breathing difficulty

[Elen__0__0]

    
      Re: breathing difficulty
    


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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.
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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.