Getting a diagnosis

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Richard Evans - 19 Nov 2007 23:04 GMT

I posted a thread a while back called "Is this the right group?"

In it I described shortness of breath that I've been suffering for
going on four months now.

I've been to a cardiologist, a pulmonologist, a gastroenterologist,
and an ENT specialist with no diagnosis.

The problem started pretty much spontaneously in late August. It is
characterized by short breaths with a pronounced "raspberry" on the
exhale. Imagine pursing your lips and blowing, i.e. giving someone the
raspberry. That's what my exhalations are like.

Anyway, my GP has washed his hands of me. He says he's never seen, or
even heard, of anything like this. As a stab in the dark, he suggested
a neurologist, so I have an appiontment with one on 12/4.

Any suggestions on where to turn for a good diagnostician? MY GP is in
Durham, NC "The City of Medicine", Duke Hospital, etc. You would
think he could offer more.

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TRN - 20 Nov 2007 02:06 GMT

> I posted a thread a while back called "Is this the right group?"
>
[quoted text clipped - 16 lines]
> Durham, NC "The City of Medicine", Duke Hospital, etc. You would
> think he could offer more.

We get people posting here all the time with your problem. At some time they
will figure it out I think. It took them 13 years for me, but you just have
to continue going back.

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Jason - 20 Nov 2007 22:49 GMT

> I posted a thread a while back called "Is this the right group?"
>
[quoted text clipped - 16 lines]
> Durham, NC "The City of Medicine", Duke Hospital, etc. You would
> think he could offer more.

There are two respiratory problems that many GP doctors fail to diagonose.
You may want to do a google search to determine if you have the symptoms
of either of these disorders. This is a great site: emedicine.com

respiratory acidosis it's related to metabolic acidosis
respiratory alkalosis it's related to metabolic alkalosis

Blood tests for

blood gases and pH
blood bicarbonate
plasma renin activity

should rule in or out these disorders.

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00doc - 22 Nov 2007 00:35 GMT

>> I posted a thread a while back called "Is this the right group?"
>>
[quoted text clipped - 31 lines]
>
> should rule in or out these disorders.

Those are both acid base problems that show up in the chemistries. One
(acidosis) refers to acidic blood and the other the opposite. The
respiratory and metabolic parts of the names just describe the causes of the
acid/ base imbalance. Sometimes repiratory symptoms can cause them but they
are not the cause of the symptoms. I'm not saying an ABG isn't warranted -
just that the above really aren;t two problems commonly misse dby GP's when
investigating symptoms seen in primary care.

The plasma renin activity has nothign to do with any of it. It is involved
in blood pressure control and potassium balance and measuring it is not
commonly indicated in clinical practice.

I'm sure your serum bicarbonate has been measured before. It is on the
routine set of chemistries.

I would try to go to a pulmonologist and possibly an allergist at the
university hospital.

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Richard Evans - 21 Nov 2007 00:11 GMT

>I posted a thread a while back called "Is this the right group?"
>
[quoted text clipped - 16 lines]
>Durham, NC "The City of Medicine", Duke Hospital, etc. You would
>think he could offer more.

Well, it looks like I have a diagnosis. The short version: It appears
to have been caused by the drug Seroquel that I've been taking for
insomnia for several years. The technical term is "tardive
dyskinesia."

I have a psychiatrist I consult with when taking psychoactive drugs
for insomnia, so I gave him a call. He nailed it over the phone in
five minutes.

The bad news: It may not be reversible.

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00doc - 22 Nov 2007 00:36 GMT

>>I posted a thread a while back called "Is this the right group?"
>>
[quoted text clipped - 27 lines]
>
> The bad news: It may not be reversible.

Lip smacking certainly sounds like TD. It shouldn't be a raspy feeling down
in the airways, which is what I thought you were describing. He is right -
it may or may not be reversible.

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00doc

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