left diaphragm

Hi all,

I have a questions regarding the diaphragm. Anthony's level of injury is slanted. More ike C4 on left side and c56 on the right side. He has more function on his right side than his left. I think due to the way the sign hit him in the throat. As you know we were having a hard time weaning him off the vent. He had a florostomy(sp) done and the left diaphragm was moving but not up to the capacity; the right side was ok. We thought with time maybe it would get stronger and this was going to be solved. He was completely off the vent a couple of times for 3 days with room air only. But this is what happens. His left lung gets a little collapsed and then secretions are not expelled as they should. He had a plug yesterday and another breathing incident late at night with his saturation down to about 75 and would not respond for a couple of minutes. So now the Dr. thinks he might have to be on a vent at night. Does anyone know if the diaphragm is a muscle that can get stronger or if maybe the nerve to the left diaphragm was damaged and therefore will not recover. thanks

Cindy, tampa fl
mom to Anthony C4(left side), C6(right side) now his Dr. says C5???
we will get it straight one of these days
inury 3/28/03

[Wise Young]

Cindy, much depends on the nature of the damage that anthony has. In general, however, his left and less functional diaphragm should gain strength with time because there are several pathways for reinnevating the diaphragm. Many animal studies have shown that unilateral loss of the phrenic nerve pathways to one diaphragm can and will improve with time. There is some data indicating that theophylline therapy will accelerate that recovery and there is a clinical trial going on to look at this question at Wayne State University (http://carecure.org/forum/showthread.php?t=39745). You should check this out and talk with Harry Goshgarian who is probably one of the world's foremost experts on the subject of respiratory restoration.

Wise.

[SCI-Nurse]

There has been some success in the use of 4-AP in strengthening weak diaphrams as well. I know that some centers also use biofeedback training in this area.

With this condition (hemi-diaphragm) the person will have the most problems breathing when positioned on their stronger diaphragm side. This may mean that he should be limited to laying on his back and left side when trying to wean. Many times it does improve, but it is a very slow process. It is possible to fully wean and move on to rehab with only half the diaphragm moving as long as he gets aggressive pulmonary therapy.

He should also be getting IPPB treatments every 4 hours at least to prevent atalectasis, followed by chest PT and clapping/postural drainage to help with secretions. The use of both quad coughing and a Cough-Assist machine on a regular basis (at least every 2 hours for the quad coughs, and 4X daily for the Cough-Assist) is also recommended. Is he in a center where they are used to using these SCI-specialty procedures?

There are ways to strengthen the diaphragm. The most simple is to have him lay on his back and the therapist (PT) puts 3-5# sand-bag weights on his upper abdomen. He should slowly build up to 20-30 minutes of breathing this way several times daily. Once he starts to make progress, family and the nurses can be taught to help with this.

A progressive inspiratory resistance device such as the PFlex is also very helpful, and relatively inexpensive. It can be used with or without the trach being capped.

PFlex (http://www.respironics.com/product_library/invoke.cfm?objectid=7AAB6F78-A124-450D-9364382886FDEC87&method=display)

This should be used at least 4 times daily, building up slowly to 10 minutes at the largest hole, then moving to the next smaller, building up to 10 minutes, moving to the next smaller, etc.

(KLD)

As always great info. Anthony is still in the hospital at Jackson Memorial. I'm sure they will be able to help him with some of the suggestions you have given; he has excellent PT. I will call Dr. Goshgarian also.

[helpr]

I am glad to hear that your son is in a good hospital. We found out the hard way that not all hospitals know how to wean SCI patients from vents. My daughter was in ICU at an acute care hospital and they were very nice, but didn't have a clue about SCI.Unfortunately, neither did we, so we allowed them to make many mistakes. At about 5 weeks post injury she was transferred to a good rehab hospital, and they immediately changed the vent settings (from the acute care settings), used a cough-a-lator and IPPB treatments. What a difference those things made. It tookabout three weeks, but they were able to get her off the vent. She too has a hemi-diaphragm, but the weak side seems to have improved quite a bit. (She is 5 months post injury)