DEAR DR. DONOHUE: I am a 16-year-old runner with a problem. I was misdiagnosed as having asthma and was put on four different medications for six months. Finally I was correctly diagnosed as having vocal cord dysfunction. I was wondering if you know about it and can give me some information. I hope to prevent others from going through the same thing I did. – F.W.

ANSWER: You’re actually luckier than most with vocal cord dysfunction, something that isn’t a rarity and something that often takes years and years to be diagnosed correctly. Asthma is the diagnosis most often made for it. One clue that asthma might not be the right diagnosis is failure of the adult or child to get better with asthma medicines. The problem, as the name says, has to do with the vocal cords. When a person inhales, the vocal cords separate to allow air to pass into the main breathing tube and eventually into the lungs. In people with vocal cord dysfunction, the vocal cords cut off airway access by coming together during inspiration and acting like a cork.

Signs and symptoms suggest asthma. The child or adult wheezes, is short of breath, coughs and fights for air. An attack can occur at any time. Often it occurs during exercise, and people think that the person is having a severe asthma attack. There have been instances where a metallic breathing tube has been put down the throat of a person with vocal cord dysfunction.

One tip-off for a person who has this problem is telling the doctor that he or she feels trouble in the neck and not in the chest, as most asthma patients do. How was the diagnosis finally made for you? Did a doctor, with a scope, see your vocal cords coming together during inspiration? That’s certain evidence for the condition.

Vocal training – learning how to relax the cords – is the treatment. Your story could speed up the diagnosis for others with the problem. Thanks so much.

DEAR DR. DONOHUE: I seem to be developing a curvature at my neck similar to a dowager’s hump. Last year, at age 55, I had a bone-density test, which was normal. For years I have done floor sit-ups with my hands clasped behind my neck and would touch my elbow to the opposite knee. I’ve always had a trim waistline and a flat stomach. Am I damaging my neck vertebrae with this exercise? I have stopped doing it and already notice my waist getting thicker. – Anon.

ANSWER:
A dowager’s hump is a sign of osteoporosis. It’s a pronounced bulge in the upper back, right below the neck, and many elderly women develop it. (A dowager is an aristocratic older woman, usually a widow. What older woman isn’t aristocratic?) It comes about because osteoporotic vertebrae (backbones) become squashed.

They’re too weak to support body weight, which compresses them. You’re pretty young for osteoporosis, and your tests show you don’t have it. I believe you have a postural problem, and I don’t believe your exercise did it. Can you voluntarily straighten your upper back so the bulge leaves? If you can, then it is a postural thing.

If that’s the case, you have to make a conscious effort to assume the posture that flattens the hump.

However, you can still do sit-ups without putting your hands behind your neck and give your abdominal muscles the same workout. Keep your arms at your sides or cross them over your chest. And you don’t have to touch your elbows to your knees.

The most important part of a sit-up, the part that gives the abdominals the most stress, is the part up to and including the motion that clears the shoulder blades off the floor.

DEAR DR. DONOHUE: My son is 19 and a power lifter. He is developing stretch marks on his arms, legs and back. Why? – J.R.

ANSWER:
His muscles must be getting bigger. Most bodybuilders develop stretch marks. Their enlarging muscles stretch the skin beyond its elastic point, and scar tissue forms. In time, the color fades, and they are hardly noticeable.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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