Is it all in my head?

[Erac]

On 6/24/04 I overate and induced vomiting because of the pain (not in a bulimic way). During that, I felt a sharp pain in my chest and noticed the vomit came out like I had drank punch. I got nervous as I feared I might have damaged my esophagus. Concerned, I looked up info on the internet and basically almost scared myself to death. On 6/27/04 I was about to go to bed at 3:00 a.m. and noticed my heart rate sped up so rapidly, I went to the emergency. While waiting it slowed down and I attributed it as palpitations from taking a stacker 2 pill and drinking a lot of diet sodas with caffeine. On 6/30/04, I had a similar episode and a feeling of dread came over me. On 7/3/04 I went to the emergency because I was feeling like I may have damaged my esophagus from the vomiting and was basically just told I had panic attacks. I also noticed I had the black stool a few days after my vomiting episode, but it was only that one time. On sunday 7/4/04, I felt as if there was something in the back of my throat, like a pill..and that feeling is still present. I went back to the emergency scared on 7/5/04 to see what was going on. During examining me, they asked about my leg cause I have DVT (I was extremely overweight and now losing weight) and later found there was a clot, so I was admitted into the hospital and am currently being treated for it and taking warfarin. However, I was told nothing of my chest or if I damaged my esophagus. They did do a chest x-ray and a cat scan on me. Would those tests determine if there is something wrong with my chest? While in the hospital, I could sleep, but at home, I try going to sleep and all of a sudden my chest tightens and I can feel my heart beat...basically making sleep impossible. Today (7/14/04), I actually got some sleep and woke up finding my throat seeming like the "thing" was gone. However, my anxiety is coming back because of what I'm reading and I can feel the lump in my throat coming back. The doctor told me my chest was fine, but I'm not sure what he was looking for, I think he was looking for blood clots. I was told during my first hospital visit that I may have ruptured or upset a blood vessel, but the fact of not knowing for sure is really scaring me and causing anxiety. I have another doctor appt. on 7/23/04 to follow up my blood thinner treatment. I was also told by a friend that if I'm on blood thinners and there was a problem with my esophagus or whatever, I'd have bled to death by now. I plan on seeing a dr. when I have insurance, but until then, I need to know what might be going on. I haven't had black stool since then (only that one time) so i might have very well just ruptured a blood vessel. I was told that my tachycardia can also trigger feelings in my body that cause me to think something is wrong. I haven't even been recommended an endoscopy. Also, my appetite is back to normal. What do you think?

[Kevin Pho, MD]

Being on the coumadin certainly increases the risk of any type of bleeding.  The black stools may also be suggestive of an upper GI (i.e. esophagus, stomach or small intestinal) source of bleeding.  Regarding the palpitations, things like caffeine can certainly increase the probability this and I would recommend stopping intake of that.  The lump in the throat can be caused by many things - the most common of which is GERD.

I would check a blood count as well as for blood in the stools to ensure that the blood count is stable and to make sure you aren't bleeding.  Tests to evaluate for ulcers or inflammation of the upper GI tract would be an upper endoscopy (more comprehensive) or upper GI series.  Given the fact you are on blood thinners, this would be advisable.  I would also suggest discussing whether being on PPIs (i.e. Prilosec or Protonix) would be helpful in your case.  

I would discuss these options with your personal physician.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[yoshi]

i agree,caffeine in soda is bad news for you,stay away from it.
Also if eating binge usually takes place at home,then find a reason to get out of the house.
Put on some comfortable shoes and walk,walking inside the mall can be rather entertaining,if you can leave your wallet at home.

[tessa0825]

Just from one patient to another I think you should give up stackers and many of the carbonated beverages you are consuming. I thought all stackers in USA were pulled from the  shelves a few months ago when it became illegal to sell ephedra OTC? They will certainly cause palpitations. There are many safer and healthier ways to lose weight than taking those things. Weight watchers has a good program that almost all Physicians approve of. It is very inexpensive to join, I can't imagine the weekly meeting fee is even as expensive as a bottle of stackers. If you go to www.weightwatchers.com you can locate all the information for them available in your location. If you fear esophageal problems or damage, carbonated beverages is one of the top items we are to avoid. I hope you feel better soon..
Tessa