Ill start by explaining a typical way the symptoms will be induced. once induced the symptoms will vary throughout a 24 hour period as explained.
I start playing a football match, or go cycling, go for a run, climb stairs, do a lot of lifting, carrying or dragging, and in a strange offshoot the symptoms appear in a weaker form when i go on roller coasters or go kart.
depending on the intensity of the activity, i will notice after 2-5 minutes that there is a significant resistance to breathing. i cannot take as deeper breath as i used to be able to. trying to is slightly painful. from 5-10 minutes later there is an underlying level of nausea, this nausea feels somewhat like an ache. breathing deeply intensifies this nausea to unbearable levels. therefore i tend to conciously take short breaths. i will start coughing. the taste in my mouth changes, but i do not get increased levels of fluid in my mouth. Its ‘like I can taste my insides’. If I keep doing the exercise the nauseating pain is awful, very unbearable. Ive never been able to go past this point and will stop my activity.
The amount of time I continue the activity after the symptoms start will define what happens over the rest of the 24 hour period. If I stop as soon as I feel the tightness, I will feel slightly nausious and have a cough. The symptoms will be gone after 50 minutes and that’s the end of it. if I continue the activity for a moderate period, say 5-10 minutes more, I have a strong nausea and feel weakened. The symptoms will tend to fade slightly over a period of 2-3 hours. After this time they will intensify again, it feels like theres an internal struggle in my chest, consuming all my energy, I feel very nausious, very weak. I feel light headed, I have hot and cold spells, the cold spells make me shiver intensely, often making the nausea worse. Its like I want to go and throw up. I cannot breathe deeply. This feeling tends to last until I go to bed. When I wake up in the morning I will still have the nausea and cannot breathe deeply, but the symptoms have faded significantly and will continue to do so throughout the day.
If I continue the initial activity until I physically cannot continue I can barely breathe at all, I cannot eat, its hard to swallow and I have no appetite. All nausea, coughing, weakness is there but very very intense. The symptoms will reduce only slightly over the 2-3 hour period, still very bad however. Between 3-6 hours later I will vomit. This greatly reduces the pain, and in comparison I feel much better. I still have nausea and coughing, but I now have an appetite and can eat without a problem. The symptoms will normally be gone when I wake up in the morning.
Ways I can reduce the symptoms: eating tends to numb the pain for up to 20 minutes. Drinking sometimes helps, though often makes it feel worse due to the change in breathing whilst drinking. Throwing up helps. Lying down helps, but it must be in 1 position. Rolling over will make me feel really bad for a few minutes then I return to as before. If I felt the need to lie down, then it tends to be about half an hour after I get up that I throw up.
The history of this is as follows. Firstly I am a 20 year old male, 5”7, 11 stone, I am not overweight, just a little chubby, purely from a lack of exercise because I cant. I first noticed the symptoms when I was 11 and I was doing a fitness test. I used to be quite fit, so this is not caused from a weight issue. I ran for 20 minutes on a very cold day. I had a very tight chest, couldn’t breathe and there was literally rivers of phlegm coming out my mouth. I discovered the phlegm was caused by fruit juices so I cut those out my diet. However the shortness of breath remained. I did go to the doctor and spat into a cup as a test. After 3 days that spit had turned bright yellow. In the end the doctor never got back to me, and just from laziness I guess I never chased it up or investigated further.
Fast forward and im now 18. ive tried over the counter heartburn meds (chalk tablets). this is really bugging me so I go and see a GP. My doctor and myself came to the conclusion the symptoms were caused by some form of gastro oesophageal reflux disease (GORD/GERD) but without the burning sensation (sometimes called LPR). This seemed to make sense. The acid causing the nausea, change in taste in my mouth, loss of appetite and inability to eat, the vomiting relieving pain. It also fits in with the exercise trigger, as exercise can increase stomach pressure.
I had an H-pylori test and comes back negative. I was put of PPI’s for 4 weeks, which I said were 20% effective but not enough to be bearable. I had an endoscopy done, and was told I have a hiatus hernia. I then had a 24 hour pH monitoring done, during which I whent for a run up and down stairs and induced the symptoms. The results came back overwhelmingly negative. As I understand it someone suitable for surgery registers +8%, I registered +0.5%, ie I have no acid reflux problems at all. In addition the exercise period did not trigger acid reflux. I was put on tricyclic antidepressants in an attempt to reduce my oesophagus’s sensitivity. This had no effect, although I was on the smallest dosage possible. The gastroenterology specialist said he was out of options and he’s never had a patient who genuinely has acid reflux problems not respond to the medication I have had. He therefore suggested the symptoms are respiratory.
This is a possibility. The symptoms only occur when breathing increases during exercise, or exertion, or from adrenaline. It explains the resistance to breathing, coughing, could explain the nausea, weakness can come from lack of oxygen. It doesn’t however explain why food and drink affects me. Maybe these offer a distraction from the pain, but don’t directly affect it? it also doesn’t explain why it causes vomiting or why vomiting helps. And it doesn’t explain the slightly noticable affect that the PPI’s had.
Anyway that is abolutely everything I know put into writing. If you have any idea what this could be please let me know.