A constellation of symptoms

[james33]

Hello, I have been having some most unusual symptoms since about early October.  Initially, I had a very mind sinus issue which cleared rather quickly, then I developed this tight heavy feeling in the middle of my chest which I also felt in my ribs and throat at times.  This feeling made my chest wall feel tight and constricted and made me feel like I could never get a good deep breath of air, and all the time my chest felt as if it had a weight inside of it.  This symptom lasted for about 6 weeks, and then started to improve (but not go away completely).  When the improvement started, I started feeling very lightheaded constantly and disconnected from my surroundings.  I will have headrushes and vertigo spells where it feels like I may faint briefly.  But almost all the time I feel disconnected and lightheaded.  This part of the symptoms has been going on 2 weeks.  Also, 2 weeks ago, my ears started sounding crunchy when I hold my nose and blow air into them, but they are not really stopped up per se.   Also, I am a regular exerciser, and none of my symptoms get that much worse when I exercise, although, exercise does greatly provoke the lightheadedness so I've been down and out much lately.  For example, just today I tried to do cardio and instead of breaking a sweat, I just started to itch all over and got extremely lightheaded and had to quit after 10 minutes, and I still feel very lightheaded right now, which was triggered by my attempt to exercise today (I thought I was feeling better this morning, my mistake!).  Very weird.    Is this something that will clear up or could there be something going on?    The first week (back in early Oct) I saw my doctor who did a Chest Xray and standard labs, all negative.  I am 33, male, history of smoking tobacco as well as marijuana (none in 3 yrs). No medications presently, no other drug history. No alcohol.

[David Tinkelman, M.D.]

Your symptoms are, indeed, both unusual but not uncommon.  They are the type of symptoms that can occur on the basis of physical disease or emotional distress.  The distinction between the two can be difficult, as the physical symptoms can, not surprisingly, cause one to experience a lot of emotional turmoil.  I believe that that these symptoms are serious enough and worrisome enough to warrant further investigation, by an expert diagnostician.  

You state:  then I developed this tight heavy feeling in the middle of my chest which I also felt in my ribs and throat at times.  This feeling made my chest wall feel tight and constricted and made me feel like I could never get a good deep breath of air, and all the time my chest felt as if it had a weight inside of it.  This symptom lasted for about 6 weeks, and then started to improve (but not go away completely).  

This symptom and your recent response to exercise raises the possibility of diseases that involve the heart and/or lungs, either as the primary disease of one of those organs (for example coronary artery disease, abnormal heart rhythms or respiratory disease such as exercise induced asthma) or as a manifestation of a systemic disease that is effecting your heart or lungs.  With regard to systemic diseases, two diseases come to mind:  Mastocytosis and Anaphylaxis.  Were the itching accompanied by hives (urticaria) would add allergy to the equation.  The abstract, below, addresses this possibility.

It would be most important that you be observed by a physician skilled in the diagnosis of cardio-pulmonary disease and the diagnosis of systemic diseases that might cause your symptons. The observations would be most helpful when any of your symptoms are present spontaneously or in response to exercise.  Should an exercise study be performed, it should be done in a very safe medical environment, should emergency care be required.

It is my sense of this constellation of symptoms that the underling disease is serious, may be one not within the scope of practice of the average medical practitioner and that accurate diagnosis and treatment may require consultation with a physician at a major medical center, such as the Mayo Clinic, the Cleveland Clinic, the Johns Hopkins Medical Center, the Massachusets General Hospital or the University of California Hospitals in San Francisco.  Should none of these be in proximity to your home, the nearest Academic University Medical Center would be my next choice, preferably with a physician in the Department of Internal Medicine or a specialist in Immunology and Auto-immune diseases.

Should you have confidence and good rapport with your current physician(s), I strongly suggest that you begin by sharing this response with them.  Whatever you do, please take action to get at the heart of this matter.

I would be most interested in the outcome of your evaluation.

Good luck,

The abstract follows:

Authors Full NameChong, Sie-Uen. Worm, Margitta. Zuberbier, Torsten.
InstitutionDepartment of Dermatology and Allergy, Charite, Humboldt University Berlin, Campus Mitte, Schumannstrasse 20/21, D-10117 Berlin, Germany.
TitleRole of adverse reactions to food in urticaria and exercise-induced anaphylaxis. [Review] [49 refs]
SourceInternational Archives of Allergy & Immunology. 129(1):19-26, 2002 Sep.
AbstractIn urticaria, adverse reactions to food are only a frequent finding in the subset of patients with chronic continuous urticaria. Mostly these reactions are of pseudoallergic nature, directed against artificial additives as well as naturally occurring aromatic components. IgE-mediated allergic reactions are a rare cause in acute urticaria as well as in recurrent chronic urticaria. In other types of urticaria, e.g. physical urticaria, food plays hardly any role as an eliciting agent with the exception of ice-cold drinks in cold urticaria. By contrast, exercise-induced anaphylaxis is frequently food-dependent. Two subtypes are distinguished: unspecific food-dependent exercise-induced anaphylaxis (FDEIA), where the filling of the stomach independently of the kind of food ingested prior to exercise is responsible for the symptoms. In specific FDEIA, an IgE-mediated food allergy causes symptoms only in combination with exercise. In the latter group, wheat is an important allergen. Copyright 2002 S. Karger AG, Basel [References: 49]

[james33]

PS--  In the 2nd line, I meant to say "Mild" sinus issue, not "mind"

Also, i've not have any fever or cough