Larynghitis - 11 days and counting - Extreme Coughing Spasms

[cowgirlnerd]

Ok, I have been sick for about 6 weeks now - off and on with flu like symptoms, going to bronchitis a couple of times (I have had chronic bronchitis for about 5 years).  I have been through 3 rounds of antibiotics, have tripled my dosage of Advair to 500mg twice daily from 250 mg once - I am taking Combivent inhalers every 4 hours, I have recently been given a massive cough medicine to make me stop coughing (isn't working) - which is the second kind of cough medicine, Singulair...

There have been 2 rounds of chest X-rays; blood work (which only shows an elevation that represents a mild asthma attack - ok, this is 6 weeks, come on), and now I am scheduled to go to an ENT on Tuesday.

The general consensus from the 3 doctors (2 ER's and my family doctor) is that I am having allergies with asthma issues.   I have coughed so hard that I have bruised my esophagus, and so now for the 11th day - I have no voice - I mean NO voice.  I still have extreme bouts of coughing that expel ALL of the air from my lungs, and make me cough to the point of completely losing my breath ( and loss of bladder control at times).  It comes in spasms like 5 or 6 bursts of coughs at a time - deep unproductive coughing.

I feel like I am choking and there is something stuck in my throat.  X-rays don't see this.  

What in the world will they be looking for when I go and has anyone had anything like this?  I KNOW I am sick - they tell me I am sick, but act like it's no big deal....except urging me to get seen by a specialist right away.  I am exhausted and want this resolved - what do you think?

HELP!

[MJIthewriter]

I've had laryngitis before, at least about a couple times.  The vocal cords get inflamed and that's why you can't talk.  It does feel like there is something stuck in there. Likely that's part of the inflammation.  I don't have asthma but I do get seasonal allergies on top of perennial allergies.  Add a cold to the mix and it does leave one feeling very miserable.

Do you get a lot of post nasal drip?  That could add to your coughing.  For my allergies and for the cold I had, they prescribed Fluticasone Propionate nasal spray. It's the generic form of something, but it helps cut down on the nasal inflammation as well as the post nasal drip.

When I had a cold this year, they had me use the nasal spray along with the cough medicine.  It didn't give the cold the chance to develop into a nasty inflammation.


BTW, when I lived with my family, my dad found it awfully cute when I got laryngitis and couldn't talk...  But I could still whisper...

[cowgirlnerd]

I can barely whisper.  I have been working this week - but it's hard to manage an office and send teams of installers out of state to jobs when you can't talk!  GEEZ!

No, I am not having any nasal symptoms.  I swear, I am sore from the top of my head to the bottom of my feet.  I have coughed and coughed until all of my muscles are sore.  I will think I am getting better, then WHAM - it gets worse.  If we hadn't been closed for a couple of weeks during the holidays - I don't know what I would have done.  

The last doctor that reviewed my xrays said it was like having a torn ligament in your leg.  He told me that my throat looks like someone just punched me in the throat - bruising, etc.  

Overall, I feel yucky.  I felt better yesterday - but had slept pretty good the night before.  The stupid insomnia going with my bipolar doesn't help.  I sleep in about 2 hour spurts and then I get up and start coughing again.  No rest.  Plus, they are making me take steroids  - which aren't good for me - make me really *itchy on top of it.

DANG!

[tomsant]

Hi,

This may be 'Adult whooping Cough' in which case, you are going to continue coughing unceremoniously for another six weeks ! (100 days cough or 3-4 mths cough) Because no treatment is going to help, as much as I know. I hope between the attacks of cough, you are feeling fine.

Your  doctors for sure, must have considered and ruled out other diagnoses like 1.Laryngitis 2. Laryngopharyngeal reflux 3. Allergy.

Diagnostic symptom is the particular type of spasmodic cough, until as if you exhale the last puff of air in the lungs and then inspire deep through a "narrowed" larynx opening (the vocal cords almost closed) making that particular sound.

As your doctors have not found anything, this is most likely adult whooping cough. The treatment should have been Clarithromycin in the initial week. Almost always the dx comes too late.

But don't worry, it should be over soon.

Best rgds,

Thomas Antony

[cowgirlnerd]

It's just weird!  I am miserable - do feel better today, but got some rest last night - finally!  The noise I make when I cough sounds just like that - like a gush of air coming through a small little whole.  

I have been on just about everything but those things - it seems.  They diagnosed me with Laryngitis but don't know why I don't quit the coughing.  He said that he thinks that my voice is because I have coughed for so long and so hard that it strained my muscles, bruised everything and that's just the way it is.  They gave me allergy drugs, but that hasn't helped  - gave me meds for asthma, steroids, antibiotics (Amoxicillin and Biactin), and no help.

What causes Whooping Cough?  I have an ENT appointment on Tuesday.  

[cowgirlnerd]

I searched whooping cough on the site and it gave a link to hear what it sounds like - it sounds just like I do.  It said that you had to be exposed directly to someone with it, though.  I can't recall being around anyone like that.  

It's bizarre how much it all sounds like what I have been through.  It says they can culture the back of my nostrils and throat to test for antibodies.  It also says that it's hard to get doctors to consider this as a diagnosis.  I guess one of my worries is that since I have been to 3 already and don't seem to be getting anywhere, how do I get the testing to move forward?

[tomsant]

Adult whooping cough is rare, but I understand that in Australia they have started vaccinating adults against whooping cough. (Do you know about the DPT vaccine given to infants, it is Diphtheria Pertussis Tetanus vaccine mixture. Pertussis is the one called whooping cough, caused by a bacteria called Bordetella pertussis.. Now that children are immune to wc, it is moving to adults;-)

Yes, they can culture from a swab taken from the nasopharynx or test for antibodies; I don't know if that facility is available everywhere.  Now if they confirm a dx of whooping cough, I don't think nothing much can be done about it. The infection is already over, and the remaining inflammation is taking its own time to go. I am not aware of any medicine that is known to make it fast.

But in case they stumble upon a different diagnosis, it may be important. But it is unlikely.

Since the three docs who already saw you didn't find anything, you can relax. Your ENT can peek into the larynx either with a mirror or scope. If it is wc, he may find only a lot of redness!

Just keep us informed :-)

Best,

TA

[cowgirlnerd]

Well, tomorrow is the big appointment.  Today, I feel worse than I have in awhile.  I coughed a lot this weekend, but I think it's because I am out of my presc cough medicine.  That pretty much knocked me out and kept me from coughing.  I am so sore and exhausted from it all.  I have burst a blood vessel in my eye from coughing so hard even.  

It seems that I am getting more mucus now in the nose down my throat.  When I cough, it seems like it won't stop until I cough SOMETHING up.  My throat seems to be getting more narrow when I cough, or it might just be that it is really sore.  I have this horrible taste in my mouth now and even though my nose isn't stuffy, it seems like it's going down my throat or something from my nasal cavity.  

I have just never ever felt this bad for this long.  I still can't talk - their is just no voice there.  NONE.  I can whisper a little, but no voice.  

[tomsant]

Just don't worry.

Any cough syrup containing codeine will suppress cough but will make one drowsy. But this is what is given for such cough.

Lets see what the ENT finds in the larynx :-)

Best rgds,

TA

[cowgirlnerd]

Well, they put the scope down my nose and throat and there is a lot of irritation, redness, swelling, etc., in my esophagus.  He  couldn't get into the voice box because it was so irritated that I started gagging, etc., but he thinks there is a viral infection in my esophagus and voice box.  Not sure, but thinks that is what it is.

Still, I have no voice - but it seems to be doing a teeny tiny bit better.  He gave me some more Tussinex (sp?), that helps with the coughing, which I still have.

He said it might take 10 weeks to get over it.  He has calculated that at a week from tomorrow.  If not better by then, they are going back in my throat to culture, etc., and see what is going one in there.

He gave me also, another antibiotic - the last kind available that I haven't taken - he said, to ensure there wasn't something lingering in a bacterial infection.

Oh well!  We will see!  

Rach

[tomsant]

I think the 'scopy findings are similar to the ones in whooping cough. As far as I know diagnosis at this stage is by testing for 'pertussis antibodies' in blood.

You may visit : http://www.whoopingcough.net/For_doctors.htm , take a printout and give the same to your doctor.

Best rgds,

TA

[cowgirlnerd]

I thought the same thing when he told me all of that.  He actually gave me another antibiotic just in case?  He told me that if it's not better by 1/27 we will need to look further.  I just wish it would be over.

It was amazing that when he told me of the prognosis and had that puzzled look, I thought of what you had told me of the whooping cough information.  

[tomsant]

Many of the doctors disbelieve a diagnosis of adult whooping cough. As I told you earlier, it is 'fairly' new.

But the diagnosis now is 'presumptive' and it can be confirmed only once it goes away for good, after the 3-4 months. He has put you on yet another antibiotic, as he will not be able to forgive himself in case this is not whooping cough. You should know any diagnosis is an educated guess.

(At least now you can cough comfortably;-)

Best rgds

TA

[cowgirlnerd]

I spoke with my ENT yesterday (his nurse actually) and he has decided to ask a specialist from Bham (a larger city with a medical university here in Alabama), to come review my case.  The specialist is going to conduct a sonar (I believe that's what she said) scope down my esophagus to see actually what's down there.   They will numb my throat and then place the scope all the way down my esophagus (ouch)

She said they want to look for any abnormalities; polyps; gastric reflux; etc.  

Who knows.  

[tomsant]

It is because no one is sure about the dx and you are young. There is the facility, money and the inclination...:-)

Best of luck!

TA

[tomsant]

You will not believe it!

I think I have one such patient in the ward now. He has been having allergic rhinitis and asthmatic bronchitis. He got admitted to my side only 3-4 days back. Until today, the dx didn't strike me.

In spite of this discussion! :-)

But I wonder if "pertussis antibodies' can be tested for here.

Best rgds,

TA

[cowgirlnerd]

I wish my doctors would just put me in the hospital!!  I would do anything to get the dx for this horrible mess!  I am going to mention the whooping cough that you helped me with.

They are looking at possibly tumors, but want the additional scope before cutting on me.  They are also doing additional blood testing.   My ENT finally told me he wasn't sure at all what's causing it, but was sure it wasn't as simple as a normal viral infection in my throat, etc.  

Take care of that patient!!!  It's a HORRIBLE HORRIBLE thing to be coughing uncontrollably with exhausting spasms!!!  Let me know what you find out, if you can - I am curious!!!

Thanks again for all of your help!!!

Rach

[tomsant]

You may feel secure, but otherwise there is nothing much to do once you are in the hospital. At least at home you have the near and dear with you !

Our lab people are looking around where they can get the blood test for 'pertussis antibodies' done. It is not a usual test one has heard of. They say they may have to send the sample to UK!

My patient did better after a shot of steroid yesterday, I just wanted the inflammation to go for a while. He was very thankful today as he could sleep peacefully last night. But I said this may be shortlived as I can't continue  giving such medicines!

Plan to scope him tomorrow.

Best,

TA

[cowgirlnerd]

True on the being with the near and dear - but since it's been going on so long (before Thanksgiving) I know they are tired of it!  :)

I went through 2 rounds of steroids and they didn't work at all on me (plus the Advair 500mg twice a day that has steroids).  

Oh well!  I hope he gets better ....ahh sleep .....wouldn't I love some of that!

[tomsant]

My pt continues to be fine, though during the 'scopy he coughed for a minute or so. His larynx is normal, surprisingly no redness.

I gave him Dexamethasone 4mg twice daily for three doses. I might have given it when the whooping cough is already on its way out :-) But it has given him some gastric irritation.

Hope you will get well soon!

Best,

TA

[cowgirlnerd]

Hello Dr. Tom

Still no headway.  No voice and they have scoped me to death.  They are doing voice exercises now to see it they can get the voice back.  They still don't really know what happened.  Think maybe I had pneumonia at some point and caused the severe coughing....etc.  

I have a little more sound coming out, but when they did the thing that measure the sounds from my vocal cords, basically, I have no sound in the midrange and very little in the lower range.  I can make a loud shrill high pitched scream noise, but only rough sounding talking voice.  

Who knows.  I am beginning to think it's always going to be this way.  Plus, I still cough but it has improved.  

VERY tired of this.

[tomsant]

Yes, I know it is tiring and I can appreciate your feelings. When you feel down, try to spend time with your near and dear.

I am sure your doctors are discussing this with their colleagues, like what we do when we run into such long winding paths to diagnose any illness.

My patient's blood report has come as positive for pertussis antibodies (from a lab in London). I scoped him the other day, and a namesake inflammation remains on one side. (He is having allergic airway disease as well)

Be assured you are in expert hands. Feel free to write.

Best,

TA