29f Intermittent Chest Pain October 2024 Global PaJR
This is an online E-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's consent. Here we discuss our individual patient's problems through a series of inputs from the available global online community of experts with the aim to solve those patients' clinical problems with the collective current best evidence-based input.
Weight:
Body weight (April - 2025) = 54.5 Kg
Body weight (May 17 - 2025) = 49 Kg
Bode weight (Feb 11 - 2026) = 52 Kg
Since the October 2024 begins, patient is suffering from chest pain that is localized in the center spreading to whole chest. Upon every moment or pressure there is extreme pain felt. If the patient is at rest, nothing is felt but upon every moment like getting up from bed while lying down, bending forward to pick up something from the floor, moving hands, sneezing, kneading the dough or washing utensils. Some days it is intense when every little moment have extreme pressure & pain in chest and other days it is less intense but it is sitting there all the time. Same Indian doctor diagnosed it as "Chest pain as Atypical complication of Chronic GERD".
Since childhood
- Archilles tendon
- Severe headache that resides after 3 to 5 days (Currently frequency is less).
Initial Life Phase
- Patient weighted 5 pounds at birth. She was delivered by c-section. Her birth order is third and last.
- Other than the occasional sickness, she used to get sick always during exams and results. She was healthy. She used to eat everything. She had no digestion problem.
- In 2002, she was in 1st standard when she got infected with chicken pox. It took her 1.5 months to recover as they were big in size.
- In 2008, she got sick. Medical tests were done and she was diagnosed with Jaundice. she was advised a complete bed rest and medicines. she was on boiled potatoes mostly. She recovered in 2.5 months.
- Later on she was having recurring fever and throat infection every 2-3 months interval.
Journey from beginning of typhoid to recovery of TB
- In October 2010, she was in 9th standard when her health starts to worsen. She was having extreme pain in abdomen, bloating, vomiting out whatever she was eating followed by high grade fever & shivers. Medical tests were done and she was diagnosed with typhoid. After one month's treatment her condition didn't get better. Tests were repeated and the GP said her typhoid is treated but there was a question mark as to why the high grade fever & digestion issues are not getting better.
- Patient was taken to a pulmonologist. Her multiple tests were done but nothing was found. Only her HB levels were decreasing and her weight. Patient reached to a weight of 45 Kg.
- Patient was having high grade fever of 103/104 degree. Even after giving meds for lowering the fever, the fever gets to its peak of 103/104 degree every 1.5-2 hrs gap. Shivers every time.
- After 4 months, pulmonologist started TB medications on the basis of a case in her family where a member was diagnosed with pulmonary TB a year ago. Doctor indicated that if the condition starts to become better than the TB medications will be continued. (That was a Trial)
- Meds started, a week later she starts to shiver badly, later vomited everything out, trembled badly. Rushed to the emergency and was given painkillers to reside the abdominal pain & to stop the vomiting.
- Pulmonologist ordered a CT scan, in which extra-pulmonary TB was confirmed (Both Lungs + Intestine). TB medications continued.
- Few months later, patient was diagnosed with mumps. She had extremely painful swelled jaw (both sides) and was unable to open the mouth to eat so fluids were given but she was unable to take fluids as well so an injection was given. Later on taking fluids become less painful. It took almost a month to recover.
- After a while her whole body starts to swell from different parts neck, arms, foot, sole. Her doctor lowered the dose of TB meds. Swelling starts to get better but the recurring swelling of the sole took years to subside.
- Her meds were continued for 9months and she was successfully recovered in 2011.
Journey of Post TB complications begins
- Her digestion issues never resolved. Every 2-3 months she was having same episodes.
-Extreme abdominal pain (cramps) that she cannot even walk or move
-Bloating
-Vomiting that when started donot stop
-Pain do not get better with vomiting
-Abdomen feels tight
-No pain killers ever worked
-Rushed to the emergency. They gave combo of pain injections mostly (nospa & voren) and sometimes something in the drip as well. They provide oral meds for a week. With continuing soft diet and meds abdomen feels normal after a week. - Rarely, she had to visit hospital again for another dose of pain injections again after 8-12 hours as the cramps returns with same intensity.
- Her diet was getting restricted & restricted as nobody was able to figure out what food is harming. Sometimes the same food don't harm but the other time it becomes the cause of problem.
- At one similar IBS episode, her pulmonologist ordered abdominal X-ray in that condition and the gas was found in the X-ray.
- In 2014, patient was in 12th standard when she got admitted due to similar condition of pain & vomiting in the hospital for 3 days to keep her under observation by pulmonologist. Surgeon was also involved because they were suspecting intestinal blocks. She was on drip (pain relieving, acid reducing, etc) for 3 days. Multiple tests were done and she was discharged with prescription to follow as nothing severe was found so surgery wasn't performed.
- Occasionally, her neck used to get swelled whenever she slept in the wrong head tilted position.
- Occasionally, she used to get fever of 100 due to tiredness.
- Occasionally, her knees got jammed like locked while sleeping and required a help to straighten it. That was painful.
- These IBS episodes continued with the same frequency until 2016 when she was in her 2nd year of graduation. The frequency reduced and these episodes starts to occur once in 6-7 months.
- In 2nd Year of her graduation her monthly periods cycle reduced to once in 3-4 months. Sometimes periods comes on its own after 3-4 months & sometimes it has to be induced by Duphaston 10mg (Dydrogesterone). In 2017 ultrasound was performed.
After 3-3.5 years it got better when patient was graduated. 1.5 months of naturopathic intervention was also taken.
- Later she was found Vitamin D defficient (level 6). Meds and course of injection was continued. It was back to normal.
- In 2017, her eyesight got weak where distant objects weren't clear and she got a minor number. Doctor said it cannot be reversed. Patient stopped using mobile phone and laptop in the dark for two years. Occasionally wore prescription glasses.
After 3 years her eyesight was back to normal again. - She graduated in Dec 2018. After that frequency of IBS episodes increased more as in once every month.
- In August 2019, she got admitted again in the hospital for 3 days by GP. Multiple tests were done and nothing was found. Last day of discharge she got fever so GP delayed the discharge by one more day.
Note: She never used to tell her family in the first hour of the occurrence of pain. After 6-7 hours of extreme pain when she became breathless to bear then she informed.
Psychological Issues with its own physical complications
- Soon after the discharge, patient felt lump in the throat. That lump made it difficult to swallow solid food and drink water. (It never subsided)
- She starts to have fire like burning in her abdomen 24*7. (It took 4 years to reduce its intensity to a manageable extent)
- Her whole body feels burning hot.
- Acid reflux started. Happened everyday.
- She can't sleep for as there was discomfort in her abdomen all the time. She can't lye down due to acid reflux.
- She just take a nap in sitting position. (For 1.5 years)
- Her diet was restricted more and she ate only custard, plain rice, wet roti & boiled water. (For 1.5years). Her family thought it will be safest and easily digestible food.
- She was diagnosed with GERD and Functional dyspepsia by her GP.
- Lightheadedness which last for hours so she hang the head off the bedside which made her feel better. One time she fall down due to dizziness & black out. She rested on a bed for a while & she was fine later on.
- Extreme restlessness all the time so she kept walking in the house for hours due to which her feet got corns.
- She can't breathe properly so she sat for hours in front of pedestal fan for comfort but still she had to breath from mouth.
- Flickering of her eyes everyday. Buzzing sound in ear very often.
- Urinary incontinence and rarely poop leaks.
- Pounding heart all the time. She remained scared all the time.
- GP diagnosed her with Anxiety and prescribed anti-anxiety. She took the 1 dose and she kept sleeping for 48 hours. She stopped the medication right away as she donot want to deal with her problem by sleeping.
- She went to another renowned doctor who sent her home by saying it is all her "wehem".
- Her hand trembles all the time.
- Extreme exhaustion & tiredness.
- She had unreasonable pains in her body. Severe chest pain with chest tightening.
- Her eyes become harder to open where it got noticed by a friend who suggested to take therapy but the family declined.
- She felt like the body is shutting down slowly. Her mind was killing her.
- She started taking online therapy from a psychologist secretly from march 2020.
- Her 24*7 severe burning sensation intensity starts to get better after 6 months of its onset and she learned some coping techniques to deal with her anxiety.
- Psychologist recommended to approach a psychiatrist and convinced her to take help of medicine as well because counseling was not enough only.
- After psychiatrist evaluation, co-morbidity of Generalized Anxiety Disorder followed by panic attacks and major Depression was diagnosed.
- Flux 20mg (Fluoxetine HCL) was started once daily and continued for 1 year by psychiatrist. Counseling sessions by psychologist was continued for 6 months.
- She vomited after 4-5 days of taking the medication followed by panic attack.
- 1st episode of her allergy got triggered where she continuously sneezed whole day for a month. She discussed with the psychiatrist where she was told it is not because of medication. Since then time to time she has these allergy episodes up to this date.
- Mood starts to get better with months passed but other than else everything was same.
Journey from 2020 - 2025
- In August 2020, occurring of the IBS episode leads to approaching a gastroenterologist. Who performed some medical tests and declared once and for all "we do not have her cure. Her psychiatric medications will be continued as her treatment is there. She might have to take psychiatric medications & pain killers for her IBS episode for lifetime."
- Patient felt relieved after knowing that truth at that time as every other doctor was just stuck in performing medical tests and providing multiple medications. She was just fed up of it.
- Later that year she got in contact with the doctor from India who after listening to her whole history provided the insight that the patient's bowel movement is slow, it is not regular as emptying a bowel in her case took minimum 3 days. He educated her regarding her issues, gave bowel movement training, tracked her daily routine, asked her to follow low FODMAP diet for few months, did a course of omeprazole and asked her to take only one medicine (omeprazole) whenever any problem arises.
- She starts to eat better, her condition started to improve. With good nutrition she gained weight after more than a decade. From her average weight of 48 she reached to 56 and even 58 with time.
- Since 2021 - 2024, IBS pain episodes were reduced to 2-3 times yearly which was managed by omeprazole only & later Bascopan plus.
- In between these years there is a vitamin D deficiency again, irregularities in periods but it is currently good now. Extreme whole back pain for 6-7 months where patient can't get up from bed and daily functionality was hindered badly. The pain subsided on its own after 6-7 months.
- Since December 2023, patient has a floater in left eye.
- In August 2024, Patient suffered from extreme pain in the eyes followed by Hardness and severe pain in both eyes, Eye movement was painful, Extreme pain in eyelids on touch, Redness, Extreme pain in light (Darkness was soothing) so patient wore sunglasses all the time. Patient took an expert opinion online who prescribed an eye drop ofloxacin. Took it for a week but nothing improved. After 10 days patient took paracetamol and 90% of the problem was resolved within 15 mins. Patient went to ophthalmologist. Her eyesight got checked which was normal. Eyes were evaluated and nothing was found. Doctor ruled out everything major and said mild inflammation is there only. He said those severe symptoms could be due to depression but no reason is certain.
- Since the October 2024 begins, patient is suffering from chest pain that is localized in the center spreading to whole chest. Upon every moment or pressure there is extreme pain felt. If the patient is at rest, nothing is felt but upon every moment like getting up from bed while lying down, bending forward to pick up something from the floor, moving hands, sneezing, kneading the dough or washing utensils. Some days it is intense when every little moment have extreme pressure & pain in chest and other days it is less intense but it is sitting there all the time. Same Indian doctor diagnosed it as "Chest pain as Atypical complication of Chronic GERD".
- Since last 3 Januaries patient is having severe throat infection that takes a month to recover but this January 2025 she had a change of smell as well where everything smells so badly that it was unbearable. After 3 days she got her 70% smell back. After 15 days she got 99% smell back. After a month she got 100% smell back.
- In February 2025, due to constipation she strained a lot for the bowel movement at 10 pm. After 5 hours when she went to pee at 3 am she bled a spoonful of blood from rectum area. She got fever in the morning and then in the evening. She kept in check for the blood for few days but there was no sign just pain in the area. She also had pain in the body since few days due to physical work load which was the reason for the fever probably. Paracetamol helped a lot in this case.
- Later on time to time she had fever either after taking shower or after getting tired. This event happened approx 3 times.
- In march 2025, she slept on hand by mistake for 30 min. After waking up her whole index finger got numb. In 10 mins half of the sensation came back. Remaining half was not intact. Her motor function was normal. Finger looked fine but slightly swollen & heavy. She felt current sensation on touching dorsal side of hand between index finger and thumb. She felt minor unusual sensation till her elbow. Later reduced sensation in half of her middle finger also just like index finger. While giving it rest, fingers were becoming stiff. So she kept using it and did work with it. Now it is a lot better. Only minor issue is left. This radial pinched nerve issue in right hand comes and go since years.
- At the end of march she again had throat infection. 3 days of antibiotics course was done.
- On 10 March 2025, After eating 1 Guava (without seeds) in empty stomach the IBS pain triggered and with 3 doses of buscopan plus & omeprazole the pain didn't reside. After 4 years it becomes severe that the patient went to the hospital where nospa forte injection was given with a prescription to follow for 3 days.
29 April 2025
PaJR PHR Moderator: The narrative event data below is suggestive of musculoskeletal pain👇
"Upon every moment or pressure there is extreme pain felt. If the patient is at rest, nothing is felt but upon every moment like getting up from bed while lying down, bending forward to pick up something from the floor, moving hands, sneezing, kneading the dough or washing utensils."
PA: Sir what will you suggest about this ?
PaJR PHR Moderator: If it's truly musculoskeletal then one need not worry. A chest X-ray image could tell us further.
Also I guess the important radiology images supporting the diagnosis of extra pulmonary tuberculosis in this patient is not available anywhere now?
PA: Ok sir I will go for chest x-ray.
No sir those images are not available now.
Sir what should i do further?
PaJR PHR Moderator: A proper small bowel enema if that is available?
Not that the organic diagnosis will change management at this point of time. I have a patient unpajred but in touch through pm who has exactly similar history and I'm following her up since 2005!
PA: Sir this is small bowel enema, the same you mentioned?
30 April 2025
PA:
1 May 2025
PaJR PHR Moderator: Thanks! The lungs look hyperinflated. Did she ever have any history of bronchial asthma?
PA: No sir. No history of bronchial asthma.
When she was going through mental health issues in 2019. She had severe breathing issues. She used to breath though mouth. Later with years it got better.
In 2020 allergy got triggered she sneezed non stop for a month. Till this date with perfume, dust, smoke or any unknown things triggered the allergy every week where she either get better on its own within an hour or she has to take cetrizine/levocetrizine.
Still with just few physical work or stressed she has breathlessness.
PaJR PHR Moderator: These symptoms are matching her chest X-ray
PA: Sir what is the reason and what is your diagnosis? What you will suggest or conclude?
PaJR PHR Moderator: When was her last attack of breathlessness?
Please describe that in hourly detail
PA: 2 days back on 29 april
12pm
I woke up after 3 hours of sleep.
1pm
I had my 1st meal which i took 1 hour to finish.
2pm - 4pm
After namaz, I searched about musculoskeletal pain and took a nap in between.
4:30pm - 6pm
I pressed my clothes. Got ready and father took me to hospital which is at a distance of 2mins drive.
I was little worried about it so very minor breathing difficulty started.
While i was waiting for my turn in the hospital breathing difficulty started more probably due to anxiousness.
6pm
I came home and went straight to shower.
6:30pm
I prayed namaz which took me 10mins. After that I had call with my sister where talking becomes difficult. Where she said to me to stop talking due to breathlessness. I said it is normal, it happens all the time so i kept speaking and sat down for a while. I went to kitchen and fried kababs.
At 7pm
I prayed namaz
I had my second meal.
7:30pm-9:30pm
I was sitting, resting and talking to mother when breathlessness went away i guess.
9:30pm
I prayed namaz. It took me 20mins.
10pm-12am
I watched a documentary.
12am
I was tired and slept early. Took 1 omeprazole before sleep as there was burning in the abdomen. Woke up in the the middle due to acid reflux, drank some water and slept again in inclined position.
PA: Only little work makes her breathe through mouth and bone/body pains. So whatever physical work she does, she do it with gaps, sit for a while and start doing again.
Talking longer also makes breathing difficult.
PaJR PHR Moderator: Thanks. These details are making things more clearer. I hope it's all being archived in a case report for later recall?
PA: Yes sir I will update it.
3 May 2025
PA: @PaJR PHR Moderator sir what should i do further for this musculoskeletal pain and hyperinflated lungs?
PaJR PHR Moderator: Exercises like yoga including breathing may help
PA: Ok sir thank you
16 May 2025
PaJR PHR Moderator: This is a very well done patient update.
Can we have a similar when she last experienced her chest pain? Are both the symptoms associated closely?
PA: Sir, it is very difficult to explain. But chest pain is there all the time. Since october, it is there every day. Certain position doesn't allow me to lie down on bed as the pain becomes sharp.
PA: May 15
6am
I ate oatmeal. Walked for 20-30mins.
7am
I slept in inclined position. Within few mins acid came and I woke up drank water and slept again.
1:30pm
I woke up and the intensity of chest pain was severe.
2pm - 3pm
I took shower. Pain was so much that I can't even take out handwash from the dispenser. Later with hours pain reduces.
3pm
I had one onion paratha and 1 fried chicken. (I was able to eat only half of it)
Breathlessness started and i felt very down. Heart felt like sinking. (Probably due to weather)
4pm
I prayed namaz. Took me 20mins.
4:30pm
I just got to bed and rested so that it gets better.
5:30pm-7:30pm
I prayed 2 namaz in between this time. Took me 15-20mins each.
I drank sugar/salt water.
Till then energy was really low. Energy was draining and draining and just can't talk to anyone. Really low. I was just on bed lying down.
7:30pm
Finished the rest of the remaining meal.
9pm-10pm
I slept for 1 hour.
When i walk up burning started in the abdomen. I walked.
After sleeping i felt better in terms of energy.
(I thought of doing a lot of things on that day but was unable to do it)
PA: Breathlessness and acid reflux issues are since years. Sometimes i felt it is more like related to acid.
Although the chest pain is less and severe according to various reasons also when lift heavy objects. But the day the acid comes at night, the intensity increases definitely.
PaJR PHR Moderator: Looks like esophageal pain
PA: Is it something serious or could lead to something serious?
How can I resolve it that it doesn't lead to something serious?
As I am already scared about it since months.
PaJR PHR Moderator: @Meta AI What is the natural history of chronic unexplained esophageal pain? What complications can it lead to?
Meta AI: Chronic unexplained esophageal pain, often associated with esophageal spasms, can manifest in different ways. There are two main types of esophageal spasms:
- Types of Esophageal Spasms
- Diffuse Esophageal Spasm: Also known as corkscrew esophagus, this condition involves abnormal simultaneous contractions in the esophagus, leading to difficulty swallowing and chest pain. It occurs in about 2% of non-cardiac chest pain cases and 4% of dysphagia cases.
- Jackhammer Esophagus: Also known as nutcracker esophagus, this rare hypercontractile disorder causes painfully strong contractions in the esophagus.
Causes and Triggers
The exact cause of esophageal spasms is unknown, but potential factors include:
- Abnormal functioning of nerves controlling swallowing muscles
- Defective propagation of peristaltic waves through the esophageal wall
- Exposure to acid, which can result in esophageal spasms
- Consumption of very hot or cold foods and drinks, which may trigger episodes
Complications
Chronic unexplained esophageal pain can lead to:
- Difficulty swallowing solids and liquids
- Regurgitation of food and liquids
- Squeezing pain in the chest or upper abdomen
- Increased risk of anxiety and stress due to persistent pain
Treatment Options
Treatment for esophageal spasms may include¹:
- Medications: Nitroglycerin, calcium channel blockers, and low-dose antidepressants like trazodone or nortriptyline to reduce symptoms
- Dilation: Widening of the esophagus in severe cases
- Surgery: Rarely necessary, but may be considered for severe cases
It's essential to seek medical attention if you experience persistent chest pain or difficulty swallowing, as these symptoms can also be indicative of other serious conditions, such as heart disease.
17 May 2025
PA: Sir @PaJR PHR Moderator I have started omeprazole 40mg from yesterday for 1 week as suggested by @Participant.
30 August 2025
PA:
Update
* Last 5-6 months patient was having extreme mental health issues due to which she lost 7-8 kg weight coz of not eating properly.
* From 54.5 kg she reached to 47-48kg.
* GERD got extremely severe at that time.
* She takes omeprazole 40mg for GERD on and off.
* Since last 3 months she had a grip over mental health and started to recover.
* As the anxiety reduced so as the intensity of GERD.
* But her weight is still 48Kg. It is not recovering.
*Area of concern:*
After 5 years of severe GERD issues, It's been 10 months of continuous chest pain probably (esophageal pain).
As the acid reflux is becoming better, chest pain is also reducing but not completely gone.
And patient is worried, as the duration of esophageal pain is 10months, it doesn't lead to esophageal cancer.
PaJR PHR Moderator: When was her last upper GI endoscopy?
PA: It was never performed.
PaJR PHR Moderator: Then it is necessary
PA: Ok dr.
11 Feb 2026
PA: In September 2025, patient visited gasteroenterologist due to her severe Gerd issues that is since 2019.
Her main concern was her chest pain probably due to acid reflux.
He clearly advised me to treat my anxiety for my gut issues as my issues are due to my mental health + sensitivity of gut.
Upon asking for endoscopy he clearly declined it as he found it not necessary at this stage.
He started omeprazole 40mg, suralfate syrup and Levosulpiride. Patient took these medications for 1.5 months.
She visited him again in the mid of october and dr asked her to continue it. He adviced her not to focus on her chest pain as of now. The chest pain started to improve. She started to gain weight which she had lost 8kg in the previous year.
She stopped the Levosulpiride on her own as she don't wanna take any medicine for mental health but continue taking the other two for 2-3 weeks.
Since then she is on omeprazole and sucralfate on and off.
Her chest pain was improving but 2 weeks before the acidity becomes worse again due to up down of diet. And her chest pain become severe again. The sensation that something is stuck in her throat had never left her since the beginning of Gerd in 2019.
She have gained 2Kg weight since September.
Currently she is on omeprazole 40mg since 2 weeks and sucralfate. But it is been long she have bad sleep quality due to acidity.
PaJR PHR Moderator: In the past, when was the last endoscopy done for your patient?
PA: It was never done.
PaJR PHR Moderator: That's strange. How long has this patient been suffering from gerd?
PA: 6 years. Visited many doctors but they never did endoscopy and this time gastro also said that as we already know we will find burns so there is no need to perform endoscopy.
PaJR PHR Moderator: No that doesn't sound right! I'm saying this as someone who is an advocate of the anti over-testing movement but these Gastros appear to be riding the crest of that movement!😅
PA: Ok dr.
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