bone ache

when i was seven months pregnant , the doctor that i visted diagnosed the pain that iwas expiernecing as muscle pain.the pain was isolated to the area around my underarm.there were no lumps and my lymph nodes were not swollen the pain returned when baby was six weeks old. doctor again diagnosed as muscle pain. the pain has then moved from armpit area to shoudler blade area and across the rib cage , this has continued for several months and the pain exists for five to six days at a time ( dull ache) pain has now recently moved to the back area of the rib cage. the baby is now seven months old, and the pain is on and off. does this sound like it could be a calcium defficency? iam extremly healthy and watch what i eat , no sugars alcohol, caffenine.iam not overweight but gained a large amount when ia was pregnant 50lbs all has been lost.  Iam 30yrs old and iam a non-smoker. the pain also changes locations , can be any of the three areas listed above at any time.

please advise your thoughts

tiia owens

[Forum-M.D.-DT]

Dear Tiia Owens,

Thank you for visiting the Family Practice Forum.

You describe pain in 3 locations; under the arm (axilla), shoulder blade, and across the ribcage and the back area of the rib cage. While muscle inflammation is certainly a possibility ... it seems to be persisting for longer than I would expect for mere muscle inflammation.
I would like you to speak with your doctor about the possible presence of gastroesophageal reflux disease or gallbladder disease. Here is why:

1. Pain coming from the stomach or gallbladder or due to the "reflux" of acid up from the stomach into the esophagus is commonly present in the middle abdomen or "epigastrium" but may also commonly be "referred" to the left shoulder or back. (i.e. the pain from the stomach/gall bladder is "felt" elsewhere).

2. You had gained considerable weight during your pregnancy. Both weight gain and the "pressure" of the baby pushing up on the stomach would increase the chance for acid reflux. This may have started the inflammation of the stomach/esophagus which has not yet resolved.  

3. The pain comes and goes. lf this was muscle inflammation I would have suspected that the pain would have been present and subsequently resolved in the following weeks.

If you came to my office with the symptoms you describe I would due a blood test to check your liver and pancreas function and check you for the presence of excess intestinal bacteria (known as H.pylori) which may cause stomach irritation if present in large quantities. I would also consider starting you on a medication to help reduce stomach acid. If there were any abnormalities of the blood tests of the liver / pancreas ... an ultrasound would need to be performed to look for gallstones. Also, if not done recently (just to be on the safe side) an EKG should be done. Commonly pain from the heart may also be "referred" to the shoulder. (not typically the back however).

If all above is normal the next step would be to have a blood tests to check for different types of arthritis.

I hope this proves helpful. If this is not determined to be due to the stomach, gallbladder or acid reflux, I really would think about conditions such as "Polymyalgia Rheumatica" which can be associated with "migratory" arthritis (muscle and joint pain/inflammation). These are best treated through LONG courses of anti-inflammatory agents.

I wish you (and your baby) well!

Dean M. Tomasello, M.D.