In Medicine and in any other field persistence. If one wants to do a surgery -more one does he gets better . The same hold true for shooting baskets . But sometimes one has to dig deep to get to the bottom of the problem. In medicine that should be the rule. That brings me to the story for today.
I saw this young lady for consultation. She was in her twenties. She had not been smoker and has been physically active , going to gym and not having any problems with breathing. But her boyfriend had noticed some wheezing when she was sleeping .So he told her to see me .She was young lady and had not been smoker and had no other health issues . She had good oxygen saturation and had clear lungs and no wheezing. She had no shortness of breath even when she was running on tread mill. So I was not sure as to what and how to treat . Here is a patient who has clear lungs and has no shortness of breath and only time there is abnormality is noticed is when she is sleeping and that too by her boyfriend . We did a chest x- ray and did breathing test. She had normal chest x- ray and the breathing test showed that she had asthma - obstructive pattern on spirometry. This happens when bronchial tubes collapse with exhalation. So I gave her an inhalers . She come back for the follow up. I asked her if she finds any difference. She told me she tried the inhaler for short time but she has no cough ,no shortness of breath and no wheezing and so how can she see the difference - difference in what ?I told her to use the rescue inhaler as needed in case she is short of breath or has bronchospasm. But I decided to do new breathing test in 3-4 months . She did the test and the report was same . She had same obstruction . In the first test I had noticed abnormality in one part of the test called flow volume loop . That was seen in the second test too. I was concerned but I had not noticed any strider on trachea and so I was not sure what to make out of it. But this time she wanted me to clear her for surgery for breast augmentation. And I needed more test to make sure that she did not have problem with trachea -the main wind pipe. She was not very happy as I would not clear her unless she had done further testing . I did CT scan . And there it was .She had abnormal aorta and and abnormal blood vessel crossing the trachea making it narrowed . That would explain the abnormality seen on flow volume loop and perhaps other part of the tests .Her trachea would collapse when she forcefully exhaled or when she was supine .My feeling is that the trachea may not be fully developed or may be not have enough cartilages and support and may be fibrous and so she had no problem when she exercised as that part could stretch and no air flow obstruction could occur, but the test did show abnormality.
I have sent to a tracheal - chest surgeon and he wants to do additional tests. The jury is out as she has not done the tests yet.She is thinking about it.
