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Dr. Muneeb Ali
Dr. Muneeb Ali, Doctor
Category: Medical
Satisfied Customers: 1354
Experience:  MBBS, MD.Currently working in Critical Care Medicine with 6 year experience in internal medicine
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I have a tight diaphragm, tight throat, and shortness of breath.

Resolved Question:

I have a tight diaphragm, tight throat, and shortness of breath. Not necessarily a pain, more a squeezing sensation. Have been to the doctor several times and was diagnosed with GERD. Took Prevacid and Zantac, both with no results. Have a stressful life, but this is continous (and has been for 2 1/2 months, almost daily). Continues even when I'm relaxed.

Any ideas?
Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Muneeb Ali replied 4 years ago.
Hi,
Im sorry to hear about your symptoms,

Can you tell me have you had any tests done like endoscopy etc?
HAs your heart been checked?
Any swearing alongwith this?
HAve you undergone a barium swallow, 24 hr ph monitoring test?
Are you on conservative measures for GERD? like elevating the head of the bed etc?
Customer: replied 4 years ago.

Have not had endoscopy done.

 

Heart shows a slight arythmia on V3, but its not common or persistant.

 

Any sweating? Or was it really swearing? Sweating, yes occasionally. Swearing, no.

 

No swallow or ph.

 

Nothing else for GERD, as of yet.

Expert:  Dr. Muneeb Ali replied 4 years ago.
Thanks for the additional information,

Sorry it was sweating, not swearing was a typo :), well glad to know there isnt any swearing :).

Anyway coming to the point, well i believe your physician has you on the initial period of GERD treatment in which treatment is tried without any tests BUT that last for 4 - 8 weeks, if the patient doesnt show any signs of improvement then we move onto the next step which is getting the tests that i described done, so here the next step for you should be,

Endoscopy
24 hr ph monitoring test to see if there is an acidic ph in your oesophagus
Barium swallow if needed.

i believe the squeezing sort of pain that youre experiencing is probably due to one of two causes. One is that of oesophageal spasms which can accompany GERD and this can be picked up on ph monitoring and manometry studies which checks the pressure in the oesophagus. This is a common condition which can occur with or even without GERD, this condition is usually initially treated with the same treatment as GERd but if that doesnt work then the next step is to do the tests and then add calcium channel blockers or nitrates to the medication regimen.

Now the other possibilty whcih i must mention here is that of heart conditions, the reason i mention this inspite of your young age is because you mentioned an arrythmia, which may be unspecified, in one of you EKG leads. By itself it is insignificant but in the presence of symptoms like yours and also the fact they are not improving with conventional GERD therapy, this means that the heart MUST be ruled out. the minimum testing which should be done consists of the following,

STress test
24 hour holter monitoring which is essentially a 24 hour EKG via a device which you can wear at home.
Echocardiography

These are tests which should be done in light of the failure of the GERD therapy.

Now another reason for the failure of your GERD therapy can be H.pylori infection which can worsen the symptoms and thus cause oesophageal spasms, this can be checked with the help of Urea breath testing and stool antigen test for h.pylori. This if positive can be treated with antibiotics.

Lastly, im surprised that conservative measures were not advised by your doctor, ill give you some of them to try and ill give you a useful link to read and then implement those strategies,

Raise the head of the bed at night with the help of 3-4 pillows
Eat your last meal 2-3 hours before bedtime
Eliminate smoking and alcohol from your diet
Cut down on your weight if overweight

Here is the link i mentioned,

http://www.mayoclinic.com/health/gerd/DS00967


I would suggest that you discuss these with your doctor and also if prevacid isnt helping ask him to change you to a higher dose or to some other drug like esomeprazole or rabeprazole. Sometimes different drugs can help as well. I hope this helps you

Customer: replied 4 years ago.

Thanks.

 

I don't have health insurance so alot of this will have to be put on hold for the time being.

 

Is there anything I can take to relieve some of the pressure on my diaphragm? It's really uncomfortable not being able to breath.

Expert:  Dr. Muneeb Ali replied 4 years ago.
Well, if youre having trouble breathing then i would strongly urge you to seek medical care, simply because i cant rule out a heart condition online. Trouble breathing and sweating alongwith chest pain,throat pain all are pointing towards a heart problem. this MUST be looked at.

But considering your insurance issues, you can take tylenol which should affect your GERD, also if you take Iburpofen for the pain or Naproxen which are both available OTC, then increase the dose of prevacid to twice daily or zantac to twice daily. But apart from that there arent many options available.Also have a look at the herbal remedies in the site that i gave you which shows licorice and chamomille tea as a treatment option.

I am worried about you in light of the symptoms i mentioned above and i do feel that you should atleast get a clinical exam if not the bare minimum tests like an EKG.

Customer: replied 4 years ago.

I made a visit to the ER on December 1st. The EKG showed 1 arythmic beat in a 5 minute scan, they felt it may have just been caused by stress. If I sit still and check my pulse, nothing changes and its perfectly fine 55-70bpm depending on movement and activity.

 

It's been 2 months, with pretty much just the tight chest and shortness of breath. Not gasping for air, just feels tough to breath. I have no acid regurg., heartburn, or other stomach issues.

 

I'm very active, 165lbs, 6'2". Don't smoke or drink, and never have. No drugs, and I rarely rely on OTC meds (took me a good month to decide to start on the Prevacid treatment). Ran on the cross country team in high school ~15 miles a day up until 3-4 years ago.

 

 

Could it be caused simply by a stressful lifestyle? I own my own landscape business and am consistantly under pressure.

Expert:  Dr. Muneeb Ali replied 4 years ago.
Well since you have had these symptoms consistently for two months, the heart problem has a less likelihood but again a stress test is advisable. Secondly a tight chest and shortness of breath can be symptoms of anxiety as well and considering the stressful lifestyle that you have described, this could be a factor. This is usually treated by ..reducing stress but you would already know that. Biofeedback techniques and if needed anxiolytics for short period of time can be helpful like xanax, clonazepam etc.

If your heart is ruled out, then it is definitely a possiblity that these symptoms are the result of anxiety. Simple way to check if this is the case, take a few days off, relax a bit...if the symptoms improve then you have your answer, but an examination is must.

Dr. Muneeb Ali, Doctor
Category: Medical
Satisfied Customers: 1354
Experience: MBBS, MD.Currently working in Critical Care Medicine with 6 year experience in internal medicine
Dr. Muneeb Ali and 4 other Medical Specialists are ready to help you
Customer: replied 4 years ago.

Thanks for your advice. Easier said than done on the stress reduction, but I'll give it my best.

 

Take care

Expert:  Dr. Muneeb Ali replied 4 years ago.
Youre welcome, i do hope that you feel better

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