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What causes shortness of breath and constant back pain?

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Posted on Tue, 16 Aug 2016
Question: Hello, I am a 23 year old Caucasian male and for the past year or so I have been experiencing a variety of symptoms. The most severe is a constant dull pain in my back, on the left side and maybe an inch below my shoulder blade and about 4 inches from my spine. The pain is located almost exactly where I had a mole removed a couple years ago. I had the mole removed, not biopsied, through "evisceration", and the doctor didn't say it looked odd. The scar has healed well and is never discolored or anything, the pain is definitely below the surface.

Oddly, there is absolutely no pain after I sleep, just a weird "pressure". The pain only comes on after I shower or lean over in my chair, and then won't go completely away until I sleep again. I can manipulate my back-left shoulder blade/scapula to "snap" constantly, without pain.

About a month ago I was involved in a pretty violent MVA in which both involved cars were totaled. I felt fine at the time but the next day pretty much my entire left side was in pain. That went away after a few days and now, about 1 month later, I'm experiencing this same left shoulder blade pain, except it is much more severe, radiating all the way through to my heart. I've also experienced infrequent shortness of breath over the past year or so, which I've chalked up to stress as it is never painful and goes away after a couple days. Now I am thinking it may be something more. Lower abdomen discomfort/"pressure" also accompanies the breathing difficulties and shoulder blade pain, but only sometimes.

I recently had blood work, my cholesterol/BP is supposedly so low it's considered "high risk", though my GP didn't feel the need to call me in on it and wrote "all good" in the general results. My ABS WBC is 0.94, monocytes high at 17%, not sure if that is related. All other results were in reference range. I wanted imaging but was talked out of it and prescribed 4 weeks of PT. I am going back this week and insisting on imaging as the pain is getting progressively worse, radiating into my heart/left lung and breathing difficulties. At it's worst, it feels as if there is a narrow, sharp pin sticking through my back and into my heart. I've never gotten dizzy or disoriented, never slurred speech, always just pushed trough it. If you were looking at me while I was in this pain, it would not be apparent at all.

I'm 6' 1", about 170lbs, occasionally smoke, almost never drink. No medications ever. I avoid fast food and red meat. Only family history of cancer is maternal grandfather, which was attributed to asbestos exposure as he worked in a mine for 25yrs. HBP on fathers side and nothing else. Thank you for any help you can provide. The general attitude of my GP is I'm young and appear healthy, so it must not be anything serious. The pain and accompanying uncertainty is definitely affecting my quality of life and I am determined to find the cause.

My next step if GP rebuffs me is to call 911 and say whatever I need to in order to get imaging done. I'd rather not do that as ambulance rides alone cost thousands in NJ, but I am at that point. To clarify, it's never gotten to the point where I NEED to call an ambulance. But I tend to have a higher tolerance to these things and am not unsubscribed to the notion that it could all be stress related. Thank you again for your time and any help you can provide.
doctor
Answered by Dr. Mahaveer Patil (1 hour later)
Brief Answer:
DEFINITLY NOT STRESS RELATED

Detailed Answer:
Hi XXXX
Hope this message finds you in good health.

Thanks for sharing your history and the complaints in such a beautiful and detailed manner,more than what we generally expect from patients.

I have gone through your complaints and understand your concern.

I generally see many cases like this at my clinic and have found out that its not at all realated to anxiety and stress ,most of the times.
I give them a splint,rest,analgesics,anti-inflammatory tablets and ice pack till the swelling/ pain reduces to some extent. Then i get an xray and if necessary an mri done to find out the exact reason.

In your case,there are 5 possibilities-
POSSIBILITY 1. SOFT TISSUE INFLAMMATION- there may be no bony involvement,only the soft tissues around the back might be inflammed that may be causing the pain

POSSIBILITY 2. NEUROPATHY- there may be a partial or complete inflammation of the nerves in that region that may be the root cause of such kind of pain.

POSSIBILITY 3. DISC PROLAPSE-there may be a compressed a nerve in the region somewhere that might be causing radiating pain in those regions.Possibility of a disc prolapse should be kept in mind.

POSSIBILITY 4 - PLEURITIC ORIGIN- some part of the pleura might have inflammed,causing that pain.

POSSIBILITY 5- INTRA THORACIC PATHOLOGY- almost always missed out by clinicians.

As you have rightly mentioned,everything has to have a reason,it just cant be stress related always.

I suggest you get an Xray as well as an MRI of neck and the painful area in particular,and a detailed blood profile done to find out the exact cause. An HRCT chest could be of immense help to rule out any intra thoracic pathology.

Physiotherapy,analgesics,anti-inflammatory drugs should help till then

I assure one thing, even if it is either of the above 5 possibilities,all have a good prognosis
You should eventually get back to normal in coming few days.Nothing to worry about, as long as i am there to help you.
We together, will definitely find out the diagnosis .Do share the reports once you have them ready.     
I hope your question has been answered.
If you have any follow-up queries,feel free to consult me anytime.
Thanks,Take care,God bless. Wish you a healthy life : )

Above answer was peer-reviewed by : Dr. Priyanka G Raj
doctor
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Follow up: Dr. Mahaveer Patil (1 hour later)
Hello Dr. XXXXXXX

Thank you for your prompt and informative response. Without sounding like a hypochondriac, I can say I already feel a little bit better thanks to your reassurance.

I will be sure to upload any information from my imaging once it is done. I have my blood results from about 2 weeks ago but I'm not sure how to upload it yet.

When you say detailed blood profile, what exactly is that and how does it differ from routine blood work? I will also run that by my GP. My idea was to get x-ray on chest and MRI on back area around pain, though I would definitely appreciate any advice if this seems inappropriate or inaccurate.

Do you think my mole removal from a couple years ago has any connection? I had the mole removed as it was painful and discolored, almost like a zit. Though the doctor removed it and didn't say it looked extraordinary.

Could the snapping in my left scapula indicate anything? I can make it happen over and over again when I am in a hunched-over position, though it is not painful. After awhile it becomes uncomfortable.

About the pain radiating through to my heart, could this be some sort of referred pain from my back? The pain in my heart can be described as tight, like there is not enough blood or a blockage of some sort. Would it be better to ask a cardiologist this question?

Shortness of breath often lasts a few days and goes away for days or weeks at a time. I have not been able to discern any pattern, but have read that muscle issues in the back can actually constrict breathing to an extent. Could this be a possibility?

Lower abdomen discomfort is very subtle, only lasts a day at most and comes on once every week or so. Any cause for concern?

My HDL is 38, my LDL is 57. This seems dangerous to me, though my GP is unconvinced for whatever reason. My monocytes are very high at 17%, and WBC ABS, even though in reference range, seemed a tad high at 0.94. I had a cup of matcha green tea that morning, and am not sure if that could have thrown the results at all. Any input on these results would be appreciated.

Thank you again Dr. XXXXXXX I look forward to hearing from you.
doctor
Answered by Dr. Mahaveer Patil (13 minutes later)
Brief Answer:
check the follow up answers

Detailed Answer:
Hi XXXX
Welcome back
1. detailed blood profile should include- complete hemogram,serum creatinine,creatinine phosphokinase,uric acid- minimum
2.instead of xray-better to get hrct chest- xray will just show u bones and some gross idea of lungs. hrct will confirm even a minor abnormality in lungs
3.connection to mole removal- less likely unless the doctor has gone very deep to injure a nerve in that region
4.snapping scapula- means the muscles in that area slip over one other making a snap sound- its insignificant
5. pain to heart - might be a radiating back pain-less likely to be cardiac- considering you short breath,u can have a ecg done to rule out any cardiac cause.
shortness can be caused by neuritic pain
6. lower abdominal discomfort- well if its occasional- just leave it, dont worry at all
6. i suggest u get the blood investigations on a 14 hours empty stomach to avoid variations
I hope your question has been answered.
If you have any follow-up queries,feel free to consult me anytime.
If you do not have any clarifications,you can close the discussion. Wish you a good health.Have a great day : )
Take care,God bless.
YOUR RATING FOR THIS ANSWER MATTERS A LOT AND WILL BE HIGHLY APPRECIATED.

Above answer was peer-reviewed by : Dr. Nagamani Ng
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Answered by
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Dr. Mahaveer Patil

Orthopaedic Surgeon

Practicing since :2002

Answered : 1209 Questions

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What causes shortness of breath and constant back pain?

Brief Answer: DEFINITLY NOT STRESS RELATED Detailed Answer: Hi XXXX Hope this message finds you in good health. Thanks for sharing your history and the complaints in such a beautiful and detailed manner,more than what we generally expect from patients. I have gone through your complaints and understand your concern. I generally see many cases like this at my clinic and have found out that its not at all realated to anxiety and stress ,most of the times. I give them a splint,rest,analgesics,anti-inflammatory tablets and ice pack till the swelling/ pain reduces to some extent. Then i get an xray and if necessary an mri done to find out the exact reason. In your case,there are 5 possibilities- POSSIBILITY 1. SOFT TISSUE INFLAMMATION- there may be no bony involvement,only the soft tissues around the back might be inflammed that may be causing the pain POSSIBILITY 2. NEUROPATHY- there may be a partial or complete inflammation of the nerves in that region that may be the root cause of such kind of pain. POSSIBILITY 3. DISC PROLAPSE-there may be a compressed a nerve in the region somewhere that might be causing radiating pain in those regions.Possibility of a disc prolapse should be kept in mind. POSSIBILITY 4 - PLEURITIC ORIGIN- some part of the pleura might have inflammed,causing that pain. POSSIBILITY 5- INTRA THORACIC PATHOLOGY- almost always missed out by clinicians. As you have rightly mentioned,everything has to have a reason,it just cant be stress related always. I suggest you get an Xray as well as an MRI of neck and the painful area in particular,and a detailed blood profile done to find out the exact cause. An HRCT chest could be of immense help to rule out any intra thoracic pathology. Physiotherapy,analgesics,anti-inflammatory drugs should help till then I assure one thing, even if it is either of the above 5 possibilities,all have a good prognosis You should eventually get back to normal in coming few days.Nothing to worry about, as long as i am there to help you. We together, will definitely find out the diagnosis .Do share the reports once you have them ready. I hope your question has been answered. If you have any follow-up queries,feel free to consult me anytime. Thanks,Take care,God bless. Wish you a healthy life : )