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<h3>Unexplained and non responsive breathlessness in young adults</h3>
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Have you ever felt that your body is sending some signals, but you cannot identify what they are? The story of Khun Thanchanok Loekraisit (Kik) who had to go through a long search for the cause of her illness from health problems lasting for years until she found the correct diagnosis and received appropriate treatment, enabling her to have a good quality of life.
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<h2>The beginning of the problem with symptoms of easy fatigue – chest tightness</h2>
“The initial symptom that made me feel that my body was abnormal was easy fatigue – less able to exercise. At first, I didn’t think much about it until it got worse. I started to feel tightness in the throat and difficulty breathing, especially when lying down. It became a sleep problem that affected my daily life. This was the starting point that made me decide to see a doctor. The first doctor I saw initially suspected it might be “acid reflux disease” because the symptoms were similar. So, I consulted a doctor for acid reflux and received treatment continuously, including taking medication, adjusting behavior, and undergoing acid level monitoring by inserting a probe through the nose into the esophagus to record acid levels for 24 hours to see how much acid reflux I had.
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That period was very painful. The test results showed that I did have excess acid, but not much. The initial conclusion was that it was probably acid reflux as expected, so I continued treatment for acid reflux for a long time, about a year. But in the end, the symptoms remained the same: easy fatigue, tightness in the throat, and difficulty sleeping still persisted.”
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<h2>The turning point that led to the real diagnosis</h2>
The important turning point came when someone recommended consulting a lung specialist.
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“Someone suggested I see a lung doctor, so I had the opportunity to meet <a href="https://www.phyathai.com/th/pyt3/doctor/dr-winai-boweja">Dr. Winai Boweja</a>. The doctor asked detailed questions about my history and symptoms, but my symptoms were not clearly indicative of any specific disease. Since there were no specific symptoms, the doctor tried to find abnormalities starting with a lung function test (Pulmonary Function Tests: PFTs) to check the respiratory system because I had shortness of breath. The results showed only slight abnormalities, but the doctor thought there might be some lung problem that couldn’t be clearly identified and recommended further examination with a CT scan.”
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“At first, I hesitated to do the CT scan because I was scared and thought I probably didn’t have anything serious. But I finally decided to do it because at night I couldn’t sleep due to increasing chest tightness. The next day, I went back to see the doctor and agreed to have the CT scan.”
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<h2>The test results brought us closer to the cause of the disease</h2>
“Before the CT scan, the doctor explained that it wasn’t scary and that the advantage was seeing inside the body in detail to know exactly what was wrong so it could be treated properly. The CT scan results revealed something I never expected.”
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“The results showed that during exhalation, my bronchial tubes were abnormal; they looked flattened and the shape was unusual. The doctor re-examined my health, which led to the true diagnosis: I had pectus excavatum.”
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Actually, pectus excavatum is a congenital condition, but I never knew about it. If asked whether I noticed my chest looked different from others, I did notice when wearing a swimsuit that my chest was more sunken than others, but I thought it was just a body structure issue and never thought it would affect my health and daily life.”
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“Dr. Winai explained that the real reason I was tired and had chest tightness might be because my pectus excavatum was severe enough to affect the pressure in my chest, which eventually caused compression of the bronchial tubes during exhalation.”
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“To confirm the diagnosis, Dr. Winai recommended additional tests including bronchoscopy and pulmonary function tests to assess whether the bones were compressing the lungs. Cases like mine are quite rare; it is very uncommon for pectus excavatum to compress the bronchial tubes and cause problems. The examination showed that the sunken chest could indeed affect the pressure in the chest and compress the bronchial tubes during exhalation.”
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<h2>Once the true cause was found, targeted treatment was possible</h2>
“Once the diagnosis was clear, Dr. Winai recommended the appropriate treatment: surgery. But it was not a scary surgery; it was a minimally invasive surgery called the Nuss Procedure, which uses a metal bar inserted under the sternum to support the sunken bone, reducing chest pressure and bronchial compression.”
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The conclusion of targeted treatment is surgery
“I admit I was scared because surgery always carries risks and concerns. Normally, I like to do many activities such as diving, climbing, and adventurous sports, so I was worried if I could still live the same life after surgery. The support from the doctor helped ease my worries a lot. The doctor provided detailed information, which greatly relieved my concerns. After surgery, with about 6 months of recovery and self-care, I could return to almost all activities. Although during recovery, some activities like rock climbing or those causing impact had to be avoided, I could still go diving, which was very good for me.”
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<h2>Today, the disease is treated. Thanks to the doctor who found the cause</h2>
“I want to thank Dr. Winai for his care and belief that I was truly ill and wanted to recover. He tried to find the real cause until it was found because throughout the treatment before meeting Dr. Winai, I had tried many treatments but none were targeted.”
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“At first, the doctor was concerned that I might be imagining the symptoms, so he requested to meet my mother to get more history. Then, together they carefully decided on the cause. The doctor was very attentive, listened to me, and believed that my chest tightness and discomfort were real and caused me suffering in daily life. Later, when talking with the doctor again, he said my face showed how much I was suffering from the illness, so he believed me and tried to find the cause to relieve my suffering.”
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Today, the long journey to find the cause of the abnormal symptoms has ended.
“Currently, I no longer have the same symptoms disturbing me. My quality of life has greatly improved. I feel relieved that I finally know what I have and have been treated accurately until I recovered.”
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<h2>Dr. talk: Dr. Winai Boweja</h2>
<h2>Difficulty breathing and incomplete breathing (tested and treated but still not cured) in middle age</h2>
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“unexplained and non responsive breathlessness in young adults
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Difficulty breathing and incomplete breathing in middle age is not uncommon, and the common causes are asthma, bronchitis, and acid reflux.
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Other less common but still found causes include airway compression, which causes difficulty breathing and incomplete breathing due to airway compression. Common causes include enlarged lymph nodes, goiter, cancer, etc. However, it cannot be denied that many middle-aged patients come with symptoms of incomplete breathing, undergo thorough investigations but the cause remains unknown. When taking additional history, it is often related to stress, mental health problems, or somatoform disorder.
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Therefore, it is challenging for doctors to find the cause and manage patients with breathlessness and incomplete breathing but no identifiable cause. Sometimes, a lung CT scan to assess airway shape combined with bronchoscopy may be a solution to evaluate the cause. However, this depends on the doctor&#8217;s discretion.
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Detailed history taking and physical examination, along with history from cohabitants, may help screen for anxiety disorders, as family members can provide additional information to the doctor about whether the patient truly has anxiety. If not found, further investigation to find the cause can proceed, which may involve increased costs.

The initial symptoms that made me feel like something was wrong with my body were easy fatigue and reduced ability to exercise. At first, I didn&#39;t think much of it, but it worsened. I started feeling a lump in my throat and had difficulty breathing. 

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