(LINKS webPAGE)

CAN'T BREATHE? SUSPECT VOCAL CORD DYSFUNCTION!

Links (Please also see References, on webPage 9)

 
(A)  ADVANCES in DIAGNOSIS and TREATMENT of VOCAL CORD DYSFUNCTION: A State-of-the-Art Conference -- CONFERENCE  AGENDA, at National Jewish Medical and Research Center [in Denver, Colorado, Friday and Saturday, July 20-21, 2001] This was a great (and rare) opportunity to learn important recent discoveries about Vocal Cord Dysfunction, from experts at National Jewish Medical & Research Center, abbreviated as NJC (Nat'l Jewish...Center)! 

Those welcomed to attend included: Physicians, Speech Pathologists, and Allied Health Professionals, like Emergency Room Personnel, Nurses, Physicians' Assistants, Anesthesiologists, Dentists, Pharmacists, Researchers, Emergency Medical Technicians, Respiratory Therapists, and others. Information learned at this Conference was added to this website. See webpage 9 (Ref.21), and webpage 8, of this website. The second VCD Conference was July 18 & 19, 2003. See these following links, about the conference agenda, etc.
http://cantbreathesuspectvcd.com/page8.html
http://www.njc.org/education/vcd2.html

(B) NAT'L JEWISH-GERALD TUCKER MEMORIAL MEDICAL LIBRARY books, journals, databases, services, digital collections, guides & resources, "Impulse", the library catalog, catalogs, consumer health resources, ovid/MEDLINE
http://Library.NationalJewish.org

(C) NAT'L JEWISH MEDical SCIentific Update: VOCAL CORD DYSFUNCTION, A publication of the Office of Professional Education (303-398-1000): Vol.11, No.5, May, 1993. Vocal Cord Dysfunction, by Susann M. Brugman, MD & Kenneth Newman, MD. (National Jewish Medical & Research Center, 1400 Jackson St., Denver, CO 80206-2671, 303-388-4461). Lung Line:1-800-222-LUNG(5864). Very informative article by very observant doctors.
library.nationaljewish.org/MSU/11n5MSU_VCD.html

(D) IRRITANT INDUCED VOCAL CORD DYSFUNCTION: Dr. Ronald C. Balkissoon, M.D., M.Sc., D.I.H., and Dr. John Perkner, D.O., M.P.H. briefly review their important article, called "Irritant-Associated Vocal Cord Dysfunction" (See References, on webpage 9.).They discuss a new way to detect narrowing of areas of the upper airway, using "an acoustic reflectance device", as a "Non-Invasive Evaluation of Vocal Cord Dysfunction". This device can detect "upper airway dysfunction", even when laryngoscopy seems to be "normal". The device can detect narrowing at the vocal cord level, above, and below vocal cord level. They also tell of a new study, in collaboration with Dr. Frederick Wamboldt, Psychiatrist, of treatment options for some of these patients, who (after having VCD attacks) have developed some symptoms of "panic disorder". http://www.NationalJewish.org/faculty/balkison.html 
Also, see http://www.nationaljewish.org/deoh/acr6.html

(E) PATIENT INFORMATION SHEET ON REFLUX by Center for Voice Disorders of Wake Forest University. Excellent information about a major (common) cause (among others) of Vocal Cord Dysfunction (VCD)&/or LARYNGOSPASM. Written by 2 ENT (ear nose & throat) doctors, Dr. Jamie A. Koufman, MD and Dr. Gregory N. Postma, MD, at their Medical Center in Winston-Salem, North Carolina. Includes newly recognized important differences between "heartburn" type GERD (Gastro-esophageal reflux disease), and 'voice box/throat area' type GERD, which they call "LPR"(Laryngo-Pharyngeal Reflux). (One can have either type, or both together.) 

This article has useful patient "Tips For Reducing Reflux and LPR", including diet changes, and urging folks to NOT WEAR TIGHT PANTS, BELTS, corsets, OR TIGHT CLOTHING AT ALL, avoid bending over too much, etc. They have a large web-site, worth visiting. Note: ENT (Ear Nose and Throat) means the same as ORL(Oto-Rhino-Laryngology). Please also see holistic "book about digestion" (Ref.15), on Reference webpage: webPage 9 (See bottom of this page), for natural treatments ideas. Also see links (Q) and (EE), below. http://www.bgsm.edu/voice/pt_info.html 

(F) LESSON 6, VOL. 13 VOCAL CORD DYSFUNCTION AS AN ASTHMA MIMIC Article by Robert Paine, MD, stresses many predisposing conditions associated with VCD, & has some very good references (articles in medical journals). 
www.chestnet.org/education/pccu/vol13/lesson06.html

(G) U of MN:PEDS PCCM [Pulmonary Critical Care Medicine] PULMONARY TEACHING FILES: VOCAL CORD DYSFUNCTION (last updated 12/10/97), Dr. Michael Shreve, MD, includes historical perspective, reminds readers (medical students)that they will see VCD in their practice & includes a  bibliography.
www.peds.umn.edu/divisions/pccm/teaching/vcd.html

(H) WHERE CAN I LEARN MORE ABOUT VOCAL CORD DYSFUNCTION? MELISSA Korenblat-Hanin, social worker & family therapist, answers questions about asthma, VCD, & social services. 
www.thriveonline.com/medical/asthma/ask/melissa.02-03-00.html

(I) WHAT IS VOCAL CORD DYSFUNCTION? ASTHMA DOC, Dr. Phillip Korenblat answers questions medically. 
www.thriveonline.com/medical/asthma/ask/asthmadoc.02-07-00.html

(J) VOCAL CORD DYSFUNCTION James Allen, MD refers to Ohio State Univ. Voice Institute, and Voice Disorders Institute (614-293-8064). He writes of associated conditions, e.g. post nasal drip, GER (gastroesophageal reflux), exertion, fumes, etc.
home.columbus.rr.com/allen/vocal_cord_dysfunction.htm

(K) DG [Doc Guide] DISPATCH CHEST:PATIENTS WITH VOCAL CORD DYSFUNCTION MAY PRESENT WITH ASTHMA SYMPTOMS article by Margaret Pearson (11/2/99), Special to DG News; describes symptoms, diagnosis, and treatment.
www.pslgroup.com/dg/1412aa.htm

(L) VOCAL CORD DYSFUNCTION-AN ASTHMA MIMIC, by John Neil Rhoades, RRT (Registered Respiratory Therapist), himself an asthmatic, answers questions in forums, chat rooms, etc.
Numerous folks are looking for info about VCD, and asthma. Some of them have stubborn cases, and they seem very frustrated. Others try to comfort the frustrated ones, telling their own success stories and providing resources.
asthma.about.com/library/weekly/aa022398.htm

(M) NSDA, Nat'l Spasmodic Dysphonia Association - defines S.D., treatments, support groups, referrels, publications & videos, events (conferences & support meetings), & latest news about S.D.(which sometimes is closely related to VCD; usually affects the voice; sometimes causes breathing problems). 
http://www.dysphonia.org
NSDA also has a Spasmodic Dysphonia voice forum (bulletin board), at http://www.dystonia-bb.org/forums/sd/

(N) EXERCISE-INDUCED LARYNGOCHALASIA MIMICS BRONCHOSPASM [This is also called UAD/Upper Airway Disorder/dysfunction, and is VERY SIMILAR & related, to VCD].
Article abstract refers to a report in the Nov., 2000 issue of Annals of Allergy, Asthma, and Immunology (Ann Allergy Asthma Immunol 2000;85:387-391) about abnormal movement and collapse of the "arytenoid folds" [near the vocal cords] in several athletes (swimmers, bicycle riders, etc.), during exercise, causing symptoms very similar to Vocal Cord Dysfunction:(See webpages 2 and 3). Although this article deals with a surgical treatment, surgery is only one of many (conservative) treatment options: See webpages 4 and 5. Also see the 4th link (D), on this "links" webpage, about the acoustic reflectance device, being researched by Dr. Balkissoon, M.D. (pulmonologist/lung doctor) at National Jewish Medical & Research Center to help diagnose this type of "Upper Airway dysfunction/Disorder" (UAD). See webpage 7 for how to contact Nat'l Jewish, for help.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11101182&dopt=Abstract

(O) MUSCLE TENSION DYSPHONIA AND SPASMODIC DYSPHONIA: The Role of Manual Laryngeal Tension Reduction in Diagnosis and Management -- article by Nelson Roy, MCLSC, Charles N. Ford, MD, and Diane M. Bless, PhD, Madison, Wisconsin. This very technical article describes the "circumlaryngeal massage" (around the larynx) that helps to lessen excessive activity (hyperactivity) of "extra-laryngeal muscles" (muscles outside the larynx), thereby decreasing "extra-laryngeal tension" (tense muscles outside the larynx). 

The circumlaryngeal massage has resulted in improving some patients' conditions of VCD [Ref.21, on page webpage 9], Muscle Tension Dysphonia (MTD), and Spasmodic Dysphonia (SD). WARNING: This technique must be learned from a doctor or Speech Pathologist to avoid possible dangerous results of doing it incorrectly. Also, this technique may be contra-indicated for some patients having certain medical conditions. (Dr. Nelson Roy, PhD, teaches these methods.)
http://reach.ucf.edu/~spa6211a/Circumlaryngeal%20Massage/distonia.html

(P) THE VOICE CENTER AT EASTERN VIRGINIA MEDICAL SCHOOL: by Dr. Randall L. Plant, MD, in Norfolk Virginia. Dr. Plant is an Ear, Nose & 
Throat (ENT) doctor who knows much about voice & breathing problems. Dr. Plant's informative website includes anatomy & physiology of the larynx (voice box), information about various voice & breathing problems. The discussion forum, however, was closed, in October, 2002.
http://www.voice-center.com

(Q) This is the same as Reference 26, on webpage 9: See Ref.26 for description of this important article: THE DIFFERENTIAL DIAGNOSIS OF PARADOXICAL VOCAL CORD MOVEMENT [PVCM/same as VCD] by Jamie A. Koufman, MD, whose article is reprinted from THE VISIBLE VOICE, Vol. 3, No. 3 (July 1994). To read &/or copy article, click on the following link:
http://emcrit.org/065-132/067-ent.htm 

(R) VOCAL CORD DYSFUNCTION--ADULT and PEDIATRIC: There are several effective therapies (treatments) used at National Jewish Hospital to successfully treat VCD patients. "The most effective therapy for VCD consists of breathing exercises, developed by Dr. Florence Blager, Chief of Speech Pathology" [and] must be taught by a speech therapist familiar with this disorder [VCD]." Dr. Blager also uses "Pilates", a special exercise form, and special coaching & pacing methods, to help VCD patients (young or older) having exercise-induced VCD. Dr. Blager can be contacted at Nat'l Jewish, by calling their LUNG LINE nurses, at 1-800-222-LUNG(5864):

(S) SCENTS TO DIE FOR--LITERALLY by Charles W. Moore, September, 1999: The writer describes dangerous effects of TOXIC FRAGRANCES (including examples of chemical ingredients), which can include damage to the respiratory, neurological, digestive, endocrine, immune, blood, reproductive, and other systems. The toxic (poisonous) chemicals found in "fragrances" can cause cancer, birth defects, infertility, and possibly genetic damage, etc. "Unscented" may mean has "masking fragrances...and actually contain toxic fragrances". "Fragrance free" products are "safer" (but "unscented" products may not be "safe"). This article is an important "alert" for VCD and asthma patients, their families, friends, and employers.
http://reformed.net/thoughts/scents.shtml

(T) FRAGRANCES AND PERFUMES ARE DANGEROUS TO OUR HEALTH: This article has important information for VCD patients and their doctors, exposing the health dangers of sprays, air "fresheners" and other "scented" products to people of all ages. Examples of many TOXIC CHEMICALS found in "FRAGRANCES" are listed.
http://wwws.us.ohio-state.edu/~steen/ei/fragrance.html

The above link doesn't work (11/08), so please see this good and helpful link: http://www.nontoxic.com/nontoxic/fragrancefree.html

(U) FRAGRANCE SENSITIVITY GUIDE: The included links to many articles explain how "toxic fragrances" are poisonous to people with (and without) respiratory conditions, and the links explain how bad reactions to "toxic fragrances" are not just "sensitivity" or allergies.
http://allergies.about.com/cs/fragrances/index.htm

(V) GERD PILLOW: Some VCD patients who have GERD (Gastro-Esophageal Reflux Disease) and/or LPRD (Laryngeal-Pharyngeal Reflux Disease) have found a special large GERD pillow helpful for sometimes preventing some GER/LPR episodes while sleeping or while lying down. A patient having both VCD & GER/LPR gave me a link to the "Prop up pillow" website, because she found the GERD pillow very helpful for her. This special type pillow can be an alternative to putting 6 inch to 8 inch blocks under the head end of one's bed. (I have no connection to this company, or to any others.) Please check with your physician first, to be sure that this GERD pillow would be safe for you to try.
http://www.propuppillow.com

(W) VOICE, SPASMODIC DYSPHONIA (SD), MUSCLE TENSION DYSPHONIA (MTD), BREATHING: This new website, created by Micki Nellis, includes a patient forum, links, "success stories", and much useful information about voice problems. Some doctors believe there may be closer connections between VCD (Vocal Cord Dysfunction) and SD (Spasmodic Dysphonia) and MTD (Muscle Tension Dysphonia), than was formerly believed. What benefits VCD patients is often similar to what benefits SD & MTD patients! The patient forum is uncensored, and allows free exchange of ideas. SD usually affects the voice, but sometimes affects breathing also! SD may predispose some people to getting VCD.
http://www.spasmodicdysphonia.us

(X) IS INDOOR MOLD CONTAMINATION A THREAT TO HEALTH? by Harriet M. Ammann, Ph.D., D.A.B.T., former Senior Toxicologist, Washington State Department of Health, Olympia, Washington (not sure of date). This is a very informative & interesting article, that shows the many possible bad health effects due to exposure to toxic molds. This raises an important question of whether (& how) VCD could be directly or indirectly caused by mold exposure. 

Some molds can cause bad effects on the following bodily systems: vascular (in several areas of body), digestive (diarrhea, vomiting, intestinal hemorrahage, liver effects, etc.), respiratory ("respiratory distress", etc.), nervous system (tremors, headaches, incoordination, depression, headache, etc.), cutaneous (skin, eyes, etc.), urinary (kidneys, etc.), reproductive system, immune system, etc. 

"Health effects [of molds] generally fall into four categories...allergy, infection, irritation (mucous membrane and sensory), and toxicity. All this is well described in this helpful article. See the following link: http://www.mold-survivor.com/harrietammann.html


(Y) SIDE EFFECTS (of Dilaudid, a NARCOTIC ANALGESIC).  This webpage is part of a website called RxList, produced by a pharmacist. A patient (also is a nurse) said (12/02) she has had adverse (bad) reactions to 2 "opiate" drugs (Hydrocodone--found in Vicodin, for example, & Dilaudid). The bad reactions included itch ("pruritis") & laryngospasm

This RxList website states that "The adverse effects of DILAUDID-HP (HP=high potency) are similar to those of other narcotic analgesics and represent established pharmacological effects of the drug class." Narcotics are natural &/or synthetic derivatives of opium, and are used as analgesics (PAIN KILLERS) &/or COUGH SUPPRESSANTS. The RxList website says, "Respiratory: Bronchospasm and laryngospasm have been known to occur." [with the class of drugs called narcotic analgesics].
http://www.rxlist.com/cgi/generic3/hydromorph_ad.htm

(Z) FIRST SELF-HELP GROUP FOR VCD PATIENTS in GERMANY. Marianne Krommer told me (1/03) about her website, for the first self-help group for VCD patients in Germany. The website is written in German. One medical clinic in Germany (clinic link is in the website) had 2 people come to the VCD Conference held in Denver, Colorado, in July of 2001, to learn the latest information about VCD. See link (A) above, about the second VCD Conference, that was held July 18-19, 2003. 
http://www.vcd-selbsthilfe.de

(AA) ENTERO-LAB FOR GLUTEN & FOOD SENSITIVITY TESTING. Dr. Kenneth Fine, M.D. (Gastro-enterologist) is a medical doctor who helps babies, children & adults to discover which foods they are sensitive (intolerant) to. Food sensitivities can cause GERD (gastric reflux), and many other serious health problems. Also, gastric reflux can cause VCD attacks--in infants, children & adults! 

Dr. Fine found that certain new kinds of stool tests (looking for abnormally large numbers of antibodies to certain proteins, when the antibodies are made in the large intestine, as an auto-immune reaction to incoming foods/proteins, that one is sensitive to) are often more reliable (diagnostic) than blood tests, or even intestinal biopsies, regarding detecting: food (protein) sensitivities (like gluten sensitivity, casein sensitivity, etc.) & food intolerances (for example, lactose/milk-sugar intolerance), Celiac Disease (one type of gluten sensitivity), other non-celiac types of gluten sensitivities, milk protein sensitivities (like sensitivity to casein, whey, etc.), etc. 

Stool samples can be sent to Dr. Fine's EnteroLab, for analysis. Dr. Fine offers nutritional advice for people having these problems. Note: Gluten is found in wheat, rye, barley, (oats & buckwheat can be cross-contaminated with gluten at processing plants, etc.). Brown riceis a gluten-free grain. Corn is gluten-free, but many are sensitive to corn proteins. Some gluten sensitive people do well with millet. Others don't. Dr. Fine recommends avoiding all grains. 

A lady "JCC" at a peripheral neuropathy forum, at http://www.braintalk.org first alerted people to Dr. Fine's innovative work, regarding Celiac Disease, other gluten sensitivities, & other food (protein) sensitivities. JCC also started the Gluten Sensitivity/Celiac Disease forum, also at braintalk.org 
http://www.finerhealth.com

(BB) DIAPHRAGMATIC FLUTTER EMULATING [looking like] RECALCITRANT [stubborn] ASTHMA by Paige Harrison, RRT (respiratory therapist), and Douglas J. Onorato, MD, Hartford, CT. The authors list MANY medical conditions that can cause or be associated with Diaphragmatic Flutter (DF). DF can "mimic" VCD, but DF is NOT VCD--although a person can have BOTH conditions (DF & VCD), at the same time. DF can be treated once doctors find the underlying causes of each patient's DF. 

"Diaphrgamatic flutter has been reported with cardiomegaly [enlarged heart], metabolic alkalosis, fracture of the xyphoid process and cervical ribs, thoracic herpes zoster [a virus related to chicken pox, in the chest/ribcage area], viral encephalitis [brain inflammation due to viruses], lymphoma, and rheumatic heart disease." [Rheumatic heart disease is one of several types of auto-immune responses to a streptococcus bacterial infection, like strep throat. See link (W), for links to a streptococcus connection to DF]. 

"It [DF] has also been associated with peritoneal adhesions, gastro-intestinal mal-function, emphysema, atherosclerotic heart disease, and anxiety." [Peritoneal adhesions are fibrous scar tissue on the moist abdominal lining (peritoneum). A normal (no adhesions) peritoneum gently holds abdominal organs, such as intestines, in their correct position, allowing for some movement during digestion and absorption. Adhesions are often due to inflammation or trauma/injury, sometimes from surgery]. 

"Diaphragmatic flutter has been reported as a post-operative complication of coronary artery bypass surgery, mediastinal adenopathy [swelling & changes in lymph nodes, &/or gland disease, between the lungs], pleurisy [inflammation of the lining around the lungs], and hyperventilation syndromes. [DF]...has also been observed as a complication of the treatment of status asthmaticus [continuous asthma attack which must be stopped] and inspiratory stridor. Although speculative, causal relationships in diaphragmatic flutter intimate local phrenic nerve or diaphragmatic muscle irritation."

This article says that most commonly mentioned causes of DF are central nervous system disorders. But, "peripheral phrenic nerve and diaphragmatic irritation have also been implicated." [Central nervous system includes brain & spinal cord. All other nerves, outside the brain & spinal cord, are called "peripheral nerves."]

The authors used a special test called "respiratory inductive plethysmography"--pronounced pleth-iss-ma-grow-fee-- (shows changes in blood flow, indicating size changes, in organs) to help confirm their diagnose of DF.

(CC) INVOLVEMENT OF RESPIRATORY MUSCLES IN ADULT-ONSET DYSTONIA: A CLINICAL AND ELECTOPHYSIOLOGICAL STUDY by A. Lagueny, P. Burband, G. Le Masson, F.X. Bergouignan, X. Ferrer, and J. Julien, Service de Neurologie Hospital de Haut Leveque, CHU Bordeaux, Pessac, France. This article is from the journal, Movement Disorders, Vol. 10, No. 6, 1995, pages 708-713.

This technical article concludes that there is probably more respiratory involvement with dystonia (type of brain injury), than was previously thought. They also write that tic disorders usually begin in youth, more in boys than girls, but that in adults, "differentiation between tics and dystonia is sometimes difficult." They found that the diaphragm muscle (and other respiratory muscles) could be involved with tics &/or dystonia. "Dystonia and tics may coexist...[and there may be] a physiological overlap...", concerning the part(s) of the brain that, when injured, may cause these neurological conditions, due to "brainstem hyperexcitability".

This is relevant, because respiratory tics &/or dystonias can "mimic" VCD. (2003 VCD Conference, Dr. Susan Brugman, MD). 

Also see information about Spasmodic Dysphonia & Meige's Syndrome, on webpage 5.
Click here for (CC) article's link.

(DD) RESPIRATORY FLUTTER SYNDROME, An Under-recognized Cause of Respiratory Failure in Neonates [newborn babies] by Eliot S. Katz, Estelle Gauda, Thomas Crawford, Folasade Ogunlesi, Maureen A. Lefton-Greif, Sharon McGrath-Morrow, and Carole L. Marcus, Eudowood Division of Pediatric Respiratory Sciences, Division of Neonatology, and Division of Neurology, John Hopkins University, Baltimore, Maryland.

The authors write that Respiratory Flutter includes Diaphragmatic Flutter (DF), spasms (flutter) of intercostal [between the ribs] muscles, and is associated with dysphagia [difficulty swallowing], laryngomalacia [softening of the tissues in the larynx/voice box], and gastroesophageal reflux. It is not known yet, what causes the swallowing problems and reflux. This may be either due to the underlying brainstem injury, &/or, maybe from the Respiratory Flutter itself (from "mechanical fluctuations in intrathoracic pressure induced by the Respiratory Flutter").

DF can "mimic" VCD. DF can strike any age person. Like VCD, DF can occur only when breathing in, or only when breathing out, or throughout the breathing cycle. DF may stop during sleep, or, may continue during sleep. DF patients may hyperventilate (breathe very fast), or they may breathe abnormally slowly. DF can last days, or even for years. Neurologist specialist doctors can differentiate between VCD and Respiratory Flutter. There are treatments, such as CPAP (Continuous Positive Airway Pressure) &/or medications, etc.
http://ajrccm.atsjournals.org/cgi/content/full/164/7/1161

(EE) LARYNGOPHARYNGEAL REFLUX (LPR). This "ENT- Ear, Nose & Throat Journal--September, 2002 Supplement", has 8 useful and interesting articles, about newly recognized bad respiratory effects of LPR, (including VCD). LPR's effects are different from the effects of heartburn type of GERD (Gastro Esophageal Reflux Disease). Includes many surprising, unexpected symptoms & signs of LPR, testing methods, bad clinical conditions caused by LPR, treatments, pediatric LPR, & internet resources about LPR. Authors are expert doctors: Jamie A. Koufman, MD, FACS; Peter C. Belafsky, MD, PhD; Gregory N. Postma, MD; Milan R. Amin, MD; Jonathan E. Aviv, MD, FACS; Jacob T. Cohen, MD; Kevin K. Bach, MD; Lawrence F. Johnson, MD; William F. McGuirt, Jr., MD. Also see links (E) and (Q), above. 
http://www.entjournal.com/Archives_FR.htm?ID=961
Above link may not be working. Try this following link, to get to original ENT-Ear, Nose & Throat Journal--Sept., 2002 Supplement:
http://findarticles.com/p/articles/mi_m0BUM/is_9_81/ai_92281755/

(FF) DIAPHRAGMATIC FLUTTER PRESENTING AS INSPIRATORY STRIDOR by Peter J. Cvietusa, MD; Sai R. Nimmagadda, MD; Raymond Wood, MD; and Andrew H. Liu, MD (all from the Division of Allergy/Immunology, Departments of Pediatrics, National Jewish Center for Immunology & Respiratory Medicine, and University of Colorado School of Medicine, Denver, CO.) This article can be found in the medical journal, CHEST 1995;107;872-875.

Diaphragmatic Flutter can strike children, teenagers, or adults.

This important case report tells how a teenager was mis-diagnosed as having each of the following: possible seizure disorder, Tourette's syndrome, cough variant asthma, VCD, and psychological problem. Nothing tried could stop the "attacks", so she was seen at Nat'l Jewish, where it was found that she actually had a "rare" condition called DF/Diaphragmatic Flutter (a VCD "mimic").

DF involves "rapid, involuntary contractions of the diaphragm, often superimposed on normal diaphragmatic excursion....usually episodic [intermittent, not constant] in nature, but in our patient, it was continuous for nearly 8 months."

In addition to shortness of breath, there can be "epigastric pulsations, [visible rhythmic beats/contractions seen on the skin at or near the stomach, from 35 to 480 times per minute], fatigue, and/or pain of the abdominal wall muscles.", "respiratory alkalosis", and perhaps for the first time reported, in this article, "stridor [noisy, harsh, gasping sound] with each inspiration [inhaled breath]." 

In this patient's case, her vocal cords snapped shut, with each diaphragmatic spasm. This made it look like VCD, when she was laryngoscoped, originally. 

Dr. Liu said (1/06) that deeply inhaling (breathing in), and even doing VCD breathing techniques, may each WORSEN diaphragmatic flutter. 

The DF caused dyspnea (shortness of breath), inability to speak well, and fatigue possibly from low oxygen, that limited her activity. The vocal sounds during DF episodes, included "stridor", in a very rythmic fashion, somewhat resembling the sounds of severe hiccups (hiccoughs). The cause of this patient's DF may have been a previous head injury (diving accident), injuring her left phrenic nerve. 

The cure, for this patient, was a phrenic nerve "crush", with the left phrenic nerve (purposely crushed by the doctors)  re-growing normally, after some months (usually takes up to 6 months to re-grow). There are 2 phrenic nerves, so her diaphragm functioned normally, while the injured and then crushed (left) phrenic nerve regenerated. Before doing the "crush", anesthetic injection into the mal-functioning phrenic nerve is tried, and if this causes temporary improvement, this improvement predicts more likely success, with a subsequent (later) crush technique.

Possible causes (etiologies) of DF, include: "disturbances of the central nervous system" (brain or spinal cord) abnormally exciting the phrenic nerve, and "the most common central nervous system disturbance is encephalitis" [Encephalitis means inflammation of the brain, and can be  caused by (at least) VIRAL infections from virus infected foods or milk, viruses spread by mosquitoes or by ticks, LEAD POISONING, VACCINATION REACTION, "irritation of the phrenic nerve itself, or irritation of the diaphragm", "irritation of left phrenic nerve by the heart", "mass lesions impinging on the phrenic nerve or trauma to the cervical root of the phrenic nerve [like from the diving accident, where patient hit her right side of head on side of a swimming pool],..."pleurisy, peritonitis, or ischemia of the diaphragm" [lack of proper blood flow to diaphragm muscle, causing damage or death of some diaphragm cells, from lack of oxygen and food, leading to mal-function, that is, the fluttering/spasming--and, the cause(s) of the ischemia must be found], and, "metabolic disturbances [not sure exactly what these are] may be important co-factors to any of the above causes."

Some specialist doctors know about this "rare" condition called DF, that can "mimic" VCD. These doctors include (at least) allergists and pulmonologists (lung specialists), and also laryngologists and neurologists. See:
http://www.chestjournal.org  or, contact Dr. Liu, MD, at Nat'l Jewish, for reprints of this article.

http://journal.publications.chestnet.org/data/Journals/CHEST/21710/872.pdf is the working link to this article.

(GG) LIVING WITH VOCAL CORD DYSFUNCTION, is a new (July/Aug., 2007) website about a teenage young lady whose long term VCD began early in her life, was often very severe, often including total vocal
cord closure, causing passing out. The young lady's VCD was lessened when her mal-functioning gall bladder was removed. See: http://www.difficulttobreathe.com

(HH) What's This Thing Called Vocal Cord Dysfunction? By Susan M. Brugman, MD, is a very helpful article, by a VCD expert, who is a pediatric pulmonologist at Nat'l Jewish in Denver, CO. The article has the following objectives:
  1. To detail the confusion around, and brief history of, vocal cord dysfunction.
  2. To define vocal cord dysfunction and describe its clinical presentation.
  3. To propose a rational, diagnostic evaluation of vocal cord dysfunction.
  4. To determine the proper therapeutic strategy for vocal cord dysfunction.
  5. To discuss some proposed etiologies of vocal cord dysfunction.
See this link to read the article:
http://www.chestnet.org/education/online/pccu/vol20/lessons25_27/print26.php

(II) An English patient's "cure" for his laryngospasms was oral Magnesium supplements, etc. This is an interesting layman's website, with links to doctors' articles, showing how a magnesium deficiency can cause laryngospasms. Magnesium can also help prevent a heart rhythm irregularity called Atrial Fibrillation. Be cautious, since too much Magnesium can be harmful or fatal! Link to the English person's website is http://www.retinascope.co.uk/laryngospasms.html

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