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Suggest Treatment For Symptoms Of Musculoskeletal Pain In Rib Area

Posted on Tue, 3 Feb 2015

Question: Hi

I have a stitch type ache on my left rib which moves to the right rib and then slight pain in the centre of the abdomen. It's been like this for 3 weeks. I also have hemmroid. Now I started to get back pain when I sleep not sure if it's because I am lying down too much.

Answered by Dr. Deepak Kishore Kaltari (6 minutes later)

Brief Answer:
Additional information required

Detailed Answer:
Hi
Welcome to Healthcaremagic
Greetings of the day
Dear Mr XXXX

It would be very helpful if you could provide me with the following additional information for me to be able to assist you

1. Is the pain in the ribs continuous pain or its intermittent type of pain associated with any aggravating factors ?

2. Do you have associated heartburn?

3. Do you have any nausea ot vomiting

4. Is there any pain in the ribs on applying pressure or dies pain aggravate on pressure ?

5. Do you presently have any symptoms attributable to hemorrhoid like bleeding per rectum ?

6. Does the back pain increase in any posture ?

Awaiting your response

Take care

Best regards
Dr Deepak Kaltari
Consultant Surgeon

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

Follow up: Dr. Deepak Kishore Kaltari (8 minutes later)

1. The rib pain is dependent on posture.
2. Heartburn not really
3. No vomiting
4. Its more like a stitch than a pain or a dull ache. Yes in some places it does but it moves.
5. No bleeding right but there was a week ago.
6. If I am lying down.

Been feeling fatigued as well not sure if that is because I think i am suffering with my sinusitis.

I also had a small bowel resection 15 months ago from trauma from an accident.

Answered by Dr. Deepak Kishore Kaltari (24 minutes later)

Brief Answer:
Likely to be musculoskeletal pain

Detailed Answer:
Dear Mr XXXX

Going by description given its likely to be fatigue and malaise associated with viral prodrome especially involving respiratory tract .

I would suggest you the following

1. Hot water fomentation : Either by using cloth soaked in hot water or using hot water bag. It will relieve the pain and muscle spasm . It wil help relieve the rib and back pain

2. Analgesic like Ibuprofen will be helpful

3. Also do take acid suppressant like Pantoprozole

4. Adequate rest and avoid sleeping on back. Sleeping on side either left or right will be helpful

Do get back to me if you need any further assistance, will be glad to assist you.

Wishing you and your family a very happy and healthy life.

Take care

Best regards
Dr Deepak

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

Follow up: Dr. Deepak Kishore Kaltari (7 minutes later)

Ok do you not think it may be pancreatitus or an ulcer or something related to my small bowel resection? I am scared to eat alot becyase of thus.

Answered by Dr. Deepak Kishore Kaltari (4 minutes later)

Brief Answer:
Unlikely to be Pancreatitis

Detailed Answer:
Dear Mr Deevashan

Pancreatitis or issue related with bowel resection will usually have other associated symptoms like nausea / vomiting, loss of appetite or features of adhesion of bowel. Do isolated complaints of vague pain is likely to be musculoskeletal pain. I would also suggest you to maintain your hydration and nutrition by adequate intake of water and meals.

If the pain worsens or you develop new gastrointestinal symptoms then do consult your physician for further assessment.

Wishing you a very Happy New Year 2015

Take care

Best regards
Deepak

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

Follow up: Dr. Deepak Kishore Kaltari (1 hour later)

Hi

Thanks but i have not been alot over the last few days abd have been having this gurgling noises on the left side past my ribs.

Answered by Dr. Deepak Kishore Kaltari (9 minutes later)

Brief Answer:
Kindly follow the advise

Detailed Answer:
Dear Mr XXXX,

Kindly follow the advise and things will definitely improve.

Take Care

Best Regards
Dr Deepak

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

Follow up: Dr. Deepak Kishore Kaltari (23 hours later)

Hi

I went for xray, it showed up nothing

Answered by Dr. Deepak Kishore Kaltari (1 hour later)

Brief Answer:
Normal X ray is reassuring

Detailed Answer:
Hi

Normal X ray is very reassuring. I hope you are relieved of your symptoms.

Take care

Best regards
Dr Deepak

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

Follow up: Dr. Deepak Kishore Kaltari (18 minutes later)

Hi

I am not feeling better from the advice. What do i do? Should the xray have not showed up anything?

Answered by Dr. Deepak Kishore Kaltari (2 hours later)

Brief Answer:
Further assessment by Ultrasound scan

Detailed Answer:
Hi

X ray may fail to reveal many of issues. In such scenario I would suggest you the following

1. Thorough clinical examination from your physician

2. Ultrasound scan of abdomen In consultation with your Physician

Take care

Best regards
Dr Deepak

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

Follow up: Dr. Deepak Kishore Kaltari (2 hours later)

Doing an ultrasound tomorrow

Answered by Dr. Deepak Kishore Kaltari (1 minute later)

Brief Answer:
Kindly get back to me with report

Detailed Answer:
Dear Mr XXXX

Kindly get back to me with the report.

Take care

Best regards
Deepak

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Deepak Kishore Kaltari (59 minutes later)

I did an amalylase and lipase test which came back normal

Answered by Dr. Deepak Kishore Kaltari (1 hour later)

Brief Answer:
Pancreatitis ruled out

Detailed Answer:
Dear Mr XXXX

Negative Lipase test conclusively rules out Pancreatitis. Kindly get a thorough clinical examination from your Physician apart from getting Ultrasound scanning done.

Take Care

Best Regards
Deepak

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Deepak Kishore Kaltari (2 hours later)

However would it not be negative after 3 week period as it is only effective for a week?

Answered by Dr. Deepak Kishore Kaltari (6 hours later)

Brief Answer:
Negative Lipase test during pain rules out Pancreatitis

Detailed Answer:
Dear Mr XXXX

As I had earlier mentioned to you that pain is unlikely to be Pancreatitis in light of symptoms of only isolated pain in abdomen. An episode of Pancreatitis will usually not last so long. As you are still having pain , negative lipase test during episode of pain rules out Pancreatitis. Ultrasound scan will further confirm it.

Take care

Best regards
Deepak

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Deepak Kishore Kaltari (34 minutes later)

Ok thanks what do you mean by isolated pain? Its just that the pain is less or nothing when standing and lyinh down.

The pain has been shifting between ribs and the centre.

Answered by Dr. Deepak Kishore Kaltari (2 hours later)

Brief Answer:
Isolated pain is pain occurring alone without other symptoms

Detailed Answer:
Dear Mr XXXX

Isolated pain means only symptoms of pain without other associated symptoms like nausea, vomiting or loss of appetite.

Did you get a thorough clinical examination from your Primary care Physician?
What was his/her clinical impression?

Awaiting your response

Regards
Deepak

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Deepak Kishore Kaltari (1 hour later)

Should i ask them to check anything specific during the ultrasound.

Answered by Dr. Deepak Kishore Kaltari (8 minutes later)

Brief Answer:
Look for mesenteric lymphadenopathy

Detailed Answer:
Dear Mr XXXX

Apart from routine assessment, ask them to look for following

1. Free fluid in lesser sac
2. Subphrenic collection
3. Any bulkiness in Pancreas
4. Collection in Hepatorenal pouch (Between liver and renal)
5. Mesenteric Lymphadenopathy

Take Care

Regards
Deepak

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Deepak Kishore Kaltari (2 hours later)

Report says no splenic or pancreatic abnormalities

Answered by Dr. Deepak Kishore Kaltari (2 hours later)

Brief Answer:
Kindly consult your physician if pain still persist

Detailed Answer:
Dear Mr XXXX

If the pain is still persisting then would suggest you to consult your physician for further assessment. Normal Ultrasound scan is very reassuring.

Take care

Best regards
Dr Deepak

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Deepak Kishore Kaltari (26 minutes later)

Hi

What do you mean is assuring?

I am having a scope tomorrow to rule out possibilities.

What is your general feeling?

Answered by Dr. Deepak Kishore Kaltari (2 hours later)

Brief Answer:
Likely to be acid peptic disease

Detailed Answer:
Dear Mr XXXX

Normal Ultrasound is reassuring means there is unlikely to be significant intrabdominal pathology as cause of symptoms. In my opinion possibility of Acid peptic disease with Gastric /Duodenal ulcer is likely cause of symptoms.

Do get a clinical examination from your physician

Take care

Best regards
Dr Deepak

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Deepak Kishore Kaltari (41 minutes later)

Yes I have had. I feel less fatigue though.

Answered by Dr. Deepak Kishore Kaltari (1 minute later)

Brief Answer:
What was the clinical opinion of Physician

Detailed Answer:
Dear Mr XXXX

What was the opinion of Physician on clinical examination?

Awaiting your response

Take Care

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

Follow up: Dr. Deepak Kishore Kaltari (3 minutes later)

He wasnt sure. I saw two Physicians. I am also doing some blood tests tomorrow.

Answered by Dr. Deepak Kishore Kaltari (10 minutes later)

Brief Answer:
Kindly get back to me with report

Detailed Answer:
Dear Mr XXXX

Kindly get back to me with the report.

Wishing you a very happy and healthy life.

Take care

Best regards
Dr Deepak

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

Follow up: Dr. Deepak Kishore Kaltari (29 hours later)

Hi

The scope revealed i have inflammation in my stomach.

Answered by Dr. Deepak Kishore Kaltari (4 hours later)

Brief Answer:
Start on Proton pump inhibitors like Pantoprozole

Detailed Answer:
Dear Mr XXXX

As I previously mentioned to you that acid peptic disease with ulceration is likely cause of your symptoms. I hope H Pylori infection was ruled out during a scopy.

Were any acid suppressant medicine started by your Physician?

I would suggest you the following

1 . Ensure intake of meals at regular intervals.

2. Do not skip meals

3. Avoid carbonated / alcohol / caffeinated beverage

4. Antacid like Pantoprozole will be helpful

5. Liquid antacid containing Sucralfate will be helpful

Do keep me updated about progress.

Take care

Best regards
Dr Deepak

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

Follow up: Dr. Deepak Kishore Kaltari (3 hours later)

Does this explain the stitch like pain in my chest?

Even though it cganges with posture.

Answered by Dr. Deepak Kishore Kaltari (5 hours later)

Brief Answer:
Likely to be acid peptic disease

Detailed Answer:
Dear Mr XXXX

Acid peptic disease could have variety of presentation. It definitely explains your symptoms.

Take care

Best regards
Dr Deepak

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

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