The pain was slightly to the right of the middle of my chest. It felt as if there was something with a dull point poking me there with each breath I took. I was 28 years old.
Strangely, it would come and go. One day it would hurt as I woke up in the morning and continue until I fell asleep that night. The next, it would be gone. Sometimes the pain stayed for several days before disappearing, only to reappear a week or more later.
The pain wasn’t debilitating. I coped with it. Sometimes it intensified with each breath, easing as I exhaled. Sometimes it stabbed when I moved. Still, in the back of my mind was a vague fear that there was something wrong with my heart, even though the pain wasn’t on the left, but just right of center.
I hadn’t injured myself. I hadn’t been ill with a respiratory bug that could leave me with a pain (something I’d never had happen, but when you can’t explain something, your mind goes there). I hadn’t lifted anything heavier than my three-year-old daughter, and she was light as a feather, a tiny child, smaller than other children of her age.
After several months of this on-again, off-again pain, I finally made an appointment with a doctor. I’d been out of the Air Force for about two years; I’d only recently landed a full-time job that included health insurance. A friend at work had recommended him.
He listened to my complaint and examined me. He had one of the nurses do an EKG, just in case my heart was causing the pain. The result was completely normal. Since I hadn’t hurt myself, he seemed almost as mystified as I was. In the end, he said that it was possible that the cartilage that connects the ribs to the sternum at the middle of the chest might still be forming; it does, apparently, grow until we’re in our early 30s. Or, it could be a tiny spur of cartilage rubbing the muscle tissue there, causing irritation and inflammation. It could even be stress-induced, he said, after inquiring about my daily life. As a single mom with a small child, stress was a normal part of my day.
Still, the doctor felt that whatever the pain was, it would go away in time. He told me to take Tylenol for it when it hurt, but not to worry about my heart. And if it got worse, I should come back to see him again.
I went away relieved that I wasn’t in danger of dying suddenly, but perplexed about the ambiguous diagnosis. I did what the doctor recommended, though, and took Tylenol. And indeed, in time, the pain in my chest disappeared. It has never come back.
Three years later, I was re-married, living and working in Northern Germany. After suffering agonizing, on-again, off-again pain in a variety of joints over several months, I was diagnosed with rheumatoid arthritis.
It wasn’t until recently that I connected that old pain in my chest to my RA. During an appointment, my rheumatologist was talking about how RA also attacks, along with the joints, the body’s soft tissue—and that includes, he said, the cartilage and ligaments. He said my RA was the culprit behind my hip bursitis. Not only were the bursae inflamed in both hips, but the long ligaments (the ilio-tibial bands) connecting each hip to each knee were inflamed, as well.
Now, I already knew that RA attacked “soft tissues” as well as joints, but I’d only thought of tissues like the heart, the eyes and the other vital organs. But RA also attacked the ligaments? And cartilage? Wow. (Actually, if I think about it, RA attacks the ligaments and cartilage–soft tissues–in the joints, as well…)
A couple of weeks later, something piqued my memory of that long-ago mystery pain in my chest. Cartilage! RA affects cartilage! Suddenly, all the puzzle pieces fell into place: That sharp poke I felt nearly 30 years ago could have been a manifestation of rheumatoid arthritis symptoms in my body. I had it even then, though it wouldn’t become freely active for a few more years.
Yesterday, my mom reminded me that when I was a junior in high school, I complained once about my right heel hurting. It was so bad I could barely put my weight on it. The doctor didn’t know what was causing it—the usual culprits didn’t apply and x-rays didn’t show anything unusual—so he had me take a painkiller and put me on crutches for a week. The heel pain gradually went away.
Oddly, I had forgotten all about that. I still can’t dredge up a concrete memory of it, though I do vaguely recall stumping through the halls at school on crutches, trying to move fast enough to make my class on time. Could it be? Was that heel pain actually an early RA flare, too?
There might be other childhood pains I suffered that have slipped through the sieve of memory. I do remember, rather clearly, the chronic leg-aches that came on at night when I was a child and a young teen; they hurt so bad they’d make me cry. Mom and Dad said they were “growing pains.” They always went away after an aspirin and a couple of hours. Dad used to wrap the affected leg in his old blue terrycloth bathrobe, a garment that acquired almost magical healing qualities over the years.
Was that rheuma, too? I don’t know. But it is nice when some of these old, personal mysteries are finally solved.
Note: Upon googling “chest cartilage pain” several articles about a condition called “costochondritis” came up. This is a rather common inflammation of the chest cartilage that connects the ribs to the breastbone–and it sounds exactly like what I had. The cause is unknown, but it does tend to go away on its own. I can’t recall my doctor from way back then mentioning it as a diagnosis; he really did seem completely baffled. I’ll have to ask my rheumatologist if RA can cause costochondritis as a co-morbid condition… hmmm …