Christian Hospital Patient ‘Has Her Life Back’
By Bret Berigan
Ann Parker is breathing easier today and feels she has her life back after years of being treated for misdiagnosed asthma. One simple test last summer showed that Parker was really suffering from a vocal dysfunction that responds to therapy, not medication, with dramatic results.
CH interventional pulmonologist Brian Taylor, MD, "challenged" Parker's asthma diagnosis last summer on her very first visit with a test called the methacholine challenge, which showed there was nothing wrong with Parker's lungs. From there, Parker went to see CH interventional pulmonologist Doug Zweig, MD, who diagnosed vocal dysfunction, which mimics breathing disorders, and referred her to CH outpatient rehabiltation services located at Graham Medical Center.
"Ann has what doctors call 'vocal dysfunction' and what us speech/language pathologists call 'paradoxical vocal fold motion' because they close when they shouldn't," says Shannon Lui, SLP, who provided Parker's therapy three times a week for several weeks. "I took a class two years ago on this very condition, and it was wonderful to be able to so effectively help my very first patient. Now Ann can breath, she's off her asthma medcations and as a result loosing weight. She can also go on trips without the fear of ending up in an emergency department, and she's looking forward to working again."
Stress, as in Parker's case, is a major cause of this condition. The neck muscles contract and close the vocal folds and cut off the airway for breathing. "And they just stay closed that way," says Lui. "Like in the middle of the night, causing Ann to stop breathing."
"I had a raspy voice and was always clearing my throat because it felt like I had something in there," says Parker, "and I was only getting about 50 percent lung function at the time and always had upper respiratory infections. Everyone thought I had asthma and for the last several years I was being treated with monthly injections, breathing treatments and lots of prescription drugs." But all that changed last September when Parker began her treatment in the speech pathology voice program at CH outpatient rehabilitation services.
Treatment is very simple -- vocal exercises and relaxation techniques.
"The first thing I did with Ann was reteach her to breath," says Lui. "Put your hand on your chest. That's where most people tend to breath when they're stressed and breathing like this is just going to stress you out more and add to tension in your neck, which in turn will cause your vocal folds to close because the muscles that control the folds are there. When these muscles are at rest, the vocal volds stay slightly apart making room for air to flow.
"If you teach breathing at the lower part of your trunkwhere your lungs expand, your diaphragm comes out and down and you're thinking about this area -- take a deep breath and exhale," says Lui. "That's going to relax you just by doing the deep breath, but now you're also breathing correctly because you're using the muscles for breathing, and taking the focus off the voice area. We used other vocal focus points as well as a lot of imagery."
Lui stresses the importance of being aware of the mind-body connection.
"Breathing and relaxing so your muscles do what you tell them to do is so important," says Lui. "We also refocus the voice (to areas in front of the vocal folds practicing from sounds, to words, to sentences. Eventually we were having conversations while walking around, because exercise is one of Ann's goals as well. So that's a social communication skill we also developed that allows her to be able to go somewhere with someone and talk while walking."
To help Parker relax, Lui utilized progressive relaxation and taught Parker to close her eyes and visualize herself in a peaceful, calming place and to be intune with her inner self. (my goal was actually just to relax muscles, this is just another powerful way to do it- you can say that instead if you want, otherwise I think the relaxation thing gives people the wrong impression- even though it is simple, the effect of the exercise is ultimately more physical relaxation than emotional, for voice therapy purposes)
"From the moment I walked through the door I could feel a bonding relationship with Shannon," says Parker. "I've never had someone on my side or worked with someone who cared and helped me so much as Shannon. She taught me how to breath during an episode, which is what I was thinking before were asthma attacks. Knowing now that it's an episode, I can focus on my breathing and relaxation tools and not panic when my throat is closing off and I can't get air. Before this my mom or son would automatically call 911 for an ambulance because sometimes I would pass out."
"This is a condition that medically gets missed a lot," says Lui "and it's very rewarding for me to know I can take care of it with no medication."
And it has made a world of difference for Parker who in 2009 had one six-week period in bed. "I had asked my best friend to be ready to do my eulogy," says Parker. "And a year later I'm off all my medications and I feel great."