Persistent Throat and Chest Discomfort: A Patient's Journey

Physical discomfort?

Hello, Doctor.
About a month and a half ago, I suspected that I inhaled some debris through my nose, and since then, I have been unable to clear it.
I didn't pay much attention to it, but the next day, I developed a strong sensation of a foreign body in my throat.
I started visiting an ENT specialist, who used a nasal endoscope and prescribed medication for chronic pharyngitis, but there was no improvement.
During this time, I also had a routine check-up, and the chest X-ray report indicated possible vascular shadows at both lung hila, suggesting pseudonodules that could be monitored.
At night, the sensation of a foreign body in my throat became more pronounced, making it increasingly difficult to sleep.
I experienced insomnia for two weeks until I started taking vitamin C before bed, which provided slight relief from the throat discomfort, but I still woke up early (around 5 AM).
The throat sensation persisted, and I began to cough, accompanied by discomfort in my chest, sometimes feeling tightness in the center of my chest.
I then consulted a pulmonologist, who ordered another chest X-ray and diagnosed me with bronchitis, prescribing medication for asthma and cough relief.
I mentioned to the doctor that I had experienced weight loss and occasional fever (sometimes feeling inexplicably hot, with a temperature ranging from 37.1 to 37.4°C).
The doctor noted that my appetite was quite good and that it didn't seem like a low-grade fever, as it would need to reach 38°C to be considered significant.

Currently, my symptoms include persistent fatigue but waking up early (wanting to sleep by 8 PM, waking up at 3 AM and unable to fall back asleep), frequent tightness in the center of my chest, a sensation of a foreign body in my throat, coughing when taking a deep breath, occasional unexplained warmth, and a missed menstrual period (which was due about a month ago).
Given that my symptoms started in the throat and progressed to the chest, and recalling news reports of someone accidentally inhaling cauliflower through their nose into their lungs, I would like to ask the doctor:
1.
What additional tests can I request from my doctor? (For example, low-dose CT scans, even if they are out-of-pocket)
2.
Which other specialties should I consider consulting regarding these symptoms?

Nìmíng, 20~29 year old female. Ask Date: 2016/09/08

Dr. Jian Shuntian reply Pulmonology

Based on the symptoms described, it appears to be a nasal issue.
It could be due to allergies, foreign bodies, sinusitis, or other conditions.
Please visit an otolaryngologist for further examination and treatment.

Reply Date: 2016/09/08

More Info

Hello! Thank you for sharing your journey regarding your persistent throat and chest discomfort. It sounds like you've been through quite a lot over the past month and a half, and I can understand how distressing these symptoms can be. Let's break down your situation and explore some potential next steps.

From what you've described, it seems that your symptoms began after an incident where you suspected inhaling something irritating. This led to a strong sensation of a foreign body in your throat, which has persisted despite treatment for chronic pharyngitis. The chest discomfort, cough, and feelings of tightness in your chest, along with the fatigue and sleep disturbances, are concerning and warrant further investigation.

1. Further Testing: Given your ongoing symptoms and the initial findings from your chest X-ray, it may be beneficial to request additional imaging studies. A low-dose CT scan of the chest could provide more detailed information about any potential abnormalities in your lungs or airways that might not be visible on a standard X-ray. Additionally, considering your symptoms of weight loss, fever, and persistent cough, it would be prudent to discuss the possibility of a bronchoscopy with your physician. This procedure allows direct visualization of the airways and can help in obtaining samples for further analysis if necessary.

2. Specialist Consultations: You have already seen an ENT specialist and a pulmonologist, which are appropriate steps. However, given the complexity of your symptoms, you might also consider consulting with an allergist or immunologist. They can evaluate for any underlying allergic reactions or sensitivities that could be contributing to your symptoms. Furthermore, a gastroenterologist could be helpful if there is any suspicion of gastroesophageal reflux disease (GERD), which can sometimes present with throat discomfort and cough.

3. Symptom Management: While you await further evaluations, managing your symptoms is crucial. You mentioned that taking vitamin C has provided some relief; however, it may also be beneficial to explore other supportive measures. Staying well-hydrated, using a humidifier at night, and avoiding irritants such as smoke or strong odors can help soothe your throat. If you experience significant anxiety related to your symptoms, discussing this with a mental health professional could also be beneficial, as anxiety can exacerbate physical symptoms.

4. Monitoring Your Symptoms: Keep a detailed diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare providers in determining the best course of action.

5. Follow-Up: Make sure to maintain regular follow-ups with your healthcare providers. If your symptoms worsen or new symptoms develop, do not hesitate to seek immediate medical attention.

In conclusion, your symptoms are multifaceted and may require a comprehensive approach to diagnosis and management. By advocating for further testing and exploring additional specialist consultations, you can work towards finding relief and understanding the underlying causes of your discomfort. Remember, it's essential to communicate openly with your healthcare providers about your concerns and any changes in your condition. Wishing you the best on your journey to recovery!

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