Chest pain from striated versus smooth muscles

self-diagnosis

DEALING WITH PERSISTENT PAIN EXPECTED TO BE TEMPORARY

*** NOT medical advice. I’m not that kind of doctor. ***

Having abandoned the hospital last Tuesday with a relatively clean cardiac bill of health, and after the cardiologist visit on Wednesday, I noticed the pain hadn’t stopped. Not discomfort; PAIN.

(By the way, the cardiologists lose all interest in you at that point.)

It was a bit smaller due to relief – but that was all.

On Thursday, sensing it would finally work, I made the effort to voluntarily NOT cough when my body wanted to. That’s a trip, by the way: you have to catch it and distract it.

But it wasn’t enough. I was still setting off the kick-in-the-chest-by-a-mule feeling when I would do such small physical tasks as walk to the bathroom, go down 7 steps to the living room, and, the worst, coming UP those 7 steps and having to walk down the hall and across my tiny office to my desk chair, where I would sit, and grit my teeth until the pain started subsiding.

If I had not already done that, I probably would have made that hospital ER trip.

Why didn’t you go to yet another (or one of the same) doctor, Alicia?

Because I decided, if I knew I probably wasn’t going to die yet, that the whole experience had completely wiped out any chance I had of getting better without some serious rest time.

Internet lookup of possible sources of chest pain

Surprisingly not, it was hard to find the information online about non-cardiac causes. Because of course you push ‘get checked out by your doctor’ and ‘go to the ER’ as solutions, if you don’t want to have your patients’ families sue you.

Have you noticed how all sites that start with ‘Non-surgical ways to…’ quickly end up with dismissing those ways and heading for, ‘If you have to have surgery…’?

In the end I found NOT ONE SITE stating that coughing could CAUSE pain elsewhere that wouldn’t necessarily go away by itself.

And none of the sites talked about HOW long-term coughing might trigger TEMPORARY chest pain – I ended up deciding that one strictly on my own. Since it happened to me, I’ve decided it IS possible to cough so much that your chest gets supersensitive, and any little thing can then set it off.

Ibuprofen, which I now allowed myself, helped a bit – but not for long – and didn’t remove the crushing/tense feeling that minor exertion set off.

Some of the sites that talked about non-cardiac chest pain had a list of other serious things that it could be (with the ‘temporary’ part not discussed).

  • Some of them were pulmonary – things like pleurisy or pneumonia.
  • A bunch were gastrointestinal – having to do with spasms of just about anything from one digestive end of you to the other.
  • A very small number were musculoskeletal (specifically talking about the intercostal – between-ribs – muscles that help you get air in and out), and mostly seemed limited to sharp pains that might have been brought on by sudden muscular exertion.
  • And no one mentioned the specific area that seemed to be aching, the outer chest wall pectoral muscles.

Using the old noggin – a dangerous thing with mine

Assuming I’m not dying from something else wasn’t hard: I convinced myself the mule-kicks were induced by coughing, and would eventually go away if not continuously triggered.

So I decided to see if I could fix the phantom mule with things on hand in a regular household like ours, and figure out what it was. I also promised the husband I’d see my doctor again if the pain persisted despite my best efforts.

I decided, from the region affected, that the three candidates were:

  1. esophageal spasms
  2. pectoral muscle spasms
  3. intercostal muscle spasms

Tools on hand:

Last summer, I pulled my usual ‘I don’t want to go to the doctor’ routine when I’d had a bout of waxing and waning spasms of the GI tract, until, 8 days in, and 4 later than I would have taken anyone else, I went to Urgent Care and complained. I’d never had that intensity of pain before, and I was hoping it would go away before I had to have my insides subject to scoping – which would involve doctor visits, labs, tests, all things which are 1) exhausting, and 2) suck up my so-limited writing time because I have to leave the house.

When I finally went to UC, the doctor prescribed an anti-spasmodic called dicyclomine, and within a day or two my innards had stopped punishing me for eating, and drinking water. Much better. I stored the remainder, thinking it was a nifty thing to have with you on a vacation just in case.

Also, from a previous doctor I had Skelaxin, a muscle relaxant – said doctor saying I could take up to three a day. I had found that I could barely tolerate 1/3 of a pill, very occasionally, and it would knock me out. I’m a bit sensitive to medicines, which is why I try not to take them! But I have a couple of bottles of the stuff left, which will probably last until I’m in a nursing home, non compos mentis.

Plus over the counter cough suppressant, and the nice cough syrup with codeine which is the only thing that really suppresses a cough – and wipes me out.

What to use – and why?

I figured out the important thing depended on a fact I learned in Anatomy in 1968: that we have two kinds of muscle fibers:

  • striated muscles – heart, skeletal muscles, with the heart muscles being INVOLUNTARY
  • smooth muscles – lining your gastrointestinal tract (also blood vessels?)

The difference is that the striated ones can be affected by a muscle relaxant, and the smooth ones need the anti-spasmodic anticholinergic meds.

Using the muscle relaxant had helped a bit with Mr. Mule, but once I found the dicyclomine, and took some, I’m finding that the same medicine which the UC doc prescribed for acute abdominal cramps seems to be helping with spasms in the chest region. Same system: GI.

Conclusions

Which brings me to the conclusion that the pain probably comes from an esophageal spasm – a scary thing to consider if it were persisting or getting worse – but taking a few doses of the anti-spasmodic dicyclomine seems to be bringing the severity and duration of the pain attacks down to bearable.

Where we will keep them until they stop happening.

7 steps now trigger a much smaller animal kick; a jackrabbit, maybe.

I’m still having to control coughing attempts voluntarily, but I can do that, and the severity of that is also going down, so a week after this stuff sent me on an ambulance adventure, I am in a state of less pain, I plan to continue to avoid the doctors, and maybe I can get enough rest to get back to not leaving the house so I can write.

I’m so glad I took anatomy.

I’m not a medical doctor, so don’t do what I do.

But if you do, tell me what you figured out about your body.

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19 thoughts on “Chest pain from striated versus smooth muscles

  1. Alice Audrey

    I had a similar process with my medicine for post-op. They really pushed the Oxycontin. I don’t like the stuff because it not only messes with your head, but GI tract as well. So I ditched it almost the minute I got home.

    Results- my legs swelled up. Turns out it wasn’t just Oxy. it was Oxy HC. Luckily I recognized the HC as a diuretic in my blood pressure medicine. So I switched to the blood pressure medicine, which my pharmacist approved with my particular drug cocktail dujour. Over the next week and a half I weaned off it. Seems to have done the trick without totally messing me up.

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    1. Alicia Butcher Ehrhardt Post author

      They do not warn you enough – and all you want is to get the heck out of there.

      Glad you’re okay.

      I don’t like my head messed with – it’s so fuzzy so much of the time already. I lost all quality of life.

      Still hoping they got ALL the problems.

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    1. Alicia Butcher Ehrhardt Post author

      Meanwhile, if you have the cough syrup with codeine, and can take it, that’s the best cough suppressant out there.

      The chest pains have been outrageous – I almost went in again today. Will call my doctor tomorrow – there’s no hope of getting anything written when I feel this way.

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  2. Janna G. Noelle

    Sounds like you’ve been in a bad way.

    Last winter, I had a cough for three months straight. I tried cough drops, cough syrup, a puffer prescribed by the doctor, but it just would not go away. There was a new woman who started at my work around the time my cough started. Three months later, she remarked that she’d never known me with it. The doctor ruled out bronchitis, walking pneumonia, and all the other usual suspects (no tests were done for any unusual suspects). The only thing that eventually got rid of it was springtime.

    I’ve never had chest pains from coughing, but man did I have abdominal pain. I don’t think I laughed once during that three months for the pain of it. I totally believe that excessive coughing could cause chest pain, though – coughing is incredibly hard on the body. I’m glad that cardiac causes have been ruled out for your chest pain. I’m sure that is a relief even if the pain itself is still with you for now. I hope you get better before spring.

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    1. Alicia Butcher Ehrhardt Post author

      I’m ready for it to be over. Have managed not to cough, by force of will, since last Thursday. But the spasms – whatever they are – are still as painful as what sent me to the hospital. Never had anything like that before, and I’ll be happy not to do it again.

      I’m a writer! I can’t write! Makes me fractious. I have the time and can do whatever I want. I sit here for HOURS every day – and the brain won’t focus enough for fiction. Fiction is HARD.

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    1. Alicia Butcher Ehrhardt Post author

      I’m working on it! Thanks for prayers – always welcome.

      I keep getting the mule kick unless I’ve taken the dyciclomine, in which case the total pressure is less, but I have to stop what I’m doing so it doesn’t keep going – and then sit or lie quietly until it goes away.

      Still hoping all the new stuff is just temporary!

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  3. marianallen

    During my last bought of coughing, several people told me that they or family/friends had broken ribs from coughing so much. I know I’ve pulled muscles before during coughing spells, or displaced them or pinched nerves with them. Wish I could fly through the internet and baby you until you’re well!

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    1. Alicia Butcher Ehrhardt Post author

      Just talking to me is great – I enjoy commenting this way.

      I am pretty sure it’s not a broken rib, but, yes, long-lasting coughing isn’t a good thing.

      Never happened before, so I didn’t even think of it until AFTER the chest pains turned out not to be a blocked artery somewhere. I knew it wasn’t good, but didn’t realize how much.

      Live and learn, as always.

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  4. joey

    I figured out I’m super sensitive to a lot of meds, so like you, I don’t like taking them, and whenever possible and necessary, I take half to see if I really need the whole thing or if I’m going to pass out or vomit or feel weird. Usually yes.
    I figured out that right before my period I like to buy a pile of sweets and not necessarily eat them, but have them as an arsenal?
    I figured out that apple cider vinegar is my best digestion friend.
    Oh so many things. Too many to list.

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        1. Alicia Butcher Ehrhardt Post author

          In hindsight, if I’d insisted we get the humidifier working, that would have helped. If I’d insisted husband take precautions with his cold, and not infect/reinfect me, I might have avoided the extra 2+ months of coughing.

          That’s about it. And if I’d known about the other kind of damage the coughing could do, I still wouldn’t have avoided the ER – because you can’t take that chance unless you’re SURE it’s not cardiac.

          Dunno. If it helps someone else – great. I almost do these posts to force myself to analyze something that happened, and write it down. The insights can get very lost if I don’t.

          Still taking dicyclomine – if that goes a few days and things are not markedly better, I’ll go be responsible and see a doctor, but my expectations and hopes were that I can put this behind me without that – until this morning. It’s almost still as bad.

          Liked by 1 person

        2. joey

          That’s rotten. Even my lil one had the spasms when we had the flu. Don’t blame yourself. I’m hopeful your post helps others as well.

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        3. Alicia Butcher Ehrhardt Post author

          Sorry you all had the flu – and your little one was sick. That’s something you can’t explain to kids.

          I just wish the spasms would stop. I cleaned the countertop/sink in the bathroom – and set it off again. Really, it was less than 3 minutes of cleaning – had to go lie down for a half hour (but the sink is clean).

          My doctor won’t give me a prescription unless I go see her (or the Urgent Care people, depending on timing).

          So if it doesn’t go away by itself, or with the dyciclomine, I will lose at least another day to leaving the house and seeing the doctor, plus whatever the new meds (assuming she has any) cost me in side effects.

          Some CFS people have this as a regular part of their lives. I don’t see how they do it.

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    1. Alicia Butcher Ehrhardt Post author

      Same here – as few meds as possible. Have decided I can’t risk the statins, which don’t work for older women all that well, anyway.

      But they have a history of causing more pain and memory problems for some people, and I won’t take the risk.

      I’m barely getting a few words done as it is. I’m a writer, darn it.

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