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CAN'T BREATHE? SUSPECT VOCAL CORD DYSFUNCTION!

 

What are some causes of VCD, triggers of VCD, aggravators of VCD, and associated conditions that may predispose people to develop VCD?

 
There may be MANY possible causes (etiologies) of VCD. Many patients have several to many causes of their VCD. There appear to be many inter-connections (and overlapping) between causes, triggers, aggravators and associated conditions that may predispose people to develop VCD. Also, there is controversy and disagreement among the medical community about VCD. And, there is sometimes political pressure (resistance) from the industrial, pharmaceutical, medical insurance communities, and even educational institutions, landlords, government (like the toxic government supplied mobile homes used after Hurricane Katrina, that outgassed formaldehyde, etc. or, when mold may be present, and it would be very costly to fix the mold problem). Resistance sometimes comes from those who may fear loss of profits and/or who may fear litigation (getting sued).

NOTE: To find References mentioned below, look at web-page 9 of this website (and the "links" web-page). Here are links to web-page 9, and to the "links" webpage:
http://cantbreathesuspectvcd.com/page9.html
http://cantbreathesuspectvcd.com/links.html

Some VCD patients had their first "Irritant-induced VCD" (IVCD) attack immediately or shortly after (usually within 72 hours [3 days]--tripling the previously defined 24 hr. time limit) [but was said to be 24 hours again, at Nat'l Jewish's 3rd VCD Conference, July 2007]--the following situations &/or conditions; The study of these situations &/or conditions,  is called ENVIRONMENTAL AND OCCUPATIONAL MEDICINE/HEALTH SCIENCES (formerly called CLINICAL ECOLOGY):

Irritant exposure creates "Upper Air Way Vulnerability" to VCD. Some have needed to change jobs, or change sports, in order to fully conquer their "Irritant-induced VCD" /IVCD.  (Ref.21--VCD Conferences in 2001 & 2003).

  • CHEMICAL SPILLS: CORROSIVES (like lye [NaOH/sodium hydroxide], anhydrous ammonia/NH3, etc.), toxics [poisons], pesticides: insecticides (to kill insects), herbicides (to kill "noxious" weeds), fungicides (used on golf courses, etc.--to kill fungus), chlorine gas, etc.  (Ref.4,9,17,20,21,22 on webpage 9,  and "links" webpage:  (D)Irritant-Induced Vocal Cord Dysfunction)

  • IRRITATING &/or TOXIC (POISONOUS) OCCUPATIONAL & HOME USE CHEMICALS: gases (carbon monoxide in car exhaust gases, defective furnaces, ozone, very irritating & toxic--from ozone generators, some air cleaners that say they give off ozone, copy machines, laser printers, air pollution (like SO2/sulphur dioxide). Ozone is also an asthma trigger.), smoke (firemen, chefs, forest fires, brush fires, burning sugar cane fields, oil well fires, CIGARETTE SMOKE, etc.), toxic chemical fumes (from paints, "stains", varnishes, thinners, polyurethanes, turpentines & other petroleum products/petro-chemicals, printers' inks, paper mills, etc.), vapors (in carpet stores, etc.), mists, SPRAYS OF ANY KIND, aerosols (beauty parlors,etc.), dust (from ceiling tile, drywall, plaster, old carpets, some paint, etc.), harsh cleansers, "stage fogs" (special effects for actors), and others. Dust masks are not enough protection, against chemical fumes. Special respirator protective masks are better, but are not always 100% protective. CHEMICAL POISONING can harm other organ systems, in addition to the vocal cords, lungs, nervous system, liver, blood, etc. (Ref.9,17,20,21,22 on webpage 9, and "links" webpage: (D) Irritant-Induced Vocal Cord Dysfunction, and (S), (T), (U).)

  • IRRITANTS & TOXINS/POISONS (continued): outdoor air pollution, &/or, indoor air pollution which can cause BRI/Building Related Illness. BRI exists when the exact causes (specific irritants, toxins, dusts, etc.) have been discovered. SBS/Sick Building Syndrome, exists when exact causes of illnesses have not yet been discovered. BRI is more insurable than SBS. Some irritants include: toxic vapors like formaldehyde (and other toxic vapors) "outgassing" from plywood (resins), NEW CARPET (glues/adhesives in backing), new upholstery, new mattresses, fresh varnish, resins(glues) in particle board, insulation, etc.

  • IRRITANTS & TOXINS (continued): More irritants are: NATURAL GAS heat, wallpaper glues, petro-chemicals, HAIR SPRAY (& all sprays), dry-cleaning chemicals, some (toxic) carpet cleaning chemicals, cleaning fluids, harsh cleansers such as anti-bacterial cleansers, fabric softeners, anti-static laundry sheets used in dryers, plastic-like insulation that heats up, in new TV's (found in step-up transformer, capacitors, cathode ray tube/picture tube, & chassis), plastics in some new computers, etc.

  • IRRITANTS & TOXINS (continued): Another irritant is MOLD (spelled "mould" in the UK) from floods or water leaks, &/or bacterial airborne infestations, etc. See question about mold, at bottom of this page.   Other irritants include: odors, PERFUMES, SCENTED PRODUCTS, "TOXIC SYNTHETIC FRAGRANCES" found in "air fresheners", many candles, beauty products, body care products, etc., very HOT air [like being too close to a brushfire, wildfire, forest fire, building fire, etc.], and other irritants. Irritants can cause VCD in children & adults, in schools, in their own homes, at the workplace, outdoors, etc. Often unsuspected irritants are PEST CONTROL CHEMICALS (called pesticides--including insecticides, herbicides that kill "noxious" weeds, fungicides, etc.), insecticides in PET FLEA COLLARS, PET FLEA POWDERS, PET FLEA OINTMENT, termite poisons, rodent (mice, etc.) control poisons, insecticides SPRAYED on standing water, etc., to kill MOSQUITOES, insecticides such as CARBARYL ("Sevin", etc.) sprayed on TREES to repel PINE BEETLES, etc. Also, CHLORINE in swimming pools, and CHLORINE BLEACH, has caused VCD attacks. (Avoid drinking chlorinated water, too).

  • IRRITANTS & TOXINS (continued): Unfortunately, some very sensitive people are sensitive to some "resins" (glues)--may be fumes outgassing &/or particles-- that are found in (holding together) a HEPA FILTER, and HEPA filters are used in certain air cleaning machines, etc! See some "SINUS TIPS", called Appendix A, at http://cantbreathesuspectvcd.com/page10.html for some alternatives to HEPA filters.

  • IRRITANTS & TOXINS (continued): Some factors that can contribute to BRI or SBS are: windows that cannot be opened, ventilation system malfunctions, including where CENTRAL AIR CONDITIONING &/or CENTRAL HEATING picks up & then re-circulates TOXIC DUSTS, TOXIC MOLDS, toxic/poisonous FUMES, etc. (Ref.9,17,20,21,22,31 on webpage 9, and "links" webpage: (D) Irritant-Induced Vocal Cord Dysfunction, and (S), (T), (U), (W) & (X).)

  • "CHALLENGING" PATIENTS WITH THEIR OWN VCD "TRIGGERS": At Nat'l Jewish Medical & Research Center, and at several other clinics in North America, doctors and SLP's (Speech & Language Pathologists) use "triggers" that patients say cause them breathing problems. This can include exercise, smoke, chemical fumes, odors, perfumes, etc. (see large list below). If a breathing attack results, then a laryngoscopy done during the attack can tell whether or not it is a VCD attack. Such "challenges" do not always produce VCD attacks, even when later on it is found that the patient DOES have VCD. One SLP in Canada said that VCD attacks are produced by "trigger challenges", only about 50% of the time, in actual VCD patients, at their clinic! (Ref.1,17 on webpage 9)

  • "METHACHOLINE CHALLENGE" is used only by doctors who are very experienced with treating VCD patients, and only in a very controlled setting. The methacholine challenge is done to "rule out" asthma. If the patient is found to not have asthma, the methacholine may cause a VCD attack. Or, the patient can have both an asthma attack & a VCD attack at the same time. If this happens, Albuterol is given to stop the asthma attack, and a laryngoscopy is done to confirm the diagnosis of a VCD atttack. (Ref.3,9,10,17,22)

  • ANESTHESIA INDUCTION. See section about medications, below. (Ref.17,26)
Some VCD patients developed VCD very quickly, or more gradually in relation to the following situations &/or conditions (which cause "Upper Air Way Vulnerability" to VCD (Ref.21):
  • ASTHMA MEDICATIONS such as bronchodilators or steroid sprays that irritate the vocal cords-- "The administration of Beta-agonists [e.g. the bronchodilator, Albuterol] not only fails to relieve symptoms [of VCD] but may actually aggravate them." Beta-agonists can weaken the LES (lower esophageal sphincter), causing more gastric reflux, and this reflux can cause VCD attacks. And, "...the deposition of inhaled medications and corticosteroids on the vocal cords may contribute to upper airway irritability"--meaning, making it more likely for VCD attacks to happen. These asthma medications can cause or worsen VCD, in both asthmatics, & in people who were MISdiagnosed, who don't have asthma at all! (Ref.4, 5,17,22)

  • ASTHMA MEDS (continued): Oral STEROIDS (for asthma &/or for other conditions), can irritate the stomach, causing worse GASTRIC REFLUX, leading to more VCD and ironically, to worse asthma.

  • ASTHMA MEDS (continued): Systemic STEROIDS (for asthma &/or for other conditions), can cause tracheal collapse, causing TRACHEAL STENOSIS (a type of subglottic stenosis). Subglottic means below vocal cord level. Stenosis means narrowing of the space within. Tracheal collapse, tracheal stenosis, & other kinds of subglottic stenosis, can cause VCD. (Ref. 17--2003 VCD Conference, and see webpage 3).
  •  
  • ASTHMA ITSELF can cause VCD, and VCD can cause asthma. Many asthma patients say they have greatly lessened their asthma by using "BUTEYKO" (drug-free) breathing techniques (See Reference #30, on webpage 9, about Buteyko for asthma, etc.), plus other techniques (consult with your physician). When the Buteyko breathing methods help, asthma patients often can, (only under very close, qualified, asthma doctor's medical supervision!) slowly decrease dosage of asthma medications. When and if safe to do so, decreasing or eliminating asthma meds (medications) often results in none or fewer VCD attacks. Experienced Buteyko practitioners/teachers (including Respiratory Therapists, Nurses, Speech & Language Pathologists, etc.) strongly encourage patients to be closely monitored by their doctors, regarding asthma medication tapering, etc. (Ref.17,21, 30, on webpage 9, and see "links" webpage: (S), (T), (U).)

  • SOME MEDICATIONS can result in VCD by drying out/dehydrating vocal cords, &/or from other bad side effects. (Read labels-->): Antihistamines (very drying), Decongestants (very drying), Diuretics (very drying), "NSAIDs", (Non-Steroidal Anti-Inflammatory Drugs) and Aspirin , Cough suppressants, Tricyclic Anti-depressants, e.g. Elavil (The Tricyclic Anti-depressants appear to have many side effects that can contribute to getting VCD).

  • MEDICATIONS (continued): Panic disorder patients may need to begin with very low doses (like 1/4 of the usual starting dose) of anti-anxiety medications, because these patients seem to experience great increases in side effects; An example of an anti-anxiety medication is Paxil, in the class of medications called Select Seratonin Re-uptake Inhibitors/SSRI.

  • MEDS (continued): Other potentially troublesome medications include: Chemotherapy, Vitamin C, Androgens (used a lot by weight lifters, bodybuilders, etc.), and others. Also, some "neuroleptic" drugs, like Chlorpromazine (Thorazine) & Haloperidol (Haldol), both "antipsychotics", can induce VCD, as one of several "drug-induced laryngeal dystonic reactions", (along with "extrapyramidal" symptoms--same as side effects of drugs used to treat Parkinson's Disease).

  • MEDS (continued): Thiopental (an ANESTHETIC), at certain doses, may cause VCD/laryngospasm, during the "induction of anesthesia", just before operations; This may be prevented by giving "topical lidocaine". (Ask doctor & pharmacist about potiential adverse effects of using a prescribed "lidocaine spray" to stop VCD attacks.)

  • MEDS (continued): One patient said (12/02) that she first got VCD shortly after she began using STATIN DRUGS, including Lipitor, Zocor, & Mevacor, & the VCD lasted 7 years. The VCD stopped shortly after she finally stopped taking the STATIN (anti-cholesterol) medications.

  • MEDS (continued): One VCD patient said (12/02) she had a VCD attack from using Hydrocodone (a cough suppressing narcotic analgesic/pain killer/cough suppressant, found in Vicodin, for example). She previously had a VCD attack possibly with an asthma attack, from a Dilaudid injection (also a narcotic analgeisic--pain killer). This patient (a nurse) also had itch along with the VCD attacks, & believes she had an allergic reaction (or a hypersensitivity reaction?), leading to VCD attacks. In addition to avoiding this class of medications, she will carry an "EpiPen", prescribed by a doctor. See ALLERGY section, below, & See link (Y), on links webpage.

  • MEDS (continued): There probably are other medications that also may cause or contribute to causing VCD, due to adverse (bad) side effects. Please carefully read the paper "package insert" of every medication you take, and if safe (check with your doctor), use non-medication alternatives when possible (under good, close, medical supervision.). Don't suddenly stop taking any medications, unless your doctor says it is OK to do this. Why? Because: Some medications MUST be slowly, gradually, tapered down (weaned off of), to prevent harm or death! It can be dangerous or even deadly (fatal) to suddenly stop taking certain medications! Ask your doctor & pharmacist, for advice, before you stop taking any medications. (Ref.19,21,26  and, see webpage 4 about caution with benzodiazepines, such as Valium, Xanax (alprazolam), etc.)  Speak with good pharmacist about this, and with your physician, and with good anesthesiologist when needed.
  •  


    REFLUX (may or may not cause "heartburn")
    and is also sometimes called "regurgitation":


    Gastric Reflux (gastric = stomach)
    (With "gastric" reflux, stomach liquid goes back up the wrong way, back up into the esophagus, at least)


    GASTRO-ESOPHAGEAL REFLUX DISEASE
    , (GERD), gastric reflux, stomach acid reflux, (or can be an "alkaline" reflux, if bile backs up into stomach, and then into esophagus), heartburn (pyrosis), reflux esophagitis, and the newly discovered "LPR" (Laryngo-Pharyngeal Reflux), meaning 'voice box/throat area' type reflux, and other names. There may or may not be noticeable symptoms (like heartburn pain &/or burning), and there may or may not be more subtle symptoms, like BELCHING, BURPING, where burps may or may not have a little vomit in them (with no nausea, and no warning), or, having a burp that tastes bad or sour (tastes like from the stomach). Cough &/or laryngitis &/or extra throat phlegm/mucus can be some symptoms of LPR.


  •      (NEW INFO! July, 2007) Dr. Jeffrey Conklin, MD (gastroenterologist in Los Angeles, CA) said that:
    (1) BILE sometimes refluxes back from duodenum, back into stomach (a small intestinal reflux), and this causes "reactive gastropathy". I suspect this might then cause severe gastric (stomach) ALKALINE (BILE) reflux, causing bile to rise high up into the esophagus, leading to severe VCD attacks.
         Bile is made in the liver; then the bile stored in the GALL BLADDER; then the bile gets squeezed through bile ducts, into the duodenum--first part of the small intestine, to help with fat digestion/breakdown. Bile is a complex mixture of bile acids, alkalis & salts, with the net effect being that bile is alkaline.
        (2) Small intestinal bacterial overgrowth can cause IBS (irritable bowel syndrome), and reflux (associated with the IBS), and the gastric reflux could then cause VCD attacks.

Among various things that can cause small intestinal bacterial overgrowth, are, for example, BROAD SPECTRUM ANTIBIOTICS (and sometimes other antibiotics). There can be other ways of catching these infections, too (touching infected surfaces, including in hospitals. When caught in a hospital, an infection is called "nosocomial"):

NEW INFO (Sept.,2007): One kind of infection
, (can be mild, or serious, or sometimes even fatal) in the small &/or large intestine, that can be caused from taking any of various antibiotics, or, catching it in a hospital, etc., is called Clostridium difficile, abbreviated as  C. difficile, or C. diff. Some symptoms of this bad bacterial infection can be ORANGE COLORED liquid DIARRHEA, VERY BAD ODOR, MUCUS OR JELLY-LIKE LOOK TO STOOL, ABDOMINAL CRAMPING, etc.

A very helpful website, from C. diff. patients' experiences, about getting diagnosed, and curing this Clostridium difficile infection (many treatment choices, both with or without "medications", often using certain types of probiotics/friendly, beneficial bacteria &/or friendly yeast, etc.), is called C. Difficile Support Group, at this link: http://cdiffsupport.com/phpBB/index.php  Also see some more info about this, on webpage 10, in Appendix B (some gastric reflux tips).




  • GERD/LPR (continued): Three signs of LPR that may be seen during LARYNGOSCOPY, are (1) redness (erythema) of vocal cords & nearby tissues. Redness is not always present, but often is, and makes the area look "beefy" (red in color), (2) swelling of vocal cords, sometimes even creating a "bowed" look, (3) mucus "stranding" across (between) the vocal cords.                                                                                                  

  • GERD/LPR can cause VCD attacks at ANY TIME, even AT NIGHT, WHILE SLEEPING. GERD/LPR can be found in any age persons, including infants (& pediatric GERD can be life threatening, not recognized, and misdiagnosed as SIDS/Sudden Infant Death Syndrome).




  • GERD/LPR (continued): 


    Avoid ICY COLD DRINKS, CHEWING/EATING ICE,
    &/or EXTREMELY HOT DRINKS, all of which  can irritate the stomach, are bad for ulcers, and can cause gastric reflux episodes, by shocking/paralyzing stomach muscles.

    Some people are addicted to chewing/eating ice. Compulsive ice chewing/eating is called Pagophagia, and is one type of "pica" (compulsive eating of non-foods, or ice). Pagophagia can be caused by an iron deficiency anemia, which can be caused by poor diet, small intestinal 'mal-absorption' of iron (due to using acid blockers &/or gluten sensitivity, milk protein(s) sensitivity etc.), internal bleeding, excessive bleeding during menstruation, etc., pregnancy, various medical conditions, worms, etc. 

    Pagophagia may also be related to eating disorders (like anorexia or bulimia, etc.) &/or related to OCD (obsessive compulsive disorders). OCD can sometimes be caused as a result of PANDAS (Pediatric Auto-immune Neuro-psychiatric Disorders Associated with Streptococcal infections, such as strep throat, etc.) PANDAS happens when there's an auto-immune reaction (attack) to an area of the brain called the basal ganglia, that the immune system mistakes for being strep bacteria. Then, the basal ganglia get inflamed, causing obsessive compulsive behaviors, like ice chewing/eating. One treatment for PANDAS, is IVIG (Intra-Venous Immune Globulin). See this link about PANDAS:
    http://www.cmaj.ca/cgi/content/abstract/165/10/1353

    And, for more information about PANDAS, see the excellent book: "SAVING SAMMY", by BETH MALONEY.

    Teeth can crack &/or voice problems in singers may result from this ice chewing/eating habit. Some foods are naturally rich in iron. Eating such foods, if iron deficient anemic, can prevent constipation and stomach problems that some iron supplements cause. Please see gastric reflux tips (Appendix B), on webpage 10. Also see gluten-free, milk-free tips (Appendix E) on webpage 10.

    Two excellent articles about pagophagia and picas have these links:

    http://www.mayoclinic.com/health/chewing-ice/AN01278  (shorter of the 2 articles, that beautifully summarizes the following article), and

    http://www.medscape.com/viewarticle/405804_6 (part 6 of 8 part article--very comprehensive & interesting!)



  • GERD/LPR (continued): Sometimes GER/LPR can even result from inhaling irritating chemicals, some of which get swallowed (Dr. Ronald Balkissoon, MD, said, at VCD Conferences, 2001 & 2003)



  • GERD/LPR (continued): Gastric Reflux can also be caused by stomach reactions to eating certain foods, when one has one or more of these: FOOD SENSITIVITIES, FOOD INTOLERANCES, & FOOD ALLERGIES. Examples: GLUTEN sensitivity (gluten is in wheat, rye, barley, etc.), &/or a MILK PROTEIN sensitivity (to Casein, whey, etc.), LACTOSE intolerance (to milk-sugar/lactose), etc. Gluten is found in wheat, rye, triticale (wheat crossed with rye, creates the hybrid called triticale), and barley. Oats & buckwheat can be contaminated with gluten at processing plants. Brown rice is gluten-free. In some gluten sensitive people, even a tiny amount of gluten can cause some or many bad effects, including reflux. For more about this, see "gastric reflux tips" on webpage 10, (Appendix B for adults & older children, and Appendix C for infants--includes colic), at http://cantbreathesuspectvcd.com/page10.html 



  • GERD/LPR (continued)See "links"(E), (V), & (AA) on "links" webpage (at http://cantbreathesuspectvcd.com/links.html) for more information about LPR, including many treatment choices! (raising head of bed or crib, by using blocks on floor, creating a tilt/slant/incline, or, using a special GERD PILLOW,  and DIET/FOOD & clothing changes, etc.) 



  • GERD/LPR (continued): Sometimes EXERCISE can be ONE of several causes of a gastric reflux episode, and sometimes it is the GASTRIC REFLUX that causes the VCD attack! See "some GASTRIC REFLUX TIPS", at http://cantbreathesuspectvcd.com/page10.html for more information. And, see the "EXERCISE" section (below) for the connection between exercises, &/or, the "Valsalva's maneuver" (straining when lifting weights, or when very constipated)& GER/LPR! (Ref.4,7,9,15,17,21,22,26,29)  & (Ref.15,23,24,25: about GER & constipation treatment options).



  • GERD/LPR (continued): NEW INFORMATION!! (Nov., 2004, & July, 2007) about HGM/HETEROTOPIC GASTRIC MUCOSA: Up to 10% (or more) of cases of LPR (laryngo pharyngeal reflux) may be caused by acid-secreting stomach cells that migrated (rose) up high into the esophagus, (or elsewhere--see below) while the person was still an embryo or fetus, before birth.
  •    These "parietal" (acid-secreting stomach type) cells, now wrongly located high up in the esophagus (for example)--like having a second (small) stomach--, if functional, secrete hydrochloric acid, and this can cause either no symptoms, or can cause the following symptoms:
    --voice problems (hoarseness),
    --difficulty swallowing (dysphagia),
    --painful swallowing (odynophagia),
    --VCD attacks,
    --coughing,
    --"esophageal strictures [narrowing of opening inside esophagus],
    --webs [tissue or membrane that extends across the opening of the inside of esophagus; intereferes with swallowing food], or
    --esophagotracheal fistula [abnormal tube-like connection between esophagus and trachea,
    which can cause choking, aspiration, etc.]" etc.
     
  •        These misplaced/out of normal place (ectopic) stomach cells are called HETEROTOPIC GASTRIC MUCOSA (HGM). Such misplaced stomach cells (located outside of the stomach) may be in tiny, invisible, microcopic spots ("foci"), or, if a group of these stomach-type cells are visible without a microscope (macroscopic), and if located somewhere in the esophagus, this visible group of stomach type cells is called an INLET PATCH.  (not the same as Barrett's Esophagus)
  •        Often, acid blocking medications are not effective against this different type of LPR. However, surgical removal of the inlet patch is effective, in stopping this under-estimated, under-recognized type of LPR. Careful endoscopy by a knoweldgable gastroenterologist, with biopsy of various areas high up (or elsewhere) in the esophagus, to check on cell types (histology) can confirm or rule out the presence of an inlet patch.
  •         Also, these misplaced stomach type cells that secrete (give off) stomach acid (hydrochloric acid) can be found in any area(s) of the digestive system, including in the tongue, epiglottis (part of the larynx, in respiratory system), esophagus, gall bladder, small intestine (duodenum, jejunum, etc.), large intestine, rectum, etc. (maybe pancreas...not sure).
  •         I first read about this condition (HGM), (11/04) in an informative message by a speech pathologist at the sid3voice listserv (voice forum). To join the voice forum, please see webpage 4, for a link to the sid3voice listserv.
  •         http://usagiedu.com/articles/HGM/HGM.pdf is a link to an excellent medical journal article about HGM. To see a summary/abstract of this article, here's a link: http://www.blackwell-synergy.com/links/doi/10.1111/j.1572-0241.2004.04082.x/abs/
  •         Dr. Jeffrey Conklin, M.D., is a Los Angeles gastroenterologist (stomach/digestive system specialist doctor) who is one of the few MD's who know a lot about HGM. I learned from him in July 2007, that there's a new type of "endoscope" (that came out in 2006), called Narrow Band Imaging Endoscopes that use pure blue light to make HGM (inlet patches/gastric mucosa of parietal cell type) visibly stand out, making it easier to discover/see "inlet patches". HGM may be found in at least 10% of reflux patients, mostly in their upper esophaguses, according to Dr. Conklin. Dr. Jeffrey Conklin can be contacted by interested physicians, patients, parents, etc, at jeffrey.conklin@cshs.org
  •         In 2006, a VCD patient at Nat'l Jewish (Denver, CO), was found by a Denver gastroenterologist (after 2 previous 'false negative' endoscopies) to have HGM causing his VCD! The patient's doctors then wrote a medical journal article called "Inlet patch of gastric mucosa in upper esophagus causing chronic cough and vocal cord dysfunction" Here's a link to a summary/abstract of the article, saying this may be the FIRST TIME AN "INLET PATCH" WAS FOUND TO CAUSE VCD and chronic cough!  Authors are: Silvers, William S. [allergist]; Levine, Joel S. [gastroenterologist]; Poole, Jill A.; Naar, Erick; Weber, Richard W. [allergist]

    http://www.ingentaconnect.com/content/acaai/aaai/2006/00000096/00000001/art00021




    • GERD/LPR (continued): MILK PRODUCTS/"DAIRY" products (cow's milk, cheese, including pizza, cream, half & half, ice cream, some sherbet, junket if made with milk, yogurt, buttermilk, etc.) seem to cause extra throat mucous/congestion in some people, leading to more VCD attacks. Milk products can sometimes trigger GASTRIC REFLUX episodes, which can cause VCD attacks. This may be related to sensitivities to cow's milk proteins such as casein, whey, etc., &/or intolerance to lactose/milk sugar), &/or other factors. Cow's milk can cause more acid to be produced in the stomach, which can be irritating, and this can lead to gastric reflux episodes.
    •         There are milk substitutes, such as brown rice "milk"--home made, or look for "gluten-free" milk substitutes, meaning, avoid these glutenous grains: wheat, rye, barley. Avoiding gluten is necessary, if one has Celiac Disease (CD), or other kinds of gluten sensitivities. Avoid oats & buckwheat, if gluten sensitive, due to possible contamination with gluten. Avoid soy milk, if sensitive to soy, and, too much soy milk might contribute to breast cancer. Goat's milk and Sheep milk agree with some, not with others. Goat's milk and Sheep milk have less casein than cow's milk. Nut "mylks", made with almonds, hazelnuts/filberts, etc. (if not allergic), can substitute for cow's milk. (Ref.17: an MD & VCD patients, and Ref.23,24,25,26,29 on webpage 9, and link (AA) on "links" webpage, about FOOD SENSITIVITIES).



    • GERD/LPR (continued): Some ALLERGISTS know a lot about FOOD SENSITIVITIES/INTOLERANCES & FOOD ALLERGIES, and some know how food sensitivities, intolerances, allergies can cause gastric reflux, &/or, other reactions. Reflux (due to various causes, including eating foods that one is sensitive to, intolerant to, allergic to) can cause breathing problems, including VCD, asthma, etc. See GERD/LPR sections, above.



    • GERD/LPR (continued): (NEW INFO! July, 2007) GALL BLADDER SURGICALLY REMOVED (CHOLECYSTECTOMY), when gall bladder was not properly functioning, LESSENED VCD in a patient.  Patient's VCD went from very severe, to mild, right after badly functioning gall bladder was removed! This information came from Nat'l Jewish's 3rd VCD Conference, July, 2007 (presenter: EMT/Emergency Medical Technician, Cody Blount). I'm working on finding connections between gall bladder problems, and VCD. Will update this when I find answers. Opinions welcome. Questions: Can gall bladder problems make reflux worse? Can HGM (see above) in a gall bladder, cause worse reflux?



    • GERD/LPR (continued): (NEW INFO! MARCH & APRIL, 2008) 
      EGID/Eosinophilic-associated Gastro Intestinal Disorders, is a group of "allergic" type problems, (not a "regular" allergic problem), --one type of EGID is called EE (Eosinophilic Esophagitis), and another type of EGID is called EGE/EOSINOPHILIC GASTRO-ENTERITIS--, and I believe that EGE can cause gastric reflux, sometimes leading to VCD attacks. SEE A GASTROENTEROLOGIST, who can diagnose any type of EGID, such as EGE, by taking biopsies during an "endoscopy" of the digestive tract, looking for elevated (abnormally high) numbers of certain white blood cells called eosinophils. This "upper endoscopy" exam is also called EGD (Esophago Gastro Duodenoscopy), looking at and taking biopsy samples from esophagus, stomach, and duodenum/first part of small intestine. Also helpful, are ALLERGISTS/IMMUNOLOGISTS.
       
      To learn more about EGID (diagnosis and treatments, including diet changes), including EGE (Eosinophilic GastroEnteritis), a severe and painful inflammation of stomach &/or intestines, and EE (Eosinophilic Esophagitis), etc., see these links, from a good website, about EGID.  
       
       
       
      I know of a VCD patient--a teenager who has the EGE type of EGID, and her reflux and VCD and pain are all improving, because she is avoiding gluten and other food proteins that cause her immune system to over-react. (8 most common allergens, from this link http://www.mayoclinic.com/health/food-allergies/AA00057)  :
      • "Milk
      • Eggs
      • Peanuts
      • Tree nuts (such as almonds, cashews, walnuts)
      • Fish (such as bass, cod, flounder)
      • Shellfish (such as crab, lobster, shrimp)
      • Soy
      • Wheat"
      The over-reaction includes producing too many eosinophil type white blood cells in the digestive tract, and one effect is stomach pain, irritation & inflammation (gastritis), resulting in reflux, leading to VCD attacks. Difficulty breathing (VCD) from the EGE's reflux, can sometimes last all day (can be constant). I don't know the original cause(s) of the EGE (maybe: reflux? infections? medications? vaccinations? environmental toxins? various MOLDS? food protein "sensitivities"? &/or ?).
    •             EGID patients often need to TEMPORARILY go on what is called an ELEMENTAL DIET (no proteins, just doctor prescribed amino acids), in order to "calm down" the eosinophic inflammation reactions to certain incoming food proteins, that can cause pain & misery from inflammation in the digestive tract, where the inflammation is related to the vast increase of numbers of the eosinophil type blood cells, that "infiltrate" the lining of the digestive tract. Then, after the eosinophilic inflammation calms down, parents will do food trials, with doctor testing, to get the eosinophilic inflammation under complete control (completely calmed down). Then, parents can work on figuring out all the non-EGID causes of the possible VCD (with help of MD's & SLP's).
    •               The VCD/EGID teenager patient's mother (nurse) said that EGID specialty clinics in the U.S. include: Childrens Hopsital of Cincinatti (Ohio), Children's Hospital of Philadelphia (Pennsylvania), Dr. Glenn Furuta, MD, at Children's Hospital of Denver (Colorado), UC (University of California) San Diego Rady Children's Hospital, and researcher (PhD) Steven J. Ackerman, at University of Illinois, at Chicago, IL. 
                   The mother (nurse) said that "For adult patients, the expert is Dr. Nirmala Gonsalves", M.D., Department of Gastroenterology, Northwestern University, Feinberg School of Medicine," at Northwestern in Chicago" (Illinois).
    •                 See http://www.apfed.org/ and click on "about apfed" to get names of specific doctors who are on their medical board, and who know a lot about EGID.
    •                The mother (nurse) also said that "Childrens Hospital of Phladelphia adds beef and corn as frequent EE [Eosinophilic Esophagitis] triggers ahead of nuts and fish."
    •                Here's a somewhat technical but helpful article about EE (Eosinophilic Esophagitis), that says that reflux can sometimes cause EE, or, EE can sometimes cause reflux, or that a person can have both EE & reflux, where the EE & reflux are unrelated to eachother. This article contains additional useful links!               http://www.thedoctorsdoctor.com/Diseases/esophagitis_eosinophilic.htm
    -------------------------------

    NEW INFO (July/Aug., 2008)
     
    Some babies/infants with reflux, have symptoms formerly called Sandifer's syndrome (now called "ARCHING" OF BACK), which I believe may be due to severe gastric reflux PAIN &/or a hiatal hernia, &/or something else.
     
    Sandifer's syndrome/ARCHING OF BACK is a pediatric/early childhood (infants especially) neurological response--similar to, but not the same as seizures (Sandifer's syndrome may be a new "vagal reflex" according to this link: http://www.ncbi.nlm.nih.gov/pubmed/18031943) a neurological INVOLUNTARY reaction to painful severe reflux.

    Symptoms include at least:
    head rolling/tilting from side to side plus head falling to back, inconsolable crying/screaming (Also check on possible vaccination bad reactions), BACK ARCHING (looks like tetany), eyes rolling back in headstraightening out or flailing spasms in limbs (arms, legs)gasping, breath stopping for several seconds (Call 911 immediately for any breathing problems!), gurgling sounds coming from throat, hiccup-like sounds (?diaphragmatic flutter? or ?), baby becoming very quiet, &/or very fussy, etc.

    CALL 911, AND AS SOON AS POSSIBLE, TAKE BABY WITH ABOVE SYMPTOMS TO SEE A PEDIATRIC GASTROENTEROLOGIST, PEDIATRIC LARYNGOLOGIST (ENT/ear, nose & throat doctor who is a throat specialist), and a PEDIATRIC NEUROLOGIST, for diagnosis and treatment (preferably without meds, when safe & when possible, to avoid bad side effects--find & remove causes when possible).
     
    I am wondering if VCD (short duration laryngospasms) are sometimes associated with Sandifer's syndrome (ARCHING OF BACK). Feedback is welcome. See email below.
     
    There can be a danger of SIDS (Sudden Infant Death Syndrome) from aspiration (breathing in) of stomach liquid, during gastric reflux episodes that are high up (LES/laryngo pharyngeal reflux). Lessen the reflux, (remove causes, & gently treat when needed) to lessen Sandifer's syndrome.
     
    Pediatric reflux has many possible causes, including (but not limited to) hiatal hernia &/or sensitivity to: gluten, milk proteins, soy proteins, yeast proteins, egg proteins, corn proteins, among other reflux causes. Please see http://www.finerhealth.com for gastroenterologist Kenneth Fine, MD's "EnteroLab" website, which does non-invasive stool sample testing, to find various food protein "sensitivities", in babies, children, and adults.
     
    I have not found much info on the internet (yet) about connecting Sandifer's syndrome/ARCHING OF BACK (a neurological reaction to painful reflux) to gastric reflux that is caused by various food protein sensitivites.
     
    Here are 2 videos, showing babies suffering with painful reflux/Sandifer's syndrome/BACK ARCHING.
     
     
    and
     
    "Sean's sandifer's"
    http://www.youtube.com/watch?v=y36pYx1EXLk

    -------------------------

    GERD/LPR (continued): (NEW INFO! DECEMBER, 2009)

    "Esophago-pharyngeal reflux (EPR) is the regurgitation [backwards motion] of esophageal contents back into the larynx [voice box] and pharynx [throat].... The problem with EPR is that of bolus [swallowed chewed food or liquid] transport and esophageal emptying. Most patients with EPR have a disorder of esophageal motility [coordination of wave movement of esophagus]. " See neurologist and gastroenterologist.
     
    These sentences about EPR came from this link:
    http://www.ucdvoice.org/lpr.html

    -------------------------------------

    • BULIMIA ("binging & PURGING): This is an eating disorder involving self-induced vomiting, after "binging" (excessive overeating), to avoid gaining weight. This dangerous behavior can cause the same problems as GERD, and other serious health problems. Psychological support helps patients increase self-esteem,  so they can choose to use safer, positive coping methods. A SLP said (Oct., 2002) that this VCD-cause (bulimia) needs to have much more attention focused on it. The SLP said that much more attention needs to be focused on the relationships between SEXUAL ABUSE, BULIMIA, ANOREXIA (self starving), and VCD! However, "rule out" diseases that cause digestive problems, resulting in reflux &/or vomiting. Such diseases (like Celiac Disease, colitis, certain kinds of arthritis, etc.) can exist alone, or along with, bulimia. To help with diagnosis, see a good psychologist or psychiatrist, and see doctors who are experts at digestive problems, auto-immune problems, etc. (Ref.17[SLP's/Speech & Language Pathologists])
    NEW INFO (late 2010): IN SOME CASES, BULIMIA MAY BE AN OBSESSIVE COMPULSIVE DISPORDER (0CD), SOMETIMES CAUSED FROM "PANDAS" (Pediatric Auto-immune Neuro-psychiatric Disorder Associated with Streptoccus bacterial infection/s). This can affect not only children, but adults too, and has nothing to do with the bear-like animal called a "panda". Sometimes, like with PANDAS, a virus can also cause an auto-immune attack on the brain's "basal ganglia", resulting in either "tics" and/or OCD (Obsessive Comulsive Disorder), including BULIMIA!

    For more information about PANDAS, see the excellent book: "SAVING SAMMY", by BETH MALONEY.





    • SINUS CONDITIONS OR INFECTIONS, causing Post Nasal Drip that irritates the vocal cords. (Ref.1,3,4,14[has excellent treatment options, such as easy, gentle NASAL IRRIGATIONS, HOT WATER (warm mist) VAPORIZER--keep about 7 feet from nose, AIR CLEANERS, gentle treatments for yeast/Candida infections, etc.],17,21,22, and see "links" webpage: (S), (T), (U), (V), (W)). Please see webpage 10, Appendix A, for very helpful "SINUS TIPS", at http://cantbreathesuspectvcd.com/page10.html 

    • SINUS CONDITIONS OR INFECTIONS (continued), including post nasal drip, can be caused (or worsened) by AIR POLLUTION (irritants, toxins, etc.), &/or GASTRIC REFLUX, &/or TOOTH PROBLEMS, etc. See IRRITANTS/TOXINS (above), GASTRIC REFLUX (above), and TOOTH PROBLEMS (below). Dr. Murray Morrison, MD, said (at 2003 VCD Conference) that he believes most post nasal drip is due to gastric reflux.


    • UPPER RESPIRATORY INFECTIONS/URI's , including Croup, (which is often viral) have been associated with VCD (and recently, URI's have been  associated with resulting in GER/LPR, due to viruses damaging the vagus nerve).

    • UPPER RESPIRATORY INFECTIONS/URI's (continued): For a CHILD with possible VCD,  ask the doctor to do a blood test for possible WHOOPING COUGH/PERTUSSIS, since this can cause VCD (&/or a vocal cord paralysis which can lead to VCD). Also, many ADULTS (even if previously vaccinated/immunized) can get WHOOPING COUGH/PERTUSSIS, causing much coughing, but with little phlegm. Most doctors are not aware of how common whooping cough is, in adults. (It's often MISdiagnosed as being bronchitis.) Whooping cough is not just a childhood disease: A Blood Test can help diagnose Adult Pertussis. Patients may need help to control (decrease) the COUGHING, and need to prevent DEHYDRATION (See below). Erythromycin & related antibiotics can be very helpful to treat Whooping Cough/Pertussis. With most antibiotics, it is important to take Acidophilus/Bifidus "beneficial bacteria" ("probiotics") in between antibiotic doses, (& after finishing the course of antibiotics) to prevent or treat CANDIDA ALBICANS (Yeast) infections (called "Thrush" when in mouth or throat areas). Ladies, teenagers and older girls should avoid using internal tampons (during menstruation), because the tampons can incubate yeast cells, making it impossible to cure a yeast (Candida) infection. Instead, they can use old fashioned external sanitary napkins.  (Ref.1,3,12,14,17,21,22,29, on webpage 9).


    • BRONCHITIS (often viral, with much coughing and phlegm) can cause VCD attacks during the day, or even at NIGHT, while SLEEPING. Ask doctor if using a "FLUTTER VALVE" device would be OK, to be prescribed, in your case. A flutter valve is available only by prescription). A "flutter valve" helps decrease coughing (fewer coughing episodes) by allowing one to "schedule" when to "productively cough", and helps gets phlegm out much more easily, "pleasantly", and effectively (with less effort!). This results in more sleep, and less coughing. Exhaling (as taught by an expert, like a Respiratory Therapist) into the "flutter valve" causes a small solid steel ball to flutter up & down, bouncing, creating a vibration that is transmitted to one's chest, simulating "percussion" ("pounding" using "cupped" hands to cushion with compressed air under the hands) used by respiratory therapists (part of "postural drainage") to loosen phlegm. Anyone with an "unstable trachea", etc. should not use a flutter valve. One company that distributes Flutter Valves (called a "FLUTTER") is Axcan Scandipharm, Inc., in Birmingham, Alabama. Phone numbers are 800-472-2634 or 205-991-8085. Their website is at http://www.axcanscandipharm.com(Ref.14,17,21,22,29)


    • INFLUENZA-LIKE ILLNESS ('flu')  (Ref.6,21,22,29)

    • VIRAL SYNDROMES (viruses, due to infection &/or possibly vaccinations/immunizations, including "flu" shots, etc.) Also, see question section, near bottom of this webpage, about possible connection between post polio syndrome and VCD. (Ref.6,16,21,22,29)



    • TOOTH PROBLEMS, like root canals that "went bad" (remained infected), causing sinus conditions, etc.  Sometimes having DENTIST or oral surgeon pull out bad tooth (instead of doing root canal, or after root canal, if it "went bad") can help to solve sinus conditions, etc. See a good dentist for help. (Ref.14,17)


    • INFECTED TEETH in general can cause sinus problems. See a good dentist. (Ref.14,17) [Also see other dental problems (jaw problems) below, in this list.]


    • FUMES/gases, such as carbon monoxide exhaust from cars, snowmobiles, defective (or incorrectly vented) gas type boiler or furnace, &/or heating system etc., plus other kinds of toxic fumes  (Ref.17,21,22)

    • CIGARETTE SMOKE (can include "second-hand" smoke)  (Ref.1,21,22)


    • ALCOHOL USE &/or TOBACCO USE (cigarette, pipe, cigar, etc.) both are very drying/dehydrating to vocal cords). Avoid.    (Ref.21)


    • COLD AIR (Ref.5,17) A face mask, "dust mask",  "neck gaitor" pulled up over the nose, "balaclava", scarf, "muffler" or handkerchief (bandana) can pre-warm cold air. (Use caution with scarves whose ends could get caught in machinery.)


    • DRY AIR  (Ref.14) A hot water (warm mist) vaporizer (with NO medicine added) will add moisture to room air. The vaporizer can be placed about 7 feet from one's nose. Hot water (warm mist) vaporizers are better than cool mist humidifiers (breeds molds), & warm mist vaporizer is better than supersonic humidifiers, which add tiny irritating particles to the water droplets. One patient said (2/03) that a spray bottle of plain water, sprayed (fine mist of water) into her throat helped stop VCD attacks. Also, see section about "dehydration", below. Also, see page 10, Appendix A: "some SINUS TIPS" at http://cantbreathesuspectvcd.com/page10.html


    • ODORS/SMELLS/SCENTS/FRAGRANCES (in the home, at school, at work, motels, hotels, jobsites, offices, stores, shopping malls, etc.) Examples: scented "air fresheners" (plug-ins, etc.) in homes, bathrooms, cars, automobile "detailing", also the "new car smell", scented: soaps, shampoos, laundry detergents, dish detergents, fabric softeners (can cause asthma & VCD attacks), laundry anti-static sheets, germ killing (antibacterial) cleansers, furniture polish, shoe polish, nail polish, etc. (Ref.1,9,21,22, on webpage 9, and see "links" webpage: (S), (T), (U).)


    • SMOKE (Ref.5,9,10,21,22) from fires, from cooking, from burning trash, forest fires, brush fires, oil well fires, burning tires, etc.


    • PERFUMES, AND COLOGNES, includes scented after shave lotion, scented hand, face, & skin lotions, anything having a scent or fragrance, etc. Both natural fragrances (like scented massage oils, essential oils, religious annointing oils, incense, pot-pourris, etc.) and toxic synthetic fragrances, can trigger VCD attacks. Go fragrance-free & scent-free, to speed recovery from VCD. Also be aware of possible allergies to these substances. (Ref.5,9,21,22, and see "links" webpage: (S), (T), (U).)




    • EMOTIONAL UPSET &/or STRESS &/or sports or academic "PERFORMANCE ANXIETY": Examples are: school exams, traumatic life event (like sad situations regarding family member or friends, disasters seen in person, or on television, etc.), major life events (like marriage, moving to different home or area, job change) the stress of sports competition (pushing oneself too hard, &/or parent pushing child too hard, &/or child worried about disappointing a parent), anxiety, depression, somatization disorder, panic hyperventilation syndrome, childhood abuse, and other stressors.  Any one or more of these can cause "psychological vulnerability" to VCD. (Ref. 17)

    • EMOTIONAL UPSET, &/or STRESS, etc. (continued): PTSD is post traumatic stress disorder. Some patients developed PTSD (contributing to VCD), from having been trapped while being exposed to toxic chemical exposures, when their bosses/employers would not allow them to leave the area. Some PTSD results from the trauma of near drowning, &/or, being "cramped up" or confined in a closed space &/or, from other traumatic life events, military, war, terrorism experience, abuse--physical, emotional, sexual--, or the stress of repeated misdiagnoses and continued VCD breathing problems, etc.,

    • EMOTIONAL UPSET &/or STRESS (continued): This can be caused by CHEMICAL POISONING, from working at dangerous jobs (painting, printing, etc.), &/or, from IRRITANTS & TOXINS in the air, at home, at schools, at work, outdoors, etc. Also see "sick buildings" and "building related illness" from air pollution--in the "Irritant-induced VCD" section, near the top of this webpage. Avoid toxic chemical exposures. (Personal communication with VCD patients).
    •  
    • EMOTIONAL UPSET &/or STRESS (continued): Counseling, &/or "therapy"(psychotherapy), etc. can often reduce stress. Improving diet may also help (e.g. more vitamin B complex, in foods &/or supplements, if medically OK for patient). See a good nutritionist for advice. Homeopathy may help also ("Bach Flower Remedies", etc.).  Cutting down on sugar & artificial ingredients (sweeteners, artificial sweeteners, colors, flavors, preservatives, etc. -- read labels carefully) can help by reducing mood swings (Look for info about the "Feingold Diet" regarding "hyperactivity" in  children.). In addition to the above, the following can sometimes be helpful: some types of non-strenuous exercise (like easy walking--later, when well, can try more strenuous exercises--see below), biofeedback, meditation, etc. (Ref.3,10,17,21,22,23,24,25,26).



    • EXERCISE, exertion, strenuous physical activity, straining, lifting, running, jumping, athletic/sports competition, frequent bending over, even running up stairs, etc. Examples: gymnastics, wrestling, "sit-ups", weight lifting, lifting heavy objects, (uses repeated Valsalva's maneuvers), running, bicycling, swimming, basketball, kayaking, alpine (downhill) skiing, nordic (cross country) skiing, mountain climbing, military activities, ballet DANCING, CHEERLEADING, etc.  Some believe that when people say an athlete "chokes", sometimes it may really be VCD attacks. Temporarily (for about 2 weeks), avoid strenuous exercise, while working to conquer VCD.

    • EXERCISE, (continued): Note: The Valsalva's maneuver means straining, like when lifting weights, or when very constipated. Some doctors think the Valsalva's maneuver and/or frequent bending over, &/or running (shakes up stomach), &/or jumping (shakes up stomach), &/or dancing, may sometimes combine with OTHER THINGS like FOOD SENSITIVITIES &/or BAD AIR QUALITY, to "trigger" GERD episodes, leading to VCD attacks! (GERD=Gastro-Esophageal Reflux Disease). See GERD,above, on this webpage (webpage 5).
    • EXERCISE (continued): Also see Emotional upset &/or stress, above, on this webpage (related to sports competition). While recovering, the VCD patient can temporarily exercise by doing easy walking (if doctor says this is safe), and any other exercises that don't involve "straining" & that don't shake up the stomach. Also, there are special exercise coaching/pacing methods that can help. These are taught at Nat'l Jewish, and involve Pilates (a special execise method), and a VCD-knowledgable SLP/Speech & Language Pathologist.

    • EXERCISE (continued): Some athletes find that STARTING SLOWLY, with WARM-UP exercises, helps prevent VCD attacks. (See Ref.1,3,5,7,8,10,15,17,21,29, on webpage 9)

    • VCD triggers are often similar to ASTHMA TRIGGERS  (Ref.1,21, on webpage 9, and see "links" webpage: (S), (T), (U), (V), (X), (Y).)


    • NEUROLOGIC CYSTS, e.g. "central [brain &/or spinal cord] neurologic process" (posterior fossa arachnoid cyst--in brain) caused VCD in one patient. The VCD resolved (stopped) after the cyst was removed. (in this case, a surgical cure)  (Ref.3,26)


    • BRAINSTEM ABNORMALITIES can cause VCD. Also, the following conditions can combine with brainstem abnormalities to cause VCD, or to create a more severe case of VCD than might have occurred with brainstem abnormalities alone. These conditions are: "... bilateral abductor paralysis [vocal cord paralysis], apneic episodes [breathing stops temporarily, from many possible causes], and central sleep apnea syndrome." The brainstem connects both the cerebrum & cerebellum to the spinal cord. The brainstem includes the midbrain, pons, and medulla oblongata.

    • BRAINSTEM ABNORMALITIES (continued): Examples of brainstem abnormalities are: "Severe closed head injury, [Arnold-]Chiari malformations I and II [can be born with this, or, these can develop later on] , meningomyelocele ["congenital"/ some people born with this], and Cerebro Vascular Accidents (strokes of the posterior circulation). These brainstem abnormalities can cause "stridor" that continues during sleep. Surgery sometimes helps with "congenital lesions of the brainstem."  When cerebral & brainstem edema subside over time, the VCD may disappear. Some infants have bilateral vocal cord paralysis (with stridor) that may be CAUSED by a Chiari malformation. This is dangerous, and must be diagnosed with MRI (magnetic resonance imaging) & treated. Some people have Chiari malformations, but were misdiagnosed as having Fibromyalgia/Chronic Fatigure Syndrome. Ask a good laryngologist and neurologist about these (and look at a good anatomy book).(Ref.3,26, and, See neurological forums at http://www.braintalk.org etc.


    • PREVIOUS NECK SURGERY: "Patients with a history of neck surgery may have damage to the vagus or recurrent laryngeal nerve, resulting in a [vocal] cord paresis [partial paralysis] that predisposes them to developing VCD or laryngospasm." Also see "PAST SURGICAL HISTORY", below. (Ref.5,21)

    • PAST SURGICAL HISTORY: "Procedures associated with [surgical] injury to vagus [nerve], RLN [recurrent laryngeal nerve], SLN [superior laryngeal nerve]." 

    • Examples of such surgeries are: THYROIDECTOMY (removal of thyroid gland), PARATHYROIDECTOMY (removal of parathyroid gland(s),)--also see web-page 3, about how low calcium from parathyroidectomy, can cause laryngospasm--, CAROTID ENDARTERECTOMY (removal of inside lining of diseased or blocked carotid artery, to hopefully lessen stroke risk), ANTERIOR CERVICAL FUSION (spinal fusion of neck bones/vertebrae, on front side--one neurological surgery example is an odontoidectomy),

    • PAST SURGICAL HISTORY (continued): MEDIASTINOSCOPY, (endoscopic examination of the mediastinum): Endoscope is a tube with optical system, to look inside a hollow organ or body cavity. Mediastinum is organs & tissues near lungs: heart & its large [blood] vessels, like aorta, etc., trachea [windpipe], esophagus [food tube], thymus [gland], lymph nodes, and connective tissue.,TEF [tracheo-esophageal fistula] REPAIR (surgical repair of abnormal connection between trachea & esophagus), INTRATHORACIC SURGERY (surgery on anything in the "thorax"-- from the bottom of the neck, down to the diaphragm. The thorax includes the ribcage, and everything in chest area, above the abdomen/belly--including the HEART, etc.), ESOPHAGEAL RESECTION (surgical removal of part of esophagus). (Ref.17,21,27 on webpage 9, & see webpage 3.)

    NEW INFO: July, 2010:  PAST SURGICAL HISTORY (cont'd): VNS/VAGUS NERVE STIMULATION "IMPLANT", for seizures (epilepsy) &/or severe depression, can often cause VOCAL CORD PARALYSIS, or partial paralysis (paresis/weakness).  Bad side effects of VNS (VAGUS NERVE STIMULATION "IMPLANT") are: left vocal cord paralysis, VCD, hoarse voice, sleep apnea, apnea, dyspnea (difficulty breathing/shortness of breath), pain, chest pain, nausea, vomiting, etc. [I will add more references about this, as I get them.] Here are 6 references about adverse (bad) side effects of VNS: (I haven't read them, yet):

    (one): Title: Predictors of Laryngeal Complications in Patients Implanted With the Cyberonics Vagal Nerve Stimulator
    Authors: Gary Y. Shaw, MD, Philip Sechtem, MS, Jeff Searl, PhD, Emily S. Dowdy [I will find the date, etc., and will add this later]

    The authors concluded that about 50 % of those implanted with a VNS (Vagus Nerve Stimulator) will get a vocal cord paresis! (weakness/partial paralysis of vocal cord), and it can be long lasting!

    -------------

    (two): Title: Laryngopharyngeal  Dysfunction From the Implant Vagal Nerve Stimulator

    Authors: Craig Zalvan, MD; Lucian Sulica, MD; Steven Wolf, MD; Jeffrey Cohen, MD, PhD; Omar Gonzalez-Yanes,  MD; Andrew Blitzer, MD, DDS (dentist)

    The Laryngoscope

    Lippincott Williams & Wilkins, Inc., Philadelphia

    2003 The American Laryngological, Rhinological and Otological Society, Inc.


    --------------

    (three): Marshall Smith, MD  ["laryngologist" type of ENT doctor] 
    Voice Disorders Center

    University of Utah School of Medicine,  Salt Lake City, UT

    Dr. Smith wrote the following in 2008 on a voice forum called sid3voice listserve:

    "....Vocal fold paralysis commonly occurs after VNS implant. The paralysis (or immobility) intentionally occurs as the VNS fires for 30 seconds, every 5 minutes, with titanic [hugely powerful] contraction of the laryngeal muscles. Usually this is a minor annoyance. However, persistent or permanent vocal fold immobility due to injury to the vagus nerve (a paresis or paralysis) can occur. We have seen several cases of this.  If the vocal fold is immobile (not just during VNS firing), and the surgical procedure was recent, further time is needed to see if the paralysis will be permanent...."

    -------------------

    (four): Zalvan C, Sulica L, Wolf S, et al. Laryngopharyngeal dysfunction
    from the implant vagal nerve stimulator.
    Laryngoscope 2003;113(2):
    221–5.
     
    (five): Shaffer MJ, Jackson CE, Szabo CA, et al. Vagal nerve stimulation:
    clinical and electrophysiological effects on vocal fold function.
    Ann
    Otol Rhinol Laryngol 2005;114(1 Pt 1):7–14.
     
    (six): Ghanem T, Early SV. Vagal nerve stimulator implantation: an
    otolaryngologist's perspective.
    Otolaryngol Head Neck Surg 2006;
    135(1):46-51.PMID 16815181

    __________________



    • EXTRINSIC AIRWAY COMPRESSION (something outside of the airway presses on the airway): This can be caused by a GOITER or MEDIASTINAL INFECTIONS. (Ref.10, webpage 9). A goiter is an ENLARGEMENT of the THYROID GLAND, (may or may not be due to cancer). A goiter 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 gland due to an auto-immune condition like Hashimoto's thyroiditis, Reidel's thyroiditis, etc., or, 
      --infection, or,
      --tumors, or,
      --hyper-thyroidism, that is, over-active thryoid gland, etc. 
      Also see webpage 3 about this, at http://cantbreathesuspectvcd.com/page3.html 

      EXTRINSIC AIRWAY COMPRESSION (continued): Goiters can compress not only the larynx/voice box, but also the upper part of the trachea/windpipe, 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: When a CT scan of her thyroid gland and trachea was finally done, in 2003, tracheal compression and lateral (sideways) displacement of the trachea, due to a goiter, was finally noticed, for the first time! The patient then had her thyroid gland surgically removed (thyroidectomy operation), and she is hopeful that now, she will have no more VCD attacks! She will take oral replacement thyroid hormones.


       

    • RADIATION THERAPY [may do damage &/or create scar tissue]  (Ref.21) If scar tissue removal is not possible, a tracheotomy can be helpful, for some patients.


    • PREVIOUS THROAT TRAUMA (physical &/or psychological) including "neck torsion injury" (like from a car accident, etc.), strangling, choking, near drowning, surgery on neck &/or throat, etc. Biofeedback has helped some VCD patients to reduce the negative effects of memories of such trauma, possibly "curing" their VCD. Biofeedback (has similarities to meditation) creates more "alpha" brain waves in one's EEG (electro-encephalo-gram), which is calming and relaxing. Try to heal the physical trauma, also, with gentle Physical Therapy, Feldenkrais Method, Aston-Patterning, Alexander technique, better diet, etc.  (Ref.17,21,22)


    • INTUBATIONS (Endotrachial Tube/"ET", to help breathing during operations, or for other reasons,--but can damage vocal cords, &/or naso-gastric feeding tubes) for premature babies, or at any age. Also see allergies (to latex), below. See webpage 3 for more information about Endotracheal Tube (ET) intubations and possible complications of removal of ET's ("extubations"). (Ref.17,21,22)


    • CYSTIC FIBROSIS, with much coughing (a VCD trigger) and phlegm. Many use a "FLUTTER VALVE", as part of treatments. (Also see "bronchitis", above). (Ref.3,17,21)
           
    COUGHING
    (from reflux or from Pertussis/whooping cough, or from other respiratory infections, from air pollution, or from other causes) is a VCD trigger: At least 1 reason why is:

    Coughing can cause the "Valsalva's maneuver" (straining, like when lifting something heavy, or pushing a heavy item, or when constipated), and this extra pressure in the abdomenal area, can promote (contribute to) gastric reflux, and then, the resulting reflux episode itself, can bring on a VCD attack. There are 2 ways that I know of, that reflux can lead to VCD attacks:
     
    a) Aspiration (breathing in) of stomach liquid ("refluxate"), during a high up reflux episode (LPR/laryngo pharyngeal reflux), can cause direct contact of "refluxate" liquid (very corrosive--can be acidic, or alkaline--if bile is present--, or can have digestive enzymes, etc. in it) with vocal cords, causing the vocal cords to close up in a VCD attack (short duration laryngospasm), to protect the lungs that are below the vocal cords.
     
    b) If the stomach liquid doesn't happen to get all the way up to the top of the esophagus, in a reflux episode, then, certain "receptor cells" in the upper esophagus, send a neurological message (in the afferent/sensory part of a reflex arc) to the brain (some part of the medulla oblongata, I believe), and the brain then sends an efferent/motor message back to laryngeal nerves, where these nerves would be saying (anthropomorphizing here), something like this, "Attention, vocal cords--some bad liquid from the stomach is on its way up to you, so you better close up now--in a VCD attack--to protect the lungs, in advance of (ahead of) the stomach liquid actually touching the vocal cords".


    • DYSTONIAS involving vocal cords, such as Meige's Syndrome or Spasmodic Dysphonia:


    • MEIGE'S SYNDROME, a "severe non-focal (meaning affects more than just larynx) DYSTONIA involving the larynx [voice box] and pharynx [throat], & sometimes includes "blepharospasm" (spasms of eyelids).  Meige's Syndrome is related to Spasmodic Dysphonia, a type of "focal laryngeal dystonia". See below:


    • SPASMODIC DYSPHONIA (SD), is a "focal" laryngeal DYSTONIA that can also predispose one to getting VCD. I am not sure if any kind of SD (there are several kinds of SD) can predispose one to getting VCD, or,if only a type of SD called "Respiratory type of Adductor Spasmodic Dysphonia", which may respond to botox (botulism toxin) injections into the vocal cords, is the type of SD that can predispose one to getting VCD. Some consider this "Respiratory type of Adductor Spasmodic Dysphonia", itself, to be a severe type of VCD! See web-page 4 for more about this. Dystonias (prolonged muscle contractions) may be associated with many "metabolic or neurologic diseases & other conditions, such as head trauma, viral encephalitis, stroke, brain tumor, toxic levels of manganese/Mn [in the workplace, etc.] or carbon disulfide/CS2 [textile/rayon workplace, etc.], wasp stings, and...[bad] side effects of drugs used in treating parkinsonism and [bad side effects of some] anti-psychotic medicines [etc.]." Some think that exposure to some harmful chemical(s) in old yellow shag carpets, etc., resulted in their getting SD.
    •      A SPEECH PATHOLOGIST, CONNIE PIKE, HAS HELPED VARIOUS TYPE SD PATIENTS (INCLUDING HERSELF), WITHOUT USING BOTOX. HER METHODS INCLUDE "COGNITIVE BEHAVIORAL THERAPY", AND CONNIE PIKE'S WEBSITE IS AT THIS LINK:
    • www.freetospeakvoicetherapy.com 
    •  (Ref.6,26,27,29, on webpage 9,  &, see "links" webpage: link (W))


    • DEHYDRATION, causing dehydration of vocal cords, like from the diuretic (drying) action of caffeine (found in coffee, soda pop, chocolate, etc.), Sometimes dehydration is caused by MEDICATION SIDE EFFECTS (See above in this list). Many do not drink enough good quality water, and are chronically dehydrated, making the vocal cords more vulnerable to getting VCD. But, check with doctor about contra-indications to drinking too much water, such as kidney disease, glaucoma, etc. Avoid water that has water softener chemicals in it. Avoid distilled water/soft water (can leach calcium out of bones, contributing to osteoporosis). Some prefer well water ("hard"/mineralized water better than "soft" water), spring water, or filtered water, to avoid chlorine or fluoride. Filters using silver may cause heavy metal toxicity. Solid carbon filters need more frequent changes, but are less expensive, and may be safer than silver filters. There are other types of water filters, also. Some reverse osmosis water purifying systems can remove too many good minerals from the water. Several VCD patients said that they often take sips of water, all day, to help prevent VCD attacks. Also see section about "dry air", above. (See Ref.14,18,21 on webpage 9)


    • NEUROLOGIC &/or AUTOIMMUNE CONDITIONS have co-existed with VCD, in some VCD patients. Examples are Multiple Sclerosis (MS), Chronic Fatigue Syndrome (CFS), Fibromyalgia, (Ref.17: A Speech Pathologist in Denver, CO, & some VCD patients)-- See "brainstem abnormalities" section, above, about some patients having Arnold-Chiari malformations who were misdiagnosed as having Fibromyalgia.  Myasthenia Gravis, and Lupus (Systemic Lupus Erythematosis/SLE), are two (among many possible) "inciting factors" of VCD. NOTE: CFS (Chronic Fatigue Syndrome) is also known as ME (Myalgic Encephalo-myelitis) in the UK/United Kingdom & Canada. Also see question section below, about possible connection between post polio syndrome and VCD. One of many possible CAUSES of some of these conditions, includes GLUTEN SENSITIVITY--See link (AA), on links webpage. (Ref.21, 32, on webpage 9, and see "links" webpage: links (S), (T), (U), (W), (AA).)


    • LARYNGOMALACIA (One cause of this may be gastric reflux)  (Ref.21)


    • PARKINSON'S DISEASE patients (having VCD) can greatly benefit from speech therapy.(Ref.17,21)


    • ALLERGIES/Allergic reactions,  e.g. Allergy to DUST MITES. Use special "barrier cloth" mattress covers, special pillow cases. Remove carpet from home (at least, remove carpets from bedrooms). (Personal communication, info from patient).

    • ALLERGIES/Allergic reactions (continued):  Example: possibly severe LATEX ALLERGY including anaphylaxis/tracheal swelling. "All medical products must be labeled if they contain latex." This can include rubber "balloons" used during "intubations". If you have severe allergies, ask your doctor about carrying an "EpiPen", which can be life saving. An EpiPen allows one to self inject epinephrine (adrenaline), which counteracts anaphylactic (severe, allergic, life threatening) reactions. Several patients believe this type of allergic reaction has triggered some VCD attacks. Allergies can cause edema (swelling) and rhinitis (nose inflammation with runny nose), both of which can somehow contribute to getting VCD. Also, see MEDICATIONS (bad side effects), above. Allergists and Acupuncturists can help. Allergists can tell you which foods may bother you (cross sensitivity reaction), because of being related to the rubber plant, etc.(Ref.17,21, on webpage 9, and see "links" webpage: (S), (T), (U), (X), (Y).)


    • VOICE ABUSE (while TALKING, shouting, singing, etc.) (teachers, singers, preachers, coaches, lawyers, military, & others) Speech & Language Pathologists (SLP's) can greatly help one to avoid this. (Ref.21)


    • TOOTHBRUSH POWDER (Some VCD patients now use baking soda/sodium bicarbonate/NaHCO3, or calcium carbonate (CaCO3/chalk), mixed with a little water, or just plain water, instead of toothpaste & toothpowders). People having gastric reflux (which can cause VCD) should avoid MINT(in all forms, including toothpaste, tooth powder, mouthwash, tea, candy, etc.--at least until no more VCD attacks for 3 months). Also avoid scented and chemical products, including for teeth.  (Ref.17,21, on webpage 9, and see "links" webpage: (E)  about avoiding mint, etc.)


    • VERY SPICY FOOD(S), like hot chile peppers, hot mustard, etc.(Ref.21)


    • EXTREME EMOTION of appreciating music, while listening to "breathtakingly beautiful music", at a public concert, and while worrying that one might cough. (possibly related to or similar to a seizure or migraine headache) [feeling all 'choked up']  (Ref.21)




    • DENTAL PROBLEMS such as "TMJ" (Temporo-Mandibular Joint) problems (a form of "jaw mis-alignment") can lead to Muscle Tension Dysphonia (MTD), and MTD can lead to VCD. Common causes of TMJ include: BROKEN/fractured JAW from  car or other accidents, or from violent attack/abuse, a "BAD BITE" (upper & lower teeth not meeting properly), often helped by a dental "BITE GUARD", clenching & grinding of teeth (BRUXISM) especially at night [can often be helped with VITAMINS, MINERALS, & IMPROVED DIET, and by treating hypoglycemia if present, and by using a BITE GUARD, &/or a "JAW SPLINT" &/or corrective jaw surgery, etc.], bad dental work (including faulty braces work--"orthodontia") that needs to be corrected, stress, etc. On the other hand, a VCD patient (a nurse) said (12/03) that good braces work, done by an excellent dentist, corrected his "bad bite" and corrected his jaw problem (TMJ). The good dental work thus stopped his MTD/Muscle Tension Dysphonia, and this ended 6 years of VCD attacks!

    • DENTAL PROBLEMS such as "TMJ" (continued): Some other causes of "TMJ" are: bad posture or bad ergonomics (including while at a computer), cradling telephone between shoulder & jaw, chewing only on 1 side of mouth, gum chewing, ARTHRITIC jaw problem due to LYME DISEASE (Some ticks carry the bacteria that causes Lyme Disease), etc..  (Ref.17: a VCD patient, friend of 2 singers having Lyme Disease, Ref. 25, and "links" page: (P), (W)). See very good Dentist, & Ear, Nose , & Throat (ENT) doctor, and if needed, a LLMD (Lyme "Literate" Medical Doctor). And see a good Speech & Language Pathologist (SLP)!

    • MUSCLE TENSION DYSPHONIA (MTD), causing voice problems like: "vocal fry"(gravelly, rough voice),  low pitch,  strained voice quality,  laryngeal pain & fatigue when using voice. MTD can also cause "adduction spasms" (VCD?), with 'stridor' as a sign/(symptom).  (Ref.17,21,22,29  and "links" webpage: (O), (P), (W)). Also see webpage 4 of this website, that includes description of new "manual laryngeal tension reduction" technique, done by experienced SPEECH PATHOLOGISTS, that often helps MTD and also VCD. Many things can cause MTD. See a good Speech & Language Pathologist for help. Some have also used "Feldenkrais Method", a special kind of neuro-muscular physical therapy, also called "Awareness Through Movement": See link "P", on "links" webpage. Feldenkrais Method can help to relieve many kinds of muscle tension problems.
           MUSCLE TENSION DYSPHONIA (MTD) continued:

    (New info: 12/2011): Wearing tiny glasses causes the need for extra head movements to look around a room or area. Larger glasses may help decrease MTD, because they allow a person to move only their eyes, rather than their entire heads & necks, to look around.





    • "IRRITABLE LARYNX SYNDROME"/ILS includes "Muscular Tension Dysphonia" (MTD), &/or Episodic laryngospasm [VCD], with or without  "globus"(feeling of a lump in throat), and with or without chronic cough, and includes visible or palpable [can be felt by touching] evidence of tension or tenderness in laryngeal muscles [also sometimes includes  difficulty swallowing]...[all] considered to be "hyperfunctional laryngeal symptoms".
    TO SIMPLIFY, THINK OF "ILS"AS BEING VCD.

    • "IRRITABLE LARYNX SYNDROME"/ILS (continued): These "symptoms" [including VCD] are caused by a definite symptom-triggering stimulus, such as: Gastro-Esophageal Reflux (GER), &/or other esophageal irritant,  &/or viral illness [(virus infection, like UPPER RESPIRATORY INFECTIONS/URI's, colds, bronchitis, etc.) --I believe (from reading medical journal articles) that viruses can sometimes "migrate" (travel) to central nervous system (brain, &/or spinal cord) or to the peripheral nervous system (nerves outside of brain & spinal cord--like the vagus nerve or branches of the vagus nerve)], &/or Dystonia  (like Spasmodic Dysphonia), &/or Environmental stimuli such as odors, airborne particles, or chemicals, &/or Allergies, &/or Voice abuse, &/or Psychological problems &/or "Neck torsion injuries", &/or neck "Nerve or tissue injury", etc.  (Ref.17,21,22 which is THE ARTICLE about IRRITABLE LARYNX SYNDROME, Ref.29, and "links" webpage: (O), (P), (W)). Also, see 'new' "Manual Laryngeal Tension Reduction" maneuvers, on webpage 4.



    • UTERINE CANCER: One VCD patient finally learned that uterine cancer had enlarged her uterus so much, that it was "pushing all" her "organs out of position", "putting pressure on everything". This "indirectly" caused "the shortness of breath and spasms" [severe VCD atttacks]. Since her hysterectomy followed by radiation, she has had no more VCD attacks. I don't yet know the exact pathway of how the large uterine tumor led to VCD attacks. Ref. 17 (personal communication).

    •  
    • PECTUS EXCAVATUM (PE), also known as funnel chest &/or sunken chest is a congenital (born with it) condition that not much is known about, concerning causes. PE may be related to scoliosis, &/or genetic conditions such as Marfan's syndrome, etc. 
         I think there CAN BE a possible connection between PE & VCD, in several possible ways:

    • 1) I think that patients with PE (uncorrected surgically) are more likely to get TOS/thoracic outlet syndrome -- compression of nerves &/or muscles &/or blood vessels, located between the clavicle (collar-bone) & first rib on either side (and some of these chest muscles extend UP INTO THE NECK). 
    •    And, TOS IS A KNOWN POSSIBLE COMPLICATION OF SURGICAL REPAIR OF PE!!

    • Then, the TOS can cause NECK MUSCLE TIGHTNESS/TENSION, maybe causing muscle tension dysphonia, pulling the larynx out of its normal position, leading to extra tension/stress (pulling) on vocal folds, making them more "twitchy"-- that is, more prone to spasming shut in VCD attacks. 
    •  
      Patients can speak with their surgeons about TOS being a possible surgical complication of PE surgical repair, and if present, what to do next:
       
      Feldenkrais Method (a type of neuro-muscular physical therapy) can help lessen TOS. Also, Aston Patterning (similar to Feldenkrais Method) can also help lessen TOS. Look up practitioners in phone books, and in forums about TOS.

    • Ask a "thoracic surgeon" doctor (M.D.), to recommend  an OCCUPATIONAL THERAPIST &/or a Feldenkrais Practitioner (or Aston Patterner), some of whom know a lot aboutTOS


    • IMPORTANT! A person can get TOS (Thoracic Outlet Syndrome, just from "over-use" of arms, bad ergonomics at work, while using computer, etc., --not only from having funnel chest!)

    Some OCCUPATIONAL THERAPISTS (OT's), know how to do Feldenkrais Method. It is gentler than most physical therapy. Look for an experienced Feldenkrais practitioner, or Aston patterner, (ask a THORACIC SURGEON for referrals) and ask how much the Thoracic Surgeon and the Feldenkrais people know about TOS.
    •  
      2) PE (funnel chest/Pectus Excavatum) can cause lungs to not be able to fully expand. From what I've learned at Nat'l Jewish VCD Conferences, I believe that anything that lessens air flow below vocal cords, can pre-dispose a person to getting VCD.
       
      3) There may be other factors associated with PE, that may pre-dispose a person to getting VCD, (see 2nd link below) such as mal-absorption syndromes (Celiac Disease, non-Celiac gluten sensitivity, etc.), where not enough calcium, magnesium, etc., is absorbed in the small intestine, resulting in making vocal cords extra twitchy. (See Ricketts discussion in 2nd link below). 
       
      4) Here are two links that include treating PE (pectus excavatum) either surgically or non-surgically: 
       
      http://www.emedicine.com/PED/topic2558.htm (includes a link to a non-surgical way to treat PE, and it's about the same method used by a doctor in South America, as the website below has!)
       

    • HEART CONDITIONS &/or BLOOD VESSEL PROBLEMS: (New info:, Jan., 2014):
    • Infrequently (maybe), a patient with either Mitral Valve Prolapse (MVP), or, with Mitral Valve Stenosis, can sometimes develop a condition called Ortner's Syndrome, (a "cardio-vocal" condition), whereby a vocal cord paralysis (mild paralysis is called paresis) promotes hoarseness &/or laryngospasms/VCD attacks! Here's one link about this:
    • http://www.jcdr.in/articles/PDF/1827/25%20-%203175.(A).pdf

    • Other conditions/situations (for some examples, see webpage 3, etc.)


    More medical research, and "feedback" from VCD patients, is needed to answer questions about VCD, such as:
    Which medications (besides the ones listed above) have side effects that may cause, trigger, aggravate or predispose people to develop Vocal Cord Dysfunction (VCD), &/or laryngospasm, &/or Spasmodic Dysphonia? What causes these bad side effects? (allergy? hypersensitivity? toxicity? irritation? other?) How can drug interactions (drug/drug, drug/food, drug/vitamins, drug/herb, herb/herb, herb/food, herb/vitamin, etc.) possibly intensify such side effects? The use of any drugs, vitamins, herbs, etc. should be done in a careful, thoughtful way, to try to avoid harmful interactions.
    (Ref.19,21,  and consult with good pharmacists, nutritionists, etc.)


    What is the mechanism by which a methacholine or histamine challenge induces VCD?


    What effects can some anesthetics &/or general anesthesia &/or muscle relaxants (like 'Versed') have, like causing or aggravating VCD and/or laryngospasm? Which anesthetics can do this, and what can be done to prevent or stop the effects? When can 'acupunture anesthesia' be an effective alternative to general anesthesia?


    What effects, if any, might high altitude (airplanes, mountains, high plains) have on VCD?


    One VCD patient asks: What connection might there be, between dry, photo-sensitive eyes, dry throat, stuffy nose, and VCD/laryngospasm?

    Can contact lenses possibly "trigger" VCD attacks, (by "vagal stimilation" or ?) ?


    Another VCD patient/nurse asks: Can VCD be caused by LATEX ALLERGY &/or ANAPHYLAXIS and/or due to use of latex products, used during "intubations" where rubber "balloons", RUBBER GLOVES, are used? If so, how common is this? Dr. Grossan, M.D.(California ENT/Ear, nose & throat doctor) has found particles of rubber in some patients who may have used old, deteriorating rubber bulb syringes (for nasal irrigations). See Allergy section, above. Also see SINUS TIPS (on webpage 10) for non-latex (rubber-free) method of doing nasal irrigations.


    What are possible relationships between VCD (Vocal Cord Dysfunction), SD (Spasmodic Dysphonia), and MTD (Muscle Tension Dysphonia)?


    Can MOLD CONTAMINATION (black mold and other types of molds, from hurricanes, storms, flooding, water leaks, etc.) can be indoor or outdoor types of molds-- cause VCD, either directly or indirectly, by way of allergy &/or bad effects on immune system, &/or infection, &/or irritation, &/or toxicity (for example, to lungs)--including the release of toxic fumes from the "substrate" that the mold is growing on?

    An example of a mold (a type of FUNGUS) caused condition, is (San Joaquin) Valley Fever (coccidioidomycosis), found in dusty soils of southwest USA, in Arizona, California, New Mexico, Mexico, etc. 

    On links webpage, See Ref.(X), which is a copy of the article called: Is Mold Bad For You?     http://www.ramseyenvironmental.com/ismoldbadforyou.htm

    Can lung hypersensitivity reactions (due to a fungus infection--like molds, &/or San Joaquin Valley Fever, also called Coccidioidomycosis,  Candida (yeast), etc.-- &/or due to toxic chemical inhalations, etc.), including lung damage (like scarring, lung collapse, etc.) cause VCD?


    Can a TONSILLECTOMY operation pre-dispose one to getting VCD?


    Can ANEMIA predispose one to getting VCD? If yes, find all the underlying causes of the anemia, and gently remove and treat the causes, to get rid of the anemia.


    Can hormones (at puberty, menstruation, pregnancy, giving birth, change of hormonal output after some gynecological surgeries, &/or, by aggravating one's asthma, etc.) cause or aggravate VCD?


    Can pushing very hard during labor, for several hours (when a mother gives birth to her baby) cause VCD to happen 2 days after giving birth? How can this Valsalva maneuver (bearing down) cause VCD? Might neck muscle tension be involved? Hiatal hernia? Gastric reflux? Or ??

    Tic disorders can "mimic" VCD. Tic disorders can come from "PANDAS", a type of auto immune attack on the brain, mistakenly thinking the brain is antibodies to streptococcal bacteria). Tic disorders can come from "PITAND" (non-strep infections, such as from viruses, vaccines, etc.) or "PANS".

    PANDAS means Pediatric Auto-immune Neuro-psychiatric Disorder Associated with Streptococcal infections.

    PITAND means Paediatric Infection-Triggered Autoimmune Neuropsychiatric Disorders (All sorts of infections can cause this, with tics).

    PANS means Pediatric Auto-immune Neurological Syndrome (can include tics, etc., and even vaccinations can cause this, in addition to strep, viruses, etc. ). PANS is the most inclusive term, for such tic disorders &/or obsessive-ciompulsive disorders (OCD).

    This is explained in more detail on webpages 3 and 9. See webpages 3 & 9


    Can tic disorders pre-dispose one to getting VCD?


    Can post polio syndrome (PPS) cause VCD? (post=after) . Two helpful links about PPS (Post Polio Syndrome) include the following:
    http://braintalkcommunities.org/forums/showthread.php?t=1260 (tells experiences of what helps and what doesn't, including physicians' names and various treatments --both allopathic and holistic-- by those who have/had Post Polio Syndrome), and:
     
    http://www.ppsr.com/infolocator.html This link came from above link, and is a link to PPSR, which stands for Post Polio Syndrome Resources, such as MD's, Hospitals, Clinics, Rehab Centers, Support Groups & Organizations:

    (2012): Some are now saying that some polio vaccines may have caused either an outright case of polio, or may have caused a mild form of polio, leading years later, to post polio syndrome. Some think that FIBROMYALGIA  may be a form of post polio syndrome.


    Can polio possibly cause a Post Viral Vagal Neuropathy, promoting VCD?



    Can using chlorine bleaches cause VCD attacks? (Yes, because chlorine is now known to be a VCD trigger--both in the home, in cleaning & doing laundry, and in swimming pools)



    Can UARS/Upper Airway Resistance Syndrome), cause VCD? UARS is a type of sleep disorder, that is NOT the same as OSA/Obstructive Sleep Apnea. UARS patients have problems of physical narrowing in several areas relating to their upper airway (space in nostrils tends to collapse, for various reasons, &/or, there may be less than 10 mm opening behind back of tongue, &/or, turbinates may be too big, &/or there may be a very deviated septum, etc.) and CPAP (Continuous Positive Airway Pressure: air from mask forced into patient's nose/mouth, used by those with OSA) may or may not help the UARS patient.

    The narrowing, may be from a genetic or non-genetic problem. Check on possible Marfan's Syndrome (a genetic problem).

    Some UARS patients required multiple surgeries, to partially correct symptoms. UARS manifests (shows itself) as multiple EEG (Electo Encephalo Gram, showing brain waves) arousals during the night, from partial upper airway obstructions, leading to daytime fatigue (bigtime), leading to many other problems. Many UARS patients are NOT obese, and may never have breathing entirely stop, as happens in sleep apnea.

    One patient having UARS (early 2006), suspects possible VCD (Vocal Cord Dysfunction), as a partial factor causing patient's residual problems from UARS, and suspects that the UARS may have predisposed patient to getting VCD (along with possible LPR/laryngo pharyngeal reflux, air quality problems, etc. etc.).

    An excellent article by 2 doctors (many clinical observations, and sympathetic attitude) about the controversial diagnosis of the sleep disorder now called UARS, is at this link:
    http://www.medscape.com/viewarticle/494651

    The article's title is: "Upper Airway Resistance Syndrome-One Decade Later", by physicians Gang Bao and Christian Guilleminault, and article is from the medical journal called Current Opinion in Pumonary Medicine, 10(6):461-467, 2004. Copyright Lippincott Williams & Wilkins.

    Dr. Guilleminault, M.D. (sleep disorders expert) is at Stanford University, in California--the only sleep center that recognizes & specializes in UARS.

    Apparently, not only is UARS controversial, but payers (insurance
    companies) don't always (if ever) recognize it, and won't even pay for cpap, when the cpap does help!



    A Florida VCD patient asks whether the air pollution produced from rocket/space ships taking off from Cape Canavaral, Florida can cause or worsen VCD attacks?

    A Texas asthma patient has noted a connection between worse asthma, and high numbers of chem trails/jet contrails/jet trails put out by high flying airplanes, and wonders if this can also worsen VCD.


    What would you like researchers to investigate about VCD? Please see email, below.

                          **************************

    Please make a paper COPY of web-PAGE 5, and circle every factor that may relate to your life, from birth to the present (use pen or pencil, not magic markers, which can be VCD triggers). Then, try to safely ELIMINATE (or AVOID) EACH FACTOR (or lessen &/or gently treat those than can't be completely removed or avoided). Please check with your physician(s) to find out how to safely do this, for your own unique situation.

    Also, pease go back to web-PAGE 3, make a paper COPY, and circle each relevant factor. Then, try to SAFELY eliminate, avoid, lessen, or treat the relevant factors (also under your doctor's supervision).

    And, please make a paper COPY of web-PAGE 4, which describes many TREATMENT CHOICES for VCD patients. Webpage 4 also lists some possible underlying VCD causes!

    You are now at the bottom of web-page 5. Please read web-page 6, next.
     


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