Possible causes of breathing discomfort-Tests so far are normal

[Ruthiejb]

I'm a 59-year old post menopausal woman, never smoked, exercise regularly, 5'2", 110 pounds, taking Zocor 10 mg, Lotrel 5/20, HCTZ 25 mg, and 50 mcg Synthroid.  Approx. 11 months ago in June, I woke up with a head cold, followed by an issue where I would run out of air when I spoke along with breathing discomfort in my upper chest.  Sometimes the discomfort makes me cough, but it's a slight dry cough and never hacking.  It doesn't bother me when I sleep.  I don't have problems exercising or exerting myself; the problem running out of air is only when talking and not all the time.  After a month my doctor sent me for a chest X-ray which was clear and she did an EKG which was normal.  She prescribed Singulair which seemed to help at first, but the discomfort returned a few days later while still taking the Singulair.  She said it was an alllergy and left it at that. In October I saw an ENT who scoped my throat and ordered a contrast CT-scan of my neck, both normal.  I also had a thallium stress test, also normal.  I'm still living with these symptoms.  I am seeing a pulmonologist next week to determine if this is a problem with my lungs; my GP doesn't think so since I don't get breathless upon exertion.  What else could cause these symptoms?  It comes and goes; some days it doesn't bother me, other days it's with me all day.  Occasionally I will experience chest pain just right of center when I bend forward.  Almost a year has gone by with this discomfort and while it hasn't gotten worse, it hasn't  gotten better either.  Any insight would be greatly appreciated.  Thank you

[David Tinkelman, M.D.]

What you describe does not suggest a lung problem.  This likelihood is supported by the normal Chest X-ray in a young non-smoker who continues to exercise without breathlessness.  That your symptoms are limited to when you are talking suggests that the problem might reside in your larynx, possibly dysfunction of your vocal cords.  It was good that you were thoroughly examined directly with a laryngoscope, by the ENT and all was normal.  That means that if the problem resides in your throat, it is functional, rather than anatomical.

In that circumstance, all structures could easily be normal in appearance, yet not functioning normally when you experience symptoms.  You might want to discuss the possibility of Vocal Cord Dysfunction with your doctors, including the ENT.  

In addition, if I understand your time-line of this illness, the chest X-ray was taken about a month after the onset of symptoms, sometime in July 2010?  If that is the case, it would be wise to have a repeat chest X-ray at this time.  Also, if you have not had pulmonary function tests performed, with measurement of what is called flow-volume loops (inspiratory and expiratory), such testing could also be helpful.

Difficulty with breathing, limited to when one is speaking, is often associated with anxiety and you might want to give some thought to that possibility.

Good luck

[Ruthiejb]

Thank you very much for your response, Doctor.  I will be having the pulmonary testing this week and will also ask the doctor about a repeat x-ray.

[Ruthiejb]

Thank you, joe, I'll look into that.  I've actually never heard of it.

[joek39]

Seeing a Pulmonologist next is a good idea.  Issue could be in action of one or both your phrenic nerves, which is what controls your diaphraghm action.  Phrenic nerves start in your upper spinal cord and go down to each side's diaphraghm.  Any chance you have a pinch in your spine?  A good chiropractor might help as well.  Phrenic nerve issues are usually diagnosed by a neurologist.  Good luck, I've had experience with all of the above medical areas before my phrenic nerve issue was diagnosed.

[Ruthiejb]

I just wanted to add that my blood tests have all been normal, no anemia or elevated white cells.  Also, I have no mucus issues; when the ENT scoped my throat he saw no mucus.  Thank you again.