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Avatar universal

Muscle Spasm

Live in Japan, age 49.  Previously diagnosed with something which probably translates as cervical spongylosis (x ray shows nerve rubbing against one of the vertebrae).  In my last visit (below) doc said not a big problem as canal is wide and not any bone deterioration. Generally symptons include some pins and needles in arm if I lean forward, and/or a pain in the shoulder if I have not been to the gym in a while (keeping fit with mild weight training seems to help, not doing so seems to invite some pain/numbness). Now the problem:

One day after exercise (after 2-week pause for weights), while walking, got a sharp pressure like feeling in chest/back.  Came and went with movement. 1 81 mg asprin and I felt ok.  Two days later, more exercise (aerobic and weight) and next day, more of same. Slight dizziness (nerves?). Dr. (orthopedist) says cervical spongylosis ok.  Says most likely muscle (membrane?) spasm in chest.  No exercise for 2 days. Feel ok. Take aspirin.  Then again today same, when walking up subway stairs. Aspirin relieves )or psycological).

Never breath shortness. I have mild bronchial asthma, under control.  No recent attacks. See allergist this saturday.  So far blood pressure during exercise is normal (120/71 or less).
Past stress tests (treadmill 10 and 20 years ago normal). Father had heart disease. Pain is wierd, scary. If it is some spasm, why do I get it, how to get rid? Thanks,

Paul PS. When people say "radiating" pain, not sure meaning. I feel vague, in more areas than one (chest/back left arm?)  Like throbbing? Not sure what radiating means.
13 Responses
Avatar universal
Dear Paul,
In general pain that comes and goes with movement is usually due to musculuar-skeletal or nerve problems.  These problems may be brought on my "overdoing" an exercise program or by some sort of trauma.  Aspirin or other non-steroidal anti-inflammatories (e.g. ibuprofen) usually work well for this kind of pain.  

"Radiating" pain is a constant, steady pain that starts in one area and feels like in "moves" out to another.  For example heart pain might start in the chest and extend out to the left arm and hand or to the neck and jaw.
Avatar universal
Thank you. Because I tend to be a hypochondriac (so was my father and he HAD heart disease) and because Drs. sense it, I often get told not to worry.

Intuitively, I feel it is muscle related.  I can't find anything on the web that sounds like what I have. I know my orthopedist tends to look at orthopedic things, my
asthma doc at asthma things.  I am wonder if if I should go to a Sports Dr (though I hear it is not very advanced in Japan yet).  To rule out stuff, I wonder if a cardiac
check is also in order.  All I know is that it seems to have come one day after exercise in both cases, and that the exercise itself (fast "Life-cycle" lateral aerobic machine--like cross country skiing) did not produce discomfort (and blood pressure was typically low immediately after aerobic exercise of 50 minute
duration. Would heart related things not show during such aerobics?

Also when I get it (on average twice a day when walking up a stairway--again not on that aerbic machine--, or when hunching my shoulders against the cold as I dart across the street) I take aspirin, so I worry that the effect of the aspirin, if it IS the heart, is masking the
problem.  I guess I have classic hypochondria--despite the reassurances, I think of something that may be getting overlooked.

But  I "may" have overdone the weight training machines. As said, the orthopedia Dr. suggested some sort of spasm which mimics angina, but he offered no test or confirmation

Wierd that general activity does not seem to produce the pain, but that suddenly it appears after a day or so.  Definitely FEELS like the heart.  Accompanied by mild
panic, so it is also a chicken and egg situation.  I take Paxil for anxiety, though, so no panic attacks, and no shortness of breath. Other medication is Proscar (for
hair), theophylline, Intal--have taken for a long time), Singulair.  Worry about aspirin because of asthma, but chose that because I hear it is good for the heart.

Anyway, I see my asthma doctor in two days (he is a good asthma doc and well known--a pediatrician) and can ask him to refer me to someone in the same hospital.  Just afraid of having my complaints dismissed and want to have things ruled out.  Not fat, not thin, eat largely vegetarian diet--beans 4-5 times a week (but have a weak spot for chocolate), tend to exercise 2-4 times a week, not a body builder, in fat lack of testosterone (related to infertility) means I do not become extremely muscular, my weight is about 78 kilos, 167 centimeters, body fat was 29-30 now is about 27 percent, was obese as a child, still much more than average Japanese where I live, but probably look like smallish American. Father had heart disease at least from mid 40s (I am 49) and died of weak heart related to chemotherapy for prostate cancer at age 74, mother died of emphysemia (she smoked 2 packs), older brother has adult onset diabetes since age 30 (he is now 60 and under control with insulin). I have since 10 years ago been  the health nut in the family. Mother's parents died at age 94 so her genes may be "better".  Father used to take his pulse compulsively when I was a kid, this is a dramatic memory which feeds my hypochondria.

Probably giving you too much info.  Promise not to keep asking questions, but just need to know what to request from Drs so as to rule out/confirm muscle/skeleton stuff, heart/asthma-related.

Thanks,

Paul



Avatar universal
By the way, the doctor will no longer respond to your queries.

It sounds like you pulled one or more of the intercostal muscles (between the ribs).  They take a long long time to heal, and will ache after being used.  Aspirins should help, but the pain will likely come and go for weeks/months.  To be sure that it's not the heart, I would have myself checked out by a cardiologist and specifically have a stress test conducted (ekg/treadmill).  The results from that should assure you and the doctor.

Good luck.
Avatar universal
Thanks arthur
Avatar universal
Hi again Albert, all.

Saw the Dr.  He made an appointment on the 19th (so far away!)
for a cycle test (same as treadmill?) with radioactive isotope as well.  I have to have IV first and then an injection. Not sure why two things. Plus will have an echo cardiogram
(ultrasound) the same day.  In all I will be there much of the day and can't eat at all, except between one of the tests and the repeat test of something.  

Then I have to have another x ray and consultation on the 25th.

Japan's hospitals are notoriously busy.  In any case, he gave me
5 more nitroglycerins and a 3 week supply of the bufferin 81 mg aspirin plus the other for rythem (also doubles as a diabetes medicine I hear).


I asked what if I get headaches from my preexisting cervical spondylosis and they said that rather than take
more aspirin (I wonder why not?) I should take another pain reliever.  I have some voltaren or similar from the dentist I could use, or my wife has soemthing for menstrual cramps, or
I could take ibuprofen or something.  They didn't seem to care.

I guess they rule out the heart stuff and then, if nothing is found, then goes the process of elimination.

Dr was not interested in my speculation about other things like
intercostal muscles/nerves, but I asked if I can do exercise.

I so despserately want to avoid gaining weight and keeping at least some of my muscles in decent condition (as my cervical spondylosis gets worse when I don't exercise.  I assume if I drop dead from aerobics, it will have been my heart, but until now there has never been an episode that occurred during aerobics.

He said I can do as I normally do, but didn't seem to care (Drs here are notoriously uninformed about other specialities...no-oen even recognizes the ENglish or Japanese names for cervical spondylosis!).

My idea is to go to the gym and avoid any of the things that would put pressure on  my chest--but that seems to be all the upper body exercises.  I suppose I can just do the aerobics and the lower body, but then what about situps!!!!

I wonder if there is another forum where I could get advice on that since I am not confident I can get those answers here in Japanese hospitals.

Thanks

Paul
Avatar universal
Hello Paul,

I am a 56 year old woman, living in the Netherlands.
I have neck and back problems for years and years.
The same stuff with the arm when I lean forward(needles and pins).
Much pain in shoulders and neck.Often PVC's.Racing heart.In a few weeks I get an ECG.(I think it has to do with menopause)
I am a little bit a hypochondriac too.
But I know this:
YOU WORRY TOO MUCH. PLEASE RELAX!!!
Do some breathing excercises to calm your body and spirit.
This will help your body too relax the muscles.
It realy helps.
Trust the outcome of this, I mean the results of the tests, and trust your body.(I think it will be o.k.)
The pain in your chest could be caused by costochondritis/tietze's syndrome.
Can be painfull, is benign.(I have Tietze's sydrome)
Has to do with the chestbone and the mucles attached to that bone, and the muscles between the ribs.Feels like if it is the heart, but it's not. It needs rest!
(sorry if it is not to clear to you, my english is not that good)
Takes often a long time to heal, and can come back again.
I think it has to do with too much training of the upper body.
Slow down.Go and do walk excercises for a couple of weeks (or months)That will burn the fat too.
You do not have to train so hard to keep fit!
O well, look at google's search engine for costochondritis-Tietze's syndrome, and you will find a lot of information!
Just thought I let you know.
Keep up the positive thinking!!!

***Ianna***

Avatar universal
Thank you, Ianna. I will try.

Did get a scare last night..some would say it is a good thing.

Went to the gym.  Only did reebock machine (like skis) but without the arm movements, 30 minutes.

And weights only did the leg extensions and curls.  No upper body stuff. No sit ups.
10 minutes.

All fine. On the way home, felt the oain in the chest (this tome felt more like the back).

Took for the first time a nitro tablet.  By the time it dissolved, in about 2 minutes) I reached a
stoplight. The pain subsided. Of course i don't know if it was the nitro, the stoplight or
just a short spasm.   Needless to say I am either relieved that it MAY have worked or scared
that it DID eortk, indicating a heart problem.  Is this a typcial reaction of denial?
How does one know?  Will the tests I have in a few weeks (bike with isotope. echo, etc be able to tell?
I live in dread of the next pain and test.

One thing.  I also have the beginnings of a chest cold.  Always something to complicate things.

But I will try to have a positive outlook.

Paul
Avatar universal
Hi again.

Dr. in about.com said best to avoid exercise until evaluation since it could be serious if it IS heart.  He said that unlike Japan, where I have to wait a few weeks for tests, in the U.S. a good place would do it soon. So it is best until the outcome to be cautious.

While waiting for his response on whether to rule out ALL exercise or not, I will ask here. I do NOT get pains on exercise. One instance was 12, one 24 hours after. One was on exiting the hospital for a normal checkup. One was 40 minutes after exercise. A couple seemed to have no relationship to exercise.  Sex did not bring on any attacks, at least in the last 24 hours. So when he says forgo the execise, does that mean even walking or slow bicycling?  I can see dropping the weights.
In any case, this is only for 2 weeks.  

As far as exercise AFTER heart disease is confirmed, I do not see much that is clear.  For example, if it helps bring about a reversal of heart diaease.  Or if there is danger in the long term.  I guess I have to wait on the results of the test.  But wonder if there is any good reading on the benefits and/or risks of exercise once different types of heart disease have been confirmed.

Thanks,

Paul

Avatar universal
To Paul and others,
I am a 23 year old athlete, am very active. I started having a very similar chest pain about 3 weeks ago, and like the rest of you freaked out about it, and thought i was having heart problems. I had an EKG, and then an echocardiogram.  My EKG was fine, and so was the echocardiogram, except i had "Hyperdynamic" pumping which means my heart was racing, probably because i was so nervous because i am too a hypochondriac. Anyways, it turns out my ehart is fine. But, i began going to my chiropracter about 2 weeks ago who insisted I had just pulled muscles.  I am a cyclist, and just started riding my bike outside, which means that my chest is all crunched up as i hold the handlebars.  He worked out the muscels 3 days a week, and i did very little exercise (the stationary bike WITHOUT leaning over--the key is to keep your chest OPEN) and TONS of stretching. It sounds to me that you may have this. I got pains randomly throughout the day, but also on my right side, which made me think it wasn't necessarily my heart.  Hold your arm against a wall high up and turn away from it, to stretch your Pectoral muscles.  HOld it hear for 30 seconds, and then move your hand lower on the wall and stretch it. My chiro also had me do neck exercises, turn head to left and use your other hand as resistance pushing against it, push your head down, and use resistance to push up, and all around, ear to shooulder, etc.
It really helped. I went on vacation and did NO exercise for a week. I went in a canoe for an hour, and after i got out, that was the first time, i felt the pain in mychest again, but i stretched and it is gone.  I also iced it alot.  I am planning on gettin gback into my cycling schedule soon, but will be sure to do lots of stretching, as well as yoga to keep my muscles loose.
Good luck, hope this helps!
Cori
Avatar universal
Thank you.

I have been away from the forum for a while (had alse been to the one on About.com), so did not see your answer.

It is encouraging, but want to wait until I see a chiropractor,
sports dr.  In fact, I rarely do streching, thinking that my
ski machibne exercise was aerobics and strectching at the same time.   I do that for 30-60 minutes and then light weights on machines.  I wonder, if this IS the cause like it is in your case, are these what are called pulled muscles?

Also, chiropractors are not very well regarded in Japan, and I am not sure where to go yet.  Will need to look around.  And despite this being asia, orintal medicine is also not that
regulated and maybe less good than in China, surprisingly.

I will ask around if the heart doc gives me a clean bill of health heartwise.

Same with sports medicine...not vwell developed.

I realized the difference when my wife and I were in the States
a few years ago and we asked her gynecologist/reproductive endocrinologist about a number of other medical things, including my orthopedic problmes, and he had borad knowledge,

Ask a Japanese doctor about things other than therir specialties and you get blank stares.  Plus in Japan the patient/doctor relationsip is not very good, since patients still entrust all to their doctor.  When my father in law had something like pleurisy with suspected growths in the lungs, my wife's mother told us NOT to ask the dr. too many questions as she was "too busy".  !!!!!  Sounds wierd, but people prefer not to know more than they are told, which is why many people do not even ask if they have cancer and still many places do not tell.  A woman I knew 15 years ago went to the National Cancer Hospital in Tokyo, was given a vague diagnosis, did not trust it, went to another cancer hospital in Kyoto and was told she had breast cancer that required surgery, had the operation on both breasts and was fine.

Had she gone along with the Drs at the first hospital, she might have died without knowing why!

Anyway, thanks for your answer.

I will post another note with my comments on my tests so far.

Can't get a question in to the Drs.  so will see if any
patients and those who have been there can make sense of it so far.

Probably all very familiar terrirtory if you have been there, but still confusing to me.
Avatar universal
Hi

It has been a while...have done exams, switched doctors
because of the slow pace and the lack of explanation at the first place (new Doc is wonderful, Dr. Saito
at Shonan kamakura Hospital in Japan). They did all tests over again, some twice, PLUS catherization.

I also have posted recently on about.com, where the Dr. comes back to keep responding, but thought I would post my LONG note here as well.  In fact, they found something, but it is not likely the cause of the pain, so I will have to go several routes...


  
First, this is the result of my tests:
(If anything is unclear, it is my mistranslation
since the doctor explained this in a mixture of
Japanese and English). I asked a lot of questions,
and he was good about answering them, but as always
one thinks of more once he leaves the office.

(1)I have some kind of blockage, possibly greater
than 50 percent, in the left anterior descending
or LAD.  LCX Left Circumflex is ok. Right Coronary Ratery (RCA)
is ok.  

(2) Dr. Saito said that there are two options for treatment:
(a) medication (for about a year?) and then recheck
(b) DCA (Directional Coronary atherectomy), which he said
is ONE TYPE of angioplasty.

(3) He said I would check in on day one, do the operation same day,
check out on day 3. I asked which HE would do if it were HIS
heart.  He said he would do the DCA if he were me.

(4) He said the success rate for this type of surgery is
close to 100 percent. BUT, he said that the probability of
recurrence is about 30%.

(5) He said the risk for one or more of the following in all types of angioplasty  was 1/200 down to to 1/500 (Japanese people always quote in reverse!) for death, myocardial infarction, cerebral ? embolism?? (stroke??). Which is 0.5 to 0.2 percent.

But, as usual, my wife says she knows someone who had it and died. (Probably got hit by a bus right after leaving the hospital)

She also says she read that continued use of pain medications damage to the nerve sheaths.  Just what a hypochondriac like me needs to hear.

(6) My blood results are:
TG (triglycerides):  182 (normal range 50-149)
TC (total cholesterol?) 211 (normal range 150-220)
HDLC (low density cholesterol) 55.2 (normal range ???)
LDLC (high density cholesterol) 115 (normal range ???)
K (???potassium) 5.0 (normal range 3.4-4.8)
Na (sodium?) 143 (normal range 135-147))
CK (???) 193 (normal range 50-149)
CRP (??) 0.59 (normally less than 5.0)
UA (uric acid)  7.3  (normal range 3.2-8.0)

Sometimes I have what feels like gout.. on the inside of each foot,just up from the big toe)


Glu (sugar?) 91 (normal 70-110)
Blood pressure in the office--top is 140 to 150.
Blood presuure in the waiting room (and sports club),
in this range: 112/79, 119/74, 123/70

He noted that although my cholesterol figures are ok,
some authorities recommend that LDLC be LESS THAN 100. Still, is this less than you expected given my triglycerides?

My questions: (a million, sorry.  hope it helps
others)

Q 1. Re the blood results for a 50 year old:
--weighing 78 kilos (was close to 90 kilos when I was 14 years old)
at 167 cm;
--who has been 70-80 percent vegetarian on and off
over the last 20 years;
--with a father who had heart disease from at
least his 40s and a brother who has had adult onset diabetes
for 25 years (from his 30s I think);
--who has exercised 2-4 times a week over the last
5 years at least, with less exercise for the previous 10 years:

    Are my results for each of  these factors in #6
   horrible, so-so, better than can be expected, great???

Q 2. What is an ideal ratio of high/low cholesterol
for someone of my age and can I reasonbly expect to be able to reach
it if I do more exercise/better control of my diet? Would I
HAVE TO go on drugs to achieve it (hoping the answer is no).

Same for any of the other figures in # 6.

NOTE--My diet is good BUT I have a weakness for sweets
which may be counterproductive.

Q 3.  Here is my typical daily diet (I cook and freeze
and eat similar things each day due to work schedule which
keeps me at work at odd hours). Question follows:

breakfast--mixture of RAW oat and barley flakes with
frozen blueberries and a banana, with flax seeds and a small
handful of raw cashews, pumpkin seeds, raw hazelnuts, raw
walnuts, sometimes soy protein, and a few spoons of
plain yogurt (full or non fat) and/or soymilk, with FOS
syrup ( fugtooliosaccarides), which my asthma doctor says is
good for allergies.

dinner--barley, rice, bulghar, handful of same nuts as above,
broccoli, Japanese sweet potato, carrots, bok choy. onion,
garlic, curry powder, no oil or canola/olive

lunch  and snacks---some whole grain bread, 1-2 cups of
coffee or tea (green is common), but also a slice of cake or
chocolate bar, ice cream here and there.

I work odd hours, so I may eat dinner as late as 10 PM,
and this foces me to snack a little too much.

Job is often on my feet as a university lecturer much
of the time.

I also eat  meat if I have no choice that day, in
restaurants, and fish when I can.

Supplements--multi vitamin with 1000/500 calcium ratio,
800 folic, 800 D, 1000 c, 400 D-alpha E, 200 mcg chromium,
200 mcg selenium and other factors....

Also SOD tablet and  Co-enzyme Q10 30 mg.

Specifically for QUESTION 3

---Is this  great, so so, can be improved?

-- is 100 mcg of vitamin k1 a problem (in
that it can encourage blood clots???) or reasonable
(it is in the multivitamin by Nutriguard Research)

--are the other things I am taking neutral, harmful, positive?

--would I be best advised to continue, or add more
fish (Japan is the land of fish, but I wonder if that would
be protective or if the mostly vegetarian diet is ok)
I eat it perhaps 1-2 times a week fresh and 1-2 times a week
in a tuna sandwich.

Q 4. Given I have a deposit (occlusion?) of over 50%, what would
be the possibe cause (history, becoming a vegetarian too late, genetic
predisposition, other?)

Q 5. Given my exercise and partial vegetarianism, is it likely
that I would have been in worse shape if I had not done these things?

Q 6. What would possibly explain 30 % possible recurrence
of the deposits AFTER surgery and how long can
it take (or how soon might it recur)?

Is it one of those medical unknowns?

Q 7.  Is there any data on which of the two options are
better and/or recommendeed by cardiologists?

Q 8. He said I would likely take drugs after the surgery. Is
this a lifetime thing or just until the results are known?

Q 9. Drugs I take now are isosorbide mononitrate 20 mg,
ticlopidine hydrochloride and aspiron 81mg, all TWICE a day.
He stopped the beta blocker given by the first doctor because
I am asthmatic (although with no recent attacks). I take theophylline,
intal (cromylyn sodium), singulair and furotide for that.  Would statin drugsbe an option  with or without the surgery?  I have heard they can damage the liver. I also take Paxil 20 mg a day and Proscar (for hair!)
5 mg every 4 days. (Father had protate cancer and old
doctor said it couldn't hurt in that department).

Q 10. If I do not do anything, can I expect it to
affect my life expectancy?

Q 11. If I do drug therapy first and it fails, would
then suregy be the only recourse?

Q 12.  If the problem recurs ( I assume it took a lifetime
to reach this stage, not sure how long it
would take to recur), am I out of luck, do it again?

Q 13. He said the pain I have is most likely NOT due to
the blockage, nting that I have had no difficult in
any of the stress tests.  I am also never breathless.  
He said therefore that I need not take the Nitroglycerin.
And he said I can exercise, but no scuba diving (presumably the
pressure would be bad). I assume being an astronaut is
also out of the question (SMILE).  Although I am
relieved to hear that my pain is probably from a different
source, I am scared to stop the nitro as it makes me feel
reassured.  Also, paradoxically, last night I had the
pain worse than usual.  Probably also because I panicked.
I took the nitro, and as usual, it is not clear if
if worked as the pain did not seem to go away immediately.
(I think I carried my shoulder bag more than usual, which
I had been avoiding).  If indeed it is not the heart causing
the pain, which started after exercise, what is the next
step in evaluating it--- (intercostal muscle, for example).

He said it is ok to exercise but in one month the pain still
comes on avarage once a day, usually when doing nothing
in particular.  I find lying on my STOMACH seemed to help last
night.  


Q 14  Is it ok if I take
nitroglycerin even if I don't need it, just for
peace of mind?


Q 15  Last one, I promise. Would there be any value (harm, wasted money) to take, under supervision, Policosanol as an adjunct to or alternativeto any statin drug. How about niacinamide?



Refs:
http://www.cholesterolcheck.org/policosanolstudies.htm
http://www.mediasphera.aha.ru/cardio/97/7/e7-97ref.htm#5


As said,  I feel guilty for asking so many questions.
Hope that the answers to them help not only me


paul

***@****
Avatar universal
Hello,

I am 31 years old and male. I have no physical conditions except some hypertension which I have had since I was 13-14. I did all possible tests then and everything was normal so the doctor said I must have essential hypertension. I take hypertension medication - Losartan Potassium - 50 mg - once a day and with that now my readings are about 140/90.
Since a year I have had a very inactive, couch potato kind of lifestyle. Prior to that for about a full year I was exercising everyday at the gymnasium doing cardio and strength training. I used to alternate between running on the treadmill (1 hour at speed 8) and moderate weight lifting. But stopped doing that totally due to some mental worries.
I started the gym again since the last 20 days. I have started with about 4 days cardiovascular workouts (running and stepper) and 2-3 days weight training. I am running continously for about 50 minutes to an hour and doing moderate weight lifting. Since about a week I have been noticing a slight "pull" kind of tightness feeling on the left part of my chest and sometimes in the center and the right side too. I had noticed this feeling earlier too sometimes when I had not begun exercising at the gym, especially when I got up in the morning after sleeping or after I had lied down a while. This time I noticed it after I had worked-out hard for a couple of days. The tightness feeling is more apparent when I do something physical or maybe laugh hard for a while. I have not worked out since a week and it has subsided but it is still there somewhat. Also, since this started I sometimes have to make an effort to catch my breath -i.e. on the inhale.
Worried, I went to the doctor and got my electro-cardiogram done which came out normal. My blood pressure was ok too and the doctor said since electro cardigram and blood pressure was ok, there was no cause to worry. He also made me do some deep inhales and exhales etc. He said maybe it is something muscular.
My question is do you think I need to get any more tests done or do you think this is a normal experience of exercising a lot? Should I resume my exercises again? Please advise.
Thanking you in advance.
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