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What could be the reason for pain under the right breastbone inspite of my hiatal hernia?

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General & Family Physician
Practicing since : 2008
Answered : 3394 Questions
I have been having pain under my R breastbone since late October/early November, when I had an asthma attack. I am a bariatric patient -- two years out-- and initially my doctor treated me for costochondritis. Then I began to have more severe pain under my R breastbone and, most recently, they were treating me for an ulcer. This past Tuesday, I had an endoscopy, an ultrasound and an upper GI. All results came back negative (except that I had a tiny hiatal hernia). I am having an MRI with contrast on Monday and an appt with a Gastroenterologist on Tuesday. I am still in pain underneath my R breastbone. The pain is always there with differing levels of intensity. Itvis always tender. Usually, it's pretty painful. I am still constipated and am taking Milk of Mag. (I added a probiotic to see if it would help.) Doctor, what do you think this is and, most importantly, what can I do about the pain? I'm really at my wits end. It's limiting my daily activities. Many thanks for your response.
Posted Mon, 17 Mar 2014 in General Health
Answered by Dr. Raju A.T 13 hours later
Brief Answer: Hiatal hernia could be the cause Detailed Answer: Hi, Thanks for your query. Sorry for the delay in answering. The reason for your pain under the right breastbone could be the hiatal hernia you have. sometimes due to spasmic contraction of the herniated loop of the stomach. Usually pain in the hiatal hernia is milder and of burning nature. The reason of the for such pain is reflux if the acid from the stomach which is very common. But sometimes severe sharp stabbing pain can be experienced as a direct effect of the herniated loop of the stomach. Taking antispasmodic medications like Hyocine or dicyclomine will surely help to get rid of the pain. The definitive treatment of your problem may have to be decided after the scan you have planned. Meanwhile you an take antispasmodics for pain. Wish you good health. Regards,
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Follow-up: What could be the reason for pain under the right breastbone inspite of my hiatal hernia? 3 hours later
Thank you for your response, Dr. XXXXXXX I'm not having any reflux issues that I'm aware of, unless they are happening internally. My reflux went away once I had gastric bypass. Would the "herniated loop of the stomach" still exist even though I had gastric bypass? Why wouldn't the bariatric surgeon pick that up? She seemed dismissive of that fact: "you have a tiny hiatal hernia." Why wouldn't she prescribe something for the pain? She's letting the gastroenterologist figure it out on Tuesday. Again, I've been having this issue since late October/early November. The pain has gotten progressively worse. It is now sharp and stabbing. Yesterday afternoon, I had to take codeine which was prescribed to me in the ER two weeks ago. I've been taking Tylenol and using heat patches up to this point. My two concerns are the sharp pains as well as the continuing constipation. Both conditions are not getting any better. How do I ask for anti-spasmodic medication? The bariatric surgeon didnt think she needed to prescribe anything for pain. I don't see the gastroenterologist until 3:30 pm on Tuesday. What can I do in the meantime? I really appreciate your responses, as I feel I am in between a rock and a hard place. Thank you!! !
Answered by Dr. Raju A.T 26 minutes later
Brief Answer: Hiatal hernia or the adhesions Detailed Answer: Hi, thanks for the information. Considering the history of gastric bypass surgery, i would like to mention another possible cause for the pain. Adhesions at the site of surgery could be anther considerable possible cause for the pain. Also there are chances where you can get hiatal hernia if it was partial gastrectomy you underwent during the bypass. Since the pain killer for your pain has to be chosen only after finding out the exact cause. I would consider a milder antispasmodic like ones I mentioned would be better choice both in case of hernia or the adhesions. No, these medications need a hand written prescription. Constipation can be explained by both conditions, as any sort of irritation in the early part of the GI tract can lead to sluggishly moving lower bowel. Please do contact your treating doctor for better pain management with antispasmodics. Wish you good health. regards,
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Follow-up: What could be the reason for pain under the right breastbone inspite of my hiatal hernia? 19 minutes later
Thank you so much for the insight, Dr. Raju!! What should I do for TODAY? Bariatric Surgeon wants me to wait for Gastroenterologist and referred me to him. The bariatric office also suggested going to the ER or talking to my PCP. (I went to the ER 2 wks ago and they surmised it was an ulcer. It wasn't.) i spoke to my PCP and he told me to follow direction of my Bariatric surgeon. Whom should I call today about pain? I don't know why they can't prescribe something --based on my tests-- to get me through until I see the Gastroenterologist Tuesday at 3:30 pm. (As I write this, it's 6:30 am on Monday.) Im a teacher who is trying to go to work so if you could respond as soon as possible, I will call the office you suggest. Again, thank you!
Answered by Dr. Raju A.T 25 hours later
Brief Answer: Hi, Detailed Answer: Extremely sorry for a late reply. I was continuously working at the ER for 16 hours and could not attend your query on time. If you have intolerable pain you should visit ER. I hate doctors pointing fingers at others when someone is in pain. They are legally endorsed to relieve the pain for time being. Call your PCP office and ask if he can fax prescription of Tramadol to the local pharmacy and you can pick it from there.
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