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Have Broken Ribs. Suffer Pain While Coughing And Sneezing. On Sleeping Pills. Remedy?

Posted on Sat, 3 Aug 2013

Question: I have my ribs broken many times they just broke breathing or sneezing anything I have been having this really bad pain on a scale 1-10 its an 11, they are sending me to get X-rays and ct again which I have had many many times it just shows where my ribs were broking so many times that they just don't heal right the doctor just says I must of broken them again, but it doesn't feel like that this time its only on my left side under my ribs more to the front but does go some to the back it is really bad right under my left breast, its hard for me to move with out the pain, im on sleeping pills cause otherwise I don't sleep, I already take pain pills and meds for RA my hands are starting to change and can't hold onto anything I always have pain but this is different this has happen many many times and nothing works for the pain I did hear about something called Tietze Syndrome, I see an RA doctor, family doctor, and pain managerment doctor, and migraine doctor I just some time even one day I do not hurt the pain is just hard to take this has been going on for years and its only gotten worse I hope you can help

Answered by Dr. K. Naga Ravi Prasad (8 hours later)

Hi,

Thanks for writing to XXXXXXX

After going through the entire description, I feel that you have a severe grade of osteoporosis. This has been strengthened by the fact that your ribs are getting fractured spontaneously.

You have multiple issues which have an adverse effect on bone turnover and weaken them
* Rheumatoid arthritis (by itself weakens bones)
* Osteoporosis as such
* Age
* Post hysterectomy (not sure whether the ovaries are retained or not)

Tietze syndrome is UNLIKELY in your case as it is due to the inflammation of the costochondral junctions in the FRONT of the chest (i.e. where the ribs gets attached to the breast bone -sternum). Typical feature is localised swelling, redness and pain at the involved site. You haven't reported any such symptoms.

I think the only way to counter the problem of spontaneous and recurrent fractures of the ribs is to correct the underlying OSTEOPOROSIS. And this can be done by the following -
* CALCIUM XXXXXXX DIET : A daily intake of 1500mg of calcium is required for an adult aged 50 and above. Foods XXXXXXX in calcium are Milk and milk products, Fresh green vegetables, fruits and wheat products, fruit juices.
* VITAMIN SUPPLEMENTATION : A daily allowance of 400-800 IU of Vit D or a daily 15 minutes of sunbath is essential for healthy bones. Vit C improves absorption of calcium. Vit K plays a significant role in the synthesis of osteocalcin.
* REGULAR PHYSICAL ACTIVITY : is needed because strong muscles make and maintain bones
* AVOID SMOKING : because smoking causes delayed fracture healing in broken bones.
* REDUCING NUTRITIONAL "BONE ROBBERS" : These withdraw calcium from the bones - High alcohol intake, CAFFIENE , carbonated drinks like COCA COLA
* AVOIDING CERTAIN DRUGS : Corticosteroids , Anti convulsant drugs, certain diuretics , Anti depressives and thyroid hormones.

The management of rib fractures is as under -
* Using analgesics (Narcotics or NSAID's)
* Applying local anti inflammatory gels
* Ice compressions
* Avoid lying on the affected side
* Using a rib belt which prevents sudden expansion of rib cage during sneezing or coughing.
* Calcium intake as mentioned above.

I suggest you to undergo a detailed evaluation for osteoporosis after consulting your treating doctor.

Hope I have addressed all your issues. Happy to help in case of any more queries.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. K. Naga Ravi Prasad (8 hours later)

Thank you for your help, I never smoked and don't drink I can't with the meds I am on, I am doing the recast which is an IV once a year, but doesn't seem to be helping, you said to avoid thyroid drugs they just put me on them cause my blood came back and it was really low and I just keep gaining weight and won't go away cause I don't eat much, I take depressive meds cause if I don't I would be a really basket case with all my health problems that seems to taking over my life, I have tried all the inflammatory gel everything nothing helps I am in so much pain can't breath or sneeze or cough with out it feeling like my heart is going to jump out of my chest, I had a total Hysterectomy they toke every thing at the age of 30, there has to be some reason for all of this I can't keep living in pain like this, I need some help I went to my pain management doctor and they ended up putting a Neuromodulation put inside my and the wires go to the place where my pain is the only problem with that is I get pain somewhere the wires are not at so then I have to have more surgery to get the new pain spot, I can't keep doing that I do have breast implants and sometimes I get worried that its something wrong with them cause the pain is part under my left breast, but the pain starts at the center of my chest/ribs and now going almost all around to the back, I hope you might have some help, all my doctors say I am strange if something could happen health rise it would happen to me
Again Thank you for your help
XXXXX

Answered by Dr. K. Naga Ravi Prasad (15 minutes later)

Hi XXXXXXX I can sense the pain and agony you are experiencing because of the morbidities you have.

Though the thyroid hormones are related to osteoporosis, there is no way that you can skip them because you have low blood levels. To compensate this, you have to regularly take calcium supplementation as described in my previous answer.

One more option to tackle the pain in your ribs is by INTERCOSTAL NERVE BLOCK with a long acting analgesic. This will produce good pain relief. But this has to be done by an interventional anesthesiologist.

If everything else fails to give relief , PRAY GOD.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (9 minutes later)

Thank you for your help I have had many nerve blocks, they even burned the nerve few times also, Trust me I have be praying I am just at the point with this pain I can't take it anymore even if I could get just one day with out pain that would be great I thought when I saw and read about Tietza Syndrome I might finally have an answer, also forgot my cholesterol is really high its 319 so I am on meds for that also I am 5'5" 130, also I saw about Costochondritis, there has to be an answer for this no one should have to live with pain every day

XXXXX

Answered by Dr. K. Naga Ravi Prasad (19 minutes later)

Hi XXXXXXX even the drugs prescribed for lowering your cholesterol like ATORVASTATIN or ROSUVASTATIN will also cause severe muscle pains and tenderness. So you are entangled in a web of problems.

BE POSITIVE AND DONT LOSE HOPE. GOOD LUCK

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar