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What does my scanning test suggest?

Q: I am 52 years old male suffering from cough and cold for the last eight years and have taken treatment also. I underwent tests - scanning, PFT, x-ray, chest fluoroscopic screening. Features are in keeping with right hemi-diaphragm paralysis. In the scanning test, the impression is elevated right diaphragm with no evidence of mediastinal shift, calcific specks in left lobe of liver -suggestive of granulomas and right renal microlith. Now I am taking tablet Synasma, Syroflo 250 (inhaler) Salmeterol and Fluticasone. Please advise.

A:I see that you have had complaints of cough and cold for the last 7-8 years or so. I also see that you have had extensive testing done and have been noted to have a few abnormalities namely kidney stone (renal microlith), granulomas in the liver (suggestive of old healed infection), and right hemi-diaphragm paralysis. I will try to concentrate on your respiratory issues namely cough, cold and right hemi-diaphragm paralysis. With regards to your cold and cough, I suspect your physician is treating you for asthma based on the medications that you have been taking. However it is very possible that your cough could just be related to a very common condition called as post nasal drip (which can be caused by runny nose - commonly referred to as cold). The treatment in such a scenario would be to identify the cause of runny nose / sore throat and treat it accordingly (recurrent runny nose can be caused by allergies, nasal polyps, recurrent sinusitis, etc). The treatment for these conditions could vary from nasal steroid sprays (like flexinase) to antibiotics to some surgical procedures (polypectomy) and this can be decided by an ENT physician or your pulmonologist. I suspect your runny nose could be the cause of your cough but that does not mean that you cannot be having super imposed asthma. Without having the benefit of reviewing your PFT results and the other results, I would defer the decision to treat or not to treat you for asthma to your personal physician. However I do have some reservations with regards to the medications that you are currently on. There have not been good trials to show the benefits of medications like deriphylline in the treatment of asthma or COPD. Personally I hardly ever use those meds and on top of it using another medication (Synasma) which is very similar to that makes no sense to me. So I recommend that you talk to your physician about these medications. Finally, with regards to right hemi-diaphragm paralysis, based on the information that you have shared with us, I can't figure out the cause for it (like any prior neck surgeries, thoracic or abdominal surgeries or neuropathies). It can be idiopathic (cause unknown) in some instances and that will be the case if all other known causes are reasonably excluded. Unilateral (one sided) palsy hardly results in significant symptoms in most patients, who are otherwise healthy and usually causes shortness of breath on exertion and / or shortness of breath on supine (lying down) position. In your case, since you are not complaining of any shortness of breath, I suspect this is not contributing to your complaints much. I don't think cold and cough are the typical symptoms associated with diaphragm palsy and at this stage I suspect it is of no clear significance. However, your personal physician will always be at the best position to advise you about your health concerns and I advise you talk to them directly about all your concerns. One thing not noted in your history is your smoking status. If you are a smoker, I strongly recommend that you quit smoking since that will be the most cost effective treatment in alleviating most of your symptoms. Good luck and hope you start feeling better soon.

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