Persistent nausea in a young female

Dear Ask The Doctor: A couple months ago I started to have pain under my left breast. The pain was did not last long. It would hurt more upon inhaling and if I inhaled deeply (which was quite hard to do due to the pain) it would go away. The last time this happened, I was sitting/laying down on the couch and the pain just started out of the blue. It was very hard to get a deep breath in and when I did, I felt a “pop” and the pain was relieved. At first the pain would happen once a week but now it is an everyday thing. I would not think much of this, but lately I have been having some other issues. Since August I have been nauseated. Initially, I was throwing up after essentially every meal and always nauseated. I started taking Omeprazole and stopped drinking Mountain Dew and I only threw up every couple weeks but the nausea persisted. I got used to the discomfort after eating and continued to take Omeprazole every morning. In March, I was (severely?) anemic. I tried to give blood and my H & H was 32 and my blood test at the Student Health Center resulted in an H & H of 31. I started taking iron 3 times a day and I did this for a month until my anemia went away. Still, the nausea persisted. It wasn’t just the feeling that I was going to throw up all the time though. There was pain, sometimes in the middle of my abdomen and sometimes below my sternum. I started to worry so I went back to the Student Health Center and this was about when the actual pain went away. I was told to take Omeprazole twice a day. That didn’t help. I was then put on Carafate. I took it a few times but wasn’t sure how many times a day to take it. The doctor told me 4 times a day and the bottle said once at bedtime so I just didn’t take it. I just want to get better. I am 18 years old, have a decent diet, and already have enough going on in my life. Why am I falling apart? Is it stress induced? Has the stress awoken some disorder that had previously been dormant? I have been looking up my symptoms and all that I have found about them doesn’t look so great. Should I be referred to a GI specialist or should I just deal with the constant discomfort?

Dear Vanessa: The initial pain you describe, worse on inspiration (inhaling) is often referred to as pleuritic chest pain. It is usually as a result of inflammation of the pleura, two membranes which surround the lung tissue. This type of pain may occur as a result of infection viral or bacterial, chest wall injuries, lung diseases, pneumothorax (when air escapes into the pleural cavity), pulmonary embolism (blood clot in the lung) and sometimes no cause can be identified. Nausea is a non-specific symptom and there are many causes ranging from a simple gastro-intestinal infection to pregnancy, gastro-oesophageal reflux disease, inflammation of the pancreas, inflammatory bowel disease, motion sickness, vertigo or medication side-effect. It is difficult to know whether all your symptoms and iron deficiency anaemia are linked. If your symptoms are not improving, I advise that you attend your family doctor for a full history and clinical examination to exclude many of the above conditions, and discuss further necessary investigations including: repeat haemoglobin level, blood tests for inflammatory markers, and possible referral to a gastroenterologist for endoscopy, which allows visualisation of the upper gastro-intestinal tract through a camera lens.