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Nurse Susan
Nurse Susan, Nurse (RN)
Category: Health
Satisfied Customers: 1084
Experience:  RN, BSN, MSN-ED, Nurse Educator whose passion is helping people understand their health and wellness
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i have been diagnosed with the past month of having bacterial

Customer Question

i have been diagnosed with the past month of having bacterial bronchitis. i was regularly coughing violently to the point of vomiting , wheezing, having severe upper back pain due to coughing, extreme fatigue, and laryngitis. a chest x ray was done showing severe swelling and irritation, but no pneumonia.

to treat it i was placed on Factive (helped significantly but not completely) an inhaler, and a cough suppressant and expectorant. later on i was placed on Levaquin (no perceived improvement) muscinex dm, and ibuprofen.

we also did an upper gi test which showed severe GERD. i am unaware of how long i have had it and left it untreated. and have never had issues previously but could have irritated it significantly (i work for a pizza company and thereby eat lots of pizza). i have been on omeprazole and am currently on the 6 out of 14 day treatment (it states relief of symptoms should occur in 1-4 days)

two weeks pass. i now still have the regular severe coughing fits, and vomiting induced coughing (it has lessened to 4-5 times a day, though still leaving me feeling malnourished) extreme nausea, and swollen sup-mandibular lymph nodes.

i am 18, male, and an otherwise healthy, athletic nonsmoker. i take stratera for my adhd (80 mg) and fish oil pills daily. i have kept taking ibuprofin, and as previously mentioned am taking omeprazole with slowly worsening symptoms and no signs of improvement.

please help
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Owen replied 2 years ago.

Dr. Owen :

Hello, and I am pleased to help, use of my answers are for educational purposes only.

Dr. Owen :

Can you list what medications you are taking right now?

Dr. Owen :

Are you taking any antibiotics besides levaquin?

Customer:

i finished all of the 5 day treatment of levaquin about 2 weeks ago. in my last section i listed all meds i am currently on, none being antibiotics.

Dr. Owen :

so what is bothering you is your coughing and the vomitting, is that what is your question?

Dr. Owen :

And, what medication are you given specifically for cough?

Dr. Owen :

I have to ask - when you work in the pizza place - do YOU make or work with the dough?

Customer:

the coughing is violent and regular. and the vomiting is conjoined with it. so yes those are the primary symptoms bugging me. i have taken varying levels of benzonatate, promethazine, and muscinex dm. none have been helpful except for the dm and that was only mildly effective and felt short term

Customer:

and no i am a delivery driver

Dr. Owen :

Do you even walk through where the flour is?

Dr. Owen :

Have you had a CT scan of the chest?

Customer:

yes it is in the food processing area, i also cut, box and work with the pizza after it is done. i have never had issues with irritants previously though. granted on the genetics term, my mother has severe allergies to MANY things

Dr. Owen :

Have you had an Endoscopy and a Bronchoscopy - to look into the esphagus and bronchus of the lungs?

Customer:

no, only the xray and the UGI. my primary care physician said that would take 3 months or so to set up.

Customer:

i cant handle another 3 months of this :/

Dr. Owen :

3 months to set that up?

Dr. Owen :

do you live in a small area?

Customer:

with seeing a pulmonologist? yes

Customer:

relatively yes

Dr. Owen :

Do you have a way to get to a bigger city - (I'm not sure where you live) - but bigger cities/ suburbs have plenty of doctors that can see you the same day.

Dr. Owen :

And, the reason is that this is going on too long, and a healthy individual should not have this type of problem -

Customer:

i understand. the closest is st. louis.

Dr. Owen :

This could be pulmonary and it sounds like that.

Customer:

explan?

Dr. Owen :

In St Louis there is a large medical center.

Dr. Owen :

Well if you could get seen at this large hospital center you might want to be admitted to the hospital - to get a full evaluation.

Dr. Owen :

This could be something as simple as an allergy to flour - that is why I was asking

Customer:

i already understand that. and i understand it's my lungs. but what though

Customer:

would a simple allergy test be sufficient?

Customer:

i am a college student and money is rather tight

Dr. Owen :

I understand.

Dr. Owen :

Do you have any health insurance through your school?

Dr. Owen :

Usually schools in the US require a group health insurance plan at a minimum?

Customer:

only through the family. but even still it would be significant out of pocket

Dr. Owen :

Well here is my concern - although it could be something as simple as an allergy -

Customer:

it could be worse

Dr. Owen :

This could be something as severe as TB - tuberculosis - unlikely for you to have this if you have not been exposed, if you have not traveled to certain areas - but I am thinking a bit OUTside the box so to speak

Dr. Owen :

And, your cough fits if they are not improving should be more thoroughly evaluated.

Customer:

i understand. no i have stayed within missouri and have not traveled

Dr. Owen :

I understand your primary care doctor is trying to treat it - but you do need to get a pulmonologist involved further -

Dr. Owen :

You need testing such as a Bronchoscopy, you need to get a sputum culture to check for any infections such as bacterial and or fungal infections.

Customer:

understandably.

Dr. Owen :

honestly if I was your parents - I would really try to get you further help.

Dr. Owen :

And, your doctor would be making phones calls to get you seen sooner than 3 months -

Customer:

money is tight for all of us in the family

Dr. Owen :

Personally I think you should be seen within the next 1 to 2 weeks.

Customer:

thats the issue with living in jackson missouri

Dr. Owen :

I know money is tight

Dr. Owen :

Do you have Asthma?

Customer:

no and never had any issues with it

Customer:

no family history either

Dr. Owen :

the medications you are using are expensive and adding up, I know

Dr. Owen :

Let me ask you this - is there a hospital in your town

Customer:

2 of them. st. francis and southeast missouri

Dr. Owen :

Because instead of a family doctor, there are doctors that are called Internal Medicine doctors and you might want to make an appointment with one of those type of doctors

Customer:

what is the differeance?

Customer:

speacialized?

Dr. Owen :

Pulmonologists are actually Internal Medicine doctors - that are then trained for an additional training in the lungs only.

Customer:

ah i understand

Dr. Owen :

A family doctor - is not really trained in any one particular area - that is why they are generalists - and they do a good job, but when you have a problem such as yours, a referral to a specialist should be done- and the closest you can probably get to a Pulmonologist would be an Internal Medicine doctor.

Dr. Owen :

So, there has to be an Internal medicine doctor in your town somewhere - as these doctors have a bit more training for what you might need.

Dr. Owen :

I wish there was something else that I can do for you -

Dr. Owen :

I really do

Customer:

ugh i understand

Dr. Owen :

I wish you the best

Dr. Owen :

sorry I had the rating button off - please only click on it if you click on Great service, thank you

Dr. Owen :

otherwise please do not click on it, I can use the positive rating

Dr. Owen :

thank you

Dr. Owen :

that was a negative rating -

Dr. Owen :

bye

Expert:  Nurse Susan replied 2 years ago.
HelloCustomer

I am writing because my view is somewhat different than the above Expert.
Often, the simplest explanation is the truest one; Occam's Razor certainly suggests it. Please understand though that no one on line can state anything with 100% certainty, all any of us can do is give our best most informed guess based upon what you've written.

The most common reasons for a chronic cough are post nasal drip and GERD.

Its possible that the bronchitis you had left you with a post nasal drip; colds upper respiratory infections can stimulate the production of more mucous. I hesitate to suggest that the GERD is responsible for the cough since you did not have the cough before you had the bronchitis....but anything is possible.

Another explanation comes to my mind. You've had bronchitis, which has irritated your lungs, causing you to cough to clear that irritation. Coughing, however, is an irritant. It is possible you are trapped in a vicious cycle of coughing from which it is very hard to break.

The only confounder here are swollen sub mandibular lymph nodes. Its possible they are still swollen from the bronchitis, but ordinarily those don't swell unless something truly wrong is occurring.

My suggestion is...since this is a dry non productive, useless cough, is to speak to your doctor about serious means of stopping this cough. I am referring to prescription medications containing codeine. I do not know what cough suppressants you used before, but a trial of some serious heavy duty ones may be in order. Its possible once the cycle is broken, it will stop. And if THAT doesn't work after a week or two, then you can proceed to pulumonologists, lung biopsies, other tests to see where this cough comes from.

If you had TB, (tuberculosis) you would have a whole host of other symptoms besides the coughing...fevers, night sweats, weight loss. Additionally, the chest X Ray you had would have seen if you had a case of active TB. I also find the sudden spontaneous development of an allergy to flour only after this bronchitis improbable.

Here is some information on post nasal drip: http://www.webmd.com/allergies/postnasal-drip

Because it was mentioned, information on TB http://www.webmd.com/lung/understanding-tuberculosis-basics

I hope I was able to help,
Sincerely,
Susan
Nurse Susan, Nurse (RN)
Category: Health
Satisfied Customers: 1084
Experience: RN, BSN, MSN-ED, Nurse Educator whose passion is helping people understand their health and wellness
Nurse Susan and 9 other Health Specialists are ready to help you
Customer: replied 2 years ago.
the post nasal drip seems to be a very viable answer. i have irritation in the back of my throat that generally starts to coughing and in turn the vomiting, the two primary symptoms. that seems to be consistent with what your cited information said about it. i have had the thought previously of a cough as an irritant but none of my research showed anything in support so i gave up on that hypothesis. i have only had noticeably swollen lymph nodes for the past 1-2 days. besides codeine, which there is a distinct chance i might be allergic to due to family history, are there other, including natural remedies, supplemental, and simplistic home therapies i could do to fix it?
Expert:  Nurse Susan replied 2 years ago.
Hi Customer,

Often the simplest solution is the truest one. Its said in medicine, hoof beats in the distance most often belong to a horse....though that doesn't mean an occasional zebra might surprise us!

There may be no real research to support it, but coughing by itself can be irritating, if it goes on and on, does nothing, as it is abrasive to muscles and an esophagus that is already stressed from the bronchitis.

Allergic to codeine. Thats a problem; codeine is the most effective for stopping a cough. What I have found soothing for a cough is honey, which may help you.

I cant recommend "natural supplements" because those have not been tested or assessed by the FDA for either safety or efficacy. I did however find a recipe, written by a nurse, which is all natural herbs which are commonly in use already: cayenne pepper, ginger, honey, apple cider vinegar; that link is here: http://www.pitt.edu/~cjm6/sp99cough.html

You can try OTC cough suppressants again, but this time take them regularly; also, you can ask your doctor for an alternative. Medications containing dextromethorphan are cough suppressants; please though consult with your doctor before taking any medication, even OTC ones.

Information about dextromethorphan is here: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000695/

I hope that helped, and I hope you feel better, I do know the discomfort of prolonged useless coughing myself.

Sincerely,
Susan

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