costochondritis

[azucena]

Anyone know much about costochondritis?

DD16 was diagnosed with it by pediatrician about 3 weeks ago and given naproxen. She's been hiding that she wasn't improving until the dam broke Friday and DH took her to urgent care. They tested for everything and ruled out covid, strep, mono, etc. Last night she told me it was more painful than ever and she was really worried that the chest pain was something heart related but had hesitated to say much bc of everything we have going on and also bc she was worried about medical bills. When I told her urgent care had only cost $40 and ER would be $100 she said let's go right now. DH ended up taking her at 8 and they didn't get home until 2 am. I was still on safety watch with bonus teen. Tore my mama heart apart to feel like I should have gone with DD. DH texted me hourly updates and they came home with everything heart related ruled out and a script for prednisone. 

Her other main symptom is extreme fatigue which is causing her to fall behind at school. We've been fighting with her about limiting her teen life while she recovers. She's had her license since July and seems to think it gives her carte blanche to run her own life. Growing pains for all of us.

She's supposed to be performing in school choir rehearsal today and concert Thurs, but I've let director know that she'll need to sit out and that the makeup assignment can't involve singing per doctor's orders. She'll need to come up with something else.

She's set to play Mrs Peacock in Clue 10/31-11/3 so is in the final two weeks of increasing rehearsals and stress. Will work with the director to accommodate and plough through as best we can bc DD will absolutely shut down

www.mayoclinic.org/diseases-conditions/costochondritis/symptoms-causes/syc-20371175

[pulmonarymd]

Costochondritis is painful but not serious. Usually treated with Motrin or aleve. It is unlikely to be the cause of her other symptoms. She needs to see her pediatrician for further work up. The ED will only rule out serious or life threatening causes, but will not evaluate further. Chest pain is unlikely to be due to heart issues in a 16 yo of either sex. Hope this helps

[bean29]

I hope her symptoms ease up quickly.  I am sure she will be disappointed if she misses any of her performances.

I have to admit, I was expecting this thread to be about some kind of Costco related shopping addiction.  

I never heard of this before, but I think I have experienced similar symptoms.

[jerseygirl]

Ouch! That’s very painful but will go away

[azucena]

Oct 22, 2024 8:58:50 GMT -5 pulmonarymd said:

Costochondritis is painful but not serious. Usually treated with Motrin or aleve. It is unlikely to be the cause of her other symptoms. She needs to see her pediatrician for further work up. The ED will only rule out serious or life threatening causes, but will not evaluate further. Chest pain is unlikely to be due to heart issues in a 16 yo of either sex. Hope this helps

Thanks, was hoping you'd chime in.

Any idea why the ER doc would have told DH to hold off using the prednisone script until it gets even worse? She's been taking naproxen daily for 3 weeks. All sorts of blood work tests and scans have been done now. Will def check in with ped again.

[pulmonarymd]

Prednisone can interfere with certain blood tests that may be needed to evaluate further. If she takes them and they are normal, would need to have them repeated. Many times costochondritis resolves on its own, and prednisone can have side effects. As I said painful but not serious, so we would rather not use prednisone for something like this

[azucena]

Thx that explanation is helpful.

[The Walk of the Penguin Mich]

Here’s my 0.02, not about costochondritis though.  Pain causes fatigue.  The stress of dealing with it totally wipes you out.  You sleep, but sleep badly, which perpetuates the cycle.  

Secondly, there are a lot of NSAIDs on the market.  I have taken a good chunk of them and IME, some work better for me than others.  The one that worked the best ever for me (Bextra) got yanked off the market.  If I had to rate them, diclofenac (prescription) works best.  Ibuprofen is next effective.  I put Naproxen at the end of my list, along with Meloxicam (another prescription), neither worked at all for me.  

My point is that if she’s getting no relief from naproxen, try ibuprofen.  You might want to try the OTC topical Voltaren (same active ingredient as diclofenac) too to see if it might help (either/or, not both).  

[azucena]

Oct 22, 2024 11:31:06 GMT -5 The Walk of the Penguin Mich said:

Here’s my 0.02, not about costochondritis though.  Pain causes fatigue.  The stress of dealing with it totally wipes you out.  You sleep, but sleep badly, which perpetuates the cycle.  

Secondly, there are a lot of NSAIDs on the market.  I have taken a good chunk of them and IME, some work better for me than others.  The one that worked the best ever for me (Bextra) got yanked off the market.  If I had to rate them, diclofenac (prescription) works best.  Ibuprofen is next effective.  I put Naproxen at the end of my list, along with Meloxicam (another prescription), neither worked at all for me.  

My point is that if she’s getting no relief from naproxen, try ibuprofen.  You might want to try the OTC topical Voltaren (same active ingredient as diclofenac) too to see if it might help (either/or, not both).  

Appreciate this. I was making the same connection with pain and fatigue this morning as I read more. She's sleeping from 10 pm to 6 am and then also napping from 5 to 8 pm. Was also thinking if she's not taking full breaths that won't help her energy wise.

I'd been kinda hung up on the sleeping and just her general attitude reminding me too much of my own untreated depression in my teen years and have been asking her questions about that. Doesn't seem to be the issue though.

[pulmonarymd]

My wife worked for a group of orthopedic surgeons. They swear by aleve. They think it works far better than ibuprofen. Meloxicam is the next choice.

The causes of fatigue are myriad, and not something I would hazard a diagnosis of over the phone, ranging from benign to serious. The amount she is sleeping warrants an evaluation by her pediatrician, since he also knows her history and should know her family history. All we can do is make a guess. Seeing her physician will hopefully lead to a faster resolution of her suffering as well.

[busymom]

Has the doctor been able to rule out ulcers?  I had horrible pains just under my rib cage in high school & college.  Good old stress & being over-scheduled.  JMHO, and I get that being in high school she wants to be in a million activities (my DD did!), but she need to S-L-O-W down, and let her body heal.  Also, what kind of food is she eating?  Is she eating balanced meals, or just grabbing fast food as she runs from activity to activity?  (I gave up drinking Coca-Cola as it seemed to make my symptoms worse.)  Praying the doctor(s) figure things out.  

[The Walk of the Penguin Mich]

Oct 22, 2024 12:25:41 GMT -5 pulmonarymd said:

My wife worked for a group of orthopedic surgeons. They swear by aleve. They think it works far better than ibuprofen. Meloxicam is the next choice.

The causes of fatigue are myriad, and not something I would hazard a diagnosis of over the phone, ranging from benign to serious. The amount she is sleeping warrants an evaluation by her pediatrician, since he also knows her history and should know her family history. All we can do is make a guess. Seeing her physician will hopefully lead to a faster resolution of her suffering as well.

That’s what’s strange.  Doctors assume something works better, but IME it doesn’t always.  In the 25 years where I got to take NSAIDs (since there is no way in 1985 they’d do a hip replacement on a 25 year old), I got to try them all.  

If I had to put together a list, best to least effective, it would look like this:

Bextra
Diclofenac
ibuprofen
Celebrex (but needed to take it regularly for several days)
Indocin (made me dizzy)
Vioxx
ketoprofen
Naprosyn
Meloxicam

Diclofenac is sold OTC in Europe and Asia, so I pick this up there.  

[pulmonarymd]

Oct 22, 2024 13:10:31 GMT -5 The Walk of the Penguin Mich said:

Oct 22, 2024 12:25:41 GMT -5 pulmonarymd said:

My wife worked for a group of orthopedic surgeons. They swear by aleve. They think it works far better than ibuprofen. Meloxicam is the next choice.

The causes of fatigue are myriad, and not something I would hazard a diagnosis of over the phone, ranging from benign to serious. The amount she is sleeping warrants an evaluation by her pediatrician, since he also knows her history and should know her family history. All we can do is make a guess. Seeing her physician will hopefully lead to a faster resolution of her suffering as well.

That’s what’s strange.  Doctors assume something works better, but IME it doesn’t always.  In the 25 years where I got to take NSAIDs (since there is no way in 1985 they’d do a hip replacement on a 25 year old), I got to try them all.  

If I had to put together a list, best to least effective, it would look like this:

Bextra
Diclofenac
ibuprofen
Celebrex (but needed to take it regularly for several days)
Indocin (made me dizzy)
Vioxx
ketoprofen
Naprosyn
Meloxicam

Diclofenac is sold OTC in Europe and Asia, so I pick this up there.  

There are few head to head studies on these type o comparisons. Which is why insurance companies get away with requiring us to change prescription medications after the beginning of the year. If there was data on it, they would not get away with it. You are posting about your individual experience.patient will tell me that x drug works better than y drug for their asthma. I have no reason to disbelieve them, but it doesn’t mean that is the universal experience, as studies show they both work. But unless you have data that I have not seen, your opinion is my more valid than theirs

[The Walk of the Penguin Mich]

Oct 22, 2024 14:23:50 GMT -5 pulmonarymd said:

Oct 22, 2024 13:10:31 GMT -5 The Walk of the Penguin Mich said:

That’s what’s strange.  Doctors assume something works better, but IME it doesn’t always.  In the 25 years where I got to take NSAIDs (since there is no way in 1985 they’d do a hip replacement on a 25 year old), I got to try them all.  

If I had to put together a list, best to least effective, it would look like this:

Bextra
Diclofenac
ibuprofen
Celebrex (but needed to take it regularly for several days)
Indocin (made me dizzy)
Vioxx
ketoprofen
Naprosyn
Meloxicam

Diclofenac is sold OTC in Europe and Asia, so I pick this up there.  

There are few head to head studies on these type o comparisons. Which is why insurance companies get away with requiring us to change prescription medications after the beginning of the year. If there was data on it, they would not get away with it. You are posting about your individual experience.patient will tell me that x drug works better than y drug for their asthma. I have no reason to disbelieve them, but it doesn’t mean that is the universal experience, as studies show they both work. But unless you have data that I have not seen, your opinion is my more valid than theirs

This is why I suggest she try something other than naprosyn if she doesn’t get relief.  Yeah, many people do get relief, but not all.  They are all otc and the bottom line is ‘what works better for me’.  

On my hip groups, there are clearly people where drugs work differently for them.  Anecdotally, (which I realize it’s not data but would be an interesting study) is that everyone who Meloxicam does not work on finds ibuprofen better.  My best guess is there is a difference in how our cytochrome P450 metabolizes the drug.  All it takes is chopping off a side group and efficacy could be affected.  

[pulmonarymd]

Oct 22, 2024 16:05:11 GMT -5 The Walk of the Penguin Mich said:

Oct 22, 2024 14:23:50 GMT -5 pulmonarymd said:

There are few head to head studies on these type o comparisons. Which is why insurance companies get away with requiring us to change prescription medications after the beginning of the year. If there was data on it, they would not get away with it. You are posting about your individual experience.patient will tell me that x drug works better than y drug for their asthma. I have no reason to disbelieve them, but it doesn’t mean that is the universal experience, as studies show they both work. But unless you have data that I have not seen, your opinion is my more valid than theirs

This is why I suggest she try something other than naprosyn if she doesn’t get relief.  Yeah, many people do get relief, but not all.  They are all otc and the bottom line is ‘what works better for me’.  

On my hip groups, there are clearly people where drugs work differently for them.  Anecdotally, (which I realize it’s not data but would be an interesting study) is that everyone who Meloxicam does not work on finds ibuprofen better.  My best guess is there is a difference in how our cytochrome P450 metabolizes the drug.  All it takes is chopping off a side group and efficacy could be affected.  

There are patient to patient differences in response to medications. Which is why I answered factually and did not give a recommendation initially. People on the internet love to give opinions. But I need to be careful about giving advice for someone personally as it could be construed to be actual medical advice. Taking specific advice from internet strangers is dangerous. Just like giving financial advice without the full picture is not appropriate, neither is medical advice here. I have a differential diagnosis in my head about this, but is it not my place to share it because I do not have all the information needed.

ETA: we have a saying in medicine: anecdotes aren’t data. People based treatment decisions in the early phases of COVID, and that was a disaster. Something to keep in mind

[TheOtherMe]

My stomach can't tolerate Aleve

[daisylu]

I have never heard of costochondritis, so have nothing to add other than I hope she finds relief soon.

I will second that different NSaids work differently in everyone. Aleve does nothing for me, but naproxen does. Ibuprofen does very little for me. Diclofenac has been a life saver with hip and knee issues.

[pulmonarymd]

Oct 22, 2024 16:43:42 GMT -5 daisylu said:

I have never heard of costochondritis, so have nothing to add other than I hope she finds relief soon.

I will second that different NSaids work differently in everyone. Aleve does nothing for me, but naproxen does. Ibuprofen does very little for me. Diclofenac has been a life saver with hip and knee issues.

Alive is naproxen. Naproxen is the generic name

[daisylu]

Oct 22, 2024 16:47:24 GMT -5 pulmonarymd said:

Oct 22, 2024 16:43:42 GMT -5 daisylu said:

I have never heard of costochondritis, so have nothing to add other than I hope she finds relief soon.

I will second that different NSaids work differently in everyone. Aleve does nothing for me, but naproxen does. Ibuprofen does very little for me. Diclofenac has been a life saver with hip and knee issues.

Alive is naproxen. Naproxen is the generic name

I know. But I get still different results from each.