Brief Answer:
Gastritis and Lymes disease

Detailed Answer:
Hi Mr. XXXXXXX
Thanks for choosing health care magic.
I have gone through your query and I want to discuss your symptoms and rule out disease conditions.

Pinching pain in the chest: This symptom gives rise to suspicion that it could be either angina (cardiac cause) or gastritis and acid reflux.

The doctors in the ER have ruled out angina by doing EKG and other tests.

The other most common reason for upper abdominal pain is acute gastritis.
This condition presents with dull abdominal pain which is usually diffuse all over the abdomen and may radiate to back and chest.

I suggest you get in touch with your GP for a prescription of antacids, and preferably a proton pump inhibitor (Pantoprazole) which has to be taken twice daily before food for a week. I also suggest a smooth muscle relaxant to relieve your pain.
Ultrasound of abdomen can be done to rule out other causes of abdominal pain as suggested by your doctor.

Lymes disease: This disease is caused by tick bite and presents as fever, rash with joint pains.
Diagnosis of this disease is tricky as the antibody response appears late in this infection.

The symptoms of this disease vary according to the stage of the disease.
I suggest a confirmatory test like ELISA for IgM and IgG antibodies.
I suggest a confirmation of the disease first and then appropriate therapy can be taken subsequently.

I hope I have answered your query satisfactorily.

Thanks.

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Brief Answer:
diagnosis detailed below

Detailed Answer:
Hi Mr. XXXXXXX
Apologies for the late reply.

Lymes disease occurs in 3 stages:
Stage 1 - Round rash around the tick bite which is spreading and itchy. This occurs after 3-30 days after tick bite.
Stage 2 - Occurs few weeks after stage 1. Here patient has fever, headache, body pain, joint pains and lymph node swelling. Some patients can develop brain lesions during this stage.
Stage 3 - Also called persistent infection. This sets in months to years after stage 2 and characterized by joint pains, skin rashes, neurological symptoms and brain lesions.

Diagnosis of Lymes disease:
There have been reports of discrepant results given by IGeneX Lymes test and hence is not considered reliable by many labs.

CDC recommends two step testing process for Lymes disease.

First test is usually an Enzyme Immunoassay.(ELISA)
If it is negative, no further testing required.
Other diagnosis should be considered.

If first test is positive or indeterminate (not clear) then a second test is done to confirm using western blot test for IgG or IgM depending on the number of days the patient has had symptoms.

If patient has had symptoms for less than 30 days, both IgM and IgG testing is done.

If patient has had symptoms for more than 30 days, only IgG testing is done.

As mentioned in my previous reply, Lymes disease diagnosis is tricky because antibody response appears late in this infection.

Normally in any bacterial infection, IgM antibody is produced within the first week of the infection and then later IgG antibodies appear in the blood.

But in Lymes disease, the antibody response of IgM appears at 20 to 30 days of infection followed by IgG.

Hence it is easily missed during early infection and the doctor diagnoses Lymes based on clinical signs and symptoms.

I would suggest confirmation of the Lymes disease and further therapy based on test results.

I hope I have cleared your doubts.

Thanks

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Brief Answer:
Western Blot is confirmatory

Detailed Answer:
Hi Mr. XXXXXXX
Western blot is a confirmatory test and as it has been more than 30 days since your symptoms, IgG will be detected rather than IgM.

False negative results in Western blot is rare. If it is negative I suggest you get in touch with your treating doctor and explore other causes for the present symptoms.

Thanks,

Wishing you a speedy recovery.

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