Grunting

A decade ago I attended at Doernbecher Children’s Hospital. I would regularly admit kids in respiratory distress from asthma.   Now contrary to most people’s understanding the problem with asthma is not lack of oxygen it is carbon dioxide accumulation.  (They are can have oxygen desaturation but the fundamental problem is too much CO2.)  The signs of a bad asthma attack can be fast breathing, the expiratory phase of a breath being longer than the inspiratory phase, intercostal and suprasternal retraction, and grunting.  Grunting occurs as the kid exhales  she makes a grunting sound.  It’s the body’s way to expand the lungs to enable more CO2 to be expired.

As usual a tangent – cardiac tamponod is a life threatening condition in which fluid accumulates around the heart and compresses the heart eventually leading to death if the fluid isn’t removed quickly.  It can be a difficult diagnosis to make and time is working against you.  A subtle finding are distant heart sounds but that can easily be missed.   A simple bedside procedure called pulsus parodoxus is diagnostic.  And training Medical Students is very critical.  But  this condition is rare and when it occurs the last thing you are thinking about is Med Students.  You are thinking about sticking a large long needle and syringe into the pericardial sac!  (Or in my case finding a doc who knows how to do that.)

Turns out that kids with a bad asthma attack also have an abnormal pulsus parodoxus.  So I would always take the opportunity to drag a few Med Students to the kid learn how to do the procedure.

Right about now you are probably wondering what this flight of ideas has to do with ALS and me.  Well the last few months I consistently make strange sounds on most of my exhales.  It can sound like a moan, a hum, a groan, or other odd sounds.  It is remarkably hard for me to suppress the sounds. 

Then I had one of those “ah-ha” moments!  I thought the sounds I make are similar to the asthmatic kids when they are “grunting”.   I reflected on the fact that ALS and asthma can lead respiratory failure via excess CO2 accumulation.   What they have in common is the respiratory muscles’ inability to meet the demands of the body to get rid of the excessive CO2 – although the mechanisms of the respiratory failure are very different.

In kids with an asthma attack grunting is a late sign before they go into complete respiratory failure.  So when it happens it gets the doctor’s attention!   In my case it is obviously not an impending respiratory failure.  Rather I think it represents my slow respiratory decline.  Well I did just get on the Kaiser Hospice service which makes sense given my respiratory status.

Rasjad