Expert: Dr. Victor Dolan, DC, DACBSP - 7/12/2009

Question
Hi I was treated for Tuberculosis last year and I originally had sharp pains which disappeared with my tuberculosis treatment but I had this sharp pain in my right ribs when I tried to breathe, so I couldn’t almost breathe. One morning when I woke up I knew I had pain so refrained from even trying to take a breath, I used my nose instead to breathe. When I got up, I stretched my arms up and I took a full breath and I felt my right ribs crack in. It was like they had been pushed or pressed in, and ever since then I haven’t been able to take a full breath. When I wake up I felt the pain on a short breath. Sometimes when I try my best to take a full breath I feel the pain directly behind my ribs in my back but I suspect this is referred pain. I also experience my right upper chest tightening and the hospital say this is because I'm not taking a full breath. Last December I had a CT scan and nothing abnormal was found except this: "In the thoracoabdominal region, there is some asymmetry of costal cartilage with some concavity on the right side.this presumably may have resulted from past trauma and be giving rise to mechanical chest pain" I also had an ultrasound scan and MRI scan and there was nothing found. I was on painkillers for a long time and they weren’t helping so I stopped taking them and now they way I’m surviving is just drinking hot water and using a hot water bottle at night. Without this I can’t breathe properly. The breathing pain in my right ribs sometimes radiates to the middle and very frequently I experience a small pain in my left ribs but that is nothing compared to the great pain in my right ribs. Can this be fixed in any way? I can’t sit or stand properly because the pain is too much. I want to know if the concavity in my right side found in the scan can be fixed? I still feel this whole right side pressed in and I can’t take a full breath and at times not even half a breath. It has been One and a half years and I’m still in the same situation, stuck in the house and limited in my activities because of my pain. The orthopaedics specialist said nothing really but just inflaming of the ribs and he sent me to the pain specialist who I saw in March 2009 and he didn’t check me thoroughly and is going to give me an injection in November 2009. I also want to know if the injection is necessary for my pain. It’s very complicated but please help me. I will really appreciate it. Thanks.  

Answer
Hello Babar,



This is much more of a Thoracic Surgeons question, or perhaps an orthopedic question.

That said, I will throw my 2 cents in, but recommend a second opinion at a different specialty.

I am sorry to hear of your complaints.

Let me congratulate you.

You are in the United Kingdom, with socialized healthcare; Looks like the USA is heading your way too!  You can get all the healthcare you need for free, hopefully we will have the same here someday.


"....When I got up, I stretched my arms up and I took a full breath and I felt my right ribs crack in....."- there are many instances of PATHOLOGICAL fractue.  Bone weakened by a disease process can collapse, fracture, break.  From your description, it certainly sounds that way here.


"....and ever since then I haven’t been able to take a full breath....", when it happened, what did the doctors say? what did the initial Xray that day show? Any fracture or displacement?  When they took the comparison films two weeks later- did the Xray show a healing fracture or a deformity?

"...."In the thoracoabdominal region, there is some asymmetry of costal cartilage with some concavity on the right side.this presumably may have resulted from past trauma and be giving rise to mechanical chest pain" .....", mechanical chest pain, does the test show 'old, healed fracture(s)' ?

".... I was on painkillers for a long time and they weren’t helping ...."- some information on PainKillers that I hand out in my Staten Island Chiropractic office:


PAIN


Pain is a 'red light on the dashboard'.

Pain is your body telling you that something is wrong.

That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?

Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?

Pain,
do you cover up the pain by taking a painkiller?
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?



NOTICE ON PAIN RELIEVERS:

Label changes ORDERED by FDA; the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding
and liver damage (FDA news 206- 207; 12-9-06) ;

The American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA
statement 2-26-07).

NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage  destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse. These medications cover up the pain, and cause the
problem to worsen.


Pain can often be the result of the Vertebral Subluxation Complex.

Vertebral Subluxation ( ‘VSC’ , ‘subluxation’ )
Vertebral Subluxation is actually a quite common condition. Doctors of Chiropractic look for pathological conditions which may require referral to other specialties, and also look for ‘Subluxation’. Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system (the master control system- ALL health disciplines learn this). VSC- ‘Subluxation’ – can be the cause of many
symptoms and conditions.



Only a Doctor of Chiropractic will evaluate and treat for VSC, as
well as other pathology.



The course of VSC is highly variable. Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons
or lift heavy weights. Some patients immediately develop symptoms related to the VSC, some patients take years to develop symptoms. Some people suffer for
only a few days with pain and symptoms, some people suffer for months. Some people recover in days, some take months or years, depending upon severity of the condition.

A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.


The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a
stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.

Vertebral Subluxation cannot be corrected through chemicals
(medicine), stretching, yoga, vitamins or physical therapy alone.
Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with
the chiropractic adjustment.

Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a  Hospital in New York State (DHSI); As Seen in PREVENTION Magazine

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"....Can this be fixed in any way? I can’t sit or stand properly because the pain is too much...."- IF you had rib fractures, and IF your rib fractures have healed in this manner,,,, I do not think that much can be done:  AGAIN I recommend a visit to the chest surgeon (thoracic surgeon) and/ or the Orthopedic.  Perhaps some surgical intervention can be performed to remodel your chest.

".... I also want to know if the injection is necessary for my pain....", only YOU can determine if the injection is necessary.  Do you hurt, a LOT ?  If you hurt A LOT, then perhaps the shot was necessary.  There are side effects to every procedure/ medicine- ask your pain management specialist.

I am surprised this problem was allowed to develop.  Proper initial medical care should have healed the ribs properly.

Luckily, with socialized medicine, you should be able to get the care you need to get to the bottom of this (at no cost to you) and get the problem corrected.


If you need  further,,, do not hesitate to REcontact me here at
AllExperts.
http://www.allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm



Wishing you Good Luck, Good Health, and health improvement,
your Internet Chiropractic Staten Island Expert,


Dr. Victor Dolan, DC DACBSP
http://drvictordolan.chiroweb.com - - -- - Email NewsLetter