HEALTH TALK: Chest pain

Pain is the most common symptom that tells you that something is wrong with you. I want to know where the pain is; point to it with one finger where it hurts the most, if possible. What type of pain is it? Is it burning, sharp, dull, aching? is it constant, or does it come and go (is it intermittent)? What factors or situations make it worse? What factors or situations make it better? On a scale of one to ten, ten being the most severe, what number would you give it? That is, how severe is it?

Does the pain stay in one place or does it go any where else? Of course, in order not to put words in the patient’s mouth, I would not ask the questions in this manner; I would simply say,” Tell me about this pain,” and let the patient use his or her own words. Patients often pick up on a doctor’s suggestion and simply say or pick up on one or two things the doctor says and agree with him. Don’t let the doctor intimidate you, don’t be afraid. Tell him your own story in your own words. You know best how you’re feeling and what your situation is.

Often patients come with a preconceived idea about what is wrong with them. Sometimes they are right, mostly they are not. They often tell me that their neighbour or a relative has told them what the problem is because they had something similar. If they are way off- base, then I find a nice diplomatic way of telling them that they should only listen to their doctor or their nurse- they have the training and the knowledge. I cannot count how many times I have been chastized by my plumber, electrician and other professionals for trying to do their work.

I will not attempt to list or discuss all the possible causes of chest pain, nor their remedies; I don’t think DNO would ever allow me so much space. I will mention a few common ones and, in future, perhaps delve a bit more in depth into specific ones. Some include pleurisy, pneumonia, aortic aneurysm, esophageal cancer, and a number of others.

One of the most common offenders that patients blame for chest pain is “gas.” In fact, gas is blamed for everything from headache to ankle arthritis. At some point, later, I will show you how this is not possible. It is possible in the chest, but  not in the way most would think. I will mention shortly.

One of the most common diagnoses I make of chest pain is a musculo- skeletal problem. This is to say a problem which involves your muscles of the chest, and the skeleton of the chest, the latter including bone and cartilage. The main bones of the chest are the ribs, which attach to the bones in your back and to the sternum, the central bone in your chest. Of course, high up is the collar bone. Now, bone does not attach to bone and you can see why; they will grind each other down.

So the ribs are attached to the central bone by a cushion called cartilage, and some of the lower ribs, because they cannot reach the sternum, attach  to each other by this same substance. Now, sometimes because of injury or  inflammation, this cartilage is damaged, leading to pain. So the pain is usually sharp, can be pinpointed with one finger, goes no where else, is of varying intensity and relieved by rest and certain painkillers. It gets worse sometimes when you take a deep breath, cough, sneeze, or even laugh. Why? Because you expand the chest, and put more strain on the injured structure. Some of us call it ‘ open chest ‘ when it’s in the centre. Conditions involving the ribs and the cartilage are usually termed “costo chondritis “– costo for ribs and chondritis for cartilage.

A similar scenario occurs when there’s muscular damage to the chest wall. There are small muscles attaching ribs to each other, called intercostal muscles. These can be strained or damaged like any other muscle in the body can. The picture in terms of symptoms etc. is usually quite similar to that of costo-chondritis. But there’s an additional concern. Running right under each rib is an artery, a vein (blood vessels), and a nerve. You would know that you are likely to feel some pain when you affect a nerve by having affected a rib. Quite simple, really, isn’t it?

Now, let’s get back to gas. Sorry folks, but gas does not cause pain in your chest  the way it might do in your stomach or bowel. Ordinarily, it simply has no way
of getting up there. There is a condition called pneumothorax where gas can LEAK OUT of the lungs and can be found between the lung and the internal margin of the chest cavity. This is rare except in perhaps some cases of pneumonia, tuberculosis cancer, in which case you will have other symptoms and signs the doctor will know about. Occasionally, it can happen just like that, especially in tall thin young white men.

Some of you will experience a burning pain when you lay flat in bed at night,eat spicy foods, drink alcohol, exercise after you eat, or smoke, or go to bed soon after you eat. This is called oesophageal reflux and your doctor can handle  this with little difficulty.

There are numerous other conditions which may cause chest pain but which  I can deal with as separate topics at other times, as I’ve said. The thing is, a man feels pain in his chest on the left side, almost immediately he throws himself into a panic thinking he is getting a heart attack.  Women often feel it’s a sign of breast cancer; I have seen it over and over.

I want to educate you so that you can know your body and what might be going  on with it. You can save yourself a lot of money, time, and stress. I’d like to think that this is at least part of the reason that I’m here.

See you next week.