Q: I am a 54-year old male. After open heart surgery in January 2011, I was diagnosed with a left paralyzed diaphragm. There is a limited amount of information regarding this condition on the internet. My surgeon is asking me to wait and see if the diaphragm will work as normal again. He thinks it will become better. He has also discussed diaphragm plication surgery. I have posted on several forums to try to talk with someone that has had this problem and also that has had the surgery but cannot find anyone. It appears to be a major surgery and I would really like to know how beneficial it is. Thanks for your help in this matter.
A: The diaphragm is a muscle that separates the thoracic and abdominal cavities. It is controlled by the phrenic nerve that originates from 3, 4 and 5, all of which are involved in movement of the diaphragm. Paralysis of either one or both sides of the diaphragm is uncommon. Regardless of which side is affected, the patient may experienced a diminished amount of lung capacity that will be particularly noticeable while lying down, fatigue, headaches, cyanosis of the lips and fingers and shortness-of-breath with minimal exertion.
Some of the reasons for this to occur may include surgical trauma such as that following a cardiothoracic or cervical procedure, a thyroid disorder, an autoimmune disease such as Guillain-Barre syndrome, muscular dystrophy, ALS,, cancer in the lung or lymph nodes that may be compressing on the nerve, and other neuromuscular disorders.
Diagnosis can be made through X-ray fluoroscopy, laboratory testing, a pulmonary function test, ultrasound, MRI, nerve stimulation testing of the phrenic nerve, and more. Blood drawing will measure the amount of oxygen in the blood; pulmonary function testing will define the degree of disability experienced; MRI can clarify whether there is an underlying condition of the nerve roots or spinal canal; and testing of the phrenic nerve considered to be the motor nerve to the diaphragm.
Most patients with unilateral diaphragmatic paralysis are asymptomatic at rest, but find themselves short of breath during exercise and may not require treatment. If an underlying cause is found, it can be treated. There are instances when the paralysis resolves on its own over a period of months to more than a year and in those individuals with severe dyspnea on exertion, surgical treatment has been found to be beneficial according to some reports.
Treatment may consist of waiting and watching if the patient is symptom free, diaphragmatic plication that pulls the diaphragm back down to its normal position and allows for better ventilation, a breathing pacemaker that can be used if the patient has functioning phrenic nerves, thoracoscopic plication that will allow a shorter hospital stay than some other approved techniques, and tracheostomy which is a surgical opening in the trachea that allows for a way to overcome paralysis in severe cases. The latter approach may be used for patients with a diagnosis of quadriplegia or a life-threatening disease. The plication recommended by your surgeon is commonly used for patients who have one-sided paralysis, as well as for patients with a respiratory infection, COPD and asthma.
The prognosis is generally good for one-sided paralysis, providing there is no underlying pulmonary disease but whether or not to perform the plication depends on your overall health and whether your quality of life has deteriorated because of the condition. Only your primary care specialist, your surgeon and you can make that decision. If your physician feels you are a good candidate to wait things out, perhaps this should be attempted first. If your quality of life suffers, you need to speak with him or her and perhaps advance to Plan B. Put your faith in your doctor but only you know how you truly feel. Be guided by what your body tells you.
Readers who are interested in learning more can order Dr. Gott’s Health Report “Pulmonary Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
