Cough, tickle and stomach ...

[NelsonAAA]

Dear Sir,

I am 42 years old, 6' tall and have been slightly obese for the past few years (14 - 17 stones).

My upper bowel and thorax seem easily affected by stress/ anxiety and I occasionally suffer from what I imagine is upper irritable bowel syndrome, with associated muscle tension and spasm in the chest. My stomach bloats easily and I have treated the problem, quite effectively for short periods of a few days/weeks with Proton Pump Inhibitors like Omeprazole.

However, in 2001 I had a number of breathing 'fits' similar to asthma (I don't believe I am asthmatic in the strictest sense and never have been). At the time, I was at my heaviest weight ever. I admit these hyperventilations may have been anxiety attacks, but they were brought on by a tickly sensation in my larynx. They occurred during the summer and may have been triggered by pollen, but I feel not (?).

However, for the past 2 years I still have that tickly sensation which causes me to cough regularly, especially immediately after a meal - no matter how light a snack. I also have the presence of mucous on my larynx.

Please note that I have a whitish mucous in patches on my tongue, with reddening underneath - this is slightly sore. The mucous dissappears beyond my tongue down my throat. It is easily scraped off but persistent.

Q1 : Could this be thrush, which is also established on my larynx? If so, can my larynx be treated by sucking Nystan pastilles?

Q2 : If the problem is unlikely to be Thrush, could it not be aerosolized acidic gastric contents 'attacking' my larynx, with mucous developing from constant irritation ? (I tend to use anti-acid products regularly to reduce stomach acid, including tablets and liquids, especially at meal times). I feel I have got liquid (acid) oesophagal reflux well under control through small, low fat regular meals and drugs. If the 'tickle' on my larynx and mucous is derived from my stomach, how then do you suggest I try to relieve it?

Q3 My third question relates to my breathing, especially after eating &/or stomach bloating. I cannot seem to catch the top of my breath at times and have to burp to recover my normal breathing pattern. This problem, along with the tickly/mucous described in Q1 & Q2 above, gives me a conscious discomfort that I previously did not have until the summer of 2001. How could I relieve the problem - further weight loss ?

Conclusion: Could you kindly please answer Qs 1-3 above in an attempt to relieve this breathing discomfiture, the mucous, the 'tickly' larynx and the difficulty of not always being able to fully inflate my lungs when inhaling.

Thank you for your very kind attention.

Regards,

NelsonAAA

[Kevin Pho, MD]

To answer your questions:

1) Thrush is possible, but I would consider more likely causes first.  This would include GERD, chronic sinusitis, or asthma which can all cause the symptoms you are describing in your question.

2) Yes, GERD is a more likely possibility than thrush.  A 24-hr pH study is suggested to evaluate for this.  If present, I would suggest discussing whether a regular proton-pump inhibitor is right for you.

3) Weight loss can always help.  The best test to evaluate this would be a pulmonary function test.  This can evaluate if there are any obstructive disorders (i.e. asthma or emphysema), or any other lung disorders that can be causing the shortness of breath.

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.

[kevinmd]

I will be away until January 4th. I will answer your question when I return.

Happy holidays,
Kevin, M.D.