pain lower rt ribcage radiating forward to diaphragm

[rsmry_w]

Hello.I am posting re: my husband.Last night he awoke at 1AM with severe pain,centered at rt back just below ribcage.Pain rated at 7 so we headed to ER.EKG normal as well as heart enzymes.Chest Xray normal.After a couple hours gave him IV Toradol--relieved pain in 1/2 hour.Doc sugg he pulled a muscle while helping sons move over wknd..Pain ret'd on ride home(35 mins)but he was able to sleep for 2 hours then awoke for work.Pain had worsened,was going to take Flexeril they'd prescribed (plus Motrin 600) but felt better with shower.Tells me the pain is still there now and moved toward front diaphragm. I'm concerned for a no. of reasons. 4-5 years ago we spent numerous nights in the ER with what was dx as esophageal spasms.(Awoke from sound sleep,felt like lump of ice cream stuck btwn lower ribs.) Countless specialists,tests,etc. finally wrote off to stress and poss connection to Synthroid,thus switch to Levoxyl.Prior to these "spasms" gallbladder was removed: numerous stones and inflammation. Prior to the gallbladder removal he'd had a few of these episodes over the course of 1-1/2 years. Thus, when the new wave started up they explored poss stone in duct--negative. We now live 35 mins from the ER, vs. 5 mins. at height of "spasms". I don't think I can take many middle of the night drives to the ER at 70 mph fearing a poss heart attack (all the docs say he should never write off any of these pains for that reason) and worry that lackadaisical diagnoses such as a muscle pull will not help matters. I'm hoping you'll be able to give me something more to go on.  P.S. Other things I noted last night: his BP was 180+/110 when we arrived at ER and settled to his norm of 130/76-78 as he was in the exam room. His eyes were VERY bloodshot which subsided by the time we left. (I'm assuming the high BP was due to pain, andthe bloodshot eyes due to the BP but thought I should mention just in case.) Also, his O2 level was 93% when we arrived. (I know this always read 99 for him with past ER trips.) They put him on oxygen for about an hour and a half and those readings were 98-99. After EKG and chest xrays came back normal they removed the oxygen and the level went back to 93%. Aside from the Levoxyl for decreased thyroid function, he takes Prilosec every other day. (Preventive as he used to take Bextra, now Ibuprofen for inflammation of cervical disc.) He is very healthy and walks a mile and a half daily. He's of normal weight, maybe 5 pounds over. Thanks in advance.

[Kevin Pho, MD]

The one thing you want to rule out before attributing the symptoms to muculoskeletal causes is the heart.  Even if the EKG is negative, you may want to consider a stress test to ensure no blockages is causing the symptoms.

Regarding GI causes, you can consider the various forms of dyspepsia - GERD, an ulcer, or inflammation of the upper digestive tract.  You can consider an upper GI series or upper endoscopy to evaluate for this.  

The other consideration would be Sphincter of Oddi dysfunction - a condition that rears its head more after a cholecystectomy.  An ERCP with Sphincter of Oddi manometry would be the test to evaluate for this condition.

You can discuss these options with your personal physician.  If everything is non-revealing, then musculoskeletal causes can be consideration and treatment optimized.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[rsmry_w]

Went to physician Friday, ordered enzymes blood work and CT of abdomen and chest. Pain disappeared over the weekend but were advised this a.m. to still have the CT as his pancreas enzymes levels are increased. Family physician noted that ER prob should've run the enzyme levels as it was right sided pain. Thus, we'll see what the CT scan brings. Thanks.

[Sarah Connors]

Try ruling out, Acute on Chronic Pancreatitis.

[pammie k]

a chiropractic my be an option, if all your tests prove negative. Sometimes when a rib is out it can be very painful and easy to fix.

[astros18]

Just because they didn't find a stone at the emergency room doesn't mean there wasn't one. I, too had my gallbladder removed and continued to have episodes. They told me at my local health store that stones form in the liver and I needed to do a liver flush. I did and passed hundreds of stones. Incredibly, the pain went away and I felt fantastic. Once you have a history of stones you will most likely continue to get them. A chiroprator is a great idea as pammie k suggested.