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CAN'T BREATHE? SUSPECT VOCAL CORD DYSFUNCTION!

How to recognize and accurately diagnose VCD

First, GET IMMEDIATE EMERGENCY MEDICAL CARE, for any breathing problem, in case of any life-threatening situations or conditions. Then, encourage the medical personnel to include and consider VCD in the differential diagnosis of causes of upper airway obstruction. See TABLE 1, and additions to TABLE 1: Other causes of upper airway obstruction.

There are additional conditions that can "mimic" VCD. See new information (from 2003 VCD Conference, etc.), in last part of this webpage, about Diaphragmatic Flutter, Diaphragmatic Dystonia, Diaphragmatic Tic Disorder, and overlap of these conditions, etc.

Please see webpages 4 & 5, about several more VCD "mimics".

If doctors have not yet seen the "attacks", it may help for someone (relative, friend, etc.) to VIDEOTAPE or AUDIOTAPE the patient during an attack, to show to the patient's doctor(s). This can help to show whether the attack looks like (and sounds like) possible VCD, or, might look like (or sound like) a VCD "mimic", rather than VCD. Do this videotape or audiotape,  only AFTER calling for emergency help, or while on the way to the ER/emergency room, and only AFTER trying to help the patient to be able to breathe properly (Please see webpage 4 for what to do during a possible VCD attack). 

TABLE 1. Causes of upper airway obstruction (Ref.3--see webpage 9) [I believe that the term "upper airway" here, generally refers to the parts of the respiratory system above the trachea/windpipe, including the larynx/voice box, pharynx/throat, nose, etc. In some other sources, I've seen the trachea included as part of the upper airway. The lower airway includes the lungs, and the lungs include the 2 bronchi, many tiny bronchioles, alveoli/tiny air sacs, etc.] 
 

Infectious

Retropharyngeal abscess

Ludwig's angina

Laryngo-tracheo-bronchitis

Laryngeal papillomatosis [is one type of RRP/Recurrent Respiratory Pappilloma]: (new info added 10/07):
   This is a type of throat area tumor (usually benign, only rarely becoming cancerous), caused by strands 6 & 11 of the virus called Human Pappiloma Virus/HPV. Different stands of this same virus cause plantar warts, or cervical cancer. This virus is sometimes (unintentionally) given to newborn babies, during birth, by mothers who have the genital virus called Human Pappiloma Virus (HPV). Other causes are being investigated by researchers, including possible sexual transmission in adults, and other non genital causes in children.
   The danger is this growing tumor can block the upper airway, & sometimes spread downwards to trachea, bronchi, occasionally lungs, causing symptoms that are often misdiagnosed as being asthma, croup, VCD, etc.
   See an RRP-knowledgable ENT immediately, if any of these symptoms occur in infant or child: weak cry, chronic cough, swallowing problems, noisy breathing. (In adults, usually breathing problems happen when exercising).
   Cabbage juice &/or Kim Chee (Korean fermented cabbage dish), broccali juice, etc. (Cruciferous veggies, are same as the Mustard family), can sometimes control or cure RRP, in some cases. See the article called:
"Treatment Protocols and Cabbage Juice Recipes" 
by Michael Green, half way down the webpage, at this link:
http://www.rrpf.org/newletters/RRP_Newsletter_Fall93.html
  Veggies in the cabbage/mustard family (Cruciferae), include cabbage, broccali, kale, mustard greens, watercress, radishes, etc., and are helping some patients to fight this virus-induced tumor, where the tumors have grown big enough to interfere with breathing.
   Two warnings: Avoid eating brussels sprouts before or after surgery, because their very high Vitamin K content, may promote blood clots right after surgeries. Instead, try watercress, which is said to have very little Vitamin K in it.
   And, eating cruciferous veggies, in excess, can depress the production of thyroxin (a thyroid gland hormone), in hypo-thyroid patients.
   For excellent info about RRP (what it is, how to get diagnosed and treated, who researchers are, etc.), see the RRP Foundation's website, at http://www.rrpf.org

Epiglottitis [Can be life-threatening. Get emergency help immediately.]

Bacterial tracheitis

Adenoidal/tonsillar hypertrophy [enlargement of adenoids or tonsils]

Infectious mononucleosis

Diphtheria

Tetanus [Lockjaw]
 

Traumatic

Post-intubation injury [(post=after), intubation=having an endotracheal tube (ET) that was placed between the vocal cords, to help improve breathing, and, the ET is hooked up to a ventilator machine. 

When the ET is later removed, in a process called "extubation", there can be many possible complications, including "laryngospasm", &/or swelling (edema), etc. A very skilled medical team must be present before, during, & after both intubation and extubation. Intubations can predispose one to having VCD attacks.]

Facial fractures [broken facial bones.]

Laryngotracheal trauma
 

Congenital lesions

Macroglossia
 

Neurologic

Myasthenia gravis (MG)

Meige's syndrome [a non-focal dystonia, related to Spasmodic Dyphonia]

Bulbar palsy [as in polio] 

Neoplastic

Carcinoma of the thyroid, esophagus, larynx, or pharynx. [Some tumors block part of the upper airway. Some tumors press on nerves, which can cause various breathing problems. 

Sometimes, during surgery to remove a tumor, a nerve can be accidentally "nicked" or stretched, & this surgical complication can lead to events like vocal cord paralysis, etc., which then can cause breathing &/or voice problems. See webpage 5 for details.][Also, see section below, about "Extrinsic airway compression", from non-cancerous thyroid goiter, etc. And see RRP section on the left, referring to Laryngeal papillomatosis].
 

Other

Paradoxical VCD

Foreign body aspiration [choking, drowning, inhaling a foreign object like a toy, or food, or liquid]

Vocal cord paralysis

Hereditary angioneurotic edema

Acquired subglottic stenosis [narrowing of the airway just below vocal cord level, in the larynx (voice box), but above the trachea/windpipe--not born with the stenosis/narrowing].

[Note: Subglottic stenosis can CAUSE VCD. Also, some people are born with "subglottic stenosis".]

Anaphylactic reaction [severe allergic reaction, with laryngeal edema, life- threatening if untreated] (Ref.12)

Cricoarytenoid arthritis [e.g. ask for Lyme Disease to be checked on]

Postoperative laryngeal stridor from residual muscle relaxant effect

Hypo-calcemic [low blood calcium levels] and alkalotic tetany [continuous muscle spasms][I believe that one cause of hypocalcemic tetany can be accidental removal of parathyroid glands, during a thyroidectomy.]

Retained secretions

Idiopathic [condition or disease with unknown cause]

 


Other causes of upper airway obstruction include (at least):
 

Foreign body lodged in esophagus (Ref.5--See webpage 9)

Croup [a childhood infection, usually viral] (Ref.5,12)

Abscesses (hypopharyngeal or laryngeal) (Ref.5)

Atypical pertussis (whooping cough) in infants. See webpage 5 for description of how ADULT pertussis (Whooping Cough) or CHILDHOOD pertussis can cause either upper airway obstruction &/or VCD &/or vocal cord paralysis (which can pre-dispose one to getting VCD)! Pertussis is usually unsuspected & misdiagnosed as bronchitis, in adults, because it occurs even in vaccinated/immunized adults. (Ref.6,17)

Upper respiratory tract infection [URI] or exercise...in the presence of an underlying anatomic defect, such as subglottic stenosis or laryngomalacia (Laryngomalacia is softening of tissues of the larynx/voice box, & is often due to gastric reflux). (Ref.5,12)

Spasmodic Dysphonia (sometimes called laryngeal dystonia or spastic dysphonia). The abductor type can cause dyspnea on exertion. Some physicians believe S.D. is more closely related to VCD than was formerly thought. Some S.D. patients have a "Respiratory type of adductor laryngeal dystonia": Their 'stridor' is "present throughout the day". Their stridor "disappears during sleep". Also, "the voice is normal." (Most S.D. patients have voice changes, without respiratory problems.). Botox (botulism toxin) injections, done by a very experienced voice ENT (ear, nose & throat doctor) into the vocal cords can sometimes help. See more about this, on webpages 4 & 5. (Ref.6,12,13,17,26)

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Laryngospasm due to metabolic abnormalities such as hypo-calcemia caused by hypo-parathyroidism (Ref.12)

Laryngospasm can be triggered by occult (hidden) gastro-esophageal reflux (GER) (Ref.12)

Laryngospasm, especially common among children, appears to be associated with stimulation of the vocal cord area. (Ref.10)

Laryngospasm can be caused by general anesthesia, and involves inappropriate reflex closure of laryngeal structures at three levels: the true vocal cords, false vocal cords, and the supraglottic folds....and can result in pulmonary edema (Ref.12). See webpage 1 for more about comparing laryngospasm to VCD: There is controversy and disagreement among doctors about the difference(s) between laryngospasm and VCD. There is also disagreement about how to define laryngospasm.

See webpage 4 (at bottom) for anesthesiologist Dr. Larson's "Larson maneuver/technique", which is Dr. Larson's method of putting specific finger pressure under 1 or both ear lobes, in a "dimple" called the "laryngospasm notch", that stops a laryngospasm which sometimes happens when a patient is either under anesthesia, or, when the patient is coming out of anesthesia!

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Abnormal shape or abnormal motion of areas of throat near the vocal cords, but not actually involving the vocal cords themselves. These problems cause "Upper Airway Dysfunction", similar to VCD. (See Ref.3, on webpage 9, and Dr. Balkissoon (D) on "Links" webpage, and entry (N) on "Links" webpage, about Exercise- Induced Laryngochalasia, which is one type of abnormal motion causing symptoms very similar to Vocal Cord Dysfunction). Treatment is often the same as for VCD.

Vocal cord polyps (Ref.12)

Laryngeal saccular cysts & laryngoceles (Ref.12)

Laryngeal webs [scar tissue--may need surgical removal] (Ref.12)

Subglottic hemangiomas (Ref.12)

Tuberculosis (TB) (Ref.10)

Sarcoidosis and other granulomatous diseases (Ref.10)

Extrinsic airway compression: This can be caused by goiter or mediastinal infections. (Ref.10). A goiter is an enlargement of the thyroid gland, and can be caused by (at least): hypo-thyroidism, that is, under-active thyroid gland, or lack of iodine in the diet, or thyroiditis--inflammation of the thryroid due to an auto-immune condition like Hashimoto's thyroiditis, etc., or infection, or tumors, or hyper-thyroidism, that is, over-active thryoid gland, etc. 

Goiters (enlarged thyroid gland) can compress not only the larynx, but also the upper part of the trachea, causing stenosis (narrowing) of the upper trachea. I believe that this can predispose one to getting VCD. One patient had VCD for over 20 years, and when a CT scan of her thyroid gland and trachea was finally done, in 2003, tracheal compression and lateral displacement of the trachea, due to a goiter, was finally noticed, for the first time! 



NEW INFORMATION!-- A neurological "tic disorder" can "mimic" VCD. (2003 VCD Conference, Dr. Susan Brugman, MD--see webpage 8). Diaphragmatic Flutter (DF) may be caused by "central nervous system [brain/spinal cord] disorders" (such as "tic disorder" &/or "respiratory dystonia", involving the diaphragm &/or larynx/voice box). And, "peripheral phrenic nerve and diaphragmatic irritation have also been implicated." [Peripheral nerves are outside the brain & spinal cord.] See Links webpage, links (BB), (CC), (DD) for more information! Please see a neurologist about this.

NEW INFORMATION (NOV., 2009):

http://www.webpediatrics.com/pandas.html  tells A LOT about how strep infection can cause PANDAS, and how viruses &/or mycoplasma and other infections can cause a similar syndrome called PITAND: 
 
"PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal bacterial infection) and PITAND (Paediatric Infection-triggered Autoimmune Neuropsychiatric Disorders----from viruses, or mycoplasma organisms, etc.)"....which Dr. Susan Swedo and others, educated doctors about, back in the 1990's!! 
 
These 2 syndromes can cause TICS, OCD (obsessive compulsive disorder), Tourette's Syndrome (TS), etc. etc.
 
Tics can be vocal noises, words, cursing, repetitive actions & words, facial or other body movements, couging, "sneezing", etc. that are almost impossible to stop, and TICS CAN even MIMIC VCD!

PANDAS symptoms may be caused when the immune system makes antibodies to the Strep bacteria, but the antibodies wrongly attack (auto-immune attack) brain tissue (in the "basal ganglia"), partly because the BBB (blood brain barrier) is "breached", so those antibodies can reach the brain.

and

In these excellent websites/forumsparents help eachother to find good doctors for their children, and to help patients of all ages who have TICS &/or OCD (obsessive compulsive disorders).
 
Parents warn that even if the blood work doesn't show obviously elevated results indicating a strep infection, (PANDAS) that parents should still suspect a possible PANDAS-like syndrome! (from a virus, or other infectious organism/bug), such as PITANDS!
 
VACCINATIONS with a flu shot or other vaccinationsmay worsen the PANDAS or PANDAS-like situation.

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An excellent book about PANDAS is "SAVING SAMMY" by BETH MALONEY (Sammy's mother).

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An additional website, says this (read both links):

http://www.pandas-pitandawareness.org/ (which comes from http://sanevax.org/
) includes the following, and more:

"....This condition [tics, etc.] is triggered by infection.  Streptococcal infection has been most studied; however, any infection can trigger this condition.  Thus, a new name is being considered:  P.A.N.S. is Pediatric Autoimmune Neurological Syndrome...."

The links also discuss possible aluminum toxicity, from vaccines such as Gardasil , FLU SHOTS, &/or from environmental poisoning [Avoid aluminum cookware, aluminum containing antacids, underarm deodorants, etc.].

And, some vaccines contain viruses that (for example, in the case of Gardasil and other vaccinations) might cause PANS (with TICS!).

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In "clusters" of children having "tics", find out what they all had in common, including where they ate, in case of a disease "carrier" accidentally sharing germs (bacteria, viruses, mycoplasma organisms, etc.).

Even in individual cases of tics, look for possible infections of any of these: Streptococcus (can be other than just strep throat), viruses, vaccinations, other organisms, etc.

Also, investigate possible Lyme Disease (which can cause tics), in case 1 or more children were exposed to ticks carrying various Lyme Disease organisms.

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Toxic chemical poisoning should also be investigated, when "clusters" of tics exsit, or even in single cases with tics. Check at places the children are at (schools, remodeling, nearby factories leaking industrial toxins, toxic spills, illegal dumping of toxic chemicals). See above about aluminum, also.

 
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Because many parents & patients notice worse "tics" when the child or adult eats GLUTEN &/MILK PROTEINS, some doctors, patients, etc., suspect that a gluten sensitivity &/or milk protein sensitivity, etc., may also worsen PANDAS &/or PITANDS, in people who are SENSITIVE TO GLUTEN &/OR TO MILK PROTEINS, so this is why I recommend reading Dr. Kenneth Fine's website about his "EnteroLab", that is in Dallas, Texas, and which has this link:  www.finerhealth.com .
 
Dr. Fine is a gastroenterologist, who himself, has a non-Celiac form of gluten sensitivity, which is known to cause all sorts of auto-immune attacks on various parts of the body, in gluten sensitive people. Milk proteins can also cause auto immune attacks in people who have a milk protein "sensitivity" (sensitivities are different from allergies).
 
Dr. Fine does non-invasive stool sample testing, about food protein sensitivities.


Direct LARYNGOSCOPY, using correct technique DURING SYMPTOMS "is the most important test in making the diagnosis of VCD. "Incorrect technique could cause the gag reflex to occur during the procedure, which could cause laryngospasm, -- so similar to VCD, if not identical to VCD, that this could interfere with getting accurate results of the laryngoscopy procedure. (Ref.1,5)

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Several Speech Pathologists (at a VCD Conference held by Nat'l Jewish) spoke of doing a STROBO-SCOPIC (using a STROBE LIGHT) fiber-optic LARYNGOSCOPY, in between VCD attacks (not during a VCD attack), to see if ABNORMAL VIBRATION PATTERNS of vocal cords is happening. If yes, this points towards the patient having VCD! If no strobe light is used, such VCD patients, in between their VCD attacks, would seem to have a NORMAL laryngoscopy examination! A strobe light is needed, to detect (see) abnormal vibration patterns of vocal cords, of VCD patients, IN BETWEEN ATTACKS (VCD attacks).

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Dr. Tod Olin, M.D., at Nat'l Jewish Health, in Denver, CO, is doing innovative research to help diagnose VCD patients, especially when their VCD is exercise-associated. For example, Dr. Olin has designed a bike helmet that allows the rider of a stationary bike to be laryngoscoped, WHILE RIDING THE STATIONARY BIKE! (2016)

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NOTE!!: Some of the above causes of upper airway obstruction [or lower airway problems] can also be a FACTOR in someone developing VCD! (See webpages 5, 9, & links webpage, for details.)

Various other medical tests (lung function, digestive, allergy, neurological, etc.) should be done to see if any other conditions like asthma and/or gastric reflux, (neurological) tic disorder &/or respiratory dystonias, and/or other problems may co-exist with VCD in the patient. There may be LOWER respiratory problems (with trachea, lungs, etc.) that need to be diagnosed.

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If you have had turbinate reduction surgery (a nasal/nose surgery), please see webpage 2, about a possible surgical complication called Empty Nose Syndrome (secondary atrophic rhinitis) that can "mimic" VCD.

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Please get IMMEDIATE EMERGENCY MEDICAL CARE, FOR ANY BREATHING PROBLEMS, to be safe!

You are at the bottom of web-page 3.  Next, please read webpage 4, (how to immediately control & treat VCD),  & webpage 5, after that.
 

(While looking at each web-page of this website, you can go to web-Page 9 & the Links web-page, at any time, to look at References. If you do so now, remember to then read web-Pages 4 & 5 to learn how to treat and control VCD.)
 


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