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Muscle pain in back, ribs on VIT D. Treatment.

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I have been having an almost round the clock pain that is on the right side. It feels like a muscle pain but does not really go away. Pain meds help but does not take all the pain away. My back right ribs and lower few ribs are also tender to the touch. If i push below the ribs on either side it hurts. Sometimes it also hurts in the bottom front of the ribs of the left side but that pain is off and on. The muscle pain is mainly right above my hip bone but below the rib cage on the right side only. If I push anywhere in that area i can feel it.  Massaging it helps for a while but it's always there. Also doing yard work can aggrevate it.  All blood work was ok but liver enzymes were 2-4 times high and vit d was very low. Went on meds for the vit d. Doctors keep saying muscoskeleton and let me go home. It's very annoying having the circle area of pain always there. Twisting my body and stretching also allows me to feel the pain.  Not one doctor seems to think its an organ. Kidneys have tested good. I hope you can help somewhat. I have tried it all. Its not a horrible pain more of an annoyance. 

Category: Hepatologist

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Category: Hepatologist
 22 Doctors Online

Thank you for your query at
I understand your concern.
If the pain is more localised on the right side, arising from the liver, it could be referred to the other side too. In presence of elevated liver enzymes, it will be prudent to get an ultrasound whole abdomen done to check for liver enlargement. The doctor examining you is the best judge really, because liver enlargement can be palpated and felt by the doctor. However it could be missed and hence ultrasound is a better option.
The amount of drinks could have contributed to the rise in liver enzymes. Have you been given any treatment for it? 2-4 times is significant increase and should be addressed.
If the pain is more spread towards the ribs in general, then it could be due to costochondritis, in case of which painkillers and stretching will help.
However i do agree with your doctors. If the liver enlargement is ruled out, it is more of a musculoskeletal pain. Because featutes like pain on both sides, pain getting worsened with physical activity and relieved with pain killers all poibt towards musculoskeletal pain only.

The next possibility is pinched nerve. I would advise for a MRI scan of the spine. This will help in finding the exact cause, provided ultrasound is normal.

In addition to the painkillers physical therapy should also be done for good relief.
Since you were diagnosed with vitamin D deficiency and you took treatment for it you need to check the current status now.

For how long have you been having this pain?
Can you attach your reports for me to review?
Also have you been given any treatment or were you advised ultrasound?


Patient replied :

Tried to attach the lab work but its to big. Everything was normal except alt was 174 and alt 80. Vit d was really low but took meds for that. The pain has gone away this week. It literally come for a week then goes away sometimes for a week. I was told to stop drinking for two month and come back for re test. I cut back drinking to about 15 a week but did not stop. I have no other symptoms. I have had blood work done three time and the enzymes were fine 1 of 3. Triyglicerides are high around 350 and cholestrol was 215. Hdl was 28. Is it possible I just have a fatty liver? An xray was done of the area and they said they did not see anything abnormal. I would love to get an ultrasound or mri but they will not do it. I feel it is probably muscoskelton or muscle related but would like to rule out the liver issue. Been paranoid about that.

Thanks for getting back to me with more questions.
You have mentioned ALT 174 and ALT 80. I presume you meant AST 174 and ALT 80.
These are high and are more than 2 times the upper limit of normal.
This could be due to alcoholic hepatitis/fatty liver.
An ultrasound scan of the abdomen may be done for conformation.
Fatty liver is very likely since there are many risk factors like alcohol intake, high triglycerides and cholesterol levels.
You need to quit drinking alcohol and take medications to control triglycerides and cholesterol levels.

Patient replied :

No alt is the higher on all three tests. Even when they were normal. Does that have any meaning?

High ALT again indicates liver cell damage. Some of the causes include fatty liver disease, viral hepatitis, metabolic disease of liver, autoimmune hepatitis and drug induced hepatitis. When there is hepatitis you will feel discomfort in the right upper abdomen.
If the ALT is normal and there is simple fatty liver , the liver may get enlarged and may cause discomfort in the right upper abdomen.
I would advise you to get an ultrasound scan of the abdomen done.

Dr. Ratnakar Kini
Category: Hepatologist
Fellowship - DM - TN Dr.MGR Medical UniversityResidency - TN Dr.MGR Medical University Medical School - Stanely Medical College, TN Dr.MGR Medical University
Dr. Ratnakar Kini and 4 other Medical Specialists are ready to help you

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