For the past three years, I have experienced chest pain on and off. Any sort of restriction, such as wearing a sports bra, makes it worse, as does exercise.
I was prescribed heartburn pills, which didn’t work. When I was referred to a cardiologist, he said my heart was fine. So what’s causing this chest pain?
Jane King, Bagshot, Surrey.
Your history of chest pain has clearly troubled you, but it is reassuring that, over the years, the pain has not progressed into other worrying symptoms, such as weight loss or widespread deterioration in your health — and that a heart-related problem has been ruled out by a cardiologist.
Jane King, Bagshot, Surrey, suffers from unexplained chest pain (stock photo)
From what you have told me, I suggest your chest pain is actually referred pain from your spine.
Referred pain is a phenomenon where the unpleasant sensation is felt at a site that’s distant from the underlying cause — a classic example is pain down the left arm, which can be a sign of a heart attack.
The exact mechanism that leads to referred pain is not clear, but one idea, known as the convergence theory, is that it is the result of the brain mixing up messages coming from different nerves all around the body.
There are various points along the spinal cord where different signals meet — for example, nerves from the stomach convey pain signals to the same area in the spinal cord as does the skin between the shoulder blades — which is why pain originating in one part of the body may typically be felt in another.
Dr Scurr is pushing hard to make sure that all patients with even minimal visible rectal bleeding undergo colonoscopy (stock photo)
Take the example of a heart attack: the sensations enter the spinal cord at a similar level as sensations coming from the left arm or shoulder. This makes the brain think the pain is actually coming from the arm or shoulder, and so you feel pain there.
According to the description given in your longer letter, as well as physical restriction (such as wearing a sports bra) and physical activity causing the pain to flare up, deep breathing is uncomfortable and, at times, the discomfort radiates backwards from the chest into the area between the shoulder blades and down your arms.
Broadly speaking, your symptoms appear to be musculoskeletal in origin — affecting the joints, muscles, nerves, tendons and structures that support the limbs, neck and back. And I believe it might be caused by pain originating in the spine.
On one occasion many years ago, I was consulted by a patient with a similar unresolved set of symptoms. Subsequent scans revealed he had a neurofibroma, a benign growth of nerve tissue within the spine that was causing symptoms. This was removed with surgery, with full resolution of the symptoms.
While I am not suggesting you have the same diagnosis, your spine should be investigated. This can only be achieved if your GP makes the relevant referral, ideally to a spine surgeon.
Also, although I am generally not in favour of treatment before a clear diagnosis, in this instance I believe you have nothing to lose in consulting a physiotherapist.
This may give some insight into the cause, and the exercises or advice they give may offer a degree of relief pending the necessary investigations.
I have pigmentation in the skin on my legs, apparently due to varicose veins, which runs from my ankle to my upper thigh. The advice I received was to wear support tights, but how do I know which will help?
Sonja Downing, by email.
What you are describing is chronic venous insufficiency. This is a common complaint and is generally caused by faulty valves in the veins in the legs that usually keep blood moving towards the heart.
As a result of this malfunction, blood will pool in the leg vein, which then enlarges, becoming visible through the skin.
Depending on the degree of dilation, the veins you see through the skin have different names, although the cause is the same — for example, spider veins are tiny and close to the surface; reticular veins are slightly larger and run deeper; and varicose veins are bulgy and prominent.
The exact cause is still unclear, but it is more common in women and those who are overweight. Genetics also play a part.
The enlarged veins can cause a burning or throbbing sensation and even a heavy, dragging feeling. This is far from a cosmetic issue, as that pooling of blood in the legs causes the veins to stretch further, which leads to more pooling, and so a vicious cycle starts as the blood pooling gets worse.
Left untreated, it can lead to more complications and is known as chronic venous disease.
As this develops, there may be swelling of the legs and ankles and skin pigmentation with scaly eczema due to blood leaking out of the capillaries (tiny blood vessels).
Eventually, as blood pools and normal blood flow is reduced, tissues are deprived of oxygen, nutrients and healing factors and, as a result, ulcers can develop.
In your longer letter, you also describe pigmentation affecting your arms. This is an oddity, as this blood pooling only happens in the legs as a result of the malfunctioning valves. As such, the pigmentation in the skin on your arms is unexplained and requires further investigation.
Compression therapy — the use of special stockings or flight socks, for example — is a mainstay of treatment for chronic venous insufficiency.
These work by compressing the affected veins and improving the flow of blood by physically pushing blood up through the blood vessels in the normal way.
Crucially, use of such stockings will not change the appearance of the skin pigmentation, but may, in long-term regular use, prevent or delay the condition worsening into varicose veins and other complications I have described.
If you don’t use compression stockings, your symptoms will simply persist and could worsen, depending on factors such as your lifestyle and genetics.
Stockings are available with varying degrees of compression from many outlets. There’s no risk in choosing the ‘wrong’ amount of compression, but to benefit most, you could see a pharmacist for a private consultation — you don’t need an appointment.
They are trained in the assessment for, and the fitting of, suitable compression stockings, which may be knee or thigh-high, depending on the severity of the condition.
By the way… We need bowel cancer screening at 45
Screening for bowel cancer has been one of the great success stories of the NHS since it was introduced more than 20 years ago.
Currently, this is offered to those aged 55 and over — but if recent research is anything to go by, we should be screening people from the age of 45.
French researchers have found the rate of abnormal colon growths that are likely to become cancerous start to rise sharply at the age of 45.
Cancer of the rectum or colon is common and lethal. The current screening process involves checking a stool sample for blood. If this shows blood is present, then patients are referred to have a colonoscopy, an inspection of the entire length of the large bowel using a flexible instrument with a camera, enabling minute visualisation of the intestine lining.
Any early abnormal growths are painlessly removed with the instrument there and then and taken to a laboratory to be studied to check if they are cancerous.
I have dealt with a number of patients under the age of 55 with colon cancer; one was just 28.
Another, aged 48, was diagnosed when the disease had already spread to the liver. These professional experiences have caused me to push hard to make sure that all patients with even minimal visible rectal bleeding undergo colonoscopy.
I also encourage all of my patients to ensure they respond to the invitation for stool tests when they receive it in the post and do not shirk from what might appear to be an unpleasant task.
So now, with the latest data from the new study, I join the clamour calling for screening to be offered to all patients from the age of 45. It is truly life-saving.