Asthma/VCD or something else?

[kristysmiles]

Hello everyone,

I have been having a lot of GERD/Respiratory related symptoms for the last month or so. My primary doctor recommended me to Pulmonary for further evaluation and put me on Nexium for the GERD symptoms. The Pulmonary doctor doesn't think I have asthma based off my symptoms, but because I am an active duty Soldier wanted to do the test just in case.

So I just got back from the Doctor's office where I was tested for asthma with the methacholine challenge. After three doses (1.0mg I believe) of the methacholine my breathing rate or whatever they were measuring dropped below the red line (indicative of ashtma). Of course, they stop the test and give me an inhaler to reduce the effects of the medication. Except the inhaler did nothing for me, I had 4 doses and then waited 15 minutes so they could retest me (I'm not allowed to leave until I'm back in normal range). My respiratory function was still low. So they waited 10 more minutes, same thing. Finally, they had to go ask the doctor what to do since I wasn't responsing to the inhaler. Doctor gave me two more doses and waited another 15-30 minutes (lost track). Then I finally tested in range.

The doctor is now saying I have asthma with slight evidence of also having VCD (both minor), but I'm not sure I believe it. According to the nurse, my reaction to the inhaler was extremely abnormal and in his experience has never happened before (asthmatics respond to the inhaler almost immediately). The doctor is now saying the inhaler helped me, but I feel like doing nothing but sitting there for almost an hour is probably what returned my respiratory function to normal.

I have no family history of asthma and never had any of these respiratory symptoms until about a month ago. The doctor also believed that treating my asthma and GERD would completely eliminate my CFS/ME (2+ years). Is this really asthma? Could it be something else? Am I crazy for not believing my doctor that taking all these asthma medications is gonna help my CFS/ME symptoms?

I'm afraid it's one of the serious lung problems that soldiers get from deploying to the Middle East as described in this article: http://www.huffingtonpost.com/2013/02/07/gulf-war-syndrome-veterans_n_2634838.html

Thoughts?


If you want more background on my medical, you can view my previous thread here: http://forums.phoenixrising.me/index.php?threads/reality-of-my-me-cfs.30679/page-3#post-485228

 

[Gingergrrl]

@kristysmiles I'd been following your prior posts and wondered how you were doing. Sorry you had to go through that experience at your appt today!

I read the link and was wondering if there is any way for you to see a pulmonologist outside of the military who is more familiar with gulf war illness symptoms and how they manifest in the lungs vs. a doctor who just assumes it to be asthma?

Also, what is VCD?

 

[kristysmiles]

@Gingergrrl
VCD is vocal cord dysfunction. From researching this it looks like VCD, Asthma, and GERD are correlating illnesses and can even be caused by each other or further aggravated. It just doesn't seem like I have the symptoms severe enough to have all 3, maybe I'm wrong...

I'll have to research pulmonologists on the island, but my experience thus far is that specialists with the expertise I want are just not located in Hawaii. From the Huffington Post article it looks like Vanderbilt University Medical Center was doing the research on these post-deployment respiratory illnesses. I might try finding a point of contact with them, and seeing if I can make a side trip out there sometime.

 

[daisybell]

As far as I understand it, asthma causes expiratory wheeze and VCD causes inspiratory wheeze. VCD is sometimes called paradoxical vocal cord movements, and is often related to reflux. The vocal cords are supposed to open fully when you breathe in and adduct slightly when you breathe out to help control the airflow. In VCD, the vocal folds come together when breathing in, which makes you feel like you can't breathe.
Does that sound like anything you are experiencing?

 

[kristysmiles]

@daisybell
I honestly don't even feel like I'm wheezing. I went in complaining of intermittent chest tightness, breathlessness, as well as yawning and coughing a lot (mostly during exertion). When they gave me the methacholine it just made my lungs feel tickly and made me breathless. I never feel like I can't breath, just that I seem to be getting less air than normal.

 

[Gingergrrl]

@ I'll have to research pulmonologists on the island, but my experience thus far is that specialists with the expertise I want are just not located in Hawaii. From the Huffington Post article it looks like Vanderbilt University Medical Center was doing the research on these post-deployment respiratory illnesses. I might try finding a point of contact with them, and seeing if I can make a side trip out there sometime.

@[USER=15034]kristysmiles I think it is great that you are doing your research and I think contacting Vanderbilt University is a great next step. I would ask them if they ever do consults via phone or Skpye and also if they have referrals to other doctors with knowledge of post-deployment respiratory illnesses in other parts of the country. It sounds very specialized so there may not be but you never know![/user]

 

[daisybell]

@daisybell
I honestly don't even feel like I'm wheezing. I went in complaining of intermittent chest tightness, breathlessness, as well as yawning and coughing a lot (mostly during exertion). When they gave me the methacholine it just made my lungs feel tickly and made me breathless. I never feel like I can't breath, just that I seem to be getting less air than normal.

Hmmm. It doesn't really sound like asthma or VCD to me.....

 

[kristysmiles]

Yes, I'm going to keep trying to get a differential diagnosis or at least a better explanation. Like I said the inhaler didn't seem to work for me, so I don't want to be on medication that isn't going to help. I can usually deal with the symptoms by resting, so I don't see the need for medication unless it is literally out of control (hasn't happened yet). It doesn't sound like asthma or VCD to me either, and the Doctor that saw me didn't think that was what it was until after the test came back positive. I've never smoked a day in my life and neither has anyone in my immediate family. No one in my family has asthma, and I don't have allergies (though the doctor took my blood to test just in case). Deployment related respiratory illness is most likely in my opinion, especially when statistics say that somewhere near 40% of Soldiers develop post-deployment respiratory illnesses.

 

[Valentijn]

@kristysmiles - A couple years prior to getting chronic and moderate-severe ME symptoms, I had some similar issues.

After bronchitis + undiagnosed pneumonia, my new GP saw markings on a lung x-ray indicating the recently departed pneumonia and sent me for the methacholine challenge. I also failed it eventually ... but to me it didn't feel like my throat or lungs were having problems, it felt like I was just too exhausted from breathing into the damned tube for so long.

They didn't bother to keep me around to recover, and I only heard of my failing it later from my GP. She diagnosed me with mild asthma, and then began various attempts to treat it. At the time I also had symptoms of "exercise-induced asthma" which might have just been a pre-ME thing (exercise intolerance and PEM). None of the typical asthma meds helped, and the diskus-based ones (advent, flovair) actually made me feel worse.

I was sent to NW Asthma and Allergy, and due to my non-responsiveness to medication they tested me for Paradoxical Vocal Cord Dysfunction, but came up negative for that. Though they did find that I have a bunch of big nasal polyps

Eventually a retired doc was filling in for my usual GP, and had me try Intal, which is a rather old asthma med and out of fashion. But that one helped considerably. Albuterol never seemed to do much, aside from making me jittery for a while after inhaling it.