Brief Answer:
Possible panic attacks?

Detailed Answer:
Hello and welcome,

I do want to make sure he was evaluated for asthma, not just oxygen levels. If he has any wheezing or coughing during these episodes, an allergist would be appropriate to evaluate him. The allergist will test peak flow breathing tests too. This shows how much air he is moving.

If your son does not have any underlying respiratory problems, I am going to suggest something else: panic attacks. Panic attacks come out of nowhere, do not have to be associated with any conscious feelings of worry at the time the attack happens, and are not under conscious control (although there are things that one can do consciously to help relieve them). Panic attacks can happen even when a person is sleeping, waking them from sleep in a state of distress. Usually panic attacks happen during a period of time when there may be something else that is anxiety provoking going on. For example, my teenage daughter, a few weeks before she was going to travel to another country with a teacher and not her parents, began having panic attacks. They would come out of the blue and were not preceded by any stressful event. Just sitting in English class listening quietly to the teacher could bring them on. But having some underlying stressful event is not the case with everyone. Sometimes people who have a history of anxiety problems can develop panic attacks without any predisposing factor.

If panic attacks only happen occasionally, lorazepam or alprazolam can help, but can be very sedating. But for overall treatment and prevention of them, an SSRI such as Lexapro can be very helpful. Lexapro takes a couple weeks to work start working well. Benzodiazepines such as a low dose of lorazepam can be used along side of them until the Lexapro starts to help, but again, these can be sedating.

Mindful breathing can help (sometimes) during panic attacks. For example, try to get your son to count his breath in for 4 counts, out counting to 4, then repeat for 4 more breaths. Do this for 4 breath cycles and begin again. Initially do this for 4 minutes total, but increase time gradually as he gets better at it. He should do this at least once a day, and as he gets used to it, try to do this during one of these breathing episodes. Tell him to focus on counting his breaths. Remind him that his mind will wander to other thoughts and distractions, and when it does, he should gently acknowledge this, and return his thoughts to counting his breaths.

Regarding the Traditional Chinese Medicine practitioner's analysis that it is his gall bladder, the practitioner is likely referring to the Chinese medicine concept of gall bladder. This is different from the western anatomical gall bladder. TCM works on blocked energy via meridians that are not delineated in western medicine. So it is possible that there is a problem with the TCM view of the gall bladder, but likely not his actual anatomical gall bladder. I value and respect TCM, but know that the language between TCM and western medicine is not interchangeable.

I hope this information helps. Please let me know if I can provide further information or clarification.

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Brief Answer:
Need further medical evaluation.

Detailed Answer:
I didn't realize he is in a state of chest tightness or difficult breathing all the time. Panic attacks are not a continuous state.

If this has become a chronic state, I think he needs further evaluation.

I do not know what his primary care doctor did to evaluate him so far. I assume that he or she listened to your son's lungs (and heart?) and put a clip on his finger to measure his oxygen level. Oxygen levels can remain high even during states like asthma and sometimes only deteriorate in extreme situations.

I suggest that, given he is having difficulty breathing all the time to some degree, he have a chest Xray. Probably also an EKG just to make sure there is no underlying heart arrhythmia (irregular beats or patterns) although I think this is less likely. He should be seen by his primary care doctor again, with the new information that his chest tightness seems to be getting worse (more often or continuous).

If you can get an appointment with an allergist or pulmonologist (lung specialist) in the near future you can consider going directly to them. Preferably a pediatric one, but not absolutely necessary.

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Brief Answer:
Your welcome

Detailed Answer:
I hope you are able to find out soon what the problem is so he can get help.

If this discussion is closed after he is evaluated, and you are still subscribed to HCM, if you don't mind, I would like to hear how he is doing. You can contact me by posting a new question with my name at the beginning of the first line.

Best regards,
Bonnie Berger-Durnbaugh, MD (or "Dr. Bonnie")

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