GERD or Possibly Pleurisy???

Hello,

I am a 26 year old male.  About 6'3.  Average build.  Maybe about 235lbs.  Yesterday morning I woke up with a sharp pain in my upper right abdominal to lower right chest area.  To pin point it would be about 2 inches to the right of my sternum.  The pain seems to be easier when I hold my stomach and curdle over.  When I try to stretch back out it hurts extremely with sharp stabbing pain.  Also I have to take short breathes.  It is extremely painful to take deep breathes, coughing, sneezing, yawning, etc...  Laying down makes it even worse.  About two months ago I had something similar, but only on the left side and middle of my sternum.  That seemed to feel more like acid reflux since I could taste acid in the back of my throat.  Also I ate a ton of greasy food and went straight to sleep.  This time; however, the pain is on the right side.  I was recently let go from the company I worked for and no longer have health insurance.  I am living off of unemployment.  The pain was so intense I could not take it and went to the AM/PM clinic where the doctor was positive I hurt my rib or rib cartilage somehow.  He applied pressure all over and asked me if it hurt.  I told him no.  It only hurts when I twist a bit, push my chest out, or taking deep breathes.  The pain is extreme and makes me want to hold my breath.  He gave me free samples of a anti-inflammatory.  I took them.  Pain still there.  I could not sleep the pain was so bad.  I drove to the ER.  There I did not want to go in because the price just in case it was just something minor.  I fell asleep in the parking lot sitting up in my car.  When I awoke the pain was still there.  It has been over 24 hours and the pain seems to be slightly better, but not much.  Does anyone know what this could be?  I should have a new job soon where I will have insurance.  I don't know what to do.

[Ratnakar Kini, MD]

Hi,
Some of the symptoms are suggestive of GERd and some others of pleurisy.
What I would suggest is take a course of PPI ( like prilosec). If you find improvement then it is GERD.
If not  chest xray test may be done to rule out pleural involvement.