Re: Chest Wall Pain

Posted By Sharon T on December 09, 1998 at 10:34:00:

In Reply to: Chest Wall Pain posted by CCF MD GS on December 09, 1998 at 09:07:57:






: My daughter age 14, is experienced recurrent and worsening chest wall pain.  About six months ago she had a very thorough cardiac workup (EKG, echo, exercise stress test w/ pft, and 30 day event monitoring.  All cardiac causes of pain were ruled out, although the pain was reproduced during the exercise test.  Now she is undergoing a workup for reflux by gastroenterologist, although he does not feel this is a gastro problem, the symptoms and pattern are not typical...the pain does not appear to have a connection with eating, antacids do NOT improve NOR prevent pain.  We have been trying large doses of Maallox when pain occurs and are keeping diary for gastro doc, but it appears this is going to end up a dead end.
: None the less, the last four days have been among the worst ever.  This is the longest the pain has lasted.  As usual, it began with exercise (at least 75% of her episodes start with exercise, much of the time rest improves mild attacks rapidly).  She is a competitive swimmer, and this pain has severely impacted her ability to work out.
: When the pain strikes, it tends to come on suddenly.  She says it causes sharp stabbing pains that are worse with breathing in, and doesn't really hurt to breathe out.  While experiencing this pain, she can not take deep breaths, also coughing sneezing, hiccups, laughing hurt badly.
: The worst part is when it is time to go to bed, she can not lay down when the pain strikes.  This time the pain started on Saturday...this is Tuesday and is the first night she has been able to sleep in her bed, although propped up with pillows.  She was having to sit in a chair so that she was completely upright.
: Past history includes Graves' Disease which started at age 8, and had cardiac symptoms but resolved rapidly with Tapizole...she continues taking low doses of Tapizole and is monitored regularly and is doing very well....blood thyroid levels show this disease is very well controlled and has been for a long time.
: Two years ago she had a mystery illness....at this point the diagnosis is that was onset of probable or possible lupus....although we have no firm diagnosis, she meets many of the criteria AND has positive ANA and has had repeated positives of antidsDNA, some at high levels and confirmed with Crithidian.
: I hate to see her suffer.  A few weeks ago, I took her to ER because she was in so much pain and having such difficulty breathing, but they came up with nothing, although the oxygen and shot of a sedative/painkiller helped her much...EKG was fine, and lungs were fine.
: I really don't know what else to do.  It has been hard to hold down my fear that maybe I should take her back to ER, because she couldn't breathe, but I realize ER is only for life threatening conditions.  I am supposed to take her back to cardiologist in May for followup...but last tests revealed no abnormality.  She has a neurologist because she gets terrible headaches which are migraine in nature...they started the same time as the mystery illness at age 12...she takes 75 mg amitriptyline.  She went to neurologist because the mystery illness also included severe joint pain, severe muscle weakness, numbness and tingling in legs, and inability to walk or stand...she was in wheelchair for several months despite having been a competitive athlete at the time of her collapse.  No cause was found for these problems either.
: Could the chest wall pain have a neurological basis?   If so, how could this be determined.  I mentioned the chest wall pain to the neurologist (she goes every 6 months) over the summer...he didn't seem concerned at all, however, back then the attacks were mild.  Would he be an important part of this investigation?  I feel so sorry for my kid....she tries so hard not to let any of this slow her down.  No matter how much pain she is in, she forces herself to go to school.  She hates to miss a swimming session, but has had to miss this whole week because the pain is so much worse than ususal.  I want to help her.  Last May, the cardiologist said she may just have to learn to live with the pain....now that the pain has gotten so severe I am having trouble accepting that answer.
: I appreciate any insights you might have.
: Dee
Dear Dee,
You daughter sounds so much like a lot of the symptoms I experience.  I also had Graves disease in 92.  I was recently dx with Myasthenia Gravis.  I owned my own Health Club and had to close it in Dec 93 because of weakness.  I have not had to be wheelchair bound but have had the severe leg weakness and I fall a lot.  You should really seek out a neurologist farmilar with Myasthenia.  Most common symptoms include drooping eye lid which is usually the first indicator but I have heard that sometimes the eyes are not a visual indicator of MG.  It is something I would research.  I belong to a Mailing list group called MGMail.  It is a support group for MG.  We have lots of people in the group who have had Graves and also MG.
This group is very supportative and could answer questions for you also.  There all some medical professionals that are also members of our group that respond to questions.  I attached the URL to enroll as a member.  Just follow the instructions.  This is a email group.  Once you are enrolled you will start receiving emails from all the group members.  The same URL tells you how to subscribe and how to send mail to the group.
Dee,  I have had 3 doctors tell me that I couldn't have MG since 94 because there is not any pain with MG.  That is just not true.  It is from weakness but the muscles get weak and then begin to spasm from over use and then the pain starts.  Because I have had hip aches and shoulder/neck/deltoid pains I was told it was probably Fibromyalgia and depression.  I saw a rheumatologist for the possible MG and he suspected MG just like my opthalmologist did in 94.  The sooner she is dx'd the better.  I went 4 years without diagnosis and gradually have gotten worse and worse.  There are treatments for MG to help her get her strength back.  MG is not very common and is considered to be rare but you daughter has enough of the symptoms to seek out testing for MG.  I see she has positive antigen.  MG can be tested with a MG Antigen test and EMG's or a tenisilon test.  
I would be interested in talking with you.  Please contact me at sha_tur***@****.  Does your daughter experience any double vision or blurred vision?  Does she have any dropping appearance to her face or eyes?
Many neurologists are not familiar with MG patients and that is why it is so important for you to see someone who is.
Hope this has helped.  I also have a 13 year old that is very active in sports and my heart goes out to her.  I know how devastating it is to lose your athletic abilities and conditioning.
Sharon T
"X" Personal Fitness Trainer
MG robbed me of my profession



Dr Dee thanks for the question. I'm sure you have read Sharons response as well. While MG can cause pain related to muscle weakness it would be unusual to present with just pain with exercise. I assume that with her other associated problems she is seeing a rheumatologist and if not she should be.  Sharon is correct that alot of neurologist do not see MG on a regular basis. MG has also been linked with other autoimmune disorders. Since you have a neurologist and you have new concerns it would be reasonable for hime to see your daughter for her current problem to determine if it has an underlying cause. Due to her previous bouts of weakness an EMG may be reasonable to look at. Good luck
This information is provided for general medical education purposes only. Please consult your doctor regarding diagnostic and treatment options.
Dear Doctor;
I was wondering can thyomas or thymus problems cause these pains?  I posted about torso weakness and then after posting was reading a few of the posts and this one caught my attention because of my pain I get ocassionally in the sternum area.  Can rib and chest pains also happen to someone using weak muscles, (like swimming) repetatively or continued when the weakness occurs in the muscles.  Swimming does use most all major muscle groups but what if the weakness was more generalised in the torso?
Dee, There are other symptoms your daughter has that are not considered to be the symptoms of MG but the severe weakness, inability to walk, numbness, and headaches can be symptoms of MG.  I have bad headaches also and they have been controlled by my starting medication for the MG.  I had weak neck/shoulder/deltoids muscles and pain on using these muscles to much.  When I had problems holding my head up I would find my headaches were the worst.  Does your daughter have problems holding her hands over her head when she is feeling really weak?  Is it difficult to hold her head up at times?  MG can hit different muscles in different people, mainly the leg muscles and can also move from one muscle group to another or involve many at one time.    
I have never answered any posts on the clinic to other peoples questions but your daughter's symptoms are so similar to most of mine that I felt a strong need to mention the MG as a possibility.  It truly would not hurt to have someone check her for the MG since you are finding yourself hitting block walls.  On another note;  I have had a endoscopy and CT scan of the abdomen because of my rib and chest pain.  Many times the pains would feel like they could be gallbladder, liver or esophagus.  My pains are located directly under and just below my sternum and under the breasts in the rib areas.  My tests were all negative with exception to some slight stomach irritation.   I have recently had a CT Scan of the thymus but do not have any results back.  So I have not had any confirmation either on why I experience this chest and rib pain, but believe it is caused by my MG as it happens when I am at my weakest.  I get so weak that I collapse at the midline and slough.  Where I fold over from the inability to sit up straight is where most of my pains are.  
Good luck on finding out what is wrong with your daughter.  Many prayers coming your way for your family and especially for your daughter.

Sharon T.