Maybe this is why the rehabilitation and physical medicine model would work so well for these patients. This is why vital signs, especially breathing rates, should be carefully investigated in patients with a history of significant injury, episodes of blood loss, and/or resuscitation.
Paula’s altered breathing pattern could certainly be a result of getting stuck too long in the birth canal [her Mom had Rickets as an infant and her lower body bones are crocked] and being born not breathing. Her emergency resuscitation that saved her life could have caused further injuries to peripheral nerve fibres in the throat, neck, or torso.
All in all, this was worth it, Paula turned out great and is having a wonderful life.
But why not investigate hidden injuries accounting for her altered breathing pattern? And why not rescue her breathing, if it begins to fail under circumstances of significant respiratory challenges?
Why not give her ventilatory support and rehabilitation if she develops respiratory pump failure and cannot raise her breathing rate at rest, as would be normal, during a respiratory challenge.?
Why not measure her respiratory rate at rest and her blood pressure and her heart rate and her body temperature if she has an attack of depression with dulled mentation.
Why not ask her if she can do something as simple and reliable as knowing her own address?
I am not sure I understand the pushback from doctors, including psychiatrists and neurologists and cardiologists , etc… to perform such simple tests in order to look for possible pathophysiology due to peripheral or central nerve injury?
I understand that they did not think of it before Kraepelin mentioned it; but what is their excuse today?
Illness and treatment can result in permanent injury to parts of the chest, neck, and throat. Many injuries are difficult to see but can impair the function of the motor ventilatory system. The ventilatory system requires intact peripheral nerves, skeletal respiratory muscles and neural sensors and ganglions. An altered respiratory pattern suggests a problem which, under physically challenging circumstances, could interfere with proper gas exchange. The ventilatory system moves air in and out of the lungs. The lungs can be completely healthy, but a broken ventilatory system will cause problems with the control of respiratory acids, such as excessive CO2.
Abnormal levels of CO2 in the blood will cause a bunch of problems including feeling terribly distressed [and not knowing why] and mental confusion [cognitive deficits.]- all reversible if help is supplied to make the motor functions of breathing easier.
Counting respiratory rate can help with diagnosis in complex cases. For example, many ambulatory patients with end stage heart failure [which can be missed] have a Cheyne-Stokes pattern of breathing and quiet confusion that they cannot communicate. Paula looked depressed but was most likely suffering from respiratory pump failure. Heart-related: Conditions such as heart failure, anemia, or low thyroid can result in cardiovascular changes which in turn cause tachypnea.
Next week we will see what happens when Paula undergoes a CO2 challenge at the lung function lab. Will her minute ventilation decrease? Will she fail to raise her resting respiratory rate [as would be normal to regulate gas exchange}.? Will she feel that terrible distress she describes feeling 20 years ago during her supposed depressive attack?
to be continued…..