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Reason for difficulty in breathing and pressure in chest.

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Goodday .I'm Abdulmajeed. I live in Spain. I have been having this problem for more than 5 years now. I find it very difficult to breathe profoundly. I experience pressure in my chest while inhaling or exhaling. Also air can not just go through easily down.I do not feel relax while breathing While speaking I feel some pressure which( according to my observation) comes somewhat below my diaphragm. Further conversation will just make this pressure increase, rising up over my lung and throat. Consequently, It becomes very difficult to continue conversing; to articulate sounds correctlyI suspect some intestinal distortion, but i am not sure. One analysis shows i am having a swollen liver.
.I have done some Xray with the recommendation of specialists for the study of my thorax. i have also undergo these breathe reading, air- blowing stuff. All result showed that my chest cavity and breathing capacity are fine. Although I still have some more pending tests. Yet no medication has been prescribed for me so far.
I downloaded some breathing exercise stuff which i practised deligently for sometime. I would go out for some running. but these all make no difference.
For nearly three years now, i have been going to our public medical service for diagnosis.But these services are just too slow.
Please is there anyway you can help?

Category: Internal Medicine Specialist

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Category: HIV- AIDS Specialist
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Hello. Thanks for writing to us with your health concern.
So from your history what i can summarize in a nutshell is that you have difficulty in breathing or more of a labored breathing. There are lots of causes of increased work of breathing, mostly due to obstructive ventilatory defects such as COPD, Emphysema, Asthma, Bronchiectasis, Cystic Fibrosis, e.t.c.
Certain other conditions restrict the mobility of the lung, not letting it expand, such as Sarcoidosis, Alveolitis, Connective tissue disorders. Even enlarged liver as you have mentioned can lead to breathing difficulties, because it does not let the lung expand properly on the right side. I understand this is obviously causing you a lot of distress. So it is better to get yourself evaluated properly before coming to a conclusion. You have not mentioned in history - Are you a smoker/ alcoholic/ exposed to passive smoking ? Did you ever experience asthma in childhood? Are you allergic to dust and have sneezing episodes while exposed to dust. I will also advise you to get an CT-Thorax done, which will give us a much better picture. If you already got it done, kindly upload the reports. If possible also get an Ultrasound- Whole Abdomen done, which can give us an idea of how enlarged your liver is.
For the time being you can try taking Tab. Montelukast 10 mg, once daily in the evening for the next 5-7 days and see if there is an improvement in your symptoms. Also additionally you can discuss the possibility of chest physiotherapy with your Pulmonologist.
Once you get the reports kindly upload them, and I can assist you further.

Patient replied :

Thanks a lot Doctor. I really appreciate your quick response to my message.
Relating to the question you ask- I do (never) not smoke nor take alcohol. I am not a passive smoker. I never experienced asthma during childhood.
I will try to upload the ultrasound test and others that I have done.
Meanwhile I will try the medication (Tab Montelukast 10mg) you suggested.
Thanks again,

Thanks for writing to us again.
Since you're not a smoker and also have never been an alcoholic, it reduces the chances of any liver damage, or any restrictive lung disease. So continue Montelukast and also once you have the CT- Thorax reports ready, get back to us and we will assist you further.

Patient replied :

Hello Doctor, Thanks once more for your cooperation. I have gathered some documents which I have uploaded. I do not know if they include the " CT- Thorax or/and Ultrasound Whole Abdomen. I could not upload the actual pictures of the Xray/ CT- Thorax and the Ultrasound. They just came out completely dark. I will continue with the Montelukast. Thanks Regards.

Hello. Thanks for uploading your reports.
I went through all your reports. The first one you uploaded is a series of blood tests. I went through your values and the reference range. However, the second one is probably the CT ( i didn't understand anything because i believe it is in Spanish and i sincerely apologize since i don't know and understand the language ). If there is an impression column, you can read it and translate it in english and put it up in the follow up query.
As far as i noticed, you got these tests done on 30.04.2014. Your CK values are very high which indicates some sort of muscle injury or myositis. CK is also found in heart but the heart component ( CK-MB ) is normal, so your heart is fine. But i am a little worried about your CK values and your muscles. Did the doctor mention anything after you gave you the reports? If you remember him, mentioning the cause to you, then you can share with me and i will assist you further.

Patient replied :

Hello Doctor,
Firstly I sincerely apologize that I missed the whole thing up. I didn't considered these reports are in Spanish. I am really sorry for that. My system was down yesterday .
Concerning the CK valued, My Doctor was even more alarmed about it. So she immediately arranged an emergency blood analysis that very dia for me. In that test ( 09/05/2014) the CK value dropped from 5662 to 3649. They said there is no problem that with time it will keep reducing.
I think this is the only remarkable point in this analysis. It is not different from the others.
I will try to get an appointment with my Doctor, maybe I might get information on my passed CT- thorax. I still having one Ultrasound test, "bronco provocación" and some blood test.
I am still on the Montelukast tab. Can I continue the usage after 7days( for another 7days) if I do not notice any change?
As soon as I get any information, I will sent it though.
Thanks a lot.

Hello. Its perfectly alright and there is no need for an apology. Please relax. The CK values are very high even at levels of 3000. -Did your doctor perform any urine tests on the same day? Was the urine very dark? -Do you have any muscle pain anywhere? -Any pain in front of the chest? -What is your occupation? Does it involve strenuous work? -Are you taking any drugs beside the Montelukast? Please reply to the above in the follow up at your convenience, after you get the other test results. The "bronco provocación" test is to test for asthma. You will have to stop the Montelukast tablet before this test as it can interfere with the results. You can get the pending tests done and upload the results. Montelukast can be re-started after the test and continued for 7 more days. I hope this addresses your concern. Please get back with the test results. Kind regards.

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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