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What causes cough, green phlegm and high heart beat with elevated WBC count?

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Posted on Mon, 25 May 2015
Question: I have been sick for almost 8 weeks with a cough, often with green phlegm, feeling weak, no fever, heart rate about 15-20 beats higher than normal, little appetite (I've lost 15 pounds, which is the only good thing from this). I've seen 2 Army PAs and 2 Army doctors, have had 2 chest x-rays, chest and nasal passages CT scans and an EKG, all apparently normal, 5 blood tests, all with above normal white blood cell count (21,000 was the last one), and a urinalysis that I have not heard the result of. On all visits my vitals were normal except my oxygen level was always between 94 and 96%. I've been through 2 rounds of antibotics, various cough medicines including one with codine, a week of Zyrtec and Nexium. None of these have worked to improve my condition. The Army doctors do not know what is wrong with me and I have asked for a referral to an outside doctor or allergist. Do I have Bronchitis, or what? Thanks for any help.
doctor
Answered by Dr. Parin N. Parmar (33 minutes later)
Brief Answer:
Please provide more details

Detailed Answer:
Hello Mr XXXXXXX

Thank you for asking at HCM.

I went through your history and would like to know more about you as follows:

a. I would like to confirm that did you not have fever at all? even at beginning of illness? Was it measured? Did you take any medicine for fever during the illness?

b. Do you have symptoms like headache, facial heaviness, fullness in ear, etc?

c. What are your nose symptoms - running nose, nose congestion, itching in nose, sneezing, etc?

d. What are your throat symptoms - apart from cough, throat pain, difficulty in swallowing, continuous mucous running from nose to throat, repeated need to clear throat, etc?

e. What are your chest symptoms - fast breathing, difficulty in breathing, wheezing (whistle-like sound from chest), etc?

f. Do you have any digestion related symptoms - feeling sour fluid in mouth after meals, nausea, vomiting, gastritis, constipation, etc?

g. What is the amount of green expectoration - too much or bringing out with difficulty? Was it white initially? Any change over period?

h. Do you tend to have repeated cough-colds? Do you have any known allergies? Or this is the first episode of coughing? How has been your past medical history?

i. What is your weight?

j. Do you smoke? Are you routinely exposed to smokes/airpollution/dusts/fumes, etc?

Above details would help me to know more about your complaints and therefore to make suggestions for you more specifically.

As long as bronchitis is concerned, it is possible and most of the investigations can be normal, as you already have had.

I would also like to know the differential counts when total blood cell count was 21000. In fact, it is not normal. What were neutrophils, lymphocytes and eosinophils when total counts were 21000?

Please provide above details on follow-up.

If you have any other query, please feel free to ask on follow-up. It will be my humble pleasure to help you with best of my knowledge and experience.

Wish you a very good recovery and the best of the health ahead.

Thank you & Regards,

Dr Parin N Parmar
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Parin N. Parmar (10 hours later)
I will do my best to answer your questions below:

a. I would like to confirm that did you not have fever at all? even at beginning of illness? Was it measured? Did you take any medicine for fever during the illness?

No fever when my vitals were taken during the 5 visits to get checked, and no fever the few times I checked at home. I took no medicine for fever.

b. Do you have symptoms like headache, facial heaviness, fullness in ear, etc?

Occasional headache and sinus pressure on left side of face. The occasional sinus pressure I've experienced for many years. No facial heaviness or fullness in ear.

c. What are your nose symptoms - running nose, nose congestion, itching in nose, sneezing, etc?

No running nose, slight congestion, no itching, not so much sneezing.

d. What are your throat symptoms - apart from cough, throat pain, difficulty in swallowing, continuous mucous running from nose to throat, repeated need to clear throat, etc?

Not so much throat pain (chest pain from coughing so much) but when I inhale deeply, it doesn't feel right, almost like the feeling you get in your throat when you run hard for a good distance on a cold day. It doesn't feel like I'm getting all the air that I normally do. None of the other symptoms you mentioned.

e. What are your chest symptoms - fast breathing, difficulty in breathing, wheezing (whistle-like sound from chest), etc?

Sometimes faster than normal breathing for a short period after walking from place to place (this happens during the night as well), not so much difficulty in breathing, no wheezing, but I know I'm not breathing normally. I am concerned that my resting heart rate has been around 80+ through this. It is normally in the low to mid 60s.

f. Do you have any digestion related symptoms - feeling sour fluid in mouth after meals, nausea, vomiting, gastritis, constipation, etc?

None of these, but I don't taste food normally, as when I have the cold, virus or flu, thus, I have little appetite

g. What is the amount of green expectoration - too much or bringing out with difficulty? Was it white initially? Any change over period?

It comes out probably once in 12 or 15 times I cough. It has consistently been green.

h. Do you tend to have repeated cough-colds? Do you have any known allergies? Or this is the first episode of coughing? How has been your past medical history?

No repeated cough-colds, no known allergies (maybe now?), first time I've had a persistent cough like this. Most notable procedures in my medical history are cataract surgery on both eyes in April and May 2013, Mohs surgery near corner of right eye in XXXXXXX 2013, otherwise I've been pretty healthy (22+ years in the Army, always an active runner, play golf, ice and roller hockey).

i. What is your weight?

It was 202 lbs before I got ill, 187 lbs currently.

j. Do you smoke? Are you routinely exposed to smokes/airpollution/dusts/fumes, etc?

No to all.

Above details would help me to know more about your complaints and therefore to make suggestions for you more specifically.

As long as bronchitis is concerned, it is possible and most of the investigations can be normal, as you already have had.

I would also like to know the differential counts when total blood cell count was 21000. In fact, it is not normal. What were neutrophils, lymphocytes and eosinophils when total counts were 21000?

I will try to get this information from my provider.
doctor
Answered by Dr. Parin N. Parmar (14 hours later)
Brief Answer:
Plz add mucolytic-expectorant cough syrup, warm saline gargles

Detailed Answer:
Hello Mr XXXXXXX

Thank you for your follow-up.

Your detailed answers made your complaints very clear.

I would like to make suggestions to you, based on your clinical symptoms and investigations as follows:

1. From your symptoms, I would first think of chronic sinusitis. But contradiction is that your CT of nasal passages (it must have covered sinuses and nasopharynx region) is normal.

2. You have already done CT Chest and chest X-rays. Also, you don't have significant chest symptoms (shortness of breath, wheezing, etc), so I would not think you have lung disease. If you have such symptoms, I would suggest you spirometry with post-bronchodilator reversibility to know your lung capacity and status of airways. But at present, I don't think it would help you.

3. Were I treating you, I would suggest you to get your nose region and throat region examined by an ENT specialist, who may find any source of inflammation in ENT region, if any.

4. I would especially emphasize importance of weight monitoring for you, as continued weight loss should be investigated by a physician in detail to know the cause of weight loss.

5. Regarding medications, I would suggest my such patient an antihistamine (such as Zyrtec - cetirizine) and Nexium (antacid). Of course, if you don't have gastritis/gastroesophageal reflux problems, Nexium may not be helpful to you.

However, I would prefer an expectorant type of cough syrup which helps to expectorate sputum. For example, syrups containing N-acetyl cysteine, ambroxol, etc. This will help to liquify the expectoration and will make it easier to bring out sputum.

6. Codeine containing cough syrups are cough suppressants. So I would suggest you to use them only when cough is very much distressing to you or it disturbs sleep, etc.

I would also suggest you regular steam inhalation and warm saline gargles twice a day, which will help to improve nasal and throat air passages respectively. Please be careful while steam inhalation to avoid burns and not to irritate inside of nose membrane.

7. I would also suggest you plenty of liquids during day which will maintain hydration. Please take a light and nutritious diet according to your appetite. These will help your earlier recovery.

To summarize, your investigations are not pointing towards a particular diagnosis so far. A consultation to ENT specialist and a pulmonologist may be helpful to come to diagnosis. Were I treating you, I would suggest you expectorant-mucolytic cough syrup and warm saline gargles to add to your medications. Weight loss is a concern, if it continues in future.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask on follow-up.

Wish you the best of the health ahead.

Thank you & Regards,

Dr Parin N Parmar


Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Parin N. Parmar (17 hours later)
Thanks, Dr. Parmar. I will get, scan and send printouts of my last 4 labs tomorrow as you requested earlier to compare blood differential counts. FYI, my provider recommended I get a test for mono today. He plans on referring me to an internal disease specialist, but I will request (again) that I be referred to an ENT. Thanks, again for your help.
XXXXXXX XXXXX
doctor
Answered by Dr. Parin N. Parmar (5 hours later)
Brief Answer:
If possible, please consult both

Detailed Answer:
Dear Mr XXXXXXX XXXXX,

Thank you for your follow-up.

Yes, please upload the reports at your convenience.

If possible, it will be best if you can consult both internal disease specialist and an ENT specialist. Because internal disease specialist will be the best person to review and interpret all your reports - ECGs, CTs, etc. Also, as you have complained of weight loss, an internal disease specialist would be better to consult first.
ENT specialist will focus more towards nose & sinuses and throat only.

Hope this helps.

Wish you best of the health ahead.

Regards,

Dr Parin N Parmar
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Parin N. Parmar (2 days later)
Dr. Parmar,

I'm not sure how to attach my latest labs to this. I will reply to the generic email and try to attach to that. I hope you get it.
XXXXXXX XXXX
doctor
Answered by Dr. Parin N. Parmar (11 hours later)
Brief Answer:
shall come back after reviewing reports

Detailed Answer:
Hello Mr XXXXXXX XXX
Thank you for sending reports.

Unfortunately I have not been able to download your reports. I request you to wait till the technical problem could be corrected.

You can either upload them here or else you can send them as attachments to YYYY@YYYY with Subject as Attention: Dr Parin N Parmar. It will uploaded here and I will be notified by email about it too.

Thank you & Regards,

Dr Parin N Parmar
Above answer was peer-reviewed by : Dr. Pradeep Vitta
doctor
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Follow up: Dr. Parin N. Parmar (7 hours later)
Dr. Parmar,

I cannot find YYYY@YYYY anywhere. What is your email address?

doctor
Answered by Dr. Parin N. Parmar (8 hours later)
Brief Answer:
Reports do not point towards any particular disease

Detailed Answer:
Hello Mr XXXXXXX XXX,

I have gone through your reports and would like to interpret as follows:

1. Apart from one report suggesting possibility of infection, (total counts more than 20000 with high neurtrophils), all the other reports are insignificant and do not point towards any particular disease. Usually I would suggest such patient a course of antibiotic but as you have already had two courses of antibiotics, I would not suggest you to take further course of antibiotic, unless you Internal Medicine specialist thinks you need them.

Although IgG antibodies for rubella and rubeola are positive, they are not 100% suggestive of diagnosis. Even if you had such viral infection, it is self-limiting (recovers by its own) and will recover with time. So I would suggest you not to worry about those particular viral infections.

2. I would suggest you drugs like simple antihistamines and an expectorant cough syrup, as previously suggested.

3. Conservative measures such as warm saline gargles and plenty of fluids will also help. Please have a light and nutritious diet rich in vitamins & minerals to help recovery.

4. As suggested previously, please consult a specialist doctor before going for further tests, as so far all your tests are not suggesting any specific disease. It will be good that you are directly examined by a specialist doctor.

Hope above suggestions will be helpful to you.

Wish you a very good recovery and the best of the health ahead.

Thank you very much and warm regards,

Dr Parin N Parmar
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Parin N. Parmar

Allergist and Immunologist

Practicing since :2006

Answered : 870 Questions

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What causes cough, green phlegm and high heart beat with elevated WBC count?

Brief Answer: Please provide more details Detailed Answer: Hello Mr XXXXXXX Thank you for asking at HCM. I went through your history and would like to know more about you as follows: a. I would like to confirm that did you not have fever at all? even at beginning of illness? Was it measured? Did you take any medicine for fever during the illness? b. Do you have symptoms like headache, facial heaviness, fullness in ear, etc? c. What are your nose symptoms - running nose, nose congestion, itching in nose, sneezing, etc? d. What are your throat symptoms - apart from cough, throat pain, difficulty in swallowing, continuous mucous running from nose to throat, repeated need to clear throat, etc? e. What are your chest symptoms - fast breathing, difficulty in breathing, wheezing (whistle-like sound from chest), etc? f. Do you have any digestion related symptoms - feeling sour fluid in mouth after meals, nausea, vomiting, gastritis, constipation, etc? g. What is the amount of green expectoration - too much or bringing out with difficulty? Was it white initially? Any change over period? h. Do you tend to have repeated cough-colds? Do you have any known allergies? Or this is the first episode of coughing? How has been your past medical history? i. What is your weight? j. Do you smoke? Are you routinely exposed to smokes/airpollution/dusts/fumes, etc? Above details would help me to know more about your complaints and therefore to make suggestions for you more specifically. As long as bronchitis is concerned, it is possible and most of the investigations can be normal, as you already have had. I would also like to know the differential counts when total blood cell count was 21000. In fact, it is not normal. What were neutrophils, lymphocytes and eosinophils when total counts were 21000? Please provide above details on follow-up. If you have any other query, please feel free to ask on follow-up. It will be my humble pleasure to help you with best of my knowledge and experience. Wish you a very good recovery and the best of the health ahead. Thank you & Regards, Dr Parin N Parmar