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Pain in the Chest - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2004
Answered : 37 Questions
Doctor :   hi
Doctor :  
how can I help you?
User :   Hello
User :  
I had been discussing an issue with the doctor here about an anal fissure and finally went to see the surgeon about it. The news was good; although the issue has been chronic for 9 -10 months and not healing fully with treatment, he thinks we can still probably solve this with conservative treatments
Doctor :   ok
User :  
he prescribed nitrogliceryn ointment and fibre suplements which I will start on Monday
User :  
when he looked at it he said it IS healing and is not open
User :  
but that my internal sphincter muscle is spasming a lot
User :  
you may review my chat history for details prior to that
Doctor :  
ok
Doctor :  
let me review
User :  
I have been having another condition though that landed me in the ER a few weeks ago, please review my history while I type this up
User :  
I had tight chest pain around the area of the sternum and at my back, so severe it really hurt to move so much that I couldn't. The hospital ruled out any heart related issues and the Doctor suggested costrochondritus
User :  
I had the pain again last night after eating peanuts and drinking some soda and think that diagnosis was wrong
User :   I think it may be gas related or esophical, because burping and exhaling seems to improve symptoms the most

User :   I also read that this could be caused by esophical muscle spasm and am thinking this may be the cae. (just like abdominal pain and fissure is being caused by anal sphincter spasm).

User :   I'm wondering if it's possible to have a condition that is causing muscle spasms both in the anal spincter and esophical muscles, could these be related?

Doctor :  
is your question related to this pain and anal fissure only, as your history is very long it will take much time
Doctor :  
are you with me?
User :   yes
User :  
let's focus on these two items right now
Doctor :  
ok
User :  
I don't want to overwelm you with the rest
User :  
most of the history is for the fissure anyway
Doctor :  
ok
Doctor :  
for fissure i understood that finally your ulcer is healing and your internal anal sphincter is spasmed
User :   well I think it has gone through cycles of healing and tearing

User :  
for months
Doctor :   it is good that your fissure is healing and it is possible to manage it in a conservative way, dont worry about the spasm as the nitroglycerin will relieve the spasm and will help in healing of the ulcer
User :  
but this will be the first time I tried nitrogliceryn ointment
User :  
yes
User :  
I am hopeful because diet and warm baths did not completely heal it
User :  
it healed before and came back
Doctor :  
i dont think that now you will face any problem as you are taking necessary precautions, also
User :   ok, good
Doctor :  
the cause is identified
User :   so how about the chest pain and it's relation to this if any?
Doctor :  
yes
Doctor :  
regarding the chest pain
Doctor :  
as you described that it relieved after burping
User :  
not completely, but it takes severe pain down to moderate
Doctor :   there is quiet a reasonable possibility that the pain may be due to combination of gas, acidity, and spasm of esophageal sphincter
User :   I don't have the taste of heart burn or acid reflux though

Doctor :  
i will advice you to start some antacids for some days and to observe the effect
Doctor :  
because of the spasm you will not have heart burn
Doctor :  
as the reflux and heart burn are caused only if the acid in the stomach reaches the esophagus
Doctor :  
but if there is spasm then only the pain will be experienced
User :   what causes the spasm? will an antacid treat the spasm or just the acid?

Doctor :  
spasm may be caused by some particular foods that you will need to identify
Doctor :  
antacid will neutralise the acid preventing further spasm
User :   can nuts cause thi?

Doctor :   may be
Doctor :  
have you noticed it
Doctor :  
cabbage, nuts
User :  
I was eating them both times this happened I think
Doctor :  
etc acan cause it
Doctor :  
ok
Doctor :  
it may be the cause
User :   but I need to get a lot of protein now

User :  
I need to put on more fat and muscle
User :  
because I lost 20 lbs
Doctor :  
because in costochondritis there will be pain with monvement and breathing also
User :  
and am underweight
Doctor :  
you can chose soyabean, pulses, eggs
Doctor :  
some milk products
Doctor :  
try to avoid nutd
Doctor :  
*nuts
Doctor :  
lets see if there is some difference or not
User :  
ok
Doctor :   did you follow?
User :  
yes
Doctor :  
ok
User :   avoid nuts, take antacid

Doctor :  
yes
User :  
drink milk, eat eggs
Doctor :  
yes
Doctor :  
low fat milk
Doctor :  
and paneer
Doctor :  
low fat curd
User :  
why low fat milk?
Doctor :  
because you need protien and carbohydrate
User :  
yes but what about whole milk?
User :   I am looking to gain lots of weight
Doctor :  
sorry, as you are underweight you can take whole milk
Doctor :  
now a days every one is fat
Doctor :  
it is tough to find someone underweight
User :  
yes, especially in the US
User :  
not so much in other countries I travel to
Doctor :  
yes
User :  
I am a unique case
User :  
even if I eat lots of junk food
User :  
still low weight, I can't understand why
Doctor :   some persons are like this only, no explanation
Doctor :  
depends on your body response
User :  
chemical?
Doctor :   yes
Doctor :  
hormones
Doctor :  
and other chemicals
User :  
is there any suplements I can take safely to aftect hormones that cause too much metabolism?
Doctor :  
no, dont try this
Doctor :  
let the body behave in its unique way
Doctor :  
they will cause lot of side effects
Doctor :  
be diet conscious and you will gain weight in a healthy manner'
User :   ok

Doctor :  
eat healthy foods
User :  
my concern is that for the fissure they keep wanting me to add more fibre
User :  
and the more fibre I eat, the more waste that gets produced
User :  
less gain
Doctor :  
yes it is good to eat more fiber for you, as the fissure requires your more attention
Doctor :  
once it heals completely
Doctor :  
then you can concentrate on weight gain properly
User :   ok

User :  
understood
User :  
thank you
Doctor :   Is there any thing else I can help you with?
User :   That is all, you have been very helpfull.
Doctor :   Please fill the feedback form
User :  
ok
Doctor :   Have you filled the feedback form?
Doctor :   are you with me?
Doctor :  
Thanks for consulting HealthcareMagic. Bye for now. Please refer your friends to our service.
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