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Family Physician
Family Physician, Doctor
Category: Medical
Satisfied Customers: 12816
Experience:  GP with over 27 years experience including emergency medicine
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Good morning I have a question with regards XXXXX XXXXX

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Good morning

I have a question with regards XXXXX XXXXX symptoms and how they relate to back ache and wonder if I might be having additional problems that need looking at as there are certain aspect to the condition which I cannot quite be certain are related.

I am looking for advice on the current state of my condition, whether any of my symptoms might be related to other things elsewhere and if so what line of enquiry I should pursue with my GP...

Basic stats. Male. 30 years old. weight 16.4 stone. height 5.8 ft

Current medication: Lanzoprazole 30mg. Occasional use of gaviscon.

Also, I am looking for advice on pain relief as I am having little success with that at the moment.

I was diagnosed after a gastroscopy in mid march with the following:

No Esophagitis, visible bile reflux to mid oesophagus
Sliding hiatus hernia 4 cm
gastritis Mild erythematous/exudative with no bleeding and mild reflux with no bleeding
Test positive for H pylori

I took the following: Amoxycillin 1000 mg for 1 week
Clarithromycin 500 mg for 1 week
omeprazole 20 mg for six weeks
domperidone 10mg for six weeks

also weight loss advised... current weight stands now at 16.4 stone... (as I lost a couple of stone at least during the months leading up to the diagnosis, very rapidly, due to severe stress and depression and barely eating.

H Pylori Faecal antigen test also required to find out whether H Pylori has been eradicated. I am still awaiting the results of this...

I was also diagnosed with mild fatty liver back in January... this was from an ultrasound, that came back clear apart from pancreas/gallbladder which were obscured by bowel gas.

Current Symptoms:

I am finding that it is the back symptoms which are more prevalent than the chest/abdominal issues... in that there is always some pain or ache of some description in my back regardless of when I eat or how much I move about etc and this is what is causing me the most concern and is what makes me wonder...

In terms of noticeable heart burn, I get very little, hardly ever...

Stomach pain, on occasion. Odd moment of mild stabbing like pain.

Occasional pain and discomfort under my left or right ribs.

Neck ache mainly left or back of neck

Jaw/below chin ache

Chest ache, also felt in central upper back

Burning sensation in upper back, left and right sometimes...

right side below shoulder ache/below shoulderblade ache

These I think are relating to eating as I do not suffer from them without having eaten, though I do get the right side shoulder blade ache first thing in the morning, it clears up quickly though and I get very little right side discomfort throughout the day.

yellowish stool, this has been constant since my symptoms started back in December
Burning in rectal area after passing stool. No pain when passing stool however.

Upper back ache left side: This is the big one for me.

The symptoms are as follows:

The aforementioned central chest/mid back pain over the spine area/between the shoulderblades. Not very often but it does happen a few times a day.

My main concern seems to be around the left shoulder blade area, on it, above it and below it. Here the symptoms seem to be constant regardless of food intake.

I have observed the following:

An ache below the blade felt under the ribcage sort of area

A constant pressure, very low but enough to let me feel it, this never seems to let up even when sharper aches have stopped.

A squeezing, tightening sort of pressure.. feel like the muscles sort of just tighten up suddenly, sometimes this can last for a long time and others not so much. My shoulder often sort of raises in response to it as well. However, I am uncertain whether this is muscular or not... I have tried voltarol for inflammation on the suggestion of a local chemist... doesn't seem to stop it.

Specific location for the tightening feeling seems to be either just below the left shoulder or round behind and near the armpit area...

Often I will find that along with the squeezing and tightening, I feel pressure down my left arm as well, sometimes it goes with it, sometimes the pressure/numbness in the arm seems to be there by itself... I also seem to have clicking in the joints round my upper back area...

The constant pressure, tightening of the muscles are the symptoms that are bothering me the most, I often can't get comfortable and find myself feeling depressed/panicky over the tightening.

I have been recieving osteopathic manipulations over a month period (three sessions so far) so I wonder if its something to do with that...

I am wondering if, due to the fact that muscular cream/panadol doesn't seem to put a dent in the discomfort in the slightest, the discomfort might be nerve related and if there is anything that can be done to relieve the symptoms.

Any advice would be appreciated...
Family Physician
Thank you for your question:

You mentioned that you have been receiving osteopathic manipulations for the last month. What condition or symptom prompted this treatment? Have the symptoms improved or increased with these treatments?
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Customer: replied 3 years ago.

What promoted me to seek osteopathic manipulation was research into things which could potentially help with the hiatus hernia pain and gastritis in general. A concern over whether the back ache symptoms I have been suffering with could be muscular and whether or not it might help.


 


In terms of whether it has helped or not... hard to say, perhaps I have not taken enough treatment yet but I have noticed very little change so far... the aforementioned tightening feeling in my left shoulder blade seemed to come on about four or five days after the third session of treatment, though I cannot be sure whether it is the cause or merely coincidence...


 


Hope this helps, any further questions please do ask


 


Thanks


 


 
What type of work do you do?

Do you spend much time at a desk/computer?

Did these symptoms start suddenly or gradually?

Did anything change in your daily activity shortly before these symptoms started?
Ask Your Own Medical Question
Customer: replied 3 years ago.

I do office based administration work


 


Spend all my day at a desk/computer, though depending on what position I am serving on in the day I may or may not be getting in and out of my chair a lot (I have to issue blank documents to fellow colleagues from a safe and so this involves almost constant standing up to get the documents and then sitting down at a computer to fill in our records to state these documents have been issued)


 


Other days I may be editing other documents and this involves sitting down for the majority of the day.


 


The symptoms seemed to start suddenly and then get gradually worse and change their presentation over the year.


 


To explain:


 


Back in mid December, about the time I was suffering from a cold (could be coincidence) I started to feel mild pains in my lower back and upper back and just felt generally ill with episodic moments of very mild nausea and my stool turned yellow/when wiping. I consulted my GP and he said the pains were most likely muscular


 


After Christmas I started to get occasional chest aches and concerned over this I went to A&E worrying over heart trouble. They checked my heart out, took blood tests, all was fine. slightly elevated heartrate so they did an x ray as well, kept me in observation for a few hours but then concluded acid reflux and sent me home with omeprazole.


 


Over the next two weeks I started to suffer from sporadic pain under the ribs and after that time went to see my physician again, discussing the rib pains and how they seemed to have come on after taking the omeprazole (again I don't know whether this was coincidence or not)


 


The symptoms seemed to stay similar, for a short while... my doctor took me off the omeprazole and gave me ranitidine... a couple of weeks after going onto that was when I first started to notice the ache under the left shoulderblade. My doctor sent my for the ultra sound as well which diagnosed the fatty liver as previously mentioned.


 


At this point I began to get very anxious and depressed due to not knowing what was wrong, and my stress and depression slowly built up and then it seemed to me that the constant pressure on the shoulderblade started to get slowly worse.


 


I began to seek medical attention more often my doctor booked me in for the gastroscopy.


 


Blood tests had been taken on and off throughout this time and some of the levels seemed to change, but nothing that concerned my GP, though they did book me in with a hematologist, who I saw a couple of weeks ago now.


 


We also did a blood test for amalyse levels, as my concern was for pancreatic function, that came back fine.


 


Had the gastroscopy and took the drug regime for that and things seemed to get worse during that time. For example, there was noticable pain when pressing under the left rib cage and central on the abdomen for a while but that seems to have gone completely now and I just get the usual aches under there, pressing on the rib cage makes no difference.


 


So yes I would say that the symptoms got gradually worse...


 


As to change in daily activity... not massively... normally I walk to and from work, about 2.5 miles there and 2.5 miles back and back in December I was walking a lot less (and that has continued on due to depression and feeling pain when moving, but I am walking a lot more now than I was)


 


I was noticing burning/ache around the back in the ribcage area when I was walking, sometimes strong and sometimes not and I still get that at times now. For example, I walked home from work on Friday night and felt very little discomfort, but walked down the road yesterday to the supermarket and found my back was aching and burning quite badly, so its sporadic in itself if and how much pain movement causes in that regard.



Hope this helps.



Please feel free to contact me with more questions



Thanks.
I'm sure you understand that there is no way to make a definitive diagnosis over the internet since I don't have a complete medical history, I can't examine you and I don't have the results of all the tests you have had (and can't order other tests).... With that it mind, there are several things that come to mind based on this history.

An increasing number of people are suffereing from musculoskeletal pains and symptoms related to ergonomics of the computer work station. If your keyboard and/or mouse are even a bit too high, you can experience pain, stiffnes, spasms and even numbness or weakness in your arms, back, neck etc. Adjusting your chair, desk, computer monitor may help. I have had this problem at times, and even relatively small adjustments sometimes can make dramatic differences in these symptoms.
Here are some links that can help you with proper positioning of your workstation:
https://www.osha.gov/SLTC/etools/computerworkstations/
http://www.ors.od.nih.gov/sr/dohs/Documents/ORS_Ergonomics_Poster_Rd5.pdf
http://archiwum.ciop.pl/21992
It is important to understand that this can occure with use of a computer/desk at home or at work. Sometimes it is the use of computers in the evening after work that is the issue rather than the work computer. Desks and chairs are designed for the mythical "average person". Frequently chairs that have multiple adjustments are purchased and set for this "average" person. If you are taller, shorter, heavier etc than "average", you need to make adjustments in chair and desk to give the best possible posture.

Your shoes - most people have shoes that are too old. If you do lots of walking, your shoes will loose most of their support within 3-6 months - LONG before most people think that they are "worn out". When my patients are complaining of foot, knee, hip or back pain, one of the first things I do is to suggest replacing their shoes with GOOD quality proper fitting walking shoes. I stress the importance of quality and fit over looks (this is typically more of a problem with women who tend to place fashion a bit higher on their list). Patients often find that within a few weeks, their symptoms have improved. Much like a building, your entire body is built on the foundation of your feet (and the shoes you wear). A bad foundation will cause problems with the entire building or body.

Leg length inequality - even minor difference in leg length can cause problems with back pain. Your osteopathic provider can check this for you. You can have actual leg length inequality or functional. Here is a article that explains this problem.
http://erikdalton.com/media/published-articles/short-leg-syndrome-part-2/

Finally, since the symptoms are at times related to activity (walking), an evaluation with an exercise (treadmill) stress test to exclude any heart problems is a reasonable approach. The fact that you are only 30 years of age makes heart problems less likely, however, some individuals, particularly those who are overweight, can have heart problems at a younger age.

I hope this information is helpful.
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Customer: replied 3 years ago.

Thankyou for that information. I will certainly follow up with it.


 


One final question if I may...


 


With regards XXXXX XXXXX relief, is there anything you can recommend...


 


With gastritis and hiatus hernia being factors for an upset stomach etc, I am uncertain what type of pain medication I should be taking or asking for with back pain. Is there anything in general that might help.


 


I presume stuff like ibuprofen is out, even with mild gastritis?


 


Anything else in addition to the lanzoprazole I am taking?


 


Anything over the counter, specific brands that would be safe for me to take or I could ask my GP to prescribe?


 


Or does my condition warrant further investigation before pain med recommendations can be made...


 


Many thanks for your time....

With gastritis, most physicians would advise against ibuprofen or Voltarol since both can cause the stomach or esophagus inflammation to get worse. Paracetamol is a safer option in regards XXXXX XXXXX stomach.
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Customer: replied 3 years ago.

Right.


 


Thanks very much for the information and your time


 


Regards