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CAN'T BREATHE? SUSPECT VOCAL CORD DYSFUNCTION!

How can VCD patients and medical people quickly control and treat VCD during and between attacks?

 

VCD attack "SURVIVAL GUIDE"-- Use during a VCD attack:

1) Call (911, or 0, etc.) for an ambulance, or go to an Emergency Room, IMMEDIATELY, to get experienced medical help, in case of any possibly life threatening breathing problems, because VCD can co-exist with OTHER perhaps life-threatening breathing problems, which can MIMIC (seem similar to) VCD attacks: Some examples of such possibly  life-threatening breathing problems, that are "VCD MIMICS", are (at least): 

a) asthma, 

b) anaphylaxis/severe allergic reaction. Ask doctor about an "EpiPen" (See #7, below, about this). 

c) 1 or 2 collapsed lungs, (A VCD patient had this, in March, 2003, & was mis-diagnosed as having only panic attacks with VCD). An ER (Emergency Room) doctor, who had conquered his own VCD, advised the family to take the patient to their ER & to IMMEDIATELY get a "chest Xray, and blood gases" done. This showed the 2 collapsed lungs, and saved the VCD patient's life. This young man was hospitalized, intubated with an endotrachial tube, had several lung surgeries to try to patch up numerous holes in his lungs, and he fought to live, for over 2 months. His very severe lung problems and possible other health problems caused him to pass away in May, 2003. (Personal communications 3/03-5/03). 

d) pulmonary embolism/PE/obstruction of the pulmonary artery or one of its branches,  due to a pulmonary embolus--and a pulmonary embolus usually consists of a blood clot in lung area, 

e) fat embolism, similar to pulmonary embolism, can be caused by broken bones that are not medically treated right away. Other causes of fat embolism are infections, pancreatitis, etc. Fat embolism is one of several possible causes of ARDS/Acute Respiratory Disease Syndrome, &/or stroke-like problems. See http://www.emedicine.com/med/topic652.htm about fat embolism. See http://www.pulmonologychannel.com/ards/causes.shtml#sym for more about ARDS.

f) other possible medical emergencies, including some "pediatric" gastric reflux episodes, etc.). (Ref. 17--see webpage 9)

g) Dr. Susan Brugman, MD, from National Jewish Medical & Research Center has warned that doctors should look for ALL POSSIBLE causes of patients' breathing problems, and not just too quickly conclude that a patient has 'only' VCD.

h) "Sensitivity Pneumonitis", an "allergic" type lung condition, that is a type of "allergic" reaction to certain proteins, in the FEATHERS & DROPPINGS OF BIRDS, such as parrots, parakeets, ETC.

i) Various lung infections can cause breathing problems. Sometimes, pet birds can be infected, spreading their infections to pet owners' lungs. Find a doctor who is an "infectious disease" specialist, when needed for diagnosis.

j) A Rhemumatoid Arthritis (R.A.) patient alerted me (Nov., 2011) to breathing problems caused by crico-arytenoid joint damage (in vocal cord area), done by R.A. (Rheumatoid Arthritis). She sent me links, including this one:
http://rawarrior.com/cricoarytenoid-arthritis-in-rheumatoid-arthritis-part-1/

In this article with above link, it says: "

"....What RA symptoms occur in vocal cord RA?

Here is what to watch for:

  • hoarseness
  • change in range of voice
  • pain during speaking
  • pain during swallowing
  • feeling of fullness or mass in the throat
  • choking sensation
  • shortness of breath
  • difficulty breathing...."
Causes vary, for R.A. (Check into possible gluten sensitivity auto-immune reactions!).

k) other life-threatening breathing problems, not listed here.

2) In some cases, breathing oxygen (even without helium) has helped stop VCD attacks. (Ref.17) However, too much oxygen can be harmful, or even dangerous in some medical conditions like emphysema. Get emergency medical care immediately for any breathing difficulties.

3) If the VCD patient is choking on food or drink, etc., FIRST apply the Heimlich maneuver (if that is not contraindicated, meaning, if this is safe to do), several times if necessary, TO GET FOOD & LIQUID UP, AWAY FROM THE VOCAL CORDS. Then, the VCD patient can do certain SPEECH THERAPY/BREATHING EXERCISES, along with ABDOMINAL/DIAPHRAGMATIC BREATHING, to (usually) stop the VCD attack. See 4), 5), 6), for the details. And, the Heimlich maneuver itself, has stopped some VCD attacks (personal communication with VCD patients).

4) On the way to the Emergency Room (ER), or while waiting for an ambulance, the VCD patient can try EXHALING (breathing out) through slightly pursed lips, (like gently blowing out a candle), whispering a gentle "fffffffffff". This may sound like a gentle wind or breeze, or it may be silent. Do this, using breath & lips, without vibrating the vocal cords. Keep lips in a position that is not quite as puckered, as for whistling. Keep lips SYMMETRICAL around teeth. Do NOT have lower lip touching upper teeth. It's like gently blowing out a candle, but with lips not pushed out. Some prefer whispering "ssssssss", or, "shhhhhhh". This breathing/speech therapy exercise has helped stop VCD attacks in many patients. (Ref.17)

Some people prefer to whisper an exhaled "ffff", "ffff", "ffff", against a little resistance, in somewhat short, quick bursts, all in the same exhalation.  This is like blowing out a slightly stubborn "trick" candle, and you can hear the windy sound of the "ffff", "ffff", "ffff".

5) If any of this helps, try SLOWING DOWN the EXHALATIONS a bit, (gently whispering "fffffffffffffffff") through slightly pursed lips. (similar to gently blowing out a candle). Some Doctors and Speech Pathologists know about the theories of how this Speech Therapy can get the vocal cord muscles to relax and come out of spasm, stopping the VCD attack.

6) "Speech therapy is a very important part of the treatment for VCD. Special exercises increase your awareness of ABDOMINAL [diaphragmatic]/"belly" breathing, and relax your throat muscles. This enables you to have more control over your throat." (Ref.1--see webpage 9).

ABDOMINAL/diaphragmatic/"belly" breathing means: While exhaling, the abdomen (belly) comes "in" (towards the "back"), just a little bit, making the belly seem a bit smaller; then, just LET the belly move out. This allows inhaling to happen easily, with the belly expanding--the belly seems to get larger, like a pot belly. During abdominal/diaphragmatic breathing, try to NOT use chest, shoulder, neck, or throat muscles. Try to RELAX the chest, shoulder, neck & throat muscles. 

To focus attention on using the lower abdominal muscles (belly muscles), the VCD patient can GENTLY put one hand on his or her own belly, with thumb on navel ("belly button"), and with other fingers below the thumb. Speech & Language Pathologists (SLP's) teach these important breathing techniques, modifying the techniques to meet each patient's individual needs! (Ref.1,21, on webpage 9, and link "R" on "links" webpage).

For a more detailed description of HOW TO DO 4), 5) & 6), see VCD SPEECH THERAPY with ABDOMINAL (diaphragmatic) BREATHING EXERCISES section, below, with ****.

7) If the VCD attack was caused by a severe allergic reaction (anaphylaxis), get emergency medical help immediately. Then, ask your doctor about using an "EpiPen", which self injects adrenaline/epinephrine. Also see the "allergy" section of webpage 5 about this. (Personal communication from VCD patients).

8) Some have used a prescribed Lidocaine spray, to stop laryngospasms/VCD attacks. Ask your doctor about potential bad side effects of a Lidocaine spray. See the anesthesia section on webpage 5, about using Lidocaine to stop laryngospasms. Also, "inhaled lidocaine" was mentioned at the 2003 VCD Conference (Ref. 21, on webpage 9).

9) A few patients having very severe VCD have needed a surgical procedure called a tracheostomy (to put a small opening, called a tracheotomy, into the trachea/windpipe), at least temporarily. (Ref. 17)

10) To find a SLP (Speech & Language Pathologist) AND to find a DOCTOR near you, who know a lot about VCD, you can:

a) Call a LUNG LINE nurse, at 1-800-222-LUNG(5864), and ask for referrals. This can include being seen at Nat'l Jewish Medical & Research Center, in Denver, Colorado, if possible, &/or seeing medical professionals in your area.

b) Place your question on a voice forum called "VOICESERVE for Karnell", which is used by many SLP's and ENT/ear, nose & throat doctors (oto, rhino, laryngologists), respiratory therapists, etc. Here's a link to the "VOICESERVE for Karnell"  listserve (voice forum): 

http://list.healthcare.uiowa.edu/read/?forum=VOICESERVE

c) Email me (see email link, at bottom of this webpage 4).

A nice lady from Australia (a VCD patient) had suggested that I add these "VCD Survival Guide" techniques, to this page, to be used "during an attack" (see above). 
 

TABLE 2. Treatment options for patients with VCD (Ref.3-see webpage 9)

ACUTE TREATMENT [during attacks]:

Inhaled mixture of 70%-80% Helium (He)/ 30%-20% Oxygen (O2) [useful for some VCD patients who got VCD from fires (intense heat &/or smoke inhalation), or from toxic chemical spills, etc.] [THIS IS CALLED "HELIOX".]

CPAP (Continuous positive airway pressure) [helpful for some with sleep apnea, sometimes helpful for UARS/Upper Airway Resistance Syndrome, etc.]

IPPV (Intermittent positive pressure ventilation) [helpful for some with sleep apnea, etc.]

Benzodiazepines [anti-anxiety medications] such as Dalmane, Doral, Halcion, Klonopin, Tranxene, Valium, Xanax, etc.

[USE CAUTION with Benzodiazepines: Valium, Xanax (alprazolam), etc. "Valium kills off" the "oxygen-breathing-drive", and Xanax may cause "pulsing of brain", resulting in "hyperactivity". 

This class of meds(medications) "can depress respiration in certain pulmonary patients." These meds "may worsen natural history of panic disorder". There is also the potential for addiction to these meds. 

WITHDRAWAL REACTIONS (Benzodiazepine Withdrawal Syndrome) can be SEVERE and LONG LASTING (including severe digestive & muscular problems), so patients withdrawing from these drugs will need both psychological and medical support. Ref.17,21]

[Be careful of drug interactions with many other types of drugs a patient may be taking. These drug interactions range from mild to deadly. See Ref.19 on webpage 9]

Panting exercises  [Also, see "f f f f" example, of SPEECH THERAPY, above, as part of the "VCD attack Survival Guide"!]

LONG-TERM TREATMENT:

SPEECH THERAPY [see the "VCD attack Survival Guide" example above, of whispered, exhaled "fffffff", with "pursed lips", gently, or, against a little resistance, along with Abdominal/Diaphragmatic breathing.] 

Biofeedback training [can help victims of abuse &/or violent attacks, witnesses of violent, traumatic events, etc.]

Supportive psychotherapy [helps one to cope with pre-existing stress, &/or stress caused by VCD!]

Hypnotherapy [including self-hypnotherapy: See Ref.21]

Panting exercises (can be part of SPEECH THERAPY)

[All the above (and additional ideas) were recommended at the VCD Conferences, July 20-21, 2001, and July 18-19, 2003, given by National Jewish Medical & Research Center, in Denver, CO; See Ref.21, on webpage 9, and link "R" on "links" webpage]

 


At the VCD Conference, July 20-21, 2001, sponsored by National Jewish Hospital, several Speech Pathologists spoke about an often effective finger-pressing massage technique called "Manual Laryngeal Muscle Tension Reduction" technique that has worked with some patients, to stop VCD attacks. Check with your physician and Speech Pathologist about this (not yet widely known) "circumlaryngeal" [around the voice box] massage technique, regarding your particular case. 

This manual technique must be learned from a Speech Pathologist, or a doctor, because it must be done exactly in a specific area of the neck (to avoid dangerous results). Also, this technique may be contra-indicated for some patients having certain medical conditions. This special massage technique has also helped some patients having "Muscle Tension Dysphonia", and "Spasmodic Dysphonia", both of which can involve breathing (&/or voice) difficulties, and both of which can co-exist with VCD. (See Ref.21,28, on webpage 9, and, See link "O" on "links" webpage, and read webpage 5.)

Yoga: is relaxing, encourages calm abdominal breathing, is "meditative", and has other positive, helpful qualities.  (See Ref.21 on webpage 9)

"De-sensitization" to "harmless triggers" of VCD, like strong yet non-toxic odors, etc. (See Ref.21, and link "R" on "links" webpage) Also, see next webpage: webpage 5.

Exercise pacing/coaching done by experienced Speech Pathologist  working with Exercise-Induced VCD patient, over a 2 week time period, as done at National Jewish Hospital, or longer if needed. These methods were developed by Dr. Florence Blager, Chief of Speech Pathology, at National Jewish Hospital(See webpage 7, also Ref. 21 on webpage 9, and link "R" on "links" webpage)

Also, some athletes find that STARTING to exercise, SLOWLY, WITH "WARM-UPS", helps to prevent VCD attacks.

Many cases of so-called "Exercise-induced VCD", could be re-named as "Exercise-induced GASTRIC REFLUX", where it is the REFLUX that really causes the VCD attacks. Read about this reflux-exercise connection, on webpage 5 (causes of VCD), at http://cantbreathesuspectvcd.com/page5.html and, see webpage 10 (has "gastric reflux tips"), at http://cantbreathesuspectvcd.com/page10.html

Sometimes VCD is actually caused by a kind of "dystonia" (injury to a part of the brain). An example of this is called a Respiratory (breathing problem) type of "Adductor" Spasmodic Dysphonia (SD)--which is a focal dystonia (just affects the vocal cords). Or, the VCD can be caused by another kind of dystonia (a non-focal dystonia) called Meige's Syndrome, which can affect more than just the vocal cords (for instance, can affect the eyelids--"blepharospasms": 

Specialist ENT's (Ear, nose & throat doctors) can inject "BOTOX" (made from botulism toxin) into the vocal cords, which sometimes helps improve these "dystonia" types of VCD. (See webpage 5 for more details.) Dystonia-VCD patients may also have another (non-dystonia) type of VCD, at the same time, that can be helped with SPEECH THERAPY, ABDOMINAL BREATHING, etc. Gastric reflux can worsen (aggravate) the SD type of VCD.  (See Ref.26 on webpage 9)

There are MORE MEDICAL and HOLISTIC OPTIONS for treating stubborn cases of VCD including (but not limited to) eliminating "CAUSES" of VCD, eliminating "triggers" of VCD, eliminating "aggravators" of VCD, when possible, and treating &/or curing "associated conditions" that may predispose people to developing VCD. (Ref.4 on webpage 9). (Also see webpage 5, and webpage 3)

ELIMINATING, avoiding, lessening all your UNDERLYING CAUSES of VCD, VCD triggers, & VCD aggravators, and TREATING associated/pre-disposing factors leading to VCD, are very important, to help PREVENT FUTURE VCD ATTACKS! (SEE webpages 5 & 3, & this webpage, webpage 4). 

One example is stopping or controlling "pediatric" Gastro-Esophageal Reflux Disease (GERD), in infants and babies, AND, stopping GERD in children & adults--because the high up type of GERD called LPR (Laryngeal-Pharyngeal Reflux) is a major (common) cause of VCD attacks. 

Also, see some very helpful "tips" on page 10, regarding sinus problems, & adult gastric reflux problems, & pediatric gastric reflux problems. These are called Appendix A, Appendix B, and Appendix C, at http://cantbreathesuspectvcd.com/page10.html

Following, is a more detailed description of sections 4), 5) & 6) above:

****VCD (Vocal Cord Dysfunction) SPEECH THERAPY with ABDOMINAL (diaphragmatic) BREATHING EXERCISES, that my husband and I were each taught (in 1998 & 2000), at National Jewish Medical & Research Center, in Denver, CO:

Practice these techniques several times a day, so that when you need them, they will be automatic, and will work, right away, or very fast, to open up the spasming (closed) vocal cords. 

PREPARATION:

--Loosen clothing at waist, so nothing is tight, nothing is snug. Open top buttons of pants or skirt, unzip pant or skirt zippers, pull shirt out & over pants or skirt. The reason to do this, is to prevent any pressure on the stomach, that can cause gastric (stomach) reflux (backup of corrosive liquid, into the esophagus). Gastric reflux is a major (frequent) cause of VCD attacks.

--Sit in a comfortable chair. When you need to use these techniques, you may be standing up, lying down, or sitting, BUT—first try to learn these techniques while sitting, because they are easier to learn, while sitting, than in other positions. 

--Keep water (not ice cold, not very hot) handy. Take sips, so your mouth & throat will not dry out. Swallow carefully, to avoid choking.

--Put your right (or left) thumb on your navel (belly button), with the rest of your fingers below the thumb, so you are GENTLY touching your belly (lower abdomen). It’s as if you had a belly-ache, and you were gently holding your belly (lower abdomen).

--Doing this, will focus your attention on your lower abdominal muscles.

--Try to: Relax your chest. Relax your shoulders. Relax your neck. Relax your throat. This helps you to try to use ONLY your belly (lower abdominal) muscles. Consciously try to NOT use chest muscles, etc. I don't know why, but the use of chest muscles seems to irritate the vocal cords. The use of "belly" muscles seems to relax the vocal cords. To stop VCD attacks, the vocal cords need to relax:

BREATHE OUT (EXHALE) FIRST, WITH slightly PURSED LIPS:

--Since most people cannot inhale (breathe in), during VCD attacks, please start by breathing out (exhaling) in the special way described below, and this will usually open up the spasming vocal cords, immediately, or fast.

--Start, by breathing out (exhaling), with lips 'pursed', as if you are trying to gently blow out a candle: 

--This is similar to whistling, but your lips will not be as 'puckered', as when whistling, and your lips will not be pushed forward, like when whistling. If you look in a mirror, you would see a mostly horizontal line of space, between the lips, less than an inch in length (like 1/3 of an inch), while you exhale the "ffffffffffff". Some say the small space between lips has the shape of a tiny bird with outstretched wings, like a "V" that is almost a horizontal line of space.

This set of drawings goes along with this webpage (webpage 4), where I describe several ways, of stopping each VCD attack, including how my husband and I were each taught, by speech pathologists at Nat'l Jewish, in Denver, CO (in 1998 & 2000). It's not a cure, but this symptomatically helps to stop most "regular" type VCD attacks.  

 
The easiest and fastest way to cure VCD, is to look for, find, & remove (and gently treat) VCD causes. 

See below, for drawings I made (using my "Paint" program), to show two ways the space between upper & lower lips might look, when pretending to "blow out a candle" (gently), along with abdominal/belly breathing, to open up spasming vocal cords (in VCD attacks). The horizontal (left to right) distance of the slight space between the lips may be as little as about 1/3 of an inch long, and is mostly a thin horizontal line of space, (or may look like a tiny bird with outstretched wings) with little vertical (up to down) space between the lips.

 

"Pursed" lips are first & second drawings, below.  


 

OR




These (see above) may sometimes work better, than having lips in the "whistle" position, where lips are scrunched towards the middle, and where the space between upper & lower lips is a little circle or diamond of space (see below):

 

--This may be silent, or may sound like a gentle wind or breeze, like “fffffffffffff”, and your lips should be symmetrical, around your teeth. Your lower lip will not be touching your upper teeth, like when someone says the name FFFFFFrank. This is one continuous flow of exhaled air, either silent, or making a slightly windy "sound" (non-voiced...no vibration of the vocal cords). 

--Feel your hand on your belly (lower abdomen) come IN, just a little bit, toward your back, as you are “working” (using/contracting) only (or mostly) your lower abdominal (belly) muscles.

--This abdominal exhaled “ffffffffffffff”, alone, often stops VCD attacks, immediately, or very quickly.

--Some prefer to try a variation of exhaling “fffffffffffffff”: Try exhaling  quickly, “ffff”, “ffff”, “ffff”—all part of one exhalation. Don’t inhale in between the quick “ffff”s. This helps some people to more quickly open up spasming vocal cords. This is like blowing out a slightly stubborn candle, exhaling against a tiny bit of resistance. (like trying to blow out a trick birthday candle, that doesn’t want to be blown out too easily).

--If any of this helps, try to slow down the exhalations, and gently exhale "fffffffffffffffff".

--Some people prefer to gently exhale: “sssssssssssss”, or “shhhhhhhhh”, rather than “ffffffffffffff", etc. Choose what works best in your case, or what is most comfortable for you.

--You may need to repeat exhaling the "ffffffffffff", (or "ffff", "ffff", "ffff"), etc., several times, to relax the spasming vocal cords. Repeating this, usually stops a VCD attack, by somehow making the vocal cords open up (move apart), so that you can inhale (breathe in) again, as described below:

NOW, ALLOW AN ABDOMINAL (belly) INHALATION TO HAPPEN, PASSIVELY, IN AN UNFORCED WAY, by doing the following:

--When you can’t exhale the "fffffffffffff" any longer, and your belly muscles are tired of coming in, a little, towards your back, just LET THE BELLY RELAX, LETTING THE BELLY MOVE OUTWARDS, AWAY FROM YOU, TOWARDS THE FRONT.

--Your belly (lower abdomen) will get bigger, looking like a pot belly. You will feel your hand on your belly move OUT, slightly, away from you, towards the front.

What this does, (belly moving outwards) is to pull the muscle called the  DIAPHRAGM, downwards, towards the floor. This pulls the lungs (which are above the diaphragm) down towards the floor--slightly opening up the lungs:

This creates a bit more space in the lungs, and this creates a “partial vacuum” (area of lower than normal air pressure), inside the lungs, compared with room air.

The room air is still at regular air pressure (a little higher pressure now, in the room, compared with the air pressure inside your lungs), and—

Air always wants to move from a higher pressure area (in the room) towards a lower pressure area (in your lungs).

--This creates an easy, unforced, automatic, passive, movement of air from the room, into your mouth &/or nose, down into the throat, down between the now open vocal cords, down the trachea (windpipe), and finally into your lungs. This is the easy (abdominal) INHALATION that you’ve been waiting for, now that the vocal cords are open, like they should be, again! (You had opened the vocal cords by EXHALING "fffffffffffff", using abdominal/belly muscles--pretending to blow out a candle).

SPEECH PATHOLOGISTS CAN ADJUST ALL THIS, TO YOUR PARTICULAR SITUATION, MODIFYING THESE TECHNIQUES, TO WORK FOR YOU. For example, Dr. Florence Blager, PhD, said (at 2003 VCD Conference) that if a VCD patient had been taking steroids for a long time, the patient may need to start with "easy breathing", and then the Speech Pathologist can see what muscles the patient is using, to breathe, by having the patient put hands around own waist. Such patients may not be able to immediately AVOID using chest muscles. The Speech Pathologist can guide the patient to use the lower part of the chest, instead of the higher part of the chest. Later on, the patient can learn to do the "belly" (lower abdominal) breathing.


NEW INFORMATION (2/05): Several VCD patients and one SLP/Speech & Language Pathologist have had good results using a breathing method called RESISTIVE BREATHING, that is like pretending to breathe through a straw.  The SLP said that resistive breathing should ONLY be used during a VCD attack. He said NOT to practice this in advance of attacks. 

1) The SLP told patients that as soon as they felt any tightness in the voice box (larynx) area, to pretend to suck (air) through a straw, and slowly inhale (breathe in) this way, for 6 to 8 seconds, and then exhale (breathe out) slowly (as if through a straw) for 6 to 8 seconds.

2) Then, patient should breathe normally for 2 regular cycles (in and out, in and out), if possible. 

3) If the vocal cords are still closed, patient can repeat step one, followed by step 2.

4) If the vocal cords are still not opening up, patient can repeat step one, one last time, followed by step 2.

5) A patient said that the SLP told him to do the following for night time VCD attacks: Patient was told to stand up, with back against a wall, with hands over head (as if under arrest), and do above resistive breathing exercises. 

Three patients with total vocal cord closure during VCD attacks, told me that this resistive breathing method helped open up their vocal cords, during VCD attacks.

The SLP is Dennis Fuller, a professor at St. Louis University, St. Louis, MO, who helped the patient in Dec., 2004, by teaching him "resistive breathing" techniques.


MORE NEW INFORMATION (was new, in Feb., 2005 ): A Speech Pathologist said that starting to BLOW AIR INTO (inflate) A BALLOON sometimes helps to stop VCD attacks.


REMINDER: If you have ANY BREATHING PROBLEMS, call (911, or 0, etc.) for an ambulance, or go to the ER (Emergency Room), IMMEDIATELY! See top of this web-page for details about this.

You are now at the bottom of web-page 4. Please read web-page5, next. Webpage 5 can help you find many of your possible UNDERLYING CAUSES of the VCD. (Also read this whole website--all 12 webpages).
 


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