medical advice on chronic cough

[Case]

I am asking here because of limited options.  I have seen multiple primary care physicians; however, the town I live in has bad medical care, and the primary cares don't seem to care and have ordered a few tests which haven't gotten us anywhere.  Therefore, I am forced to be my own doctor.

I have had a chronic cough for years.  It may be linked to GERD (undiagnosed).  I had chronic heart burn for years, and eventually I learned that it would go away if I limited my consumption of bread/carbs.  But, the cough remains.  I am typically coughing up colorless mucus (e.g. excess mucus triggers the cough).

This is not a major medical impairment at present, but I'd like to try to take care of it now rather than die of god-knows-what in 30 years. 

Relevant data:
-I have had a chest x-ray (ordered by primary care doc):  everything looks good.
-My father has GERD and severe heartburn
-I have tried mucus reducers (mucinex) which have no effect

The advice I'm looking for is what type of specialist to see, and/or other general approaches to treating myself.  I am thinking to see a gastroenterologist and having an endoscopy, but perhaps there are other things to consider.  Endoscopies are one of those procedures are often run unnecessarily because they are easy money for hospitals.

[sjc0816]

What is your diet like?  I would immediately eliminate all dairy products and sugar.

[swick]

Don't have any test suggestions, but my mom got rid of her chronic lung inflammation and mucous cough by giving up wheat AND dairy. The dairy is a BIG one.

All my chronic sinus issues have disappeared if I avoid it as well. Since you are up for being your own doctor anyway, why not try a 30-day food elimination experiment? Lots of people here doing various stages of Whole 30. http://forum.mrmoneymustache.com/throw-down-the-gauntlet/whole-30-starting-sept-8th-want-to-join-us/

[smilla]

+1 on eliminating dairy for a month. 

Another thing you should try is chewing your food a lot more, say twice as long as you currently do. 

[wenchsenior]

As others have said, try cutting dairy.

[NeonPegasus]

Yes, cut dairy. It'll take a few weeks for it to be out of your system.

If that doesn't work, yes, see a gastroenterologist.

[iluvzbeach]

I had the same issue and my doc suggested one over the counter omeprazole each night just before dinner. Problem solved. You may want to consider the same.

[Glenstache]

I would recommend not making random changes in diet to attempt to resolve a chronic medical condition. See if you can get a remote consult with a better doctor (GP or specialty) in whatever the nearest metropolitan area is. You may have more than one contributing issue. GERD can result in esophageal conditions over the long term, which will no longer be diet related.

Seriously: if the problem is poor medical advice in your local area, get better medical advice elsewhere. Anecdotal (and well intentioned!) advice from friends is no substitute for 10,000 hours plus of appropriate specialized training.

[Case]

What is your diet like?  I would immediately eliminate all dairy products and sugar.

I consume smaller amounts of both, but can always go lower.

[Case]

I had the same issue and my doc suggested one over the counter omeprazole each night just before dinner. Problem solved. You may want to consider the same.

I have used omeprazole before, and only as a last resort (when heartburn was unbearable).  I do not want to use it long term; lots of long term effects.

When I have used it, it does fix the heart burn; i don't recall if it got rid of the cough; probably not.

[swick]

I would recommend not making random changes in diet to attempt to resolve a chronic medical condition. See if you can get a remote consult with a better doctor (GP or specialty) in whatever the nearest metropolitan area is. You may have more than one contributing issue. GERD can result in esophageal conditions over the long term, which will no longer be diet related.

Seriously: if the problem is poor medical advice in your local area, get better medical advice elsewhere. Anecdotal (and well intentioned!) advice from friends is no substitute for 10,000 hours plus of appropriate specialized training.

While I totally agree with this, there is no harm in doing an elimination diet for a month and slowly reintroducing things to see how your body responds to them. The more information you have when talking to your doctors will help them too.

[GizmoTX]

My grandmother was 'famous' for her chronic cough. Three years ago, I started having it. After friends died from lung cancer & esophagus cancer, I became sufficiently alarmed to at least rule those out & find out what was happening. I started with my internist, then an ENT doctor, who eventually referred me to a pulmonary doctor. An endoscopy ruled out Barrett's esophagus (a cancer precursor) but confirmed GERD. I now have asthma induced from the GERD; I rarely have heartburn but mucus is a problem. I'm taking omaprazole (Prilosec) daily, would rather not, but my cough is severe without it. I suspect that I'm getting to the point where I need to consider a procedure to fix my esophageal sphincter.

[geekette]

If you can calm the GERD, the cough may go away (did for my sister).

I have a chronic cough (due to surgery that unfortunately rendered one vocal cord useless, so I have a particularly weak cough). It's really only bad when I have a lot of mucus, such as during a cold and for weeks after, and mostly when lying down, so what works for me may not work for you.

At any rate, if a cough drop doesn't help, I take a low dose of a codeine cough syrup with guaifenesin (brand name Cheratussin AC).  It calms the tickle for me within minutes. My doc prescribes a bottle or two a year for me, but it's available "behind the counter" in some pharmacies in some states.

Another thing that an cause a chronic cough is an ACE inhibitor, generally prescribed for blood pressure. I would hope your doctor knows this, though.

[SimpleCycle]

14-28 days of empirical treatment for suspected GERD is a totally reasonable way to see if GERD is the problem.  Even if you don't want to be on omeprazole long term, taking is for a month and seeing if the cough improves would be a pretty clear rule out.

[NoStacheOhio]

Where are you located?

An ENT or pulmonologist is the logical specialist, depending on your insurance referral requirements. How far is your nearest teaching hospital/university-affiliated medical center?

[Beardog]

One thing I've found helpful in relieving cough is using a neti pot.  While this doesn't help you with diagnosis, it may bring you some relief, it's inexpensive, and no medication is involved. 

[iowagirl]

I agree with removing the dairy and sugar. Sugar leads to heartburn and dairy causes mucas. If you must have dairy try goats milk or nut milks as a substitute. Also use a neti pot to clean out any mucus residing in the nasal passages.

For the cough my doctor told me to use cepacol spray to numb my throat to help stop the cough reflex. Other brands haven't work well for me. That being said you want to cough up any mucus you have or it will lead to other problems so don't do this until you get what is causing the mucus worked out.

I mentioned to someone else that it never hurts for anyone to try and AIP diet for 1 month and then add things back in to see what they can and can not tolerate. It works, I've done it. Heartburn and gerd are both symptoms of digestive issues which can be something as simple as a food allergy or intolerance or it can be a serious issue.

You should still try to find a good doctor in your area to help you rule out other conditions as well.

[NV Teacher]

It's the dairy that causes me trouble.  I quit drinking milk and went through a period of what I'll call "mucus elimination".  Strangest thing I've experienced I'll tell you.  I like dairy but all it takes is one ice cream cone or a yogurt and I cough and clear my throat for days.  So much easier to skip the dairy and get my calcium with dark green veggies and a supplement.

[bugbaby]

Have you tried a daily inhaler such as symbicort or advair?

Sent from my Nexus 5 using Tapatalk

[acroy]

Could be diet, environment, or something chronic (disease/condition)
You could –
-try an elimination diet
-Try a HEPA air filter (in bedroom & in work space if possible). If you wake up feeling awesome, then it gets worse, then something’s in the air… apparently a lot of people suffer from poor interior air quality: high humidity, mold spores, etc.
-try blood allergy testing. Pretty good cheap option for general ‘troubleshooting’. We just did this for my 4yr old who is always snotty and developing asthma. Turns out the poor guy is allergic to eggs. About $200 for a panel of 80-100 food/environment allergens.
-ENT. A good ent should be able to figure out what is going on. This may be the most expensive option though.

Good luck!!!

[GizmoTX]

Have you tried a daily inhaler such as symbicort or advair?

The inhaler does nothing for me.

[better late]

Do you take any other medications?

[Indio]

Check out mercola.com and subscribe to his emails. He says gerd is the result of not enough stomach acid and probiotics. Recommends apple cider vinegar in water before meals and probiotic supplements. I know it sounds counter intuitive.
As for docs  to see, have you tried allergist? You can find out if it's food or enrvironment that is causing cough.
Edit: not a medical professional in any way shape or form. Just adding the disclaimer I see all the lawyers put on their posts.

[the_gastropod]

Check out mercola.com and subscribe to his emails. He says gerd is the result of not enough stomach acid and probiotics. Recommends apple cider vinegar in water before meals and probiotic supplements. I know it sounds counter intuitive.

Dr. Mercola is a quack. He believes in homeopathy, and earns millions of dollars scaring and or misleading people into buying unnecessary supplements from his website. He's little more than a modern day snake oil salesman. Among his absurd beliefs are these:
* Vaccines are dangerous (thimerosal in particular, which has been thoroughly debunked in every scientific study done on it)
* GMO's are dangerous
* HIV is not the cause of AIDS. And that AIDS is instead caused by psychological stress
* Cell phones cause cancer
* Sunscreen causes skin cancer

[NoStacheOhio]

Check out mercola.com and subscribe to his emails. He says gerd is the result of not enough stomach acid and probiotics. Recommends apple cider vinegar in water before meals and probiotic supplements. I know it sounds counter intuitive.

Dr. Mercola is a quack. He believes in homeopathy, and earns millions of dollars scaring and or misleading people into buying unnecessary supplements from his website. He's little more than a modern day snake oil salesman. Among his absurd beliefs are these:
* Vaccines are dangerous (thimerosal in particular, which has been thoroughly debunked in every scientific study done on it)
* GMO's are dangerous
* HIV is not the cause of AIDS. And that AIDS is instead caused by psychological stress
* Cell phones cause cancer
* Sunscreen causes skin cancer

^This^

Go see a specialist.

[Kl285528]

What is your diet like?  I would immediately eliminate all dairy products and sugar.

First place to start

[Miss Prim]

My husband always had a chronic cough and I was always clearing my throat.  We both had endoscopy and found out we both had Barrett's esophagus.  I had a really bad case of it.  We are both on omeprazole and it has cleared up a lot of our symptoms.  I am on it twice a day as my Barrett's was bad.  This is nothing to fool around with as it can lead to cancer.  I would recommend you take this seriously and see a Dr. and if they prescribe medication, take it.

                                         Miss Prim

[PharmaStache]

For those of you who cut out dairy, how extreme did you go?  Just milk?  Milk along with cheese, yogurt, ice cream, etc?  Or did you even cut out things were traces of milk can be, as if you had a dairy allergy? 

[Kl285528]

All dairy should be eliminated . My wife and I did a cleanse diet three years ago, and have stayed pretty true to that way of eating since then. We eliminated dairy, gluten and refined sugar from our diets. We also eat mostly vegan, and mostly organic. My wife no longer gets migraines, and energy levels are significantly higher and more  level throughout the day. We did something from The Whole Tulip in Charlotte, NC. Google them if interested. Oh, and we start each day with a lemon, honey and apple cider vinegar aND cinnamon elixir. You should see a significant resuction in mucus just from dairy elimination alone.

[Iron Mike Sharpe]

Try smoking a different strain.

[Abe]

You may have what is called atypical GERD. First step is to determine if you do have gerd or not. This includes seeing a gastroenterologist for EGD and esophageal pH testing. The first is to make sure you don't have inflammation of the esophagus, and more importantly a pre-cancerous change that needs treatment (2-5% risk). The second is to diagnose GERD itself. It may be less symptomatic in later stages due to above mentioned changes to the esophagus. There is only a 30% chance that your coughing is related to GERD, but the disease is serious enough to warrant those tests. If you do have GERD then the tests to see if your symptoms of coughing are related and will improve is complex but a gastroenterologist can guide you through them.

In summary: if the physicians in the area are blowing you off, get an appointment with a gastroenterologist in the area or closest big town.

[Miss Piggy]

I saw a new ENT last year for neck/throat issues (voice-related, not cough-related, though), and he clued me in to something I was not previously familiar with: silent reflux. OP, do a little research on that and see if it matches your symptoms.

This doctor weaned me off of Nexium, which I had taken for over 15 years daily. (I was not previously aware of the risks.) And he also suggested changing my diet. He strongly suggested the book Dropping Acid: https://smile.amazon.com/Dropping-Acid-Reflux-Diet-Cookbook-ebook/dp/B00ILHW4L2/ref=sr_1_1?ie=UTF8&qid=1485023164&sr=8-1&keywords=dropping+acid

Honestly, at first I thought the guy was full of it because it made no sense to me that his suggestions would fix my vocal pain. Well, the vocal pain is still there (I knew it my heart it wasn't related to acid), but I did change my diet, and damn, overall, I feel soooooooo much better. As an added bonus, I'm no longer putting my body at risk by taking Nexium every day long-term.


TL; DR: Look up silent reflux.

[MMMaybe]

Go on the Whole 30 diet for 30 days. It cuts out most of the obvious food allergens so if you get better, you can start to figure out what it may be irritating you. Wheat and/or dairy are mucous producers (if you are sensitive). However, as an aside, sourdough bread and milk kefir don't bother me as much as regular bread/wheat products or supermarket milk. So sometimes, its not the food category thats the issue, but how it was processed or made.

Mucous can be a sign of inflammation in the body, indicating an allergy or sensitivity.

I would agree that improving your digestion is key to getting rid of GERD, if thats the cause of your cough. Antacids just compound the problem but it can be resolved through diet (I was a long term stomach ulcer sufferer until I fixed my digestive issues).

Apple cider vinegar (raw, unfiltered, like Bragg's) mixed into some diluted apple juice daily. Drink through a straw.
Digestive enzymes because you may have low digestive enzymes.
Probiotics (supplement plus daily kefir)

[givemesunshine]

Don't focus only on reflux/GERD/excess mucus - recently witnessed a friend with a chronic cough finally be diagnosed with a heart condition (fixable) but it took years! Might be worth getting a full medical check to at least ensure you're considering the right root cause.

Best of luck.

[Case]

Do you take any other medications?

Nope!

[Abe]

I agree with evaluating for heart conditions if you have a family history of congenital heart defects, or any chest pain, shortness of breath walking or at night. EKG and maybe an ultrasound should be sufficient to be sure.

[Letj]

I had a regular cough and sore throat that I developed after getting the cold. It went on for months and months and even years. I saw several doctors, some of whom diagnosed me with Asthma. Finally, I got a really intuitive doctor who realized it was just a case of allergies aggravated by the cold so I was diagnosed with allergic rhinitis. I started on a non-steroid nose spray and both cough and sore throat completely resolved.

[VeggieTable]

Have you tried http://www.crowdmed.com? Crowd-sourced medicine forum frequented by MDs. Might be a potential alternative if you don't have a lot of docs in your area.

[NeonPegasus]

For those of you who cut out dairy, how extreme did you go?  Just milk?  Milk along with cheese, yogurt, ice cream, etc?  Or did you even cut out things were traces of milk can be, as if you had a dairy allergy?

If you are going to cut out dairy, it is under the assumption that you are allergic to the cow's milk protein, not that you are lactose intolerant. Lactose is a type of sugar that can cause GI distress. An allergy is related to your body treating the foreign protein as an invader.

Lactose intolerant people can often eat cheese and yogurt because of the additional processing that reduces the amount of lactose in those products.

If you are allergic to the protein in cow's milk, you need to cut out all dairy as it will be in all dairy products, regardless of the processing.

That being said, the most important thing I could tell you is to find a better doctor. As others have shown with their anecdotes, there are a myriad of potential causes. If cutting out dairy fixes the issue, you've found your problem. You should have a pretty good idea within 2 weeks. If it doesn't fix your problem, you can mark that off the list and you need to investigate other possibilities with competent medical professionals.

[Kriegsspiel]

My two cents: get your appendix taken out.

[Glenstache]

My two cents: get your appendix taken out.

That sounded like it was pretty rough. Glad you're okay.

[BFGirl]

I had similar issues and got an endoscopy which came out okay.  My issues are mainly allergies and GERD, but I was relieved to find out that I didn't have anything pre-cancerous.  I'd go ahead and get the endoscopy to rule out other issues.

I had another problem that I had ignored for years because I tried to self-diagnose and just assumed it was stress.  I finally talked to the doctor and had a flex sig scope done.  Turns out I had something that was treated with 2 months of steroids and has completely changed my life.  Another friend has similar issues and it was colon cancer.

Go get the test.

[spicykissa]

Have you tried daily ranitidine (Zantac) or another H2 blocker? Just based on your family history and the fact that omeprazole has helped you in the past, GERD is your most likely culprit for the cough. My doc has me on that instead of a PPI due to the new research on long-term risk of side effects. I don't even remember to take it every day, but it works.

Primary docs are trained to "watch and wait" (because a lot of problems do go away on their own!). So jumping from doc to doc is counterproductive--go back to the last one you saw and say you still have the problem, so they can get further down the list of possible causes.

Also, please don't minimize any other symptoms you may be having. I can't tell you how many patients I've taken care of (I'm a cardiac ICU nurse) with terrible coronary artery disease that they believed was "just heartburn". They had exercise intolerance with classic mid-sternal radiating chest pain, etc for YEARS, and only come in after finally having a major heart attack. If you are 22 and don't do cocaine, it's probably not your heart. But otherwise it's always a possibility! 

[Poundwise]

Another possibility is cough-variant asthma.

My doctor thinks I have it... I coughed clear, sticky mucus for months and broke ribs twice coughing (that is in fact how I came to start posting here! was sick and bored). Despite having an inhaler, I would feel like I was choking to death at least once a day. A Medrol (methylprednisolone) dosepack fixed me immediately both times, but if it doesn't work next time I don't know what I'll do... die, I guess. Both times it started with a bad cold... we guess that I may have had an allergy to the virus, and then my system got stuck in a cycle of self-irritation.

So that's another thing to check, especially if asthma runs in your family.

[PharmaStache]

Another possibility is cough-variant asthma.

My doctor thinks I have it... I coughed clear, sticky mucus for months and broke ribs twice coughing (that is in fact how I came to start posting here! was sick and bored). Despite having an inhaler, I would feel like I was choking to death at least once a day. A Medrol (methylprednisolone) dosepack fixed me immediately both times, but if it doesn't work next time I don't know what I'll do... die, I guess. Both times it started with a bad cold... we guess that I may have had an allergy to the virus, and then my system got stuck in a cycle of self-irritation.

So that's another thing to check, especially if asthma runs in your family.

This is what the doctors figure I have.  I basically coughed non-stop for a year and they finally gave me a corticosteroid inhaler that helped a ton.  It gets bad again if I get a cold though, which sucks.  I had similar symptoms when I had asthma as a child. 

[Dollar Slice]

Another possibility is cough-variant asthma.

My doctor thinks I have it... I coughed clear, sticky mucus for months and broke ribs twice coughing (that is in fact how I came to start posting here! was sick and bored).

Amazingly, this is how I started reading MMM too. Head cold triggered sinusitis which triggered my cough-variant asthma, and I was basically bed-ridden for a week, unable to sleep all night for coughing, with nothing to do but read.

[Letj]

Another possibility is cough-variant asthma.

My doctor thinks I have it... I coughed clear, sticky mucus for months and broke ribs twice coughing (that is in fact how I came to start posting here! was sick and bored). Despite having an inhaler, I would feel like I was choking to death at least once a day. A Medrol (methylprednisolone) dosepack fixed me immediately both times, but if it doesn't work next time I don't know what I'll do... die, I guess. Both times it started with a bad cold... we guess that I may have had an allergy to the virus, and then my system got stuck in a cycle of self-irritation.

So that's another thing to check, especially if asthma runs in your family.

I have exactly the same thing happen after every cold I get. The doctor diagnosed me with cough variant asthma. I refused the prednisone hoping it will resolve soon since my cough is not too unbearable.

[Metric Mouse]

Another possibility is cough-variant asthma.

My doctor thinks I have it... I coughed clear, sticky mucus for months and broke ribs twice coughing (that is in fact how I came to start posting here! was sick and bored). Despite having an inhaler, I would feel like I was choking to death at least once a day. A Medrol (methylprednisolone) dosepack fixed me immediately both times, but if it doesn't work next time I don't know what I'll do... die, I guess. Both times it started with a bad cold... we guess that I may have had an allergy to the virus, and then my system got stuck in a cycle of self-irritation.

So that's another thing to check, especially if asthma runs in your family.

I'd never heard of this. It sounds terrible!

[mountains_o_mustaches]

+1 for the cough-variant asthma - was recently diagnosed and an inhaler helped a lot.  Overall, though, I would not be making medical decisions based on feedback from likely non-medical providers on an internet forum.  Even if we were all medical doctors, it's hard to make diagnosis w/o seeing you. The best medical advice is to get in to see a doctor - even if you have to travel.  If you live rurally there are sometimes options for telehealth (basically doctor visits by Skype-type technology w/ the assistance of nurses on your side of things).  Good luck!

[Metric Mouse]

+1 for the cough-variant asthma - was recently diagnosed and an inhaler helped a lot.  Overall, though, I would not be making medical decisions based on feedback from likely non-medical providers on an internet forum.  Even if we were all medical doctors, it's hard to make diagnosis w/o seeing you.

IBM's Watson can do it.