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First concern - 20 years of smoking ( I assume 20 pack years if you smoke 1 pack per day) will put your at risk (high) for many disease including cancer and atherosclerosis. So unless you quit smoking altogether immediately and take up a smoke free lifestyle there will not be much advantage from the preventive measures and tests as smoking will negate it.
The symptoms cannot be attributed to 1 single disease or organ system. However this needs evaluation. You have mentioned about Vitamin D3 levels and cholesterol levels. I would like to know whether any of these tests were done, and if so the results - ECG, Treadmill test, Renal, Liver, Kidney function test, Fasting Blood Sugar, S.Testosterone.
Your height in cms
You can reply as a followup.
Patient replied :
ATTACHING MY LATEST REPORT.
JUST TO HIGHLIGHT HSCRP VALUES WERE 0.55 mg/L in the month of June 2013. where as this report shows high values. Had taken medicines 3 days back due to cough / throat infection.
height: 175 cm
PFT in June 2013: Normal Lung Volume and Flow. MVV Adequate.
Stress Test In June 2013: "exercised according to the BRUCE for 8:29, achieving work level of MAX METS:10.40. The resting heart rate of 101 bpm rose to max heart rate of 173 bpm. Resting BP of 120/80 mmHg rose to max bp of 150/80 mmHg.
Vitamin D level had gone down to 8.5 ng/ml in April 2012
Thank you for the additional information.
You have been well evaluated and all values are within normal limit. The hsCRP value is not significant in isolation. (Probably due to unrelated inflammation.)
Cardiac Status and Pulmonary status is normal - So the mild shortness of breath is of no concern. Most probably you need to work on your aerobic capacity - Exercise more (gradually increasing aerobic exercises).
You must do and monitor (if not done already) a fasting blood sugar. As you may have a risk to develop diabetes / pre diabetes.
The main concerning symptoms I assume will be the Erectile Dysfunction , the tiredness and neurological symptoms. This will require a Neurological evaluation first - and if it is normal this could be somatization or from anxiety / stress. I am not trivialising your symptoms , but these cluster of symptoms do occur as a part of neuro psychiatric manifestation.
The Erectile dysfunction may have to be evaluated with a Doppler study and Ultrasound of the tests.
So as of now -
Monitor Fasting blood sugar 6 months
Neurological examination (you may consult a Neurologist)
Take care of any anxiety / stress precipitants.
Hope this helps