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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for shortness of breath

I am a 26 year old female that has a 1 1/2 yr history of shortness of breath. Initially was hospitalized with tachycardia/dehydration, influenza swabs negative along with PE studies. Low grade fevers. SOB ensued from there. A mono spot came back positive about 8 months later but no definite timeframe that we can pin down for when it happened. Chest x-ray s and CT s normal. End of Jan 2010 a mediastinal mass was found, resected Feb 2010-benign thymic tissue. Ended up with elevated left hemidiaphragm. Myasthenia gravis has been ruled out. PFT s normal except for decreased MIP and MEP s. Multiple respiratory infections, pneumonia x3. Pulmonology can t figure anything out. Cardiac workup has been negative including echo s, stress tests, cardiac enzymes, CHF workup, etc. Sats 97-100% on RA. Shortness of breath about the same at night, have to rest going up a flight of stairs. No peripheral edema. Multiple prednisone bursts and antibiotics. CT s and chest x-rays have been clear of anything. Shortness of breath is unchanged since mediastinal mass resection. Run low grade fevers (99.4-100.5) very frequently. WBC never elevated. Getting ready for another referral to another facility. Any ideas what this possibly could be. I have an asthma history, currently on Flovent 440 mcg BID, also have a hx of GERD and have had 2 nissen fundoplications (1st on failed). Recent EGD shows no evidence of reflux. Allergy testing has been negative, immunoglobin levels have been checked. Have a hx of low ferritin levels, just finished 8 IV doses of Venofer. No change in symptoms. Also found growths on thyroid, biopsies negative, TSH and free T4 levels WNL. Running out of ideas, my primary MD and all specialists that have been seen all agree that something is wrong, but can t figure it out. Any ideas would be welcomed.
Thu, 22 Nov 2018
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General Surgeon 's  Response
Hello,

* I would recommend contributing anxiety as the prime concern cause of breathlessness in this case before looking for other organic causes.

* Best handling of stress, anxiety with meditations, behaviour cognitive therapy and supportive care is a must to proceed for best possible outcomes.

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Bhagyesh V. Patel, General Surgeon
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