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Chest and abdominal pain with normal tests

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My father 67 years old and having problems around diabetics, hypertension, thyroid, minor coronary artery disease.

Currently he is having the below problems:

1) chest pain for couple of months now. We have visited cardiologist and did ECG, ECHO, lipid profile and other tests and the reports are all normal. Doctors said it is a non cardiac pain.

2) Lower abdominal pain- we have visited gastroenterologist and have done colonoscpy and endoscopy with all normal reports.

We are clueless on why this these are happening. please help.

Category: Internal Medicine Specialist

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Category: HIV- AIDS Specialist
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Hello,

Thank you for your consult at Doctor Spring.

Chest pain can be due various reasons like cardiac pain, gastric pain, muscular pain etc. Given the history and age possibility of a cardiac pain are high, but as on evaluation there were no positive findings, other reasons need to be evaluated.

Is he having the pain continuously? Is it associated with food intake or does the pain come down even while resting? Was ECG done while he was having an episode of chest pain?

I would recommend that he makes a note of what is aggravating an episode of pain, like spicy food, stress, cold environment, lying on one side etc?

Also he can try taking antacids like tablet ranitidine 150mg twice daily for 5 days to see if this provides relief. If taking ranitidine does not help, he should take tablet voveran 75mg after food when having an episode of pain to deal with muscular pain.

I would recommend that you consult a GP for examination and chest x ray done to see if there is any underlying cause relaetd to chest pain like rib injury or lung infection etc.

Hope this helps. Do write to me for follow ups.
Thank you.


Patient replied :

Hello Doctor, Thanks for your reply.
Further to your answer, I would like to inform you that

The pain occurs during day time and aggravates after lunch. Moreover it aggravates on lying down or in resting position while sitting. He feels better while walking or standing.

He is taking Rezo D one tab daily before breakfast for gastric but without any help.

here is the complete list of medicines he is taking now:

1. Amaryl m1 - one tab daily before lunch
2. Covance CT - 1 tab daily at 8 AM
3. Atorfit CV 100- 1 cap daily after lunch
4. Ranozex 500 Mg- 1 tab twice daily before lunch and dinner
5. Thyrox 75 mg- 1 tab once daily before breakfast
6. Rezo D - 1 cap once daily before breakfast
7. Tab gabaneuron 100 mg- 1tab twice daily before meal.
8. Tab- Robinaxol- one tab daily after meal.

He also has history of constipation and takes softovac SF daily.

Also we have done chest X-ray PA view but nothing is found in it.

Can he take tab Robinaxol and voveran 75mg together? or we should stop Robinaxol?


Hello,

Thank you for providing the medication details.

There are few contradicting factor in the information provided by you.



Chest Pain - Most likely non cardiac. GERD related pain (similar to stomach ulcer + regurgitation ). Make sure he is taking the medication Razo D early morning atleast 1 hour before food. Avoid spicy foods, full stomach (Please see some online materials on how to manage GERD).

Your father is having a history of coronary disease. Plus he has Type 2 Diabetes. So if it was me I would cautions and would evaluate this chest pain thoroughly. This will include repeat ECGs, ECHO and Tread Mill test and if required a coronary angiogram. You can discuss these options with your Doctor. She is on Ranozex which is an anti angina medication. However other mainly used anti angina medications are missing from the list you have provided (like Nitrates, Betablocker etc )

He should be taking an anti blood pressure medication called ACE inhibitors under normal circumstances as he is Diabetic. However I could not find this in the list.

Voveran, Robinaxol to be taken only occasionally if there is a strong indication like a musculoskeletal pain. I do not seen any strong indication for Gabaneuron either.

The lower abdominal pain has to be evaluated. He will need a USG abdomen, Urine tests to begin with.
I strongly recommend expert care at a good medical centre. His prescription drugs needs to be revisited.

Hope this helps
Feel free to ask followups.
Thank you


Patient replied :

Hello Doctor,

Thanks for the detailed answer.

FYI, for abdominal pain, we did USG, urine test, endoscopy and colonoscopy in last 2 months and everything is normal. We have done a Whole Body Check up on friday and awaiting reports on Monday. I will get in touch with you with the details. Thanks


Sure, Do keep me posted.


Patient replied :

Hello Doctor, PFA the details of the tests done and the suggested medication as below:

1. tab Amaryl M2- 1 tab daily before lunch.
2. tab Thyrox 100 - 1 tab daily at 7AM
3. tab Covance 50- 1 tab at 8AM
4. tab covance 25 - 1tab daily at 7 PM
5. tab Atorfit CV - 1 tab daily at bedtime
6. tab Razo L - 1 tab daily before breakfast
7. tab Ranozex 50 - 1 tab twice daily before lunch and dinner
8. cap zevit- 1 tab daily after breakfast
9. syrup Lactihep 3 tsp with softovac at bedtime SOS
10. tab Nitrocontin 2.6mp- 1tab twice at 8AM and 5 PM
11. Tab Drotin DS- 1tab SOS after food.

Please suggest.


His blood sugar need to be better controlled. Other than this his blood tests results are more or less normal.
Please refer my earlier reply for medication recommendations. A Cardiologist review should be done. Better diet control should be attempted for 2 weeks. Recheck the FBS and PPBS values. If it still stays high he may need modification of his anti diabetic drugs.

Hope this helps
Thank you


Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
Experience: 
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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