Unresolved Cough and Symptoms: Seeking Answers in Chronic Respiratory Issues

Q: Unresolved Cough and Symptoms: Seeking Answers in Chronic Respiratory Issues

Hello Mr. <br>A-Nan： Your symptoms seem to be causing significant distress, including itchy throat and dry cough, a lipoma under your right armpit, post-nasal drip, and diarrhea with soft stools. <br>You have undergone numerous imaging studies across different specialties and hav

Throat itching, coughing, and various other symptoms have not improved despite undergoing multiple tests and treatments?

Hello, doctor.
Since the end of November last year, I have been experiencing an itchy throat and dry cough in the middle of my clavicle, along with a linear tumor appearing under my right armpit.
I have no history of allergies or asthma.
After visiting a clinic without improvement, I was referred to 802 Hospital in Kaohsiung for further examination due to my concerns.
A CT scan with contrast of my lungs was performed, and the doctor stated that my lungs appeared normal with no abnormalities detected.
The tumor under my right armpit was diagnosed as a lipoma by a surgeon through ultrasound and MRI.
However, the itching and coughing have not improved, and I have been under significant psychological stress.
Around March or April, I began to notice sputum production, sometimes foamy and sometimes thick, along with symptoms of post-nasal drip, blurred vision, headaches, neck and shoulder stiffness, left lower abdominal pain, worsening diarrhea with soft stools, and a runny nose.
I have been worried that other parts of my body might develop corresponding symptoms.
Over the past year, I have undergone a CT scan of my head and an MRI with contrast of my liver to monitor a hepatic hemangioma discovered during gallbladder surgery in 2017, both of which were normal.
I also had two gastroscopies and two colonoscopies, all of which were deemed normal.
In July, I asked a doctor at 802 Hospital to perform a bronchoscopy, and the physician noted that my airways seemed more sensitive, but nothing abnormal was found.
I brought my lung CT images to Chang Gung Memorial Hospital, where a pulmonologist reviewed them and performed additional frontal and lateral chest X-rays, concluding that there were no issues.
By September, the Chang Gung doctor suspected I might have asthma and prescribed inhaled corticosteroids and antihistamines.
However, even after using them, I still feel little change; the itching has not worsened but has not improved either, sometimes being more noticeable and other times less so.
I have also consulted a psychiatrist and taken antidepressants and anxiolytics for about half a month to a month, but the itching issue remains unresolved.
Recently, I discovered that neuroendocrine tumors of the small intestine can cause asthma.
Since my gallbladder was removed in 2017 due to stones, I have had ongoing issues with diarrhea and soft stools, which I did not pay much attention to.
However, upon learning about the symptoms of neuroendocrine tumors, I began to worry about the possibility of having a small intestine neuroendocrine tumor.
I have been living in the shadow of potentially severe illness every day, and I hope the doctor can provide some insights into possible related issues.
I am truly, truly suffering.

A Nan, 30~39 year old female. Ask Date: 2019/12/17

Dr. Chen Bozhang reply Family Medicine

Hello Mr.
A-Nan: Your symptoms seem to be causing significant distress, including itchy throat and dry cough, a lipoma under your right armpit, post-nasal drip, and diarrhea with soft stools.
You have undergone numerous imaging studies across different specialties and have taken antidepressants and anxiolytics in the psychosomatic clinic.

At first glance, the physiological symptoms that need clarification are primarily related to the gastrointestinal tract, particularly the tendency for diarrhea and soft stools.
You may want to consult a gastroenterologist to evaluate whether further testing is necessary.
If no organic disease is found, it is likely that you are experiencing chronic anxiety-related irritable bowel syndrome (IBS) with diarrhea predominance.
IBS is classified as a functional gastrointestinal disorder of the colonic neuroendocrine system, which does not affect physiological health and is associated with stress, lifestyle, and dietary habits.
One suggestion is that you may need to continue visiting the psychosomatic clinic, as excessive anxiety about physical ailments, while being cautious about health is beneficial, can lead to unnecessary disease connections that may be related to illness anxiety disorder (a type of anxiety disorder).
The psychosomatic physician will assess your medical history and emotional state and recommend appropriate adjustments and treatment options.

Reply Date: 2019/12/17

More Info

It sounds like you have been experiencing a complex array of symptoms for quite some time, and I can understand how distressing this must be for you. Chronic cough, especially when accompanied by other symptoms like phlegm production, throat irritation, and even anxiety, can significantly impact your quality of life. Let's break down your situation and explore potential avenues for relief and further evaluation.

From your description, it appears that your cough has persisted since late November, and you have undergone a series of diagnostic tests, including CT scans and bronchoscopies, which have not revealed any significant abnormalities in your lungs. This is a positive sign, as it suggests that there may not be any serious underlying lung disease. However, the persistent cough and associated symptoms you are experiencing could be attributed to several factors.

1. Post-Nasal Drip: Given your mention of nasal congestion and the sensation of mucus dripping down your throat, post-nasal drip could be a significant contributor to your cough. This condition often results from allergies, sinus infections, or even irritants in the environment. It can lead to throat irritation and a chronic cough, especially at night when lying down. Treatment may include nasal saline irrigation, antihistamines, or intranasal corticosteroids to reduce inflammation.

2. Asthma: Your healthcare provider's suspicion of asthma is worth considering. Asthma can present with a chronic cough, especially if it is cough-variant asthma. This type of asthma primarily manifests as a cough rather than wheezing or shortness of breath. The inhaled corticosteroids prescribed may help, but it may take time to see significant improvement. If you have not already, consider working with a pulmonologist who can perform specific tests, such as spirometry, to assess your lung function and confirm a diagnosis.

3. Gastroesophageal Reflux Disease (GERD): GERD can also cause chronic cough due to acid irritating the throat and airways. Symptoms may include throat clearing, a sensation of a lump in the throat, and cough that worsens when lying down. If you suspect this might be an issue, lifestyle modifications (such as avoiding large meals before bedtime, elevating the head of your bed, and avoiding trigger foods) and medications like proton pump inhibitors may be beneficial.

4. Anxiety and Stress: Chronic illness and persistent symptoms can lead to anxiety, which can exacerbate physical symptoms. If you have already consulted with a mental health professional, it may be helpful to continue exploring stress management techniques, such as cognitive-behavioral therapy (CBT), mindfulness, or relaxation exercises.

5. Other Considerations: The presence of a lipoma in your axilla is generally benign and unlikely to be related to your respiratory symptoms. However, if you have concerns about other potential conditions, such as neuroendocrine tumors, it is essential to discuss these with your healthcare provider. They may recommend further imaging or referrals to specialists based on your symptoms and medical history.

In conclusion, while it is understandable to feel overwhelmed by your symptoms and the potential for serious underlying conditions, it is crucial to focus on the positive findings from your tests and the management strategies available. Continue to communicate openly with your healthcare providers about your symptoms and concerns, and do not hesitate to seek second opinions if you feel it is necessary. Remember, managing chronic symptoms often requires a multifaceted approach, and finding the right combination of treatments may take time. Take care, and I hope you find relief soon.

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