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What Causes Shortness Of Breath After Starting Chemotherapy?
Question: I have shortness of breath after walking 20 feet. I have MDS. I start chemo Monday. My red blood count is 8.6. According to doctors my symptons are worse than what they should be with MDS. I have had a chest x-ray, a chest cat scan, 3 pulmonary function test, a stess test, a heart sonagram, the alpha test, an allergy test and I have passed them all. I first noticed this shortness of breath 8-10 years ago and it is getting worse. XXXX
Brief Answer:
Rule out exercise induced asthma/ GERD
Detailed Answer:
Hello,
Thank you for trusting HCM
Since you had extensive investigations done, the only factor that needs to be ruled out now in the possibility of exercise-induced asthma / GERD (Gastroesophageal Reflux Disease) as the cause for shortness of breath.
I see that you have already undergone pulmonary function testing and it was normal. I recommend that you get a Methacholine challenge test to rule out Exercise-induced asthma.
Esophageal endoscopy and pH monitoring can rule out confirm the possibility of GERD.
Please be advised to follow up with your physician for necessary evaluation.
Hope this answers your question
Please address further questions here
Regards
Dr.Lekshmi
Rule out exercise induced asthma/ GERD
Detailed Answer:
Hello,
Thank you for trusting HCM
Since you had extensive investigations done, the only factor that needs to be ruled out now in the possibility of exercise-induced asthma / GERD (Gastroesophageal Reflux Disease) as the cause for shortness of breath.
I see that you have already undergone pulmonary function testing and it was normal. I recommend that you get a Methacholine challenge test to rule out Exercise-induced asthma.
Esophageal endoscopy and pH monitoring can rule out confirm the possibility of GERD.
Please be advised to follow up with your physician for necessary evaluation.
Hope this answers your question
Please address further questions here
Regards
Dr.Lekshmi
Above answer was peer-reviewed by :
Dr. Raju A.T
I'm pretty sure I've had the methycholine test and passed, sitting a plastic booth and that term rings a bell. If that test invovles excercise, I can no longer do any of that. I do have GERD. Since I have been on zantac and prilosec, for the last 2 years I have had very little acid reflux, maybe 4 times total and my breathing has gotten much worse in that time. I sleep with an empty stomach. Wouldn't the acid reflux have damaged my lungs and that would show up in the cat scan? XXXXX.
Brief Answer:
Follow up answer
Detailed Answer:
Hello again,
Injury to the lung parenchyma will definitely show up on the CT scan.Methacholine challenge test do not involve exercising. However, if you already had normal results with methacholine challenge test then exercise induced asthma is unlikely.
Since you have undergone extensive investigations and have been shown to have normal cardiac and pulmonary function, the only possibility is due to fatigue and anemia associated with MRS.
I would recommend to closely monitor your hemoglobin levels. Initiate blood transfusion if your hemoglobin levels fall or shortness of breath worsens.
I would also recommend getting your thyroid levels checked to rule out hypothyroidism.
Take adequate rest and do not stress too much.
Eat a healthy balanced diet.
Wishing you good health
Dr.Lekshmi
Follow up answer
Detailed Answer:
Hello again,
Injury to the lung parenchyma will definitely show up on the CT scan.Methacholine challenge test do not involve exercising. However, if you already had normal results with methacholine challenge test then exercise induced asthma is unlikely.
Since you have undergone extensive investigations and have been shown to have normal cardiac and pulmonary function, the only possibility is due to fatigue and anemia associated with MRS.
I would recommend to closely monitor your hemoglobin levels. Initiate blood transfusion if your hemoglobin levels fall or shortness of breath worsens.
I would also recommend getting your thyroid levels checked to rule out hypothyroidism.
Take adequate rest and do not stress too much.
Eat a healthy balanced diet.
Wishing you good health
Dr.Lekshmi
Above answer was peer-reviewed by :
Dr. Yogesh D
I started noticing shortness of breath 8-10 years ago and my blood counts were normal then. People don't live long with untreated MDS, so something else is wrong. I will be getting lots of blood tests once I start chemo. I will ask for my thyroid levels to be checked out. I am also thinking about getting a heart XXXXXXX I had a heart attack 16 years ago but my cardiologist does not think my heart is the problem. Could my immune system be messed up and this is causing my shortness of breath? Please rack your brain and consult other doctors for any ideas, because this is obviously not an easy diagnosis. I am not in a hurry for a reply. XXXX.
Brief Answer:
Follow up answer
Detailed Answer:
Hello again,
I understand that going through so many investigations and consulting many specialists without an answer must be very frustrating for you.
Since all your test results showed normal cardiac, pulmonary ,blood results now we will have to think about rare causes .
Myasthenia gravis is a neuromuscular disorder, where muscles develop weakness after repeated use. It can affect respiratory muscles and present as dyspnea on exertion.
Isolated respiratory muscle weakness (without affecting any other muscles in the body) is a very rare but possible presentation of myasthenia. Such patients can go on for many years with dyspnoea undergoing several tests and not getting a definite answer. CAT scan is also not helpful in such cases as thymus will not be enlarged as in typical myasthenia gravis.
It is due to antibodies that attack the neuromuscular junction.
Blood investigations to diagnose myasthenia gravis will not be positive in such atypical cases.
Blood levels checking specifically for MuSK and LRP4 antibodies need to be done.
Also repetitive nerve conduction study and single fiber Electromyography can confirm the diagnosis.
If your EKG, stress EKG and echocardiography shows normal heart function, then getting a cardiac XXXXXXX done is unnecessary.
I would also like to add that you have to quit smoking of you do so, maintain a healthy weight and eat healthy.
Please be advised to follow up with your primary care to get thyroid levels checked and undergo investigations to rule out myasthenia gravis.
Follow up answer
Detailed Answer:
Hello again,
I understand that going through so many investigations and consulting many specialists without an answer must be very frustrating for you.
Since all your test results showed normal cardiac, pulmonary ,blood results now we will have to think about rare causes .
Myasthenia gravis is a neuromuscular disorder, where muscles develop weakness after repeated use. It can affect respiratory muscles and present as dyspnea on exertion.
Isolated respiratory muscle weakness (without affecting any other muscles in the body) is a very rare but possible presentation of myasthenia. Such patients can go on for many years with dyspnoea undergoing several tests and not getting a definite answer. CAT scan is also not helpful in such cases as thymus will not be enlarged as in typical myasthenia gravis.
It is due to antibodies that attack the neuromuscular junction.
Blood investigations to diagnose myasthenia gravis will not be positive in such atypical cases.
Blood levels checking specifically for MuSK and LRP4 antibodies need to be done.
Also repetitive nerve conduction study and single fiber Electromyography can confirm the diagnosis.
If your EKG, stress EKG and echocardiography shows normal heart function, then getting a cardiac XXXXXXX done is unnecessary.
I would also like to add that you have to quit smoking of you do so, maintain a healthy weight and eat healthy.
Please be advised to follow up with your primary care to get thyroid levels checked and undergo investigations to rule out myasthenia gravis.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks for your ideas and I will act on them this week. I quit smoking 38 years ago and never smoked much. I am overweight but not obese. I will try to lose weight very gradually and eat healthier. XXXX
Brief Answer:
You are welcome
Detailed Answer:
And thank you for trusting us with your health concern
Please address any more questions/concerns you have
Wishing you good health
Dr.Lekshmi
You are welcome
Detailed Answer:
And thank you for trusting us with your health concern
Please address any more questions/concerns you have
Wishing you good health
Dr.Lekshmi
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
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