Sunday, February 15, 2015

Sunday Stroke Survival: Referred Pain

We've all been referred, right? Your PCP (primary care physician) refers you to a specialist for whatever ails ya. If you need a plumber, you ask a friend or neighbor who would they refer.

But what if it's your body pain telling you, "I hurt here." Is that where you are really hurt? Nope, not at all. There's this contradiction where the body is concerned called referred pain. So you can't believe everything you feel. Sometimes
you have to be a detective and search for what is really happening in your body. It's not always cause and result. You can hurt in some of the craziest places that have nothing to do with what is actually causing the problem.

For example when I had my heart attack, I never once felt like there was an elephant sitting on my chest. Late one summer afternoon, I had just gotten off work as the executive chef at the local Marriott. They were opening a brand new hotel and it was opening the next day. So as you can imagine, I was extremely busy with last minute details. I started sweating profusely and was exhausted. It was only 100 degrees F. outside and I had gone in at 5AM, 10 hours ago. I was huffing, puffing, and almost gasping for any cool breeze as I got home. My head was pounding so I knew my blood pressure was up. For me, heat and stress will do that.

I plopped down in a chair to just take a load off. I put my hand up to my jaw and rubbed it. Oh great, just what I need my TMJ acting up and we open tomorrow. The pain worsened over the next couple of minutes until it felt like I'd been socked in the jaw by George Foreman. I noticed my breathing hadn't eased up any since being seated in air conditioning.

Alarm bells went off in my brain. I couldn't put my finger on it, but I knew something bad was happening to my body. A memory buried in my brain what this was a symptom of, but all I could remember was it was an emergency. I called to my husband and asked if he wanted to go with me to pick up our youngest daughter from school. He agreed. The hospital was only two blocks from the school. Although I didn't feel ill, I knew for safety sake I should have someone that could drive with me. My husband couldn't legally drive on the controlled pain medication he was on, but I figured that a couple of blocks wouldn't matter.

I walked into the ER and gave them my name. When they asked what was wrong the answer that eluded me became crystal clear...heart attack. Pain in the neck and jaw are referred pain indicators for a heart attack. I collapsed after uttering the words.

So why is this important to know about referred pain? Just because you have pain in one place, say your hip, it doesn't mean you have an orthopedic problem. You could have a lower back spasm, kidney infection, bladder infection, pelvic inflammatory disease, or it could be your hip.

When I had my first stroke, I misdiagnosed myself. Dizziness, couldn't put words together correctly, confusion, disorientation, sluggish motor skills all spelled low blood sugar caused by not eating or too much insulin. The first thing I did was take my blood sugar. Yep I was right. My blood sugar was 40 (80-112 is normal). I knew I shouldn't try to cook in that state so I called Pizza Hut to have a pie delivered. Meanwhile, I'd taken my vital signs...just to be safe. My blood pressure was high 180/96, but it had run much higher before. My pulse rate was a little fast at 95, but again, no real cause for alarm. My breathing was steady. I didn't hurt anywhere. It had to be my diabetes so I ate some sugar wafers and drank some juice.

Forty-five minutes later, the pizza arrives and I'm chowing down. I waited for the carbohydrates to metabolize into sugar, about an hour and took my blood sugar again. It was 92. But why was I still having trouble thinking clearly and moving? I tried to talk to my husband but he couldn't understand me, but then, he's deaf too. I picked up my cell phone and called my daughter who lived two streets over.

I didn't think to look in the mirror for facial droop, or know that my speech was so slurred that even my daughter couldn't understand anything I said but help. The rest of the story you know. If I had known that strokes could cause a bottoming out of blood sugars would I have done things differently, probably not. Even the nurses that took care of me in the stroke unit didn't know that either. We simply were taught to look for elevated blood sugars as a possible symptom of a stroke. The neurologist at the rehab facility told us.

Why am I quoting symptoms on a blog about referred pain? If you haven't guessed by now, referred pain is also a symptom.
It's like that old MD joke...
"It hurts when I do this" and the doc answers back, "Well, don't do that."

Doctors are diagnosticians. They take all the information you can give them and make a judgement call (best guess). So if you have a pain in your shoulder, they are going to check to see if there's anything wrong with your shoulder. But, they may also run an EKG to make sure it's not a heart problem. They may run extensive blood tests to check for infections and/or unbalanced chemicals in your liver. They may even order an ultrasound of your gall bladder. Yep, referred pain could mean all sorts of things or nothing at all.
For someone like me who listens to their body and tries to find out what it means, this can be nerve wrecking. I am not a hypochondriac. But I believe your body is trying to tell you what it needs. When you crave certain foods or feel pain in a certain spot, it's talking to you. When I start cramping in my abdomen or legs, I know my potassium is low because of my Lasix so I'll eat a potassium rich food like a baked potato. If it stops the cramping then I'll know I'm right. If it doesn't, then it's something else. Now if my body is craving ten pounds of chocolate...well that's a different story.

It doesn't hurt to check with your doctor when you have pain. Granted I have Fibromyalgia, so any amount of pain really smarts. But I'determine what is causing my pain and where it comes from. Plus, I'm medically trained. I research all pain, I have to find the cause.It's almost an obsession. Sometimes it's nothing, but on many occasions it's something. Never assume the pain you're feeling is directly from that area. It could be referred pain.

Nothing is impossible with determination.


  1. Knowing many doctors have tunnel vision is scary. Thank God my GP is an internist who enjoys solving medical mysteries.

  2. Glad you realized something was wrong both times, even if you didn't know what it was.

  3. Referred pain is a Fibro symptom, too, so I know it well.



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