Phrenic Nerve Damage

[Guest guest]

Greetings All.

I am hoping to gather info on a case I have come across recently

regarding the use of acupuncture and herbs for relaxing a

paralysed/nerve damaged diaphragm. As I have not had an opportunity

to do an eval, I have only the data that was related to me by the

patient, no tongue and pulse to offer. Please comment if you have had

any experience with a similiar instance, or have a strong opinion on

how to use your experience to help in this case. Thanks for your

input.

 

Four months ago, a _67___year old male received a crushed or cut

phrenic nerve during a surgical procedure (mini maze) to address

episodes of atrial fibrillation, which was occurring intermittently

each day. Injury to the nerve may have occurred during the

clamping of the pulmonary vein or during the ablation procedure,

which was done seven times. As a result, the patient's right

diaphragm is elevated, paralyzed, and positioned above the right

nipple. A paralyzed diaphragm induces coughing, which is much less

now than it was immediately after the injury. The patient has

acquired two hernias, apparently due to the paralyzed diaphragm,

which induced severe coughing. Patient does not cough all that

much now, but lung capacity has been reduced by approximately 60%

while standing, and 80% when lying down. Patient must use a BiPap (Bi-

level Positive Airway Pressure) machine to sleep. Atrial Fibrilation

has not occurred since the procedure, and this part of the surgery is

deemed to have been successful.

 

Patient's heart beats at 95 BPM since the incident. His problem

began in 1999 when he went into atrial flutter. Several attempts to

stop this using shocking did not work. Several beta blockers were

tried that caused patient to be dizzy and weak did not work. Patient

then had an ablation surgery (Pulmonary Vein Isolation Procedure),

which worked until two years ago. Two years ago, he began to have

atrial fibrillation and Tikosyn was prescribed, and this worked

until the fall of 2007 when he began to have bouts of atrial

fibrillation.

 

Since the surgery, patient has little energy, is lightheaded and

wobbly all the time. Most activity is curtailed. There is

apparently nothing doctors can do relative to the cut or damaged

phrenic nerve.

 

Patient has hired a homeopath and is on an organic fruit and

vegetable diet, with a little wild game thrown in. The Cleveland

Clinic says that the chance for the nerve to come back is " very

unlikely at this time. "

 

Current medications taken by the patient:

cardiazam, at 120 mg dose for increasing arterial blood flow.

Coumadin, at 3mg dose, a blood thinner.

Nexium, at 5 mg dose, for reflux

 

He will begin some supplements from his homeopath in the near future.

 

Additional Health History: Patient is of normal

weight with the following additional medical history:

Eyes:

Macular traction diagnosed and treated with surgery 3 years ago.

Cataracts removed from both eyes one prior to the

macular traction. Patient believes that the

cataract surgery led to the Macular Traction

Prostate: Enlarged

Digestive: Reflux

 

Blood pressure was normal (120/80) for years, until the Mini maze

procedure. It now runs around 140/90 or higher. Heart rate was 62

until procedure and is now 95. All blood work has been normal for

years.

 

Former medications taken; attempted beta blockers for atrial flutter

in 1999, but patient had difficulty taking those. Made him weak,

dizzy. Took Prevacid for 6 years for reflux, but now taking Nexium.

Is only alleregic to internal iodine. Sleeps well. Wears a hearing

aid and also has ringing in ears. Vision good, except that he has

dry eyes that affect vision from time to time. Has never smoked,

drinks wine on occasion. Has a twin brother who also had atrial

flutter that was helped by ablation surgery. He also now has bouts of

atrial fibrillation but is taking a beta blocker that keeps it under

control.

[Guest guest]

Sounds like a nightmare. And more of an acupuncture case at least to begin with.

I have

seen days long hiccups arrested with strong acupressure on UB 1 for close to an

hour.

Apparently this is affects the phrenic nerve. I imagine UB 2 would work as well.

Start there

I would think. Tell us what happens.

Doug

 

, " James P Slaymaker, L Ac "

<acupuncture2heal wrote:

>

> Greetings All.

> I am hoping to gather info on a case I have come across recently

> regarding the use of acupuncture and herbs for relaxing a

> paralysed/nerve damaged diaphragm. As I have not had an opportunity

> to do an eval, I have only the data that was related to me by the

> patient, no tongue and pulse to offer. Please comment if you have had

> any experience with a similiar instance, or have a strong opinion on

> how to use your experience to help in this case. Thanks for your

> input.

>

> Four months ago, a _67___year old male received a crushed or cut

> phrenic nerve during a surgical procedure (mini maze) to address

> episodes of atrial fibrillation, which was occurring intermittently

> each day. Injury to the nerve may have occurred during the

> clamping of the pulmonary vein or during the ablation procedure,

> which was done seven times. As a result, the patient's right

> diaphragm is elevated, paralyzed, and positioned above the right

> nipple. A paralyzed diaphragm induces coughing, which is much less

> now than it was immediately after the injury. The patient has

> acquired two hernias, apparently due to the paralyzed diaphragm,

> which induced severe coughing. Patient does not cough all that

> much now, but lung capacity has been reduced by approximately 60%

> while standing, and 80% when lying down. Patient must use a BiPap (Bi-

> level Positive Airway Pressure) machine to sleep. Atrial Fibrilation

> has not occurred since the procedure, and this part of the surgery is

> deemed to have been successful.

>

> Patient's heart beats at 95 BPM since the incident. His problem

> began in 1999 when he went into atrial flutter. Several attempts to

> stop this using shocking did not work. Several beta blockers were

> tried that caused patient to be dizzy and weak did not work. Patient

> then had an ablation surgery (Pulmonary Vein Isolation Procedure),

> which worked until two years ago. Two years ago, he began to have

> atrial fibrillation and Tikosyn was prescribed, and this worked

> until the fall of 2007 when he began to have bouts of atrial

> fibrillation.

>

> Since the surgery, patient has little energy, is lightheaded and

> wobbly all the time. Most activity is curtailed. There is

> apparently nothing doctors can do relative to the cut or damaged

> phrenic nerve.

>

> Patient has hired a homeopath and is on an organic fruit and

> vegetable diet, with a little wild game thrown in. The Cleveland

> Clinic says that the chance for the nerve to come back is " very

> unlikely at this time. "

>

> Current medications taken by the patient:

> cardiazam, at 120 mg dose for increasing arterial blood flow.

> Coumadin, at 3mg dose, a blood thinner.

> Nexium, at 5 mg dose, for reflux

>

> He will begin some supplements from his homeopath in the near future.

>

> Additional Health History: Patient is of normal

> weight with the following additional medical history:

> Eyes:

> Macular traction diagnosed and treated with surgery 3 years ago.

> Cataracts removed from both eyes one prior to the

> macular traction. Patient believes that the

> cataract surgery led to the Macular Traction

> Prostate: Enlarged

> Digestive: Reflux

>

> Blood pressure was normal (120/80) for years, until the Mini maze

> procedure. It now runs around 140/90 or higher. Heart rate was 62

> until procedure and is now 95. All blood work has been normal for

> years.

>

> Former medications taken; attempted beta blockers for atrial flutter

> in 1999, but patient had difficulty taking those. Made him weak,

> dizzy. Took Prevacid for 6 years for reflux, but now taking Nexium.

> Is only alleregic to internal iodine. Sleeps well. Wears a hearing

> aid and also has ringing in ears. Vision good, except that he has

> dry eyes that affect vision from time to time. Has never smoked,

> drinks wine on occasion. Has a twin brother who also had atrial

> flutter that was helped by ablation surgery. He also now has bouts of

> atrial fibrillation but is taking a beta blocker that keeps it under

> control.

>

[Guest guest]

> >

> > Current medications taken by the patient:

> > cardiazam, at 120 mg dose for increasing arterial blood flow.

> > Coumadin, at 3mg dose, a blood thinner.

> > Nexium, at 5 mg dose, for reflux

> >

 

Be very careful with herbs.

 

Coumadin is an anticoagulant and requires monitoring by lab test for

safe use. Coumadin and herbs that move or resolve blood statis

create a strong positive interaction.

Details: http://en.wikipedia.org/wiki/Coumadin

 

 

I think Cardiazam = Cardizem. If so the generic name is Diltiazem.

Details: http://www.rxlist.com/cgi/generic/cardizem_la_cp.htm

 

The therapeutic effects of diltiazem are believed to be related to

its ability to inhibit the influx of calcium ions during membrane

depolarization of cardiac and vascular smooth muscle

 

Mechanisms of Action

Hypertension. Diltiazem produces its antihypertensive effect

primarily by relaxation of vascular smooth muscle and the resultant

decrease in peripheral vascular resistance. The magnitude of blood

pressure reduction is related to the degree of hypertension; thus

hypertensive individuals experience an antihypertensive effect,

whereas there is only a modest fall in blood pressure in

normotensives.

 

Angina. Diltiazem has been shown to produce increases in exercise

tolerance, probably due to its ability to reduce myocardial oxygen

demand. This is accomplished via reductions in heart rate and

systemic blood pressure at submaximal and maximal work loads.

Diltiazem has been shown to be a potent dilator of coronary arteries,

both epicardial and subendocardial. Spontaneous and ergonovine-

induced coronary artery spasms are inhibited by diltiazem.

 

In animal models, diltiazem interferes with the slow inward

(depolarizing) current in excitable tissues. It causes excitation-

contraction uncoupling in various myocardial tissues without changes

in the configuration of the action potential. Diltiazem causes

relaxation of coronary smooth muscle and dilation of both large and

small coronary arteries at drug levels which cause little or no

negative inotropic effect. The resultant increases in coronary blood

flow (epicardial and subendocardial) occur in ischemic and non-

ischemic models and are accompanied by dose-dependent decreases in

systemic blood pressure and decreases in peripheral resistance.

 

Joe