undiagnosed problems

my husband underwent four open heart surgeries-1st for a triple bypass -then three others for an aorta aneurysms/lung repair(the aneurysms bled out and eroded the lung).  Each time before the major bleeding he would have severe pain in his upper right hand side of his chest area going through to his back area-very sharp stabbing type pain that nothing gives relief to.  Since the last surgery he has this pain almost constantly and it gets worse after eating.  He has seen several doctors-the pulmonologist says it could be that since his diaphram and intestines are now moved up into his chest area on the right side that this is probably the pain-the digestive doctor says it could just be acid reflux developed by all of the tubes from surgery-the cardiologist says he doesn't want to go there because no matter what no one is going to open him back up-But he is in pain and can't stand to eat and is afraid that the aneurism (aneurysm) is growing again -its been two years now since his last surgery-there has been cat scans, mris, exrays, no one seems to know what is going on, what tests to run to find out, or what to do to fix it -he has tried pain medication , heat, ice, protonix, gas pills, liquid diet, nothing helps relieve the pain -where does he go for help-how does he cope with this -there has been alot of weight losss due to not being able to eat -there is the pain to deal with and there is the hunger to deal with when he cant stand to eat because of the pain -where does he turn -who can help with this situation-

[Kevin Pho, MD]

There has clearly been a comprehensive evaluation of your symptoms.

If there are difficulties swallowing, an upper GI series or upper endoscopy can identify blockages or motility problems of the esophagus.  

If there is a nutritional issue, supplements with liquid supplements (i.e. Boost or Ensure) can be done.  A more serious intervention would be supplementation via a feeding tube.  

A referral to a GI physician can be obtained, preferably at a major academic medical center.  

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.
www.kevinmd.com

[davisanddanes]

there is no difficulty swallowing and the only problem with nutrition as such is that it is so painful in the chest around the nipple area through to the back all of the time but especially after eating-it is accompanied by alot of gurgling.  tests have been done but no one has an answer as to what the pain is or how to get rid of it and if it is because of the intestines and diaphram moving into the chest area what can be done to rectify the situation -it is hard to keep living this way.

[Craig Job, MD]

The description of your symptoms sounds very frustrating and disheartening. I agree wiht Dr. Pho that a thorough GI workup is in order. There are a few pain syndromes that may be considered in this case however. Your husband has had several surgeries of his chest, which increase the risk of triggering a pain sensitization syndrome. These syndromes can be either due to improper healing of superficial nerves, sometimes called a neuroma. They may also be caused by the trauma to sensory nerves of the organs inside the thorax. These nerves generally only sense pressure and stretch, but when they enter the spinal cord nearby the pain nerve fibers that serve the outer chest wall (pleural lining, ribs, muscles, skin, etc), sometimes these signals get crossed and with enough  inflammation and a certain cascade of events, pain signals begin to fire without cause and the patient will be left with chronic, inexplicable pain. These pain syndromes respond to various  medicines that  blunt nerve pain and re-regulate pain pathways in the spinal cord and the brain. Your husband should consult a pain specialist after all serious possible causes have been excluded.

Craig Job, MD
www.craigjobmd.com


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.