Is it a common-cold? No, it’s the flu? No, it’s bronchitis? No, it’s musculo-skeletal pain? No, it’s costochronditis? It’s pleurisy (and chronic rhinitis and post-nasal drip)

Recently, I have been through the wars. I’ve had around 30 days off sick since March , I cannot be certain how much time off I have had, and since my boss cannot be bothered to record it, neither can I.

The colds and the cough

It all started in March when I got struck down by a really nasty nasty cold / flu thing. I was off work for 11 days. I had the worse sore throat and cough ever. I literally could not sleep for about three nights because my throat hurt so bad. Fever, chills, you know the drill. I had it all. And the cough, I think this is where the cough started, it was a violent thing. At this time I wasn’t very concerned about it at all, although the noises I made when coughing were pretty scary.

I see my GP. She says, it’s a virus. Nothing she can do. Take paracetamol and codeine. It’s strongest thing you can get without a prescription. I double up with ibuprofen too. I feel ok.

Roll on a few weeks, and I’m about to go on holiday, and I get struck down by another humdinger of a cold. This one has me feeling really horrible; weak, tired, sleepy. Of course my favourite sore throat and cough are back with a vengeance. Having spent over £2K on some plane tickets, in the middle of my illness we (my wife K, and two baby boys, D & G) jump on a plane to the West Indies. Needless to say, the flight was hell.

When we finally land in the airport, we find that the wheels for our boys’ buggy are with our luggage, and the wheel-less buggy is handed to us as we disembark the plane. We now have to traverse endless corridors of airport carrying two children, three large pieces of hand-luggage and a buggy with no wheels. At one point I turn a corner, expecting to see the luggage carousel and airport corridor extends for another 100 meters. It is one of the most desolate moments in my life. The only thing that keeps me going is knowing that my mother is within spitting distance (she will move heaven and earth for me) and D, my 2 year old, is on my neck and he hasn’t had anything to eat for a long time. He is very tired. I am shattered in a way I have never felt before. My ears almost exploded on the plane (don’t fly with a cold). I can barely hear anything at all. I have been up amusing the boys for about 16 hours. I had 4 hours sleep last night, and probably the same the night before.

Bronchitis, elevated anxiety and coughing

The next day, my mother says I should see a doctor. For once I agree with her. He says I have bronchitis. He gives me a “broncho dilator” AeroFlux which starts me on a 24 hour panic attack and Avelox which is an antibiotic. The visit to the doctor and the prescription come up to a whacking £60 (£40 medicine, £20 for the doctor). After about a week I’m feeling human again. I still have a dry hacking cough.

But most of my other symptoms are gone now. I feel human. Towards the end of my holiday, for perhaps 2 days the cough is gone. Amen. We head back to London.

I get off the plane.

The cough starts again.

I get a sore throat.

I get another cold.

I go to my doctor. I complain about getting ill very often, sore throats, a cough etc. She says it must be a virus again. I complain that I have a chest infection. She gives me a prescription for Amoxicillin, I promise if I start feeling better I won’t take the antibiotics. She also suggests that I get a chest x-ray.

I procrastinate. I do not rush out to get a chest x-ray. I never take the Amoxicillin.

I almost get back to normal (with cough) for a week or so .

Chest pains, anxiety and confusion

It is a Saturday night. I’m watching TV, I notice a new pain in my chest. It hurts when I breathe. K says it’s wind. I’m not so sure. I struggle along, carrying on as normal. Next day, the pain is much worse. I try to continue as normal. The night comes. It’s pretty bad. It’s a sharp stabbing pain in my chest (thankfully on my right side, or I would be rushing to A&E) I cannot really specify better than a sharp stabbing pain. It really is that. A few years ago, someone I knew had a collapsed lung (pneumothorax) I look it up on the Internet.

Chest pain and tightness, shortness of breath and a dry cough are all experienced. The severity depends on how much air gets into the space. from the BBC

I am certain this is me, I have chest pain, I have a cough.

I call NHS Direct. They go through it with me. They say it sounds like “a pleuritic pain”. My GP has an out-of-hours service. They call me. They (over the phone) diagnose me with a generic musculoskeletal pain (ie a pulled muscle).

The chest contains many muscles, bones, tendons, and cartilage (the rubbery tissue that connects muscles and bones). Strains or sprains to any of these can cause chest pains. Chest pains associated with musculoskeletal injury are typically sharp and confined to a specific area of the chest. They may be brought on by movement of the chest and/or arms into certain positions, and often are relieved by changing position. These pains can be triggered by pushing on part of the chest and often become worse when taking a deep breath. These pains usually last only seconds, but can persist for days. from cardiologychannel

I’m happy this is a LOT better than a collapsed lung I think. A whole lifetime better than lung cancer.

I go to see the doctor the next day. She listens to my chest.

She says it is not a collapsed lung. I fall in love with her.

She orders me to get an X-ray. My chest hurts alot. “On a scale of 1 – 10” she asks, “how painful is it?”, I laugh and say “Maybe and 8 or a 9?” she says it’s a pulled muscle. I don’t argue.

It really fucking hurts (but only when I breathe, laugh, sneeze, cough and yawn). NHS Direct says “The main symptom of pleurisy is a short sharp pain in the chest area when taking a breath.” This is very accurate but the phrase “sharp pain” doesn’t really do it justice. I also felt that there was “discomfort or tenderness to touch”. These symptoms are also for typical for costochronditis (by this time I was starting to doubt the “pulled muscle / musculo-skeletal” diagnosis) and started thinking maybe this (costochronditis) was the problem.

Pain in the chest wall around the breastbone (or sternum) is the most characteristic feature of the condition known as costochondritis. Medically, the term chondritis refers to inflammation of any cartilage in the body. Costochondritis refers specifically to inflammation of the cartilage that joins the ribs to the breastbone (called costal cartilages). The chest pain of costochondritis sometimes is severe. all about costochronditis from emedicinehealth.com

Pleurisy is not (yet) in my sights even though NHS Direct had mentioned it, as far as I was concerned pleurisy was too serious to consider – due to my mother’s continous warnings to me as a young boy that I would get pleurisy by doing just about anything (standing in the rain, in front of thr fridge, ironing late at night etc etc) and me laughing at her for being such a doom-monger. I also felt this weird clicking that I could actually feel with my fingers. Later on I decided that this must have been the “friction rub” of pleurisy.

The normally smooth surfaces of the parietal and visceral pleurae become rough with inflammation. As these surfaces rub against one another, a rough scratching sound, or friction rub, may be heard with inspiration and expiration. This friction rub is a classic feature of pleurisy from AAJP

I sleep sitting up, this seems to help. I’m not taking drugs. I reason that I need to know if it gets any worse. I want to feel it. I get the chest x-ray.

The next week is really stressful. I’m awaiting the results of the chest x-ray. I have by this time looked on the wretched internet and determined that my symptoms match not only a collapsed lung, but also costochronditis and worse still lung cancer.

I am offered a new (and better) job.

My head is swimming. I cannot sleep. It hurts.

I decide for several reasons (including health concerns) not to take the job.

Normally I worry and I am quite anxious, this week I’ve entered a new level of anxiety. It doesn’t help my chest at all. No, not at all.

I go to work for a few days. The results of the x-ray are back. I call my GP, they have to call me back. Another doctor calls me back and says that my chest looks a bit hazy which usually indicates a chest infection. He recommends I take the Amoxicillin. I do.

The Amoxicillin course ends. The pain is not as bad, but still with me. It’s a pulled muscle I tell myself. These things take time. The anxiety gets the better of me. I call my GP. The annoying and rude receptionist asks “Is it an emergency?” thinking she can fob me off. I say, smugly, “I have a very bad pain in my chest.” She shuts up and says I can come in. HA!. Chest pains RULE!

I rule out costochronditis because my pain is on my side, and I believe that costochronditis pains are around the sternum (ie a bone which holds the ribs in the middle of the chest). I’m not sure what it is any more. I’m worried and paranoid and anxious, as usual.

I see another doctor in my GP surgery. I tell her my story. I explain that I’m really worried and anxious. I hurt, my chronic cough, my fears, my chest pain. She listens. She refers me to a REAL HOSPITAL. She gives me another antibiotic (Erythromycin). I want to marry her, I love her. This is much more than the infatuation I had with the last doctor.

It’s pleurisy! Hooray?!

I go to see a doctor in a cardiothoracic out patients clinic. He is a professor. Thank you god. I am saved. He says he doesn’t “buy” the pulled muscle theory. He says “you would know when you pulled your muscle”. He says I have pleurisy.

He says that between the Amoxicillin and the Erythromycin the infection is probably gone. He orders another chest x-ray and some blood tests. He pokes me and listens to my heart. He says he’s pretty sure I’m okay. He is a professor in a world leading university hospital. If he was a woman….

I tell him about a saying my mother has “after bronchitis is pneumonia, after pneumonia is pleurisy, after pleurisy is death”. He laughs and says, almost angrily, “Not around here it’s not”.

I return to the cardiothoracic out patients clinic the next week to get the results. They came back clean. I see the X-ray of my chest. I can recognise my skeleton. In a weird way it looks exactly like me. It looks clean and nice. Seems like the 10 years of smoking haven’t killed me yet. He says the only thing is “a very slightly raised white blood cell count”. This he said usually indicates an allergy.

He doesn’t seem at all concerned about the pleurisy (although this is all I care about) and proceeds to tell me all about coughs. I’m relieved I’m not dying and just answer the questions he asks me. My brain slightly frazzled by the relief.

The now chronic cough is still with me. He says nearly all the chronic coughs he sees are because one of three things 1) asthma 2) post-nasal drip or 3) acid reflux.

Days later I would kick myself for not asking “How long does it take to recover from pleurisy?”. It’s been 2 months for me, and I am really not 100%, I’ld say about 75% recovered. I’m seeing him again in 6 weeks time. Hopefully, I won’t need to ask him that question then.

Current status

2 months after initial pleurisy pains, 3 months after the bronchitis and 4 months after the cough started

I’m taking steroids (Nasonex, mometasone furoate monohydrate) up my nose (to help the Chronic Rhinitis and Post-Nasal Drip). It has been about 10 daysnowand I think the cough is improving (ie disappearing). The pleurisy is ongoing, but not the sharp, stabbing pains on breathing. It has been about 8 weeks since the initial onslaught. Now the pains aredulland aching and sometimes in my back, but sometimes I cannot feel them at all. I’ve decided to run a course of ibuprofen for a full week to see if it actually shifts it. I’m recording my lung peakflow witha peak flow meter(!) twice a day. Variations mean asthma. Low values mean asthma. I think I’m in the clear. It has been 10 days now, and I record always between 460 and 510 liters/minute.

>General advice

I’ve just made this up, so don’t take these as gospel eh.

  • Don’t always assume that your GP is correct, try and get a second opinion if you are not happy with your diagnosis. I think you should have some idea when you get a diagnosis if it fits with what you feel. Remember the GPs will not have all the information about your illness. You are the only person with all the info.
  • If you think it is serious, do press your GP to take it further, more often than not they will say it is a cold, it is down to *you* to stress that it is more than a cold.

>About chest pains

I’m not a medical professional, I’ve just read a lot about it on the internet, and this is strongly biased by my own experiences

  • Is it collapsed lung (pneumothorax)? This screener is very helpful. In my case, I had:
    • sharp chest pains on one side of my chest
    • and a dry hacking cough

    The following is a list of the signs and symptoms of collapsed lung:

    • Sharp pain in the chest
    • Sudden shortness of breath
    • Painful breathing
    • Tightness in the chest
    • Dry coughing
    • Cyanosis (blue skin)
    • Rapid heartbeat
    • Distended neck veins (in Tension Pneumothorax)
    • Low blood pressure or shock (in Tension Pneumothorax)

    Presumably the pain from a collapsed lung and pleurisy are quite similiar. This is very easy to definitively rule out pneumothorax , and I think a GP can more or less confirm this by seeing you and listening to your chest. An x-ray will certainly confirm.

  • Is it costochondritis (Tietze’s syndrome)? The symptoms:
    • The predominant symptom is a sharp pain in the affected area, most commonly involving the second or third ribs, which are often very tender to touch. (Ribs are counted down from the top and the first rib lies under the collar bone.)
    • The pain is usually related to movement, coughing and sneezing and can occur in more than one place simultaneously.
    • Pain can also radiate into the arm and can be associated with a feeling of tightness in the chest. These are also the symptoms of a heart attack, so it is always necessary to take them seriously and make the diagnosis of costochondritis with care.

    Note this is not a respiratory illness and is not serious at all (I think :D). No one knows much about it. And although this sounds alot like pleurisy to read about the symptoms, I think the key (although I’ve not felt this myself) is that the pain is in the centre of your chest, and probably feels more like a heart attack (again, I’m making this up) than a pleuritic pain. You would most likely see your GP and he would (should) rigorously check you out to ensure it was not your heart. Cardiac related chest pains are taken very very seriously. Presumably you can have pleurisy pain anywhere around your lungs, so if you had it around your heart, that would be very scary indeed. In my case, the pain was on the right side, almost under my armpit, so quite far from my heart and sternum.

  • Is it pleurisy? First off *I think* you can get pleurisy for many many different reasons. Some of these are very scary. We are dealing here with the non-scary versions, basically spillover from respiratory tract infections.
    • pleurisy can be anywhere in your lungs (so for instance, if it is low down your chest and on your right side, it is almost definitely pleurisy)
    • the friction rub thing (see rub)
    • if you have a chest infection or cold and then you get these pains, it is probably pleurisy (and not costochondritis or collapsed lung or pulled muscle). I had an ongoing chest infection which at some point was confirmed by an x-ray. And rememer my super professor doctor said “You would know when you pulled a muscle.”
    • it is more common that you think

    The NHS list of symptoms seems to be the best (for my purpose of non-scary pleurisy diagnosis):

    The main symptom of pleurisy is a short sharp pain in the chest area when taking a breath. This often occurs at the end of a breath. Other symptoms could include:

    • chest pain when coughing,
    • fever,
    • rapid shallow breathing, and
    • discomfort when touching the affected area, even lightly.

    You may also have other symptoms because of the disease or condition that is causing your pleurisy. For example, if it’s a common cold that is causing your pleurisy other symptoms could include headaches, a sore throat and coughing. from NHS Direct

I think some key points that no one mentions (and I have inferred) are:

  • pleurisy can be anywhere in your lungs (so for instance, if it is low down your chest and on your right side, it is almost definitely pleurisy)
  • the friction rub thing (see rub)
  • if you have a chest infection or cold and then you get these pains, it is probably pleurisy (and not costochondritis or collapsed lung or pulled muscle). I had an ongoing chest infection which at some point was confirmed by an x-ray. And rememer my super professor doctor said “You would know when you pulled a muscle.”
  • it is more common that you think
ok that’s it, i’m exhausted from writing this. please comment and let me know about your experiences and inaccuracies.
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19 thoughts on “Is it a common-cold? No, it’s the flu? No, it’s bronchitis? No, it’s musculo-skeletal pain? No, it’s costochronditis? It’s pleurisy (and chronic rhinitis and post-nasal drip)

  1. Must congratulate you on a brilliant read! Just felt I needed to thank you for putting my mind at rest. For the last 2and a bit weeks had this agonizing pain in my right side (which at first they diagnosed as a pulled muscle due to coughing) It is still there now and they gave me an X ray which like u came back hazy and told me I had pleurisy. Like you I did a lot of reading on Internet(bad idea) and was beginning to think I had Lung Cancer – my mum died of this in March. Doctor gave me antibiotics which disagree with me- but I think my imfection has cleared but am left with the annoying feeling of wanting to clear my throat all the time – which in turn is agony as it coughing sneezing and sleeping. You seemed to be going through all that I am at moment- so was quite reassured -but am going back to doctors tommorrow- to see if I can get some sort of pain management. Take care and hope we are both painfree soon!!

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  4. well, I got something similar but in my case I felt like a 40 ton truck was over my chest, I could not breath less talk at all, and about cough.. it was endless I was so afraid specially at nights due to the pain plus the snots with blood.. so my solution.. that I am still pursuing: Pray to GOD, every single day even when you think it does not matter.. it does! trust me on that.. 2)Take a shower every day (a russian teacher told me that one day) 3) Do not infect your loved ones, including your family, because if one of them get sick, it shall be impossible for you to recover soon..4) Good sense of humor is good, specially on winter time

    Best Regards pal

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  6. This reply comes several Years after you posted this article, I am curious just how long did the chest pain last? I had mild viral pneumonia ( the doc only guessed this after the fact). I fell ill with only a cough, no other symptoms on 12 December it seemed to happen suddenly and I took time off work, this cough would not go away and I had a fever, night sweats and I felt really ill and weak. On new years day I started to get a pain in the lower right of my chest cavity and within 5 hours I knew something was very wrong. I went to A&E had an x-ray and was diagnosed with pleurisy. I had three courses of antibiotics. Eventually the cough got better but has never really went away. Particularly in the mornings and my chest pain also has never fully went away! It is still tender to press and I can feel inflammation occasionally further around on the right. I have to admit I am worried and have made an appointment to see the doc as it is now late March and I don’t think this should have went on for so long.

    Jan

  7. Thanks. I am going through the same thing. My first GP told me it was a pulled muscle. I told her I was having trouble breathing and she didn’t even listen to my lungs. Turned out to be pneumonia, but it seems I may have pleurisy from not recognizing the pneumonia in the first place!

  8. Pleurisy can scar so some pain can sometimes be felt inevetably even when the underlying cause has gone. There appears to be many sites with a lot of useful information unfortunatly i have been unable to find one with a callibration of information. There are many types of pleurisy wet dry virul bacterial and others assosiated with problems like tb etc. Virul pleurisy will usually go on its own whereas bacterial will need antibiotics such as amoxocilin. Pain management will usually be nsaids which are anti inflammatry such as ibroprofin naproxin or such like consult a doctor for pain killers as some can make things worse. Pleurisy is a sympton not a desease in its own right so it is important to find and cure the cause to reduce risk of scarring. I contracted a bacteria pleurisy a few weeks ago it was night time and my chest got tight within hours i was in agony my eyes were streaming i was suffering intolerable stabbing pain localised to my left side my breath was getting shorter and shorter and i also began getting stabbing pains in my left arm and across my left shoulder. I honestly thought i was going to die that night but as time went on i realised it couldnt be a heart attack so a taxi to the surgery first thing gave me an immediate diagnosis of pleuritic chest infection. Beware that pleurisy can go from one side to the other so early diagnosis is important another heads up is that if left untreated can cause further complications or even fatal. Pneumonia or a lung collapse are but a few. Take this condition seriously any respiritory problem required medical attention. Early treatment will normally irradicate long term issues whereas late treatment could create long term problems which is why it is difficult to put a time span on pleurisy symptons
    if in doubt get checked out

  9. I get a lot of chest infections due to being asthmatic sunday I was having a good day by Sunday night I was in agony by Monday morning I phoned the Doctor by 5pm seen Dr was diagnosoned with Pleurisy put on antibiotics pain killers also steroids Dr sent me for x-ray Wednesday asked to see me again thursday was given another dose of steroids and antibiotics all in 4 days got to see Dr again next wednesday after bank holiday and Jubilee Im still in agony the pain is now in my right arm as well as my back and chest I cannot take anti inflamatries so just gotta perserverve I was also told by Dr that it will take longer to clear due to me not being able to take anti inflamatries .

  10. My husband of 25 yrs was diagnosed with pleurisy last year, (smoker forever, family history of heart disease, a couch-potatoe and 30lbs overweight, and has been taking prescription meds for high blood pressure and cholesterol) had a pleural efusion (aka: stuck a big hollow needle in your back and drain as much of the pleural infected fluid out- this is done in outpatient without any sedatives, just a local anesthetic, and operator must be very practiced so as not to puncture hole in your lung). Hubby feels instantly better, they put him on strong antibiotics (Zithromax) and send sample of fluid to lab. 2 weeks later we are calling doctor every day for test results (is it cancer for gods sakes?!!). Results are negative, no cancer, no visible/obvious result, doc doesn’t know how/why he was infected, but nobody cares since he seems like a new man and feels great. It’s important to say that he was NOT sick prior to onset of symptoms, which came on suddenly. (pleurisy is commonly caused respiratory infection that gets out of control). Post op, 6 mos. and he gets it again, it’s worse this time, he cannot breathe at all, has severe chest, back and shoulder pain and we are a little freaked-out, as we were told most people don’t get a relapse under his circumstances. Doctor repeats the pleural effusion and antibiotics. For two weeks, he feels much better, then wakes up with severe shoulder pain and cannot breathe, is coughing/barking like a walrus – nonstop. Back to the doctor, referred to pulmonologist again, who decides he needs a biopsy of lung tissue. This all coordinates with a new job he had been trying to get for 8 months, we have been financially strained and the stress of the illness is causing depression, the cycle is in full 109-mph gear…I have been on the Internet endlessly trying to help him – I am scared but don’t want him to know. He has never had severe pain before (no surgeries, broken bones, severe illness, etc., so the chronic pain is really freaking him out..he is eating 800mg ibuprofen – prescription and cherry cough drops.). The ongoing, loud/racking/dry coughing is unreal, I spend hours at the drugstores looking for a cure so he (we) can sleep. Nothing helps. He is getting (third) X-ray tomorrow, I am über – worried about the upcoming biopsy possibility, but need an answer and results. I read there can be pleurisy symptoms that are ‘dry’ as opposed to wet/filled with fluid. This is more painful….I will update when I know more, hopefully SOON. Note: the prescription med for high blood pressure he has been on for a few years can cause a dry cough I read, his doc takes him off the med…(hoping it helps his cough, but what about potential heart problem now?..)

  11. Oh wow, Well, they say my EF rating is 15%, I have a defib installed 2 months ago, and had zero symptoms. 20 mile bike rides, personnel training 2x a week. They said I would have been one of those guys that just dropped dead… a virus attacked my heart. Myh heart continues to get worse. Someday I guess I’ll notice it.

    So you can have a life threatening condition with zero pain/symptoms was kind of blind luck it was found from a mobile health clinic 5 in 1 deal, I just where to have my cholesterol checked in my neck vein since I was 48. Guess what..that was good too.

  12. Gosh You had a really nasty experience! Glsd to know you are better in spite of all the diagnosis you had. I am in your boat now. 3 weeks and no joy! That horrible cough, 5he excrucisting stabbing pains in my right lung, full length of the rib cage, post nasal drip that never clears, phlegm that feels siffocating, non-stop coughing eachbtime I breath in and yell with pain … and so it goes on … perhaps I should find someone to take me to a doctor (I fear the hospitals because they do not care about their senior citizens, who try to help themselves) I pray that you will heal 100% and never have to look back! God bless you alk!

  13. Hello. I hope you can explain what I’m experiencing…

    Since January, have rapid heartbeat, chronic coughs, chest bone so sore and back-stabbing pain right-side of my back when cough. Feeling exhausted all the time. Cannot be bothered to workout, which I love.

    Doctor checked my blood pressure (good), my chest (good), heartbeat (too fast). Those are the main things I’m worry about… lingering coughs (chronic coughs) and rapid heartbeat

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