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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Medical
Satisfied Customers: 193
Experience:  28 years of excellence in delivery of internal medicine/family practice care and service.
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shortness of breath, extreme fatigue, fluid retention, abdominal

Customer Question

shortness of breath, extreme fatigue, fluid retention, abdominal distention with pain, low blood pressure, all routine blood test results normal, ECG's normal, trop T normal
Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Frank replied 4 years ago.
Chat Conversation Started
Dr. Frank :

Dear client,

Dr. Frank :

Have you received any correspondence from me? I switched to the Q&A format because I have a lot of question to ask you and I keep losing my responses about two thirds of the way through.

Dr. Frank :

Please let me know so I can report this to a moderator. I am very worried about you!

Dr. Frank :

Dr. Frank MD

Dr. Frank :

I will try my best to do this in this format although I find it more difficult.

Dr. Frank :

a) How long ago was the first episode? Did it come on abruptly or did these symptoms come on slowly over days?

Dr. Frank :

b) When you had the ECHO was it a stress or rest ECHO?

Dr. Frank :

c) Do you have actual distension of you abdomen?

Dr. Frank :

d) Have you ever had a Pulmonary Embolus (blood clot to your lungs...I am very worried about this possibility.

Dr. Frank :

e) Is there any family history of similar events?

Dr. Frank :

f) When you had the nuclear study was it adenosine/sestamibi or something else?

Dr. Frank :

g) Have you experienced any discomfort in your chest, neck or arms. Even any tightening sensations or choking other than the coughing?

Dr. Frank :

h) Have you been on an airplane lately where you would have been sitting for a long time?

Dr. Frank :

i) Did you have a doppler scan of your legs for occult clots? Or have you had a pulmonary angiogram...to rule out blood clots?

Dr. Frank :

h) Ascites is fluid in the abdominal cavity. It can occur as one becomes fluid overloaded. Do you feel this could be a possiblity?

Dr. Frank :

I'll wait for you to respond to some of my many questions now. Sorry about that.

Dr. Frank :

Dr. Frank MD

Customer :

A) Mid July 2010 I had two episodes of SOB accompanied by sudden hot flush on route to work by car both times stopped driving sat in cool air listening to radio at side of road and after about 7 minutes was able to drive on to work. Both times on arrival I was extremely SOB but recovered without treatment within 15 minutes. Initially presented with lower extremeties oedema which I saw the GP for, it was height of summer and he thought the heat was the source of the problem and treated me with 40mg Frusomide daily which helped but clearly did not resolve the problem.The 3rd episode was 19th July I went on duty for 0800 and was extremely sob went to A&E was seen and found to be in Pulm oedema, which was evidenced on Xray. After 80 mg IV infusion Frusemide I was discharged home on Rx 80mg Frusemide bd/

Customer :

.B) rest echo

Customer :

b)rest echo

Customer :

c)Yes , it feels like I have winds in my abdomen which goes round into my mid back region . It feels like if I could prick it like a balloon I would deflate.

Customer :

D) I have never had a pulm embolus but have been reassured by cardiologist it is unlikely as my saturations were never below 97% even on air despite my being severely sob. A GP friend suggested it could be micro emboli causing the problem.

Customer :

e) no

Customer :

f) the stress test was not drug induced but done with stationary bike riding, interestingly even though I was physically battling to breath and felt exhausted during the stress test they battled to get my heart rate up to optimum despite exercising me for over 30 minutes.

Customer :

g) One episode of chest tightness after losing my temper( the worst I ever had) very stressed at time, had ECG which showed no changes, once again although sob at time did not require any specific Rx. No sensation of choking but appear it is now normal for me to sleep 5 -6 hours when I spontaneously waken no matter how tired I was when I went to bed. In the beginning of this illness I could not stay awake all day and would sleep most of he day away but still sleep through the night.

Customer :

h) I have not travelled or in any way been immobile for any length of time. I drive myself in a car.

Customer :

i) Have not had a doppler scan of legs or a pulmonary angiogram. The cardiologist has told me that if the cardiac scan does not show anything he will order an cardiac angiogram / and investigate possibility of pulm hypertension.

Customer :

h) Ascites; I imagine this making you feel heavy in the abdomen as opposed to bloated and therefore light as if I am air filled like a balloon. Initially about 2 weeks ago I had a focused tearing pain just of centre on the left side of abdomen 1 cm above the umbilicus, saw GP he told me it was a fat nodule gave me an anti inflammatory cream to treat this. Needless to say this has not helped. I am wondering if it could be a renal or endocrine problem I am being confronted with?

Dr. Frank :

Dear ma'am I will tell you how I would handle this problem if you were here in the US.

Customer :

My family medical Hx is riddles with cancer deaths on both paternal and maternal sides of family. Maternal grandfather sufffered from emphysema as does my mother ( she also has asbestosis from living on an asbestos mine which is where I grew up.

Dr. Frank :

My first concern is that which could kill you. That would obviously be a pulmonary embolus. Many people throw these off over time. It is extremely difficult to diagnose unless you think about it...so I would be admitting you to a hospital a rule that one out first.

Customer :

My father died from an MI age 77.

Dr. Frank :

Your cardiologist is partly right. You could be having "silent ischemia" intermittently or what is known as crescendo angina. So many people, including me, do not feel their angina.

Dr. Frank :

In addition, it is possible that you could be having intermittent arrythmias such as atrial fibrillation. This will make you weak and SOB and cause marked fatigue. You would need continuous ECG recording to see this (i.e. King of Hearts study).

Dr. Frank :

If you were having pulmonary emboli this will cause pulmonary hypertension and back up fluid into the distal parts of the body.

Dr. Frank :

Please see you doctor (cardiologist). Ask him for a pulmonary angiogram so we don't suddenly lose you to something that is treatable.

Dr. Frank :

I hate to be so matter-of-fact but you worry me!

Dr. Frank :

God watch over you.

Dr. Frank :

Dr. Frank MD

Customer :

my pulse is steady as a rock 70 to 80 seldom have palpitations or any other arrythmias even at my worst. It worries me that my pulse did not go up on exercise as it normally would when I exersise at my gym, why would this happen? Lack of adrenaline or something.

Dr. Frank :

Yes, I agree, this worries me also. This would almost always be cardiac in nature. I am curious as to if you had your O2 sat. tested during this stress test? In any event, the only way to rule out pulmonary emboli is to have an angiogram. If I can be of further help please do not hesitate to call on me. Please let me know how you are and what happens once you get a definitive dx.

Dr. Frank :

Dr. Frank MD

Customer :

Tx I want to investigate some other ideas all I really want is to be well and able to carry on with my nursing

Dr. Frank :

I wish you the best outcome so you can continue with your nursing. Dr. Frank MD Thank you for this interchange.

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Dr. Frank
Dr. Frank
Sabbatical for continuing education
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28 years of excellence in delivery of internal medicine/family practice care and service.