Wednesday, April 30, 2014

Medical concern? Sometimes the simple answer is the right one

On three different occasions over the years, I have found myself with some breathing trouble. This is not the usual allergies and related issues that I’ve had all my life. Rather, it is a feeling that’s akin to asthma. In fact, one doctor once called it “extrinsic asthma.” By that, he meant that I didn’t actually have asthma but had similar symptoms. Either way, it is very distressing.

The symptoms started again a few months ago, but when I went to see my doctor, I made clear that I did not want batteries of tests like the other two times this happened over the past 12 to 15 years. In those cases, they did cardiac tests and pulmonary tests, but they never found anything wrong. In essence, the diagnosis was a well-educated shrug.

So this time, the doctor just did an EKG, bloodwork and a general exam. Again, nothing was discovered. No one ever really put a finger on what the issue was.

In each case in the past, the symptoms eventually went away. Still, it took a few months and was distressing whenever it was hard to get a full breath. It also was tiring and quite aggravating. Then, in the past couple of weeks, something occurred to me. Several months ago, I changed jobs. When that happened, I changed insurance. This wound up being a good thing. I will get to that in a moment.

Going back to several months ago, under my old insurance, the co-pay for a prescription medication called Nexium (which reduces stomach acid) went from $20 to $100. At that time, I asked the doctor to switch me to something else, since a $100 co-pay for a reflux medication seemed exorbitant. So she switched me to a generic medication called omeprazole. I didn’t start the omeprazole right away, because I still had some Nexium on hand. What occurred to me just recently is that I started the omeprazole a few months ago, right about the time the breathing problem started. Thinking back, I remembered that the last time this breathing issue happened, a few years back, I wasn’t on Nexium or any acid reducer, and the pulmonologist commented that reflux can cause breathing issues. Was the omeprazole not working well enough for me? Also, I took a look at a few weeks ago at the side effects of omeprazole. One of them was “bronchospasm.” So maybe that was the issue—or part of the issue.

So I e-mailed my doctor and asked if I could be switched back to Nexium. While the cost is higher, if it either is better at controlling acid or has less side effects (or both), at least for me, then it’s worth the extra money. She congratulated me on my analysis and “detective work” and wrote the new prescription right away. The extra bit of nice news with this is that I have found out that the new place’s health insurance has a co-pay of just $50 for Nexium. So it’s not quite as bad as the old one became.

Regarding the other possible cause for my issues, I found reinforcement for what the pulmonologist said a few years ago in all my reading—that acid reflux can cause breathing problems. Even if you’re not feeling the burning, there can be a certain amount of acid being quietly brought up which gets into the lungs. This bit of acid can be enough of an irritant to cause problems in the bronchial tree.

Granted, this is somewhat theoretical for now, and I don’t even have the Nexium yet. However, I am off the omeprazole, just to be safe, and I’m taking over-the-counter Zantac 150 in the meantime. It’s possible that the results are coincidental, but I definitely seem to be doing better for now. I sure hope that I have found the answer. I guess the main lesson in this is to keep digging and not take “no” for an answer (or a diagnosis) from medical providers. I don’t doubt that the doctors did their best and made their best guesses when this happened in the past, but if the answer is this simple, then all of them, including cardiac specialists and pulmonary specialists, missed a simple explanation while they were doing all of their fancy tests.

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