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Old 08-25-2012, 12:13 PM   #1
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Left Upper Back, Rib Cage, and Front Rib/Chest Pain

Hi all. I'm new here. Nice to meet you. I'm a 44 year old mother, wife, and teacher who is currently employed as an aide due to budget cuts (I started teaching at 40).

Last month, I had a horrendous bout of something...still don't know what. I have been diagnosed with SLE Lupus.

It began during the day as a vague, dull ache on my upper left back. As the day progressed it became worse and at bed time, I was crying and shrieking when my husband had to pull me up from the sofa. I was also running a low grade temp of 99. My normal temp is 97.5.

When I started to lie down, I could not lie on my side, back, anywhere that I could get comfortable. The pain was so intense, I was crying. I sat up all night with a heating pad, took a Tramadol and Ibuprofen, but nothing touched it. I could hard walk without the jarring causing pain. I went to urgent care and they gave me a shot of prednisone, but offered little else. The prednisone offered relief. I then took my prescription pack and it went away completely in a few days.

I revisited the GP for a follow-up and she was looking for a cracked rib. There was no cracked rib in the X-Ray and no specific mention of fluid.

Yesterday morning, I awoke with the same thing, again. I could hardly do my job. By bed time, I was crying again. This morning it is better, but my feet, ankles, and right knee hurt.

My rheumy is 2 hours away and I can never get in when I'm having a flare-up. She isn't a lot of help, anyway, unfortunately. She thinks because I see her for an hour every six months and my levels are normal that I may not have Lupus, even though I have had a positive ANA and an anti-double stranded DNA antibody. She told me herself that test results will fluctuate. I do take Plaquenil every day. These days, I don't have the energy that I had on the Plaquenil that I had before.

Also, how much protein in the urine is acceptable? Because mine is running anywhere from 15 to 30 and as high as 100 in a couple of instances. My blood work came back as stage 2 kidney disease and I checked it against the Kidney Foundation calculator, but no one has mentioned anything about it.

Has anyone else experienced these same symptoms and level of frustration?

 
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Old 08-25-2012, 01:39 PM   #2
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Re: Left Upper Back, Rib Cage, and Front Rib/Chest Pain

Many Drs question your diagnosis if it was A) made by someone else or B) you have neg blood work at the time they test you. It is frustrating, but with positive anti DNA, ANA, your joint symptoms and protein in urine, I would feel comfortable with the diagnosis, and try to get established on a combo of meds that will protect your kidneys better and prevent these flares. I would see a nephrologist, and ask that he/she consult with your rheumatologist to come up with a treatment that will benefit your kidneys and the rest of your symptoms. It is possible that the back and chest pain you experienced was inflammation of the cartilage along spine and rib cage, or it may have been pleurisy. You can tell the difference, because pleurisy causes sharp chest or back pains with a deep breath, whereas the cartilage pain is duller and your chest wall is tender if you press where it hurts. Both can occur in lupus and both respond to prednisone. Placquenil is a good med for skin, joint and fatigue in lupus, but is not really helpful for the kidneys. I hope you have a nephrologist within reach or at least where your rheum is so you can visit both in same trip. And welcome to the board!

 
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Old 08-25-2012, 04:23 PM   #3
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Re: Left Upper Back, Rib Cage, and Front Rib/Chest Pain

Thank you so much for your reply and your welcome. It is so nice to be somewhere where people understand.

Yes, I have sharp pain when I breath in. I wince when I do.

I will do my best. First I have to get someone to listen to me and look at the labs. I'm assuming that the kidney numbers aren't bad enough for anyone to notice?

 
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Old 08-27-2012, 04:43 AM   #4
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Re: Left Upper Back, Rib Cage, and Front Rib/Chest Pain

Hi, SLHamm. I want to add just one word to the most excellent suggestions & advice you just got. Cartilage inflammation (as described) is called costochondritis; it's inflammation emanating from where sternum meets breastbone, and like pleurisy, it can be mighty painful.

I hope you schedule that additional consult. Don't take NO for an answer. I really can't fathom a doctor NOT pursuing abnormal kidney values. My rheumatologist would be all over it in a heartbeat... which is the level of care and concern I'd like for YOU. Please let us know what happens next, OK? Sending my best wishes, sincerely, Vee

 
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Old 08-27-2012, 05:53 AM   #5
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Re: Left Upper Back, Rib Cage, and Front Rib/Chest Pain

My rheumatologist said that my kidney function was normal when she looked at the same test.

 
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Old 08-27-2012, 05:54 AM   #6
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Re: Left Upper Back, Rib Cage, and Front Rib/Chest Pain

I dunno. That is why I'm confused.

 
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Old 08-27-2012, 06:40 AM   #7
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Re: Left Upper Back, Rib Cage, and Front Rib/Chest Pain

Hi. Gee, I'd be plenty confused, too! On which test(s) did your rheumatologist comment? If protein in urine, did lab print its reference range? If blood tests, which ones & were the ref ranges included?

There may be other possibilities that might explain both protein in urine & low back pain. After a total urinary blockage years back, I had a radioactive dye kidney function test done years back, forget its proper name. Next step, if needed, would have been 24-hr. urine collection test, then a biopsy if more info was required. It turned out I was forming very tiny urinary stones, more like crystals. This can happen for various reasons, including dehydration, which I probably had rather often due to chronic GI misery. My symptoms were episodic discomfort, sense of fullness, frequency & urgency, yet I wasn't testing positive for UTI's. (I don't know if any of this relevant, but worth a moment's thought, maybe?)

Aside from this---not that it's a minor point, it isn't---do you respect how your rheumatologist has handled you so far? If not, are there other rheumatologists whom you could see? Hang in there! Sympathetically, Vee

 
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Old 08-27-2012, 10:36 AM   #8
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Re: Left Upper Back, Rib Cage, and Front Rib/Chest Pain

To clarify your question about protein in urine, if these are random specimens, not 24 hr collections, 30mg equals 1+ protein on a dipstick, 100mg = 2+ protein, 400 + 3+, and 1000mg = 4+. Normal protein on randome urine is up to 10-20, depending on reference. To get the most accurate protein levels on urine, use a clean catch technique, as vaginal mucus and semen will falsely elevate protein, and avoid very strenuous exercise before specimen collection for same reason. Most Dr's expect neg prot, some will accept trace levels, but anything over that is not normal, and should be addressed. There are many measures of kidney function, and protein in urine is one of the earliest signs of renal involvement in lupus. This should not be dismissed, as treatment in the earliest stages will preserve kidney function. I urge you to seek another opinion and see a nephrologist, who will likely want to do some other testing of kidney status. We often have to fight for what we need, so assertiveness is your new friend. Good luck, take care!

 
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Old 08-27-2012, 08:29 PM   #9
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Re: Left Upper Back, Rib Cage, and Front Rib/Chest Pain

Hi again, all. The numbers came from a blood test. The GFR was 78, and on the bottom it displayed the values with the stages. Mine fell in stage 2, but I may not know all there is to know. I do my best to clean catch, but those are always possibilities. Thank you all for yor help. I'm so tired today, I can hardly crawl and discovered a knot in my groin well over 2 centimeters while I was showering tonight. I have to go in for a blood draw and will give a message to the doctor about it. I saw a new GP today, and it seems like she is truly willing to consider the Lupus issues. Said she could tell I was flaring. Put me on Prednisone, again. All I know is that I don't know how I'm going to work this way.

 
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