paralized daphragm

[Victoria67]

I was diagnosed with M. Abscessus in 2004.  In June, 2006 I had 2/3rds of my left lung removed.  Since then I have a lot of difficulty breathing.  I can't walk more than 50ft with out getting so short of breath I almost passout.  My doctor ordered an echo and did show some problems, but according to the pulmonologist wasn't bad enough to warrent a heart catheterization.  They ordered a pft rest/walk study; my pulse ox went from 92 to 82; a sleep study which didn't indicate any apnea; a sniff test which indicated the paralized diaphragm, but doesn't think surgery would help.  They also don't think oxygen would help either.

I have been on iv antibiotics since I was diagnosed.  My question is do you think surgery would help my breathing? Or, am I doomed to be short of breath the rest of my life?

[National Jewish]

First, I would request a second opinion from a cardiologist on the echo.  Further clarification of any heart problem might serve as a guide for heart medicines.

Second, I would ask your doctors why they believe that supplemental oxygen would not help.  The situation where oxygen does not help is in the presence of what is called an anatomic shunt.  In the absence of that, when the fall in oxygen level is due to lung disease of the remaining lung, oxygen often helps prevent the fall in oxygen level that occurs with exertion.  The fall in oxygen level with exertion is, in all likelihood, a significant factor in your shortness of breath and added oxygen might relieve some of the shortness of breath.  You should ask them to repeat the pulse ox study, with the use of nasal oxygen at 2 to 4 liters per minute.

Third, in many, but not all instances of paralyzed diaphragm, pulmonary function is improved with a surgical procedure called diaphragmatic plication.  There may be a reason why plication would not be an option for you, such as the removal of two-thirds of your lung.  Ask your doctors about this.  Collapsed lung in conjunction with paralysis may also lead to a fall in oxygen level by, in effect, becoming a site of shunting.

[maggiemag]

I don't have an answer for you but I am very interested in your cervical rib problem.  I have some congenital rib and vertebrae deformities, and mild pulmonary hypertension and shortness of breath with exercise.  What symptoms were you having before your surgery and how did they diagnose your rib problem??  What artery was being compressed?  Thanks in advance for your response!

[MaryTweed]

Hi there.

I did have surgery in late October 2006 - was on heavy pain meds and minimal activity until January - my symptoms started at that time...when I began to get more active...  My surgery was done by a Thorasic surgeon - had the first cervical rib and surrounding tissue and muscle removed due to compression of the major artery in the neck...  My breath in-take is serverly reduced...and it isn't a problem with my lung...had a heart echo today...so I should find out something soon...

I read there is a pace-maker type mechanism that can be implanted in the diaphragm...at least there is something that can be done ... if you can get someone to do something about it...  what type of doctor specializes in the diaphragm..would that be a GI doctor???

Thanks for all your information...I really appreciated getting a response back!
:-)

[Victoria67]

Sniff Test.

This test is done to check to see if you have a paralyzed diaphragm.  The patient stands in front of a flourascope and the doctor asked the patient to breathe normally.  Then the doctor asked the patient to take a quick sniff through the nose.  A normal diaphragm will extend as the lung fills with are, but it will not move if it is not working.  This is done lateral and from the side.  The results are immediate.  The doctor should be able to diagnose the problem at that time.

Paralyzed diaphragm happens only when a patient has surgery or trama to the chest.  

For info on the subject go to your search for paralyzed diaphragm or acs surgery: principles and practice, written by Bryan F. Meyers, M.D., F.A.C.S. and Benjamin D. Kozower, M.D.

Mine is due to surgery.  Now I can't get anyone to help me get it fixed.

[MaryTweed]

What is a sniff test?

I have been seeing some specialist because of severe pressure under my rib cage, and pain in by upper back (right below the bra strap area), I have a reduced lung capacity (I scored 35 on the pulmonary lung function test) but a good oxygen level (92)...  The pulmonologist ordered a CT of the lungs right away and thank GOD that came back clean (my dad died of lung cancer).  I have an echo of my heart next week, and I have an abdominal ultrasound and MRI of my Thorasic spine Friday...  Blood tests were taken to check for Lupus .. I'll know in about 3 days...

I thought my diaphragm was paralized because that is the area that hurts when I take a breath...I had a cervical rib removed in late October, was on pain meds until January...and then in January when off the pain meds...I started have difficulty with upper back pain that has now grown into a vice-like grip in my chest...  My breathing is restricted and I have SOB when I move around and talk... (I don't have a gallbladder...but did have bilial colic before they removed the gallbladder...my PCP believes I could have a stone in the bile duct...even without a gallbladder...so the ultrasound was ordered.)

I'd like to find out how to test for a paralyzed diaphragm...if you don't mind telling me how this is done...

I hope you feel better...you are in my thoughts.