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November 30, 2002

Aches and Pains

Question from Brisbane, Australia:

My 62 year old husband has been running for twenty years, but about six months ago, he started walking with me because he was getting a pain under his ribs after running. We walk at 5:30 AM for 30-45 minutes. We walk at 3.3 kilometer per hour pace, and we try to include one or more steep hills. Initially after stopping running the pain eased, but now it is returning, and I am not sure what is causing it. He feels breathless as he climbs the hill (legs ache), but the pain seems to come on as the morning progresses and feels a bit like blood pulsating or throbbing. It seems worse on weekends when our walks are usually longer and a little more strenuous. He was away for two days this week and had no pain while he was away and not walking, but yesterday the pain bothered him all day. His doctor has no explanation for it. His cholesterol is 4 and a stress test has shown no heart problems. We really enjoy our walks and would appreciate any advice you could give us.


The first thing is to make sure that his symptoms are not angina. I would recommend he start with a stress test and have it supervised by a physician who is familiar with cardiac stress testing. Chest pain can be caused by esophageal dysfunction, gall bladder disease, cartilage inflammation in the ribs, and many others. However, when someone has type 2 diabetes, a condition associated with increased cardiovascular risk, it is important to rule this out first.