Vocal Cord Dysfunction

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Hi Dr Thomas,
 
I was recently referred to you and had an appointment scheduled to rule out/in VCD.  At the time I scheduled, it occurred to me that I had been on daily inhalers and only after a couple of months did I find that my vocal cords/airway were very inflamed.  I decided to start gargling instead of just washing any residue away.  Within 4 days, the inflammation I was experiencing was gone along with voice issues that sometimes came and went (sometimes I could scarcely speak).  My experiment was running some cross country races.  The first one before the gargling was horrendous, even with albuterol beforehand and my usual daily symbicort.  It took extreme focus to keep the vocal cords from clamping shut.  The same occurred in a half marathon I ran the next weekend.  
 
After the gargling, I have not had any issues, ony one slight "almost" for a few seconds during a race.  I have been feeling great lately, so much so that I signed up for another marathon.  Looking back I realized how miserable I have felt this entire year.
 
Fast forward a couple of weeks, my physician decided we would do a methacholine challenge to rule out asthma.  It was negative.  I have been off the inhalers (but still gargle 2x per day) for about three days and I am experiencing discomfort in my airway though not to the extreme as before along with voice changes.  This does not make sense:  inhalers and gargle, feeling good.  No inhalers and gargle, not feeling so great when all of the pulmonary testing I have had was negative.
 
My questions (I have done a lot of research but am unable to locate my specific symptoms):
Can VCD be a 24/7 issue?  It is not only during exercise that I experience this.  I will often feel lightheaded and feel a bit of "congestion" throughout the entire day, even when I am not training.  The information I find describes episodes during extreme exercise and granted, this year I was training for another Ironman (lots of extremes) and I couldn't breath when it came to running off the bike in training or on race day.  I had symptoms every waking moment.  My first doctor called it reactive airway, but from my understanding, the methacholine challenge would have picked up on it?  
 
I was told for the appointment we would try to induce the vocal cords into closing.  I did not want to do that (and have a bill) if I had no way to induce the problem once I started the gargling.  I have already ended up in the emergency room, gotten second opinions and still have questions.  I am not sure if the testing the other day irritated things enough that it may take a few days to clear.  I will certainly know more this weekend after another cross country race.  
 
The next step was a voice therapist though I think I need more information.  My concern is that it may not be only one issue based upon my research of symptoms, though it might be that it isn't published that it can be a 24/7 problem.  Sleeping actually is not an issue and I feel okay when I get up.  Usually after an hour or so we begin the cycle.
 
Any thoughts would greatly be appreciated,
Christine
James P Thomas MD's picture
Submitted by James P Thomas MD on Sat, 2012-04-07 12:53

Dear Christine,

I tend to think that good examinations are typically the answer to the type of question you are asking.