Dr. Roach: Observant reader nails description of Cheyne-Stokes breathing
Dear Dr. Roach: My wife of 52 years is 71 and has developed what I assume is a problem with her breathing when she sleeps. During some periods of sleep, she starts taking a rhythmic set of breaths. There usually are four deep breaths followed by four shallow breaths. Each set of the four breaths decreases in intensity, and the shallow breaths are barely recognizable. She also has developed tics in her arms and legs. Needless to say, this frightens me. She has peripheral neuropathy and takes Lyrica and two different doses of Cymbalta daily. Can you provide any suggestions?
Dear C.G.: I congratulate you on your marriage, but also commend your attention to detail. You seem to be doing an excellent job of describing a type of breathing called Cheyne-Stokes, which can be found in many conditions, including several neurological conditions (I don’t have enough information to make a diagnosis, but her neurologist probably does); heart failure; and in some normal people. However, it is most concerning as a sign of sleep apnea, often in combination with one of these conditions. If I were seeing her, I would strongly consider a sleep study. Since essentially every sleep study I have ever done is positive, I have come to the conclusion that I am not ordering enough sleep studies: I must have had patients with sleep-disordered breathing that I didn’t suspect. If she does have a sleep-disordered breathing diagnosis, treatment may improve her quality of life.
Dear Dr. Roach: I’m in the process of working out a salivary stone. From what I can tell, it’s in my left submandibular gland. The ENT doctor said it is making progress, so he doesn’t want to remove it. He recommends that I keep myself hydrated. I’m just not totally sure where it’s supposed to end up coming out of, and thus where I should be encouraging it to go. It seems to have stopped making progress.
Dear D.E.: There are three main salivary glands: the parotid (in the cheek), the sublingual gland (under the tongue) and the submandibular glands (on either side below the tongue). Dehydration and some medicines predispose a person to developing these.
A traditional treatment is the lemon cure: Sucking on a lemon is a strong stimulus for saliva, which can help propel the stone out. (It comes out through the salivary duct in the floor of the mouth, near the base of the tongue.) Unfortunately, it doesn’t always work, and sometimes an ENT doctor has to either dilate the duct or grab the stone and pull it out. Stones less than 2 mm usually pass by themselves.
If the stone doesn’t pass, there are alternatives to surgery, such as extracorporeal shockwave lithotripsy, commonly used for kidney stones. This procedure uses sound waves to blast the stone into small pieces, which usually can then pass easily. Since it hasn’t gotten better, I think it’s probably time to go back to the ENT doctor.
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