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A Pain in the Chest

 
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Anonymous
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PostPosted: Tue Nov 25, 2003 7:27 am GMT +0000    Post subject: A Pain in the Chest Reply with quote

Hey Doc,

Last Sunday I was out at RHR riding and about 35 minutes into my ride I suddenly started having my chest hurt. Just to the right of center and then I noticed it also felt like a spike coming out of my back about the same placeas it hurt in front. I kind of freaked and slowly headed bake to my truck. By that time, about 30 minutes later the pain was still there but noe more like a tightness and the place on back still felt like a spike.

I drove to my doctors office (yep, office hours on Saturdays and Sundays) The doc listened and poked, ran an EKG and a wind test. I did the wind test again after an inhaler. Fricken Asthma he says. WTF?!?!?! How can I have asthma NOW? I never had trouble breathing just the constriction causing the pain. He gave me that purple inhaler thingy for a few days and I'm supposed to go back after the holiday for a follow up.

So have I maybe had this all along and didn't know it until now? I started my ride just as the wind and weather changed. The temp dropped about 10-15 degrees just as I started out. Is the sudden cold a trigger?

At least it was not a heart attack and is managable.
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G-Hoch
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PostPosted: Tue Nov 25, 2003 12:12 pm GMT +0000    Post subject: I have had a similar experience. Reply with quote

I had a similar sensation for year, then one time I was driving 400 miles to go back home and it happenned while I was driving. I could barely take a breath. My mother got me into her chiropractor, and he said I had a rib out of place. He fixed it, and it has hardley given me any trouble since. I had gotten the doctor and he told me (after the tests on my heart) that he didn't know what it was. It felt like something was poking me in the lung. You might look into this before you start down the asthma medication route.

Gary
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The Bike Doc
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Joined: 08 May 2003
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Location: Corpus Christi and Warda, Texas

PostPosted: Tue Nov 25, 2003 6:15 pm GMT +0000    Post subject: Reply with quote

Debbie:

Your symptoms could be asthma, but I cannot jump to that diagnosis at this time with the information at hand.

Now the wind test you did may have been a Pulmonary Function Test (PFT). If there were certain change in your air flows that showed a significant reduction in your airflows that subsequently improved after the bronhodilator, that would be entirely consistent with the diagnosis of Asthma.

Asthma does occur for the first time in adults. Risk factors for developing asthma include a history of respiratory allergies (Hay Fever), allergic skin problems (Eczema), history of smoking or exposure second hand smoke, a history of wheezing or recurrent bronchitis in childhood and/or direct family members with similar histories.

Asthma symptoms such as chest tightness, coughing, shortness of breath or wheezing can be brought on by excercise, especially in cold air, Upper Respiratory Infections (colds), exosure to aerosols, dust or tobacco smoke. Additionally laughing hard or crying can bring on asthma symptoms.

Other disorders that can cause chest pain and tightness include coronary artery disease (angina), gastro-esophageal reflux, muscle spasms, impinged nerves (which likely what G-Hoch was experiencing), vocal cord disfunction (a disorder in which the vocal cords spasm with hard breathing).

Talk with your doctor, if your history, physical exam and laboratory test are strongly consistent with asthma, then medical intervention is indicated. The "Purple" inhaler he put you on is called Advair a combination of Fluticasone, an inhaled corticosteroid that is topically active but not systemically active, and Salmeterol, a long acting inhaled beta agonist (bronchodilator). It is an effective therapy, but must be used on a daily basis, twice a day to achieve maximal effect. It comes in three strengths and if you do not get addequate symptom control you may require a higher strength.

If you have any concerns, do voice them with your doctor and if you desire, seek a second opinion with a Pulmonologist (a lung specialist) to help you answer your questions and make sure you are correctly diagnosed and treated.

Thanks,
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Paul K. Nolan, MD
AKA: The Bike Doc
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Kyle
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PostPosted: Fri Dec 05, 2003 9:21 pm GMT +0000    Post subject: Reply with quote

get an EKG done, that is how my whole thing started......just my opinion but if it hadnt been for my EKG I wouldn't be here today!
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The Bike Doc
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Location: Corpus Christi and Warda, Texas

PostPosted: Mon Dec 08, 2003 8:41 am GMT +0000    Post subject: EKG Done Reply with quote

Kyle:

An EKG was done; see the body of the original text. An EKG should be done as part of a chest pain work up. A normal EKG does not rule out heart diseases but a postive one is helpful.

Thanks,
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Anonymous
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PostPosted: Mon Dec 08, 2003 9:32 am GMT +0000    Post subject: Reply with quote

Doc did an EKG and said it looked very good, ruled out a clot and something else. The PFT showed 240ml, or over 30%, improvement after the inhaler. Said that indicated asthma, along with the noise he heard in my chest where it hurt. Or actually I think the noise he heard led him to do the other tests.

I went to the followup last week. Doc wants me to do the Advair before riding as a maintenance precaution. Said it will lessen the future effects. Kind of like taking alergy meds so you don't get slammed. At least that is my interpretation.

Also, the Doc looked back at my lab work for the last 5 years and was very "excited" about my cholestrol levels. Said they were excellent and he was not worried about my heart.

So right now the Advair is with my gear to hit before I go out riding. I'll follow his advise for now and see what happens.

My mom was recently diagnosed with asthma and has had breathing problems for years. I've suffered from hay fever most of my life and had bronchitus last year. So the asthma for me does not seem too far fetched.
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The Bike Doc
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Joined: 08 May 2003
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Location: Corpus Christi and Warda, Texas

PostPosted: Mon Dec 08, 2003 11:15 am GMT +0000    Post subject: Reply with quote

Debbie:

I am glad you are on the right track for your diagnosis and treament.

You will have optimal benefit of the Advair if you use it twice a day routinely. Advair is a mix of two asthma medicatioins: fluticasone, an inhaled topically but not systemically active corticosteroid, and salmeterol, an inhaled long acting bronchodilator. Inhaled corticosteroids take a couple of weeks achieve there maximal benefits. The salmeterol takes 30 minutes to reach its peak effect and last about 12 hours. If you take the Advair just before you ride only and not on a routine daily basis, you will never get the benefit of the inhaled corticosteroid (fluticasone) and you will have to take it at least 30 minutes before you exercise to get the maximal benefit of the salmeterol.

Asthma is an inflamatory disease of the airways charterized by airway hyper-responsiveness (bronchospasms) to various stimuli. The mainstay of asthma therapy is daily inhaled corticosteroids as this class of medications are the only class of drugs that have been demonstrated over the long term to actually decrease disease severity and death rate from asthma. That is why it is beneficial for you to be on Advair; just be sure you are using it in the correct way, twice a day routinely.

A short acting inhale bronchodilator such as albuterol can be taken 15 minutes before exercise to help prevent asthma attacks for occuring while exercising.

BTW, inhaled corticosteroids and the above mentioned bronchodiators are approved by the International Olympic Comittee, UCI and USA Cycling. Professional athletes who take these medications, must declare them on an appropriately filled out form signed by the prescribing physcian.

Thanks,
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Paul K. Nolan, MD
AKA: The Bike Doc
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