Re: Help with a Patient PLEASE

[Guest guest]

Send her to Dr Feinberg in hermiston

Sent from my Verizon Wireless BlackBerry

Help with a Patient PLEASE

 

Listserve, especially you Neuro guys,

This is a patient that is beyond me, and the poor family is at their wits end

with constant coughing. She can no longer work because of exhaustion and

disturbance to those around her. Below is an outline of the last 11 years.

 

Patient:                 

..             No history of smoking

..             Rarely drinks alcohol

..             BMI 22.5

..             Corporate executive / moderately active

..             Thyroiditis creating hyperthyroid condition (not Graves) -

diagnosed in March 2010, controlled with methimazole 10 mg

..             Healthy, no other chronic illnesses or medications

..             Surgeries: Thymectomy four years ago (no effect on cough)

 

Diagnosis:

47-year old mother of three/four pregnancies (one first term miscarriage)

Idiopathic non-productive cough for 11 years, starting in first trimester of

fourth pregnancy.

Cough experienced every day, throughout day (some relief at night, see below)

Episodes moderate to severe in intensity, lasting 20 seconds - 10 minutes, 2-20

times an hour

No other signs/symptoms

Cough improved but not completely relieved by:

..             IM lidocaine injections along dorsal, superior ridge of right

trapezius, near insertion

..             Massage of right trapezius

..             Oral prednisone (occasionally effective for short periods)

..             Position-dependent relief at night by laying on left side/back

 

Differential Diagnoses have ruled out:

..             GERD

..             Asthma /Allergy (including post-nasal drip)

..             laryngeal/tracheal lesion

..             pulmonary obstruction or lesion

..             Brain stem lesion

..             Cardiac or autoimmune disorders

..             Viral cause

 

Specific Diagnostics and Trials (all tests yielded results WNL unless otherwise

specified)

Multiple labs and medication trials over 11-year period:

..             Mantoux test for TB exposure

..             Urinalysis with microscopy

..             Blood: CBC with differential / CMP

..             Singulair, fluticasone, Advair, fexofenadine, and loratadine

trials (alone and in various combinations) for possible allergy involvement

..             Lyrica, gabapentin for nerve involvement

..             prednisone

..             Benzonatate / tussionex for symptomatic treatment

..             Allergy skin test / percutaneous allergy titrate test

..             Evaluation by speech pathologist

..             Methacholine challenge test to r/o asthma

 

2004: OHSU-- Pulmonologist ordered

..             Bravo probe to r/o GERD

..             Bronchoscopy to r/o tracheal/esophageal abnormalities and lesions

..             6-month treatment with esomeprazole (PPI) to r/o GERD (no effect

of cough)

..             CT scan of chest and sinus

..             X-ray chest

 

2006/07: Oregon Clinic - Neurologist and Thoracic/cardiovascular surgeon ordered

..             CT scan of neck and chest w/contrast (showed enlarged thymus,

removed through endoscopic procedure, no effect of cough)

..             MRI vocal cord paralysis

..             X-ray lateral chest

..             X-ray chest

 

2009: ENT ordered

..             CT chest w/contrast

..             CT scan of face and jaw

..             CT w/contrast of chest/pelvis/abdomen

..             Fiberscopic laryngoscopy

..             Laryngoscopy w/stroboscopy

 

2010: OHSU: ENT and neurologist ordered MRI brain stem and MR angio of head to

r/o brain stem lesions and vascular involvement on nerves

 

2011: Osteopath: manipulation and massage of neck and shoulder for symptomatic

relief; pertussis vaccination and booster d/t negative titer

 

Treatment with Magnetic Resonance Stimulation:

..             Cough improved but not relieved completely during treatment

..             Cough relatively unchanged between treatments

 

 

Ted Forcum, DC, DACBSP

Back In Motion Sports Injuries Clinic, LLC

ACA Sports Council, Past President

'08 US Olympic Sports Medicine Team Member

11385 SW Scholls Ferry Road

Beaverton, Oregon 97008

503.524.9040

www.bimsportsinjuries.com <http://www.bimsportsinjuries.com/>

 

 

The information contained in this electronic message may contain protected

health information confidential under applicable law, and is intended only for

the use of the individual or entity named above.  If the recipient of this

message is not the intended recipient, you are hereby notified that any

dissemination, copy or disclosure of this communication is strictly prohibited. 

If you have received this communication in error, please notify Back In Motion

Sports Injuries Clinic, LLC at 11385 SW Scholls Ferry Road, Beaverton, OR-97008.

and purge the communication immediately without making any copy or distribution.

 

[Guest guest]

Ted:

Send this to Day on FMUSA and see if she can run it by Luigi Stecco, he is

currently working on visceral aspects of fascial work. If you have Stecco's blue

book, look up AN-ME-CL and AN-LA-CL in the centers of fusion. These are points

that can be related to the oropharynx. CF's are manipulated more gently than

CC's as they are generally more surface than the deeper centers of coordination.

I'm not sure how these points relate to deeper structures, if the palpatory

verification causes coughing, you may be on to something. Worth a try.....

Rod

Rodney G. , DC

Tillamook Natural Health Center

309 Laurel Ave.

Tillamook, OR 97141

503-842-6532

Help with a Patient PLEASE

>

> 

>

>

>

>

>

>Listserve, especially you Neuro guys,

>This is a patient that is beyond me, and the poor family is at their wits end

with constant coughing. She can no longer work because of exhaustion and

disturbance to those around her. Below is an outline of the last 11 years.

> 

>Patient:                 

>.             No history of smoking

>.             Rarely drinks alcohol

>.             BMI 22.5

>.             Corporate executive / moderately active

>.             Thyroiditis creating hyperthyroid condition (not

Graves) - diagnosed in March 2010, controlled with methimazole 10 mg

>.             Healthy, no other chronic illnesses or medications

>.             Surgeries: Thymectomy four years ago (no effect on

cough)

> 

>Diagnosis:

>47-year old mother of three/four pregnancies (one first term miscarriage)

>Idiopathic non-productive cough for 11 years, starting in first trimester of

fourth pregnancy.

>Cough experienced every day, throughout day (some relief at night, see below)

>Episodes moderate to severe in intensity, lasting 20 seconds - 10 minutes, 2-20

times an hour

>No other signs/symptoms

>Cough improved but not completely relieved by:

>.             IM lidocaine injections along dorsal, superior ridge

of right trapezius, near insertion

>.             Massage of right trapezius

>.             Oral prednisone (occasionally effective for short

periods)

>.             Position-dependent relief at night by laying on left

side/back

> 

>Differential Diagnoses have ruled out:

>.             GERD

>.             Asthma /Allergy (including post-nasal drip)

>.             laryngeal/tracheal lesion

>.             pulmonary obstruction or lesion

>.             Brain stem lesion

>.             Cardiac or autoimmune disorders

>.             Viral cause

> 

>Specific Diagnostics and Trials (all tests yielded results WNL unless otherwise

specified)

>Multiple labs and medication trials over 11-year period:

>.             Mantoux test for TB exposure

>.             Urinalysis with microscopy

>.             Blood: CBC with differential / CMP

>.             Singulair, fluticasone, Advair, fexofenadine, and

loratadine trials (alone and in various combinations) for possible allergy

involvement

>.             Lyrica, gabapentin for nerve involvement

>.             prednisone

>.             Benzonatate / tussionex for symptomatic treatment

>.             Allergy skin test / percutaneous allergy titrate test

>.             Evaluation by speech pathologist

>.             Methacholine challenge test to r/o asthma

> 

>2004: OHSU-- Pulmonologist ordered

>.             Bravo probe to r/o GERD

>.             Bronchoscopy to r/o tracheal/esophageal abnormalities

and lesions

>.             6-month treatment with esomeprazole (PPI) to r/o GERD

(no effect of cough)

>.             CT scan of chest and sinus

>.             X-ray chest

> 

>2006/07: Oregon Clinic - Neurologist and Thoracic/cardiovascular surgeon

ordered

>.             CT scan of neck and chest w/contrast (showed enlarged

thymus, removed through endoscopic procedure, no effect of cough)

>.             MRI vocal cord paralysis

>.             X-ray lateral chest

>.             X-ray chest

> 

>2009: ENT ordered

>.             CT chest w/contrast

>.             CT scan of face and jaw

>.             CT w/contrast of chest/pelvis/abdomen

>.             Fiberscopic laryngoscopy

>.             Laryngoscopy w/stroboscopy

> 

>2010: OHSU: ENT and neurologist ordered MRI brain stem and MR angio of head to

r/o brain stem lesions and vascular involvement on nerves

> 

>2011: Osteopath: manipulation and massage of neck and shoulder for symptomatic

relief; pertussis vaccination and booster d/t negative titer

> 

>Treatment with Magnetic Resonance Stimulation:

>.             Cough improved but not relieved completely during

treatment

>.             Cough relatively unchanged between treatments

> 

> 

>Ted Forcum, DC, DACBSP

>Back In Motion Sports Injuries Clinic, LLC

>

>ACA Sports Council, Past President

>'08 US Olympic Sports Medicine Team Member

>11385 SW Scholls Ferry Road

>Beaverton, Oregon 97008

>503.524.9040

>www.bimsportsinjuries.com <http://www.bimsportsinjuries.com/>

> 

> 

>The information contained in this electronic message may contain protected

health information confidential under applicable law, and is intended only for

the use of the individual or entity named above.  If the recipient of this

message is not the intended recipient, you are hereby notified that any

dissemination, copy or disclosure of this communication is strictly

prohibited.  If you have received this communication in error, please notify

Back In Motion Sports Injuries Clinic, LLC at 11385 SW Scholls Ferry Road,

Beaverton, OR-97008. and purge the communication immediately without making any

copy or distribution.

> 

>

>

>

>------------------------------------

>

>All posts must adhere to OregonDCs rules located on homepage at:

/

>Tell a colleague about OregonDCs! (must be licensed Oregon DC)

Links

>

>

>

[Guest guest]

Hi Ted,

I had a case very similar to this a number of years ago' it was a male about 70yrs. old who had been coughing every few minutes for over 3 yrs. he had been through a battery of tests with no positives and tried various Rx's with no results. Finally out of desperation they consulted a D.C. ignoring the dire warnings of their M.D. The D.C. in taking the case history found that there had been a severe respiratory infection several years before and that the persistent cough had started shortly after.

My exam revealed multiple TP's in the intercostal m's and the muscular attachments of the diaphragm to the costal cartilage. It took a while to ferret out all the active points but after the first session he had his first relief from the cough in years, after four more visits he reported that there had been no return of sx. It has been years since I last saw him.

Good luck with this case if I can be of any help with this patient feel free to call on me.

Herb Freeman D.C.

(503)364-1414

Help with a Patient PLEASE

Listserve, especially you Neuro guys,

This is a patient that is beyond me, and the poor family is at their wits end with constant coughing. She can no longer work because of exhaustion and disturbance to those around her. Below is an outline of the last 11 years.

Patient:

.. No history of smoking

.. Rarely drinks alcohol

.. BMI 22.5

.. Corporate executive / moderately active

.. Thyroiditis creating hyperthyroid condition (not Graves) - diagnosed in March 2010, controlled with methimazole 10 mg

.. Healthy, no other chronic illnesses or medications

.. Surgeries: Thymectomy four years ago (no effect on cough)

Diagnosis:

47-year old mother of three/four pregnancies (one first term miscarriage)

Idiopathic non-productive cough for 11 years, starting in first trimester of fourth pregnancy.

Cough experienced every day, throughout day (some relief at night, see below)

Episodes moderate to severe in intensity, lasting 20 seconds - 10 minutes, 2-20 times an hour

No other signs/symptoms

Cough improved but not completely relieved by:

.. IM lidocaine injections along dorsal, superior ridge of right trapezius, near insertion

.. Massage of right trapezius

.. Oral prednisone (occasionally effective for short periods)

.. Position-dependent relief at night by laying on left side/back

Differential Diagnoses have ruled out:

.. GERD

.. Asthma /Allergy (including post-nasal drip)

.. laryngeal/tracheal lesion

.. pulmonary obstruction or lesion

.. Brain stem lesion

.. Cardiac or autoimmune disorders

.. Viral cause

Specific Diagnostics and Trials (all tests yielded results WNL unless otherwise specified)

Multiple labs and medication trials over 11-year period:

.. Mantoux test for TB exposure

.. Urinalysis with microscopy

.. Blood: CBC with differential / CMP

.. Singulair, fluticasone, Advair, fexofenadine, and loratadine trials (alone and in various combinations) for possible allergy involvement

.. Lyrica, gabapentin for nerve involvement

.. prednisone

.. Benzonatate / tussionex for symptomatic treatment

.. Allergy skin test / percutaneous allergy titrate test

.. Evaluation by speech pathologist

.. Methacholine challenge test to r/o asthma

2004: OHSU-- Pulmonologist ordered

.. Bravo probe to r/o GERD

.. Bronchoscopy to r/o tracheal/esophageal abnormalities and lesions

.. 6-month treatment with esomeprazole (PPI) to r/o GERD (no effect of cough)

.. CT scan of chest and sinus

.. X-ray chest

2006/07: Oregon Clinic - Neurologist and Thoracic/cardiovascular surgeon ordered

.. CT scan of neck and chest w/contrast (showed enlarged thymus, removed through endoscopic procedure, no effect of cough)

.. MRI vocal cord paralysis

.. X-ray lateral chest

.. X-ray chest

2009: ENT ordered

.. CT chest w/contrast

.. CT scan of face and jaw

.. CT w/contrast of chest/pelvis/abdomen

.. Fiberscopic laryngoscopy

.. Laryngoscopy w/stroboscopy

2010: OHSU: ENT and neurologist ordered MRI brain stem and MR angio of head to r/o brain stem lesions and vascular involvement on nerves

2011: Osteopath: manipulation and massage of neck and shoulder for symptomatic relief; pertussis vaccination and booster d/t negative titer

Treatment with Magnetic Resonance Stimulation:

.. Cough improved but not relieved completely during treatment

.. Cough relatively unchanged between treatments

Ted Forcum, DC, DACBSP

Back In Motion Sports Injuries Clinic, LLC

ACA Sports Council, Past President

'08 US Olympic Sports Medicine Team Member

11385 SW Scholls Ferry Road

Beaverton, Oregon 97008

503.524.9040

www.bimsportsinjuries.com

The information contained in this electronic message may contain protected health information confidential under applicable law, and is intended only for the use of the individual or entity named above. If the recipient of this message is not the intended recipient, you are hereby notified that any dissemination, copy or disclosure of this communication is strictly prohibited. If you have received this communication in error, please notify Back In Motion Sports Injuries Clinic, LLC at 11385 SW Scholls Ferry Road, Beaverton, OR-97008. and purge the communication immediately without making any copy or distribution.