confused

[deezina22]

Hi,

   I have been suffering from " gerd " and hiatal hernia since i was about 16 years old . The first endoscopy showed an ulcer and was treated with diet modifications and meds at that time . I have been taking Nexium, prilosec etc for the past 15 years or so .

During the last 2 years i had chronic cough with sputum and sometimes it was dry on and off specially during winter . I also had hoarseness of voice . I never treated them with any antibiotics or allergy medicines . I thought that it was due to ' GERD" , as i felt that acids were entering my throat all the time and often had a sour stomach . I have been a chain smoker since i was about 16 years old and drink 4-5 cups of cofee  every day .Now i am 30 years old .I tried not to take my gerd meds or reduced them to only once a week or when it was desperately required as i was tired of taking them for such a long period of time

A few months ago the acids were so bad that when i tried to brush i had to swallow the residue of toothpaste as i could not literally throw it out as though there was a suction pump inside my body that was pulling it inside , My touncils were also very bad , the whole throat was " sore" . It is now much better after resumption of nexium . I still do have reflux with burning in the chest etc but is a little better

almost 2 years back i had a serious chest burning and pain with the pain deviating to the shoulders, left hand , back, almost everywhere that heart symptoms are .I went to the emergency and everything was fine . They gave me some laxatives , anti acids and the burning and pain subsided after that

I was having similar symptoms this year as well and i had an ecg and stress test which was fine . Almost a month ago when i was coming back from new jersey in cold weather i tried a cigeratte given to me by one of my freinds who is a liquidator . As soon as i tried the first one . I had termendous amount of shortness of breath for a few minutes , literally as if i was choking .

I went to my gp who heard me wheezing and recommended me to a pulmonologist . When the pulmo checked me physically he thought i was fine as he couldnt hear any wheezing but gave me a PFT for the following week .
This was my first " PFT" which was done in a professional grade setting, I had to sit down and blow as much air as i could blow and this was repeated 3-4 times for accurate readings , I was given a nose clip etc ..very professional .

The results were as follows:-

                               REF      PRE MEAS  %PRE REF      POST MEAS    POST%REF    POST%CHANGE
FVC :-                      5.66         3.89              69                  4.16                    73                     7
FEV1                       4.40         3.38              77                  3.70                    84                     9
FEV1/FVC  77             87                             89
FEF25%-75%           4.55          3.57             79                   4.22                    93                   18
PEF                         10.14        5.12             50                   5.97                    59                   17
FET 100%                3.92                                                    4.39
FIVC                        5.66          3.99             70                   4.24                    75                    6
FIF50%                    3.63                                                    4.17
FVL                                         1110111                             001011

LUNG VOLUMES      

VC                         5.66            3.99            70
TLC                        7.59            5.34            70
RV                         2.00            1.34            67
FRC PL                  3.9              2.56            66
ERV                       1.88            1.22            65
IC                           3.75            2.78            74
RAW                      1.13            0.89            79

Single breath lung volumes

TLC SB                   7.59            5.08           67
RV SB                    2.00            1.93           97
RV/ TLC                  27                38

DLCO                     32.7             26.3           80
DL ADJ                   32.7             26.3
VA                         5.08
DLCO/ VA              4.58              5.18          113
DL/VA                                        5.18
IVC                                            3.14

The computerized report said . There is no obstructive defect indicated by fev1/fvc ratio . There is a mild restrictibe defect . Diffusion capacity is within normal limits . Fev1 changed by 9% which is interpreted as a mild response to broncholidator

I was not satisfied with the doctors prognosis as i thought he wanst sure about anything for a while , until i told him that i have more shortness of breath after lying down and eating , at night and sometimes while walking feel more short of breath. He told me that i had ashma and that " gerd" and ashma were like brother and sisters he prescribed me symbicort 80/4.5 which i have not used to this date . I am around 210 lbs which is 30 pound more than i should be for my age .Anyways i had quit smoking 2 weeks ago after smoking for 15 years . After being quit for 13 days i was told that my father had a heart attack on the flight and was admitted in hospital in dubai , When i was told that they had to revive him 2 time and gave him 9 shocks , I couldnt control myselft and started smoking again m though now i am trying again to quit and have reduced them to 4-5 and plan on quitting in 2 days . After quitting smoking mt shortness of breath did get a little better .

I did a lot of research and was very scared of the interstinal lung disceases , fibrosis etc which i though could be possible because of the mild restrictive lung defect indicated by the spirometery according to the ratio of fev1/fvc . I was not satisfied with the prognosis so i thought a second opinion would help . I am still getting out of breath sometimes with a lot of acid reflux specially on my left side and hand . At night time i feel like i literally have to control my breathing . On exertion if i am brisk walking the first 3 blocks are tough and after that it gets much easier until i try to over exert myself and feel like there is a pain in my back like my lung is irriatated or something

I saw another pulmonologist yesterday who was 71 years old and a bit nasty , i had another spirometery not in a professional setting , the lady dint put any clip in my nose ..just told me to blow in a pipe 2 times and she was like thats it . When i saw the doctor after that he was not willing to listen a word i had to say reagarding my gerd etc and told me that i had fev1 of 44% and after broncholidator 74% so that meant that i had bronchial ashma and mild copd . He told me he was 100% sure about it and he was in mount sinai hospital for 15 years blah blah and he knows everthing and there is no relation between gerd and these disceases etc . When i asked him the fact that my 1st spirometery which was done a month ago said mt fev1 was 79% and according to his 44% could there be sucha huge variation in one month , He said he dint know about that and that he had to leave etc ..very rude like as if anyone dint agree with him was a fool and he was the highest authority on earth

I am so confused dont know what to do ,He has prescribed me symbicort 160/4.5 .I find it difficult to burp although there is belching and acids are there and when i do get a big burp shortness of breath usually at rest gets much better . Any help would be highly appreciated also have nasal allaergies and nose is closed very often .



This discussion is related to white sputum.

[deezina22]

Hi Thanks a lot !!

I tried symbicort today and at night my vision seems to be very blurry, I saw on the website of symbicort and it was mentioned as one of the side effects and that the doctor should be consulted regarding that . I am having a very torrid time dealing with this new Disease as i have to take time off work and the more i think about it the more anxious i get .

Its like my life is coming to a stand still position. I was having shortness of breath while walking 5-7 blocks but i forced myself to walk 40 plus blocks today as i dont want to feel like i am handicapped ..well if this is what this discease warrants at my age i would take death over it .Whenever i have a small problem i try to ignore it as i cant be taking 100 medicines a day .. have been taking medicines for allergies and reflux all my life ,,simply fatup of it .. It becomes very depressing .

I have cut down on smoking now down to 5 as of today ...hopefully will go cold turkey on tuesday .

No actually i did show the results of my first spirometery results to the second doctor . He did see the results and when i asked him how could there be so much variance in results in 1 month he said i dont know . The  point that pissed me off was the fact that he could not give me an answer as to what would cause such a huge difference in fev1 in a month yet he was confident that i had both bronchial ashma and copd and was challenging me on it ...so that means you are only going at your convenience . If he was that competent and sure about his prognosis and experience he should have showered some light on that too ,,as far as i am concered thats incompetence ... if you think you know everything there should be no exceptions ..

fev1 from 77% to 44% is quite a decrease in just under a month and secondly at 77% (1st spirometery the difference after broncholidator was only 9% and the second time from 44% to 72% is also a huge difference and the fact that spirometery is effort dependent could also ask a lot of questions ..

thank you very much for your suggestion , I am planning to take a 3rd opinion well i hope that i only have ashma because copd is irreversible ..all they can do is slow down the progression

[bsmsl]

Hello,

I do have a friend whose son has severe acid reflux which led to asthma.  Reflux is a common trigger for asthma.  

Asthma changes from day to day.  One day you can appear normal by PFT, and the next be really bad - huge changes depending on triggers and lung inflamation.  PFT is a measure of how you are that day.  My allergist does one every time I go in to maitain a baseline to compare to when I am symptomatic.  For me, anything below 100% of norm is low and says I am sick.  BTW - nose clips are available but only used if a patient can't seem to not blow air out their nose too.  Kids typically do use them.  I wouldn't consider that, or the type of device used as a sign of how "professional" the office or doctor is.  It is just a matter of preference and what the doctor has.  The big sit down machines in sealed rooms are very expensive and very few places have them.  

Even though my allergist does PFT's, she is more concerned with symptoms and what my lungs sound like than with the numbers.  

I think that the second doctor wouldn't comment because he didn't have the test results there to look at.  Also, one pulmo I saw wouldn't comment on what I said my normal PFT's were at my allergist's office because he didn't know what reference values were used.  Your second pulmo's lack of commenting may not have been rudeness but more of lack of having the test results to look at and compare to his in a precise manner, a clinical decission.  

One thing I tell a lot of people is that doctors practice "The Art of Medicine."  It isn't the precise science we patients want to think it is sometimes.  Some docs do act like they know everything and are arrogant.  Others are humble and will admit when they are just making an educated guess, which they do a lot.  I think both doctors need a little slack.  

I think the first maybe the better doc, but your lungs were good that day so his evaluation was based on a good day.  He was confused because symptoms that brought you to his office did not match the number for the day or his exam which is valid.  The other doctor seems past his prime and on the arrogant "know it all" side, but your lungs were bad that day so his diagnosis is probably correct.  I have seen several arrogant /rude docs whose diagnosis was correct even though I wouldn't see them again.  One a GI who said I had a dislocated rib pinching a nerve, but he was extremely rude to me.  It pops out just enough in the opposite direction from normal to pinch the nerve but not enough to show up on x-ray.  

My advice, start taking the medicine the second doc prescribed, but go back to the first doc with a copy of the second PFT for a regular doctor.  He is humble enough to admit he doesn't know everything, and wise enough to listen to you and your symptoms.  He knows that reflux can cause respiratory symptoms as well.  He really does sound like a pretty good doc.

Now about the smoking and reflux.  Quitting smoking is the absolute best thing you can do all the way around.  You know smoking is bad for the lungs, but it can also trigger reflux.  You also need to drastically cut back on your coffee intake.  Caffiene is another major reflux tirgger.  You may also want to eliminate/reduce spicy foods like peppers, garlic and onions. They are also triggers.  You may also have personal food triggers.  Very tiny amounts of cumin triggers my reflux.  

There are also many life style changes that will help reduce symptoms.  

Let us know how you are doing with quitting smoking and your doctors.

Take care.

[deezina22]

                REF   PRE    PRE%   POST  POST%  %CHNGE
FVC           5.66  3.89      69         4.16         73      7        
FEV1         4.40  3.38      77         3.70         84      9
FEV1/FVC %77    87       89
FEF25-75% 4.55  3.57     79         4.22         93      18
PEF           10.14  5.12    50         5.97         59      17
FET100%              3.92                4.39
FIVC           5.66   3.99    70         4.24         75       6
FIF50%                3.63                 4.17
FVL ECODE          111011       001011

LUNG VOLUMES

    VC            5.66     3.99       70%
  TLC             7.59     5.34       70%
    RV             2.00     1.34       67%
    FRC PL      3,90     2.56       66%
    ERV           1.88     1.22      65%
     IC             3.75     2.78      74%
     RAW        1.13     .89        79%
                  







Single breath lung volumes

TLC SB                   7.59            5.08           67
RV SB                    2.00            1.93           97
RV/ TLC                  27                38

DLCO                     32.7             26.3           80 %
DL ADJ                   32.7             26.3           80%
VA                         5.08
DLCO/ VA              4.58              5.18          113
DL/VA                                        5.18
IVC                                            3.14

[deezina22]

Sorry i saw the results were not clear

The results were as follows:-

                               REF      PRE MEAS  %PRE REF      POST MEAS    POST%REF  
FVC :-                      5.66         3.89              69                  4.16                    73                    
FEV1                       4.40         3.38              77                  3.70                    84                    
FEV1/FVC                77             87
FEF25%-75%           4.55          3.57             79                   4.22                    93                  
PEF                         10.14        5.12             50                   5.97                    59                  
FET 100%                3.92                                                    4.39
FIVC                        5.66          3.99             70                   4.24                    75                    
FIF50%                    3.63                                                    4.17
FVL                                         1110111                             001011

LUNG VOLUMES      

VC                         5.66            3.99            70
TLC                        7.59            5.34            70
RV                         2.00            1.34            67
FRC PL                  3.9              2.56            66
ERV                       1.88            1.22            65
IC                           3.75            2.78            74
RAW                      1.13            0.89            79

Single breath lung volumes

TLC SB                   7.59            5.08           67
RV SB                    2.00            1.93           97
RV/ TLC                  27                38

DLCO                     32.7             26.3           80
DL ADJ                   32.7             26.3
VA                         5.08
DLCO/ VA              4.58              5.18          113
DL/VA                                        5.18
IVC                                            3.14