Re: breathing difficulty
Re: breathing difficulty
Posted by ccf neuro M.D. on May 30, 1997 at 15:05:30:
In Reply to: breathing difficulty posted by Ellen on May 24, 1997 at 16:40:10:
: I have been experiencing progressive breathing difficulty.
Past history includes splenectomy/exploratory lap and
L4/5 laminectomy following trauma, myomectomy and
2 c-sections. About 2 years following splenectomy I
began having some breathing trouble. Pain in chest and
along ribs, and a feeling that I couldn't use my diaphragm
well. Also, had a "thickening" in front at the level
of my waist, with no weight gain. This breathing difficulty
subsided after a few weeks, at least the pain and shortness
of breath did, although I still felt a little "weaker" in my
breathing. This happened two other times, however, it was
during my pregnancies, so we attributed much of it to the
pregnancy. Also, I have had a cough, the cause of which
has been unexplained. When I had these breathing problems
I found that if I had a coughing jag, I would feel a little
better. Yet during my last pregnancy, the coughing didn't
serve to relieve the tightness, which felt like it was
right along my airway. Of course, I don't know if it was
actually the airway, but it was in this area. Well, also
during the last pregnancy, during about March 1996, I had
a pain in the area of my diaphragm, right at the top of my
pregnant belly. Figured it would go away after birth. It
was worse after birth. Extremely worse. There was a pulling
pain from this area up to my sternum. I do have an abdominal
hernia as a result of the splenectomy, which became worse
from the pregnancies, and it was suggested that the pain
may be from that. Give it some time to heal and then think
about hernia repair. It hurt REALLY BAD, but I decided to
tough it out. My breathing was okay at that time, although
I noticed that the pulling pain, which did seem to inhibit
my breathing somewhat, was made worse if I was taking really
deep breaths. Also, it was relieved if I pulled up my pelvic
muscles or bent forward to relieve the pulling. This went
on until Sept. 5th. At that time, I started doing exercises
to try to firm up my tummy, even though I have this hernia,
which was making a situp nearly impossible. But I tried
anyway. What happened was that the pain was INCREDIBLE.
I also had a cold at this time, so I'm not sure which
was the precipitating factor. But this pain over the course
of a few days wreaked havoc. Within about 4-5 days, my entire
body was weak. Twitching EVERYWHERE, legs, arms, torso,
mostly in the torso. Legs would buckle if I stood more
than 1 minute. Couldn't even lift my 2 month old baby.
And I was so short of breath, with the slightest activity.
I had such pain in the area of my waist. Like I was being
ripped apart. The legs and arms were COMPLETELY BETTER
after about two weeks. But the breathing trouble continued.
I kept doing all my normal activities in the midst of all
the pain and restricted breathing, and when I was grocery
shopping on October 12, I doubled over in pain and
became slightly faint as the pain shot in a straight line
right up to my throat, with the worst pain in the middle
of the chest. It was deeper than anything I had ever
experienced. I was worked up in the ER for pulmonary
embolism. Negative. The pain could not be relieved by
any medications. I suffered with this pain - the pain
up the middle and the ripping/tearing pain around my
middle, til around the beginning of January, when the pain
subsided a teeny bit. Again, through all of this, if I
bent over, the pulling that I now felt all the way to
my throat was relieved greatly and I could breathe better.
In October I sensed a weakness to my swallow. Nothing
terrible, just weak. Tests showed all was okay. CT scan
chest and abdomen negative. However, by this time, I was
not able to stand and breathe using my diaphragm. My
phrenic nerve conduction is okay, but my abdomen would
not move out. I used to sing in choirs and know how to
do diaphragm breathing and cannot seem to do it now.
The pain that began in the area of the diaphragm and moved
up was now also seeming to disappear in an ascending manner
as well. However, it seemed that wherever the pain left,
a deficit remained. In Feb., I had another cold - lots
of coughing. I could feel my throat "go loose". Where
it felt tight before, it just felt loose. I began to have
trouble with food going down. Retesting showed esophageal
dysmotility. Reflux ruled out. Also, the pain in the chest
has decreased but also so has my chest breathing. When
the whole trouble began, I sensed that I was having to
pull air in really hard, like I was stretching everything
out in order to get air in. Kind of like blowing up
one of those teeny balloons. Well, now it's as though
the balloon is all stretched out. I can take air in,
but there is little to no "force" to my breathing. It's like
breathing through a straw with holes in it. And my pain...
now it's up to the right side of my neck. I feel a
throbbing in the right side of my neck, below my ear,
down to my collarbone, and across my shoulder. Just
a note, I was concerned about autonomic deficits, as my
b.p. has been high with this too. Testing shows reduced
cardiovagal function. I also sense trouble with the back
of my throat, like it's caving in a little and a little
on the right side, too. I will have speech pathology look
at this soon. Whew, sorry this has been so long. So, I'm wondering what you think. I'm going to throw out
my idea and concern. I'm thinking maybe I've had a nerve
injury. Perhaps the vagus. The pulling pain reminds me
so much of the sciatic pain I had when I had damage there.
It was explained to me that I couldn't straighten my leg
because the nerve was shortened as a result of injury.
Also, because of the reduced cardiovagal function, the symptom
for me being tachycardia in the upright position. Also, the
esophageal dysmotility (proximal). And now the sensation
that my pharynx is becoming involved. I understand that
autonomic disorders, per se, don't usually have pain related
to them and that even in ALS, the problems of swallowing
and breathing aren't precipitated by or associated with
pain. I have read that sometimes a vagus neurilemma can
be an uncommon cause of cough. I guess I'm still hopeful
that if I do have a nerve injury that it can heal and
perhaps some function can be restored, but only if the
area of the lesion is identified. My greatest difficulty
though remains with my breathing.My chest barely rises
and falls with the hugest of breaths. My pulmonary function
tests show mildly reduced FEV1, MVV has gotten better which
I think is curious (from 70% in Sept. to 96% in March).
My MIP is reduced at 54%, but MEP is okay at around 85%.
This is all in the sitting position of course. It all
changes in the standing position. Much weaker. My TLC has
increased from 80% in Sept. to 107% in Feb. I'm concerned
that my FRC is 65% of TLC. The pulmonologist doesn't seem
concerned. But that's high, isn't it? I have no history of
lung problems, and my diffusion is good. Is it possible
that a nerve injury has caused my lungs to become hyper-
inflated? I'm still thinking that this hernia may have
pulled on some adhesions or something. And I have lots of
adhesions. They had to use forceps during my C-section,
because the adhesions were so bad. Well, golly, this has
been long. I'm sure hoping you can come up with some
possible ideas. Thanks for any help you can give.
=
Ellen, Sorry, but we cannot help you with this type of problem. I would suggest seeing a general surgeon and a psychiatrist, whose realms of expertise would be more appropriate for the symptoms you describe.
|
|
