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Thoracic Radiculathopy masquerading as "gallbladder disorder or disease"?

RFJ
My pain is on my right side.  Underneath and behind the lower rib cage.  3 yrs ago I began to have a "sore muscle" and didn't thnk much about it because it did not interfere with daily activities.  I convinced my wife that our bed was worn or not giving me enough support to the back and ended purchasing a new one.  The "soreness" persisted.  One month ago my pain began to worsen and depending on quick movements or standing from a sitting position it causes a sharp pain that immoblizes me for about 30 seconds.  If am walking for a l length of time I began to tire out from the dull acheness that turns into moderate pain.  2 weeks ago I ended up in the ER for what appeared to be "gallbladder malfunction" because the pain was directly underneath and behind  my right rib cage.  A CT scan, HIDA scan, ultrasound, endoscopy all return NEGATIVE. My Both my PCP doctor and GI doctor who did the endoscopy both told me to follow up after a 4 day hospital admission and discharged with mild gastritis.  My PCP doctor has no answers other than painkillers and lidoderm patches.  My GI doctor suspects radiculopathy.  My pain has now extended around to my lower rib cage and is very sensitive to touch at certain areas.  This causes hardness or bloated feeling.  I was referred back to my neurologist.  He gave me epidural steroid injections 4 yrs ago for hip join arthritis. After my visit with him he explained based on where my pain is "referred"  that it could possible be radiating from the thoracic spine or nerve, tissue, etc.   He has ordered MRI both of my thoracic and lumbar sections.    Do you feel that I am heading in the right direction as far finding a possible cause of my pain.  I have missed many days of work because of this.   Some days worse than others.  At times I have "relief" and feel that it is getting better, but its like a cycle now, and the pain comes back with determination.  Bewildered and tired male 46 yrs old, slightly overweight in the mid section.   Ray F.
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Avatar universal
RFJ
UPDATE:  I had my first Epidural steroid injection yesterday.  All I wanted to know was "is it going to hurt me".   I said "I'm a big boy now, just tell me what to expect so I can forewarned and compose myself.   They said, "Don't you worry about a thing... I am going to take good care of you... How are you feeling now... comfortable?"  ...  I says "  Uh-huh"  and then  I don't even remember how I got dressed after it all.  Next thing I knew I was in a wheelchair at patient pickup.    LOL...   The lady anesthetist gave VRSAID (sp.??)  Am a bit sore and stiff the day after, other than that, I dcan notice already the nerve pain in nill to none!   Wow what a relief.  Course that could just be the anesthetics, but we'll see what happens in a couple of days.   I have a "followup appt procedure"  in 10 days.   Hmm I wonder what that means? Another round?    Sincerely, Feeling A WHOLE LOT BETTER :)
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Avatar universal
RFJ
ANOTHER UDPATE:  

I have a new doctor now, a pain management doctor.  My MRIs are negative so my pain is not stemming from a pinched nerve or bad discs.  The neurologist referred me to my new doctor. After he read all the notes from my case, he is almost certain that I have been experiencing a less severe form of Shingles.   I have occasional blistering or rash but it was nothing that led me to suspect that it was shingles and it wasnt until I left the office visit and began to go back and think all those times when I had those "blisters" popping up near my scalp and skin welps along the same area of my pain.  I was only trying to resolve the "referred pain" in my gallbladder/kidney/low lung area inside me.    We are still diagnosing it but I am already scheduled for Epidural steriod injections this week!   It's finally good to know something about where this pain might be stemming from.   Time will tell.  He asked how long I have been this way and I told about 2 years and more recently the last two months with the severe pain in my side.    So he thinks its the shingles virus that layed dormant in my nerves ever since I had chicken pox in the 2nd grade and now it has waken up.   I hope whoever reads this forum that it will help you find your diagnosis.   I am happy that I was persistent in getting answers or even if only a logical answer where this pain is from ... about 2 years ago  I had caught a bad cold and had broken out in a bad rash in my upper body, since then I have had occasional blisters or what I thought were "pimples" and I kept thinking "sign of youthfullness" right???   Well,  shingles is more likely the cause and the worst of it is in the nerve or nerves in the thoracic area of the body.    Hope to come back and let you know how the injection procedure went and report how well the pain is doing then.   Take care!  
Sincerely, "still in pain" but somewhat relieved in a different kind of way!
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1331804 tn?1336867358
Hi Ray,

Happy New Year!!

It is likely that you have what is called chronic myofascial pain syndrome (a fancy diagnostic phrase for chronic muscular pain).  I have the same thing along with degenerative disc disease and radiculopathy.  Myofascial pain is caused by tight bands of muscle that overlap or surround the various triggerpoints located on your back.  These tight bands of muscle apply pressure on the trigger points and cause them to activate and send pain signals to the brain.  Muscle relaxers (like what you received in the ER) can be very effective short term for this type of pain.  Over the long term, they can lose their effectiveness.  I have been on a muscle relaxer called Flexeril for 6 years and I am going in Friday to hopefully replace it with something more effective as my body is tolerant to the Flexeril.  Trigger point injections could be helpful for you as well.  I have had epidural steroid injections but not trigger point injections; however, I plan to try these later this year.  I also use a Theracane to perform self-accupressure and this helps quite a bit as with a lot of pressure applied to the tight bands of muscle, I am able to break up those tight bands and temporarily "turn-off" a trigger point.  Trigger points tell your body when something is wrong, like injury, but sometimes they can malfunction and go off when there is nothing wrong.  

Gabapentin or Lyrica is really good for nerve pain.  I take Gabapentin for the nerve pain I have and it is very effective.  Something to try if you think you have nerve pain.  I was just prescribed Voltaren Gel yesterday and it is really effective on my low back pain.  It is an anti-inflammatory gel.  Something to try if you think inflammation may be the cause of your pain.  

I am glad you are feeling better and that the medications are working for you.  I would make an appointment with you primary care physician to see if you could get refills of some of the meds you received from the ER that were helpful.  Thanks for the update and please keep us updated on how you are doing.  


femmy
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Avatar universal
RFJ
UPDATE:  Friday late night I developed a horrible neck pain in the bone nuckle area.  Along with the pain at my side.  I just did the MRIs the day before at the same hospital.  The ER doctor had a look at them and the report and all are Negative.   The doctor ordered a neck xray just to make sure. Negatifve.  He gave me a mega does of muscle relaxer.  It took a while for it start working but when it did, I felt like I was in a parallel universe.  I was prescribed arthritic medication, pain killers, and muscle relaxers.   I will follow up with the neurologist in 2 weeks the earliest he is able to see me.  I have a strange feeling I am having some sort of inflammation or nerve pain either the tissue or bone.  Or could it be just Severe Muscle Spasms???    The medications when taken all together allow me to move around and do my secular work with more ease and less pain.  
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1331804 tn?1336867358
I am glad that you finally got your MRI scheduled.  That is wonderful news!!

I am sorry to hear about your worsening pain.  The MRI may not determine the cause of the pain located at the site of your digestive organs.  You symptoms sound very familiar to those in people with gallbladder disease but your earlier post states that all of the diagnostic tests came back normal and they did the right ones related to determining whether or not you have gallbladder disease.  So i am at a loss as to what could be causing the abdominal pain.  I do hope your doctors are able to find what is wrong soon so that it can be treated.  My only other suggestion is for you to request a liver panel test.

Please keep me updated if you can.  Take care.

femmy
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Avatar universal
RFJ
UPDATE: New symptoms, pain and numbness lasting for an hour each time twice this week, shoulder blade tender and aching, headaches.

Original pain in the deep gut near kidney/stomach/gall bladder area, still persists.   What is going on?
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Avatar universal
RFJ
UPDATE:  I received a phone call from the hospital's radiology appointment desk for my MRIs scheduled for  tomorrow afternoon!!!   I was on the phone with the insurance company since Christmas break started.  It took a while but I think it finally got some results because of being proactive and diligent and of course with the help of 2 of their outstanding customer specialists.   And it couldn't have come at a better time, my pain is a moderate 7-8 scale for today.   Hanging in there...
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Avatar universal
RFJ
UPDATE:  My employer is switching over to a new insurance provider as of Jan 1!  Wow perhaps some relief in sight after all.  Let's hope.  I spent the last 2 days with minimal pain and but not so today.  Now the cramping (stiffness/bloatedness)  is real bad and difficult to move about just like before when I went to the ER in the beginning.  My wife tells me that she suspects a pinched nerve or even a bulging disc.   Today (Monday) might well have been a holiday as many in the medical field took the holiday today.  Let's see what tomorrow brings.  Remaining hopeful!   RFJ.
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1331804 tn?1336867358
Hi Ray,

I am sorry to hear about the extra frustration that your insurance company is causing you.  I have been with an HMO for my whole life; however, next year I will be switching over to PPO and will have to deal with claims and possibly other similar issues.

When I asked my primary care physician for the MRIs, he just ordered them and I went in to do them.  I have never had to deal with the insurance company telling me whether or not the MRIs were needed or not.  I have heard that the MRI scans are not cheap to the insurance provider but the insurance company shouldn't make it difficult for you to get the scans completed.  Perhaps a referral to neurosurgery would be advantageous as they could document justification for the MRI scans, whether is states it will be used to determine if surgery is required or would be helpful.  

I do hope things resolve themselves so that you can get these scans completed so you know how to best treat your chronic pain.  You shouldn't have to go to the ER just for MRI scans.  I wish I had some other advice that I could offer you but I have not had to deal with similar issues.

femmy
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Avatar universal
RFJ
Thanks for your support. Now my insurance company (UHC) and the hospital that schedules the MRI's are in conflict due to a "preexisting clause" on my insurance plan that my employer so happily provided to us. And it's all about one claim for services provided on a specific day in November.   But any claims before that date and after that date, UHC has no issue processing.  Why this one particular one?  It has nothing to do with the reason for which I need the MRI so badly in need of right now.  It's sickening to me that I am being denied services.  Figure this out... I called UHC have spoken to a customer rep and a claims specialist and both have made a complimentary call to both the doctors office (the one ordering the  MRI) and the hospital (who is scheduling the MRI) to explain that neither of them should be denying either the minimal copay set out for me (which I paid over 5 times the amount) and the hospital scheduling the MRI.   I've been told by UHC that the hosptial processes certification for the procedures over the internet and a "FLAG" was placed on my account  which kicked back the certification "DENIED".  But denied by who?  UHC or the hospital?  It seems that the schedulers or powers that be should go ahead and certify the procedure, because UHC directly told them to not handle the matter as they were doing.   So to make matters even more difficult,  I have to prove eligilibility over ONE claim, before any treatment or agreed copays will be provided to me.  What if I begin having pain?  Would UHC suggest that I go and visit the ER?  Why would they want me to initiate more claims that are more costly?  Is this the only way to get an MRI done?  and let my doctor know asap that I'm in the ER and have it done that way?   Sincerely, FEDUP WITH PAIN & PROVIDERS :(
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1331804 tn?1336867358
You may want to request that your doctor also order an MRI scan of your cervical spine (neck).  Herniated discs in the neck can many times cause numbness and tingling in the arms and fingers and also muscle weakness in these areas as well.  

I have had 2 MRI scans of my thoracic spine and 1 MRI scan of both my cervical and lumbar spine.  The lumbar spine by far has the most damage.  It takes about 45 mins in the MRI machine to scan each section of the spine: cervical (45 mins), thoracic (45 mins) and lumbar (45 mins).  I had all of these regions scanned in one setting and it was not a comfortable experience but they can do all of them at once.  Just be aware that you may have some pain sitting up from the table after the scan is completed.  I found that taking valium helped me a lot with the MRI scans because the machine gives you a claustrophobic feeling and it is really noisy even with the ear plugs in.  So the valium helped me relax and remain as still as possible during the procedure.  So ask your doctor if he could provide some anti-anxiety medication for the procedure.  You may also find that the anti-anxiety medication helps a lot with your pain as well.

Once you have a diagnosis (hopefully your MRI findings will shed some light on the reasons you are in pain), many doors will open with a variety of treatment options to manage your pain.  My pain is managed very well now with medications, light excercise, stretching, and self-accupressure such that I am able to function well without the need for any back surgeries at this time.  Which is good as back surgery has a success rate of ~60%, much lower than many other common surgical procedures.  So, in other words, there is a 40% chance that surgery can make the pain worse or not help the pain at all.

femmy
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Avatar universal
RFJ
This morning I woke up with numbness in both arms and fingers, strange.
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1331804 tn?1336867358
I think MRI is a great diagnostics tool due to the high resolution 3D imaging of the spine, vertebre, and discs that it provides.  I am very hopeful that you will get some solid answers from your MRI findings.

Please post updates on the findings if you can.

femmy
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1340994 tn?1374193977
My ex had something like that and his mom thought it was due to the weight of his belly pulling on his rib cage.  She was a nurse.  He stopped complaining with it when he lost weight.  
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