Dear Ask The Doctor: Hi, I am in desperate need of a cause and solution to a problem I have had for 3 years. Though my problem is not chest pain, I couldn't find any other categories to place this question in so I hope I've got it right. I am female, 26 years old, overweight despite eating healthy. I'm going to try and provide as much information as possible, I have no idea if any of it has any relevance but I've seen 3 doctors and none of them have helped one bit. 3 years ago I suddenly found it difficult to take a deep breath. It felt like I constantly needed to take a deep breath but when I tried, it was as though my lungs weren't fully inflating. No amount of trying would give me a deep satisfying breath (the kind you have when you yawn). I have had this problem now for three years, I never know when it is going to happen or how long it will last. It can vary from an hour to 3 or 4 days at a time, with absolutely no respite. Then it suddenly stops, sometimes for a day, sometimes a week. I also get heart palpitations. It feels like my heart is thudding in my chest and about to burst through the skin. I can often hear my heartbeat in my ears and head. My heart rate quickens to around 124 to 162 bpm despite not moving around. Right now my heart rate is at the lower rate and I haven't moved from my chair for 30 minutes. Some information.. 1. I have chronic Sciatica and I am on 50mg Tramadol and 15mg Codeine Phosphate, both 4 times daily. I have been on them for 6 years. I became addicted and was taking approximately 16 of each tablet a day but as of January 2011, I have cut down massively. 2. I have Urticaria which began around 2 years ago but wasn't diagnosed until June 2011. I am not sure if the diagnosis is correct as I don't get islands of red blotches. I get rashes in my knee pits, arm creases, armpits, stomach etc. They are extremely itchy and like little white bumps on red skin. I am mentioning this because I don't know if it's a diagnosis in its own right or if it's a symptom. 3. I have been tested for Asthma and had chest xrays, none of which showed any problems with my lungs. 4. At the peak of my addiction, the doctors insisted my breathing problems were due to my medication. Being on a much lower dose hasn't helped at all. 5. Doctors also suggested that I am borderline anaemic, Ferrous Sulphate hasn't improved my breathing. Panic attacks were also suggested, which is most definitely not the case. 6. The breathing happens any time of day or night. I suffer with acid reflux a lot. If I eat whilst I'm having difficulty breathing, I get sick and burp a lot. For these reasons, I have been eating much smaller portions and more frequently to avoid vomiting. 7. The burping can often be horrendous, it's much worse than when I'm in my normal state. I'm not swallowing too much air when I eat, as suggested by one doctor. 8. I don't think it's allergy related as I've cut out various foods from lactose to wheat and even coffee fizzy drinks, all to no avail. I have my suspicions that this isn't lung related, that it's more stomach related perhaps? I am really and truly fed up and tired of suffering with this, it's debilitating. I would be VERY grateful for any advice, suggestions, possibilities or questions I can pose to my doctor. I would give anything to solve this problem and to not have to deal with it any more. Kindest regards, Sarah Robinson
Dear Sarah: I can understand the difficulty that you are going through, after undergoing through all the tests and medication and not being able to come to a diagnosis. As a doctor, it is certainly difficult to make a definitive diagnosis based on your presenting symptoms. And many of the differentials such as asthma, anemia, anxiety disorder and medication has been rules out.
However there is one likely cause that you have not mentioned whether your doctor have investigated into. Laboured breathing, "air hunger" or dyspnea is a symptoms of hypothyroidism. This may be caused in some patients with low levels of thyroid hormone. Hypothyroidism causes weakness of the respiratory muscles and a decrease central drive of respiration leading to breathing difficulties. Blood-work to check for thyroid levels can be done to rule out hypothyroidism. Also you do have evidence of a gastroesophageal reflux disease for which proton pump inhibitors or H2 blockers may be indicated. I wish you well and hope that we can come to a diagnosis soon, till then take care.