Chest MRI Vs Chest CT scan and echocardiogram questions

Hi Dr Junig,

Thank-you for the feedback on the cervical MRI disc issues & your advice on Cymbalta. I think I am inclined to proceed with Cymbalta for 2 months. I was curious however about your thoughts of Lexapro, as I read it does not promote weight gain and seems to be well tolerated. Pristiq I read about but it is not available in Canada as of yet.

I will finally let go of the cancer fears based on what you and my doctor have said and of course the numerous tests I have had.e.g  Chest X Ray, Body CAT scan, Bone scan, Gastrocopy & thoracic spine mri, Abdominal Ultrasound.  The last of my blood work was normal/negative crp, esr, cbc, LDH, T4 free TSH,  PTH, calcium, Lipase and amylase and protein & immunoelectrophoresis, RF and ANA panels were all normal/negative

Given the location of the pain I am still  somewhat concerned about my heart, but the Nuclear stress test was ok, as were the ecg's and heart blood panel. I do have one last test result pending, an echo-cardiogram. Not sure of the differences between the nuclear test and this one except that I read it looks at the heart valves and chamber better/differently than a nuclear stress test.

I am curious if I might benefit  from a chest MRI, would it look at more than the Chest CT scan?  Curious as to what are your thoughts on that and are there any other diagnostic tests you think I might benefit from to assess my mid chest and back pain and the feeling of a tight chest sensation?

Assuming the echo-cardiogram is normal and as disconcerting as my pain is, I am ready to move on with meds and Psychiatric help to deal with and try to mitigate my stress, anxiety, depression somatizeation and Hypochondriosis conditions and hopefully in doing so ease my fears of cancer and heart disease and of course my pain.

Thanks for your help. it has been greatly appreciated!

  

[Mark2929]

http://www.hc-sc.gc.ca/dhp-mps/prodpharma/sbd-smd/phase1-decision/drug-med/nd_ad_2009_pristiq_115439-eng.php

Turns out Pristiq was just very recently approved by Health Canada, so I can discuss this option with my Dr. on Wednesday, although if it doesn't help with chronic pain I think I am likely better sticking to Cymbalta for 2 months to see how it works for me.

[Mark2929]

http://www.fibromyalgia-symptoms.org/fibromyalgia_milnacipran.html

This new drug seems promising and is undergoing phase 3 trials in the USA and Canada and has as an SNRI has shown great promise with handling chronic pain, especially for Fibromyalgia and other chronic pain conditions.

[Mark2929]

Hi Dr Junig,

I am still waiting for the echo cardiogram results & they likely wont be ready until next Tuesday or so. 2 weeks to read an echo seems rather inefficient, but there is not much I can do about it. No additional diagnostic tests or blood work are presently scheduled, not that there are many diagnostic tests left :)

I saw my former Psychiatrist yesterday after a one year hiatus, when he left the region and much of the 40 minute session was taken up with him asking many questions & updating an intake assessment & slowly getting reacquainted with my issues/conditions, medications  etc, as he has allot patients he remembered some, but not all of my background.

He has put me on 30 mg of Cymbalta for 3 days and then is pushing it to 60 on day 4  and I just started today. Already within 2.5 hours I had some nausea and diarrhea, but that's expected I guess for the first week or two.  I provided him with all my substantial diagnostic tests and blood test results and he felt that I have had a very solid work-up  which would have detected a serious cause of my Mid chest and back pain had there been one. such as cancer or heart disease, which is my primary and at times paralyzing fear. He feels that the chest/back pain likely has a minor cause and is being exacerbated by my Depression, anxiety, fixation on the pain, hypochondria and somatizeation disorders I suffer from

His opinion of the chest MRI vs the CT scan question I am also asking you about is that I  that I don't need it at all, as they both do virtually the same things and the CAT  Scan would in fact look at the chest and abdomen better, whereas for nerve, brain and spinal issues he likes the MRI for detecting things like MS,  which a CT Scan cannot do.  

Bottom line he feels that I don''t have a chest cancer/mass or heart disease causing my disconcerting mid chest and back pain & he expects the echo cardiogram will be normal given the nuclear stress test, stress test, and 4 ecg's have been normal. Still he said the Echo test is a good one and looks at the chambers and especially valves well.

Unfortunately the way I am wired and even though I agree I have had a very thorough physical work-up for my pain,  I associate pain with bad things like cancer and it petrifies me. Hopefully seeing my Psychiatrist weekly and the Cymbalta over time will help me. He wants to ween me of of the benzo, Clonazepam and then try Buspar, which is not as addictive and has far less side effects and tolerance related issues than benzos develop over time. In about a month once he see what Cymbalta can do and if it works I will transition from Clonaepam to Buspar, which I hope is a good medication????      . He said the Buspar's primary drawback though is it is a much slower acting anti-anxiety medication and will once started take a few weeks to get a maximum effect. He wants to take a slow approach and not introduce or change my meds to quickly until we find a primary snri or ssri that works well for me.

Lastly I am quite worried/dismayed about the potential SNRI's//SSRI side effects.  I know given my conditions that I need help both from talking to my psychiatrist and from some medications like Cymbalta. I have read horror stories about SNRI & SSRI meds with symptoms both on and especially coming off of them when required. Brain zaps, electrical shocks, severe headaches and heightened anxiety, suicidal thoughts, becoming immobilized etc. Can you please provide some detailed feedback on this from your patient experiences & your overall knowledge of the SNRI's?  Some patients online swear Cymbalta & Effexor have worked amazingly for both depression & chronic pain reduction and changed their lives for the better. I am obviously hoping I fall into the latter category.

[Mark2929]

Just a quick positive update, the Dr. received a verbal that my Echo Cardiogram test is normal so heart problems causing my chest pain are now ruled out between that and the nuclear stress test, regular stress test ,numerous ecg's & blood work & the chest CT scan which also looks at the heart were all okay/normal. I accept that my heart is okay and not the cause of my mid chest and back pain, but I am still somewhat concerned about my cancer fears despite the tests and dr's reassurances that I don't have cancer causing my mid chest/back pain because of all of the normal blood work and diagnostic tests

[Mark2929]

Hi Dr. Junig,

I have a few pending questions in this post and need to ask another about the Cymbalta I just started, as I am already developing some side effects. On/off Tingling/ mild electrical type feelings in my limbs and back of the head, very tired, bad headache & some mild nausea. I have also felt extra panicky and cry/get sad more easily.  I started 3 days at 30 mg and Sunday moved to 60mg. I am worried about this medication & it's early side effects thus far. Are these side effects normal and should they clear up once I have adjusted to the medication in a couple of weeks? The only other psych med I am taking is clonazepam at 0.5mg 2x per day. I am not sure if I should consider stopping the cymbalta at this point?

I am no longer worried about heart disease given my test results of a normal nuclear stress test and heart echo, but still feel really worried about cancer somehow being the cause of my mid back & chest pain despite the body ct scan with dye, chest x ray, bone scan, Gastrocopy, Thoracic MRI & very extensive blood work showing nothing serious going on etc.

My family Dr. said that SSRI/SNRI medication adjustment can be tough and cause some side effects including feeling more panicky but should settle down within a couple of weeks and he says there is no way I should worry about cancer causing my pain as I have had a very thorough diagnostic workup and I need to let go of the cancer fears despite the pain and he states that I do not require a chest MRI as I had the chest and abdominal CT scan and many other tests.

I have a call into my psychiatrist about the Cymbalta side effects and am waiting to hear back from him hopefully by tomorrow, as he is out of the office today.

Thanks for all of your help and answers Dr. Junig, as I am going through such a rough time in my life.

[Mark2929]

Cant seem to make any new posts, Dr Junig is it possible for you to answer the questions in this post when you have a moment. Thank you