Diaphragmatic Paralysis - Anatomy Question

[aadams]

I'm diagnosed with idiopathic diaphragmatic paralysis (right side).  Doctors recommend diaphragmatic "plication" which may afford some relief.  But they are reluctant to expound on the benefit of this invasive surgical procedure.  I am looking for a description of the anatomical mechanics that explain how diaphragmatic plication works (or may work) to improve the respiratory function.  Of particular interest is how and to what extent (if any) left and right respiratory mechanics overlap or otherwise relate to one another.  My thanks in advance to anyone who may be able to help.

[National Jewish]

In most instances where 1 side of the diaphragm is paralyzed the symptoms are relatively mild.  The favorable outcome of such cases does not require aggressive treatment.  This is true for people who had normal lung function prior to the paralysis.  This is not necessarily true for people with a lung problem, such as COPD.  For these people even a relatively small loss of lung function may make a difference.

You state, "afford some relief".  From your description the nature of what you are seeking relief from is not clear.  If you are seeking relief from shortness of breath, diaphragmatic plication may be of some help by allowing compressed lung to expand.  However there is no guarantee.  Plication works by tightening and flattening out the diaphragm.  This allows the lung in the area to expand.  Often plication can also prevent excessive inefficient flailing of the paralyzed hemidiaphragm.  It may also lessen the tendency of one lung to shift toward the other with deep inspiration.

Our best advice is that you seek out a good pulmonary specialist, who has had experience with plication to get an educated opinion.

[Sunny602]

Hi Aadams, I am so sorry you are facing this. I have bilateral diphragmatic weakness (have a pretty rare type of muscular dystrophy from what the docs say). As far as I know about unilateral paralyisis, as is in your case just the right side is affected. Alot of times, the docs find this incidentally when you get a chest xray for some reason, such as to check for infection. Do you have symptoms with this? Many people do not, but some do...they get short of breath bending over or they feel their overall stamina isn't what it should be. I have heard of plication for unilateral paralysis, if I am wrong with anything, just holler, it involves tacking the affected side down so that it doesn't move upwards. Let me explain better...when the doc looks at your chest xray, he more than likely sees that the side where your paralyzed is elevated. You might hear terms "like elevated hemidiaphragm on the x side". When you breathe in, your diaphragm tends to drop down to let air in, if one side is paralyzed, it just remains upward, sometimes it affects the function of the lung. I guess plication depends on how you feel, your symptoms and severity and other factors. I am no doctor, just a person who has been poked, prodded and through many tests and options. Please talk more with your docs about your options, especially if you have symptoms like shortness of breath. I hope I have helped you...and not confused you! Good luck- Sunny

[aadams]

Thanks, Sunny.  I'm curious as to how "plication" may work to improve ventilation.  There's a lot of professional journals and clinical studies which address diaphragmatic paralysis.  But I don't know of anything of substance written for the average person.  Perhaps someone will read our posts and point us in that direction.

[Sunny602]

Hmmm...my guess it that plication improves ventilation by not allowing the paralyzed diaphragm stay up high in the chest crowding the lung. Your lung stays fully inflated with plication from what I have read, which theoretically would lessen the shortness of breath and improve your ventilation. I have to find the actual articles, I read them awhile ago when I first going through the diaphragm issue myself about 3 years ago...As I said, I have muscular dystrophy, at this point I live on a vent, but hey, I can breathe now. I actually feel better now than I did prior to the vent. I am getting off subject LOL...If I find those articles, I will post them for you. They are from reputable sources...I know I have it in my computer...somewhere. I will keep in touch..Sunn :)

[Sunny602]

Hey, I found one of the articles..you probably have read it, it is the same one I posted above on the "collapsed lung" thread. It does mention a smidgen about plication, how that it not only prevents compression of the affected lung, but seems to help the healthy side of the diaphragm somehow function better. Not a bad article...from e-medicine:

http://www.emedicine.com/med/topic554.htm

Hope I have helped...Sunny:)

[aadams]

Thanks for the link to e-medicine.com. The information you found is very(!) useful. An explanation in terms of "lung mechanics" is exactly what I was looking for. I assume, in your case, that surgical "plication" is not an option. I'm new to all of this and consequently, of little or no help to anyone. Nevertheless, let me know if you have any questions within my limited range of experience.

[Sunny602]

I am so glad I could help you...I have learned alot from these forums,but it also keeps my mind active. I used to be an ICU nurse before I became too ill to work. In my case, no, surgical plication would not be an option because I have bilateral involvement, my lung functions are too poor...hence the ventilator that I require. Prior to my vent, my lung functions were probably as good as a babies, my capacities were horrible. My muscles, especially my diaphragm (not to mention the accessory muscles like the ones between our ribs and near our neck and bak) were mush. Ironically, the phrenic nerve was just fine. The docs at one time did consider a diaphragmatic pacemaker, but decided against it because my muscles were not functioning...I liken it to whipping a dead horse, no matter how much you try to stimulate it, it isn't going to work even with a viable nerve. Christopher Reeve had a diaphragmatic pacemaker and was actually doing fairly well on it prior to his death. Many people who have had spinal injuries have actually been placed on the pacemaker and how they do varies. It is amazing just how far technology has come. In twenty years, there will be a whole new set of gadgets out there, cures for diseases that were once incureable...the list goes on and on. I say the same for you as well, any questions you have, just e-mail me my addy is ***@****
Even if you want to bounce anything off of me or just want to talk, e mail me any way. I hope everything works out for you, hugs Sunny :)

[sonnymack]

I am a 63 year old male who was diagnosed with an elevated left diapraghm in 1990 but was told that it was insignificant. In 2001 I was admitted to the hospital for shortness of breath and pain in chest and left arm.  The doctors thought my problem was due to heart condition and conducted test on my heart. When the test proved negative, I was released from the hospital and told that nothing was wrong. Later, I started having severe pain in the neck and was diagnosed with severe degenerative diseases with spurring and spondylosis. Later, after complaining of shortness of breath, another test revealed that my left diapraghm was paralyzed.  I was operated on in July 2005 but three months later, I started having problems with shortness of breath but the doctor told me that this was normal due to the nature of the surgery that I had.  To make a long story short, My diapraghm is now worse than what it was before the surgery.  I am now seeing a different pulmonary specialist who said that surgery should never have been done without first determining what cause.  Because of my problem, I am experiencing dizziness,
general fatique, irritable bladder and pain.  Has anyone out there had similar problems?  I am interested in finding out what to do next.
Sonnymack

[kfindle]

A related discussion, bilateral diaphragmatic paralysis was started.

[Barb11]

A related discussion, paralyzed diaphragm was started.

[gracee]

A related discussion, phrenic nerve damage was started.

[polly1234]

A related discussion, diaphragmatic pilation was started.