Doctors Lounge - Chest Answers
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Forum Name: Chest symptoms
Question: coughing for 9 weeks+
|cheftitan - Fri Sep 30, 2005 3:28 pm|
I am a 33 y/o f with Copd and chronic Phumonia, bronchitis and sinus and allergies. I have HTN , DM II (non insulin dep), PCOS. I have been on 6 anti-biotics and 6 different cough meds and 2 dose's of methleprednisone and 1 dose of medrol , all with no relief.
I recently went for a chest x-ray due to left side rib pain after a coughing attack. Dr. suspected a broken rib. none found. But did find a lump on my rigth para trachial area.
i was then sent for a CT scan with Iodine. that showed 3 lymphnodes swollen to 11 mm and a portocaval lypmphdenopathy measuring 1.5x2.0 cm. As well as smaller mediastinal lymph nodes which in addition to medistinal fat and prominent azygos vein, and fatty infiltration of the liver.
I was sent to a pulmonogist who sent me for the following labs.
IgG1 results.. 562
C3 186 HIGH ?normal 75-135
C4 36 ?normal13-75
IGA 293 ?normal 100-400
IGM 87 ?normal 45-250
IGE 598 High
IGG total 1017 ?normal 560-1800
angiotensial converting enzyme (not back yet)
I have looked up most of the results on line.. and the IGE is HIGH but I cannot find normal values for the IGG1,2,3,4 or the CH50.
can some one let me know about the others so that I can find out if this a finding of Sarcodosis, Cancer or Jobs syndrome.. which is what i was told is a strong possibility. allso if you could tell me what the Pawn Brokers symbol is .. three spots in a triangular shape? something to do with the cat scan as well.
thank s :?
|Theresa Jones, RN - Sun Oct 02, 2005 7:25 am|
Lab values may vary from one lab to another. According to the research I have found from Specialty Laboratories, here are the following reference ranges:
>18 years old
IgG1 344-966 mg/dL
IgG2 133-622 mg/dL
IgG3 12-138 mg/dL
IgG4 1-115 mg/dL
IgG Total >14 years 600-1600
CH50 22-60 U/mL
Have there been any mention of any other diagnostics, bronchoscopy etc.?
As for your question regarding "Pawn Brokers Symbol" I will defer this to an answer from one of the physician's on the forum.
|Dr. J. Jennings - Sun Oct 02, 2005 1:49 pm|
I am not sure why the doctor ordered all of those Ig tests; a high IgE ocurs in people with asthma (sometimes) or allergy to cetain fungus (i.e. aspergillus). In the latter, a high-reolution CT should be done to look for bronchiectasis. A sputum sample or even a bronchoscopy may be needed to further diagosis this. These test though, have very little to do with the adnopathy seen on the CT scan. Those nodes may be from an infection (perhaps causing the cough), sarcoidosis is a possibility, and cancer. The nodes are not very big, so a biopsy may not be feasible. One option would be to repeat the CT in 3 months. If the nodes are bigger, they need to be biopsied. If they are smaller, it would suggest an infectious cause.
|Dr. A. De la Guerra - Mon Oct 03, 2005 7:27 pm|
Hi cheftitan, I agree with drj about bronchoscopy (with bronchoalveolar lavage) and with the probable causes of lymph node enlargement.
When infection is not a diagnostic option, in 70% of bilateral mediastinal lymph node enlargement the underlying cause is sarcoidosis.
Regarding your question about pawnbrokers sign: the combination of right paratracheal and bilateral hilar lymph node enlargement is often considered a reliable sign of sarcoidosis and has been called “1-2-3 sign” or “pawnbroker’s sign”.
|cheftitan - Wed Oct 05, 2005 11:29 pm|
I am going to one of the doc's who ordered 1 of these test in the am (10-6-05). I did have a sputum test done. Here are the results:
Day 1 Gram Stain Evening Sputum
1. Abundant Epithelial Cells
2. Moderate White Blood Cells
3. Moderate Gram Positive Cocci in Chains Gram Positive Cocci in Clusters
4. Few Gram Negative Diplococci
1. Moderate mixed normal Oropharyngeal Flora Present
Day 2 Morning Sputum
1. Abundant Epithelial Cell
2. Moderate white blood cells
3. Abundant gram positive cocci in Clusters gram positive in chains
1. Abundant mixed normal Oropharyngeal Flora Present
I also have the results of the Angiotensin Converting Enzyme Serum
ACE 406 range 9-67 U/L
The only thing that I have been told so far is that i have 2 signs of sarcoirdosis
right paratracheal and 1 of the hilar lymph nodes. A friend of mine is a pathologist and he is the one pushing for all of these tests to be run. I just want to know if there are any others besides the brochoscope or bronchial lavage. I am still coughing just as hard and as frequent. Now I am just tired all the time.. my mom and husband say that it is because I am using all my energy up coughing.
Thanks for all your help. I will keep intouch and let you all know what happens next!!
Keeping my fingers crossed that some one can figure this out soon.
|cheftitan - Thu Oct 06, 2005 12:03 am|
My mom is here with me and wanted me to let you know that I have also been tested for cushings disease and had a nasal swab for pertusis (negative).
And give a list of my meds.
Singuliar 10 mg. Avandia 4mg. HCTZ 50 mg. Avapro 150mg., Zyrtex 10 mg.
Astelin 2x per day, Pulmicort 2x per day, Intal inhaler 2 puffs every 8 hours PRN,
Spiriva 1x in AM, Protonix 40mg 1x per day for 1 week once per month.
One a day women's formula. and PRN for the following Albuterol inhaler and nebulizer,
darvocet for pain and Naproxen Sodium for swelling in my joints. I have arthritis of the knee hip and shoulder. I have had 2 surg's on my knee due to it buckeling all the time.
I also have "boils" on my skin.. that i have been told is a sigh of being allergic to staff and was given topical cream called bactroban ( it first started in 1997 and i still get it .. some times i have 1 other times like now i have 5 in random places on my body)
All of these meds have been the same for at least the last year, some for over 5 years, the only thing new is the intal, sprivia, and the Avapro.( I was on Altace for 5 years and the doc thought that might of been causing the cough.)
My mom also wants you to know that I have severe Med and Food allergies plus hayfever and indoor and outdoor allergies as well. I have been sick since I was a child. I had a heart murmor at birth and by 6 months old it was gone. I was born Blue and at 3 months old had scarlitina. Many upper respritory infections, tonsilitis, chicken pox 3 times (twice as a child and 1 time as an adult.)
I had athsma all my life and when I turned 30 my Pulmonologist said that it is now considered COPD??? don't know y but ok.
Since the coughing started I have.. VESELVEGAED 3 times while in the bathroom.. started coughing soooo hard while going that i passed out and when i came to my hubby and mom said i was pastey white and sweating profusly. but since on the protonix i have not done it again.. (good thing.. it was scarry)
Is there any med on my list that after prolonged usage could cause the coughing?
Should I have my throid checked as well?
Can you have 2 out of the 3 signs of Sarcodosis and all the other symptoms and not have it?
Again thank you.. I appreciate all the help and you have gave me alot to ask the doc's as i go to see them that i would not of known to ask.
|Dr. A. De la Guerra - Sun Oct 09, 2005 12:19 am|
Hi again cheftitan. You have a lot of information there. I will try to deal with it in a chronological order.
First, about your heart murmur, it is thought that around half of all babies and young children have innocent heart murmurs. These murmurs are called 'innocent' because they are not linked to any type of disease or structural abnormality. In most cases, the murmur will resolve by adolescence, and your’s disappeared in 6 months. You don’t have to worry about it.
Second, you have PCOS, and most women with PCOS have varying degrees of insulin resistance. Insulin resistance tends to be more pronounced in those who are overweighed and do not ovulate. These conditions put those with PCOS at a higher risk of developing type 2 diabetes and cardiovascular disease. That will explain your DM II and HTN, both being well treated by your doctors. They also tested for Cushing's syndrome because it can be confused sometimes with PCOS. About having your thyroid checked, yes I think you have to, because some who have PCOS are also hypothyroid, and also thyroid hormone modulates ACE activity, and you have high levels of ACE.
Third, about your allergies. When a person has a history of many kinds of allergies (med, food, pollen), doctors call them “atopic patients”. This condition is based on allergic predisposition by family history and is associated with allergic rhinitis, atopic dermatitis (allergic dermatitis), asthma and food allergy with IgE increased. These allergies can be controlled with medicine and diet.
Fourth, about COPD, if your doctor confirmed it by pulmonary function testing (spirometry, postbronchodilator spirometry, lung volumes, and diffusion capacity), there is no reason to doubt. Risk factors for COPD, among others, are also a past medical history of asthma, allergies and sinusitis. A recent study shows that adults with asthma are 12 times more likely to develop COPD than those who do not have the condition.
Don’t worry, I will answer you about the sputum test and sarcoidosis in a couple of hours.
|Dr. A. De la Guerra - Sun Oct 09, 2005 1:57 am|
Hi cheftitan I’m back. About your sputum results, there is nothing special, I suppose it was ordered to rule out TB (mimics sarcoidosis). Your ACE levels are very high. Also you have an abnormal CT scan, with findings consistent with sarcoidosis involvement of the mediastinal nodes. If ACE levels are high, other diseases have been ruled out, but if you have clinical findings consistent with sarcoidosis, then it is likely that you have an active case of sarcoidosis.
But is not easy to confirm a diagnosis of sarcoidosis; a biopsy is necessary. I think you may need a bronchoscopy with a bronchoalveolar lavage (BAL) and also a transbronchial biopsy of the lymph nodes. Ask your doctor about available tests that can be done with the BAL sample. I’m a little concern about your skin lesions. Cutaneous involvement is seen in 25% of patients with sarcoidosis; your doctor can tell if those skin lesions are likely to be a sarcoidosis manifestations, and maybe take a biopsy of one of them.
Hope you find this information useful.
|cheftitan - Sun Oct 09, 2005 2:09 am|
Thanks Dr. T... I am going to the pulmonologist Mon in AM and I am going to ask him all the questions that u have mentioned. I appreciate all the help and I can't wait to stop coughing.. I hope soon. I will let everyone know mon PM what happened... Again thanks bunches !!!!!!!!
|Dr. A. De la Guerra - Mon Oct 10, 2005 10:22 pm|
You are welcome cheftitan, I will be waiting for your results.
|cheftitan - Tue Oct 11, 2005 2:52 pm|
Well.. I saw the pulmonologist and I am having a Brocoscopy W/ Lavage and he is going to attempt a biopsy as well .. All on Friday.. He said that i am going to be in some pain and due to my horrible gag reflex he is going through my nose..
tell ya more later
|Dr. A. De la Guerra - Tue Oct 11, 2005 5:26 pm|
I'm glad things are going in the right direction. Don't worry, bronchoscopy is a safe procedure and complications are relatively infrequent and most often minor. Also, insertion of bronchoscope through the nose is better tolerated by patients; before the bronchoscope is inserted, your nose and the back of your throat will be numbed with a local anesthetic to prevent pain, coughing and gagging during the procedure.
The best you can do during the test is to relax, it will be done in a few minutes.
|cheftitan - Wed Nov 30, 2005 2:02 pm|
I am not any better than before. Sorry I have not be able to respond in a while. I have been in Michigan and in Wash. State, for family funerals. Just returned. I am now wondering if it is something in PA or my house that is making me cough. I left on the 15th and returned last night. While I was gone there was minimal coughing except when extremly upset or tired, and no allergy symptoms, since i have been home (about 12 hours.) I have coughed non stop and can't catch my breath again. It is much more humid here in Pa then in MI or WAsh.
There was no biopys on the brochoscope. was told by doc that lymphode was too small now and to wait 3-6 months and repeat?
3 days later I had endoscopy no signifacant findings. Raw voicebox and raw windpipe.
Changed allergy meds to Tavist. Still searching for a cure or diagnosis.
The Brochoscopy HURT and Was Painful as well as I got a feeling of drowning. was givin 5units of Verset.. and was still gaging and chouging. Not something i want to do ever again!! sorry.
The pathologist and my mother talked after the brochial lavage.. apparently i have the cleanest lung fluid he has ever seen in someone sick. he did say that the pictures show alot of irratation. go figure.
thanks again wendy
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