[37F] Experiencing persistent cough and gastrointestinal symptoms
Patient Description
A 37-year-old female has been experiencing a constant cough for about a month, which sometimes takes her breath away and can be both dry and phlegmy. The cough is mostly moderate to severe and occurs several times a day, lasting from one to five minutes. Lying down triggers coughing fits, and sometimes these fits are so intense that she almost throws up. She also reports a sore throat and diarrhea, which started about a day ago and involves loose to watery bowel movements occurring three times a day. She experiences abdominal pain and cramping that comes and goes, but it doesn't seem to be related to eating or drinking. She feels nauseous at times, especially during coughing fits, but has not vomited. She has a history of asthma and chronic bronchitis, diagnosed at age 12, and sometimes notices wheezing and a slight increase in the use of her inhaler. She had a COVID-19 test about a week or two ago, which was negative. She hasn't started any new medications or supplements recently, other than a cough suppressant, which helps only while she takes it. She hasn't noticed any specific triggers for her symptoms, except for exposure to smoke at work, which makes her cough worse. She has a family history of diabetes, depression, and anxiety. She has allergies to Vicodin, aspirin, and codeine substitutes, but not to codeine itself. The medications she is currently taking include ibuprofen and allergy relief pills.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, here are some possible explanations:
Chronic Cough and Sore Throat
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Asthma or Chronic Bronchitis Exacerbation:
- Given your history of asthma and chronic bronchitis, it's possible that your symptoms are due to an exacerbation of these conditions. Asthma can cause a persistent cough, especially when lying down, and chronic bronchitis can lead to a productive cough.
- Typical treatments include inhalers (bronchodilators and corticosteroids), and sometimes oral steroids or antibiotics if an infection is suspected.
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Postnasal Drip:
- Postnasal drip can cause a chronic cough and sore throat. This can be due to allergies or sinus issues.
- Treatments often include antihistamines, decongestants, and nasal corticosteroids.
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Gastroesophageal Reflux Disease (GERD):
- GERD can cause a chronic cough, especially when lying down, due to acid reflux irritating the throat.
- Treatments include lifestyle changes (diet modification, elevating the head of the bed), antacids, and proton pump inhibitors.
Diarrhea and Abdominal Pain
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Viral Gastroenteritis:
- A viral infection could explain the sudden onset of diarrhea and abdominal pain.
- Treatment typically involves staying hydrated and resting.
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Irritable Bowel Syndrome (IBS):
- IBS can cause intermittent abdominal pain and changes in bowel habits, including diarrhea.
- Management includes dietary changes, stress management, and sometimes medications.
Unifying Diagnosis
- Infection: A respiratory infection could explain the cough, sore throat, and possibly even the diarrhea if it's a viral infection affecting multiple systems.
- Asthma Exacerbation with Postnasal Drip: Your asthma could be flaring up, possibly triggered by allergens or irritants like smoke, leading to postnasal drip and a chronic cough.
What you can do
Chronic Cough and Sore Throat
- Asthma Management: Ensure you are using your inhaler as prescribed. If your symptoms persist, consult your doctor for a possible adjustment in your asthma management plan.
- Postnasal Drip: Use over-the-counter antihistamines or nasal sprays to manage symptoms. Staying hydrated and using a humidifier can also help.
- GERD: Avoid foods that trigger reflux, eat smaller meals, and avoid lying down immediately after eating. Elevate the head of your bed if nighttime symptoms are bothersome.
Diarrhea and Abdominal Pain
- Hydration: Drink plenty of fluids to stay hydrated. Oral rehydration solutions can be helpful.
- Diet: Stick to bland foods like bananas, rice, applesauce, and toast (the BRAT diet) until your symptoms improve.
- Rest: Ensure you get plenty of rest to help your body recover.
General Tips
- Avoid Triggers: Try to minimize exposure to smoke and other irritants that could be exacerbating your symptoms.
- Symptom Tracking: Use MDandMe to journal your symptoms, track your progress, and share your notes with your healthcare provider.
What you should look out for
- Worsening Symptoms: If your cough, shortness of breath, or diarrhea worsens, seek medical attention.
- Signs of Dehydration: Such as dry mouth, decreased urination, or dizziness.
- Severe Abdominal Pain: If your abdominal pain becomes severe or is accompanied by fever, seek medical care immediately.
- Difficulty Breathing: If you experience significant difficulty breathing or wheezing, seek emergency medical care.
Remember, while I can provide guidance based on your symptoms, it's important to consult a healthcare professional for a formal diagnosis and treatment plan. If you have any more questions or need further assistance, feel free to continue the conversation.
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4 mo ago