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Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS?

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Pulmonologist
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Hey Dr.

So I am starting to feel back to normal. No pains in chest anymore. No feeling of inflammation anymore. No heaviness feeling anymore.

But i do still have restriction in my lungs when i try to take deep breaths. I can take up to ten deep breaths now. But by the tenth one today I started coughing the real dry cough. It was only two weeks ago that I could only take maybe 3 deep breaths. I realized that i am breathing with my stomach still mostly, as my chest is still restricted. I do feel my rib cage move pretty good, so I must be getting some chest expansion.

So is the restriction in my lungs part of RADS still?

Do you think that restriction will go away with time also?

Should the Dr. use one of those little mirrors to look down my throught at least see my trachea?
I guess it is just restrictive in my lower lungs, rear rib cage area.

Do you think this is part of the healing pro
You said siliicosis is possibility. Do you think it is a big possibility?

Thanks
Posted Tue, 25 Jun 2013 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 21 hours later
Hi,
Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following:

1. That you are symptomatically improving is a good sign.

2. Considering your picture RADS is a possibility. Silicosis should not be a big possibility but theorotically can not be ruled out.

3. You are lucky that there was no anatomical or physiological lung damage evidence.

4. Laryngoscopy will not be of any help in your case.

5. The chest tightness should eventually decrease. You are on your way to healing.

6. Remember PFT monitoring at regular intervals.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 2 days later
Hey Dr.

Well I guess i am just worried because I still have that wheeze, whistle thing when I put my chin down and exhale. Maybe it is Stridor, and maybe I should have my epiglottis examined? I also noticed that food seemed to go down the wrong hole a couple times recently.

Its not really my chest that is tight so much as it is my lower lungs, like in the rear. seems to be getting better slowly. Should I be more concerned because it is lower?

Its hard for me to feel lucky about the CT. I keep thinking that it was too soon to show damage?
I guess my chest is still tight also. It is much more noticeable when i lay on my back. It is getting better tho.

Do you know if in acute silicosis, if the lung inflammation is just an initial thing or a chronic? Because I know I felt an intense inflammation initially, but the Dr. says that was no sign of inflammation on the CT six weeks later. I Just wonder what it was? It was so intense. Then a respiratory therapist told me it would be chronic in acute silicosis.
Thanks
 
 
Answered by Dr. Gyanshankar Mishra 4 hours later
Hi,
Thanks for the follow up.
1. Your's won't be acute on chronic silicosis since it requires repeated exposures.

2. If you are getting wheezing episodes then, you need to take your inhalers regularly.

3. If you are having difficulty in swallowing then you should take an ENT specialist opinion/ clinical evaluation and local examination of the same.

4. If you are symptomatically improving then no need of worry. 6 weeks is a good time to see initial changes of silicosis if present.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 47 hours later
hey Dr.

I was just wondering if you know of magneto pnuemography? Is it still being used?

Most of my tightness and feelings of inflammation have gone away, especially in my upper airways. It still feels like my lungs are week and a little dry still. I am afraid they might be damaged so bad and so full of sillica. and they might not heal up. I do also still have a dry nose. I sneezed the other day and I put my hand over my face. A small piece of mucosy blood came out. I think it may have came out of my mouth.

It is still tight in my lower back rib cage. are those still signs of RADS? It seems like RADS is just upper respiratory, and mine got in the lower regions also?

I have a little feelings of breathlessness still but that seems to have gotten better from about a month ago. It seemed like the heaviness in my chest was just weighing down my breath and causing the breathless after some time.

I just do not know what to think. i am getting better in some ways but not sure if the lungs themselves are.

I dunno, I almost just wish my Dr. would diagnose me with acute silicosis and get it over with. It seems inevitable. Even the other Dr on here said he strongly believes I have the symptoms.
i also just tried to jog a little bit. It felt so dry and my lungs felt dry. Not really anything there.
 
 
Answered by Dr. Gyanshankar Mishra 9 hours later
Hi,
Magneto pneumography is an old procedure not employed now a days.
Its nice that you are feeling better. If you had an episode of hemoptysis, you need to visit your doctor, get an xray done.
RADS is airway involvement and is mostly of the lower airways.
A CTscan after 1 year needs to be done.
Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 2 days later
Hey Dr.

I was just wondering if you can tell me why they do not use Magneto pneumagraphy anymore? It seems like it would be helpful in determining risk factors.

They did do a few xrays the last four months now. Maybe the small mucosy blood did come out of my nasal cavity. I am not sure. It was the only time so I will keep an eye out for it again.

Well, I do seem to be healing in a lot of ways. I hope I can heal up ok from this. I know you say one year. I guess I have 8 more months. Maybe a lot of it is in my airways. It is still kind of dull feeling in the center of my chest when I lay on my back. I just had that big inflamation initially. I still wonder what that could have been?

So I had this very heavy exposure, high silca content. Do you still think it is possible that I can heal up and have a normal health? What about other associated diseases? (sclerderma, lupus, renal) Do you think there is a small possiblity?
oh, and why is it sore in my lower back rib cage area? is that lungs or airways? or both...?
Thanks


 
 
Answered by Dr. Gyanshankar Mishra 5 hours later
Hi,
Thanks for the follow up.

1. Its good that you are feeling better. A HRCT scan thorax after a total of 1 year duration is recommended.

2.Today advanced investigations include dlco, hrct scan thorax, mri thorax etc. and hence magneto pneumography is not done as still studies had to confirm its validity on a large scale.

3. With your health improving, I do not think you have any realistic chance of devloping systemic diseases.

4. A ct scan at 1 year will give us a better insight. Lower back soreness could be due to soft tissue , bones on lung parenchyma involvement.


I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 8 minutes later
lung parenchyma? would that have shown on xray one 3 weeks ago? like scarring in there?
paranchymal abnormalities are common in all acute silicosis patients, i read. Is it possible I could have now? or it could be starting? Or maybe it is just sore from all the swelling i had originally.
 
 
Answered by Dr. Gyanshankar Mishra 3 hours later
Hi,
Lung parenchymal association is just a possibility but it should be visible on chest xray however a ct scan at 1 year will be the definite investigation. If it was already present from the start then it is probably residual symptom which should go off. However if it is a new development then further ct should pick it up.

Yes, if parenchymal abnormalities are shown, then it favours silicosis but till now none of tyour investigations have substantiated this.

Having said this there is no difference in management at this stage. You management will remain the same.


I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 9 hours later
ok, I have that appointment for follow up CT in September. That will be about 7 months from time of incident. I wonder if I should keep the appointment or have them reschedule for a little later?

I was so sore and pain and feelings of inflammation in my entire thoracic region in the beginning. I feel better from then. I am hoping it is in my airways mostly, but that might be wishful thinking. I am not sure if the lower back tightness was there originally or became apparent later. I do spend a lot of time laying in bed on my back too, so maybe it is from that. Or from trying to cough it out. I am not sure. '

I did talk to an industrial hygenist that says to not worry quit as much because some of the silca is amorphous and not so bad, and only so much respirable. But the respirable did get me obviously if I had that inflammation.

thanks,

 
 
Answered by Dr. Gyanshankar Mishra 31 minutes later
Hi,
A good time for ct would be after 1 year. In the mean time xray monitoring at regular intervals can be done.
Back pain can be due to coughing, previous chest discomfort as well as posture related but such a back pain should not be of new onset.
Regarding the respirable dust in one of my previous posts I have already said that all silica dust is not of respirable size but some are.
However the most important thing is that your symptoms are resolving and hence you are on you road to recovery.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 1 hour later
Yes, I do remember you saying that. I guess that I did not understand the concept that it was the invisible stuff that is respirable. I did also ask him about crystobolit and tridymite and he said he had only seen crystobolit on one occasion and never seen tridymite. I guess that made me feel a little better.

I am going to try and get back on a low dose of prednisdone this week. Maybe that can help me. My breathing is still funny. that tightness in my back and it just seems like i am really trying to breath. The sides of my throught in my neck move, and my mouth is almost like a gasping. I feel like so much damage was done that I can not heal from this.

I do not know if i can wait until one full year for the next CT. My life is at such a stand still. I am anxious to know what is going on inside of me.
 
 
Answered by Dr. Gyanshankar Mishra 8 hours later
Hi,
The decision to start oral steroids should be in consultation with your treating physician, since you are already on inhaled steroids and oral steroids are not without side effects. But yes they are used for their anti inflammatory process in such cases.

Again the decision of ct scan will also be determined by your symptomatic profile as per the assessment by your physician. Since a 2 year follow up is generally recommended in such cases and hence a ct at 1 year will help but the decision rests on your treating physician.

However regular pft monitoring and if possible dlco monitoring should be done.


I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 15 minutes later
i know i asked you this before a couple times, but it is still so dry and hollow feeling in my airway. How do i get moisture in there again? and could it be all scarred up and without epithelium or something? How can i tell if my airways are all damaged up? The Dr. said it would not be scarred because my pft was fine, but is that true?

I think i told you that a month or so ago i took a shower and after i got out i blew out steam from my lungs a few minutes after i got out of the hot shower. That did not seem normal at all?
it still feels restricted deep when i try and take deep breaths. better then what it was, but still there.

But certain things have went away. the pains near my kidney stopped. that discomfort when i drank hot or cold went away. The dryness when i try and cough is going away and almost gone.

So some things better.
 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
You are symptomatically improving and that is certain.
Even though you feel dry, lungs aren't actually dry and there is always moisture inside.
Pulmonary function test is a very sensitive test to detect early changes in lung function hence they should be monitored at regular intervals.
I hope I have answered your query. I will be glad to answer follow up queries if any.

Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 4 hours later
but pft can detect changes and damage in airways also?

I remember you saying that scarring is our body's way of healing. Does that mean you believe I have airway scarring?

Why did steam stay in my airways for so long and then i was able to blow it out?

 
 
Answered by Dr. Gyanshankar Mishra 59 minutes later
Hi,
PFT picks up both obstructive (airway involvement) and restrictive(parenchymal involvement). It is however more sensistive for airway involvement.
Scarring mainly occurs in the parenchyma.
It is your perception that the steam took out long to be exhaled however if your pft is normal then there is no need of worry.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 3 hours later
ok, I just do not know what to think anymore. It seems like false hope to keep thinking i will heal up from this.

I told you about my breathing. i read that scarring in my respiratory can lead to mechanical ventilation. That is not good.

and now I have sore parenchyma. I wish i could just know one way or another. If i need to plan for end of life care?

Does it still seem like just rads?
 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
You are thinking too far.
Right now end of life care is a very very distant thing. Since you lungs have no demonstrable anatomic or physiologic abnormality.
At most it will lead to some localised fibrotic scar.
Regarding RADS, yes there is a possibility of RADS as also acute silicosis (since there was exposure to silica) but the management is not going to differ.
Mechanical Ventilation will not be required for such acute episode which has passed by.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 34 minutes later
well, if it is acute silicosis then it will not be very distant thing. My chest aches also in the center region when i take a deep breath. do you think that can go away? it has gotten better

I have these moments where it feels as if i am getting better. i just know i inhaled so much of that dust over days, not knowing it was so XXXXXXX and respirable. It does not seem possible that i can heal up and not have bad lung damage.

The dr that i see says he is 99% certain that i will heal up all the way. I just do not think he understand what i went through and how i felt and still feel.
 
 
Answered by Dr. Gyanshankar Mishra 5 minutes later
Hi,
I do think and am very sure considering your history and investigations that you will be pretty alright.
You do not have any demonstrable lung damage so you will heal up pretty soon.
You are getting better and will only get better from here.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 12 hours later
hi,

you mentioned acute silicosis again. do you think i could have now already? I do think I had a traumatic very heavy exposure. But i really am getting better, it seems. the restriction is even better. even from yesterday it feels better.
I do wish i knew what that inflammation feeling was originally? The respiratory therapists said it was like an allergy or aggravation. do you think that could be?

I am probably going to just do the CT in september. I dont think i can wait the full year. maybe i can get xrays after.

 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
There was acute exposure of silica containing dust. There are no demonstrable signs of acute silicosis so you are lucky. An aggravation after the episode is more like RADS- where breathlessness and cough are the symptoms.

September ct thorax should be normal and that should boost your confidence.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 19 hours later
hey Dr.

I just wanted to ask if you thought it would be advantageous for me to take another round of prednisone again?
I did take two rounds, with the last being about six weeks ago, and it seemed to help. I still have some tightness in center of chest and back ribs when i inhale/exhale.

My Dr. did not think i needed so i am considering seeking another opinion. Plus the nurse said that i was talking fine on the phone, so i must not be bad. Is there a correlation between talking on the phone and lung health? They think it is all in my head and do not want to believe my symptoms. it is very disheartening considering everything i am going through.
 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
Steroids have specific indications like deteriorating lung function documented on pft or deteriorating lung shadows on ct scan on xray or a fall in dlco / saturation or increased symptoms. Since you are not having any of these steroids are actually not indicated and do remember frequent courses of steroids are not without side effects. The final decision will be of your treating physician.

Talking does give a rough estimate of your lung functions. If you do not have to interrupt in between sentences due to breathlessness then generally your lung functions should not be severely decreased.

I suppose waiting for ct results with regular current medications and chest physiotherapy should help.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 15 hours later
deteriorating lung shadows? That is another sign of acute siicosis....It seems like everyone believes that is my prognosis, but not saying it.
I just want to know if i will live or die soon. or heal up and have a normal life ever again. i dont understand why no one can tell me.

It seems like half the people tell me i should heal up still and the other half tell me I should be concerned.

what about the lung inflammation I felt initially. What was it? If it was acute silicosis would the inflammation have continued or gone away?

And even if I do not have it now, Is it possible that I can not get it with this very heavy exposure?
 
 
Answered by Dr. Gyanshankar Mishra 3 hours later
Hi,
Deteriorating lung shadows is a poor prognostic sign. It may be a sign of silicosis. You do not have this till now.

You are not going to die due to this aliment in near future considering your concerns.

Lung inflammation heals with time if the lesion is limited in the initial stage.

Yes even after heavy exposure it is possible not to be affected.



Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologis
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 3 hours later


It seems like the remaining tightness is in my bronchi still. Do you think the dust is all cleared out of lungs and bronchi by now? is it just the after inflammation?

I am just wondering if i should keep eating all this jaggery sugar still? I am afraid we might protect our lungs with it but end up with type 2 diabetes.

Is there still healing up until the end of one year? I am hoping its just RADS still.

That RADS was your first instinct and I hope you were correct. It is hard to believe it could be RADS with it being silica, but you are the Dr. and i want to believe you.

Also, does the silica cause major scarring and prolonged inflammation in the airwarys? i just hope it can heal up and I not have copd or chronic bronchitis?

Should I be concerned about the tightness in my back? It might be from the coughing. I keep trying to cough and see if anything is coming out. I cant help it. I know I have to stop.

The food going down the wrong hole seems to have stopped. I have an appointment with an ENT on Friday anyways. I do still have that whistle noise in my upper airway and I just want to get checked out by them.


Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 1 hour later
it is still tight in my whole thoracic also. Im so tired of this. I wish these symptoms would subside faster. Maybe I need to ask the Dr in person for more prednisone.
It seems like there is pain sometimes when i breath in my main upper airway? can that go away with time? I feel like im in rough shape. I cant believe thie pretty much all hit me at once.
I still have that dry like a shallower breathing too.
I wanna think i am getting better. When I am standing up and walking around I feel much better then lying.
 
 
Answered by Dr. Gyanshankar Mishra 11 minutes later
Hi,
Your current symptoms seem to be residual effect of initial inflammatory changes. They will resolve slowly. Please do not over eat jaggery, its not a proven therapy. Its good you got an ENT appointment.
Please do not try to cough if its not coming out.
The effect of silica on airways depends on dose and duration of its exposure. Your duration was short and the dose did not cause any detectable abnormality.
You need not worry as there was no detectable anatomical or physiological damage to your lungs.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 10 hours later
Hey Dr,

I just realized short time ago, that I can request a phone call from you?

Would sometime in your morning work? anytime is fine by me.

I have a cell phone 608 514 5579. or skype# 608 448 3530 or skype name justinkuehl if you can skype?
 
 
Answered by Dr. Gyanshankar Mishra 43 hours later
Hi,
The telephone consultation is available on this site. You can contact the administrators of the website and they can arrange a telephonic conversation between us.
Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 22 hours later
Hey Dr.

I had my ENT appointment yesterday. They said everything looks fine, except some minor irritation which will heal.
I almost should get the video and have a Dr. on here look at it. Can you, or should it be an ENT Dr.?

Other then that, I seem to be turning another corner for the better. A little tightness in my upper chest and still a small amount of general restriction when i lay on my back.

I still feel some shallow breathing. Should that resolve with time? And it that my heart?

Thanks
 
 
Answered by Dr. Gyanshankar Mishra 4 hours later
Hi,
An ENT opinion will be better regarding the video of examination above the vocal cords.
You are symptomatically improving and it will resolve with time. Your heart should be fine. There is no evidence either clinically or investigation wise to suggest heart involvement.
Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 3 hours later
Hey Dr.

I hope you are right. It seems like one hour i am feeling better and then my breathing and everything is just in pain. Do you think i should try and find another hospital? i dont know if i need more oral steroids or pain meds?

i want to keep believing you that this will heal with time. I just cant believe there is no damage showing but I am suffering so much this whole time.

Do you think it is inflammation that will resolve or permanent scarring? I was always asking about the epithelium. It seems like that would be it because it does not show on CT, but could be causing my symptoms?
Maybe I should be taking an over the counter anti inflammatory? Could that help, or harm? I never really thought of it this whole time, but I need something for the pain.

The ENT dr said i have been biting my cheeks, and i didnt even realize it.

I hope is just residual effects of the inflammation like you said. There is still a lot of achy and pain and some restriction when i try and breath deep.
So you always thought RADS and six months to one year. What happens during that time? The body continues to heal during for a whole year? It just seem like whatever healing it could do in my case what have been done already?
You know my history and my ongoing symptoms and everything. Do you really think September CT will be good, with one local lesion at most?

It is just that I unknowingly put myself through this traumatic event. Now I want to have glimmers of hope that I am going to be clinically ok and possibly recover.

I asked you earlier about copd or chronic bronchitis. Do you think those are a possibility?
 
 
Answered by Dr. Gyanshankar Mishra 5 hours later
Hi,
6 months to1 year is the expected time of healing in such cases.
Healing is not a static but dynamic and ongoing process and it continues till completion.
Septmber ct should reveal the localised fibrotic scar seen in the previous ct.
You are at a risk of COPD due to your previous smoking status and not due to the recent acute inhalational exposure.
Regards
Dr. Mishra
Above answer was peer-reviewed by
 
Follow-up: Having restriction in the lungs while breathing, no pain in chest. Is this due to RADS? 59 minutes later
HI,

That makes sense about the healing time.

Do you think I could have copd now, or risk in the future?

Actually then i realized recently that it was 8 weeks, and not 6 from the time i left the house to the time i got the CT. So thats a little better in my favor.

Well, thank you again for everything. I am sorry to keep bothering you all the time. I guess i am just not good at being sick. I have never been my whole life. that is why it is harder for me to accept, and why i was so foolish and not think it could happen to me. I kept wanting to leave and my gf did not want to check into a motel. then she kept leaving anyways and here me and my dog are the ones that got sick. everything just happened so fast and everyone told me not to worry. its all so surreal now looking back.
But i think you are correct about all this. you are probably the best pulmonologist, and probably see a lot of things, especially in india. my case is pretty unique tho. maybe just people that live in sandstorms and volcanoes can maybe compare. or the people that lived near wtc in new york.

 
 
Answered by Dr. Gyanshankar Mishra 53 minutes later
Hi,
As per the current symptoms and investigation results , you are currently not suffering from COPD but your previous smoking history places you at a risk of COPD especially in old age.
Your current symptoms are healing and that's good.
Best of luck for the CT. Please do not wprry.
Regards
Dr. Gyan Mishra
Above answer was peer-reviewed by
 
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