tender sternum / back pain

[ahydress]

Had chewed nicotene gum for about 6 months.  Noticed spasms lower right rib (8 pieces 2mg of nicotene gum/day), quit gum.  Month later, lifted heavy object - pain in chest.  Chest X-ray - OK. 3 enzymes - OK. 15mg prevacid did nothing. Upper GI found "minor bacterial infection in lining of lower stomach" - prescribed carafate liquid.  Sonogram showed nothing.  On second bottle of carafate, most symptoms gone.  Am totally nicotene free.  Developed 2 symetrical lumps on back of tongue - oral surgeon suggests reaction to acid reflux or extensive gum chewing.  Remaining symptoms are tender at base of sternum, minor back pain between shoulder blades.  Stomach bubbles frequently - like a water cooler. Hard stools, infrequent diarrhea if any, no headaches.  What could cause this???

[OcalaGator]

A related discussion, Sternum pain was started.

[ahydress]

I had waited about 7 to 10 days after the exertion to run the heart tests - enzymes and EKG all normal.  A few days later, the stress test - normal.  Only problem I have with these results is the window of oportunity in which they are really valid -- don't they only mean something if done within a reasonable window of the exertion/event?
My gastro Dr. told my wife the results of the upper endoscopy was a minor bacterial infection (I was coming out of sedation).  I left him voice mail for a follow-up the other day -- his return voice mail said I had minor duodenitis, but to drop my carafate to 1 teaspoon x 3 per day instead of 2 x 3.
(I don't see the connection to a tender sternum/back pains -- these do seem to come and go...)
I'm sure the GERD isn't under complete control, but the Dr. tells me the duodenitis has to heal first.
Could I have had the condition and agrivated it via exertion?  Other than this, I'm pretty healthy.  I jog a couple of miles/day, swim and hit the weights in moderation.
BTW - I dropped the Wellbutrin to begin a process of elimination - turns out 150mg of Wellbutrin is the SR type - potential side effects - abdominal pain.  Some of the major stomach bubbling appears to be under better control.
(I know this may not be your forte, but can a person get an aortic ameirysm from exertion?)
Thanks

[Kevin Pho, MD]

Here are a few thoughts.  You note rib spasms with cardiac rule out via enzymes x 3.  I would continue to ensure that the pain isn't coming from your heart since it was brought on with exertion.  An exercise stress test would be the most reasonable test to evaluate for this.  

If the heart test is negative, you may want to consider upper endoscopy or 24-hr pH study to ensure that GERD is controlled.  The upper endoscopy would also be helpful to see what is causing your stomach bubbling.    

Other avenues would be to approach this as musculoskeletal pain (i.e. costochondritis), obtain further imaging tests (plain films of the chest and possible CT scan), and be referred either to an orthopedist or physiatrist.  

Regarding the bacterial infection in the stomach - I would test for H Pylori.  This can be done via a serum blood test.  If positive, it can be treated with antibiotics.  

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.

Thanks,
Kevin, M.D.

[ahydress]

Sorry - meant to add am taking 150mgx2 Wellbutrin for smoking and 40mg/day of zocor for cholesterol.