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My PFT Tests Show Normal Spirometry; However, I Have Confirmed
Question: My PFT tests show normal spirometry; however, I have confirmed low DLCO (1st test 41% predicted value, 2nd test 37%). The second test was done in the box. CTs and Xrays (with and without dyes) show no abnormalities of the lungs. Right heart catheter shows no pulmonary arterial hypertension. Echocardiograms show a small shunt that did not increase with exercise (have done 3 in all)
As a boy scout I would trail the troop by an hour or so on an all day hike at altitude (7000+ feet). Excellent sprinter, but after more than a couple hundred yards would develop shortness of breath symptoms. Tried cross country in high school to get fit - pure torture.
Symptoms seemed to subside around age 19. Began snow skiing. Even went on a mine tour at 15,000 feet in Bolivia at the age of 42. The symptoms did not completely go away as I did see a doctor around the age of 30 who mis-diagnosed me with exercise induced asthma. (Inhalers never worked)
I have been taking one to two trips a year at altitude (6000 feet). Trips normally last two or three weeks. At around gae 55, I started to notice symptoms when walking uphill (up a slope) and they have been getting worse each year. This year I cut my trip short. This year they ordered the diffusion test for the first time (I had had the other PFT's prior). I am 63. 5'10", 160 lbs.
My pulmonologist (at least 24 years experience) and his colleagues seem to have covered all the standard tests. Any ideas?
As a boy scout I would trail the troop by an hour or so on an all day hike at altitude (7000+ feet). Excellent sprinter, but after more than a couple hundred yards would develop shortness of breath symptoms. Tried cross country in high school to get fit - pure torture.
Symptoms seemed to subside around age 19. Began snow skiing. Even went on a mine tour at 15,000 feet in Bolivia at the age of 42. The symptoms did not completely go away as I did see a doctor around the age of 30 who mis-diagnosed me with exercise induced asthma. (Inhalers never worked)
I have been taking one to two trips a year at altitude (6000 feet). Trips normally last two or three weeks. At around gae 55, I started to notice symptoms when walking uphill (up a slope) and they have been getting worse each year. This year I cut my trip short. This year they ordered the diffusion test for the first time (I had had the other PFT's prior). I am 63. 5'10", 160 lbs.
My pulmonologist (at least 24 years experience) and his colleagues seem to have covered all the standard tests. Any ideas?
Brief Answer:
Get done lung biopsy, hormone levels.
Detailed Answer:
Thanks for your question on Ask a doctor forum.
I can understand your concern.
I have gone through the detailed history you have given.
In my opinion, you should convince your doctor for following tests.
1. Lung biopsy - because you had low DLCO. So better to rule out interstitial causes. Chances are very less because of normal CT scans.
2. Detailed hormone work up - Hormonal imbalance do occur in males also.
3. Trial shunt repair - This is very difficult to get done but if all things are normal then this is the last option - Trial and error.
4. Test for methemoglobinemia - again this is very rare but can cause similar symptoms.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Get done lung biopsy, hormone levels.
Detailed Answer:
Thanks for your question on Ask a doctor forum.
I can understand your concern.
I have gone through the detailed history you have given.
In my opinion, you should convince your doctor for following tests.
1. Lung biopsy - because you had low DLCO. So better to rule out interstitial causes. Chances are very less because of normal CT scans.
2. Detailed hormone work up - Hormonal imbalance do occur in males also.
3. Trial shunt repair - This is very difficult to get done but if all things are normal then this is the last option - Trial and error.
4. Test for methemoglobinemia - again this is very rare but can cause similar symptoms.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi Doc:
Thank you for your response. Follow up question:
Re: hormone work up - what type of unusual result would the doctor be looking for?
Re: methemoglobinemia - is there a reason the symptom of dyspnea would occur under exercised induced conditions and not conditions at rest.
D.
Thank you for your response. Follow up question:
Re: hormone work up - what type of unusual result would the doctor be looking for?
Re: methemoglobinemia - is there a reason the symptom of dyspnea would occur under exercised induced conditions and not conditions at rest.
D.
Brief Answer:
Hypothyroidism should be ruled out.
Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
In hormonal imbalance, hypothyroidism, low Cortisol levels should be ruled out.
Sorry to say but I don't understand your methemoglobenemia question.
Can you please elaborate more on this?
I will be happy to help you further. Wish you good health. Thanks.
Hypothyroidism should be ruled out.
Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
In hormonal imbalance, hypothyroidism, low Cortisol levels should be ruled out.
Sorry to say but I don't understand your methemoglobenemia question.
Can you please elaborate more on this?
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Kampana
Answered by
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