This should be easy if you're an MD, which I certainly hope you are if
you answer.  I have a pain in the upper-left stomach area, just below
my ribcage and maybe three inches away from my sternum.  Sometimes
it's a dull ache...sort of burning.  Sometimes it's a rather sharp
pain, but that usually only lasts a couple seconds.  The skin is even
tender above and around it -- other than that it's very local.  This
condition started about thirty hours ago.  I'm 27 years old, male, and
fairly healthy as far as I know.

So, should I go to the doctor?  I do have medical insurance, but am
financially engrossed in a project at the moment...I don't even have
enough money for the co-pay right now!  Seriously.  Now, if it sounds
like something that could kill me I'll go...other than that I'd prefer
to wait a couple weeks (pain allowing).

Hopefully I haven't offended would-be answerers by the price of my
question, but I figured this would only require "typing time" for a
doctor.

On a scale from 1 to 10 (1 meaning "don't worry", 5 meaning "see a
physician as soon as you cash your next check", and 10 meaning "get to
the ER right now and don't delay")please rate where my sense of
urgency should be.

Thank You

---

Request for Question Clarification by aceresearcher-ga on 22 May 2003 01:25 PDT

dussin,

Your pain might be heartburn or indigestion, or the onset of a heart
attack, or something else.

However, you don't even want to know how many people die or suffer
severe heart damage every year because they wait WAY too long to seek
treatment, simply because they believe that what they are experiencing
is only heartburn or indigestion.

The fact that you have financial concerns right now may only be adding
to the other stress factors in your life.

I can't emphasize enough how IMPORTANT it is that you see a doctor
immediately.

Even though you are 27 and healthy, you need to know that:
********************************************************
for 40% of people who have heart attacks, the very first
sign that they even have a heart problem is -- Death.
********************************************************

Am I being a bit alarmist? Perhaps.

A couple of years ago my spouse, who is a Pathologist, got called in a
couple of days before Christmas to do an autopsy on an 36-year-old,
healthy and fit male runner who dropped dead at his wife's office
Christmas party. Although he had been experiencing symptoms for
several hours, he didn't do anything about it -- he thought he had a
case of heartburn.

"What are the warning signs of a heart attack?
The following are the most common symptoms of a heart attack, however,
each individual may experience symptoms differently. Symptoms may
include:

- severe pressure, fullness, squeezing, pain and/or discomfort in the
center of the chest that lasts for more than a few minutes

- pain or discomfort that spreads to the shoulders, neck, arms, or jaw

- chest pain that increases in intensity

- chest pain that is not relieved by rest or by taking cardiac
prescription medication

- chest pain that occurs with any/all of the following (additional)
symptoms of a heart attack:
  sweating, cool, clammy skin, and/or paleness
  shortness of breath
  nausea or vomiting
  dizziness or fainting
  unexplained weakness or fatigue
  rapid or irregular pulse

Although chest pain is the key warning sign of a heart attack, it may
be confused with indigestion, pleurisy, pneumonia, or other
disorders."
http://www.holyname.org/health_information_resources/health_manuals/Men/hrtrisk.htm

Please don't wait a moment longer. Call your doctor's office and ask
to be seen immediately. If they refuse to see you, go to the Emergency
Room.

Even if you end up out a sizeable chunk of change for heart tests and
find that your heart is healthy and you do only have indigestion, it
is a far, far better fate than the possibility at the other end of the
spectrum.

I will be crossing my fingers and hoping that your only news is good
news.

Best Wishes,

ace

---

Clarification of Question by dussin23-ga on 22 May 2003 09:09 PDT

Thanks for your help.  Not long ago I was experiencing dizziness, etc,
and went to see a cardiologist.  They had me wear some kind of monitor
-- I forget the name right now -- for 36 hours or something like that.
 They said my heart is fine.

---

Clarification of Question by dussin23-ga on 23 May 2003 23:21 PDT

Thanks to you, too, Voila.  I think I'm alright...I'm not sure what it
was, but I had virtually no symptoms today.  It's a scary thing when
something hurts like that -- where you've never had a pain before --
but I'm pretty sure now that it was just the burger I had for lunch
that day.

If it starts up again, I think I'll do what you suggested and call the
insurance company.  It never occured to me that such an outfit could
have sympathy, lol.  Ya' never know, though.

dussin23,

I am VERY relieved to hear that you don't have a heart problem.

Some information you might find helpful when seeking medical advice:
When you pay a physician for advice, you aren't paying them for their
"talking time" or their "typing time". You're paying them for the
benefit you receive from their years and years of experience,
training, and education, for which they most likely paid thousands and
thousands of dollars.

After 16 years of undergrad, med school, residency, and fellowship
training (during which I pretty much supported our family on my
salary), my husband now owes over $150,000 in med school loans, which
increases by $10,000 in interest every year. The stereotype that
physicians all make loads of money and are rich has not been true for
many years. Between the mortgage and the student loan payments, we
pretty much just break even every month.

The fees that physicians charge, in most cases, are well-deserved and
well-earned.

Best Wishes for your continued health,

ace

Thanks, and I understand that very well.  I wasn't trying to cheat
anyone out of anything -- I am in two-week period in which I have
absolutely no available money, and I just wanted to get an idea
whether or not I have a serious condition.  I know enough that I
wouldn't ask for a diagnosis without a proper examination, anyway.

If someone asked me about my area of expertise and only wanted to know
if they should see a professional in the field, I'd do that.  I know
enough about my field to do that very quickly, and I imagine a doctor
or med student would, too.  That's all I wanted.

I'm not normally so destitute.  As long as I don't drop dead from
this, I'm glad it's happened because now I have some idea what it's
like to be poor and without health insurance.  It's very sad that we
live in the wealthiest nation in the history of mankind, yet so many
of our own citizens do not have adequate access to healthcare.  I
agree with you that doctors deserve the salaries they get, and I'll
take it a step further and say that they shouldn't have to pay so much
for their education.  The costs of healthcare should be spread evenly
throughout the classes, as the well-being of our people is a public
good (in my opinion, at least).

Anyway, I'm feeling a bit better now.  It's still there but I believe
it's going away.  I'll leave the question open in case it comes back
or something.

Thanks for your time, ace.

dussin,

I am glad to hear that you are feeling better, and you are SO right.

Both healthcare and education (necessary, not frivolous) should be
available equally to all our citizens, and the fact that the most
powerful country in the world can't manage what some of the smallest
countries DO manage is a shameful thing indeed.

Best wishes,

ace

Hello dussin23,

If you were equipped with a Holter monitor seen at this website
http://www.mmhs.com/clinical/adult/english/cardiac/electro.htm
these are used to detect transient arrythmias not detected on a
standard EKG done in a doctor's office.  A normal Holter wouldn't
*necessarily* rule you out for an MI, now and forever.  This might be
a totally benign episode of heartburn, GERD, or something
musculoskeletal but one never knows for sure.

You mention that you're already under the care of a cardiologist. 
Every symptom doesn't *always* necessitate a visit; however, chest
pain of any kind usually does.  I would at least call your doctor's
office and report this.  He/she will probably want to know if the pain
is meal associated, positional, or if you've done any heavy physical
activity recently.  He/she may also want to know if you've had an
increase in caffeine use, stress level, insomnia, or any lifestyle
changes.

Your cardiologist will have your family history available and can
assess your cardiac risk better than any researcher can.  I would urge
you to take a moment and review the questions listed above.  The more
descriptive you can be about your symptoms, the greater likelihood for
pinpointing your problem.

Pain:  Is it gripping, sharp, stabbing, dull, gnawing, burning,
boring, or searing?  Scale of 1-10?
Frequency:  Every few minutes, before/after every meal, every day?
Position:  Sitting, lying, stretching, bending?
Where:  At home, at work, in traffic?
When:  While running, during sex, after meals, upon awakening, during
the night?

As for your co-pay, I've always been able to explain the situation to
the financial person or billing manager and they've always billed me
the co-pay for an emergency visit.  I think people understand a
temporary financial hardship.

Best of luck to you,
V