### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Hi, My name is Wendi and I am 39 yrs old. I have been suffering from chest pains that shoot across my chest for over a year, and lately I have been getting milder versions of this pain throughout my chest, under both breasts (more on the left than the right), and I also have a severe pain under my left arm that causes my entire arm (including hand/fingers) to go numb. I also feel like I have something stuck in my throat constantly and it won t go away. I have had x-rays and an MRI that are normal. My dr. has run all kinds of blood work and everything is normal. I have also had a mammogram that was normal. She thinks I may have a hiatus hernia but I am waiting to have an upper and lower endoscopy to see if there is anything there. All chest/heart tests have also come back normal. Could all of this be releated to a hernia??? Most of the time when I take an attack it feels like I have a golf ball on fire in my throat and I get severe pain in my chest, upper abdomen, and upper back. Also, if I bend over a certain way I the pain under my ribs on the left is so severe that I actually can t breath. My Dr. put me on Ranitidine 150 mg twice daily and that does absolutely nothing, so she put me on Pariet 20 mg once daily and that only dulls the pain when I have an episode of severe throat pain. I have alot of heartburn and no reflux . Any suggestions would be very welcomed at this point.

### output:

Any time an internal body part pushes into an area where it doesn't belong, it's called a hernia. The hiatus is an opening in the diaphragm -- the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening. There are two main types of hiatal hernias: sliding and para esophageal (next to the esophagus). Many people with hiatal hernia have no symptoms, but others may have heartburn related to gastroesophageal reflux disease, or HERD. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having HERD, and others have HERD without having a hiatal hernia. People with heartburn may experience chest pain that can easily be confused with the pain of a heart attack. That's why it's so important to undergo testing and get properly diagnosed. Most people do not experience any symptoms of their hiatal hernia, so no treatment is necessary. However, the paraesophaeal hernia (when part of the stomach squeezes through the hiatus) can sometimes cause the stomach to be strangled, so surgery is sometimes recommended. Other symptoms that may occur along with the hernia such as chest pain should be properly evaluated. Symptoms of HERD, such as heartburn, should be treated. U can try syrup machine gel 2 SF thrice daily before food for 7 days.