pleuritic chest pain - really bad

• Yes, I know you are not my doctor. Yes, I have been to see a doctor. To date, no diagnosis and no drugs prescribed, a lot of pain that shows no signs of going away. Background: I have a chronic cough (5+ years) plus some combination of OCD and generalized anxiety disorder (see below), which I am currently getting treatment for. I *think* what is going on is pretty simple --- I think I have the flu, and I think it has interacted with my chronic cough in a really destructive and painful way. The first night it started up (two nights ago) -- I had a mild fever and painful inspiration + some dizziness, so I went to the emergency room thinking it was a bad case of the flu. They listened to my lungs, didn't hear anything, gave me ibuprofen and sent me home. Yesterday it was worse, so I went to see my PCP, who sent me for a barrage of tests -- I got a chest X-ray and a host of blood tests for pneumonia and other bacterial infections. All the tests came back just fine. On the way home from the hospital my lungs seized up in the car and had to pull over because I couldn't breathe -- I was totally panicked and gasping for breathe, and a passerby called an ambulance which came and gave me oxygen for about twenty minutes. It passed pretty quickly and I called a friend for a pickup. I declined going to the hospital since I had *just been there* twice, and it didn't make sense to go back for more of the same (to date, it's been "take ibuprofen and drink lots of fluids") Whatever is going on with me is NOT normal. I have never had anything like this before, and it's very scary. I do not, as far as anyone can tell, have anything in my lungs - no cysts, no mucous, no bacteria, no weird growths. At the moment, though, it feels like the bottom portion of my lungs have completely collapsed -- breathing is very shallow and painful, and occasionally flares up in an excruciating way that takes over my entire front chest area - lungs, diaphragm, chest, the whole thing just feels like it's on fire, and every breathe is really really painful. I don't have any other symptoms of the flu (I had a mild fever the first night, but since then nothing) --- just constant back pain and occasional seizing up of my chest cavity, which makes it fucking difficult to do anything at all. The main problem at the moment is that I can't get anyone to give me anything for the pain since I am on Ativan which interacts poorly with painkillers of the sedative variety (see below) **Background context** Again, I think what's going on here is pretty minor -- I think I have the flu, which is interacting with this cough and sending me into the land of stabby chest pain. I have a chronic cough going on five years which is also undiagnosed (they're working on it). Chest X-ray + TB test last year came back clean. Pulmonary Function Test this year came back clean. Most recent chest X-ray came back clean. I've met with an ear nose and throat specialist who declared me totally healthy, except for the constant cough and throat clearing. I have a barium swallow scheduled for tomorrow to see if it's GERD, though I may not wind up getting over there if I feel the way I feel today. I also have "anxiety" which comes with a host of entirely different symptoms, which is what I'm taking the Ativan for. The anxiety attacks have been tapering off recently (thank god) and are of an entirely different variety --- I am seeing both a psychiatrist and a therapist and an on medication and the whole shebang. The panic attacks aren't real -- they're terrifying and overwhelming, yes, but not of the variety that will make you collapse on the sidewalk because you cannot breathe. But I have them. Consequently, I have a lot of doctors who are unwilling to prescribe me anything for pain because of the Ativan. Obviously when you can't breathe it ups your anxiety, but the thing I am more concerned about is that there is real pain in my chest that I can't get diagnosed or treated. More to the point, I am currently *in* a lot of pain, to the point where I can't drive and can't sleep, which seems to be moving swiftly out of the "ibuprofen and fluids" category of management. At the moment I am resorting to a careful combination of whiskey and Ativan to help me fall asleep at night --- otherwise I'm on the floor, coughing and hurting and awake until three in the morning trying to find a position that doesn't make my chest feel like it's on fire. Yes, I know that's bad, but every doctor I've seen has been unwilling to prescribe a painkiller in spite of being in clear and visible pain *in their office* - so you know, there's that. Like I said, I've been to the ER, been to see my PCP, had a chest X-ray and blood tests and spent last night hanging out with a team of EMT's -- so "GO TO THE HOSPITAL" is not useful advice here. Likewise, please don't yell at me for trying to solve my own problems drug-wise -- like I said, I am in a non-negligible amount of pain. Any ideas? Anyone had these symptoms and had it turn out to be something totally banal? All that sounds very dramatic, but at this point I've knocked all the scary stuff all the list -- lung cancer, tuberculosis, pneumonia, pleuritis. Now I'm just left with a pair of lungs that hurt a whole lot, a bunch of doctors who are unwilling to prescribe me anything, and the dubious task of figuring out my own drug combinations, which nobody (including me) thinks is a terrifically good idea.

• Answer:

  Is there a reason you haven't had a CAT scan or another diagnostic test? I ended up getting diagnosed (after weird breathing pain, though nothing that bad) with borderline asthma, which was just flaring up in a seriously painful, chest-rending way between environmental conditions and bad interactions with certain inhalers. The CAT scan showed I'd also had pneumonia at some point, which I didn't know, and it at least ruled out the really scary stuff. Have you been to see an actual pulmonologist, or just a GP + ER docs? If you mention something like "can't sleep, breathing hurts too much, medicating with whiskey" you should be able to get an appointment really, really soon.