Case presentation: Female patient with laryngospasms

[brathey]

Case presentation

A 56 year old female was presented at our (teaching) practice (speech and language therapy). She works for the government at a Ministry. She reported several laryngospasm attacks during day and night over a period of many months. After the first ones she was examined thoroughly by several specialists, also an MRI was made. The MRI pictures showed a mass in the larynx which can be related to a former finding, a paralyzed vocal cord after strumectomy some years ago – that should not be the cause of the laryngospasms.
After exclusion of any organic/ structural cause for her attacks she got a prescription for speech and language therapy, with the focus on breathing therapy.

Family: She has an adult daughter who lives on her own. Her husband was diagnosed with colon cancer in January 23 and has been getting treatment until now. She is a likable woman who speaks out directly letting you know when she finds something unfitting or not good for herself. She also has a dry humor, hardly smiling when she makes a funny remark, is good to deal with, also very cooperative with all exercise offers during therapy and deliberate. It was and is very important for her to come to the sessions.

During the first 10 sessions we concentrated on breathwork and ways to relax, in order to try to tackle the spasms. The topic how she could deal with the attacks during the attacks was addressed, too.

When I met her first and heard her story I immediately thought of mind body disorder. And in one of the first sessions I inquired more detailed and let her describe exactly how she experienced these episodes. She said that – naturally – she is terrified when she experiences them and finds it extremely threatening that she cannot breathe in in those moments. I wanted to know how long the episode usually takes and what she did to deal with it.
I tried to lead her thoughts towards the (relative) shortness of the incident and that it always ended on its own. (Although there are patients with exercise induced laryngeal obstruction who have to be taken to the hospital which was not the case so far in this patient. I didn’t mention that, of course.). Moreover, we worked on and talked about some of the ´usualˋ ways to deal with these moments.

And here’s what has bothered me all the time.
I find it very challenging to tell her „you are safe, everything will be fine“ – referring to brain education in dealing with MBD as she deals so much with deep fear in these moments.

Anyway, after a guided body scan, deep breathing exercise and manual therapy for improving abdominal breathing in one of the recent sessions which she enjoyed and found helpful we reflected her observations afterwards and she expressed something interesting: She said: “I am often dreaming that I suffocate. This is my worst fear as my mother had Amyotrophic Lateral sclerosis and when the muscles couldn’t support the breathing process any more she died choking. I am very afraid this might happen to me.“
When she said that it struck me and I thought in a way it is very consequent to live through laryngeal spasms then…I only said something like that I have an idea that there might be a connection.
By the way, the laryngospasms had not occurred since the beginning of the SL therapy for months – only very recently some short weaker attacks were reported during a persistent cold.

I did not explicitly conduct MBD therapeutic interventions as we concentrated on classical SLT methods – especially since many of the sessions were done by a student that I supervised. But first I was thinking to offer these interventions to her. Then, this did not seem necessary to me as she hadn’t had the spasms for quite a while.

The conflict that I have been thinking about, though, would be to tell her something like „feel safe, nothing can happen” in therapy while she experiences fear of death during the attacks. I think that is a very big challenge especially as she says – naturally- that she is not able to try to relax during the attacks. And I would like to hear your thoughts and suggestions for dealing with it and supporting her in an effective way should we decide together to work on it, treating it as a MBD.

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