During a recent medical check-up, my GP suggested a chest X-ray after noticing “crackles” when breathing in and out. I am 62 years old, a non-smoker and very active. What could be the cause?
Kay Parton, Oxfordshire.
The term crackles is used to describe abnormal breathing sounds heard when a doctor listens to the chest with a stethoscope.
It’s a rattling noise, one of several sounds in the chest that can indicate a potential problem. Others include snoring (whistling when breathing), rasping (an audible “rasping” sound), and stridor (many of us will have heard it when caring for a child suffering from croup).
Crackles (also known as rales) are heard when the lungs are affected by pneumonia (an infection in the air sacs of the lungs, which may then fill with fluid), bronchitis (inflammation of the bronchial tubes), or edema (fluid in the lung tissue usually caused by heart failure).
It’s hard to explain why you hear crackles in someone like you, who is active and healthy, and who doesn’t cough.
Crackles are one of several chest sounds that can indicate a potential problem.
In his longer letter, he mentions that he had COVID last summer and asks if that played a role in his case, but that seems unlikely since he feels fine now.
Your GP has recommended that you have a chest x-ray. If it shows no abnormalities, I would be reassured, especially if the rales have already disappeared.
However, if they persist, I would recommend spirometry (a lung function test that measures how much air you can exhale in one forced breath) as this will help determine if there is a problem affecting the lungs.
If this test is normal, then there is another possibility to consider: silent acid reflux, where small amounts of stomach acid leak into the esophagus, but without causing the traditional symptoms of heartburn.
If this happens, especially at night, it can cause acid to back up into the lungs and produce similar crackling sounds in the chest.
I urge you to make sure you get re-examined.
Although it is not a treatment, it may be useful in improving the balance of beneficial bacteria in the intestine.
I have had chronic diarrhea since April 2023 after an episode of gastroenteritis. I have been referred to a gastroenterologist, but I have a long wait ahead of me and I am getting desperate.
Name and address provided.
Chronic diarrhea lasting more than a year requires a diagnosis.
You say in your longer letter that your GP has carried out tests which will have excluded infectious organisms such as E. coli, salmonella and Campylobacter.
Those tests revealed that her level of fecal calprotectin, a marker in the blood that indicates inflammation in the colon, was elevated.
This could be the result of an infection, but also prescription medications, diverticular disease (where bulges form in the intestinal wall), inflammatory bowel disease, and in some rare cases, colorectal cancer.
In my opinion, diarrhea is a symptom of intestinal haste. Food passes through the intestine quickly and reaches the colon partially digested and prone to fermentation, which causes gas and diarrhea.
The question is why? The gastroenterologist will almost certainly recommend a colonoscopy, in which a camera is used to inspect the lining of the colon.
In the meantime, there is nothing to lose by taking a probiotic such as Symprove or VSL 3, available in pharmacies, until you see a specialist.
It is not a treatment, but it may be useful to improve the balance of beneficial bacteria in the intestine.
Keep track of your weight as well, as losing weight can also be significant and you should tell your doctor about it.
In my opinion: Doubts about DNA testing for cancer
I first heard about the Galleri test (a single blood test that could detect more than 50 types of cancer) a few years ago, and thought it was a breakthrough of astonishing proportions.
But subsequent investigations have brought with them questions and answers.
The aim of the test, called a liquid biopsy, is to find fragments of cancerous DNA in the blood, which helps diagnose 75 percent of all cancers early, offering the best chance of a cure.
The big question, still unanswered, is how accurate is this for detecting a cancer that has not yet caused symptoms?
A 2021 study involving 150,000 people and published in the Annals of Oncology found that the test detected only 16 percent of stage 1 (i.e. very early) cancers.
And the Pathfinder study published last year found that 1.4 percent of participants had a positive test result, which turned out to be a false positive in 62 percent of cases.
Another question is when a blood test is positive, how do you find the site of the cancer so it can be removed?
Time and methodical research will reveal whether my initial enthusiasm was justified.