Question: Hi Doctor,

If I could get a response it would be greatly appreciated. Sorry if this seems too long, but I'd like to give an accurate picture and start from the top...

I had my appendix removed in Dec.'11 (8 mos. ago), and haven't felt quite right since (my current issues may or may not be related, this is just when I first began having issues). I went to the ER complaining of the classic appendicitis symptoms, so they did an abdominal CT scan, and saw that it was slightly inflamed and went for surgery. Also on the scan were 2 "small" cysts on my ovaries. Following the appendectomy, I had nausea (which was typical) for 6 months (which is not typical). My GP and several OBs said the nausea could be related to my cysts. So, I had an ultrasound on my ovaries, and they found that I had a 3cm and 4cm cyst on each ovary. They considered these to be normal and fluid-filled, so they ruled out cancer. They started me on a low-dose birth control. After my follow-up ultrasound showed that I still had the cyst (only one and 3cm this time), they urged me to stick with the birth control. Around two months later, I began having back pain around my left shoulder - towards my spine. I also suddenly had a tickling in my chest that, when I forced myself to cough, sounded like a XXXXXXX hacking cough, but was non-productive. I am also unable to take a XXXXXXX breath without a tight pain around my chest cavity. Because of this breathing difficulty, I am also very anxious. I went back to my GP, concerned that I might have a pulmonary embolism. She did a Chest CT, and everything came back clear ("likely" no embolism, pericarditis, or pleurisy). So, I left without a diagnosis. I came back 1 month later because the back pain, SOB, chest tightness, and tickling in my lungs was still present. I told her I could only force myself to have that hacking cough when I take a XXXXXXX breath, that I didn't have a naturally occurring cough, just the need to clear my chest. She responded with, "Oh, I can make myself do that too XXXXXXX This cough is not pleasant sounding, and I have never been able to "make myself" do this before. I know something's not right at this point. Now, within the last 3 weeks, I stopped my BC (I have had issues in the past with finding one that worked with me), and have noticed constant breast tenderness, sharp pains in my breast and armpits, and difficulty keeping a bra on b/c of tightness around my chest. I would just like to know what's going on, if any of this seems related, and if cancer can be ruled out (my biggest concern).

Some things to know:
-I am 24 y/o female
-Overweight
-Have had abdominal ct Dec. '11
-Chest CT March '12 (all clear/normal)
-3 ultrasounds (all pos for at least one 3cm cyst)
-1 abdominal ultrasound for gall bladder, liver, and pancreas (all clear/normal)
-Current problems: breast/chest/armpit soreness and sharp pains occasionally, upper back pain near shoulder spine area still present (this pain is in a very specific small area), trouble taking XXXXXXX breaths, SOB, tickle in chest and forced cough, anxiety as a result, occasional heartburn, pain worse at night.
-Have considered everything from GERD, muscle spasm in my back, cancer (breast, lung, ovarian), IBS (post-surgery, I had bouts of diarrhea/constipation that lasted a solid 3 months)
-Family hx of cancer (mother-lung) and heart disease (father).

*My GP seems unwilling to take my problems seriously, but you know when something's wrong with your body. Thanks again for any help!

Hi Dr. Maji,

Thanks for your reply. In response to your questions:

1. My cough is more intense at night. Though I have a history of allergies, this doesn't seem to be a reaction to an allergen. Again, the cough is only present when I take a XXXXXXX breath and force air out.
2. Chest tightness is also more profound at night, not morning.
3. The breathlessness seems to occur randomly, not at any particular time of day or during a particular activity. For instance, I was driving my car and suddenly just felt the tightness and breathlessness.
4. I stopped the birth control on my own 3.5 weeks ago. I thought I needed to stop in order to determine if it was causing my symptoms, and rule out a birth control effect.
5. The cough and SOB have never woken me of sleep.
6. Non-smoker
7. I am a research assistant, which is rarely stressful, though at the very start of my chest pain (3 mos. ago), it was particularly stressful since we began a new study.
8. I have noticed a decline in my ability to perform daily functions, but only somewhat. I am still able to accomplish everything, I just have these symptoms to deal with in addition.
9. My cough does not produce expectorant/sputum.
10. 5'8", 225 lbs.

I need to add that I have had an ECG done (around 3 mos. ago, before my chest CT scan), and it read "abnormal XXXXXXX but did not show any significant problems. I was told it was common to have an "abnormal" readout. Also, my doctor cleared me of heart problems by my CT scan. I see that you mentioned pleurisy; would that not have been caught by the CT? I am unsure what the CT scan really rules out.

I have an appointment with my OB for a follow-up ultrasound, and I am going to mention my breast issues. The new breast issues are probably related to my quitting the birth control and hormonal imbalance, but I will have her examine.

I thank you again for consulting with me. I understand it seems like my symptoms are not worrisome, but because of the cancer and heart disease history in my family, I am concerned. I have begun a plant-based whole foods diet, in hopes of losing the excess weight, and gaining overall health.

Again, it's the chest/back pain and chest tightness that concerns me.

Thank you again,
XXXXXX