A Trip to the Hospital
I finally had my doctor visit to the Cleveland Clinic. They took the blood test for alpha-one deficiency, and sent away for the results.
Then we discussed my asthma and the lack of results I have gotten with my medicine.
I was a bit frustrated with Doctor #1, as I don’t think she “got” the whole ultra running thing. She kept asking me why I had stopped the meds, I told her, because I don’t have a long (like over 60 miles) run anytime soon. She left to go discuss with Doctor #2.
Doctor #2 actually knew an ultra runner, someone that worked at the hospital, so that was bit more helpful. He proposed another somewhat diagnosis-vocal cord irritation.
Did I ever get GERD while running? Why, doctor, yes I do. Would vomiting during a run also irritate the vocal cords? Hmm, that would also. Doctor #2 said it would be hard to diagnose this, as I can’t exactly produce cold weather and running for sixty miles and have an ENT specialist ready to stick a tube down my throat.
Dr #2 mentioned vocal cord dysfunction, it was trouble inhaling..like breathing thru a straw. I sat right up at that one. Yes!
Apparently asthma is usually more of a problem on exhalation, unlike my symptoms, which is on inhaling. I always thought asthma was a problem with breathing in.
The symptoms are just similiar to asthma: difficulty breathing, coughing, wheezing, throat tightness, hoarse voice, voice changes
Triggers? Breathing in lung irritants, excercising, GERD, may trigger symptoms of VCD.
There can also be some pyschological aspects of VCD as I googled along the internet.
In one study, 75% of asthmatics were found to also have VCD.2 Female athletes have been found to be especially prone to episodes.3 Stress and anxiety are both strong contributing factors in triggering episodes. A study comparing teens with VCD and asthma found higher levels of stress and anxiety in the VCD group. Anecdotal observations have also revealed that athletes who suffer undiagnosed VCD will, over time, have a decrease in exercise tolerance precipitating an episode.8
It’s the vestibular folds that cause the problem. These are thick mucous membranes that protect and sit above the vocal folds and below the epiglottis. During inspiration the folds will abduct, or open, to allow the flow of air in. Problems with vocal cord dysfunction, these folds close, causing the breathing problem!
Also on my internet googling, I found that vocal folds have been found to be especially sensitive to hormonal influences, particularly androgen, estrogen and progesterone where specific receptors can be found in the epithelial and granular cells and fibroblasts. I haven’t had time to research this further, but I’ve gone through the five or so stages of menopause in the last five years, meaning my estrogen levels have gone wacky.
I have to schedule another appointment at the hospital, a methacholine challenge test, that can rule out whether I have asthma or not. But on the surface, on a bunch of articles that I have quickly read (and will elaborate on another post) it seems my symptoms match more of vocal cord dysfunction.