The week before last, Monkey was in full-day soccer camp, and only had one VCD episode all week. He’s at overnight camp now, and so far as I know, has not had any episodes yet. (He will write home and tell me if he has any episodes, but of course it takes some time for me to receive his notes.) He seems to really have the breathing and posture down. 
So, we’re in a good place at this point. He’s dropped the IMT training for the summer since he felt awkward about doing it at camp. I hope he will do it more regularly during the fall, so that he’ll be well-prepared for PE class in the winter semester, and spring soccer in the spring (duh). My guess is that that is all it will take to get his number of episodes down to zero. If that doesn’t do it, we will probably try the spiriva for soccer season.
Archive for the ‘Inspiratory Muscle Training’ Category
Another week of soccer camp
August 1, 2007June 22 — Inspiratory Muscle Training
June 23, 2007Today we went back to the speech therapist to learn what to do with the IMT device. She had a student observing, and the student ended up being quite helpful as she had just had a class on VCD.
We decided that we could do the training without officially measuring his PI Max. We just had him find a level on the trainer at which he had to expend a little effort, but could almost do the abdominal breathing without tensing up. They had him lie on his back with a book on his belly and first practice abdominal breathing lifting the book. Then they had him breathe through the training device and still do the same thing — concentrate on lifting the book as he inhales, and also trying not to tense up. He only needs to do this for 3-5 minutes per day. When it gets easy, he should increase the threshold on the training device a little bit to make it more challenging.
It seemed like a productive visit, and Monkey seems quite interested in doing the training.
June 12, 2007 Received Threshold IMT Training Device
June 12, 2007Monkey’s Threshold trainer arrived in the mail today. Due to general June craziness, I had to wait and schedule his next speech therapist appointment to learn how to train with it for June 22, which will be the day after his next pulmonologist appointment. While at the pulmonologist, I’ll make sure they measure his PI MAX (maximum inspiratory pressure, which I assume is part of the usual spirometry workup, but may not be for all I know about it). That number is needed to determine the correct threshold setting for the trainer. I’ll update here after he gets started, of course.
Another IMT review
June 6, 2007This is an article about using inspiratory muscle training (IMT) in COPD patients. I’m mostly just blogging this here to keep track of the link. It’s another article that says that the threshold or targetted training devices seem to work (for COPD in this case), and the untargetted ones don’t seem to. Just another piece of evidence in favor of chosing the threshold model over a cheaper Pflex (if we could even get one singly, which doesn’t seem to be an option anyhow).
We’re going to go ahead and buy the Threshold trainer and have Monkey learn to use it, as long as he still feels that it would be worth his while to do the training. There’s not much evidence about its use in VCD patients yet, but it makes sense that it could help, it can’t hurt, and if nothing else it may increase his athletic endurance (which is why these are marketed directly to athletes in addition to being sold to healthcare providers through medical supply catalogs).
Inspiratory Muscle Trainers
May 30, 2007I did a little research on inspiratory muscle training today. I found several articles suggesting that the “threshold” type is the best type.
A Primer on Inspiratory Muscle Trainers
The Threshold brand of threshold type trainer is sold online in individual units (versus the 10-packs in the medical supply catalogs the speech therapist had). Here is one place
May 29, 2007 — Speech Therapist Visit
May 30, 2007Today was a more productive visit to the speech therapist. Monkey went in with a better attitude after I pointed out that going to 4-8 speech therapy visits and working on the things he learned there might be enough to make the problem go away forever.
She worked with him more on diaphragmatic breathing and progressive relaxation exercises. She even got him on a treadmill and had him work a bit on his running posture and breathing while jogging. He’s going to work on the breathing exercises at home, and also try running short sprints while thinking about his posture/tension. He needs to relax his shoulders and fists when running, which is not natural for him.
If he has an attack, he’s to try the relaxation and breathing methods.
She also suggested that he might want to try inspiratory muscle training. She said there were some preliminary studies suggeting that it can help, and it looks like it might be something worth doing. I found a reference to this here:
Inspiratory stridor – How do you deal with ‘asthma’ when the drugs don’t work? and
Inspiratory Muscle Training in Exercise-Induced Paradoxical Vocal Fold Motion
Inspiratory Muscle Training in Three Athletes with Exercise-Induced PVFM
She is looking into helping us buy one or obtain a sample via a couple of medical supply catalogs, but they are sold in sets of 10, so if we can’t get a sample, I may look to purchase one online. They sell IMT devices for athletes which look be simliar, and one of them is the actual device used by the authors of the first article linked above.
We’ll go back in a week.
We get to pay for this out of pocket even though it’s for a medical diagnosis. Our insurance doesn’t cover speech therapy except under very specific situations, which this doesn’t fit under. Oh well, in the long run we may save more than this on asthma meds he may be taking in vain.
