Mystery Medical Problem
July 26, 2024 1:43 PM Subscribe
Please help me solve a medical mystery. Unfortunately, the details are quite long.
Background: I am a 71 year old male, overweight and with type II diabetes but otherwise relatively healthy. I have no history of heart or lung problems. My father died of congestive heart failure, but not until he was 85.
A few weeks ago, I got a bad headache which persisted, and then a few days later started having pain in my chest, to the point where it was really painful to take a deep breath - but no loss of mobility or difficulty performing everyday tasks. I drove myself to the clinic attached to my doctor's office, and they performed some tests, including an EKG (which I believe they botched because they couldn't get all the electrodes to attach to my overly hairy body). They showed the results to my doc (who in general I have a lot of faith in), and he wanted me to go to the emergency ward of a nearby hospital to be checked out further. Not just go, he insisted I take an ambulance because he was worried about me having a heart attack on the way.
I spent the afternoon at the hospital, getting blood taken and getting a new EKG and other tests. Eventually the doc in charge came to tell me that they'd ruled out everything major. My heart was fine, my lungs were fine, etc. I asked him what was causing the pain and he said he didn't know, but it wasn't anything major. I went home. The pain went away after a couple of days without any treatment on my part.
Now the pain is back, though slightly worse. Slight headache, but it's the pain in my chest which is problematic. This time I've having to take Tylenol (1000mg), which works for a few hours but then the pain returns. What should I do?
One last piece of data: an internist acquaintance of mine told me he was certain it was sleep apnea causing both the headache and the pain, and he wanted to try me on a CPAP machine, but unfortunately he left the country before we could get together. He will not be back in time for the prostate surgery. If it IS apnea, that's fine, because I don't think that will be a concern for my surgeon.
So, dear mefites, what do you think I should do? I will thread-sit for a bit, in case you need details I haven't supplied. Thanks for your input.
Background: I am a 71 year old male, overweight and with type II diabetes but otherwise relatively healthy. I have no history of heart or lung problems. My father died of congestive heart failure, but not until he was 85.
A few weeks ago, I got a bad headache which persisted, and then a few days later started having pain in my chest, to the point where it was really painful to take a deep breath - but no loss of mobility or difficulty performing everyday tasks. I drove myself to the clinic attached to my doctor's office, and they performed some tests, including an EKG (which I believe they botched because they couldn't get all the electrodes to attach to my overly hairy body). They showed the results to my doc (who in general I have a lot of faith in), and he wanted me to go to the emergency ward of a nearby hospital to be checked out further. Not just go, he insisted I take an ambulance because he was worried about me having a heart attack on the way.
I spent the afternoon at the hospital, getting blood taken and getting a new EKG and other tests. Eventually the doc in charge came to tell me that they'd ruled out everything major. My heart was fine, my lungs were fine, etc. I asked him what was causing the pain and he said he didn't know, but it wasn't anything major. I went home. The pain went away after a couple of days without any treatment on my part.
Now the pain is back, though slightly worse. Slight headache, but it's the pain in my chest which is problematic. This time I've having to take Tylenol (1000mg), which works for a few hours but then the pain returns. What should I do?
- Wait for it to get better on its own again. But it's already taken longer than it did last time, so I don't feel really sanguine about that.
- Return to the clinic. But if they didn't know what it was the first time, how will they know now?
- Something else? If so, what?
One last piece of data: an internist acquaintance of mine told me he was certain it was sleep apnea causing both the headache and the pain, and he wanted to try me on a CPAP machine, but unfortunately he left the country before we could get together. He will not be back in time for the prostate surgery. If it IS apnea, that's fine, because I don't think that will be a concern for my surgeon.
So, dear mefites, what do you think I should do? I will thread-sit for a bit, in case you need details I haven't supplied. Thanks for your input.
I think you should call your doctor, report that it's returned, and ask for advice. Questions:
1) Did you have a fall or a head injury before this all started?
2) Is it the same pattern as the last time (headache followed days later by chest pain)?
3) When your blood pressure was taken at clinic & hospital, was too high, or too low?
4) When your glucose was measured at the clinic & hospital, was it too high, or too low?
5) Were you dehydrated the last time? Were you given IV fluids at the hospital? (Dehydration can cause headache and chest pain, weirdly.)
6) Do you have a history of acid reflux/acid indigestion?
7) Have you checked for a carbon monoxide leak in your home?
[Apnea would be a concern for your surgeon & anesthesiologist]
posted by Iris Gambol at 2:04 PM on July 26 [2 favorites]
1) Did you have a fall or a head injury before this all started?
2) Is it the same pattern as the last time (headache followed days later by chest pain)?
3) When your blood pressure was taken at clinic & hospital, was too high, or too low?
4) When your glucose was measured at the clinic & hospital, was it too high, or too low?
5) Were you dehydrated the last time? Were you given IV fluids at the hospital? (Dehydration can cause headache and chest pain, weirdly.)
6) Do you have a history of acid reflux/acid indigestion?
7) Have you checked for a carbon monoxide leak in your home?
[Apnea would be a concern for your surgeon & anesthesiologist]
posted by Iris Gambol at 2:04 PM on July 26 [2 favorites]
Response by poster: > Total shot in the dark but did anyone mention costochondritis?
Wow, that sounds like it exactly!
posted by ubiquity at 2:24 PM on July 26 [2 favorites]
Wow, that sounds like it exactly!
posted by ubiquity at 2:24 PM on July 26 [2 favorites]
Response by poster: > 1) Did you have a fall or a head injury before this all started?
No
> 2) Is it the same pattern as the last time (headache followed days later by chest pain)?
No, this time it was the other way around, and the headache is not as strong.
> 3) When your blood pressure was taken at clinic & hospital, was too high, or too low?
Just right
>4) When your glucose was measured at the clinic & hospital, was it too high, or too low?
It was too high, but it's always too high.
>5) Were you dehydrated the last time? Were you given IV fluids at the hospital? (Dehydration can cause headache and chest pain, weirdly.)
I don't think so. I generally keep my fluids up. They gave me a saline drip, but they didn't check first to see if I was dehydrated.
>6) Do you have a history of acid reflux/acid indigestion?
No.
>7) Have you checked for a carbon monoxide leak in your home?
I live on the 5th floor of a large, all-electric coop. I really can't see how CO could be a problem.
posted by ubiquity at 2:30 PM on July 26
No
> 2) Is it the same pattern as the last time (headache followed days later by chest pain)?
No, this time it was the other way around, and the headache is not as strong.
> 3) When your blood pressure was taken at clinic & hospital, was too high, or too low?
Just right
>4) When your glucose was measured at the clinic & hospital, was it too high, or too low?
It was too high, but it's always too high.
>5) Were you dehydrated the last time? Were you given IV fluids at the hospital? (Dehydration can cause headache and chest pain, weirdly.)
I don't think so. I generally keep my fluids up. They gave me a saline drip, but they didn't check first to see if I was dehydrated.
>6) Do you have a history of acid reflux/acid indigestion?
No.
>7) Have you checked for a carbon monoxide leak in your home?
I live on the 5th floor of a large, all-electric coop. I really can't see how CO could be a problem.
posted by ubiquity at 2:30 PM on July 26
If it is costochondritis then the headache could be due to inflammation through the shoulder joint and/or neck.
Have you tried heat or ice on either the chest or head/neck area? Has your doctor advised you not to take NSAIDs (ibuprofen, alleve, etc.) for any reason? If not, those tend to be better for inflammation than Tylenol. If you try an NSAID and it works better than Tylenol then that may be a clue.
posted by brook horse at 2:45 PM on July 26 [2 favorites]
Have you tried heat or ice on either the chest or head/neck area? Has your doctor advised you not to take NSAIDs (ibuprofen, alleve, etc.) for any reason? If not, those tend to be better for inflammation than Tylenol. If you try an NSAID and it works better than Tylenol then that may be a clue.
posted by brook horse at 2:45 PM on July 26 [2 favorites]
Response by poster: >Have you tried heat or ice on either the chest or head/neck area?
No. I'll give them a try.
>Has your doctor advised you not to take NSAIDs for any reason?
Yes. But I have anyway, and was surprised to find that ibuprofen has no effect, whereas Tylenol is useful.
posted by ubiquity at 3:11 PM on July 26 [1 favorite]
No. I'll give them a try.
>Has your doctor advised you not to take NSAIDs for any reason?
Yes. But I have anyway, and was surprised to find that ibuprofen has no effect, whereas Tylenol is useful.
posted by ubiquity at 3:11 PM on July 26 [1 favorite]
I have been experiencing almost these exact same symptoms on and off for a few years now. After more than one EKG over the years from different providers, my current doctor just last week said given how long it’s been going on, it’s very unlikely to be some kind of heart condition and said costochondritis was a very plausible diagnosis. She referred me to sports medicine to do some physical therapy to strengthen my upper back/neck/shoulders and improve my posture to see if that helps.
posted by skycrashesdown at 3:45 PM on July 26
posted by skycrashesdown at 3:45 PM on July 26
While we're tossing stuff out there, I knew someone who had "costochondritis" for ages that turned out to be their gallbladder needing to be removed. So even if the symptoms line up well, I'd keep an open mind at this point.
If it is apnea though, having surgery (under general anesthesia, I'm assuming) could itself make that pretty clear. Good news is, they're excellent at keeping unconscious people breathing, and a diagnosis would presumably get you that CPAP after all.
posted by teremala at 4:04 PM on July 26 [1 favorite]
If it is apnea though, having surgery (under general anesthesia, I'm assuming) could itself make that pretty clear. Good news is, they're excellent at keeping unconscious people breathing, and a diagnosis would presumably get you that CPAP after all.
posted by teremala at 4:04 PM on July 26 [1 favorite]
where is the headache located? any chance it's a sinus headache?
does the timing correspond with windy days, high pollen counts, nearby fires, time spent cleaning?
does taking an antihistamine help?
sometimes after i'm exposed to allergens, i get a sinus headache plus chest pain during deep breaths
i have mild asthma and an autoimmune condition, so my body overreacts to allergens, and i've had numerous incidents where i've gotten sick out of the blue and discovered later that there had been an environmental trigger
posted by Jacqueline at 7:26 PM on July 26
does the timing correspond with windy days, high pollen counts, nearby fires, time spent cleaning?
does taking an antihistamine help?
sometimes after i'm exposed to allergens, i get a sinus headache plus chest pain during deep breaths
i have mild asthma and an autoimmune condition, so my body overreacts to allergens, and i've had numerous incidents where i've gotten sick out of the blue and discovered later that there had been an environmental trigger
posted by Jacqueline at 7:26 PM on July 26
Response by poster: >where is the headache located? any chance it's a sinus headache?
forehead. it feels like a sinus headache, though it didn't improve when I tried Benadryl or Fexofenadine.
>does the timing correspond with windy days, high pollen counts, nearby fires, time spent cleaning?
sorry, didn't notice.
>does taking an antihistamine help?
no
i don't have asthma or an autoimmune condition, though I do get light sinus leakage and sinus headaches sometimes. It's rarely bad enough to require medication.
posted by ubiquity at 8:15 PM on July 26
forehead. it feels like a sinus headache, though it didn't improve when I tried Benadryl or Fexofenadine.
>does the timing correspond with windy days, high pollen counts, nearby fires, time spent cleaning?
sorry, didn't notice.
>does taking an antihistamine help?
no
i don't have asthma or an autoimmune condition, though I do get light sinus leakage and sinus headaches sometimes. It's rarely bad enough to require medication.
posted by ubiquity at 8:15 PM on July 26
I assume somewhere along the way your doctors did a chest X-ray to rule out pulmonary embolism?
posted by bluloo at 12:08 AM on July 27
posted by bluloo at 12:08 AM on July 27
Response by poster: >I assume somewhere along the way your doctors did a chest X-ray to rule out pulmonary embolism?
Yes. Done at the ER.
posted by ubiquity at 12:35 AM on July 27
Yes. Done at the ER.
posted by ubiquity at 12:35 AM on July 27
Best answer: If you are having a problem with the acetaminophen only providing pain relief for a short period of time, try extended release acetaminophen.
(I already gave this suggestion to the OP over the phone and am just posting it here so I can get best answer.)
posted by grouse at 7:45 AM on July 27 [2 favorites]
(I already gave this suggestion to the OP over the phone and am just posting it here so I can get best answer.)
posted by grouse at 7:45 AM on July 27 [2 favorites]
Costochondritis was my first thought as well. When I've had episodes of it, it can be quite painful.
posted by litera scripta manet at 10:14 AM on July 27 [1 favorite]
posted by litera scripta manet at 10:14 AM on July 27 [1 favorite]
Response by poster: Thanks for everyone's insight's. I have spoken to some doctors and they agree that costochondritis was a good bet. I ordered a heating pad to see if that will help.
posted by ubiquity at 4:27 PM on July 31
posted by ubiquity at 4:27 PM on July 31
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