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Neurology (Expert Forum)
diaphragm paralysis
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diaphragm paralysis
by Grand Pa News, Jun 27, 2003 12:00AM
My father is 82. He is on a ventilator. This is the second time within a four week period he has almost died because he cannot breathe. The first time they discovered a systemic infection. None of the doctors (cardiac, pulmonary, or neurology) can tell us why he cannot breathe. The cardiac and pulmonary doctors tell us that his heart and lungs seem fine. The neurologist do not see anything. His diaphragm is not functioning properly and so when he tries to breathe on his own his body begins to poison itself due to the high level of Co2 build up. Recently, his blood pressure drops to 60 unless regulated by medicine. ( pressure behind his heart was rated a 6) My huge concern is that in January 2003 he had a pacemaker implanted. Since that operation we have noticed a steady deterioration in his health, increased fatigue, heaving, difficulty swallowing, severe back pain (directly behind the area of the pacemaker), falling down occasionally. Is there any sort of relationship between the pacemaker operation, the marked decline in health following the surgery, and now this “mysterious” illness keeping him on a ventilator? Could heart or blood pressure medicine play a role? We are desperate because we know his body changed after his pacemaker operation and we do not know why. He’s never been sick. Is there any possibility an infection could exist in the pacemaker and it is not being detected or that the surgery set off some pre-existing disease or that something was damaged in the surgery?
Doctor's Answer
by CCF-Neuro-M.D.-JT, Jun 30, 2003 12:00AM
Sorry to hear about your father. There appears to be a number of things going on in addition to the difficulty breathing. Diaphragmatic weakness has been reported in one patient following transvenous pacing (inserted into the vein of the neck) in which multiple attempts at placing the pacer injured the phrenic nerve, which is the nerve to the diaphragm. General medical conditions such as electrolyte abnormalities, infection, hidden cancer and other metabolic problems are all possibilities. BUt one things that may be considered is a primary neuromuscular problem. Perhaps an EMG can help sort things out to see if there is any other objective nerve damage besides the diaphragm weakness that can help your doctors figure out what's going on. Consider getting a formal neuromuscular consult or a second opinion. (sounds like he may be in the hospital, but if he's not then bring him to a major academic center for evaluation and an EMG. GOod luck.
Have had no recovery so far. I am getting weaker generalized but think that is due to not being able to be real active. My fingers are wanting to curl up so I have to do lifting type exersize with each individual finger to try to prevent that. In all my years as a nurse I had not come accross anyone with b12 problems to my extent and my levels were low norm..214 i think was the level but my dr said it does not have to be below 200 to have damage. The neurologist tested me for everything else so that other possibilities would not be missed. I have had breathing difficulties in a lesser degree...mostly feel like i have to take a deep breath and that my chest is heavy. Dr felt it may not be just the b12 and maybe coming from my stomach. Went on prilosec for two weeks then zantac. Its some better as far as heavy chest feeling but still get short of breath off and on. Have them test your dad for b12..it is easy blood test and can really make a difference in treatment.