Suggest treatment for mild persistent cough with history of heart disease

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Posted on Thu, 11 Sep 2014 in Ear, Nose and Throat Problems
Question: My wife has this mild cough for over a year. started as a sore throat, then cough comes and goes over a course of a year or so. now it is back, but still mild, like once or twice a day. no other serious symptoms. occasional back pains, but good kind of sore that goes away. she has appetite, in good shape. she does have sleeping problems. is this serious? I know she should get a chest x-ray, but should I worry?

she doesn't smoke, comes from a family of non-smokers. she did tried one cigarette only once about 18 years ago. I used to smoke but stopped only a few months right after I met her, which was 18 years ago. she also had nasal polyps but was fixed. She also has problem hearing from her right ear.
doctor
Answered by Dr. Sumit Bhatti 2 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for your query.

1. The following investigations are advised:
a. A throat examination and a Video-Laryngoscopy to check for signs of granular pharyngitis, lingual tonsil hypertrophy, post nasal drip, acid reflux, chronic laryngitis which are some of the common reasons for a nagging cough.
b. A blood test to rule out eosinophilia. A hemogram and ESR test are recommended. A high ESR will denote a chronic allergy or infection.
c. A Chest X-ray
d. Lung (Pulmonary) Function Tests since she has a history of nasal polyps. Samter's Triad consists of nasal polyps, asthma and aspirin hypersensitivity. This must be ruled out.
e. A nasal endoscopy / Sinus CT Scan.

2. Tobacco smoke does not seem to be an issue here. Is there any history of anti-hypertensive medication?

3. You may upload the results here for further treatment options.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 23 minutes later
is she at risk of lung cancer? throat cancer? There is no history of anti-hypersensitive medication. She is allergic to shrimp, so she does not eat them. Also, she has a heart condition, diastolic dysfunction. She is on a low-salt, vegetarian diet, which helps a lot. She is scheduled for a chest x-ray, but I am worried sick.

She said that her cough is sometimes dry, but feels like there is fluid in her lungs. sometimes she has clear phlegm, but not much. She has energy. She breathes fine, no chest pain. She gets breathless when she exerts too much, but hardly. When she goes hiking, she is fine, no problem. When she exercises, she is fine.

she tells me that she only notices that she is coughing when I tell her. slight ticklish feeling. coughs only a few times a day, lasting at most 5 seconds each time.
doctor
Answered by Dr. Sumit Bhatti 5 minutes later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. No, she is not at risk for cancer. Lung or throat cancers are rare in non-smokers and unlikely to remain dormant for over a year. Symptoms of cancer are progressive and do not wax and wane.

2. As per your description of her health, there seems to be no cause for worry.

3. Just get the above tests as a routine screening.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 18 minutes later
Thank you Dr. Bhatti, I appreciate this greatly. Please allow me to describe this in detail:

About three years ago, she went to doctor for heart palpitation, found out she has diastolic dysfunction. She was feeling tired a lot, breathlessness and some slight chest pain. She started eating carefully and purposely lost some weight. It has helped a great deal.

Then about a year and a half ago, she went for a checkup for sore throat/coughing. Doctor prescribed antibiotics and it stopped for a while and she recovered.

Then about six months ago, her cough came back, so we went back to the doctor, who checked her breathing but she was fine. We mainly checked for her heart. we were not thinking about her lungs.

She went on a low-salt vegetarian diet and she said it has helped her feel much better. She was also talking vitamins (c and cq-10). Her cough went away.

Now, just recently, the cough came back. ALL THIS TIME, HER COUGH HAS BEEN VERY MILD, a few times a day with dry cough or cough white some clear phlegm. There has been no progression so far, all this time.

Is she still at risk of lung cancer/throat cancer? Is it her heart getting worse?

I may have repeated a few questions, I am sorry and it won't happen again. Thank you.

or is she developing cancer or more heart problems?
doctor
Answered by Dr. Sumit Bhatti 8 minutes later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for detailed reply.

1. She does not seem to be at risk for cancer. The above investigations will help rule that out conclusively.

2. An ECG, a 2D Echo study and a stress test will help check her cardiac status.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 8 minutes later
After my last detailed reply, does it change your mind about her risk of having cancer? Your first answer was "there is no risk." Now she "seems to be not at risk."

Should I worry? She has a chest x-ray coming up but I am so worried!
doctor
Answered by Dr. Sumit Bhatti 23 hours later
Brief Answer:
There is no cause for worry.

Detailed Answer:
Hi,

Thank you for writing back.

1. No, she is not at risk for cancer.

2. A normal set of test results as listed above will conclusively rule out any risk of cancer.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2593 Questions

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