My doctor did not give me any medication except Indocin for pain. My chest and back hurt and I am extremely tired. I have not had any trauma or viral respiratory infections recently, have never smoked, nor did I go near people that smoke.

X-rays were taken and my doctor said my lungs are clear. I have had no surgeries and hope never to have any. I take vitamins, exercise and try to maintain a healthy life. The doctor said it could last as long as three weeks.

Please give me your thoughts on this illness. I had never heard of it before but it is painful and could make one think of a heart attack about to happen.

DEAR READER:
Costochondritis is an inflammation of the cartilage that connects the ribs to the breastbone, resulting in sharp pain. When accompanied by swelling, the condition is known as Tietze syndrome. One or more rib cartilages can be involved and can cause severe pain that may radiate to the neck, shoulder or arm, mimicking the pain of a heart attack. Injury, infection and fibromyalgia are common causes; however, in some instances there is no apparent cause.

Your physician obviously scheduled an X-ray to rule out other conditions, since costochondritis cannot be seen through any imaging test. In fact, it is diagnosed through history, examination and hands-on palpation over the area. It differs from a cardiac-related condition in that the pain from an attack is more widespread, while this pain is focused in a much smaller area.

I am sure you were disappointed when your physician only prescribed Indocin. In actuality, his hands were somewhat tied. Pain relief is obtained through non-steroidal anti-inflammatory drugs, muscle relaxants and, in some cases, anti-depressants. Rest, heat and moderate exercise that doesn’t aggravate the condition will also be beneficial. You do not have a contagious condition. It most often subsides in about two weeks. Obviously, you are beyond that time frame and are still experiencing pain. If your swimming involves stretching your arms out in front of you, modify your strokes to allow healing to occur.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My question is, I have done research regarding the new technology of CT angiography, which some state is better than regular angiography, especially for women in detecting small vessel cardiac blockage. It is also said to be safer than traditional angiographs. For my own peace of mind, I was wondering if this would be a valid test for me to have, and if so, is it as good a diagnostic tool as a traditional angiogram, which is invasive and carries certain risks.

DEAR READER: I believe in your case, CT angiography (study of blood vessels and arteries) is redundant. This procedure is relatively new but has it drawbacks. It is generally considered more accurate than an MRI, is less invasive, more cost effective and less painful. Some drawbacks to the procedure, however, are possible allergy to the contrast material used or skin damage at the IV site and the contrast takes up to 24 hours to leave the body. It is not recommended for individuals with kidney disease or severe diabetes because of the risk further kidney damage. Individuals who are very obese may not fit in the CT machine. It is also not reliable for small, twisted arteries or vessels on organs that move quickly, such as the heart and blocked vessels or abnormal heart function make it difficult to interpret the results.

In the case of inconclusive or abnormal results, traditional stress tests or angiographies are necessary. Since you have already had a normal stress test, it is not necessary to have CT angiography at this time.

As for your diagnosis of costochondritis (chest pain caused by rib or rib cartilage inflammation), I believe this is correct. It can be mild or severe and the pain can often be reproduced by pressing on the affected area. This is not a life-threatening condition. Effective treatment includes the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Pain usually resolves in a few days with treatment but in some patients can last several months. Try using over-the-counter medications to treat the discomfort; if it persists, see your doctor who may choose to run more tests and prescribe a stronger medicine such as prednisone.

I also want to congratulate you on your weight loss. Stick with it and continue exercising. Good luck.