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Old 08-01-2005, 05:55 AM   #1
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Question Phrenic Nerve Injury? COPD? YOU be the Judge! (Please)

I'm new to the HealthBoards, but have been SUPER impressed with the quality and thoughtfulness of the postings and replies. I'm currently juggling a potential endocrine issue, but I have a longstanding respiratory mystery that begs for your ideas and suggestions.

So far, one pulmonologist has said COPD. One allergist has said allergies/asthma. Another pulmonologist has said "small airway disease". My GP is thinking it might be a "phrenic nerve injury". (I don't even know where the phrenic nerve IS!)

As a health-conscious woman in my mid-30's, former NCAA soccer player, and avid non-smoker, I am (to say the least) irked that: (1.) I can't breathe sometimes; and, (2.) fancy-pantsed doctors with expensive machines and tests can't tell me WHY!!!! Ugh!

Generally speaking, I have HUGE lungs, but sometimes, they don't work so good. Here are the Test numbers: (Pre-Bronch)

Test 3/03 3/05

FVC: 110% 111%
FEV1: 95% 110%
FEF 25-75: 71% 83%
FEF 50: 68% 67%
PEF: 55%
MEP: 41%

VC: 114% 115%
TLC: 113% 116%
RV: 108% 120%
ERV: 1.39 1.64 (142%)
DLCO: 126% 104%
DL/VA: 117% 89%

Even with a Methacholine Challenge, I have very little reactivity (abt. 8% in 2003; and, 15% in 2005) to bronchial dilators. In 2005, my FIVC actually decreased 12% after bronchial dilation. Also in 2005, the technician noted on my test results: "Cooperative with good effort and comprehension. Patient did not achieve 90% VC on 2 DLCO maneuvers"

I know the numbers seem to indicate otherwise, but I feel I cannot get enough air IN -- I force yawns and gulp/gasp to suck in air sometimes. I have no exercise tolerance - one flight of stairs has me extremely out of breath. I even have a hard time singing in my car to radio tunes. Ugh!!

Please, I welcome your thoughts, ideas, suggestions. Thanks, and take care.

 
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Old 08-01-2005, 01:41 PM   #2
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Re: Phrenic Nerve Injury? COPD? YOU be the Judge! (Please)

Hi Urban-Girl,

You results all look good. You say you are being checked for an endocrine problem, I'm just wondering if you have been carefully checked for thyroid disorder? I have hypothyroid, and shortness of breath has been a real problem of mine too. A lot of people have this problem with thyroid disease. My Dr. recently increased my thyroid med, and I am breathing so much better. When you say you have huge lungs, do you mean you have hyper inflated lungs? Mine showed to be hyperinflated in a chest xray. Also the xray showed a problem with my diaphragm, for which I'm having more tests done this Friday, but even that seems to be improving. I had been feeling as if my diaphragm was weak.
If you have had thyroid tests done, please go to the thyroid board and post your lab results. Someone over there (who is very knowledgable) will look them over for you. Sometimes our Dr's will tell us our thyroid results "look fine", just because they fall in "the range", when really they are not at a good level. This is very common.
What is that on the bottom of your results.. DL/VA? That looks like the only one that came out below normal?
good luck..
Deda

Last edited by Deda; 08-01-2005 at 01:44 PM.

 
Old 08-01-2005, 02:14 PM   #3
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Re: Phrenic Nerve Injury? COPD? YOU be the Judge! (Please)

Urban-Girl,
I know what you mean about frustration when it comes to doctors. Sometimes I don't think THEY know, so they throw out there diseases that it could be without knowing YOU. First of all, I have had similar problems. I have had allergies all my life. When I get a cold or sinusitis, it goes to my chest and lingers there for a couple of months. I have been to two different allergy specialists that tell me I have asthma. I don't WHEEZE, have ASTHMA ATTACKS, cold air doesn't bother me, I don't have any problems sleeping, ect. I guess you could say I have very atypical asthma. One doctor suggested inherited emphysems, (because my father had it), however that test came back normal. They haven't said COPD, but typically that is what you have if your obstructions is irreversable with meds. I don't remember in detail my spirometry results, but they were all in the normal, low normal ranges except for my FEF 25-75% and it was 50%. That is the small airways. But unlike you, I feel pretty good. At times I feel a little tight but I can usually walk and talk at the same time. If I climb several flights of stairs, I get winded, but I am also overweight. I am currently taking Advair 250/50 which is an inhaled steroid. I hate it because it has made my weight terribly difficult to get off. I eat pretty good now, but the weight won't budge. I am constantly reading about symptoms that might mean something else other than asthma. Right now, I am considering candida, which can affect the lungs. It is a build up of yeast in the body that can attack anywhere. I have other symptoms that suggest candida. You can get rid of it by proper diet and anti-fungal medications. Traditional doctors will blow you off though if you mention it. It is something that naturopathic doctor would be knowledgable about. Like you I am a non-smoker and in pretty good health otherwise. So I try not to let the words COPD, small airway disease, ect. worry me. They are so very very rare in nonsmokers. I have had this for about 5 years and it hasn't worsened. Good luck

 
Old 08-01-2005, 08:46 PM   #4
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Re: Phrenic Nerve Injury? COPD? YOU be the Judge! (Please)

Thanks for reviewing and responding to my q's. I will definitely post the endocrine results on the Thyroid board when they come back. Unfortunately, I think my efforts to show the two year change in my lung tests looked a bit confusing. The first percentage was in 2003; and, the second one was in 2005. So, I actually have below normal scores for: FEF 25-75, FEF 50, DL/VA; and, WAY below scores for: PEF and MEP (the ones that depend on the diaphragm). Please let me know what kind of diaphragm testing you're going to be doing, and how it goes!

 
Old 08-01-2005, 09:36 PM   #5
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Re: Phrenic Nerve Injury? COPD? YOU be the Judge! (Please)

Hi again urban-girl,

So far, they only noted a problem with my diaphragm from my chest xray. This Friday I will be getting my PFT's done, then on to see a pulmo, and I guess he will tell which further tests I'm having done. The xray showed "eventration of the right hemi-diaphragm", which is hard to get any clear cut information on, when I did a search. One definition is "a condition where there is defective muscular action of the diaphragm". Well, I've had muscle weakness problems more than anything since I've hypo for so long. My abdominal muscles, (which support the diaphragm) have really weakened. Another definition I read was, "protrusion of the intestine through the abdominal wall", which I think is a hiatal hernia. And the last one I read was "elevation of the diaphragm into the thoracic cavity". I don't know which one I have, but hopefully it will be the first one.
I will let you know when the time comes which tests they'll be doing for it. Are you having any other symptoms that might point to your thyroid?
Be sure to post those levels on the thyroid board when you get them, urban-girl, and also the ranges too.

Oh, another thing I heard is, the "phrenic nerve" is the main nerve that controls the action of the diaphragm. I've read that it can be injured and cause your diaphragm is be parilyzed. Does your diaphragm feel weak, or numb? I have also read on Dr. Lowe's website about "air-hunger", and how an undertreated thyroid problem can even cause diaphragm problems. I've been undertreated for at least 2 years now, so I'm hoping that is the root of my problems with this.
Deda

Last edited by Deda; 08-01-2005 at 09:44 PM. Reason: forgot to add something

 
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