Dr. Natasha : Hi
Dr. Natasha : thanks for requesting me
Dr. Natasha : what is going on?
chest discompfort/pain for a week
Dr. Natasha : How old are you?
Dr. Natasha : any other medical problems or medication?
not a sharp pain, mostly focused at the top outer parts of the chest, both sides like near the armpits in a 2-d drawing but not at the armpit level. it's more anterior, but also not shallow anterior, more in the center. Feels like a cramp. I have AS (ankyl. spondylitis and take naproxyn 500mg and a concomitant stomach med) but never had a sensation here. 47 yrs old, white male. I went to the ER 2 days ago to check it out- i dont think its heart related and inded blood work and EKG (ie the wet stickers they place on chest and near legs for 2 mins were negative --they wanted to do more tests like stress test but it was 2am and i wanted to go home. But it is at times very uncomfortable/pain but again not sharp pain. It originally started seven days ago like a rod of discomfort from right to left including over center but not in heart area and not in clavicle area either. like in the middle, like where a person would rest a barbell
also xray chest negative
Dr. Natasha : Reading
Dr. Natasha : Did they screen you for a pulmonary embolism ?
i'd have to research that to know what that is but i'll take a stab and say no what they did was blood work, EKG and chest xray. They also took vitals all fine. I did mention to them that i had this bacteria like feeling in my throat and wanted a swab but they said its likely allergies definitely unrelated and they'd do it later, but i left the hospital as i mentioned, and in any case today that throat etc feeling is gone and i indeed do feel pretty good from that respect
Dr. Natasha : Well in terms of your work up, if you are still in pain, you would need a d-dimer or ct of the chest
Dr. Natasha : I would still recommend a cardiac stress test
Dr. Natasha : if those are negative then you can assume it is muscle related but I would get the above studies first
I want to ask you in order to understand better: are you saying although I feel it has nothing to do with my heart, that I still need to do those and if so how soon. btw i also dont think it's a muscle. It feels closest to the AS type pains EXCEPT that (a) I never had it in this spot (I have had in the back under the shoulder blade and by the ribs and that IS painfully sharp), (b) this does NOT exponentially increase in pain with movement as the AS pain does, (c) the pain is not sharp, (d) the pain/discomfort does not feel like it is going along any joint per se and I am not sure if there is even a joint where the chest sensations are
Are you there Dr?
Dr. Natasha : I am here
Dr. Natasha : the way medicine works is by assessing worst possibility first and eliminating that
Dr. Natasha : you have never had this pain before
Dr. Natasha : you are in your late 40s
Dr. Natasha : this could be musculoskeletal pain
Dr. Natasha : so you need to entertain other possibilities like coronary artery disease and pulmonary embolism
Dr. Natasha : if this is negative then you can treat with Motrin etc for pain
So if those are negative youre thinking just muscoskeletal no big deal
Dr. Natasha : Yes
and no real urgency on the other stuff if i feel i'm ok, just a medicine thing to do to exclude severe stuff, just a pro forma checklist
i'm talking about the pulmonary and heart- i dont see the urgency
sorry, let me rephrase. In terms of the severe stuff (heart), aint i right that empirically if I the patient feel good and cant see it logically that it would be the heart (plus some tests were done and negative), then empirically overwhelmingly overwhelmingly not the heart, right?
Dr. Natasha : I have seen indigestion as the only symptom for heart disease
Dr. Natasha : Try Motrin- if it doesn't help - or you get worse- get the other stuff done
i'll skip the motrin,. I can take it, just worried a little if it means something, but i am comforted by the tests i already did. OK so if it gets worse, like a step up, then i'll go.
? I am satisfied just some delays and stepped out without the final final finalization of this, but likely she agrees. I'm ok with paying, worth it