Diaphragm Failure?

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Graybeard

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440
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PALS
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12/2013
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US
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Ca
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Surf City
I was told the diaphragm is responsible for about half the breathing when upright, and 80% while prone. That explains the value of a bipap for sleeping.

The phrenologist who checked my phrenal nerves said that without nerve stimulation, the diaphragm gets too thin for them to hook in the electrodes.

Does that mean the diaphragm will eventually fail to separate the lungs from the intestines? Is that the end?
 
I doubt it, but I so could have gone forever without that picture in my mind...
 
Think it probably means that it will have atrophied to much. Just as other muscles get smaller when they atrophy. They don't disappear, they're just smaller
 
Does that mean the diaphragm will eventually fail to separate the lungs from the intestines? Is that the end?

I've never heard anything like this. Don't think that's the way it goes.

I've always been told that the autonomous nervous system continues your breathing, but it's not enough to clear out all the built up CO2, since you need the motor nervous system to take big clearing breaths.

A low dose of morphine relaxes and opens up the lungs so breathing is easier. I saw this happen. When my wife complained of lack of O2, we gave her the low dose morphine and she instantly felt relief. It was a good thing to see my PALS breathe more easily.

Toward the end, after the motor nervous system is completely destroyed, deep clearing breaths are impossible. However, I observed in my wife that she continued to breathe in a shallow manner, as her autonomous nervous system was still intake. This shallow manner of breathing is a lot like what you normally breathe like when your asleep. Very quiet, soft and rhythmic.

Eventually, the CO2 builds up to a deadly amount and you go to sleep. Higher doses of morphine prevent you from being upset or anxious about the lack of oxygen. You just don't care. I had the impression that my wife would have smiled through her last hour if she could.
 
It's not a matter of separating the lungs and intestines. As Mike has said, it's about the nerve causing the diaphragm to work failing, causing wastage and the inability of the diaphragm to function.

For many months Chris would basically just breath with accessory muscles, so a breath in was like him lifting his shoulders in a shrug. The diaphragm dropping down causes air to be drawn deeply into the lungs, and a good push up again from the diaphragm causes all that CO2 soaked air to be expelled. The intercostal muscles (the ones between the ribs) pull the lungs outwards, and squeeze them inwards to allow lots of air to fill and be expelled.

Usually we don't use the upper chest and shoulder muscles to breath, but you may notice yourself use them if you need a really deep breath or you do a big yawn - these are the accessory muscles.

The lungs are not able to move themselves. It's the diaphragm and intercostal muscles that expand and squeeze the lungs - think of a set of bellows. The main body of the bellows doesn't move itself, but widening the handles pulls air into it expanding the balloon and pushing the handles together empties it again.

Bipap is very different to muscle movement, but it forces air into the lungs, then reduces the pressure to allow air to be expelled. This is why bipap will only work while there is some muscle strength working to breath, bipap assists the breathing. An invasive vent on the other hand actually does all the breathing requiring no diaphragm or intercostal muscles to be working.

I believe that this is why bipap early is so important because if you are struggling to breathe, you are fatiguing the muscles that are already failing and breathing becomes more difficult and progression of those failing muscles may only be hastened. Let alone you are living with a CO2 soaked body which can't help anything at all.
 
Atsugi and Tillie, thank you for the lesson. My husband's breathing is going downhill so this was a very good lesson! I've also learned that the CO2 buildup causes paralysis of the cilia that lines the lungs. The cilia normally keeps the mucous flowing. Once paralysed (also in smokers cough), the cilia can no longer move the mucous naturally and one must cough it up. And since my husband can no longer cough very hard, he has a difficult time with mucous, he has to use the cough assist machine and suction machine. Tom's having a difficult time wearing the BiPap at night, so he uses it during the day when he's watching TV. Better that than not at all I guess.
 
Excellent point about the cilia ECpara.

The whole movement and process of breathing keeps the cilia healthy. The CO2 and mucus buildup cause them to lose function as you mentioned, so the problems keep kind of heaping one on top of the other.

If the PALS breathing degrades to a certain point then bipap isn't going to help all that much. A bit like leaving the peg too long and then having trouble adjusting to the feeds.

As the diaphragm weakens, you will also notice that there may be more and more sleep apnoea, though not snoring, as it's not usually obstructive unless that was already present. It's the phrenic nerve 'forgetting' to tell the diaphragm what to do. If the PALS is laying flat, it only becomes harder and harder to breath at all.

Again this is why we don't give oxygen to PALS - it only causes them to breath out with less force because the oxygen needs are met and the CO2 builds up even more.
 
Never heard it explained so clearly. Thank you.
 
Tillie, Atsugi, Ecpara, thank you for the concise, clear explanation. Can this maybe be filed as a "sticky"? Perhaps under ALS Breathing Problems Explained. I never really understood that before, especially about what leads up to the congestion and why you should not give a PALS oxygen. Thanks again.
 
Yes, wonderful explanations! We went to Case Hospital in Cleveland (in the blizzard) last week to meet with Dr. Onders & staff. What a day. Bottom line is that Toby's phrenic nerve is flat - no readings and the same is almost true of diaphragm. Thanks to early use of bipap at least 8-10 hours a day - his carbon dioxide readings were negligible. Unfortunately Dr. Onders did not have much hope for good long-term outcome of surgery tho' he was willing "to give it a whirl". Somehow that was not a good trade off in my mind. My Dad died at the beginning of surgery and was much healthier and younger even than my husband. Anyway - thanks for all the info. Knowledge is so helpful and even comforting to me. Nancy
 
Really helpful information, thank you so much
 
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