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Asthma and Allergy (Expert Forum)
Asthma or not, in need of some good help
Answered by
CO
This forum is for questions and support regarding: Allergies, Asthma, Chronic Cough, Sinusitis, and other Respiratory Disorders.
Asthma or not, in need of some good help
by motox320, Jul 30, 2009 03:10PM
25 yr M, 5' 11" 195 lbs track star in HS
Smoked for about 4 years pack PD then quit Before-around the time I started to quit smoking developed a breathing problem.
Feeling of SOB, suffication, breath does not satisfy me, , like when you dont breathe for 10 -15 secs. somtimes goes away, and can be mild to moderate.
Worst feeling of my life usually constant, but lets off
Do not hypervenolate, never more than 25 BPM during episdoes oxogyen when tested 100% It feels like I am being smothered, sufficated, chest gets tight. Laying down helps. I have never been woken at night due to this.
Tests:
GI xray, upper GI scope. showed refux (not terrible) and 5 cm sliding hitial hernia
chest xrays -nomral
CT of chest w contrast dye. Normal
Pulmonay function test (2 times) everthing right at 100% of predicted values, including MVV, had post broncodialter, no change in numbers. Only thing off was DLCO diffusion capacity was near 250% high, which has hasent been explained to me
Another smaller PFT at docs, normal...
ECHO of heart 2 times... they said trace mitial and tricuspid, but normal, no signs of PH, all looked gd. I will mention my stroke voulme was high in my opinion (113), at a heartrate of 62. could this have something to do with diffusion capacity?
2 EKG's normal
ENT look at my throat, she said redness and some inflmation, at the time no VCD, but breathing was ok at that time
Asthma medication dont seem to help much.
CANCA and PANCA test for chrug strass or whatever those test for. looked good
***** allergy testing, no allergies
I take zegerd, still have burps some reflux maybe nd to go on gerd diet
Been using broncdiater and once a day inhaler for 4 wks, doesnt seem to help
I bought a peak flow meter. Always flow in the 650-725lpm range regardless of symptons, seems to be on the lower ednd when I cant breathe
all done UPMC PITT
Please help, any suggestions? rhematic? lung disesae? asthma? gerd-hitial hernia?
*more continued on post below
Doctor's Answer
by National Jewish Health, Aug 10, 2009 10:46AM
, Aug 10, 2009 10:46AMTo: motox320
That you quit smoking around the time you developed a breathing problem suggests that you have had the problem you describe for about 4 years. That would be ample time for any progressive physical problem of the, 1) heart, 2) lungs or 3) the neuromuscular system to fully become manifest and readily diagnosable. Likewise such disease would be extremely unlikely in the face of all the normal/negative tests you cite, below. That strongly suggests that you do not have a physical disease that would fall into any of the 3 listed categories.
But a word about pulmonary function tests (PFT’s). The predicted values are actually mean values, centered on a bell-shaped curve. Thus 5% of men your age and height would have values two standard deviations 2 S.D) above the predicted values. It is thus possible that you might have had significantly higher actual PFT values at one time and your lung function has slowly but progressively declined to the current values, stated to be 100% of predicted. Given normal oxygenation at rest and a seemingly elevated DLCO, I deem the preceding scenario to be most unlikely. You state: I am not sure, but I think my xrays, CT scan and PFT, have ruled out ALL lung disesase espically at my age (25)
I agree.
And, you state: Could there be a chance that my lungs are so strong I hide asthma on PFT test, with just chest power?
Decidedly not.
And finally, you ask about: left sided facial numbness, sleepiness in day time, sometimes dizzy, lightheaded, fatigue, clear mucus hacking allot. need to clear throat a lot. on and off feeling of sickness at times.
Of these, you should have the left-sided facial numbness evaluated. That is distinctly abnormal and could provide a clue to the cause of some of your other symptoms. And, any imaginable infectious disease is not the cause of what you have experienced.
The possibilities I would still consider include: 1) an abnormality of either respiratory drive (CNS) or chest wall compliance, 2) hyperventilation syndrome with or without anxiety, with or without Panic Disorder, 3) Vocal cord dysfunction (VCD) or a variant of it that would primarily be associated with abnormalities of inspiration, or 4) a congenital heart problem resulting in recurrent, periodic right-to-left shunting that would not be apparent on conventional Echocardiography.
I believe the testing you have had has been appropriate and, of the four possibilities I’ve listed, the most likely would be #2.
Good luck
But a word about pulmonary function tests (PFT’s). The predicted values are actually mean values, centered on a bell-shaped curve. Thus 5% of men your age and height would have values two standard deviations 2 S.D) above the predicted values. It is thus possible that you might have had significantly higher actual PFT values at one time and your lung function has slowly but progressively declined to the current values, stated to be 100% of predicted. Given normal oxygenation at rest and a seemingly elevated DLCO, I deem the preceding scenario to be most unlikely. You state: I am not sure, but I think my xrays, CT scan and PFT, have ruled out ALL lung disesase espically at my age (25)
I agree.
And, you state: Could there be a chance that my lungs are so strong I hide asthma on PFT test, with just chest power?
Decidedly not.
And finally, you ask about: left sided facial numbness, sleepiness in day time, sometimes dizzy, lightheaded, fatigue, clear mucus hacking allot. need to clear throat a lot. on and off feeling of sickness at times.
Of these, you should have the left-sided facial numbness evaluated. That is distinctly abnormal and could provide a clue to the cause of some of your other symptoms. And, any imaginable infectious disease is not the cause of what you have experienced.
The possibilities I would still consider include: 1) an abnormality of either respiratory drive (CNS) or chest wall compliance, 2) hyperventilation syndrome with or without anxiety, with or without Panic Disorder, 3) Vocal cord dysfunction (VCD) or a variant of it that would primarily be associated with abnormalities of inspiration, or 4) a congenital heart problem resulting in recurrent, periodic right-to-left shunting that would not be apparent on conventional Echocardiography.
I believe the testing you have had has been appropriate and, of the four possibilities I’ve listed, the most likely would be #2.
Good luck
Is there anything that I could be missing?
My doc, is thinking gerd-asthma combo, but I think he jumps to conclusions.
But how would I have asthma with all the PFT being normal, and no real response to medicine? I will admit, I do cough mucus allot, and I have very powerfull lungs in my opinion. Could there be a chance that my lungs are so strong I hide asthma on PFT test, with just chest power?
Could it be uncontrolled asthma? Are there other medications to try? If so, with my good PFT numbers, I would think it would be resolvebale.
Yes, I did smoke for some years, but I am young. Never had any breathing problem before, always had the best lungs ever. I would think a lung disease would show on the CT or xray. What can I rule out?
I am not sure, but I think my xrays, CT scan and PFT, have rulled out ALL lung disesase espically at my age (25) Or am I wrong? early emphezima?
Echo, shows healthy heart, no pulm hypertension
CANCA and PANCA rule out some more
What about some type of bacteria? lyme or something like that? or a rheamtic disease? I do have some other symptons such as left sided facial numbness, that have not resolved for 2 years. I had a mri, clean
Or could it be gerd and the 5 cm hitial hernia?
I really dont think its in my head, besides anxiety, have no mental issues, have even tried an anxiey medicine to see if it would help.. I am a full time engineer, educated, and these are physical symptons. My uncle is a director of oncology at UMPC PITT, I may have to go to him next, but hes an oncolgist. You guys are the best center in the US for breathing, what do you think.
The only flaws on my test so far are:
-echo.. trace mitral and tricuspid reguration. stoke rate 113
-5 cm hitial hernia and gerd
-my other symtons, that dont bug me that much, and would be happy to live with if I could get this breathing fixed are: left sided facial numbness, sleepyness in day time, sometimes dizzy, lightheaded, fatigue, clear mucus hacking allot. need to clear throat alot. on and off feeling of sickness at times.
Just throwing those in, as maybe I have something else, which is causing the breathing problems
Any idea. I do appreciate your input Thankyou
I would just like to mention one thing. My CT scan was done at UPMC presby in Pittsburgh pa in the ER. they shot the contrast into me.
The results were no pulmonay embolis present. But subsotary and sub?????(sorry on spelling, I cant remember) are suboptically evaluated. (as I guess they were hard to see)
No acute pulmonay disease
anyways, can I assume this is a high resolution CT scan, or just a normal? And would it even be a big difference if it wasnt? Or do I need another one?
Is this safe? I dont want to stop breathing over a stuipd test.
I also heard people can have asthma, and one test to detect it is a nitros oxided exhaltion? whats your opinon on that.
Also found out more about my endoscopy, did revile grade A esopgasits in the lower 1/3, and the hitaus herina was medium sized. Stomach and duuedom were normal.
Was prescibed reglan to take 1 at bedtime. Didnt take yet, maybe I should. But I heard this is a bad drug? Would it be safe to try for a couple months?
Also, I did see a physolgist. She said she didnt think I was having bad anxiety or panic attacks that would cause the brething issues, but possibly anxiey could be making them worse. But said I should push my doctors for answers.
I am done posting, thankyou