Patient replied :

The steroids and echocardiogram occured a few years back. I think the time line was not adequate. My echo was 2 years ago.
GERD has afflicted me for years. I have gotten out of breath and could not catch my breath for some time at the gym. I used to recover quickly, and I have had times where I felt air hunger for quite some time and then felt out of it. I suspect that Acid reflux may be the culprit.
I follow you, for I do not deny that there may be some sort of psychological element, but I wonder if there is a health element, that is what causes me to feel anxious. For instance, asthma, or a rapid heart rate from going up the steps, which is abnormal for me. Then, I become concerned that there is a health issue, and it is compounded by anxiety.
I am sure that I have tremendous GERD. I get bronchitis on the drop of a dime and I do not smoke. I get sore throats after sleeping, and I can feel the acid go down my throat when I stand up after laying down. Sometimes, I taste vomit or almost like regurgitated food, if I lay down too soon.
I also may have some sleep aphnea. I wake up chocking at times, and maybe because of the GERD, who knows?

So, I am wondering many things. Could my hormones be off an cause this? Could GERD side effects cause the asthma like symtoms? Could sleep apnea cause racing heart rate, etc? Could I have a block in my heart somewhere that causes these type of symptoms? Could there be a block in another part of my body that causes them, like the juggler, head, etc.?
I also have hypertention. I have had a cholecystectomy, and also a microdiscectomy of the L-5 S 1. Currently, I also have high triglycerides 357, and somewhat high cholesterol 150 LDC and 55 HDC. My blood sugar is not very high, but not good 109.
See, the reason I feel that the cause of my issues may indeed be something compounded evern moreso by some sort psychological manifestation of anxiety has to do with the fact that fitness used to cure all of my emotional ills. After a workout, I would feel unstressed, and happpy., Even severse stress would often disapear after a few weeks worth of good workouts. I used to feel wonderful after a workout. Now, a 2 mile walk keeps my heart rate over 100 (100 to 136) for a few hours and my baseline is 76 bpm. Now, I am afriad to tax myself and work out hard. When I ran up a small flight of steps last week, I got so light headed, that it took 2 minutes just to talk the guy in the resturant and order breakfast. And, I already told you of the moments where I could not catch my breath in the gym. In the past, these were moments, where I would recouperate in 10 0r 20 seconds, if that long, and not it takes 10 minutes to feel like I will not die that moment, and then I am exhausted for some time afterwards, like an hour or more. Lastly, on one occassion where my heart was racing. I took 2 mg of Klonopin. I normally take .5 to .25 mg at a time. My heart rate was still around 150, and it was 3 hours after taking the Klonopin. I had to go to the ER and was given Metoprol to bring my heart rate down.
So, does this change your mind? Would your recomend any other tests? Do you have any suspicions besides pulmonary and psychological? Lastly, which would potential diagnosis would you rank as the most likely?
Regards,
Mike

Patient replied :

Dr Vivek Mahajan

My cornary ct scan turned out ok, my scores were low. I was told that I do not have any blocked arteries, but I may have some calcium in my aortic valve. My HCP was not concerned for it could be a false positive. I am sure that I had a panic attack again, and was sent to the hosptial from work. I felt like it was difficult to breathe due to my throat feeling swollen.
Lastly, I have realized that normally before my heart races, I have noticed that I feel like it is difficult to get oxygen or I feel dizzy upon going up steps or changing heights fast. Not sure of the cause, or it could be just being out of shape when I go up steps. But, I also feel like I have a lump in my throat on ocassion and it is hard to swallow. On those days, or after I eat, I really notice the lump feeling and I have chocked on ocassion.
I have since been diagnosed with moderate asthma. But the pulmonologist wanted me to see an internist for GERD, and get an endoscopy, and she also wanted me to do a sleep test. She feels, GERD and or apnea may be the cause.
I since have had issues with a sore throat for months. I had what was diagnosed as bronchitis, and ended up being diagnosed as strep pnemonia, for 3 months. I finally got rid of it a few weeks ago. However, my throat still hurts. The ent did not see anything upon examination. As I have told you, I had issues swallowing on a few occassions and I have chocked while eating on a few ocassions. I also felt a lump in my throat before and after that occurs. I would have sworn that my esphogas had issues, like espophogitis, or strictures, etc. That would explain the out of breathing and swallowing issues, etc. But, so far with just a flex scope through my nose, my ENT could not see anything of note. I have been given a script for a barium study, and a swallowing study to do in the future.
So, I am wondering. Can nerves cause throat pain, and a lump feeling, and even swallowing issues? I was not having a panic attack when I had issues swallowing. Well, I felt panic as I chocked, but not before, and not anything traditional afterwards. For instance, my heart rate and BP were within normal limits.
I will get the echo and stress test that your recomended later this week and my liver and renal functions labs were fine.
So, what are your thoughts? I know that I have anxiety when it comes to this issue. My problem is discerning if it is all anxiety induced, or if I have anxiety due to my medical condition(s)? What do you think I should do next? Do you agree with the echo, stress, barium swallow, barium test, sleep test, and then leave it be? Should I just get treatment for anxiety afterwards and stop Dr. and test hunting. However, I did not do very well on my Spiromiter test, and was given Asthmanax to takefor the time being and she wants me to do a few more Asthma tests at the hospital. I want to be cured, and I want to be healthy. But, I feel like this has been a long trip of tests and appointments, etc... What I am trying to say, is when do you think I should stop ruling things out and treat it as panic and anxiety? It is there, undeniably, but I can not be sure if it is the cause. But, if I keep testing and it is panic, I will prolong the panic and give myself a reason to believe I have medical issues. That whoe, what came first the chicken or the egg question really rings true here. Panic, then heart and lungs or is it heart and or lungs, and then you beget panic.
Warm Regards,
Mike