you feel convinced that something more serious is at hand, ie "to me this is not acid reflux." I'm constrained to point out that you're basing the range of possible symptoms of the disorder by your own past or own analysis. In every doctor-patient interaction, each must assume their role in order for the formula to work. It's important for you to understand that the mechanics which underlie reflux disorders are highly influential to certain types of stress. You and I go a considerable way back in discussing the actual nature of your difficulties and to date over several years, I don't believe we seen any expression of the type of health concerns you tend to become concerned about here.

About every two weeks or so, the outer-most thin lining of the intestinal tract breaks down and a new layer forms. The presence of significant GI disturbances like reflux can interfere with that process and aside from appetite depression, nutritional absorption can be affected to a mild extent as well. Realize that there are certain cells in your stomach and small intestine which produce natural bicarbonate and in the presence of significant acid production, the ability of the bicarbonate to successfully neutralize it becomes overwhelmed to a certain extent and can make its way past the corridor where it is typically inactivated, producing symptoms and a sense of general malaise and ill sensation.

You are far more resilient than you tend to believe, Richard. The human body undergoes a tremendous amount of adaptation throughout life and in most all instances, does an extremely efficient job without interference. With all the medical media which increases concerns that disease is rampant everywhere, it is common for persons to develop the sensation that an albatross circles overhead and that it's only a matter of time. The truth of the matter is that for reasons we don't yet understand, most all people who express significant health anxiety actually remain quite healthy throughout life, yet their concerns rival and often exceed those who worry less but yet fall victim to the very illnesses which emotionally plague the worried well.

The bottom line is that you can't out-guess mother nature and you can't spend a lifetime in apprehension of succumbing to serious illness or disease. For people with anxiety, they leave the logical boundaries of statistical probability and live with the notion that anything is possible and that the generation of compelling apprehension can somehow actually increase the risk of morbidity or mortality. This often occurs because people with anxiety permit the anchors which normally keep such notions in check to become free-floating and attach to any salient concern which happens to occur. They might read about a particularly alarming incident, such as the recent number of athletes experiencing sudden cardiac death, and by habituation internalize the event as actual proximity to risk in their own case, despite the logical fact that no such association exists at all. A loved one might  pass away and the anxiety patient often develops proximal fears that their own life is in similar jeopardy.

As I've discussed many times on the forum, this type of fear is very unique in that the brain responds in a very archaic and predictable manner, producing physiological changes which only serve to accelerate and affirm fears that one's suspicions are potentially very accurate. The irony of such a perspective is that the usual patterns of self-confidence to separate fact from irrational fear becomes eroded and yet the anxiety patient exhibits increasing portrayals of confidence that their irrational fears are accurate, so much so that they even convince themselves on occasion that their condition is emergent in nature and that haste to the nearest emergency department is necessary to avoid risk to life.

I know that I've discussed this in a variety of contexts over the years and I wont belabor the point again here, but suffice it to say that in any instance of misdirection, the lights on the pathway back home need to be re-kindled on occasion.

You're going to be fine, Richard. The lymphocyte count is of no concern and there are many reasons for such a variability and none of which should be of any concern to you. Work closely with your doctor to get the reflux under control, refrain from second-guessing whether your medications are safe to consume and above all, take a deep breath and try to relax. You've a long life ahead and it's going to be a fairly boring journey if encapsulated within the context of apprehension.

A man languishes over the fact that he has no shoes until he meets the man with no feet.

Over the years, I've had many unfortunate occasion to see extremely sick people. Take serious contemplation of the fact that you're not one of them.

Best regards,

Rutheford Rane, MD (ret.)

Richard,

Again, I see nothing remarkable here to suggest that your difficulties are of a serious nature at all. Realize also that musculoskeletal discomfort under the right scapula can also be caused by rhomboid spasm, which is one of the most common complaints in patients under significant stress or anxiety. Aside from referred colic pain, rhomboid spasm can be extremely uncomfortable and ranges from a dull ache to sharp piercing and burning sensations. Over-the-counter analgesics generally provide relief when combined with mild exercise of the area to prevent cramping and increase blood blood-flow. Hot, moist compresses for 20 to 30 minutes also tend to provide symptomatic relief.

You're going to be fine, Richard. Focus on trying to relax and avoid habituating thoughts which suggest something is always seriously wrong with you simply because physical symptoms are present and refuse to abate.

Best regards,

Rutheford Rane, MD (ret.)

Hi Richard,

Okay, this is not atherosclerosis. It's anxiety. The physical impositions by anxiety can be quite dramatic and I'm constrained to point out here that there is a fundamental issue which remains unresolved here and I would encourage you to explore the source to determine what portions constitute irrational thoughts and beliefs.

I've examined literally thousands of patients with your exact complaint pattern and frankly, you can continue self-diagnosis and get all the tests your insurance and wallet can afford but it will only yield the same frustrating and disappointing negative results. You're not sick, Richard.

Pain between the scapula, or under the scapula as in the case of rhomboid spasm, is extremely common and the chronic pain can be quite remarkable in some instances. It is the result of constant musculoskeletal tension.

You're going to be just fine. I see absolutely nothing of your symptoms which would constitute anything serious at all and frankly, I'm sometimes reminded of how entrenched irrational anxiety can be due to the fact that with over 40 years of medical specialty behind me, patients nevertheless feel compelled to simply repeat their own version of the circumstances and seek reassurance from heart attacks or other serious outcome. If I thought there were any risk of such a compromise, don't you think I would advise you? Surely you must recognize the irrational nature of your constant pursuit to find a problem that doesn't exist and the test results actually confirm it to be the case. Do you really believe that as a physician I just don't have a clue and that all the medical tests which are based on highly accurate scientific standards are all inaccurate or insensitive?

At long last, Richard, is the problem here the inability for you to face the fact that you're wrong? Could it be that you're unable to trust anyone, including yourself? You and I go a ways back with all of this and I'm constrained to point out that to date, nothing has actually been found wrong with you and you have not suffered any type of actual consequence from the concerns which constantly confront you.

At what point do you intend to yield?

Physical therapy or even a professional massage will go a long way to helping with the back pain and you need to relax my friend. There is nothing wrong with you other than the constant ruminative anxiety that something is wrong with you. If you can't trust me when I tell you, then why do you write and confess that it helps you? Apparently, those sort of statements are coming to represent more of a contradiction than a fact. At some point, it must become unavoidable that what I constantly repeat to you in response to inquiry is the truth and doesn't change because your doubts return.

You can turn the corner when you're ready, but not until you literally let go of the irrational belief that you're sick.

Best regards,

Rutheford Rane, MD (ret.)







Best regards,

Rich,  I hope you are well.  I rarely get involved in a discussion especially when it is between someone and RLR but I thought I might be able to give you some help from someone who experiences anxiety.

The breathing is due to the fact that we are wound REALLY tight on a daily basis.  You are confused and stressed over all of these symptoms, you do not have an explanation, other than anxiety that explains them, so you worry constantly.  I mean 99% of the time.....this taxes the body and it starts to react in the way that it should if you were in danger....unfortunately that is the only way it knows how to react....fortunately you are not in ANY danger.

Think of it like this.  Everyone is like a rubber band....some people are loose and can handle anything that hits there rubberband....some people are nervous and if something its their rubberband it vibrates a little bit but it eventually calms down.

People with Anxiety are rubberbands that are stretched to their limit and every little thing makes the rubber band vibrate.

You need to look at yourself from a global vantage point....almost as if you are looking from above....you will see your thought patterns racing, your breathing irratic, your safety behaviors become so obvious!

It takes a little bit but once you start to see them then you can make a change.

For example....now when you experience the burning chest, pain in your back, racing heart....instead of reacting you say...Ok I am having that symptom that I have had before.  What happened the last time I had that symptom.  The Answer "Nothing".  Have you had all of the test and they came back negative.  The answer "yes"....ok so lets move on.

Anxiety and its physical symptoms is a truly powerful thing and shown by ALL of the people that come to this website!  The sooner you realize this and take the steps to change your behaviors, thought patterns etc you will be able to get your life back.

Like RLR says...the energy we all use to protect ourselves from NOTHING could be spent living life.

You have to start somewhere...why not start now.

I hope this helps in some way.

Hello Richard,

With respect to the sternum-related pain, it is possible to induce costochondritis arising from mechanical trauma. The need to obtain an inspirational breath, or yawn, is often telltale of shallow breathing, which can in some instances produce mild changes in blood-gas levels yielding too much CO2 and causing changes that can produce panic threshold events in some persons.

The nature of involuntary respiratory rhythm events is not uncommon and mostly endure because of awareness to the autonomic process which invariably produces unwitting intervention. It's much like the patient who becomes overly aware of the eye blink, subsequently complaining that it has become unnatural. It's important to realize the influence that the brain can have in overriding certain autonomic impulses and this is especially true with respiration. There is nothing to suggest that you have any type of underlying problem and it simply merits discussing this with your primary care physician when you visit for the tests mentioned. You'll be pleased to learn that much like your other symptoms, nothing serious is at hand.

Realize that many of your complaints are variable over time and involve multiple systems with no supporting clinical data to suggest the presence of any type of actual pathogen. This clinical picture is quite consistent with other persons who demonstrate the features of intense levels of anxiety.

You'll be fine.

Best regards,

Rutheford Rane, MD (ret.)

Rich....the gasping and yawns is all about you being tense and upper chest breathing.  I have this too but with my recent attempts to really step out of myself and see my behaviors I was able to identify these habits and that is just what they are....habits.

If you are like me you walk around all day very tense.  When you are this tense you start causing many symptoms and create many bad habits....upper chest breathing which causes changes in CO2 levels which causes you to yawn alot.  This same breathing will cause middle back pain and rib cage pain as well because it is not natural.

Do this.  Every hour on the hour take 5 minutes and force yourself to breathe in to the bottom of your stomach for 5 minutes straight.  This will do 2 things....one it will restrengthen your diaphragm and the second it will allow you to notice how NOT NORMAL your breathing is the rest of your day.

This is all due to the anxiety you have been causing yourself everyday.  When you are anxious your body does these things naturally to help yourself prepare to either run or fight......well the problem with you and I is that we have created a NEAR CONSTANT anxiety and by doing this we have changed our bodies.....so what we need to do is relearn those normal behaviors and stop giving every little thing that happens to us any attention.

Live your life to the fullest.....be healthy and live in the moment....the rest is not up to you and me so why worry about it.

This is truly the point you have to get to to get your life back.....until then you will continue to suffer because it is only natural.

Hope this helps Rich!