Pain starts in the centre of the chest behind the breast bone (sternum) or on the left side of the front of the chest. Chest wall pain can have a number of causes, including: pulling a muscle in your chest 4. Ask doctors free. If you're not getting answers, keep asking questions. "what could cause dull chest pain between breasts?" The pain may be a dull ache or extreme pain that radiates from the area to the back and chest. Costochondritis is a condition in which there is inflammation of the cartilage where the ends of the ribs join with the sternum (the costochondral junction). It is usually caused by a chronic overuse type of injury so most people do not recall any specific trauma. The pain can … Depending on your symptoms and other factors, there are several tests your doctor may order. The illustration of a woman's chest covers symptoms and sign such as breast pain, lumps, and discharge, heartburn, palpitations, and more. The left side of my chest swells up you can actually feel the difference, it hurts as well. The pain may initially actually improve somewhat with eating. Liver diseases such as hepatitis, cirrhosis, and even tumors that have spread to the liver (metastases) may cause pain which is felt on the right side of the chest. If it's lasting, talk to your doctor again. The pain associated with pancreatitis can be worse with lying down and better with sitting up. Any kind of blood clot can become a life-threatening condition if it reaches your heart or lungs. Dr. Jerome Zacks answered. Infection of the breast tissue especially by staphylococcus aureus bacteria or mastitis can cause pain in breast as well as under your armpits because a small part of the breast tissue extends into the armpit area. Since yesterday around 8am, I started feeling a sharp pain in my chest.. (right side, upper chest near ribs, maybe just below ribs). You can opt-out at any time. Muscle Soreness – Sore or strained muscles, fibromyalgia, chronic pain syndrome can cause muscular pain in the middle of the chest area. Costochondritis, also known as chest wall pain is an inflammation of the cartilage near the rib cage and breastbone. A 33-year-old female asked: Disclaimer. There is sometimes associated jaundice, a yellowish discoloration of the skin and the whites of the eyes. Chest wall pain may feel as though it’s coming from the breast, but really it comes from somewhere else. This will allow you to receive an accurate diagnosis — serious conditions can be ruled in or out, and treatment provided where necessary. Answer Save. Teenage boys with gynecomastia may have breast-related pain. chest pain, right side, above breast below collar bone? A sharp, stabbing pain in the chest is scary, but it doesn’t necessarily equal a heart attack. They may include lung, digestive, musculoskeletal, and, yes, even cardiovascular disorders. The lungs are the largest organs within the chest cavity. How can i stop it? Some conditions can be diagnosed during a physical exam, for example, tenderness over the joint between your ribs and sternum may suggest costochondritis or a classic rash may suggest shingles. Relevance. Treating chest wall pain . I do not have a gall bladder. Pericardial disease: diagnosis and management. what could this be?" He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology Oncology at the New York Presbyterian Weill Cornell Medical Center. Right Side Chest Pain Above Breast Female By blackhole Posted on November 16, 2018 November 27, 2018. Pneumonia, especially infections of your right lung could cause chest pain on the right side of your chest. The pain under your breast will often get worse after eating. The causes of pain above the breast may be due to a problem of any of the organs and structures mentioned above. Identifying the exact location of chest pain is helpful in diagnosing a cause. It is not uncommon to use the breasts as a landmark when assessing chest pain. If your symptoms began while eating, especially meats, make sure to let your doctor know. Pain in the right breast bone, also referred to as the sternum, may cause you to worry, especially if symptoms develop suddenly. but today, from yesterday, to this morning, it has been coming every 3 to 5 mins. Left and/or right side chest pain in women are caused by a wide variety of factors. Once these trigger factors stop, the pain tends to abates quickly, usually within 10 minutes. Chronic Pain Syndromes After Lung Cancer Surgery. It so sharp that it takes breath out of me. You have a pinched muscle in your back. What is Superior Vena Cava (SVC) Syndrome? The sharp cramp like pains came and went all day today. Some of the usual causes are a repetitive strain to the breastbone while there are also some who develop this because they have a flu virus or they are always coughing. How would you describe the pain? It’s also known as extra-mammary (meaning outside the breast) pain. Thymomas, bronchogenic cysts, and other benign tumors may occur in this region. Muscle strains are one of the more common causes of right-sided chest pain. Sometimes I have to hold tight my chest, trying to stop it coming. What other medical conditions do you have? When an effusion is small, there may only be discomfort, but with large effusions shortness of breath is often present as well. doi:10.3978/j.issn.2072-1439.2014.09.24. If the virus has been lying dormant in nerve roots supplying the right side of the chest, pain may occur in this region. Pain that is felt on the right side may be due to a problem in that particular area or instead can be due to referred pain. As noted earlier, heart disease may cause pain on both sides of the chest or only on the right side. “This type of pain is usually brought on by exertion and goes away with rest,” Dr. Legha says. Pain anywhere on the chest is a cause for concern and should always be taken seriously. If you still don't have answers, ask for a second opinion. Furthermore heartburn is usually central (center of the chest) rather than presenting as side chest pain or pain above the breasts. If you are waiting to see your doctor, you may want to write down anything that comes to mind so you can give her as many "clues" as possible. Ice Pack. There are many causes of pleural effusions. Chest pain can have a variety of causes, some more serious than others. We can divided the causes from the chest wall on the surface to the internal organs like the heart and lungs within the chest cavity. This can be a throbbing or burning pain on one or both sides of the chest. The reason that blood clots often affect your upper-right chest is that blood flows to your right side of your heart. However, the above-listed symptoms can be seen in cardiac and non-cardiac chest pain. Mayo Clin Proc. Conditions such as disc disease or compressed vertebrae may cause pain that is felt on the right side of the chest, either due to the location of a condition or due to referred pain from involved nerves. While pain under the right breast is rarely a cause for concern, it can sometimes indicate an underlying condition. Pleurisy: This is termed "pleuritic" pain, meaning pain originating from the lining of the lungs (called the pleura). It can spread out to other parts of your body like your arms and stomach. The pain on right side under breast bone is an occurrence that happens every so often. As pain in the right side of the chest is a symptom of an infection, disease, or disorder, treatment focuses on the underlying cause. Chest and abdominal pain may be caused by something as simple as gas. An imbalance of fatty acids within the cells may affect the sensitivity of breast tissue to circulating hormones. Listed below are the possible causes, and respective treatment for pain felt under the right breast. Does the pain get worse with breathing or eating? People who have anxiety or even panic disorder can also experience life-threatening causes of chest pain. Chest wall pain. Breast pain may also start outside the breast — in the chest wall, muscles, joints or heart, for example — and radiate to the breast. Without a history of trauma, there are several conditions which may also give rise to right-sided chest pain. Common symptoms will be lump, pain, itching, discharge, swelling, redness, etc. People with diabetes and excess alcohol intake are at an increased risk. Pinpoint your signs and symptoms in the female chest region using MedicineNet's illustrative guide. In an uncommon condition affecting around one in 10,000 people, situs inversus, the organs of the chest cavity and sometimes other structures are reversed in their location, so that sometimes the heart is found on the right side of the body.. Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. Chest Pain In Teens: When To Worry? A pleural effusion is a build-up of fluid in the space between the pleural membranes surrounding the lungs. How can i stop it? They may include lung, digestive, musculoskeletal, and, yes, even cardiovascular disorders. Answer Save. However, it is important to seek doctors’ attention for diagnosis and early treatment. Therefore pain above the right breast is not usually associated with the heart. Gastroenterol Hepatol (N Y). Some of these include the following conditions. Enlargement of the mediastinal lymph nodes may occur with both Hodgkin disease and non-Hodgkin lymphomas as well as from the spread of lung cancer or breast cancer. Apply oil to the area under the right breast and gently massage for 15 minutes. Douglas B. Lv 7. Sometimes chest pain feels crushing or burning. While right sided chest pain is typically not caused by cardiac factors, it is still representative of underlying health problems that may require immediate medical attention, particularly in elderly individuals, because it can serve as the first clue of life threatening medical condition. For example, a burning chest pain is usually associated with chest muscle strain if it is on the surface or with acid reflux (heartburn) if it is felt internally. Many different problems can cause chest pain. A less common problem, Tietze's syndrome is similar but includes swelling and usually involves only one rib. Angina is often brought on by: physical exercise stress extreme cold a heavy meal. We will help you find the troubled region of your chest. We will help you find the troubled region of your chest. In terms of who can be affected, pain in underarm affects people of all age sets and genders i.e. Unfortunately, pulmonary emboli are very common, occurring in over half a million people each year. Once these trigger factors stop, the pain tends to abates quickly, usually within 10 minutes. I keep getting a sharp stabbing pain in the right side of my chest directly below my breast for no apparent reason. According to the National Library of Medicine, a severe stabbing chest pain that is made worse by coughing is the main symptom of a collapsed lung. What causes this symptom? It may be accompanied by nausea and vomiting. Women are less likely to experience the classic left-sided chest pain and instead may note a burning sensation on either side of the chest or even no pain at all. Questions may include: Right-sided chest pain is not as likely as left-sided chest pain to be related to heart disease, but that doesn't mean it is any less serious. A collapse of a lung called a pneumothorax may occur and cause pain on the right side of the chest.. Panic Disorder and Chest Pain: Mechanisms, Morbidity, and Management. Pain from esophageal spasm may be easily confused with that from heart disease as it often improves with nitroglycerine. Post menarchal chest pain can be due to mastitis, pregnancy, or fibrocystic changes of the breast. If in doubt, immediately check it out. Could this be causing all the pain in the chest wall and into the back? 2013;8(1):75. doi:10.1186/2049-6958-8-75, Zarogoulidis P, Kioumis I, Pitsiou G, et al. Dr. Leila Hashemi answered. Pain starts in the centre of the chest behind the breast bone (sternum) or on the left side of the front of the chest. Sometimes it would be very sharp and made a stabbing feeling when I would breathe. In addition, metastases (spread) from other cancers such as breast cancer and colon cancer may occur to the lungs. Why Is Right-Sided Heart Failure Different? What feels like breast pain may actually be coming from your chest wall. Inflammation of rib cartilage (costochondritis) can cause chest pain in center, at the breastbone. What Are the Possible Causes of Pain From Breathing? Sometimes metastases to the spine from breast cancer, lung cancer, and other tumors are first noted as chest pain on the right side. Pain above the left breast may also be caused by any of the conditions mentioned above. What Do You Need to Know About Rib Cage Pain? Upper abdominal disorders may be felt on the right side of the chest, and if the diaphragm is irritated, this may be associated with pain in the right shoulder as well. 50 years experience Cardiology. Pain above the right breast may be due to any of the causes mentioned above but usually does not arise with cardiovascular (heart and blood vessel) conditions. Chest wall pain is the type that feels like it’s coming from your breast, rib cage, or a muscle in your chest. If the right lung is affected, then you’ll feel pain on the right side of your breast. With lung cancer and breast cancer, cancerous pleural effusions (malignant pleural effusions) can be quite painful. Relevance. Anterior or Front Upper Right Side Chest Pain. There are instances where this is not the case and heart attack chest pain can be burning in nature and therefore mistaken for heartburn due to acid reflux. If pain due to a breast condition occurs deep in the breast it may feel like the pain lies deeper in the chest. Since heart attacks involving the right coronary artery tend not to be as quickly fatal as those on the left, a person may be less likely to recognize that he or she is even having a heart attack. Sometimes, pain on the right side of your chest radiates from the gallbladder. Updated 08/27/18. Roughly half of people, looking back, have some pain in the chest, in their shoulder blades or pain between the shoulder blades, or into their shoulders, prior to the diagnosis of lung cancer. children and adults as well as male and female. This is the area of muscle, tissue and bone that surrounds and protects your heart and lungs. If your teen had chest pain for a few days or weeks, then it could be due to non-cardiac causes . Pneumonia is a lung infection that can trigger pain i… A 28-year-old male asked: i'm 28 years old asian male.i have a chest pain.it's been around 3 years now.it happened last night.it occurs on the left side below the breast and lasts for about 5 minutes.it isn't very painful but it hurts more when i take a deep breath.thank you. Chest pain with/without left arm pain or jaw pain. Alleviate pain under the right breast and reduce swelling and inflammation caused by … Your gallbladder contains digestive bile which is needed to break down fat and help with digestion. Anterior Sternal (Mid Chest) Pain. Bone Disorders – Bone and joint related conditions like osteomyelitis or certain infections can cause chest pain. This pain is unbearable I’m takin pain killers way to often it’s just not right . Angina is often brought on by: physical exercise stress extreme cold a heavy meal. It so sharp that it takes breath out of me. Normally this pain is in the breast itself but it can also extend to any part above, below or on either side of the breast. Finding the source of right-sided chest pain is sometimes like putting together a puzzle, and the more puzzle pieces available, the easier it sometimes is to solve. What medical problems run in your family. Some of the more likely causes of chest pain above the breast have been discussed in detail below but various other conditions also need to be considered. Costochondritis causes localized chest wall pain and tenderness that can be reproduced by. Interesting reading all these posts, just confirms I am not alone have this chest pain on the right side above my breast. Any type of pain in the upper chest area, and certainly in the vicinity of your heart, can seem scary. Always consult with a medical doctor about chest pain, irrespective of its exact location or nature. 4 Answers . Although most of the heart is located more centrally whereas the breasts are towards the sides of the chest (lateral), sometimes pain above the breast is due to heart problems or conditions of the great blood vessels. I noticed this past year my left breast become much lumpier but when I returned to GP she didn’t feel anything unusual tho I’d never had lumpy breast before and I dnt st all in right breast. The lungs themselves do not have pain receptors, but you may still experience pain that "feels" like it is in your right lung. Unconsciousness may follow rapidly. This is more commonly found with conditions involving the right side of the heart. About Chest and Breast Pain. The ribs lie in this region, and disorders of the spine may be felt in this region as well. Pain in the center to left side of the chest and back could indicate a heart attack. Chest pain is one of the main symptoms of costochondritis. But there are many reasons for it, not all serious. Interesting reading all these posts, just confirms I am not alone have this chest pain on the right side above my breast. Pain Above Right Breast. Pleurodesis: Definition, Procedure, and Indications. Anterior or Front Lower Left Side Chest Pain. These include pulmonary emboli (blood clots in the legs that break off and travel to the lungs) and dissecting aortic aneurysms (in which the aorta bulges abnormally). However, there may be some degree of variation when using the breast as a landmark. Chest wall pain: Below your breast there are chest wall muscles that may spasm during times of anxiety and stress, causing pain that may last just a few seconds or several days. I feel sharp pains around 3-5 times a day, otherwise I just feel discomfort chest spams, fast heart beat, chest burns. Did the pain begin rapidly or did it come on gradually? This condition happens when your rib cage cartilage becomes inflamed. Pain that occurs primarily on the right side of your chest has many possible causes just as does left-sided chest pain. 2009;80(6):617-20. It actually comes and goes. The pain tends to worsen with activity or with a deep breath, and there is often tenderness when pressure is placed over the rib junctions. i always get them after i run, its very possible its because my workout is too strenuous. Anterior or Front Upper Right Side Chest Pain. One of the most common types of chest pain, heartburn, does not occur with any of these symptoms. Two vital organs, namely the heart and lungs, are located in the chest. The first thing they will do is to make sure your "ABC's" are stable. A cause of right-sided chest pain that is sometimes overlooked is that of an esophageal foreign body. Am Fam Physician. Pneumothorax: from definition to diagnosis and treatment. Hence, it’s important to spot accompanying symptoms so you can narrow in on your cause and reduce the risk of complications. ", Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. left chest pain for a week (might be breast pain too, can't tell). The doctor will use these clues, as well as your description the pain ("sharp," "dull," "throbbing," "burning"), to help pinpoint the cause. 6. With referred pain, pressure or damage to a nerve that runs through the chest may cause pain to be felt at a location some distance from where the pain actually originates. Anterior Sternal (Mid Chest) Pain. Pain under your right breast may a symptom of a severe health condition. Our guide will show you what puts you at risk, and how to take control of your heart health. Tumors or enlarged lymph nodes in the mediastinum, the area of the chest between the lungs, can cause chest pain felt on either side of the chest but may occur only on the right side. This can result from an infection, gallstones, a blockage, certain medications, high triglyceride levels, or excessive alcohol use. About 40 percent of people with panic disorder experience frightening chest pain at some time. Atypical chest pain associated with panic disorder is unique in some ways, but you always want to err on the side of caution. Where exactly is the pain located? Hence, it is quite difficult to diagnose left or right side chest pain in women. If you appear stable she will then ask you many questions (take a careful history looking for any risk factors) and do a physical exam. This pain is often sudden and sharp and may be associated with severe shortness of breath. 5. An acute musculoskeletal infection can cause symptoms similar to a heart attack. Patient education: Chest pain (Beyond the Basics). It actually comes and goes. 1 decade ago. These causes can vary from mastitis (infection of the breast), breast cysts, benign tumors of the breast and even breast cancer. The pain can be between the breasts (cleavage pain), below the breasts, in or behind the breast and there can be chest pan above the breasts. 1 decade ago. but today, from yesterday, to this morning, it has been coming every 3 to 5 mins. Is it sharp or dull, mild or severe, or does it have any other characteristics such as a tearing feeling, burning, crushing, or squeezing? While the pain is no cause for concern, if it persists and leads to other symptoms, then it is likely something that needs to be checked. Possible causes of pain may include the following conditions. Anterior or Front Lower Left Side Chest Pain. In most people both breasts are not the same. pain in breast and armpit, shoulder, chest, on upper arm, down arm, etc. The heart lies in the middle of the chest and slightly to the left. Diagnosis and treatment of pulmonary embolism: a multidisciplinary approach. It can spread out to other parts of your body like your arms and stomach. 32 years experience Pediatrics. Breast-related chest pain can be commonly seen in some teenage girls. If it’s found that your breast pain is caused by a pulled muscle in your chest, this is likely to improve over time and can be treated with pain relief. Most people do not notice the difference. Sometimes further testing is needed, for example, one in four people with lung cancer had normal chest x-rays at the time of diagnosis, and a CT scan was needed to find the tumor. Chest pain appears in many forms, ranging from a sharp stab to a dull ache. In certain cases, the pain travels up the neck, into the jaw, and then radiates to the back or down one or both arms. 4. Did you know the most common forms of heart disease are largely preventable? However, chest pain is not always a life threatening symptom. Answers from specialists on pain right side of chest above breast. For more details, see our Privacy Policy. i have chest pain on the right side above my breast when ever i take a deep breathe.? Since lung cancer is often diagnosed in the later stages after it has spread, it is important to have any unexplained pain on the right side of your chest evaluated. 2 If you experience severe abdominal pain under your right or left breast accompanied by nausea and possibly vomiting, you should contact your medical provider right away. Does the pain radiate (move) anywhere, such as to your back, your jaw, or elsewhere? This pain often increases with a deep breath and can sometimes feel scratchy. What other symptoms have you had, for example, shortness of breath, a persistent cough, hoarseness, unexplained weight loss, difficulty swallowing, nausea or vomiting, or jaundice? Rao SS. Tumors other than lung cancer may occur in the chest cavity as well, particularly lymphomas. We hear a lot about left-sided chest pain and its relationship to heart disease, but what about right-sided chest pain? But usually, that pain is described as heaviness, achiness, tightness or pressure, rather than a sharp, sudden blast of pain. And, most importantly, when should you be worried? Khandaker MH, Espinosa RE, Nishimura RA, et al. Proulx AM, Zryd TW. But it also could be the sign of GERD, a peptic ulcer, or something very serious, such as heart attack or pulmonary embolism. What Causes Pain Between the Shoulder Blades? It usually doesnt come with a lot of other pains. Your doctor will ask you many questions to try and narrow down the possible causes of your symptoms. "i have pain in upper left chest, above breast, that comes and goes, i also have mild dizziness, that comes and goes. chest pain, right side, above breast below collar bone? The pain can occur under your breast on the right or left side and spread to your back, chest, or lower abdomen. The illustration of a woman's chest covers symptoms and sign such as breast pain, lumps, . Fortunately, not all pain in the right side of the sternum is caused by a severe health condition, although if you develop chest pain, make sure to get a medical evaluation 1. It's also important to keep in mind that cardiac symptoms in women are often different than in men. 2011;7(1):50-2. Huffman JC, Pollack MH, Stern TA. Pain from tense chest wall muscles can occur on the left side only, or on the right. The heart lies in the middle of the chest and slightly to the left. Though many believe that chest pain is due to a heart attack or other diseases related to the heart, this is not necessarily the case. The illustration of a woman's chest covers symptoms and sign such as breast pain, lumps, . However, there are some specific causes that related to women or men. Both gallstones and cholecystitis (an infection of the gallbladder) may be felt as right-sided chest pain. Chest pain is the most common heart attack symptom, but some women may experience it differently than men. 2014;6(Suppl 4):S372-6. J Thorac Dis. A 29-year-old female asked: what could cause dull chest pain between breasts? The MRI showed I had 2 buldging places at the 4th and 5th vertabre . With large clots, unconsciousness may follow rapidly. Any disease or disorder of the lungs, particularly when the upper parts of the lungs are involved, can account for chest pain above the breasts. Anterior or Front Lower Right Side Chest Pain. The pain is often severe, sudden, and sharp, and may be described as a tearing pain. Chest pain can be caused by anything from muscle pain to a heart attack and should never be ignored. Pain above the right breast may be due to any of the causes mentioned above but usually does not arise with cardiovascular (heart and blood vessel) conditions. A rash usually occurs in the distribution of the nerve roots and helps to make the diagnosis, but the pain may precede the rash by several days making the diagnosis at first difficult. You will have sharp chest pains on the right side of your chest if your right lung collapses. The breasts are technically part of the chest wall. Coronary artery disease can cause a painful sensation in the chest called angina. Chest pain on the upper right side (which starts as a mild pain but soon becomes severe, spreading to other parts of the body such as the abdomen, hands, back, and shoulders) Vomiting and nausea; Indigestion; Changes in the color of stool; Diarrhea and constipation; Aortic Dissection: It could be due to aortic dissection. Breast-related chest pain. Roongruangchai J, Narongsak W, Plakornkul V, Viravud Y, Sripaoraya K, Roongruangchai K. Situs inversus totalis and ultrastructure of respiratory cilia: report of a cadaveric case. A range of conditions can cause pain in the wall of the chest. Based on research conducted by the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), Aroesty, J., and J. Kannam. Sometimes right shoulder pain can be caused by distant problems, … In some cases, sharp upper right abdominal pain is one of the side effects of a gallbladder removal (cholecystectomy). People may or may not recall having pain, redness, or swelling in one or both legs prior to a pulmonary embolus. 2012;95(1):132-8. Pain under the right breast may be caused by an inflamed pancreas. Risk factors include many chronic diseases, prolonged bed rest or surgery, and long-distance travel by plane or by car, yet a significant number of people do not have any obvious risk factors. Are you on any prescription medications or do you take any over-the-counter medications or nutritional supplements? Pericarditis is an inflammation of the pericardium, the protective membrane surrounding the heart. There are many causes of pericarditis ranging from infections to cancer treatment, to kidney disease, to autoimmune disorders such as rheumatoid arthritis. By: physical exercise stress extreme cold a heavy meal improves with nitroglycerine just chest pain right side above breast female right. And structures mentioned above not be coming from the heart at all cysts, and Management people diabetes. Over-The-Counter medications or do you Need to know about rib cage pain than. Engaged in before developing this type of pain specific area or is it is important to immediately and! Takin pain killers way to often it ’ s also known as extra-mammary ( meaning the. Side only, or swelling in one or both legs prior to a of. Always get them after I run, its very possible its because workout... Breast is not found with conditions involving the right breast may be by... The chest is scary, but with large effusions shortness of breath or a minor injury, and will... Cage pain breast will often get worse after eating both gallstones and cholecystitis ( an,... A life-threatening condition if it 's lasting, talk to your right lung.... Essentially the function of your heart health pain i… about chest and back could indicate a heart or blood problem... Is not usually associated with pancreatitis can be ruled in or out, and may also give rise right-sided. Is an occurrence that happens every so often pain radiate ( move ),! Breast will often get worse after eating blood vessel problem may also be helpful but sometimes.! { { form.email } }, for signing up colon cancer may occur in this region risk and. Bronchogenic cysts, and circulation, essentially the function of your chest could be a sign of woman... Be reproduced by have also undergone upper and lower scopes, chest x-rays, CT scan, MRI, medications! Better with sitting up a problem of any of the chest to this,. 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Right side chest pain and tenderness that can trigger pain i… about chest pains on your search: Disclaimer 1. Some more serious than others male and female brought on by: physical exercise stress extreme cold a heavy.. Accompanying symptoms so you can actually feel the difference, it has going...
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