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    Old 12-15-2014, 06:44 AM   #1
    papote53
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    Is this Asthma?

    Hi,

    Just 1 month ago I started to take medication for asthma (advair 250/50) and when I started it did help a little but right now I feel the same again.

    To make a long story short this all started around 9 months ago, first they said it was anxiety, then reflux and now asthma. (maybe all 3) They have done every possible test they can do and I'm taking medication for all 3 and still the same. Yes, the anxiety medication helps a little but far away from feeling human again.

    Test results that could lead to the problem:

    Endoscopy- Mild reflux
    X-ray- Mild Hyper-expanded lungs
    Chronic sinus ( mild congestion)

    Symptoms:

    1. Breathing problems- Specially when I walk or eat. When I lay back it goes away 90%.

    2. Middle upper chest pressure and pain sometime all the way up to chin. 24/7 unless I lay back, sleep or take my anxiety medication which helps but not all the way.

    3. Dizziness/lightheaded 24/7 - Getting better
    4. Lost 45 pounds in 15 months, if I eat like crazy I gain a few pounds, if I eat normal I lose weight Rapidly.
    5. Tied abdominal pressure ( not pain) last 16 months.
    6. No Coughing, or Wheezing at all and they have disregarded COPD as the reason because I have taken 5 test so far passing all of them including blood test. Always BP 98/99% and clear chest.

    So basically even doing nothing at home I have these symptoms unless I lay or sleep. I get up and within minutes the pain and pressure is back unless under anxiety medication which helps a little.

    I seen every specialty you can see for this- GI's, ENT's, PCD, Neuro, Cardio, Lung specialist, allergy/asthma specialist and Psy. Done endoscopy twice, Colonoscopy, MRI's, CT's, blood test for everything.

    Now, my question is this. 2 of my Docs which both deal with asthma said I might have asthma so they put me on advair 250- One month later I don't feel any better. I asked my Primary to give me a referral for MAYO clinic and he thinks I should wait because he see no reason for this.

    Any comment or suggestion is appreciated.
    Jose

    Last edited by papote53; 12-15-2014 at 06:47 AM.

     
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    Old 12-15-2014, 08:04 PM   #2
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    Re: Is this Asthma?

    This can be a difficult question. Often one symptom can be the same for multiple issues, as you have discovered.

    I have some questions. You've referred to lots of specialists and tests, but didn't list out all of the tests it looks like.

    1. Have you had pulmonary function testing? How about a Methacholine challenge for the asthma?

    2. Have you had an esophagram or barium swallow done?

    3. Have you had pH testing done? How about a Manometry?

    4. Have you had allergy testing done?

    5. What medication have your tried for the acid refluxing?

    6. In all of your bloodwork, did they do in-depth assessments for anemia? Do you have ferritin results, iron saturation results, B12 results? How were your hematocrit and hemoglobin? Have they assessed your thyroid?

    I'm certainly not an expert, but have learned a lot over recent years. In my case, I had breathing problems and chronic coughing. Turns out I had asthma, severe 'silent' acid reflux, allergies/PND, and a neurogenic cough. I had to treat everything to get my symptoms under control.

    What I learned through experience:

    1. Endoscopies can show if you have esophageal or stomach damage/irritation and biopsies can rule out a lot. It is possible to have acid refluxing without the damage showing. I had 'good' EGD's for 8 years, yet other testing showed extremely severe refluxing.

    2. pH testing is a good tool to measure the occurrences (frequency, duration, severity, timing) of refluxing. Traditional pH tests are good to measure regular refluxing (both acid and non-acid). You wear the probe for 24 hours so you can see what is happening when you are upright and when you are laying down. I never had symptoms during the night, but the probes showed extremely severe refluxing, particularly in the early morning hours. There is also a different ResTech upper pH probe that measures gaseous acid (which most traditional probes don't always catch). It is often this acid that irritates the lungs and throat. I have had both kinds of testing and for me they showed a progression of my refluxing getting worse over the years.

    3. A Manometry measures the strength of your lower esophageal sphincter. If it is too lax, it allows stuff to come up.

    4. With asthma, there can be multiple triggers. Most often, they are allergies, environmental, acid reflux, etc... Sometimes it is difficult to pin down. Have you kept a log of your symptoms and activity?

    5. There are different medications for both the acid reflux and asthma. Sometimes it takes trials of the medications to see what works for you. Sometimes, it isn't just the medications, but also the dosages. For example, Advair comes in 100/50, 250/50 and 500/50. Also, medications like Advair are used for daily preventative use. Have you tried Albuterol or another rescue inhaler too?

    6. Anxiety is something real to consider too, as your docs have explored with you. I was put on low-dose anti-depressants. Not for anxiety/depression, but because my Vagus nerve had become irritated and was triggering on-going symptoms. The low-dose Amitriptyline helps calm that nerve down.

    The weight loss you describe isn't normal. Don't give up finding the right specialist to help you find your answers. It could be you have more than one issue going on..

    I had a really bad period of time 2007/2008. Symptoms kept getting worse and at one point became life-threatening. I ended up needing a team of specialists to find my answers. In addition, I needed to coordinate the communication between all of the specialists myself. Often a strong PCP will do this, but unfortunately more often than not, you need to do things yourself. Something that will always stick with me is a comment my Pulmonologist made to me in 2009. He said that if I hadn't advocated so hard for myself, I wouldn't have survived. I kept pushing to find my answers and asking tons of questions instead of just accepting what my docs said and giving up if it didn't work. Self-advocacy is critical so don't give up on yourself.

    My team consisted of my primary care doctor, a Gastroenterologist, an ENT/allergist, and a Pulmonologist. The Gastroenterologist did repeated endoscopies, bloodwork, labs, stool samples, manometries, pH tests, etc... and started treating me for the acid refluxing. My ENT/Allergies did allergy testing, administered immunotherapy shots, did laryngoscopies, CT scanning, did the upper ResTech pH testing, and fought to get me on asthma shots when insurance denied them. My Pulmonologist did the lung function testing, chest x-rays, TB testing, Esophagrams and Modified Barium Swallows. While I had figured out I had 'silent' acid refluxing. It was the Esophagram/Barium Swallow testing that showed the acid actually hitting my lungs. The pH testing showed the severity of my acid refluxing. The manometry showed my LES wasn't closing. As you've learned a lot of the other testing ruled out stuff, which is important as well.

    I'm not sure if this has helped, but hopefully it has provided you with some other things to consider.

    MR
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    Old 12-16-2014, 07:35 AM   #3
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    Re: Is this Asthma?

    Thanks for your quick and complete reply. To answer a few of your questions-

    1. Have you had pulmonary function testing? How about a Methacholine challenge for the asthma? Yes I have to the PFT (NO COPD) but no to the Methacholine challenge. My asthma/allergy Doc also gave me 3 pulmo test with a smaller machine and came out excellent.

    2. Have you had an esophagram or barium swallow done? I believe not because I do not know what it is. ;-)

    3. Have you had pH testing done? How about a Manometry? Yes and no.

    4. Have you had allergy testing done? Yes, 2 of them. Came out with mild on mold, dust (1 out of 4) No food allergies.

    5. What medication have your tried for the acid refluxing?
    Omeprazole 40DR first for 30 days, did nothing for me and LANSOPRAZOLE DR 30 MG which I took for 15 days with the same results and finally Rabeprazole SOD DR 20 but only took for 4 days when she sent me to the GI.

    I had 2 endoscopies, 1 colonoscopy, 1 abdominal CT, 2 head CT's, 2 brain MRI's, Yes, to B12, D3 and all vitamins, thyroid.

    I called yesterday my lung Doc and left a message with the nurse- I asked her if they can do additional testing on me because I don't feel any better. Its funny because the lung specialist said might have reflux so she gave me medication for 48 days, then she sent me to the GI for the endoscopy which showed mild reflux, but the GI sent me back to the lung specialist which without seeing me or doing any additional testing put me on Advair. If the lung specialist can't or won't do any additional testing I will have to push it like you did hoping to get one of them to request a referral for MAYO Clinic. Yes, is a good 3 hour drive on good days but I have no option. I understand Mayo Clinic will do just about every testing I can need from the same place and in many cases the same day or 2.



    Thanks
    Jose

    Last edited by papote53; 12-16-2014 at 09:52 AM.

     
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    Old 12-16-2014, 09:56 AM   #4
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    Re: Is this Asthma?

    Just now the lung Doc Nurse called me and said that I don't have asthma, what I do have based on her report is reflux so I should contact my GI and have them give me medication and run additional test.

    But when I asked the Nurse should I stop taking Advair she said the Doc did not said anything about that so she will have to contact her again and get back with me. Meanwhile to call my GI and follow up with the test and new medication for reflux. WOW, I'm really feeling sorry for my Ginny Pig because I'm starting to fee like her. ;-) jejejeje

     
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    Old 12-16-2014, 10:11 PM   #5
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    Re: Is this Asthma?

    If you are dealing with reflux and PPI's are warranted, my GI doc recommends a minimum of 4-6 weeks on a medication before determining if it will work or not. I've been on all of the PPI's and followed his advice for each before trying the next. I had side effects with one and have found some work better for me than others.

    If you are dealing with LPR reflux irritating the lungs or throat, most of the time it will require taking the PPI's twice a day for a long period before seeing results. The acid with LPR is hitting areas that are much more sensitive to the acid than the esophagus so it takes longer to see healing and a decrease in symptoms.

    If the acid is actually irritating you lungs, you will want to stay on the Advair. This is something to discuss with your doctor for certain.

    If you had 24 hour pH testing done, you probably had a manometry as well. They usually do that first to know where to place the pH probe. You can ask the doctor's office or hospital for a copy of your results. It is always good to have a file with copies of your test results anyway. It helps when you are seeing multiple doctors. If you had the Bravo pH testing, you may not have had the manometry.

    A Barium Swallow test involves swallowing items with barium in them and watching on live video x-ray to see what happens as you swallow and after it hits your stomach. With the esophagram they watch as you consume liquids and solids...from your chewing process all the way to the stomach. When I had the test done, the speech therapist actually pointed out where the acid was coming back up and hitting my lungs.
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    Old 12-17-2014, 07:35 AM   #6
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    Re: Is this Asthma?

    Quote:
    Originally Posted by MountainReader View Post
    If you are dealing with reflux and PPI's are warranted, my GI doc recommends a minimum of 4-6 weeks on a medication before determining if it will work or not. I've been on all of the PPI's and followed his advice for each before trying the next. I had side effects with one and have found some work better for me than others.

    If you are dealing with LPR reflux irritating the lungs or throat, most of the time it will require taking the PPI's twice a day for a long period before seeing results. The acid with LPR is hitting areas that are much more sensitive to the acid than the esophagus so it takes longer to see healing and a decrease in symptoms.

    If the acid is actually irritating you lungs, you will want to stay on the Advair. This is something to discuss with your doctor for certain.

    If you had 24 hour pH testing done, you probably had a manometry as well. They usually do that first to know where to place the pH probe. You can ask the doctor's office or hospital for a copy of your results. It is always good to have a file with copies of your test results anyway. It helps when you are seeing multiple doctors. If you had the Bravo pH testing, you may not have had the manometry.

    A Barium Swallow test involves swallowing items with barium in them and watching on live video x-ray to see what happens as you swallow and after it hits your stomach. With the esophagram they watch as you consume liquids and solids...from your chewing process all the way to the stomach. When I had the test done, the speech therapist actually pointed out where the acid was coming back up and hitting my lungs.
    Thank you again for your quick reply. ;-)

    My lung specialist took me out of Advair and put me on an inhaler just in case to be used as needed and right now I don't see the need at all. I don't have sudden need for air, I feel the pressure all the time and only Alprozalam makes it a little better. Now, she did recommend that I go back to my GI and ask for a PH Probe test so I called my GI and I'm waiting for her response. She also suggested that I go and try another medication for reflux because my GI just said to take over the counter medication like Pepsid- So right now I'm on the waiting - process..again. ;-) I did try Omeprazole DR 40 for 30 days and did nothing, now the other 2 I took for 15 days and 4 days when she took me out. On my own I called my PCM and he got me OmeprazoleDR 20 which I have been taking for 4 days with no improvement. But I prefer if they give me something which is pending right now. My Lung specialist believe I have reflux with anxiety which I have to say I agree with her. I don't feel I have asthma. Will ask for the Barium Swallow test but I guess they will wait first for the results of the PH probe test.

    Thanks very much, you are very kind to take the time to explain these things to me. ;-)

    Jose

    Last edited by papote53; 12-17-2014 at 08:53 AM.

     
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    Old 12-18-2014, 09:40 AM   #7
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    Re: Is this Asthma?

    Just an update:

    GI refusing to do any further study, she said I should go to my Pulmo and to my cardiologist. Funny, my pulmo sent me to her for further study and all the test my cardio has done (6+ months ago) shows I have a healthy heart. And to add to this I just had an Electrocardiogram done 2 weeks ago and is all normal. Waiting for my 2nd request to the GI to run these tests. Now, I do have mild Hyperexpanded lungs so maybe I do have asthma and the medication was not the right one for me. Right now is all about eliminating probable conditions.

    Last edited by papote53; 12-18-2014 at 09:42 AM.

     
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    Old 12-19-2014, 11:46 AM   #8
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    Re: Is this Asthma?

    Hi Miers, so what have you done to get better?

    UPDATE: GI still refusing to do the test, Pulmo DOC can't believe it. Upon my request Pulmo Doc gave 15 days supply of Dulero 100-

    Now I ask myself, if this was a cardio problem, would it go away if you lay back? I don't think so, but reflux and maybe asthma would. GI is even refusing to give me any medication, I did try 2 different which was authorized by my Pulmo Doc, and 1 for just 4 days, so she should look for options instead of closing the doors on me.

    Last edited by papote53; 12-19-2014 at 11:47 AM.

     
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