DEAR DR. ROACH: About five months ago, my 16-year-old son complained of soreness in the chest area. His doctor took X-rays and an EKG, and found everything to be normal, including blood pressure and oxygen level. However, he still has episodes of sharp pain on the left side of his breastbone. He says it hurts one day and then two or three days go by and he feels normal, but then the pain returns. Have you ever heard of this? — C.R.
ANSWER: Although I don’t take care of teens too often, I would say that these symptoms are fairly common in younger adults.
The location of the pain to the left of the sternum (breastbone) suggests the cartilage between the sternum and rib might be where the pain is coming from. The time course argues for a condition called, appropriately but unhelpfully, “chest wall syndrome.” The cause is not clear. Viral infections can cause a similar but usually much more acute syndrome. His doctor was wise to look for abnormalities in the heart and lungs, as unlikely as those are in a 16-year-old.
Typically, the syndrome goes away as mysteriously as it came in most people, usually within six to 12 months. Physical therapy may improve the limitations in function that go along with this diagnosis. Anti-inflammatories can provide relief until it goes away. These can be given orally or topically. A lidocaine patch may also provide relief.
DEAR DR. ROACH: Just read one of your articles about gluten-free foods and it reminded me of my grandfather eating gluten bread. This would have been in the 1940s, at least when I can remember. He did have Type 2 diabetes but no other health problems that I know of. This bread was rather chewy and had a sweetness to it. Do you know why he was eating it? Now that I’m a geezer, I’m curious. — D.D.K.
ANSWER: Gluten is composed of a mixture of proteins in flour, including gliadin, which is what people with celiac disease are highly sensitive to. People with celiac disease cannot have gluten. Even infinitesimal amounts can cause damage to the intestinal lining, which in turn may cause any combination of pain, diarrhea and inability to absorb nutrients.
People without celiac disease, and without symptoms due to sensitivity to gluten in absence of celiac, have no reason to avoid gluten. Gluten is an important component in baking. High-gluten flours provide a chewy, sturdy baked good, which is great for bread, but not so good for, say, an angel food cake. Scientific bakers know which kinds of flours to use to maximize or minimize the gluten formation as appropriate. Kneading the dough also makes longer gluten fibers and increases the chewiness of the resulting bread.
High-protein flours, which will make lots of gluten, are not sweeter than others. Your grandfather’s high-gluten bread may have had a little sugar added.
* * *
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.