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misanthropic_nihilist
Jan 4, 2006, 5:18 AM
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I am 21 and have had a persistent, loose cough for the past 2 years. I have seen 3 doctors: my GP, on-campus GP, and Allergist. I am currently seeing a Pulmonologist.
The cough started in March of 2004, after sever change in weather from t-shirt to snow storm weather. The onset was very sudden; the cough only took a day to develop. About 3 months later, when every breath was making gurgling sounds, I decided to see my doctor. The sputum (yellowish clear, >> 1 tbsp per day) originally felt like it was coming from deep within my lungs, but now feels more like it's coming from the lower part of my throat. The nature of the cough has been relatively the same over the last year and a half; it mostly kicks in with deep respirations. The cough has been accompanied with nasal problems: congestion, runny nose, lots of post nasal drip... but never a sinus infection.
Here's the data:
Signs
Audible, loud, crackling sound on forced in/exhalations, although not via stethoscope (upper respiratory?).
Nasal inflammation, with discharge varying by day.
Greater than 90% oxygen saturation.
Greater than 90% on electronic peak flow meter for my size.
Daily expulsion of greater than 1Tbsp of sputum, clearish yellow.
Symptoms
Often uncontrollable coughing fits; feels like diaphragm spasms.
Spasms especially pronounced upon first lying down.
Occasionally very deep inhalations will make my throat feel like it is about to instantly constrict, which usually results in coughing.
Allergies
Tested positive for all allergens: environmental (grass, pollen, mold, trees) and animals (dogs, cats).
No known allergies to medicine or food (although I used to be allergic to eggs).
Severe asthma (hospitalized at least 5 times, most recently 4 years ago).
Also allergic to down, but everything in my bed spread is cotton.
Medications
Advair 100/50 for the last 5 years, at least
Past History
Constant problems with asthma and allergies, including less severe family history.
Last Meal
Don't think it applies here.
Events Preceding
Wearing t-shirt and shorts to class in 1' of snow, assuming the weather was similar to the day before.
TREATMENT
Nurse Practitioner
Current Nature:
Extreme respiratory congestion, to the point of gurgling.
Diagnosis:
Cold
Treatment:
OTC Robitussin
Effects:
None
Family GP
Current Nature:
Extreme respiratory congestion, to the point of gurgling.
Diagnosis:
Walking pneumonia
Treatment:
Mucinex, Antibiotics, Flonase, X-Ray
Effects:
None. X-Ray showed nothing unordinary
On Campus GP
Current Nature:
Coughing fits every 5-10 minutes, feeling like diaphragm spasms.
Diagnosis:
Infection
Treatment:
Different antibiotics than before, Amoxicillian, I think
Effects:
Cough completely went away. Returned the day after stopping meds. I was not put back on them because of risk of developing a resistant strain (?).
Allergist
Current Nature:
Dull cough with crackling. Spasms upon laying down.
Diagnosis:
Combination of asthma, allergies, and acid reflux.
Treatment:
Increasing to Advair to 250/50 (?), Nexium 20mg (?), and Tussi, and Nasocort (then Nasonex). His reasoning was that asthma started me coughing, which flexes abdominal muscles, causing acid reflux. The acid reflux then caused more coughing, creating a cycle of coughing and acid reflux. A cat scan showed small amounts of scarring in my lungs, apparently/probably due to the acid reflux.
Effects after 3-4 months:
None noticeable.
Pulmonologist
Current Nature:
Dull cough with crackling. Not as many spasms. Very audible gurgling and crackling on forced exhalation.
Diagnosis:
Most likely asthma problems. Possible CF.
Treatment:
Nebulizer with 2 meds twice a day (cant remember which meds). Blood work and CF testing.
Effects after 3 weeks:
No change in cough. Bloodwork showed 1 emphysema gene (apparently only matters for my future children). CF sweat testing will be done in 2 weeks.
I got into climbing 2.5 years ago, a good 6 months before developing my cough. Although I may have bought my first chalk bag and block around the onset. I've taken a 3 week break from all forms of climbing, with no effects on my breathing. Frequently washing my bedspread and using a dust mite pillow barrier eases the coughing, but not the crackling. Being around my dog (only when I'm home from school during the summer) will usually agitate my cough. I have yet to use a prescription nasal spray that comes close to clearing my nose.
I don't think I have TB, since none of my family members or roommate have contracted it. I doubt the CF test will come back positive since the onset was so sudden and at a late age.
I am sick of having an annoying, embarassing cough, and.....
I WILL SEND A MONEY ORDER FOR $50 TO THE FIRST PERSON WHO GIVES ME ADVICE LEADING TO A CURE OF MY COUGH AND SINUS PROBLEMS.
I'm dead serious.
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johnathon78
Jan 4, 2006, 5:27 AM
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what the hell....
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sandbag
Jan 4, 2006, 6:17 AM
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I hope I'm completely wrong and far out in left field:
have they considered idiopathic Pulmonary Fibrosis?
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epic_ed
Jan 4, 2006, 8:47 AM
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Wow -- I thought I was going to have to move this thread because the title looked spam related, but damn. I sincerely hope you find some answers and get some relief. Good luck.
Ed
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misanthropic_nihilist
Jan 4, 2006, 5:56 PM
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I don't think it's pulmonary fibrosis, since the lung scarring is very minimal and the cough isn't dry...
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veganboyjosh
Jan 4, 2006, 6:03 PM
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oh man, this sounds like the build up to something on snopes.
seriously, tho, good luck, man. i know how frustrating consistantly being misdiagnosed is...
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kimgraves
Jan 4, 2006, 8:34 PM
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Hi,
Sorry to hear about your troubles.
I know from where you come! My mother was very ill about 10 years ago. She kept falling down and she was becoming less and less coherent. It was so bad that she had to come to live with us. We did massive searches on the internet (pre-Google!) and took her to specialist after specialist. It wasn't till we took her to this one guy who specialized in managing the process of figuring out what was wrong that we got a diagnosis. She's well now.
What I learned from all this is that any one doctor only know a small part of what is a "very big picture." And it's really hit or miss that you'll get one that can help you. This is not encouraging, I know, but it gives you an idea of how to proceed. What you need is to find physician who will work with you until you find an answer. You don't want someone who will just refer you and then wash their hands of you. If the specialist doesn't work out you want to be able to go back to the managing doc and say "now what?" You need someone who can manage your care - not someone who knows the answer.
It's hard to find that sort of doctor/person. Not many people are temperamentally suited for that sort of process. AND, this is the big AND, insurance doesn't pay the doctor very well for doing this work so not many are willing.
I can refer you to the guy we found from my mother - who's now our primary care doc. He's a cardiologist and the head of pharmacology at NYU medical center. We're in NYC. Not too far from PA so it might be worth the trip.
PM me if you want the referral. Or call me - you can find my number on my website.
Do pursue this. It's not normal to have a persistent cough for that long. You're young, but untreated illness can make you old before your time.
Best, Kim
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dlintz
Jan 4, 2006, 9:34 PM
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First off, I'm not a doctor.
I assume the CF in your post meant Cystic Fibrosis which is what I was thinking as I read your symptoms however this disease usually begins in childhood.
Have they taken a chest x-ray? Or a CT scan of the chest? What bloodwork did they do specifically how's your white cell count? If your count is up and/or you've had a consistent fever an empyema (localized lung abscess) may be a consideration. I doubt this is the case but it's a possibility.
d.
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harmonydoc
Jan 4, 2006, 11:21 PM
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Well, I am not a pulmonologist, I am a pediatrician. I obviously can't accurately diagnose you without more complete information (and not having examined you), but I can give you my thoughts on what's been done so far.
It sounds like each practitioner you've seen has done reasonable things consistent with their level of training/knowledge. It sounds like you have a fairly extensive history of asthma and have multiple environmental allergies. The idea of cough onset with rapid change in weather may be consisitent with your asthma history - some asthmatics are triggered by changes in barometric pressure. It sounds like you view this as a sudden change - different from your previous asthma symptoms - one would need to know more about your baseline asthma symptoms. Your description of the stethoscope only revealing upper airway congestion doesn't quite go along with your description of crackling on forced expiration - "crackles" is more often used to describe lower airway involvement. Oxygen saturation "above 90%" also doesn't tell me enough - is it 91% or 98%? Whether or not you have had fever along with all of this would be important to know. The reflux treatment was a logical thought - many asthmatics are triggered by low grade reflux and aspiration. Testing for CF is also logical - the disease spectrum in CF is pretty wide, some people are diagnosed in infancy and others not until adulthood (some people are more mildly affected than others). Even though you don't think you've been exposed to TB it's such a simple thing to do a skin test that I think it should be done (you never know where you might be exposed). I'd be curious to know if you were ever given a course of oral corticosteroid medication (as someone with a severe asthma history I imagine you may have taken prednisone at some point). Have you been checked for eosinophilia? Elevated IgE? (I would imagine the allergist should have done this.) There is a fungus called aspergillus that may cause a condition called allergic bronchopulmonary aspergillosis (ABPA) that is more common in asthmatics (see http://www.nlm.nih.gov/...y/article/000070.htm), although fever is often involved and you don't mention this. If your chest X-ray really is normal it's not likely you have an empyema (lung abscess). I'm curious what nebulized meds you're on now (the ones you don't remember the names of). It's also interesting that you say the cough went completely away with amoxicillin - was this a coincidence? You say that you've never had sinusitis - does this mean you had normal sinuses on CT?
There are so many things that can cause chronic cough, although your story as it stands makes it seem like your problem is most likely allergic or infectious in nature. Other possibilities are autoimmune, cardiac, GI - there is a long list.
I agree with kimgraves that you need to have one practitioner that can collate all the information that you're getting from the various specialists and look at the big picture, systematically investigating all the possible diagnoses and directing you to the next step. If you keep bouncing from one provider to another it will be very difficult for any one to get to know your history well enough. Medical diagnosis is not easy - it's like detective work, to be successful you have to be patient, persistent, systematic, and thorough. Find someone you trust to follow through and stick with them. Good luck!
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littlebilly
Jan 5, 2006, 1:23 AM
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I heard from a very good friend about one of their acquaintances having very serious asthma, to the point that, even though very athletic, couldn't run even a few feet. Having tried "everything" he went to a practitioner of Eastern medicine, was given a dreadful herbal mix to drink, and within weeks was cured of asthma all together.
A lot of people seem to doubt Eastern and alternative remedies, but China seems to have embraced them for several thousand years, perhaps there is some validity to the practice.
However you are cured, I hope it will be soon.
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z_rock90
Jan 5, 2006, 2:43 AM
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I am a doctor who lives in an area with terrible air quality. I have found the medication singulair to sometimes be useful for chronic cough when all else fails. Side effects are minimal.
^ this is my dad talking he's just using my user name
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climbingnurse
Jan 5, 2006, 3:53 AM
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The big piece of advices I'd give you is to wait and see what the CF test results are. It's kinda silly to pursue anything else until you have that.
That said, it seems reasonable that GERD (gastro-esopageal-reflux-disease) may at least be exacerbating this process*. I'm not altogether sure how GERD is diagnoised (that's not my schtick), but it would seem to me that an endoscope might be worth the time, money, and effort to take a look into your esophagus and your upper airway to see what all is going on.
I wish you the best of luck in getting this figured out. I see lots of people everyday who have a chronic condition that no one is able to figure out and it's very frustating for them, and even for those who care for them. Just be real glad that you are not one of the 43 million americans without health insurance for whom this process is damn near impossible.
*The key thing that makes me think this is that this gets worse when you lie down.
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misanthropic_nihilist
Jan 5, 2006, 4:11 AM
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Kim-
Thanks for the advice and referral offer. The pulmonologist I am seeing right now seems very sincere about helping me out. The main problem is that I am only home during school breaks, so I often go months without seeing my doctor.
dlintz-
The X-ray and Catscan of the lungs did not show anything more than a couple small scars. The only results I got from the blood test was that of the single emphysema gene.
Harmony-
Thanks for the extremely thorough response. I understand that 'crackles' is used to describe a lower respiratory problem, but it's the best way I can describe the sounds coming from my upper airway. And the stethoscope apparently didn't reveal any lower respiratory sounds. The 'crackles' are audible to anyone within 20 feet of me.
I believe my O2 saturation was 93%.
No fever. Other than coughing and sinus problems, completely normal.
I'll ask my doctor about TB when I see him.
I've taken pretension, but not since the cough started (during peak allergy season).
I'll let you know asap what nebulizer meds I am on.
I believe my sinus scans were relatively normal, but with signs of moderate swelling and mucus.
Billy-
Ever since starting Advair, my asthma (at least the wheezing part of it) has gone from so bad that I'd use my rescue inhaler upwards of 5-6 times a day to using the inhaler once a month. Although the cough may be the asthma presenting itself in a different way due to the Advair.
Z-
I tried Singulair before without any effects. Thanks for the advice though.
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catbird_seat
Jan 9, 2006, 9:52 PM
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You have been on Advair for 5 years. According to the package insert, 3% of those taking this medicine have cough as a side effect. You might ask your doctor to switch you to an alternate medication for your asthma and see what happens.
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mother_sheep
Jan 9, 2006, 10:14 PM
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It's a tumah.
:lol:
Sorry. Couldnt' resist. From 1 chronic asthma sufferer to another, good luck. Hope you find a cure for your cough.
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misanthropic_nihilist
Jan 10, 2006, 4:02 AM
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catbird-
Thanks for the info. Maybe I'll try taking myself off the Advair for a while and just rely on my albuterol... see if I get any difference in my cough.
mothersheep-
I don't think it's a tumor. I believe the x-rays and cat scans would have picked that up.
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catbird_seat
Jan 10, 2006, 7:24 PM
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Don't take yourself off your Advair without consulting your doctor first. The risk is that you might have an asthma attack. Having said that, some people tend to "grow out of asthma" as they get older.
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gunkjunkie
Jan 10, 2006, 8:24 PM
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Recently some new information has come to light about Advair and a possible role in increasing the risk of severe asthma attacks.
In reply to: The U.S. Food and Drug Administration (FDA) has warned healthcare professionals regarding the increased risk of severe asthma episodes and death associated with use of inhalation powders containing long-acting beta 2-adrenergic agonists (LABA) such as salmeterol xinafoate and formoterol fumarate. Inhalation powders included in the warning include salmeterol (Serevent Diskus, made by GlaxoSmithKline), salmeterol combined with fluticasone propionate (Advair Diskus, made by GlaxoSmithKline), and formoterol (Foradil Aerolizer, made by Novartis Pharmaceuticals Corp.).
http://www.medscape.com/viewarticle/517492_print and http://www.fda.gov/cder/drug/advisory/LABA.htm
I had been taking this to treat my asthma, needless to say I was a little pissed off to find out about it.
Deirdre
edit to correct spelling
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alpinfox
Jan 17, 2006, 6:02 PM
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The following is from a pulmonologist friend of mine whom I showed this thread to.
Always hard to work these issues on line, but you have done a good job outlining the issue. My limited advice would be:
1) to much more aggressively treat the allergies (i.e. shots, nasal simpathomimetics such as pseudophed, removing all carpets, etc)
2) considering VCD (vocal cord dysfunction) as diagnosis. You sound like you definitely have post-nasal drip, but that may be worsening some inherent VCD. I am not saying that you have VCD, but it is something to consider, which will unfortunately mean another trip to a specialist (ENT doc).
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mabrams
Jan 17, 2006, 7:09 PM
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My 19 year old brother has CF, and though he has had the disease since he was born, we have known/met other CF patients that seemed perfectly healthy until they were about 19 or twenty and then diagnosed with the disease. A family friend was always very physically active throughout highschool and then was diagnosed around 19. By the time he was 26 he was to the point where he had to get a lung transplant. The point of all this is that CF can be a very random disease. Having grown up around my brother and other CF patients my whole life I have seen some people who will be extrememly healthy, and others who's health will deteriorate extremely quick out of no where. With that said get tested for CF if you haven't already, it is not unlikely that the disease could have just been very mild your whole life and now it becoming more active. Best of luck with whatever the outcome, and if you need more info on CF let me know...my family is very active in the Cystic Fibrosis Foundation (CFF).
Cheers,
Mike
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fng
Jan 17, 2006, 7:13 PM
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Take some shots. Alcohol is the best cough suppressant there is. Thus the hot toti. 1/3 honey, 1/3 lemon juice and 1/3 hard alcohol. That will cure your cough but not the cause of the cough.
Homeless drunks will die with all kinds of respitory problems and never have a cough.
Good luck. I had a cough from bronchitis for about a year which I hacked up all kinds of lunge butter.
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misanthropic_nihilist
Jan 17, 2006, 11:11 PM
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I just checked my nebulizer meds: Albuteral and Budesonide.
I had a full breathing test done this week. The results showed mild asthma (like I didn't already know that). I think I had about a 15% improvement after using an albuteral inhaler. I'm sure it would have been a much greater change if I had been off my Advair for more than 12 hours.
I also just completed a WFR course. I found out during the lung sound lab that my lungs are definitely NOT clear. I don't know why I thought they were. Bilateral crackling and wheezing, much louder on forced in/exhalations.
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