Amer. in Saudi Arabia, Fast onset symptoms, no better after nearly 4wks

First symptoms starting March 1: dry,violent cough,chest tightness,chills,general feeling bad progressing to difficulty breathing in hours.  March 2nd began taking 100mg each 12hrs of doxycycline. Next 3 days all symptoms cycled from not as bad to really bad again, and 3rd day added symptoms of upper chest pain down center with 'quarter' sized areas of more intense pain on either side of chest bone, and lots of mucus that wouldn't come up,wheezing.

After 5 days felt getting better, went out for day, by evening as bad as before plus fatique. Continued the doxycycline, vitaimins, rest, but very ill with all symptoms. For first time have head cold symtoms (symptoms) added, and flu feelings,little appetite,dizzy.

Finally went to hospital March 12.Doctor changed meds to amoxycillin 875mg+ciavulanate potassium 125mg each 12hrs & Romilar Expectorant. Did chest x-ray they said showed no damage or pneumonia. Said acute bronchitus (bronchitis),drink lots of warm decaf tea,breathe steam if can't breathe. Still unable to sleep lying down or much at all,coughing,burning in chest,hard to breathe, especially at night & mornings. 3 days later have good day, get around, then hits hard again.

Go back to hospital May 19, same Doctor. Changes meds to 582mg ciprofloxacin HCI every 12hrs + small pill not named for encouraging expectorating/loosening mucus. Again in 3 days feeling a bit better, able to sleep, coughing but getting things up, get up and around, then hits hard again last night.  Burning in chest after coughing, and burning spreads from center to both sides and remains burning/tight, but able to breathe better than first 3 weeks.  No more head cold or flu like body feelings, but deep wheezing,deep mucus cough,always burning in chest after coughing and lasts for hours if no coughing,difficulty sleeping,hot flashes/chills/sweating,strong fatigue.

I have not had even a cold for over 2 1/2 years, I'm 54, female, smoker (cold turkey quit date april 1 - this is scaring me),good shape/weight.  Because of being in middle east now,and because will NOT get better, I fear this is something like anthrax or unusual microbe or something.  I never mentioned anthrax to doctor, and have taken advice and meds, but it's not going away, and when comes back as bad after feeling like I'm getting better, I get more concerned about diagnosis. Medical care here isn't good, and Doctor doesn't speak English well either.

Does this sound like acute bronchitus (bronchitis)? If anthrax, would it go on this long without having killed me already?  I feel like I am fighting it, but it keeps coming back as bad like none of the meds are working, and it's something different than I have ever had.

I am to go back to hospital the 26th, and would appreciate any help with questions, tests, etc to ask the doctor about before I go.

Thank you so very much for any help or advice,
Carlene

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

Inhalational anthrax would be very unlikely.  Although the symptoms would mimic a severe pneumonia, you would be much sicker (i.e. hospitalized) if it were true anthrax.  A CXR would have a suggestive finding (known as a "widened mediastinum") if anthrax were present.

The medications that you were put on (doxycycline, augmentin, ciprofloxacin) are appropriate for both bronchitis and pneumonia.  

If you are not responding to the antibiotics, then further evaluation is required to determine whether you have uncommon conditions that can cause your symptoms.  This can include a mass, allergic bronchitis (known as eosinophilic bronchitis), abscesses, airway damage, or rare pathogens.  Evaluation with a chest CT and/or fiberoptic brochoscopy would be the next step.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[Carlene]

The burning pain radiating across chest, under arms, and around back is the main symptom now.  There is no fever, coughing is deep and usually successful now in getting something to 'move' and be able to be expectorated.  Again, 4th time in 4 weeks, I've just had a day and half or so of feeling like I was going to get better, but again I feel it's getting worse.. changing, adding symptoms.  

This burning pain is like heartburn pain, but all over, and with a heavy feeling.  When I first wake up, no pain... then coughed a bunch, but no pain coughing... then it starts deep in lungs, the spreads outward.  Then once it's here, it doesn't go away, but intensifies after more coughing.  It is very strong on upper sides of chest under both underarms and armpits.  Also occassionally feel like I can't make myself take a deep breath.. it's heavy tingling pins and needles burning feeling mostly like in chest muscles after originating where the cough started moving/loosening mucus.. also dizzy and headache on and off.

I've been finished with Cipro for 24 hours, but could this still be a reaction to that drug?  I am now not taking any medication but asprin until/if on wednesday he prescribes more.  I wonder if I could have hurt myself, a nerve pinch or something to get this burning?  Or could this burning be caused by anxiety and side effects to these meds I've taken for 3 weeks?  I'm going to see if I can go to an on compound chiropractor today just to try to rule out neck or spinal nerve pinch, and to some extend anxiety causes.  

I go back to hospital wednesday and will ask about CT as you said, and wonder if I should also ask for another xray and for them to let me see a specialist. What specialist should I ask for?  This isn't a family, personal doctor.... the health care here isn't like that.  Saad medical hospital has all the equipment and awesome facility, but they don't have the reputation for knowing what to do with it all... haha... Our plans as expats are always to just NOT get sick.  So any help in giving me specific things to ask them or tests to run, etc will help get them on a diagonostic path, I hope anyway.  

I've never had anything like this, nor ever been sick this long with anything... thanks for your advise...

Carlene

[kevinmd]

Hello,
If you're still coughing despite antibiotics, you may want to see a pulmonary specialist.  

Another consideration may be heartburn.  Uncontrolled heartburn can also cause chronic cough.  You may ask your physician about treatment for this.  

Thanks,
Kevin, M.D.

[Carlene]

It's early morning on Wednesday, March 26, and I wake up feeling there is no doubt I am very sick.  I feel I have fever, can't cough up anything, the burning pain feeling is nearly completely gone across chest now, but now it's that very heavy tight feeling back again... like elephant is sitting on chest. I feel very dizzy, light headed and all over sick.  Feel like my stomach is wanting to cramp.  I truly feel so much worse after again sure I was getting better.  My upper back feels heavy and it's really like I felt 4 weeks ago when I first started getting so sick.

Last night I drank a hot tea of grated ginger and honey and it was soothing to the burning, although it didn't leave completely, I was able to get to sleep.  I'm trying that this morning too, but so far it's not helping me open up my chest.  

I've not had antibiotics for two days.  The doctor only prescribed me 5 days of cipro since last weeks appointment.  Funny, except for the awful burning and coughing often (but getting stuff up and being able to breathe well last couple of days), I was feeling so much better than I am feeing right now.  This feels so strong... like these last 4 weeks and I'm right back to beginning again.  Hard to breathe deeply.  No head cold or nasal symptoms for over 2 weeks though.

I am pretty worried now... just can't seem to shake this or keep building on the gains.  My husband is also sicker, and he says to print all this off and take with us to the hospital.  I will ask for a pulmanary specialist this time.  I've been up about an hour, and now after all the coughing but getting nothing up or loose, the burning is coming back, but localized in the middle of my chest and not radiating all the way to under both arms.

Carlene

[Carlene]

Finally was taken to see a specialist, and things now are looking up.  The tests he did found I have hietal hernia, and the awful burning across chest is from acid reflux.  Most likely having such a violent cough for so long has made the symptoms for this show up now and have never known about it before.  Also may have been made even worse due to the side effects of these antibiotics that cause excess acid build up and problems with digestion.  I'll be seeing a gastric specialist to help with this.

There a more tests tomorrow including some kind of a breath test to see if I may have some lung problems not showing up on the Xrays... like ashma or inflamation (inflammation), etc.  The inhaller and meds given after tomorrow's tests should bring the breathing difficulties under control per the doctor.  

Quitting smoking April 1 is not just a 'no brainer', it's now a necessity.  Thank you so much for your help and advice.  Just having this forum to be able to voice the concerns and ask for medical opinion has been of great help and comfort.

Carlene

[kevinmd]

I'm happy to hear that you saw a specialist and are feeling better.  

Good luck in the future,
Kevin, M.D.

[Carlene]

Just thought I'd come back on and do an update.  Mostly good news... the illness is gone now.  After tests showed the early stages of COPD per the doc, he then said it was unusual to catch it at this point, so early, where it may be reversable.  I still don't understand (his English is very spotty), but best I could figure is the breathing test results measured lung capacity, among many other things, and the capilaries where showing about 50%.  The other parts of test, including oxygen levels were normal or well above normal.  The Xrays were clear, but he didn't do any other test like that... no CT or Scan etc.

He never clarified as I tried to ask specifics, but again, sure it's the language thing.  The tests were done by a therapist with a tube in mouth where I would inhale and exhale in a variety of ways the therapist would dictate, and then some kind of treatment, then doing them all again.

Very curious (if you have the time), to tell me what you think this was all about.

BUT the great news is as of April 1, I am cold turkey, smoke/nicotine free!!!!!!!  Hardest thing I've ever done.... spent a bunch of hours clutching a pillow and just twitching and wanting to scream... withdrawal was awful!  But it's now a month, and I can honestly say, it's MUCH better, and I never want to go through that again... so I'll just never take another puff or be right back, junkie that I know I am now... this isn't just a habit.... I have gotten educated now... it's an addiction and I can't have one!!!

Within 2 weeks of stopping smoking, although I was feeling very out of sorts with the withdrawal, I was definitely breathing MUCH better and all the chest rattles were gone... that's improved as I can just feel things healing...

So thank goodness I got so sick... it was what was needed to push me over the edge and face it... to have continued to smoke all those weeks as sick as I was, well... that's what addiction is all about... woke me up finally... I smoked to hold off withdrawal... NOT because I liked smoking.

Hope I didn't wait too long to stop... hope the damage is reversable at this point...

Thanks for your advice and your suggestions and your time... This is an excellent site for us Americans living abroad and feeling insecure with the medical help we have where we live.

Carlene