a ton of test but no answers

[donnah]

My husband has had several years now of tests and no answers.  He is not a hypocondriac and rarely complains but has been going though so much pain and discomfort.  He has diminished lung capacity, difficulty breathing, pain in his right side, chest pain ,frequent heart palpitations and no stamina with any physical exertion.  He has had his heart checked, his lungs and almost everything else.  The doctor finally told him to get on an antidepressant (which did nothing). At one point they said he had a paralyzed diaphram (now it appears he does not).  The pain continues.  It used to be he would go though a few months with some relief but now maybe has it eases up for a few weeks only.  His blood work looks ok except  a d-dimmer titer was over 1000. He went to a rheumotologist and he said it was not sclerderma (thank God!).  He doesn't even know where to go from here to be tested.  We live in Michigan, near Detroit.  Any ideas of other areas to be tested?  He is a foot doctor.  At one point he was tested for nail fungus and it appeared he was alergic to that.  He has stopped grinding nails and wears a mask and gloves.  Still the difficulty breathing.  Please help.

[nurse12hr]

Try the Henry Ford Medical Center, or go to U of M in Ann Arbor.  Be persistent and insist on a diagnosis.  Don't take "I don't know" for an answer.

[donnah]

he did all of the things that you mentioned and everything came out negative.  WHat else can he try?  He is still in pain and difficulty breathing.  Still pain in the right side.  please help

[Kevin Pho, MD]

I would suggest a referral to a pulmonologist.  Many things can elevate a d-dimer, but one thing I would make sure is a chronic pulmonary embolus.  A CT pulmonary angiogram or ventilation/perfusion scan would be reasonable tests to evaluate for this.

A CT scan, including high-resolution CT scan, should be performed, in addition to pulmonary function tests - if they haven't been performed already.  

A more specialized test would be cardiopulmonary exercise testing.  Cardiopulmonary exercise testing is indicated when the etiology of a patient's shortness of breath remains unclear after the initial evaluation described above, or when it seems out of proportion to the severity of the patient's known cardiac or pulmonary disease.  This test can determine whether the shortness of breath is coming from the heart or lungs.

Another heart test would be a blood test known as a B-naturetic peptide.  Elevated levels of this would suggest a cardiac source.

In any case, I would suggest a referral to a pulmonologist to discuss the possibility of these tests.  Any academic medical center (i.e. near a major city like Detroid) would be appropriate.

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.

[donnah]

please note the problems he has with breathing and chest pain and right side pain and help come up with an answer.