Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My significant other's health has sharply deteriorated and after months we have no idea what it is.Hello. My (24F) boyfriend, Paul (29M), and I are fairly active. We go on road trips every year with our main stops being prime hiking spots. Paul is 5'7'' and 230 pounds. Due to his southeast asian/pacific genetics, his entire family is on the heavier side, but Paul is just as active as I am and eats well.Recently, we have gone long distance. Paul returned to live with his parents due to the pandemic while I stayed where I was. I visited him in June 2021. At this point, Paul had few symptoms, but some new minor health issues. We went hiking around Lake Tahoe and Paul was a little more out of breath than usual. He hasn't needed to use his inhaler since he was a kid, and he had to use it on this trip. We attributed this to recent wildfires in the area and poor air quality.However, Paul's health continued to sharply deteriorate. We went to Edinburgh, Scotland, in July. While hiking Arthur's Seat, Paul had to use his inhaler so many times he emptied it out. He could not get it refilled as we were out of the country. Until the end of the trip, Paul's breathing became more and more labored and he developed a persistent cough.I did not visit Paul August-November 2021. We spoke on the phone and Skyped regularly. During this time, Paul would sometimes leave the call or mute for a few minutes. He'd come back and apologize, saying he'd had to cough pretty violently and didn't want me to hear. I was concerned. I overheard one wracking, moaning coughing session and knew it was not just asthma or an irritated throat. By October 2021, the air quality in his area had greatly improved.I persuaded Paul to visit his general practitioner. His GP dismissed all of his concerns and cited Paul's being fat and asthmatic as the source of his issues, and that the issues would disappear with rest and exercise. I had to fight doctors for years to get them to take my chronic pelvic pain seriously, and was finally diagnosed with an ovarian cyst that was 8mm long and about to burst, so I have experience with self advocacy in the medical space. I helped Paul see new doctors.In mid-October 2021, Paul developed abdominal edema. Paul's feet, legs, and lower stomach were swelling up like crazy. He gained 40 pounds. He could barely move at all, even to go to the bathroom. He couldn't sleep lying down without suffocating, which only worsened his exhaustion. He went to the doctor again and was prescribed diuretics. The diuretics helped with the swelling and extra weight and within 2 weeks he was back to his regular weight, but the coughing and weakness persisted.About a month after regularly taking diuretics (November), Paul started feeling intense nausea on a weekly basis. This nausea would prompt coughing fits. Paul couldn't eat or focus while nauseated. Our calls became more and more infrequent as Paul's nausea and headaches grew. He told me sometimes the nausea would get so bad that he would vomit. There were no patterns to the vomiting--it didn't happen at a certain time of day or after meals. Sometimes it was foamy. He got a CT scan to look at his gall bladder and all results were within normal ranges. Blood tests, including labs for liver function, all came back normal. His doctor referred him to a gastroenterologist for more testing, but due to increases in COVID-19 cases, they haven't even processed his file, let alone scheduled appointments, which would be months out. A nurse anticipated he wouldn't be able to go in until February 2022, but at his rate of decline, this has me concerned for his mental wellbeing and life quality.This week, in late December 2021, I visited him and his family for Christmas. I had heard from Paul about his issues and was following closely with his medical updates, but seeing it firsthand was another thing altogether. I have never seen human suffering and sickness like this up close or cared for another human being in such an intimate way.Every single day, he has intense coughing fits and bouts of nausea where he makes vocalizations and gags, usually every few hours. At least once a day, these coughing fits are so bad that he spends 5-30 minutes vomiting in the sink. The vomiting has increased drastically. After this, the nausea alleviates, but Paul feels exhausted and has migraines. He barely eats. He barely sleeps.Today, he had three different nausea/coughing bouts that induced vomiting. One developed rapidly and he threw up in a restaurant bathroom. The last one, which just happened this evening as of writing this post, also caught him by surprise, and he vomited in the kitchen sink. The vomiting was so physically taxing that his nose bled profusely and he lost control of his bowels and peed himself. He was not strong enough to make it down the hall to the bathroom. Eventually, I assisted him into the shower. I am writing this before bed, and he is still coughing, and has a migraine. He hasn't gotten up from where he sat after taking the shower.I would appreciate any medical advice about what might be causing what Paul is going through, as well as tips for how to navigate the medical system to ensure this gets treated in the best way possible. I would like to reiterate that while neither of us are marathon running body builders, Paul (before all of this) was physically active and monitored his eating habits. He was also mentally active and had returned to school to pursue a degree in a new field. We both have families that are reasonably well off and are good support systems.Paul is one tough puppy, and reassures me that it "isn't so bad," but after seeing it firsthand, I know this is not something that can continue the way it is. I am extremely worried, and caring for him is beginning to wear on me mentally. Sometimes I feel sympathy nausea when I hear the noises he makes in the bathroom.Please help in any way possible. I appreciate any and every tip, and can provide additional information if needed. Thank you very much.UPDATE 12/26:We went to the ER at 4 AM right after Christmas. Luckily, it was almost completely empty. I was not allowed to go back with him, so for the entire five hours I was sitting in the waiting room, I was only ever accompanied by one or two other people at a time.Paul's shortness of breath, fatigue, and wracking coughs got him seen quickly. He texted me updates as things progressed. He got every test I wrote down from these comments--BNP test, pulmonary work, chest x rays, GI work. An echocardigram is scheduled for next week.They found out right away that Paul's BNP results were seven times higher than usual. They said this was indicative of heart failure. They also tested Paul for COVID 19. He tested negative, but did test indicating he had some kind of viral illness.Paul's doctor concluded that he was suffering from chronic RSV that was made worse by poor genetics, asthma, and obesity. Paul did confirm he had what felt like a respiratory illness in Scotland in June, then after going to a wedding in October, then this week when he got severely ill and we found out his mother had a cold.There is no cure for RSV, but a vaccine has reached human trials. The only things Paul can do to alleviate his own suffering and avoid a heart attack is to make significant lifestyle changes and live like an immunocompromised person. I believe in his ability to achieve the former, but the latter is more difficult because of his emotionally overattached mother who brings the entire extended family out for lunches, movie nights, shopping, etc. several times a week. I'm concerned she won't take it seriously or will be in denial to avoid feeling responsible and will therefore continue to expose Paul to colds that could kill him.Paul is currently resting. He was given medication for his nausea and a new inhaler. He is doing better but still coughing. We have already started on his new food regimen. I am hoping for the best, but the pandemic has proved that people rarely take precautions for others' goodwill. Thank you for all your support. Paul might never have gone to the ER if I hadn't visited and reached out to this community.. ### Response: He needs to go to the emergency department. It sounds like he has some sort of heart failure causing the shortness of breath and swelling. The nausea and vomiting could be anything, though Id be concerned about electrolyte abnormalities or increased intracranial pressure. Heart failure can cause it too but not this severe Id imagineDont have a great answer tying them together thoughThis was pretty much exactly my thought process as well. Hard to tie all of these symptoms together until we start a work up, which should definitely include an Echocardiogram. Go to the emergency department to get started, then will probably need to stay in the hospital until a diagnosis and care plan is made, as well as symptomatic improvement..