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Q. My mother is having ribcage pain and mild chest discomfort while sleeping on left side. What to do?

Answered by
Dr. (col) Rakesh Karanwal
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 17, 2019 and last reviewed on: Dec 18, 2019

Hello doctor,

My mother is 55 years old. She is taking Jalra-M for diabetes and Thyronorm 50 mg for thyroid daily. Her diabetes is under control with her HbA1C also under control. We had the tests four months back. Her fasting sugar is around 100 mg/dL.

About 25 days back, she had a pain on the left side of the chest which could be pin pointed to last few bones of rib cage just above the stomach. This pain comes again when pressed at that same point of the rib cage and got aggravated if she used to take a very deep breaths or sleep on that side of the chest. We consulted a doctor and he advised a chest x-ray and ECG both came out normal. On this, he advised DFO gel to be applied. In this period she also experienced weakness and fatigue.

After 15 days of initial pain, although her pain was very very low she used to have a slight discomfort while inhaling deep and felt weak. So the doctor suggested to do a CT scan of the chest and advised calcium, and vitamin supplements. Now there is no pain even on pressing and even while inhaling deep. Sometimes when she sleeps on the same side of the chest a very slight discomfort is observed, sometimes at back or some times at below chest rib cage bones.

I am also worried as I found out that she has lost 2 kg in the last one month without any change in the diet and more than 5 kg in the last one and a half years. Although her energy levels are almost back to normal. She does feel the heat more than others and her last BP was 130/77 mmHg and her heart rate is 97 bpm. She feels thirsty more nowadays.

My questions are, should I get the ct scan done. Is the benefit more than the radiation risk? What should I do for weight loss? Does any further investigation is warranted here? Please reply.

Dr. (col) Rakesh Karanwal

Cardiology Diabetology Endocrinology General Medicine Internal Medicine Neurology Pulmonology (Asthma Doctors) Rheumatology
#

Hello,

Welcome to icliniq.com.

You have neither mentioned the duration of diabetes, latest fasting, PP (post prandial) blood sugar levels, HbA1c (glycated hemoglobin) value or the latest TSH (thyroid-stimulating hormone) levels. Please furnish the required information, as well as, her BP (blood pressure).

Further, the description of chest pain is suggestive of either

(a) simple spasm of the muscles between the ribs (which incidentally, would have improved with a short course of muscle relaxants and warranted no further tests, including CT scan).

(b) Inflammation of the left lung covering (pleura), which if associated with weight loss and low-grade fever could be tubercular.

(c) Coronary heart disease (chest pain associated with weakness and fatigue), particularly in the case of long-standing diabetes. I will therefore strongly recommend that she undergoes either TMT (tread mill stress test) or stress echocardiography to exclude or confirm heart disease.

Also, weight loss or gain is a common occurrence in diabetes. Anti-diabetic drug Metformin (M in Jalra M stands for Metformin) reduces body weight. In addition, a successful correction of hypothyroidism leads to weight loss. For her age and height, she is still overweight by 2-3 kg.

I would, therefore, recommend the following initial investigations:

1. Ultrasound of the left side of the chest (for detecting the presence of fluid in the pleural cavity).

2. TMT or stress echocardiography to exclude, detect latent underlying heart disease.

Lastly, I do not feel the necessity of a CT (computed tomography) scan at this stage. If she still has any chest pain, a short course of five to seven days of tablet Cip-zox (Diclofenac sodium and Paracetamol) one tablet thrice daily after meals would cure her pain, provided it is due to spasm of the chest muscles. Forwarding of the desired reports would certainly help me in reaching a definite conclusion.


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