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

Answered by
Dr. Anshul Varshney
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 28, 2021

Hi doctor,

I am a 29-year-old male. My height is 5'7, and my weight is 70 kg.

I have the following symptoms;

1. Difficulty in deep breathing. It feels very tight in the middle of my chest when I try to do a deep breath, sometimes along with tightness in my upper nose (I think you call it the sinus area)

2. I burp quite frequently with some farts.

3. I observed that when 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 deeper 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 am eating less food every day recently.

4. While eating also, it can get worse, especially with solid food like dry rice with meat or chapatti (wheat), it feels more difficult to breathe while eating solid.

5. I use to get suddenly severe pain in my arms, sometimes in the left or sometimes in the right for two minutes but stopped after taking Statin.

I have been experiencing the above symptoms for eight months now, really been stressful.

I have stopped Statin medication, and I notice my symptoms have got significantly better but still on Warfarin.

All these symptoms started a few months before. Before that, I never had any problem. I had a stroke due to PFO in my heart and PFO closure surgery done (Doctors in the hospital said my problems are not related to surgery), I started my medication 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 specialist to check and did some tests as following;

X-Ray test: Normal.

Blood test: Normal (detailed blood test to check my diabetes, liver, etc.).

Oxygen level: Normal.

ECG: Normal.

COVID test: Negative (many times and recent).

Simple while lung test: Normal (Respiratory specialist said it did not seem like asthma and gave me the asthma puff to see if my condition gets better, I tried 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 there is a change in the environment).

Endoscopy for stomach: Mild inflammation in my stomach, which the doctor said will require two months to completely heal and give 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 with me about my diet and said my diet is fine. Whole life never had any stomach problem or food allergy, and all the problems started after medication.

My usual diet for six months as following:

Breakfast: Dosa or chapatti with one banana with two large dates, green tea two hours after eating.

Lunch: Rice with chicken, mushroom and a banana

Dinner: Rice with vegetable or chicken or fish, banana, and dates.

I never had a history of asthma or gastritis.

I never smoke or drink.

I never drink soda (sugary drink).

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 any reports because in my country they do not provide the reports to the patient and if I really need the reports, then I need to pay a lot of money per report, but if you really require any, I can pay and get the report.

Thanks.

#

Hi,

Welcome to icliniq.com.

After studying your case scenario, it looks you are suffering from either of the following:

1. Irritable bowel syndrome.

2. Obstructive sleep apnea.

3. Anxiety neurosis.

I am sure these diagnoses have been put in front of you previously too. Since you have got almost all sort of investigation and many types of treatment, I would recommend you a trial of SSRI (selective serotonin reuptake inhibitors) drug like Paroxetine. These drugs should give you a positive response within two weeks. Since we do not have any test to confirm anxiety, such a drug trial should keep us informed. As a patient, it is difficult for you to understand with so many symptoms that this could be anxiety, but trust me, you do not have a better option. I hope it helps you. If you have any further queries, please ask me.

Hi doctor,

Thank you for your valuable feedback.

I would like to correct my typing mistake in my previous post: I use to get suddenly intense pain in my arms, sometimes in the left or sometimes in the right for two minutes, but it has stopped after taking Statin.

Regarding obstructive sleep apnea and anxiety neurosis seems less likely for me because I had no history of anxiety disorder or never troubled with anxiety issue and any problem with the sleep issue, number one I think is probably causing the problem.

1. Let us say we go with irritable bowel syndrome. For now, I want to know what might have caused it because my diet is a very clean and active person and no history of such problem earlier. Is it possible for the medication Warfarin or Statin to cause it?

2. Also, I am thinking of other possibilities, such as mucus or sputum in my chest and lungs 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 simple 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 my middle of the chest. If I force myself to breathe, I can sometimes feel more pressure building on the left side of the chest, chest always feels of heaviness, also feeling of not able to inflate my stomach fully like when I was normal, also I am breathing mostly from my left side nose (80-90% of the time), I have been breathing mostly evenly all my life never experienced this, 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 can help me get rid of mucus or sputum in my lungs and chest? or any special treatment is required for this? The ENT doctor gave me Avamys (Fluticasone Furoate) nasal spray but not effective.

3. Also, I keep in mind the possibility of anxiety. Regarding Paroxetine, how should I go with this medication? Dosage? I do not want to be dependant 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 issue. I also have difficulty doing the 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.

Best Regards.

#

Hi,

Welcome back to icliniq.com.

As I have studied your reply in detail, my answer would be covering two points:

1. Your lung and cough related issues.

2. Anxiety part.

So, let us talk on the first part. A chest x-ray is usually done to diagnose any sort of pneumonia, lung lesion. Routine cough, allergic bronchitis is not discovered in X-rays. That is a clinical diagnosis based on symptoms and chest auscultation findings. So, if you have allergic cough, you may discuss with your doctor to prescribe you combination of Levocetirizine and Montelukast once daily for two months. These are anti allergics and they reduce allergy to much extent. In my patients who do not respond adequately to this, I add up inhaler containing Levosalbutamol and Budesonide, that has 100% response in my clinical practice. Now coming to second part, that is Anxiety. You need to obtain a prescription of Paroxetine from your general physician by sharing my opinion. I usually start my patient on Paroxetine controlled release 12.5 mg and gradually build up to 25 mg. Somehow, I believe, that you would be benefited. As far as addiction is concerned, this is non narcotic drug and has low addiction or abuse potential. Also take vitamin D3 for your hand weakness. I hope, my answer helps you out. Please feel comfortable to ask me, if any further query you have. I hope it helps you.


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