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Avatar universal

Can't Move On from Heart Issues

I am 37 years old, moderate in exercise (walk, bike, yoga, ski). Starting in September I started with palpitations. I quit caffeine, changed my diet. I continued to have the palpitations and then developed anxiety and panic attacks convincing myself I was dying of a heart issue. I had pain in my neck, chest, shoulders, lower back. I had started anxiety medications (zoloft and lorazepam) but my anxiety continued. I also had gone to the ER about 12 times from the start of this all. I have had numerous EKG's, blood work, x-rays, holter monitor test (72 hr). All the holter showed was benign PVC's. I still was not convinced. I had MRI's done to see where the pain from neck and back was from. It was found that I have 3 cervical discs herniated/bulged and my T7/S1 bulging. That was still not enough to convince me of the pain. I had a nuclear stress test and an echocardiogram. All normal results. I was then referred to a GI specialist where I had an endoscope, Bravo monitor and HIDA scan done. It was determined I had gastritis, GERD and a small hiatal hernia. I currently take pepcid, changed my diet even more to prevent acid reflux from food relations. I still was not convinced, despite that after all this my palpitations went away. My cardiologist said they would run one more test but then I need to let it go and look elsewhere to where my chest pains are coming from if all was good. I had a CT angiogram. That came back totally normal. I still was not convinced. I made an appointment with a electrophysiologist. He did an EKG in his office, found nothing wrong and I convinced him to give me another 48 hr holter monitor. Results came back normal, not even one PVC during the entire monitor. During all this I also found out I was extremely anemic, 4% iron ( all that info can be see in a post I had in the thyroid community) and that I have a mild case of hypo thyroid. I take 2 iron tablets a day and my iron will not go up. I have my GI dr concerned as this has not changed in 3 months. I am currently scheduled for a colonoscopy cause I had blood in some of my stool samples. During all this since September I have lost a total of 39 lbs and weight loss continues. To date, my entire body is in muscular tension. I am knotted up everywhere, my chest area continues to be very painful. When I palpitate my chest all over it is very sore, especially in certain areas between the ribs. If I hit it just right there are shooting pains that I get when doing so. I am sore under my arms, my triceps are always sore, my shoulder blades are always sore. My physical therapist is shocked how tense I am all the time and all the areas that I am sore, despite numerous exercise assigned to strengthen my cervical and lumbar areas. I rarely get a full nights sleep as I am still having a hard time being convinced this is not heart related.
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Avatar universal
First, I am going to give you a little anatomy lesson.  There are two major types of bodily pain:  visceral and somatic.

Visceral pain comes from the internal organs, including the heart.  It is an odd kind of pain--very difficult to localize precisely because of the way the nervous system is wired.  You literally cannot put your finger on where it hurts.  It has a deep, strange, often nauseating quality, and nothing you can do in the way of body positioning changes it.

Somatic pain comes from everything outside the body cavity, like the muscles on the outside, such as the shoulders, neck, back, and hips.  You *can* put your finger on it.  That  is, you can touch it, and changes in body position, for example, can make it better or worse.  So can massage, stretching, or hot and cold therapy.

Because of the way the nervous system develops in a baby, there is no overlap between these two types of pain.

In a nutshell, your description of your pain is entirely somatic.  Nothing you describe is related to your heart, for cardiac pain is not touchable on your body's surface.  Cardiac pain is not associated with muscular spasms in your arms or chest or shoulders.  This is a fact that you simply must accept.

So what is wrong?  1.  You are clearly suffering from anxiety.  Zoloft is often quite a good drug for panic and anxiety, but when it comes to anxiety meds, one size does not fit all.  I believe you should have another talk with your prescriber (and I hope you are seeing a real shrink for this rather than a GP, since this is a specialty area) and ask for a trial of another medication.  One important fact:  You have to take any psych medication faithfully for one full month to see the true effect.

A combination of anti anxiety medications and something called cognitive-behavioral therapy can often be more effective than either meds or shrinkage alone.

2.  Please google 'Da Costa's syndrome' and 'cardiac neurosis.'  When people have anxiety that is improperly treated, they often kind of seize on heart disorders as the cause of their pain, even though their hearts are fine.

3.  It wouldn't hurt to investigate the possibility of fibromyalgia.  This is a real and very painful disorder, more common in women than in men.  You can google it.  I have it, and finding the right treatment can take a bit of time.  A rheumatologist is the right specialist to see for this, and believe me, relief is possible.  A key element in treatment is medication that gives you a good night's sleep.

4. However, your fixation on your heart is a separate problem. You will not be able to get over it without intensive help from a good psychiatrist.  Please find one and follow his or her advice.

Good luck to you.





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