At my wit's end

[de novo]

I am hoping that someone might be able to help me with a problem I've had for over a year now.

Last March, I developed a near-constant cough following a cold virus--the virus went away, the cough did not. I was tested for allergies (scratch tests followed by injections) and did not react to a single thing on the panels they ran. I was given Zyrtec and Singulair anyway, which I have continued taking to this day. I continued to cough.

My doctor then suspected GERD, though I have never had heartburn. I went along with the idea that it could be silent and took 150 mg of Zantac twice a day for several weeks. Still coughed. I was given a 24-hour esophageal monitor and the results showed absolutely no GERD.

At this point, my doctor thought it was perhaps asthma, though I had no wheezing and no shortness of breath. Amazingly, an albuterol inhaler helped control my coughing nearly immediately. I was given a tentative diagnosis of asthma and placed on Syrabicort.

Unfortunately for me, all of my doctor's attention was paid to my coughing and my sinuses were apparently going downhill for several months. By the time they investigated my complaints last June, I had eight impacted sinuses and was immediately scheduled for endoscopic surgery.

I had immediate relief, both in my sinuses and with the coughing, but I have started to backslide over the last six months or so. I have developed a new cough, one mostly caused by a need to clear my throat, as I often have the feeling of mucus stuck in my throat and/or lungs. I am still taking Zyrtec, Singulair, Syrabicort, and Flonase, and I do twice-daily nasal rinses. When I have complained about the mucus in my airway to my pulmonologist, he says that it is due to "non-asthmatic eosinophilic bronchitis," not asthma, as they had originally suspected last year.

I am being driven crazy by my inability to rid myself of this mucus, both in my airway and my sinuses. I don't know what I am missing, or what I should be trying that I am not already doing. Is it possible that my problems are caused by an allergy (even if all my allergy tests were negative?)? Is there a better protocol for treating allergy other than the one I am on? I would love to hear any suggestions that I could bring to my allergist. I'm afraid I'm running the risk of being labeled a problem patient. :dizzy:

Rebecca

 

[MountainReader]

I've dealt with a chronic cough for quite a few years. Many of our treatments are parallelled some. I don't know if it will help you, but I will share some of what I have learned during this time.

The most common causes of chronic cough are: Allergies, Asthma, Post Nasal Drip, Acid Reflux. Your bronchitic could also be a cause of the cough.

I think many people who have the chronic cough are dealing with more than one of these. I know I am. I have all of the above with a cough as my primary symptom for both the reflux and the asthma.

You said you had allergy testing. I assume that it was for environmental allergies. They typically are. Have you been tested for food allergies?

I know for me, the sinus problems are certainly a contributer. The PND and also the upper respiratory problems that often come with them often trigger my asthma.

Did your Pulmonologit do any Pulmonary Function Testing or a Methocholine Challenge testing? That might help with confirming if it really is asthma or not. Also did you have a chest x-ray? Have you been tested for TB? With your diagnosis of non-asthmatic eosinophilic bronchitis, you certainly have some lung sensitivities. Did your Pulmonologist talk to you about what symptoms are to be expected? What to do when you "flare up"? Put a treatment plan in writing for you? I didn't realize how much docs really didn't pay attention to systematic things until I found an incredibly good Pulmonologist last year. He spenRAB 30-45 minutes just asking questions and getting a sense of everything going on with me before even doing his examination. He then put a written plan in place with me. During my last appointment, he spent just as long and asked many questions to find out how well I was self-managing things as well. It REALLY hit me how serious things were and how easily things could have turned bad because my other docs were just in, prescribe and out without really paying attention. I had actually self-referred myself to two specialists and went to a third on my Pulm's recommendation. My Pulm said he had another patient with my exact symptoms who he had just come from the hospital beRABide from because she hadn't been aggressive in finding help and treating herself. I know I'm going on and on, but this is something I had to learn a hard way.

My Pulmonologist had me do some Barium testing--a modified Barium Swallow and Esophagram. They show your chewing, swallowing and digesting processes to see how things are working. I wasn't expecting anything from those tests because I didn't think I had any swallowing problems. Was I surprised when the results came back. I had developed a hernia sometimes in the last two years. That didn't concern me much though. What bothered me was that I had food and acid refluxing back up. Some was reaching my lungs and irritating them. I was also aspirating some. The Pulmonologist said that I had to treat that before I would ever get my reflux under control. He recommended surgery. After working with my 6 months on a bunch of reflux meRAB that didn't work and messed up my system more than before, I opted for the surgery. It worked magic for me.

You had a 24 hr pH. I'm assuming you also had a Manometry. Did they give you the results? Is your Lower Esophageal Sphincter working correctly? If not, you could still have food refluxing up. My ENT does a special pH probe just in the throat to see if anything is hitting the throat and vocal corRAB. I understand from his PA that is often more accurate for detecting LPR. If you haven't read up on the LPR, you might want to do a search. There is tons info on this board. (My probe came back with reflux, but my EGD came back normal.)

I once went in to my primary care doc 9 times in 6 weeks. I asked her if I was being a hypochondriac and her response was that something was causing my problems and that we needed to work together to find the solution. Turned out I was not only dealing with a sinus infection and asthma flare, but also a reflux flare. Turned out that I also had Pertussis at the time. My only symptom for all of those things was a persistant cough. Also picked up the flu and a viral infection during that time. Boy was I worn out. I never would have known about the Pertussis if I hadn't persisted in getting treatment because my asthma and reflux treatments weren't helping at the time.

Your routine is similar to mine. My current Allergist is also my ENT. I'm actually getting better treatment than when I went to an allergy/asthma specialist. I'm doing immunotherapy because I do have environmental allergies. So far my food allergies are negative, but I'm not sure that I don't have some sensitivities. I also take Allegra, Flonase, Astelin and Singulair for the allergies. (Actually I'm trying to come off the Allegra and Flonase right now. We'll see how that works.) I take Advair 250/50 (500/50 during a flare), Singulair and Albuterol for my asthma. For the reflux, I take Prevacid Solutabs twice a day. Instead of Zantac, I supplemented with Gaviscon. The surgery has really helped, but I continue to take the PPI's also. I also do the nasal rinses. In addition to the regular rinse stuff, there is one called Xlear with Xylilol that I use. It is supposed to keep bacteria from "sticking" in your nasal passages.

I know I ranted a lot here. I hope that something is new. If nothing else, know that you are not alone in dealing with this. By the way, are you having any side issues from all the coughing? I had to deal with pulled muscles, sore ribs and some occassional incontinence when the coughing was really bad.