Pharmacists and Doctors... Please hear my situation. Medicine is not working!?

Question

So here's the deal. I had acough, slight stuffiness, sore throat and ear infection for a while and the doctor gave me zithromax (z pack 5 day treatment), and a pill that numbs you tracia for the cough, and flazonaze for postnasal drip. it didn't work. Shortly afterwords my problems changed to a serious cough, with a "gurgle" in my chest when ever I would breathe. It was nearly impossible to sleep unless I sat up. (Even then I had some trouble sleeping). I would cough so hard that I pulled a muscle in my neck and often times I would gag. When ever I did gag, I would get this greenish brown greyish snot that would come up. REALLY nasty... sorry. Strangly enough no other symptoms occompanied this; No fever, minimal stuffyness, dizziness once or twice.

I went back a 2 weeks later and demanded a chest xray. He did that, gave me an ultrasound (dont know why) listened to my chest while I breathed and came to a conclusion that I had bronchial asma. He perscribed me ammoxocillian 875 2x for 1wk. and advair inhaler 2x/day. My ammoxocillian is almost gone (2days left) and it seems to have gotten nowhere! As a matter of fact now it hurts when I breathe! Everytime I inhale I feel a sharp pain under my right rib cage like I pulled something. And its extremely painful when I cough. In addition I am stuffier than I was prior to taking these treatments. In all I've been sick for about a month and it seems to progressivly be getting worse regardless of what I take.

In your PROFESSIONAL EXPERIENCE, can you tell me what I have or what he's doing wrong because I'm worried and now broke (after all the med's and copays).

Answer 1

I am not a professional, but i have similar problems, and lots of bad experiences that have given me a little insight, so take it for what its worth.  

There is no way for a 3rd party doc to sort this out without being able to physically examine you.   The first round of symptoms look a lot like classic sinusitis.  The doc prescribed Zithromax, which is generally the first line antibiotic for upper respiratory infections, so nothing out of the ordinary there.  I am guessing that he/she also prescribed flonase (misspelled flazonaze?), or at least one of the corticosteroid sprays.  These types of sprays can really backfire, particularly if you have a bacterial infection, so that could be one reason that things got worse.

You didn't mention if you continued taking the fonase, and that could make a big difference.  Flonase side effects can create throat and chest irritation - particularly a burning sensation - I had this problem when i took Flonase.  Note that Advair and Flonase include the same ingredients, so if you are taking both of these, you are taking way too much.

Your description of the symptoms and treatments at the two week mark look like a complete shift away from upper respiratory problems to asthma and chest problems.  So, it appears that you either have two separate problems (asthma and sinusitis) or the primary problem is sinusitis, and that the chest/asthma symptoms are caused by side effects of the flonase & advair.  

If I were in your shoes, I would talk to the doc about discontinuing all the meds you are presently taking (after the antibiotics run out), and switch to taking Mucinex-D for the sinus congestion and mucus -related problems, get a prescription for albuterol to have on hand to take as needed to temporarily control ashtma symptoms, get a throat culture to see what bacteria might be causing the problems, and try talking a walk about 20 minutes per day at a slightly brisk pace (this can help mobilize and clear a lot of mucus).  Take the albuterol with you when you walk.   See what happens.  

If the problems initially escalated due to side effects of the meds., things should start to clear up in a few days.  If you actually have asthma, then the asthma symptoms will continue, but the sinus problems should abate at least somewhat.  For the long-term, you may need to see an ENT specialist or an allergist to get to the root of the problems.

Answer 2

Hello,

I substantially agree with the previous opinion.

It seems to me that the continuing trouble with your chest, is more likely to be caused by a continuing infection in your nose or sinuses, than by a serious germ on your chest.  If you like, the back of your nose is still "dripping" post-nasally into your wind-pipes, while you are lying down asleep.  Sitting up, on this basis, enables you to clear your air-tubes by forced coughing, and also to clear the 'green snot' which may have dripped in from the back of your nose.

Asthma is a good reason why a chest infection would fail to clear up, because the narrowed, wheezy air-tubes of asthma, hinder the body from coughing  all the germs out of the lungs.  And certainly asthma is often invoked as a reason, for a chest infection failing to clear up on strong antibiotics, (Zithromax and Amoxil in your case).

But I personally would be hesitant to diagnose asthma on this basis alone.  If you have asthma, I would expect a history of wheezing or eczema as a child, plus wheezing (the cardinal symptom of asthma) at other times recently, when you haven't had a chest infection.

Lung function tests for asthma, like 'peak expiratory flow'  rate, (basically how quickly you are able to blow air out into a measuring tube), won't be possible now until you have recovered from this infection.

I think the chest pain that you describe, is more likely to be due to strained coughing-muscles than to anything else.  Pain on breathing in, may also be due to an infected lung-outside-lining (called "pleurisy"), and 'pleuritic' pain is created because the infection 'roughens' the outside lining of the lung, and causes it to scrape against the inside lining of the chest when you breathe in.

However, if you had pleurisy it would normally be the result of pneumonia infection of the underlying lung, and there is no suspicion of pneumonia from what you say.  You have no fever, and I take it the chest X-ray was clear, -- also the ultrascan which may have been for fluid in the 'pleural cavity' or the 'peri-heart' cavity.

Also 'under the right rib cage' is the wrong place for pleurisy pain, - - unless you have an inflamed upper-right diaphragm, pleurisy pain should be in the chest.  I think muscular pain is the more likely, and accounts for the effort of coughing being painful.  

I don't think your doctor is doing anything wrong, indeed some GP- doctors in the UK would not have treated your infections so aggressively with strong antibiotics.  

However, if the root of the trouble lies in continuing nose- or facial sinus- infections, then focussing on the chest rather than the nose may not now be correct targetting.  I note that you say, you are now "stuffier than ever" in the nose.

You can yourself test, to a degree, for sinus infection, -  

- - (1) Try bending forwards, this puts pressure on the facial sinuses and they should get more painful,

- - (2)  During the day, blow your nose thoroughly and empty it fully of phlegm.  Then lie down flat on your bed, on your tummy, with your head hanging over the edge of your bed.  Let your head drop down, so that the *top* of your head points down towards the floor, (in this position your head is completely upside-down).   In that position, with your head upside-down, try blowing your nose again.  If a lot of new phlegm suddenly appears in your hankie, it has come from the 'maxillary' sinuses below each eye, whose drain-holes are located at the *tops* of these sinuses, (where in the normal standing-up position, gravity hinders drainage).

If these tricks are revealing, or even if they're not,  - -    I think you might well pursue the possibility of sinus infection by asking your doc about it, and maybe ask about an X-ray of your 'maxillary' sinuses.

'Old tricks' to help clear the sinuses of phlegm, include sitting in a home-made 'steam-tent,' made with a large towel over your head, and a basin of boiling water underneath.  The rising steam helps to flush out the retained sinus phlegm.  

***  Please be extremely careful, if you decide to try this,  not to upset the bowl of boiling water, or you will scald yourself badly, and let no children or adults into the room who could surprise you.  ***

Antibiotics can help sinus infections (I am stuck on this tack now, but please bear in mind it is only my supposition!!), - - but they tend to be a different choice, often.   Nose lining-shrinking nose-sprays like Xylo-metazoline, (pronounced ZYE''- lo  - Met -AZE'' - o -leen), can also help, and can be bought over-the -counter.

I hope this is of some help, and not too confusing.

Best wishes,

Belliger (retired uk gp)