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Lung diseases

Sick for Months. Please Help!

07/07/2010

Question:

I`m a 22 year old female that`s always been in good health. However, I`ve been sick since October with chest discomfort, coughing, throat clearing, ear pain and pressure, fatigue (I used to sleep for about 20 hours a day), fevers, some wheezing type sounds, shortness of breath, rapid pounding heart rate at random times, and laryngitis all of which are still ongoing with the exception of my voice. It has come back but is not the same as before and I`m constantly clearing my throat to talk normally again. I feel like a boy going through puberty with all the voice cracking. I`ve been to several different doctors each one of them putting me on a different antibiotic and on Asthmanex, and Proventil inhalers. None of which seem to help very much. I don`t know what to do anymore. I`m just so exhausted. If anyone has any suggestions or advice please let me know! Any help will be greatly appreciated! Thanks!

Answer:

At NetWellness, we are not able to offer specific treatment, and we are not able to diagnose individual problems over the internet. The symptoms that you are describing are non-specific, meaning that they can be seen with a number of medical conditions including lung disease, ENT conditions, and hormonal conditions. With this many symptoms, the tests and treatments that you get will depend to a degree on what specialist you see.

Physicians can often focus their "differential diagnosis" (list of possible diagnoses for any given patient) if they know what the main symptom is. So, for example, if cough is the main symptom, the top 5 conditions on the differential diagnosis list would be (1) asthma, (2), esophageal reflux, (3) medications [such as ACE inhibitors], (4) nasal drainage/allergies, or (5) vocal cord dysfunction. Testing and trials of treatment are then focused on these five conditions.

In the case of cough, the first four conditions can usually be diagnosed and/or treated by most primary care physicians.

Vocal cord dysfunction is a bit more problematic in that it requires a highly specialized test called a "videolaryngostroboscopy" to diagnose. This test is only available at a few ENT practices that have voice pathologists on staff and have the proper equipment available.

I recommend that you identify the main symptom that you are having. Then ask your primary care provider what the differential diagnosis is and whether each of the common conditions in the differential diagnosis list have been adequately tested for and whether they can be excluded. As physicians, we often need the patient's help to identify the primary symptom; a long list of assorted symptoms can sometimes result in the patient's work-up being disjointed and directionless.

For more information:

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Response by:

James N Allen, Jr, MD James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University