treatment for paralyzed hemidiaphram

[CarolynRF]

After experiencing shortness of breath, I have been diagnosed with paralyzed left hemidiaphram.  No cause known after CT's, other testing.  Symptoms are severe dyspnea on exertion. HIgh elevations seem to exacerbate the symptoms.   Even have SOB with moderate exertion at times.  I am (or was) active SCUBA diver and hiker.  Can't do either now.  Is there any treatment for this condition, and if so where do I seek it?  I live near Billings, MT.

[CarolynRF]

Thank you for responding.  I have had a full cardiac work-up, including cardiac cath.  Those tests confirmed no heart issues responsible for SOB.  Saw a pulmonologist who ordered abdominal and throat CT and sniff test.  He confirms paralysis, and finds no abnormality on CT scan.  Perhaps a thoracic surgeon could give me information concerning plication surgery.  Sorry I wasn't more clear in earlier email.  

[David Tinkelman, M.D.]

The first step should be for you and your doctor to request consultation with a lung specialist (Pulmonologist) to determine with reasonable certainty that the primary cause of your shortness of breath is the paralyzed left hemi-diaphragm. (UDP)  It is a bit unusual for a well conditioned person to experience such a high degree of dyspnea on the basis malfunction of one hemi-diaphragm so it will be most important to determine that your lung function is otherwise normal and your cardiac function normal as well.  It is also important to keep in mind that such paralysis can spontaneously resolve, after a year or more, partially or completely.  In addition over time many individuals adapt or physiologically compensate in response to UDP, to the point where it becomes less physically limiting .

Effective surgical intervention, called diaphragmatic plication, is an option and can be done with the use of minimally invasive techniques.  Electrical pacing of one’s diaphragm is a seldom used option but should only be performed at centers with specialized expertise, after other means have failed.

Good luck