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What Causes Deep Constant Pain Below The Rib Cage?

Posted on Tue, 14 Apr 2015

Question: i am a veteran so go to va hospital....they have taken an MRI and ultrasound of the left side of stomach area because i have a deep constant pain right below the lower rib cage....it thought it could be bruised spleen but not i have to sleep on the left side to stretch out the area so it doesnt hurt to sleep.. they have given me also the berium XXXXXXX test so far nothing but i do have this constant pain where the spleen kidney area so i am at a loss

Answered by Dr. Dr. BR Hudda (2 hours later)

Brief Answer:
Please consider following tests

Detailed Answer:
Hello sir Greetings
I had gone through your question and I can understand your concern
Looking at your history this could be due to any of following when MRI and ultrasound is normal
acute infection of the covering of lungs (pleurisy)
muscle spasm
acute gastritis or stomach ulcer due to hyperacidity

I would likeep further information to help you better
are you running fever
intensity and nature of the pain
do you smoke or consume liquor

in my opinion you should ask your doctor for baseline investigations like blood for hemoglobin CBC ESR CRP and an X ray chest as well as upper abdomen standing or a gastroscopy

Pain killers with anti acidity medicines are recommended from my side for symptomatic relief
continue fiber supplements and probiotics
have multivitamin supplements
avoid spicy fatty fried food and carbonated drinks
say no to smoking and alcohol

Hope you will find my response informative and helpful
please revert back to us with aforementioned details I will definitely help you to diagnose your illness accurately
wishing you good health

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. BR Hudda (6 hours later)

i take 1/2 pill for high blood pressure, 1@4 times dy for parkinsons(for 3yrs) i dont generally run any fever. when i started having this side pain i was using a AB chair that u do twists and turns and hold it while your twisting to left to right and then u hold it as long as u can....so i originally thought it was from to much excercising especially at my age because never had stomach problems at all and it wasnt till i started doing these AB excersises that i developed the side ache. I also have been told of degenergtive disc (3) and that the pain might be from the disc and its shoots out to my side which for a while seemed logical but now my back not hurting 4 last 3 months so that idea gone out the window. The steroid shot they gave me in Sept last year helped both back and side but it has wore off and i am scheduled forMay 27 to get another shot. the pain is 24/7 but not intense a 6 on a 10 scale. i hope in fall to get on to medicare to see if anything different can be done....or do u think as the VA says to go on Pain Mgmt and just do steroids shot. to me their solving the pain but i wanna know why the pain to begin with. 4 if it werent 4 the side pain my Parkinsons wouldnt be so bad to deal with because having a side ache and then trying to walk with parkinsons dont go together. I have at this point low grade parkinsons almost like having the symptoms and not the diease. so curing the side ache would change by world in regard to the parkinson. thanks

Answered by Dr. Dr. BR Hudda (3 hours later)

Brief Answer:
This could be a musculoskeletal pain

Detailed Answer:
Hello
thank you so much for replying back with detailed medical history

This could be muscular pain which might have been triggered by twisting exercise on AB chair.
Since you are not having any backache which rules out disc problem.

To be on safer side ask your doctor to rule out pleuritic as well as gastric problem by tests I have mentioned previously.

If you can write back to us about the medicines you are having for high BP and Parkinson disease, it will be a great help to diagnose your side pain better.

Muscle relaxant like chlorzoxazone group of drug and physiotherapy is recommended after consultation with your doctor

Hope this addresses your question
wishing you good health and vitality
regards

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Dr. BR Hudda (34 hours later)

The VA has also given a back brace but it is so bulky to wear but i think i will try to find a body shaper becasue it seems when i tighten it around my stomach the pain is in check. The weight of my stomach seems to pull down on me causing the pain, because when the brace is on it pushes my stomach up and doesnt hurt as bad. but the brace being so bulky can only be used standing up. Also the B/P pills i take is Lisinopril 40mg 1/2 tablet a day and the Parkinsons is Carbidopa/Levodopa 50/200 4 times a day both i have taken for 3yrs. I have kept away from some pain relievers because most of the side effects would only antagonize the grogginess of the parkinson medicine and make it more diffucult.So at this point the steriods are the best pain reliever without the side effects of the other muscle relaxers or pain killers. As i have said it just feels like being pregnant the weight pushing down so a girdle would at least push it back. i have an apt next month with neuro doctor and going to ask if the side pain could be because of the parkinsons and ask what he think the pain is from

Answered by Dr. Dr. BR Hudda (1 hour later)

Brief Answer:
light weight back braces are also available

Detailed Answer:
Hello
thank you so much for your reply
from your history it seems you are overweight
if you can update me about your weight height or BMI I will suggest you some guidelines to reduce and maintain an ideal body weight

Parkinsons or Medicines you are having are very unlikely to produce such unilateral pain

steroid has got more side effects then the pain killers so I would suggest you to manage this pain without medicine by modifying posture gait and physiotherapy
There are very lightweight back braces are available in the market about which I am sure your physiotherapist knows

Hope this answers your question
fell free to ask for more information I will be happy to help you
best wishes

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Dr. BR Hudda (45 hours later)

At present i weigh 184; and have been avg 182-186 since the 90's. I doexcerscise and had not a small pot belly since diagnosed with Parkinsons in 2011. I was starting to develop the small pot belly at that time and bought a AB chair to help but i was getting over zealous especially at my age in excercising and at time didnt know parkinsons slows down your metabolism so it didnt help smallr belly. the doctor doesnt say much about it other than my age and the slowing down of mt metabolism..I have seen charts that say at 5' 8' i should be 150-160 but i have never been that except when i had my radiation treatments for cancer back in 87-88 and i was 147. and doctors didnt like that. As you mention overweight, i would really like to find a way to bring up my metabolism to drop the belly fat. the rest of my body is in good shape and for whatever reason God seems to have helped my back. I have found on the internet a light weight brace. Since u mention taking muscle relaxer versus steroid guess i will try that; I also take some gas pills whenever my stomach starts to tighten which also helps my stomach from being so heavy. I have to eat small meals otherwise my stomach becomes heavy and tightens up. Its like being pregnant the stomach squeezed on top. But between the side pain and my being pregnant the parkinsons would be livable....I want also to take the moment to say t uhank yoo. This has been the biggest help....just being able to sit down and talk....I understand theres time involved for doctors but i have learned more from u than in the 3years with my doctor..My pain mgmt doctor is from XXXXXXX and he is good also....thanks

Answered by Dr. Dr. BR Hudda (5 hours later)

Brief Answer:
Please consider following guidelines

Detailed Answer:
Hello sir
Thanks a ton for your kind words and I am very happy with your feedback it's all your blessings and good attitude towards doctors which motivates them to serve better

You have low metabolism due to age as well as parkinsonin disease ; you need to boost your metabolism by regular exercise and having healthy diet, and living a healthy life style.
I would suggest you following guidelines
have small and frequent food more of fruits and steamed vegetables
avoid junk, fatty and fried food or carbonated drinks
don't go to bed immediately after food keep a gap for at least 2 hours
don't take heavy food at night
consume more of whole grains and dietary fibers

You should consult your doctor for Yoga which will be very beneficial in weight reduction by boosting your metabolism.

I hope you will find this information useful and relevant to your health
wishing you a very good health and vitality

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. BR Hudda (46 hours later)

It seems like the stomach acid problems occur mostly at night; thats the only time i get the rumblings so i take tums and a bloating relief tablet...So it is some kind of gastric acidity problem. Diet wise a have instant oatmeal with blueberries (berries for high blood pressure) lunch, a turkey and chees sandwich and at dinner no one certain food. i do eat eggs and at times also ground turket meat. Snack wise when i do eat chips its the unsalted kind and been also eating yogurt (activia) and sliced beets also for high blood pressure. I have kept away from muscle relaxers 4 the 1 my doc prescribed side effects included seizures. I have tried also to keep away from stomach medicine for side effects generally knocking me out which i avoid because the parkinsons and BP pills slow me down anyway.But i like your idea about veggies and fruit. I know i have to raise my metabolism to help my stomach. And i am hoping the fiber and probotics with fruits and veggies help. The last question i have concerns Parkinsons...At nite only my legs feel heavy making it hard to get comfortable to sleep....i get beat up at nite because i have to sleep on left side(the pain side)to get any sleep then add the heavy legs (which by the way not eve ry nite but 4-5 nites) then the BP pill; going at least 3 times in the course of the nite so i average 4hrs nitely. But i am thankful at this point the parkinsons is lite and hope it will always be....Its just if i could reduce the stomach problem the parkinsons would be easy....I will just have to wait and see what God has to sayy.....

Answered by Dr. Dr. BR Hudda (13 minutes later)

Brief Answer:
Vitamin B12 is recommended for heaviness in legs

Detailed Answer:
Hello
god is very kind to we all he will take care of everything

you need not to worry because stress and anxiety can lead to excessive acid production in stomach leading to reflux and bloating

for heaviness in legs you should ask your doctor for vitamin supplements especially vitamin B12 which can be administered via weekly injection or daily tablets

To avoid reflux follow certain preventive life style modifications as I advised you earlier

God is great have faith in god
take your medicine
try to exercise as much you can comfortably do
have healthy food
try to avoid cheese sandwiches and chips
have brown bread , steamed meat and egg without eggyolk

Hope will helps you to regain your health
regards

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Dr. BR Hudda (2 days later)

Well Dr Hudda......I am going to do a soft diet. morning my oatmeal and berries and lunch have mixed berries and peas and carrot with beets. Then at evening have ground turkey and brown rice and peas and carrots....I will cut out all my snacks (chocolate donettes, unsalted chips,popcorn)i know their the worst. and stick with the yougurt as my snack entirely. pickup some extra fruit. I talked to the nurse this morning and she was gonna t alk to Dr to get something for the bloating anyway. They dont know what to do because the MRI and ultra sound looked normal. I dont know who to go to because something is wrong. Nobody has actually looked at my stomach much less touched it to feel how hard it is or bloated. What i am hoping for is 1st of next year my car will be paid for and i will have extra money to apply for medicare and try a differerent Dr. They are trying but too many patients. its too bad i couldnt try an outside Dr and the XXXXXXX it to the VA so they could get an 2nd opinion. As i said i have learned more from you at this point. They are connected to the Vanderbilt Hospital i gather for parkinsons. I just need something to go on. It is at least comforting a doctor is listening at the other end. At least theres medicine in that it is a shame that it doesnt work well face to face time wise at least in this mode i think it is successfful for now i will count 9 months till medicare and go from there....so i hope Dr Leithner prescribes me some good bloat dissolver medicine!!! thanks

Answered by Dr. Dr. BR Hudda (7 hours later)

Brief Answer:
Upper GI endoscopy is advisable

Detailed Answer:
Hello sir
thank you so much for your reply, many veteran patients visits in my clinic so I can understand your concern well
Such problems are very common particularly in your age group so you need not to worry much

I am sure you will definitely be benefited with your diet plan and moderate physical exercise
your diet is OK now strictly follow it with more of steamed vegetables and fresh fruits
masticate your food properly
Start doing Yoga to boost the metabolism

as far as bloating is concerned it could be due to acid peptic disease because stomach hyperacidity or drug induced gastritis and acrophobia (air swallowing)
In my opinion you should discuss with your doctor for upper GI endoscopy to see the stomach lining and rule out erosive gastric lesions

you can ask your doctor for omeprazole or ranitidine group of drugs and antacids for stomach hyperacidity

here I would advise you to try to avoid medicines as much possible other than the drug for BP and parkinsons disease

Hope you will be alright very soon
Have a nice day
Regards

Note: Revert back with your health reports to get further guidance on your gastric problems. Click here.

Above answer was peer-reviewed by : Dr. Shanthi.E