Subject: breathing and ms

From: Sharon Brown <[email-masked]>
Date: Wed, 20 Aug 1997 09:33:55 -0500

for everyone's info - timothy vollmer is head of the ms clinic at yale
      --------------------------------------
~Date: 8/19/97 6:46 PM
To: Timothy Vollmer
~From: [email-masked]

I've done a little bit of research on the effects of m.s. on the
pulmonary muscles, but to know avail - i'm sending a copy of all of your
requests to my friendly neuro to see what he might say.
>From my friend Dawn: "When I say every muscle is affected, obviously I don't
>mean every known muscle, :-) but a lot of imp't ones are. And I do have
>problems breathing.
>
> My blood pressure is unstable...and low.  I've lost a lot of weight. Like I
>already mentioned, I'm having problems with my lungs. I've been getting
>infections and having problems breathing. I have asthma.I may not be on
>oxygen but I'm heading there. I've been on becloforte. I'm also pretty much
>confined to a hospital bed which is no picnic. I'm blind in my
>left eye and 50% vision in right. I have tremors and severe spasms.
>I am incontinent with the bladder and semi-continent with the bowel.
>Because I'm a quadriplegic, I use a pointer to type which isn't easy
>because I have a hard time keeping my head up. My head and neck
>muscles are weak. I'm getting voice recognition. Every time I
eat, drink, or take medication, I feel like I'm going to choke to death.

>From my friend Judy: I saw your posting today and need some help.  I recently
>had pulmonary function tests done, and the only test on which I did poorly
>was the one that tests the strength of the muscles used for breathing.
>However, my neurologist insists this has nothing to do with the MS, and that
>he's never had a patient with MS who has trouble with this.  Do you know
>anywhere I can get more info on this?  I'm going to ask Dawn also...Thanks,
>Judy Morgan

  Reply to:   RE>breathing and ms

Your note brings up two issues related to breathing in patients with MS.
 The
major issue in the first paragraph appears to be difficulty with
swallowing with
a symptom called dysphagia.  This is common in MS, particularly in
patients with
more severe disability.  It is due to loss of neurologic control over
the
muscles in the throat (the first third of the esophagus is voluntary
muscle,
which is vulnerable in MS).  Besides choking, this leads to the freguent
aspiration of food, saliva, etc., into the lungs which leads to low
level
infections and intermittent full-blown pneumonias.  Such a problem needs
careful
medical managment including physiatry or ENT consults in many cases.
The second
paragraph may refer to a problem where MS affects the function of the
intercostal muscles which lead to insufficient expansion of the lungs.
This can
occur when MS weakness affects the trunk muscles and sometimes from
spasticity
in the chest muscles.  Rarely the diaphragm may be affected when the
phrenic
nerve is damaged by MS where it enters the spinal cord.  Both can be
evaluated
by pulmonologist.

I hope this is of help.

Tim Vollmer, M.D.

-   Sharon