A PAIN IN THE CHEST (AND POSTERIOR)

Friend Gutsy Writer noted I had been in hospital for some heart tests related to chest pains. And out of concern she wanted to know what's up. I was going to do a long comment in reply, then decided, "What the %*$%@, why don't I just do a post on the thing and be done with it." This may, or may not, be of any use to anyone, but here goes.

First and foremost, I have had a long history of chest pain. So the last time I was in hospital, the good doctors set me up with a specialist to do a very thorough checkout of the situation. And my heart is in very good shape, thanks very much.

But GW wanted to know more about the benign, recurring chest pains. What you're about to get is far more than you ever want to know. But as a medical ethicist I do these things with precision.

The culprit in this case is something called costocholdritis. (That's pronounced: COST-oh-con-DRY-tis.) Ain't that just a mouthful?

Explanation. Our ribs are attached to our spine at the back and the upper ones are attached to our breast bone (sternum) in the front. There is a fair amount of connective tissue in the front. (Dani, or some other nurse can fill indetails, if need be.) Anyhow, that connective tissue can become inflamed -- like a swolen knuckle or sprained ankle. These things happen.

Problem: Because of the location of the pain, it's hard to tell when I'm having a costo attack or a heart attack. So I get into the ER. They want to know if I have a history of heart problems. I tell them, "No, but I have a history of costochondritis." They do all the stuff to see whether I'm having a heart attack; ECG monitor, blood tests, iv lock, etc. When all that checks out, they move me from the ER "front line" to ER observation. And in due course, they try something else. Morphine helps the pain, but there are other things which are more helpful (and frankly, I really don't need the morphine -- it's a waste of good drugs). There are several anti-inflammatory iv meds which will change the condition virtually in the snap of a finger. And after a while, if things are OK, they send me home.

I have anti-inflammatory meds that I take regularly, which help deal with the problem. But sometimes those aren't enough, so I have to go to the hospital. Hence I suffer both pain in the chest and pain in the posterior (because I have to go to the hospital). In some ways it's kind of a waste of medical resources. But the doctors keep telling me to come back if I'm having problems, because sometime it might just not be the costo.

Anyhow, spring has sprung, and I'll be out walking. My family doc and I have worked out an exercise program for me, and I've already started working on that. My sense is that the stronger (more physically fit) I become, the less chance I'll have for recurring costo.

As long as I don't have a physical fit in the process. ;)