881463 tn?1245345649

Follow-up on back chest pain MRI in Buffalo Tuesday on Thoracic spine

Thanks for the response/suggestions on the pain I am experiencing. Canada's Public Health care system for certain tests is awful, especially 4.5 month waits for MRI exams.  I am going to bite the bullet and drive to Buffalo at 3:30am on Tuesday for a 7:30am MRI in my thoracic spine which costs $700.00 Canadian, but saves 4.5 months of worry and perhaps if there is a herniated disc or bone spur.inflammation,  my doctor can get me a nerve block injection. If the MRI is negative and just shows mostly normal wear or a even partial slipped disc then my doctor doubts a neuro surgeon would risk surgery or nerve blocks.

The only other test I am having on May 28th is a SPECT Nuclear Heart stress test. I previously passed ecg's, a regular stress test and heart blood panels, and my Dr, doubts there will be any damage shown from the tracer, but at this point he says we may as well go the full 9 yards. If there is a problem then I will have an angiogram, but ONLY if there is a problem on the nulclear test.

As you suggest my Dr. feels this is from a bone spur, inflammation of some sort or a muscle pull or tear, perhaps from that  very awkward sneeze. He says between I ahve had a very extensive work-up the Gastrocopy, chest x ray,  Chest and abdominal CT with contrast and bone scan plus normal blood work there is no way I have a bone or spine tumor, lung cancer or any other malignancy for that matter because by the time it causes the type of strong pain I am having it would "Present itself", especially on the chest ct scan and bone scan. He also said bone/spine cancer very rarely is primary, but rather more common by means of spreading from another area and given my negative results to date says he has virtually zero concern about malignancy.

On Friday I was just told that the protein electrophoresis esr, crp, RF ana panel were all normal negative along with another normal CBC, unrinalysis, calcium PTH, Alk Phos, tsh Lytes etc.
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666151 tn?1311114376
I agree with your doctor that the serious things have been ruled out.  Realize that in medicine we always play the odds to some extent;  there is a saying, when you find hoofprints, think horses, not zebras.  The less interesting way of saying the same thing is that 'rare things happen rarely' and 'common things happen commonly'.  

You have even suggested that your fears are a bit more than 'appropriate';  I encourage you to hold that thought and take it to heart-- no pun intended.  A nuclear imaging study of the heart is less common than many other tests, even by our standards here in the US.  If you had something that was diagnosable, it would likely have been diagnosed by now.  But none of us can see the bus driving down the highway toward our car, 30 miles away, the brakes about to fail.  My point is that we find a balance between worrying and never leaving the house, or learning to accept the fact that life is precious and sometimes fragile.  I suspect, Mark, that you will be around a lot longer than I will be.

Ativan relieves anxiety, and if that treats the pain (usually that class of drugs will relax muscle, but will not do much for pain) that suggests that the pain is at least contributed to by anxiety.  I would not recommend that class of medication for long term, as it causes tolerance and loses its effectiveness.  I more appropriate choice would be an SSRI like fluoxetine or sertraline or an SNRI like venlafaxine.  They all take a few weeks to become active, but they are not addictive and they all work pretty well for anxiety and panic attacks.
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881463 tn?1245345649
My doctor told me that the bone scan from last week was normal.

I have the Thoracic MRI in Buffalo on Tuesday morning and a nuclear stress test on the 28th.

Given to date in the past 4 weeks all of the the normal/negative blood work, Chest X Ray, Bone scan, chest and abdominal Cat Scan with contrast, Abdominal Ultrasound, Gastrocopy, ecg's and stress test my doctor feels that the Thoracic MRI wont show anything serious, but likely more of a minor problem like a bit of wear and tear or a bit of a slipped disk.

As for the nuclear stress test he doubts that will show anything given the normal regular stress test a couple of weeks ago and numerous normal ecgs for the past 5 weeks. If the MRI and Nuclear stress tests are normal he says there will be no further tests and I have to accept that I have some form of non serious cause of chronic pain that over time will likely fade away
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881463 tn?1245345649
I had the Thoracic spine MRI early this morning in Buffalo and saw my Dr this evening. The radiologist already read and faxed the report as being normal except for a bit of  wear and tear. No herniated disks or nerve issues were seen etc.

My last scheduled test is the nuclear heart stress test which is supposed to be on the 28th but is now likely delayed due to the Canadian reactor going down today for a month. It supplies the nuclear tracer to approx. half of the worlds countries for nuclear medicine tests. This is the second time this has happened in less than a year and will likely delay peoples nuclear tests by over a month.

My Dr. says all we can zone in on and double check is the heart, as all of the tests for everything else including Gastrocopy, Abdominal and Chest CT with contrast, chest x ray, extensive blood work, bone scan, thoracic spine MRI, stress test, multiple ecg's & heart blood panels have all been normal/negative. He says assuming the heart is okay the pain is from something benign and not serious and that my stress anxiety and depression make it worse and that the pain given a few months will likely fade away.
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881463 tn?1245345649
They are fitting my heart stress test in on Monday before the Isotope tracer material runs out, which is great news, If it is okay then my tests are done and i have to try and accept that something of a more benign nature is causing my mid chest/back pain that will eventually fade away. The regular stress test was normal, apparently this is another stress test that also looks at the heart with a gamma camera to see how the blood is pumping in and out of the heart and to look for previous heart muscle damage which shows up as cold spots.
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881463 tn?1245345649
Hi Dr Junig,

As mentioned previously my Thoracic spine MRI on Tuesday was pretty much normal. I have also had in the past 5 weeks  to try and figure out my mid chest and back pain a normal/negative Chest & Abdominal CT scan with contrast, Chest X Ray, Abdominal Ultrasound, Bone Scan, Gastrocopy, Bruce Protocol stress test, 4 ECG's with heart blood panels and a ton of of other blood work. The Dr. says my heart and lungs sound normal on his stethescope.

I have a couple of heart related questions relating to a thalium Heart stress test, which I have on Monday morning and if all is well it will be my last test and I will have to then accept that the cause of my pain is not serious: I am of course given my anxiety and depression worried about the test going into the weekend and would appreciate any feedback you can offer.

Is the regular heart stress test a solid test to indicate possible heart disease that causes mid chest and back pain and the possible causes of heart disease and what are my chances with this Thalium Nuclear stress test detecting any problems that the other aforementioned heart tests have indicated were all normal?

Lastly how do a chest X Ray & Thoracic Chest CT scan look specifically at the heart and what do they rule out, especially combined with the negative stress test (Briuce Protocol), ecg's, heart blood panels (e.g Troponin) and the Dr telling me that my heart on the stethescope sounds fine. I would hope that the Chest CT takes a good look at the heart for size shape, potential abnormalities etc.

Thanks and have a nice long weekend in the U.S
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881463 tn?1245345649
Does anyone know if Dr. Junig on Holidays? Can't seem to post anything new.

I am hoping Dr. Junig is back soon and reads my last couple of posts and this one as well and can provide some feedback on my mid chest and back pain as well as this tight breathing sensation I get that is not asthma related (Tight chest). I suffer from asthma, gout, depression, anxiety, stress, Gerd and to a certain extent hypochondriosis when I get pain that cannot be identified. I worry about cancer and heart disease allot, especially lately.

Since my pain started over six weeks ago I have had allot of tests, which have all come back pretty much normal. The most 2 recent tests were a thoracic spine MRI that I drove to Buffalo for, which showed some normal wear and tear, but nothing serious like a slipped disk. My first stress test a month ago was normal and I just finished hopefully what will be my last test this past Monday, a Nuclear stress test, which I was also told by my doctor is also normal. Other normal tests to investigate this pain are a chest, abdominal and pelvic CT scan with contrast, normal chest  x-ray, a normal bone scan, normal gastrocopy (except every small hiatal hernia)  extensive and mostly normal blood work including CBC, Heart panels, PTH, TSH, T4 free, Normal Protein electrophoresis, negative ANA & RF panel, normal Magnesium, CRP, Calcium, CK, Lipase, Amylase, INR, Ferretin B12, LDL, HDL (slightly low) LDH, ESR, Lytes, TSH, normal plasma blood test for diabetis is normal. Normal abdominal ultrasound. 4 ecgs on different days at emerg.

Dr. Junig, My Family Dr. says that all serious things have been ruled out and i need to accept that this disconcerting pain will go away at some point. Tylenol 3 and naproxen do not reduce mid chest and back pain, however taking one 0.5  Ativan seems to provide substantial pain relief ant the tight chest is relieved for many hours and I don't know why Ativan would help in this regard.
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881463 tn?1245345649
Hi Dr Junig.

Nice to see that you have returned & I want to really thank you for your response :)) I can't seem to post any new questions, as it says the daily forum question limit is full, so I will continue off of this post.

My state of mind because of stress, anxiety, depression & worry about this pain is a real mess right now. I have only been on the Ativan for just under 2 weeks and it really seems to help reduce my mid chest and back pain and the tight breathing sensations, but the effect doesn't last more than 4-6 hours at a time. Perhaps as YOU MENTIONED that Ativan relaxes muscle I may have tore a chest/ back muscle during that awkward sneeze and therefore ativan helps because it is a muscular type injury?

I am already taking a bit more Ativan to maintain the effect, so I am cutting back to eliminate it asap and am already having disconcerting mood swings of sadness and despair, extreme worry, uncontrollable crying, headaches etc. Hopefully this wont last long. I am breaking the tablets roughly in half .2 per day instead of .5 to try and wean off of it. I have read it becomes addictive very quickly & causes really crappy side effects to get off of it. Luckily I have not been on it for long. Any idea how long these side effects will last with 2 weeks of use .5 to 1.0 max per dose per 24 hours?

Can you please tell me a bit about Cymbalta 60mg. My Doctor wants to put me on that, as he says it is good with pain reduction, especially the fibro type pains I suffer from and especially the flareups of it when I am in a highly prolonged anxious state. Is it relatively safe to go on and if it doesn't work well come off of? . Does Cymbalta cause erection problems like most SSRI type drugs and I dont want to walk around in a coma because of medicationeither? Is there an SSRI that causes less sexual issues?  Also you mentioned an SNRI med, what is an SNRI?

You say that Nuclear stress tests aren't done very often in the US. Is it at least a half decent heart test? My Dr. says that 4 ecg's and heart blood panels have been negative, 1 normal stress test and a month later a normal Nuclear stress test. Are these good heart tests. My Dr. feels that especially two stress tests with the second visually showing good blood flow would have indicated if there was a problem that required further testing. I passed both, so he says I should not worry about my heart. I asked for an echo cardiogram and he said no more tests are necessary. I fully agree with your earlier suggestion about not having invasive tests such as an angiogram, unless absolutely necessary. In fact my Dr. read that Fibromyalgia can cause the type of chest wall and back pain I am experiencing

I have to agree that the tests I have to date should be very good at ruling out serious causes of pain, such as the the stress tests (1 Nuclear)  chest, abdominal & pelvic CT scan with Contrast, bone scan, Thoracic MRI, Gastrocopy, Chest X Ray, Abdominal Ultrasound and tons of bloodwork inc ESR, CRP, CBC, LDH TSH T$ Free, Protein Electrophoresis RF ANA panel among many other blood tests are when combined an excellent workup for ruling out serious causes of mid chest/back pain.. My question to you about tests: ARE there any other non invasive tests that I might benefit from to determine the cause of this mid chest & back pain?  

At some point and despite the pain I have to try and let go and accept these good/normal test results. In fact lately I am getting extreme high anxiety leading up to tests & then waiting for the test results, so if I don't need anymore that is in a way more than okay with me.   Unfortunately the way I am wired I associate undetermined pain with horrible things like cancer/ heart disease and I am afraid of something being overlooked. My doctor said with the amount of tests I have had nothing serious would have been overlooked.

Thank you for your ongoing help & suggestions, they are much appreciated. I hope these questions can be answered in detail when you have a few free moment as I have to make important time line sensitive medication decisions and ensure no more tests are required. Thanks again Dr Junig.
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