I have difficulty in deep breathing, and I burp frequently. Please help.

Hi doctor,

I am a 29-year-old male. My height is 5 feet 7 inches, and my weight is 150 lbs. I have had the following symptoms for the last eight months- difficulty in deep breathing. It feels very tight in the middle of my chest when I try to take a deep breath, sometimes along with tightness in my upper nose (I think you call it the sinus area). I burp quite frequently with some farts. I observed that my breathing issue is worse in the morning when I wake up. If I take my breakfast late, it makes it even worse, also especially when I am hungry. I can feel my throat also getting tighter, along with breathing difficulty in deep breathing. Sometimes when I feel sleepy, it is challenging to take a deep breath. If I start to eat more, then it gets worse again, so I have been eating less food every day recently. While eating also, it can get worse, especially with solid food like dry rice with meat or chapati (wheat). It feels more difficult to breathe while eating solids. I often get sudden severe pain in my arms, sometimes in the left or sometimes in the right, for two minutes, but it stops after taking Statin. I have been experiencing the above symptoms for eight months now, and I am really stressed. I have stopped Statin medication, and I noticed that my symptoms got significantly better, but I am still on Warfarin.

All these symptoms started a few months back. Before that, I never had any problems. I had a stroke due to PFO in my heart, and PFO closure surgery was done (Doctors in the hospital said my problems were not related to surgery). I started my medication with Warfarin 5 mg and Atorvastatin 20 mg. I personally think I have side effects from medication, but doctors said it is not related to the medication. I went to the hospital and saw some specialists check and did some tests as follows-

The X-ray test is normal. The blood test is normal (detailed blood test to check my diabetes, liver, etc.). The oxygen level is normal. ECG is normal. COVID test is negative (many times and recently). The lung test is normal (the respiratory specialist said it did not seem like asthma and gave me the asthma puff to see if my condition gets better, I tried it for seven days straight but did not have any relief). Endoscopy for nose and throat- ENT doctor said there is a lot of mucus accumulated in my nasal path due to allergy or change of environment. I never had an allergy issue in my whole life or nor has there been a change in the environment. An endoscopy for my stomach shows mild inflammation in my stomach, which the doctor said will require two months to completely heal and gave me Famotidine 40 mg to take two times a day and Gascon 40 mg to take three times a day. The doctor said there is no particular reason why it happened. They are not sure why it happened. The dietician also checked my diet and said my diet was fine. Whole my life, I never had any stomach problems or food allergies, and all the problems started after medication.

My usual diet for the last six months is as follows

1. Breakfast includes dosa (pancake) or chapatti (Indian bread) with one banana with two large dates and green tea two hours after eating.
2. Lunch includes rice with chicken, mushrooms, and a banana.
3. Dinner includes rice with vegetables or chicken or fish, bananas, and dates.
4. I never had a history of asthma or gastritis.
5. I do not smoke or drink.
6. I never drink aerated drinks (sugary drinks).
7. I hardly eat junk food, especially since last year. Due to my work, I need to walk a lot, so I walk for more than one hour each day.

Please let me know if you recommend any tests, and also, do you think with the above medication prescribed, it will be fine in two months? Also, what do you think about the whole situation? I am really very stressed, not breathing like a normal person every day, cannot relax, cannot sit, walk, eat, or sleep well. I will not be able to provide you with any reports because, at my place, reports are not given to the patient, and if I really need the reports, then I need to pay a lot of money per the report, but if you really require any, I can pay and get the report. Thanks.

Hi doctor,

Thank you for your valuable feedback. I would like to correct my typing mistake in my previous post. I used to get sudden intense pain in my arms, sometimes in the left or sometimes in the right, for two minutes, but it stopped after taking Statin. Regarding obstructive sleep apnea and anxiety, neurosis seems less likely for me because I have no history of anxiety disorder or have never been troubled with anxiety issues or any problem with the sleep issue. Let us say we go with irritable bowel syndrome. For now, I want to know what might have caused it because my diet is very clean, and I am a very active person with no history of such problems earlier. Is it possible for the medication Warfarin or Statin to cause it? Also, I am thinking of other possibilities, such as mucus or sputum in my chest and lungs can cause obstruction? Can an x-ray test reveal if there is any mucus or sputum accumulated in the chest or lungs? Or any test that can make sure there is no mucus or sputum in my chest or lungs? I am going to have a spirometry test on Wednesday. Because I always have mucus or sputum accumulating in my throat, which I need to swallow frequently, also anytime when I breathe, there is always resistance in the middle of the chest. If I force myself to breathe, I can sometimes feel more pressure building on the left side of the chest. My chest always feels of heaviness, also feeling not able to inflate my stomach fully like when I was normal. Also, I am breathing mostly from my left side nose (80 % to 90 % of the time). I have been breathing all my life evenly and never experienced this before. Sometimes, I can also hear a slight whistling sound in my breath which I have never had before. Is there any puff or inhaler you suggest that can help me get rid of mucus or sputum in my lungs and chest? Or any special treatment required for this? The ENT doctor gave me Avamys (Fluticasone Furoate) nasal spray, but it was not effective.

Also, I keep in mind the possibility of anxiety. Regarding Paroxetine, how should I go with this medication? What is the dosage? I do not want to be dependent on such medication, but I do not mind trying for two weeks to test. I have also been doing meditation for quite a long time, but I have not done it since last year because of my breathing issues. I also have difficulty doing a high-intensity workout. I am not anxious about almost anything, only concerned and quite tired about breathing issues. It is irritating. I am not worried about COVID nor the current global situation or my financial situation, and everything is good in my life apart from breathing. Thank You.

Hi doctor,

I would like to update you on my case and let you know the progress. I was released from the hospital and was prescribed 40 mg Famotidine two times a day for 24 days. So for the first ten days, I took a total of 80 mg a day, then I started to feel cramps, tightness, and constipation in the stomach, so I reduced the dosage to 40 mg a day and felt more comfortable then again after seven to eight days felt the tightness coming back in the stomach, so I reduced further to 20 mg a day. I have felt some improvements since I messaged you the first time. My breathing tightness got better, and I am also able to start to breathe from both the nostrils. Tightness in my throat is much less, and I am able to breathe better than before. This is the best I have been able to breathe for nine months.

Also, recently I did some lungs test, and the doctor said that I have no lung problems and sometimes the gastric issue can cause an asthma-like effect. So, I think what I may be experiencing now is the acidity rebound effect when I lowered my dosage. I guess that I have had gastric or hyperacidity (since I started the medication). I have stopped all the medication other than gastric medication. My questions are- When I lower my dosage, I feel acidity comes back means I start to feel tightness in my chest, and breathing tightness is also coming back but not as intense as before. I think my comfortable range is 20 mg to 40 mg, but right now just on 20 mg per day even though it is not very comfortable (is just enough to tolerate), but I want to get rid of the Famotidine medication as I do not want to get used to it. Can you recommend how I should reduce the dosage? Should I increase or decrease my dosage? How long do you think I need to keep taking the medication, approx how many weeks or months to get the normal level of acid production? Any home remedy? I have been drinking jeera water with a little honey everyday morning on an empty stomach since today. I take my 20 mg of Famotidine in the evening before my dinner.

Thank you.