Monday, September 22, 2014
Inquirer Daily News

Mild pain in the sides while coughing could have several causes

Question: For the last few weeks, whenever I cough or sneeze, my sides hurt a little. I told my doctor and he told me that it was from a muscle strain and to take two Advil for relief. That helps, but the pain keeps coming back. Is it anything to worry about?

Answer: With a limited history, it’s tough to know for sure what’s causing your pain. It certainly could be a muscle strain, and if so, it should resolve soon. I don’t think it’s a rib fracture because the pain is on both sides, there’s no complaint of pain with breathing, and your pain is described as mild at worst. Pleurisy, an inflammation of the lining of the lungs, would cause a lot of pain with breathing, something you didn’t describe.

If your pain lingers beyond the several-week healing time of a muscle strain, I’d suggest that you get a chest X-ray just to be sure something isn’t overlooked. If your mild chest pain remains persistent despite all tests being normal, a visit to a chiropractor might be the answer. You may have ribs that are "out of adjustment." Called "subluxation," it can happen following a bout of persistent coughing or sneezing, or simply twisting one’s torso in an odd way. Subluxation of ribs is a common and easily treatable problem.. Q: I am taking Crestor, Lovaza, and Trilipix for a high cholesterol/high triglyceride problem, but despite taking three drugs and watching my fats like a hawk, my LDL cholesterol is still above 160. Is there anything being worked on by the drug companies that might work better than what I’m taking now? A: As a matter of fact, there is a completely new method of treating high cholesterol in development, especially for people like you who are already taking cholesterol drugs and are still not to goal. It involves a fully human "monoclonal antibody" injection twice a month that binds (i.e., blocks) to a specific enzyme in liver cells that breaks down LDL ("bad") cholesterol receptors. LDL receptors are needed to bind/collect LDL "bad" cholesterol particles from the blood so that enzymes in the liver can break them down. The more LDL receptors the liver has, the more LDL cholesterol particles are broken down. That results in lowering the LDL cholesterol in the bloodstream.

In Phase II investigational trials involving 183 patients with an LDL cholesterol above the target of 100 milligrams per deciliter despite an average of 7 years of Lipitor statin therapy, LDL cholesterol levels fell by as much as 72 percent at 12 weeks — and this is above and beyond the LDL lowering effect from Lipitor. The most effective dosing regimen required one subcutaneous injection (akin to an insulin injection) every two weeks.

In Phase III, the drug will be self-administered subcutaneously using a fixed-dose pen. Drug companies Sanofi and Regeneron are sponsoring the research.

Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H," Box 767787, Atlanta, Ga. 30076.
Mitchell Hecht Medical Columnist
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