quick question -cardiopulmonary probs as adult?

[always smilin']

Quick question: doctors say that I shouldn't worry about cardiopulmonary problems as an adult - more worried about my pain. I have a HIGH pain tolerance. But, I've noticed that I'm huffing and puffing a lot for silly short distances. Anyone heard of cardiopulmonary problems in adults? should I push for eval at next appt? if so, how do they test for this?

Always Smilin'

surgery 1982
pre op (left thoracic) 45 - post op 33
pre of (right thoracic) 53 - post op 18

rechecked 2006
right thoracic 57
lower lumbar 34

[discombobulated]

Hi :-)

While I'm not a doctor, I am really surprised at what you've been told. My understanding is that a severe progressive (esp. thoracic) curve at any age places increasing pressure on the heart &/or lungs. Possibly the reason why a surgeon may be less concerned about cardiopulmonary scoli issues in adults than in kids/adolescents is because by adulthood many naturally curves stop progressing, so shouldn't present major problems. But it sounds from your post as though you feel your curve is still increasing? Is the breathlessness quite new?

Either way, I would trundle off to your GP (general practioner....uhh...maybe a primary care physician in the USA??). Shortness of breath could indicate anything from a slight decrease in your fitness, asthma, mild pneumonia (lung infection), right through to pulmonary problems resulting from additional curve progression.

Lung function is tested easily & painlessly - they peg your nose, stick into your mouth a plastic mouthpiece (attached to a tube, attached to a machine), & ask you to exhale as hard as you can for as long as you can. The procedure is usually repeated a half dozen or so times to test lung capacity under physical strain.

If you find you don't have asthma or any other identifiable cause, I would definitely push your surgeon about whether your curve's progression could be causing this. If s/he does not address your concerns to your satisfaction, I would absolutely seek a second opinion. You need your heart & lungs!

Hope this helps some - I'm sure some more useful answers will be along soon :)

Best of luck to you.

[SIsForSarah]

I would push for an evaluation at your next appointment. I started having breathing problems with a thoracic curve that was around 60 degrees and if I've read your history correctly, your thoracic curve is now at 57 degrees. Now, I did have my problems as an adolescent and haven't had problems since, but I would think that if a curve around 60 can affect breathing in an adolescent, than a similar curve would affect breathing in an adult.

[always smilin']

THanks for both your replies and advice. I had forgotten about that fun little machine that you blow into (hated it after/before my surgery as a child but understand now its importance). I am trying to keep a list of questions to ask my doctor next Monday (I'm scheduled for an MRI at that time). The doctor is most concerned with possible cervical spinal stenosis as I'm losing control (not sure if that is right word) of my hands - difficult to write -typing is easier somewhat. He was going to ignore the other curves unless I was in too much pain. I've seen 3 doctors now - 1 wanted to fuse me from head to toe (OK slight exaggeration) after a 3 minute consult - then I saw my adolescent spine surgeon who told me that once I was in too much pain to return - and I'm now at my 3rd (and I think - final - consult). I've heard good things about this doctor - read about him online- so will just push for a longer meeting. I met him 3 weeks ago and the meeting was brief. He ordered an MRI and said we'd talk more on Monday.

I've noticed the breathing thing over the last year - I know it's not asthma related as I've dealt with that during pregnancies and it doesn't feel the same. I just find with the little exercise I do I'm huffing and puffing (it's really embarrassing that I can't talk and walk at the same time and I'm not overweight). My blood pressure is somewhat elevated - but I'm not on medication YET. Can spine problems cause high blood pressure?

I do appreciate y'all taking the time to give your input. The last 2 years have been a bit rough - I'm so glad I found this site!
THANKS
Always Smilin'

[augemac]

always smilin'

Does your breast bone ever hurt? I have noticed also that has been happening lately. Also my breathing but mostly when I do any stairs or any strain and I feel so out of shape it isn't even funny. But I am also curious if my curve is on the move again. Waiting to see the Dr. in November to talk about my MRI.

I hope all goes well for you.

[LindaRacine]

While a moderate thoracic curve will have some impact on lung function, most of the literature states that it doesn't get critical until the curve reaches around 100 degrees.

[Debra JGL]

Hi Always Smilin,

I would say my biggist concern is my lung function in the future. I feel ok now but I do not want to get to a point where I have significantly reduced lung funcion (which would not only reduce my quality of life, but hamper a successful scoli. surgery). I feel I have a high pain tolerance too, though the pain has increased throught the years. Over the past couple of years I have felt some mild increased difficulty breathing at times. On occasion when I lay on my right side at night I have difficulty breathing and have to change positions. This was scary one night when I woke up breathless after falling asleep on my right side. I've decided to get a lung function test, scheduled for next week. I'm not sure what they can tell me but I least I feel I'll get a base line and can track progression if I feel it is getting worse. I'm planning at this time to wait a few years for surgery until my kids are a little older, but I feel I owe it to myself to keep an eye on all aspects of various ways scoli. is affecting me.

If you feel your having problems, check it out. There's only one you.

Deb

[Karen Ocker]

Linda: My experience has been severe breathlessness well before 100 deg. I had even lost lung tissue with 30/80/40 deg curves. A coronary stress test was used to rule out cardiac causes. I even got out of breath after a large meal--very scary.

Severe restrictive lung disease can occur with curves averaging 82deg:

http://www.ncbi.nlm.nih.gov/pubmed/15129066?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed


Children with curves in the 60 deg range showed abnormal pulmonary function:

http://www.ncbi.nlm.nih.gov/pubmed/17474634?ordinalpos=46&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Persons who believe they are safe pulmonary wise before scoliosis reaches 100 deg have a false sense of security and most certainly feel out-of-breath well before that.

[txmarinemom]

Exactly, Karen ...

And it can depend greatly on rotation. If she's post-op - and progressing - it sounds like there is some decompensation (which typically results in MORE rotation).

100° is far too high to set the bar for organ impingement/loss of pulmonary function.

Pam

[titaniumed]

When I had my physical at my Primary care Physicians office, they had me blow into a computerized machine and it came up with "restricted breathing". I could not get a reading and it sure seemed like I was blowing up a Macys day parade balloon. They reset the device and had me try it about 6 times and every time it came up with "restricted breathing"

I didnt think I had any problems with my breathing at all,even with skiing and hiking up at 10000 feet in the mountains.

I noticed that if I would overeat, I would be out of breath. I also noticed my heart would race with overeating. Needless to say, I "Try" not to overeat. It takes major discipline at Thanksgiving. Overeating is a No No!!!!!!

My curves were C12,T70,L70
50% correction after surgery

Ed

[txmarinemom]

There's a ton of data on PubMed about this ...

"Pulmonary function and spinal characteristics: their relationships in persons with idiopathic and postpoliomyelitic scoliosis." (http://www.ncbi.nlm.nih.gov/pubmed/11245755?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed) claims:

"No single factor can predict the severity of impairment in scoliotic patients' pulmonary function. In both groups, severity of pulmonary impairment was related to the combined features of the spinal deformity. However, uppermost vertebra, scoliotic angle, and patient's age may play important roles influencing pulmonary function in both groups."

And "Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis. A study of six hundred and thirty-one patients." (http://www.ncbi.nlm.nih.gov/pubmed/16140807?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed) concludes:

"Some patients with adolescent idiopathic scoliosis may have clinically relevant pulmonary impairment that is out of proportion with the severity of the scoliosis, and this may alter the decision-making process regarding which fusion technique will produce an acceptable clinical result with the least additional effect on pulmonary function."

BTW, both the studies - one on adults, and one on adolescents (Lenke and Newton both contributed to the AIS study) mention curve location and number of vertebra involved. Neither mentions a set degree of curvature, although the adult study vaguely mentions scoliotic angle.

Just food for thought ...

Regards,
Pam

[always smilin']

Wow! I didn't expect so many responses and to be so educated. THANKS everyone for the extra reading - I just find that keeping in contact with you and reading up helps a ton. I don't want to deal with more breathlessness - but I don't really want to deal with any of this back stuff - I was so convinced that I was "cured" 20 years ago - I'm so frustrated that I didn't "get" that this was a lifelong battle.

I appreciate very much your support and feedback and will keep reading and educating myself. Wish me luck at my MRI on Monday - I'm totally nervous - my last MRI was a bit scary but I made it through - I'm much more nervous this time around.

I wrote up a list of questions to ask my doctor so hopefully that will help guide discussion. One of the questions is his opinion on my thoracic curve and lung function. (My first operation was done because of the concern for cardiopulmonary function - my lung function was severely compromised at that time). Stenosis-arm and hand numbness numbness, heavy legs, and breathing - oh my!

THANKS AGAIN EVERYONE:)
Always Smilin'

[SIsForSarah]

Wow, you've got a lot going on with you, always smilin'! Good luck with the MRI - sometimes the answers aren't as scary as we expect them to be and sometimes the scary answers mean things will at least start on the path to getting better. I hope it all works out for you some how.

[always smilin']

I always joke that I just like to do things a bit differently than everyone else - my body has its own mind:) I survived this thing once - I'll beat it again somehow:)

Always Smilin'