pleuritic chest pain - really bad
October 24, 2013 9:46 AM   Subscribe

Yes, I know you are not my doctor. Yes, I have been to see a doctor. To date, no diagnosis and no drugs prescribed, a lot of pain that shows no signs of going away.

Background: I have a chronic cough (5+ years) plus some combination of OCD and generalized anxiety disorder (see below), which I am currently getting treatment for. I *think* what is going on is pretty simple --- I think I have the flu, and I think it has interacted with my chronic cough in a really destructive and painful way.

The first night it started up (two nights ago) -- I had a mild fever and painful inspiration + some dizziness, so I went to the emergency room thinking it was a bad case of the flu. They listened to my lungs, didn't hear anything, gave me ibuprofen and sent me home. Yesterday it was worse, so I went to see my PCP, who sent me for a barrage of tests -- I got a chest X-ray and a host of blood tests for pneumonia and other bacterial infections. All the tests came back just fine. On the way home from the hospital my lungs seized up in the car and had to pull over because I couldn't breathe -- I was totally panicked and gasping for breathe, and a passerby called an ambulance which came and gave me oxygen for about twenty minutes. It passed pretty quickly and I called a friend for a pickup. I declined going to the hospital since I had *just been there* twice, and it didn't make sense to go back for more of the same (to date, it's been "take ibuprofen and drink lots of fluids")

Whatever is going on with me is NOT normal. I have never had anything like this before, and it's very scary. I do not, as far as anyone can tell, have anything in my lungs - no cysts, no mucous, no bacteria, no weird growths. At the moment, though, it feels like the bottom portion of my lungs have completely collapsed -- breathing is very shallow and painful, and occasionally flares up in an excruciating way that takes over my entire front chest area - lungs, diaphragm, chest, the whole thing just feels like it's on fire, and every breathe is really really painful. I don't have any other symptoms of the flu (I had a mild fever the first night, but since then nothing) --- just constant back pain and occasional seizing up of my chest cavity, which makes it fucking difficult to do anything at all. The main problem at the moment is that I can't get anyone to give me anything for the pain since I am on Ativan which interacts poorly with painkillers of the sedative variety (see below)

**Background context**

Again, I think what's going on here is pretty minor -- I think I have the flu, which is interacting with this cough and sending me into the land of stabby chest pain. I have a chronic cough going on five years which is also undiagnosed (they're working on it). Chest X-ray + TB test last year came back clean. Pulmonary Function Test this year came back clean. Most recent chest X-ray came back clean. I've met with an ear nose and throat specialist who declared me totally healthy, except for the constant cough and throat clearing. I have a barium swallow scheduled for tomorrow to see if it's GERD, though I may not wind up getting over there if I feel the way I feel today.

I also have "anxiety" which comes with a host of entirely different symptoms, which is what I'm taking the Ativan for. The anxiety attacks have been tapering off recently (thank god) and are of an entirely different variety --- I am seeing both a psychiatrist and a therapist and an on medication and the whole shebang. The panic attacks aren't real -- they're terrifying and overwhelming, yes, but not of the variety that will make you collapse on the sidewalk because you cannot breathe. But I have them. Consequently, I have a lot of doctors who are unwilling to prescribe me anything for pain because of the Ativan. Obviously when you can't breathe it ups your anxiety, but the thing I am more concerned about is that there is real pain in my chest that I can't get diagnosed or treated.

More to the point, I am currently *in* a lot of pain, to the point where I can't drive and can't sleep, which seems to be moving swiftly out of the "ibuprofen and fluids" category of management. At the moment I am resorting to a careful combination of whiskey and Ativan to help me fall asleep at night --- otherwise I'm on the floor, coughing and hurting and awake until three in the morning trying to find a position that doesn't make my chest feel like it's on fire. Yes, I know that's bad, but every doctor I've seen has been unwilling to prescribe a painkiller in spite of being in clear and visible pain *in their office* - so you know, there's that. Like I said, I've been to the ER, been to see my PCP, had a chest X-ray and blood tests and spent last night hanging out with a team of EMT's -- so "GO TO THE HOSPITAL" is not useful advice here. Likewise, please don't yell at me for trying to solve my own problems drug-wise -- like I said, I am in a non-negligible amount of pain.

Any ideas? Anyone had these symptoms and had it turn out to be something totally banal? All that sounds very dramatic, but at this point I've knocked all the scary stuff all the list -- lung cancer, tuberculosis, pneumonia, pleuritis. Now I'm just left with a pair of lungs that hurt a whole lot, a bunch of doctors who are unwilling to prescribe me anything, and the dubious task of figuring out my own drug combinations, which nobody (including me) thinks is a terrifically good idea.
posted by puckish to Health & Fitness (17 answers total) 2 users marked this as a favorite
Are they really really sure it isn't pleuritis? When I had that a few years ago, the symptoms sounded awfully familiar--shortness of breath due to the pain of inhaling, lungs on fire, trying to find a way to lie down without pain. Apparently it doesn't always show up on a normal x-ray, and they will occasionally do x-rays in a different position to try to spot the inflammation.

If the Ativan is the obstacle to getting adequate pain control, could you stop taking the Ativan while you are on a stronger painkiller? I'm not going to yell about self-medicating, but breathing problems plus the combination of Ativan and alcohol seems dangerous.
posted by mittens at 10:11 AM on October 24, 2013 [1 favorite]

(meant to mention, the regimen they had me on was actually non-sedating, just heavy-duty NSAIDs to reduce inflammation.)
posted by mittens at 10:11 AM on October 24, 2013

Is there a reason you haven't had a CAT scan or another diagnostic test? I ended up getting diagnosed (after weird breathing pain, though nothing that bad) with borderline asthma, which was just flaring up in a seriously painful, chest-rending way between environmental conditions and bad interactions with certain inhalers. The CAT scan showed I'd also had pneumonia at some point, which I didn't know, and it at least ruled out the really scary stuff. Have you been to see an actual pulmonologist, or just a GP + ER docs? If you mention something like "can't sleep, breathing hurts too much, medicating with whiskey" you should be able to get an appointment really, really soon.
posted by jetlagaddict at 10:18 AM on October 24, 2013 [2 favorites]

Re your current symptoms, this may be coming from left field, but how current are you on your whooping cough vaccination? They don't last forever, and I wound up getting whooping cough as an adult as a result.
posted by gudrun at 11:02 AM on October 24, 2013 [2 favorites]

puckish, I am curious to know: if you lie on your side, is there any lessening in the severity of the pain you're experiencing?
posted by Poppa Bear at 11:35 AM on October 24, 2013

I am not a doctor and no one, regardless of his or her medical background, can provide you with an internet diagnosis. That being said, there is a quick & easy diagnostic test for influenza. If you are convinced you have influenza, go to an urgent care center or freestanding medical clinic and request the test.

Feel better. Lung pain and shortness of breath can be very frightening and alarming. I hope that you find answers soon.
posted by pecanpies at 11:47 AM on October 24, 2013 [1 favorite]

Also, in regards to this:

At the moment I am resorting to a careful combination of whiskey and Ativan to help me fall asleep at night

There is no safe or careful combination of alcohol and benzos. If you do continue this regimen, please do not add narcotic pain medications to the mix. I know that you are in pain, but alcohol mixed with benzos and narcotics is often a deadly combination. Please call your PCP today and insist on being seen again as quickly as possible. Insist on a referral to a pulmonologist.

Is there anyone who is able to stay with you or drive you to appointments?
posted by pecanpies at 11:57 AM on October 24, 2013 [2 favorites]

Does your prescribing doctor know you're self-medicating with alcohol? If not, tell them that the only way you can cope with the pain is by adding alcohol into the mix - that might change the calculation on what other drugs are best for you to take at the moment (as someone suggests above, maybe Ativan is not the most important thing for you to be taking right now - maybe pain relief is more important).
posted by penguin pie at 1:21 PM on October 24, 2013 [1 favorite]

Yes, coming back to ask if you have seen a pulmonologist specifically, or an allergist?
posted by gudrun at 2:15 PM on October 24, 2013

I'm not sure if this fits with your symptoms exactly, but is it possible you've bruised or strained your rib cage in any way, perhaps during a coughing fit? It certainly can make breathing very painful and can contribute to shortness of breath or dizziness if you're unconsciously breathing more shallow to minimize the muscular pain. Good luck.
posted by aspen1984 at 2:54 PM on October 24, 2013

Response by poster: Thanks all. Some quick responses:

1) Lying flat on my stomach helps, as does lying on the opposite side. Mostly the pain is concentrated on the left side, behind and around the rib cage, so lying away from it helps.

2) I have friends who now driving me places and also a partner who is around pretty much all the time who would notice if I started turning blue.

3) I would also stop taking the atavin if I had a prescription for Vicodin or some other painkiller -- that's probably the next step. It would be nice it it felt like they trusted me to do that --- they don't really have any reason not to, I think it's just standard risk aversion.

3) I haven't yet been to see a pulmonologist for the cough-- so far it's ER, ear nose and throat, and GP - but that's probably the next step. I got the sense that that was off the table since the chest X-rays came back clean.

As far as the general cough goes, my GP has kind of gone from "Yesssss, we're going to get to the bottom of this!' to "uh, I don't really have any other solutions if this next test doesn't work out - so hopefully it'll work out" Which is a little disheartening, but I expect I could probably still see a pulmonologist if I asked. At this point vis a vis the ongoing cough, I'm mostly just tired of going to doctors and having them tell me I'm fine (and instead slowly settling into the notion that I'll just buck up and live with it).

That becomes less feasible, though, if the cough manifests itself as evil terrifying flu. And yes, I should probably go get tested for that too.

Anyway, thanks for the feedback. It's feeling better at the moment, maybe it's just a viral thing.
posted by puckish at 5:30 PM on October 24, 2013

I'm not going to go near trying to give you a diagnosis, but I can make general comments with the caveat that I'm not your doctor.

- Influenza typically manifests with a number of different symptoms. It is not usually just a cough. It's also not yet truly flu season, which makes flu even less likely. However, there are plenty of other viral causes for upper respiratory infections. Bronchitis is more plausible.
- Pleurisy is a clinical diagnosis and is actually a symptom of other diagnoses such as pneumonia etc. Pleurisy is just inflammation of the lining of your lungs. Taking x-rays in different positions might show a pleural effusion (fluid in your lung), which can also be caused by a number of different things such as pneumonia etc.
- Asthma ought to be picked up by the pulmonary function tests (PFTs) which you have already had. A CT scan is not usually done on people who have typical symptoms of upper respiratory infections like fever and cough and chest discomfort for 2 days, only if something more serious is suspected. For the chronic cough of 5 years, a pulmonology referral sounds quite reasonable to inquire about if the barium swallow is clear. Not everything in the lungs can be picked up on a chest x-ray, so the fact that your x-ray was clear does not mean that your lung problem could not be a pulmonary issue.
- Narcotics are not typically used to treat chest pain that happens with respiratory infections. Doesn't matter if you're on Ativan or not, that is not usual protocol (except maybe as part of a codeine type cough syrup!). If you have a broken rib, maybe. There are other non-narcotic options that I think you should be trying before you do something dangerous like combining sedatives, which is not a good idea at all. For example, what about alternating ibuprofen and Tylenol? (be sure you're taking an appropriate dose). What about asking your doctor about a Lidoderm patch? If you approach this as "my biggest problem right now is not having narcotics" you are going to get the side eye from your medical providers. Stop using alcohol to self medicate. Call your doctor and say you are looking for other pain control options, and that you're open to non-narcotic solutions. I'm not yelling at you for trying to solve your pain problem, I'm yelling at you for not trying to solve it in a safe way.
posted by treehorn+bunny at 8:14 PM on October 24, 2013

Just a guess here, but what about Costochondritis? Some of the symptoms are:

The pain usually will be sharp and located on your front chest wall. It may radiate to your back or abdomen and is more common on your left side. The most common sites of pain are your fourth, fifth, and sixth ribs. This pain increases as you move your trunk or take deep breaths. Conversely, it decreases as your movement stops or with quiet breathing.

A friend had this, her symptoms were very similar to yours, it took awhile for her to be diagnosed. She could not lay on her left side and wearing a bra exacerbated the pain.
posted by JujuB at 8:42 PM on October 24, 2013

Response by poster: For the record, I haven't been asking for narcotics --- I've been taking ibuprofen (a lot of it), but it hasn't been particularly helpful. It's frustrating to have obvious difficulty breathing and have the doctor shrug and tell you to take ibuprofen and drink fluids. I know it's not their fault, but it's still frustrating.

Anyway, I'm going back today, so we'll see how it goes.
posted by puckish at 4:22 AM on October 25, 2013

Hey, I *have* had this! For me, it was a combination of acid reflux and a chronic sinus infection causing post nasal drip (and occasionally escalating to bronchitis and/or pneumonia, and then shifting into pleurisy). Years of allergy shots, steroids, antihistamines, acid blockers, TB tests, and CAT scans from my PCP and allergist, and finally, FINALLY my daughter's allergist said, "you know, that wracking cough is probably caused by a sinus infection. Have a z-pack." And I was miraculously cured of years of debilitating illness (seriously, 9 months of the year I couldn't even talk on the phone). At least ten years of being sick 9 months of the year, and I've pretty much been fine since. I keep a close watch on sinus symptoms when I get a cold these days, and if it doesn't go away in a month I ask for antibiotics-- after several years of this, and much improved self care and sinus rinsing, I don't even need antibiotics much any more.* It might be worth mentioning to your doctor, to see if it could be the cause for you, too.

* I am aware of antibiotics abuse problems, and in general I am a sweat-it-out kind of person. But I really learned the hard way that sinus infections are death to my deviated septum, so now I don't wait until I've been hacking up a lung for 6 months to ask for help.
posted by instamatic at 8:25 PM on October 26, 2013 [1 favorite]

I believe I've had something called precordial catch syndrome a few times in my adult life. That the pain lessens when you lie down in certain positions makes me feel fairly confidant that that's what you're experiencing too.

Hopefully, it has passed for you (I don't recall it lasting more than a weekend for me), but this is my guess as to what's happening to you. The short version: it isn't dangerous (as far as I know), there's no way to treat it (as far as I know, but I'd be happy to be wrong), and it goes away by itself. Which is positive and negative.

When I discovered that lying on my side made the pain go away, I put my time in on the couch watching tv, reading, and playing video games until I was okay again. It's what I plan on doing if it ever happens to me again.
posted by Poppa Bear at 5:28 AM on October 29, 2013

Oh, and don't pay attention to the duration component of the wiki article I linked. It's just there to give you a head start on a Google search. I'm at work or else I'd have fished for something more substantial. I have had this sensation for days at a stretch.
posted by Poppa Bear at 5:38 AM on October 29, 2013

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