Follow up to back strain with a chest muscle strain. It never ends.

[strawclutching]

Hi again folks. You may remember I posted about straining a back muscle and feeling unwell. This happened 16 days ago and last Sunday I was hitching myself up the bed (using arms, not back muscles)and heard something pop in the middle of my chest. Another searing pain and still feeling poorly, not eating much, I called 111 on the Monday morning. Because of the chest pains they took me to A&E. Cardio print out didn't reveal anything serious, bloods indicated low sodium which has been the case for months. They gave me a single 5ml dose of Oromorph and sent me home with a follow up blood test 2 days later. Sodium still below normal but not dangerously so, doctor said.

Thing is, the back and chest pain has now spread to under the arms, encircling the pelvic area that leaning on my right side when walking is really painful. I also seem to have aquired an additional muscle strain on the right side of the ribs which is painful to touch.

I finished a course of Nitrofurantoin 4 days ago and despite upping my fluid intake, am not passing very much urine at all. Also, I can barely keep my eyes open. I begged my GP for a short course of Oromorph but I'm only using this when the pain is overwhelming, and the falling asleep is nothing to do with the Oromorph as it's happening early in the day to lunchtime and I'm not taking the medication until later. It's only 2.5 mls. On the positive side, my appetite has improved, but I don't have the energy to make anything elaborate in the kitchen where I have to stand for longer than a few minutes.

I read somewhere about a toxin released by torn muscles which can cause a condition of the kidneys called Rhabdomyolysis. Not sure if I'm getting spooked by the internet.

I upped my Pred from 14mgs to 20 mgs for a few days, then down to 17 mgs and plan to reduce again to 15mgs?

Is it feasible for multiple muscle strains to happen one after the other like this after 3 years on Pred (varying doses) which I know can damage interconnective tissue like collagen, etc. though I have been supplementing with bovine collagen for the last year?

Should I bother the GP again about this? I'm reluctant to go to A&E again as I spent more than 6 hours in there last week (2 days apart) after which I was completely spent.

Sorry for the incredibly long post, I just need someone independent to offer a bit of advice. My daughter keeps nagging me to pester the professionals. I know I can't continue like this much longer. Unable to do housework, get in the bath, go out, etc. I live alone and have had insulin dependant diabetes 42 yrs.

[PMRpro Ambassador]

If you are not passing much urine, it might be worth checking a bit - record what you drink and eat and what you pee out plus make a note of stools. If you really are peeing a lot less than you are drinking you then have some evidence to present to get medical advice.

The sleepiness concerns me a bit and you are very restricted in what you can do - no wonder your daughter is concerned. I think you need to take her with you!

[strawclutching in reply to PMRpro]

Thanks PMRpro. Do I have to measure the input & output in mls over 24 hrs? I get up at least 3 times in the night but only pass a small amount. This could be a full time job.

[PMRpro Ambassador in reply to strawclutching]

Preferably - it is very easy to under or overestimate how much you are actually peeing unless you do. In mls is best - but measure the cup/mug.glass you usually use and that is near enough as long s you can add it up at the end. Pee is best in mls using a jug.

[strawclutching in reply to PMRpro]

Thank you.

[DorsetLady PMRGCAuk volunteer]

Sorry to hear this, nothing constructive to add other than to agree with your daughter and PMRpro you need professional intervention - and sending best wishes that you get things sorted asap 🌸

[strawclutching in reply to DorsetLady]

Thanks Dorset Lady.

[redruth123]

Hi Strawclutching, Your situation sounds just awful. I know what I'm about to write is only a small part of your issue and not of any immediate help, or maybe of no relevance at all, but you mentioned in your previous post about thoracic pain. I have also recently had tremendous thoracic back pain as well as neck and shoulder pain, and have managed to find some relief.

I say this because by chance I saw myself in a side facing mirror and realised just how much my head thrusts foward (dowagers hump) AND how much time I spend with my head bent - cooking, laptop computer, reading, in the shower, walking, etc etc etc. That's nearly 20kg of weight constantly pulling neck and back muscles - since being conscious of this and not doing this so much - by keeping chin down, head back and neck straightened as much as possible - my thoracic back and other pains have lifted. In the meantime I used heat packs, voltaren cream, (voltarol in UK), panadol, sitting in a reasonably ergonomic chair -these all helped a little.

Wishing you well and some intervention and improved health very soon.

[PMRpro Ambassador in reply to redruth123]

20kg of force because of the angulation - not weight!

[redruth123 in reply to PMRpro]

Yes indeed. Thx for the reminder.

[strawclutching in reply to redruth123]

Thanks for that suggestion, redruth. I'm pretty sure the chest pain is from a muscular strain, as it was caused when hitching myself up the bed with the flat of my hands & rigid arms so as not to strain the already strained back muscles I'd injured 10 days before. I actually heard a noise inside my chest when it happened and there was excruciating pain at the same time. That being said, and since the second injury, I'm avoiding spreading my arms as it hurts my chest, so there's a protective factor there which alters the posture automatically. I'm trying to do very gentle stretches in those areas until the pain begins to hit, just to keep some strength. My back pain is more concerning to me, especially since it was present before the injury, though in a milder form. On a positive note, my peeing capability seems to be improving. 😊 Thanks again.

[redruth123]

So much going on for you strawclutching. Sorry I may not have been clear - my experience was only of back pain but I hope you are somehow able to find some relief, both back and chest. A relief to hear that your peeing is improving !!

[strawclutching in reply to redruth123]

Thanks Redruth, I was puzzled because thoracic pain is usually chest-related. Sorry, must have got the wrong end of the stick.

[Missus835]

Have they done any xrays or scans? I have 8 fractured vertebrae at last count. Both thoracic and lumbar. Muscle spasms are excruciating and wrap from spine around to diaphragm and stomach, making eating but for a wee bit, and deep breaths when standing, very difficult. Standing or sitting long enough to make a tin of soup is about it. Then the muscle pain kicks in. The only pain-free time is when lying on the bed. I can walk, but use my walker. I believe first fractures happened end of June when my spine seemed to pop and bent a bit and down I went onto the couch I was standing beside. My neck seems to be good at this point, but it does make a cracking noise. I do have osteoporosis which has been caused by the Pred I take for PMR.

[strawclutching in reply to Missus835]

Thanks Missus. No, they haven't done any scans or xrays, which concerns me as they just assumed it was muscular. I have osteoporosis too and my last bone scan was January 2022 which showed -3.9 in the spine. This is likely to be worse by now. I declined Zolendronic acid infusion at the time as I was determined to get the Pred down as quickly as possible but this is proving more difficult now. I definitely heard my chest pop when I got that injury, so who knows if it was a rib or inter-costal muscle. I only know the pain is really bad and it's hard to get through the day, and like you say, to stand long enough to open a tin. After hanging onto the phone to my GP for most of the day, finally got through and they're having a huddle in the morning to discuss my case.

Are you using any pain relief?

[Missus835 in reply to strawclutching]

Pain relief is what you call in the UK paracetamol with codeine. 2 pills every 6 hours. Does cause constipation though. Here in Nova Scotia it's Tylenol 3. It does work for a few hours. Opioids did not touch the pain. I'm blessed to be able to sleep well. They assumed for a long time, that I had a pulled muscle when actually it was my back muscles spasmed, trying to support a fractured spine. Still is. We are our own best advocates here. I had to start keeping on the system's arse to get anywhere. My rheumy is the unreachable star and very little help. I now have a Nurse Practitioner, Rheumatologist, Neurologist and the surgeon who fixed the first two fractures. Started with no advocacy at all. I didn't want the infusion either, but cannot tolerate AA. Fingers crossed for both of us. Take care my friend. Hugs.

[strawclutching in reply to Missus835]

My rheumatologist is not eager to communicate - only through a nurse, and keeps telling me to stick to the plan - not to increase Pred even when ill. I've not taken her advice and will not have seen her for 12 months by the time my next appt is due. I will continue to pester the GP as he's all I have apart from going to Emergency again which I find exhausting hanging around for hours at a time. Thanks for telling me your story. They make you feel like you're imagining things. I should have learned when they misdiagnosed my GCA twice for a virus.🙄

[PMRpro Ambassador in reply to strawclutching]

They are crackers - no-one tells the PMR/GCA there is a fixed plan - and it does what it wants.

[strawclutching in reply to PMRpro]

I wish they'd get the message.