Constant congestion, cough, clearing of throat.

[lennny01]

Problem:  For the past at least 10 years I have had constant congestion, almost always on the right side.  This congestion causes PND and forces me to clear my throat and cough.(I blow my nose a lot to clear it)  The mucus is always clear.  The congestion on the right side is year round.  Sometimes the cough turns into a dry heave and sometimes I vomit.  The biggest problem is that after strenuous exercise the cough is very bad and leads to the dry heaving.  During strenuous exercise I feel tightness in my throat like I can't get air in.  Sometimes the cough is after I eat as well.  Feels like something is in my throat that I can't clear.  

Actions taken to correct:
Stomach:
-Doctors thought it was GERD or acid reflux: have taken Prilosec and Nexium-no change.
-Upper GI conducted- Nothing abnormal
-Gastric emptying study conducted- Nothing abnormal, except weak motility

Nose:
-Have taken: Nasonex, Astepro(makes me drowsy), Veramyst, Flonase, Omnaris- No change
-Had deviated septum surgery with reduction of turbinates- No change
-Had uvulectomy- No change
-Use a nasal rinse- Helps a little but still cough
-Affrin helps to clear congestion, but only use it very infrequently

Allergies:
-Tested positive for seasonal allergies (birch, ragweed, mold etc)
-Tested negative for fool allergies
-Was on a gluten and lactose free diet for 8 days- No change

Current Meds: Singulair and Atrovent(7 days so far)- No real change noted
Me: In very good health, workout 6 days a week, do not smoke, rarely drink.

Possible causes:  PND, Sinusitis, Exercise induced broncoconstriction (never been diagnosed with Asthma), an Autoimmune disease, Vasomotor rhinitis.....

What do you think my condition is and how should I go about treating it?

Chris

[David Tinkelman, M.D.]

The information you have provided suggests that yours, for the most part is an upper respiratory problem, very likely to be chronic sinusitis, perhaps with a complicating factor on the right side such as allergic fungal sinusitis.  If not already performed, you should have a Sinus CT, with special attention to the right-sided sinuses.  Any abnormality on the scan should then be further investigated with biopsy and culture (including fungus culture) of abnormal lesion.  Another consideration would be a lesion (cystic or other) in the hypopharynx.  This area can be evaluated indirectly with imaging studies such as CT or MRI scans or directly with the fiberoptic laryngoscope.  GERD is a condition that could aggravate either of these conditions and should not be ruled out on the basis of an Upper GI Series or the absence of a demonstrable response to pharmacotherapy.  

You state:  During strenuous exercise I feel tightness in my throat like I can't get air in.

This symptom suggests the possibility of inappropriate closure of the vocal cords, called Vocal Cord Dysfunction (VCD) and a characteristic feature of this condition is difficulty breathing-in, rather than as with asthma, difficult breathing-out.  This too could be aggravated by GERD and is diagnosable by direct examination with the fiberoptic laryngoscope.

You also state:  Sometimes the cough is after I eat as well.  Feels like something is in my throat that I can't clear.  

This symptom could be secondary to increased mucous production and post-nasal drip, stimulated by eating, swallowing or GERD.  Or a swallowing disorder resulting in micro-aspiration.  A radiologic swallowing study could be diagnostic in this circumstance.

You may want to discuss some or all of the above with your physician, who is in the best position and best qualified to determine the likelihood of any of the conditions cited.

Good luck

[Skipsalong]

I feel compelled to account my problems with postnasal drip and all accompanying symptoms, misery, and now finally, a complete cure.  It is a long story, similar to the many I have read about on numerous websites, sans the cure part.  

It started about 10 years ago or so with an occasional itchy throat and occasional cough, sneeze, or throat clearing.  It continued to evolve through the years to get worse and worse, so that eventually it was debilitating, i.e., there was no normal life left.  In the past three years, my business took me to China on some dozen occasions and while the stress of the trip is always pretty bad regardless of how you try to mitigate it, my trips were particularly stressful since I would return home with very bad sinus symptoms and be insomniac for up to a week afterward; more than could be accounted for by jet lag alone.  In fact, eventually in the last couple of years, the symptoms were just plainly bad without regard for the trip to China.  

I couldn’t breathe and I couldn’t sleep.  I was wheezing like I was asthmatic and was frequently sick with a cold or the flu.  The insomnia could only be relieved with a strong dose of diphenylhydramine and Advil.  I couldn’t lay on my left side for the wheezing and coughing.  I had frequent headaches and rare migraine with aching muscles and joints.  I developed a cardiac arrhythmia that lasted for several months before more or less magically disappearing.  I know now why.  I had to make a trip during all of this to a near sea level location, and since I live at an elevation of almost 6,000 ft, I was unable to clear my Eustachian tubes and lost my hearing for some time.  I now wear hearing aids with a permanent hearing loss that was partly, at least, due to that event.  In general, I have been a miserable human being and increasing felt unable to function.

I tried every known remedy.  I spent thousands of dollars in pursuit of relief.  I tried antibiotics, anti-fungals, antihistamines, immune builders, vitamins, nose sprays, oregano oil, you name it, I tried it.  No relief.  I changed my diet to exclude gluten, milk, and sugar, and unless you have tried that, you can’t imagine how little there is left to eat.  None of it gave me lasting relief.  And then one day. . .

I splurged and ate a little Bryers ice cream one evening.  I had already concluded that sugar and milk were having little impact on the symptoms, but I got increasing worse as the evening wore on.  I looked at the ingredient list and saw that it had little in it but milk, sugar, and carrageenan.  So I wondered what is carrageenan?  I looked it up and discovered that it was a thickening agent made from seaweed, and that it could contain up to 20% MSG???  So I wondered, is that the key problem with it??

This began a quest to uncover just what MSG, the substance we have all tried to avoid for years by reading labels, was really about.  Our discovery was profound!  MSG is now contained in as much as 90% of all commercially available food items.  It is in just about every mouth full of food we eat in this country.  I ate a pretty pure diet, but it didn’t matter.  I checked the symptoms of MSG sensitivity and poisoning, and there I was!

My wife and I (she also has symptoms of sensitivity) immediately threw out a 6 months supply of extra food (several thousand dollars worth) and we are now on a MSG free diet.  

My symptoms of MSG poisoning, every last one of them, along with my wife’s, disappeared in less than 24 hours!!!!!

I no longer have any of the problems that have plagued me for a long portion of my life.  I strongly suggest that anyone with this problem do a simple two or three day test to see if it doesn’t stop their problems as well.  It is not an easy transition to make and live with, but a hell of a lot easier than the continual life-robbing suffering.  

I am including a list of links that can be opened to better explain how this situation is so out of control in the US and abroad.  China is a hot-bed of MSG and undoubtedly contributed to my final three years of increasing misery.  PLEASE, for the sake of yourself and your family, read the list of ingredients that now secretly hide the fact that MSG is in everything you consume.

I well know I sound like a radical zealot who has an axe to grind.  I am not, but I never intend to allow the FDA, food companies, medical profession, health supplement companies and US government to destroy my health and life again.  Please take action for yourself.  I am a Pathologist (research and industrial) by education with a strong background in biochemistry and I know what I am talking about.  Please open the links below.  

http://agentlejoy.wordpress.com/2008/05/01/msg-hidden-and-not-so-hidden
http://www.truthinlabeling.org/ (a huge website)  
http://www.msgmyth.com/  (a book written by someone who found out like I did)
http://www.msgtruth.org/avoid.htm
http://poisonevercure.150m.com/monosodium_glutamate.htm

This is just a few of the hundreds of sites about this terrible problem.  

Skip Halterman
Navajo Dam, NM  

[lennny01]

Also could this be Laryngopharyngeal Reflux Disease? (LPRD)  The symptoms match up.