good doctor appointment

[Guest guest]

Well, yesterday I went to the ENT for my cough. At first I thought

I wasn't going to like him because he was kind of bruque but in an

efficient sort of get to business sort of way. I found it

interesting that his history did not ask for any diagnoses

previously made aside from a checklist of the common ailments that

could run in your family. So, he could certainly tell from my

medications some of the stuff I am treated for, but didn't know

about the CFS or Fibro nor did he ask. I did mention the CFS as an

aside in mentioning the dizziness. He didn't pay any attention. In

any case, I told him that I had practiced speech pathology and

wanted to know what he was looking for and all. He seeming almost

relieved that I knew about stuff and was excellent at explaining

what he was doing with his testing. He stuck a camera through my

nose down to my vocal cord (not pleasant but not horrid). I hadn't

ever seen this done in person but had seem it in classes on VCR

tapes. After the test he showed me all the photos and pointed out

the structures and what he was looking at.

He immediately said he knew what part of my problem was. Turns out

that I had nerve damage when I had my thyroid removed so that one of

my vocal cords was damaged and is actually shorter than the other

and doesn't close fully. He asked if I had noticed any change in my

voice and I said I thought a bit but wasn't sure. He said I'd have

compensated for it by now. He couldn't tell me whether the surgery

or the fact that the tumor had broken out of the thyroid capsule

caused the surgery, but suspected it was the surgery. I'm kind of

bummed about that, but considering there was a chance I would

totally lose my voice I guess this is not awful, and it's not any

different than yesterday when I didn't know.

In any case, he diagnosed me with neurogenic cough. He said it is a

fairly new diagnosis that not a lot of docs know about but that it

has been a particular interest of his for the last year. I asked

exactly what it is and he said he couldn't explain it exactly. It

seems to have (now that I can't recall what he said for sure)

something to do with the nervous system being overexcited or

something and so I cough to protect my airway from an irritant that

isn't there. He said there is no physical evidence that there is

anything wrong, but it is diagnosed, I guess, on symtoms. For some

reason, with the vocal cord nerve damage, I am a perfect candidate

to have the treatment for this. He also said the fact that I had

already seen the allergist and pulmonolgist suggestd that this was

probably what is going on. The treatment is low dose

amytriptaline. He started me on 10mg and the most to increase to is

40mg. Not a dose to use it as an antidepressant. I actually took

this as my very first antidepressant and it has horrible side

effects, the worse being constipation. I am hoping that at this low

dose it will not be an issue.

In any case, he also said that I am taking way too many meds and

that he is of the old school that if you are on more than three

medications then you have no idea what sort of interaction you are

having. I happen to agree with this. In any case, since the

amytripaline is sedating, he took me off the three meds that I use

for sleep. He said I could stop them all at once but I called my

psych and he said I could stop two all at once but the third I need

to taper off slowly to not have issues. I did sleep last night with

the new meds and 2/3 of the dose of the med I'm tapering off of, so

maybe this will work. I hope so. And if it does, I will have

traded one med for three. He also said he is not sure if I actually

have asthma and will have to confer with the pulmonologist on how

bad my test results were there. He thinks I may be able to get off

all the asthma related meds which would eliminate quite a number of

meds (most of which I don't tolerate and can't use anyway). He

seems to think he can then eliminate allergy meds too but I guess

we'll see about that. He wants me to end up with just taking my

thryroid meds and maybe one antidepressant. He knows nothing of my

history with depression so I don't know how my psych will feel about

that. But for meds used only for depression I think I only take two

and they each work differently.

So, having now had so many different diagnoses of this cough I am

hoping that this guy is right. I see him again in 3 weeks so I

guess we'll see. I increase the meds every three days if the cough

persists up to a maximum of 40mg. Right now I just am on 10mg.

So, cross your fingers for me that this works and the cough stuff is

gone and that maybe I will end up with only minimal meds. I didn't

think to ask but he didn't mention being on the meds long term, so I

don't know if it is somehow resetting the nervous system issue or if

it a long term treatment.

Meanwhile, I talked to the medical librarian at the hospital to see

if I could get a clearer definition of what exactly this cough is

and how it is diagnosed. She said she'd get back to me today

hopefully.

Sandrea