Respiratory symptoms

Emergency medical personnel should know that a patient is on the MP. The article Notice for health care providers provides information that emergency medical personnel need to know.

Patients who feel throat tightening, a lump in the throat, or difficulty swallowing due to inflammation should take immediated measures to reduce immunopathology. If exacerbated respiratory symptoms threaten to close the airway, seek medical attention immediately.

Swallowing is a process that requires correct functioning of the salivary glands, tongue, pharynx, larynx, esophogus and associated muscles and nerves. It is not unusual for people with sarcoidosis or other obstructive respiratory diseases to experience dysphagia (difficulty swallowing) as a symptom and as immunopathology.

While dysphagia may begin abruptly, patients can be on the alert for alterations in the functioning of their throat and voice box that would signal they might also have a problem if you ate at that time. The vocal cords must be able to close properly to avoid choking.

Avoid experiencing this intolerable immunopathologyAn unbearable or unsafe severity of bacterial die-off reaction. by maintaining the olmesartan blockade, thereby ensuring that olmesartan dosing doesn't lapse before one eats. It will probably be of limited benefit taking oral olmesartan at the time of dysphagia. However, chewing the tablet and placing it under the tongue may provide faster symptom relief.

A variety of strategies that do not involve medication are available for patients who have uncomfortable respiratory symptoms including breathing exercises, getting more fluids, rest, and others. Also, patients have reported relief taking guaifenesin, using bronchodilator inhalers (steroid inhalers are contraindicated), and nebulizers. Supplemental oxygen may be useful or necessary in some cases even though it may be needed only for a few hours a day for a few months.

While it is certainly possible to contract an acute respiratory infection while on the Marshall Protocol, many symptoms of immunopathology mimic those of an acute respiratory infection. Early recognition and effective management of immunopathology are very important when a patient has respiratory symptoms. Any symptom that correlates with MP therapy may be due to immunopathology.

Emergency medical personnel should know that a patient is on the MP. The article Notice for health care providers provides information that emergency medical personnel need to know.

Early recognition and effective management of immunopathology are very important when a patient has respiratory symptoms. Any symptom that correlates with MP therapy may be due to immunopathology. Whenever the cause of symptoms is in doubt, an extra olmesartan may help dampen them. Increase olmesartan to every four hours (for 24 hours if no immediate result) to see if it relieves symptoms.

Cold-like symptoms, including coughing, are a common immune system reaction. Getting well with the Marshall Protocol always involves immune system reactions. These reactions can be symptoms you currently have, symptoms you've had before or brand new symptoms.

The MP will make no difference to the course of a cold. If anything, it will allow the immune system a better chance to fight the virus. On the other hand, flu-like symptoms are a very common manifestation of immunopathology. They come and go more quickly than a viral cold does.

Trevor Marshall, PhD

Note that immunopathology may be mistaken for an upper respiratory infection.

The following are non-medication strategies that may help palliate respiratory symptoms:

• Drink more fluids – Water helps loosen mucus and soothe an irritated throat.
• Elevate the head – Use extra pillows to elevate the head four to six inches at night. This can help keep mucus from interfering with breathing at night and ease a dry cough.
• Avoid irritants – avoid exposure to inhaled irritants, such as smoke, dust, or other pollutants, or wear a face mask that is appropriate for the exposure. Patients may also try avoiding aerosols, fragrances or chemicals that may aggravate breathing.
• Use nasal spray – Saline nasal spray or a water-soluble clear gel (Ayr is one over the counter brand) used regularly will keep blocked nasal passages moist and allow easier removal of debris. Patients may also use petroleum jelly to keep nostrils moist. See also Nasal irrigation and neti pots.
• Try breathing exercises – can improve breathing ability and reduce shortness of breath. A respiratory therapist can provide guidance for breathing exercises and many clinics have respiratory programs to teach patients how to cope with reduced respiratory function.
• Get adequate rest – Remember that pacing and rest are very important. By being pushed to the limit of tolerable immunopathologyA state in which a patient has maintained an acceptable intensity of bacterial die-off reaction. The primary goal of the Marshall Protocol., the body is working to capacity.

Coughing can be very tiring, not just to you, but to others around you. The physical exertion as well as the sound tends to be a mental drain as well. Most of the coughing associated with sarcoidosis doesn't bring up phlegm, which may worry some folks as well (because it is non-productive). I found that immunopathology resulted in coughing and breathing difficulties on the MP, it was imperative that I stop and rest. Even if I didn't fall asleep, frequent resting helped improve coughing and fatigue. So, rest… rest… rest.

Belinda, MarshallProtocol.com

Several patients on the Marshall Protocol site have been advocating (and using with good results) neti pots for sinus and other nasal issues. But, there have been reports of deaths resulting from using tap water in neti pots. Instead, patients considering nasal irrigation should use distilled or other purified (boiled) water.

An MP patient should contact his or her physician or pharmacist for advice about palliative medications or other treatments that can be used to provide temporary relief of symptoms such as shortness of breath, nasal congestion, gastric upset or pain. Patients whose progress on the MP is hampered in any way should reexamine their medications.

Persistent coughing can strain the muscles or ligaments of the chest wall. When these muscles are strained, even normal breathing can cause mild chest pain. Constant coughing can be exhausting or occur when a person is trying to sleep.

Pay attention to the nature of the cough. As the immune system starts to properly work again, the coughing changes perceptibly. Whereas the coughing of sarcoidosis is shallow and non-productive, once the immune system kicks back in the coughing is always productive, and usually involves more chest muscles, particularly the lower ones.

Trevor Marshall, PhD

Guaifenesin is an expectorant drug usually taken orally to assist the bringing up (“expectoration”) of phlegm from the airways in acute respiratory tract infections. The use of guaifenesin is acceptable in limited amounts, especially when managing intolerable immunopathology, although patients should know that the drug does have mild immunosuppressive activity. Single ingredient guiafenesin (tablets or liquid) are preferable to any combination products which may contain ingredients such as decongestants, antihistamines or cough suppressants which patients may not need.

Cough suppressants, also known as antitussives, suppress the body's urge to cough. Cough suppressants should be used carefully if one's cough is wet-sounding and produces mucus (phlegm) as it is important to cough up this mucus to prevent an acute respiratory infection. However, if one's cough is usually productive but one needs to suppress it to get some relief, use only enough cough suppressant to keep chest wall pain and/or fatigue tolerable.

• dextromethorphan (Robitussin, Vicks, etc.) – Dextromethorphan, the active ingredient in cough medicines, such as Robitussin, NyQuil, Dimetapp, Vicks, Coricidin, Delsym, and others may be modestly effective in decreasing cough in adults.¹⁾
• theobromine – Theobromine, also known as xantheose, is a bitter alkaloid of the cacao plant, found in chocolate, as well as in a number of other foods, including the leaves of the tea plant. A 2004 study published by Imperial College London concluded that theobromine has an antitussive cough-reducing effect superior to codeine by suppressing vagus nerve activity.²⁾ In the study, theobromine significantly increased the capsaicin concentration required to induce coughs when compared with a placebo.³⁾ It is possible to get an effective dose from 50g of dark chocolate, which contain 2-10 times more cocao than milk chocolate.
• codeine – Codeine is an opioid (narcotic) that acts on the vagus nerve to suppress coughing. It is available only by prescription in many states. However, other states permit pharmacists to sell cough remedies containing codeine without a prescription if the customer signs for it. Because codeine is an opioid, some people fear it may be addicting. In reality, addiction is uncommon. Codeine can be helpful at bedtime because of its slight sedative effect. While codeine was once viewed as the gold standard in cough suppressants, the evidence to support this is weak, with a recent placebo-controlled trial finding that codeine was no better than placebo.⁴⁾

Steroid inhalers suppress the innate immune response, reduce immunopathology, and delay progress. A bronchiodilator inhaler is superior choice. MP patients taking steroid inhalers should work with their physicians to switch drugs. However, if adjustment of MP meds fails to control respiratory symptoms, a steroid inhaler/puffer (or nasal spray) might be effective in an emergency situation.

Bronchodilator inhalers enlarge the bronchi and bronchioles, decreasing airway resistance and thereby facilitating airflow. Bronchodilators are most useful in obstructive lung diseases such asthma, chronic obstructive pulmonary disease, and sarcoidosis. A bronchodilator is delivered either by Medicated Dose Inhalers (MDI) or Dry Powder Inhalers (DPI) may be useful to reduce shortness of breath (dyspnea). Note that some combination products including Seretide, Advair, and Symbicort contain both bronchiodilating and steroidal medications and are therefore contraindicated. Also note that generic inhalers are less expensive than their brand name equivalents.

It is fine to use Ventolin without Flovent. Hundreds of thousands of folks use it alone. Some people find benefit from Atrovent with the Ventolin, and your doc will know about this. If the Ventolin works by itself there is no need for any other lung med. Flovent is to be avoided routinely because it is a steroid, but it could still be used in an absolute emergency situation. It is much better to control the immune system response with Benicar and antibiotic adjustments, as Flovent shuts down your immune system.

P. Bear, RN, MarshallProtocol.com

• antihistamines (Benadryl) – For a runny nose, use an antihistamine. Diphenhydramine (Benadryl) works well, is short-acting and causes drowsiness. Claritin (Loratadine) can be used in the daytime. There are also long-acting antihistamines available by prescription only, such as Zyrtec and Allegra. Note: These should be used only while symptoms are intolerable as they are immunodulatory.
• anti-anxiety agents – A medication for anxiety may calm respiratory symptoms.
• throat lozenges (cough drops) – Cough drops are a good way to occasionally soothe an irritated throat. Expensive medicine-flavored cough drops are not any better than inexpensive candy-flavored ones or hard candy. Most cough drops have no effect on the cough-producing mechanism. If nasal congestion prevents air passage, over the counter decongestants can also be used, but should be used judiciously.
• zinc lozenges – Zinc lozenges are touted to prevent viruses from multiplying in the throat, but there is no scientific proof of this.⁵⁾
• vitamin C (ascorbic acid) - Ascorbates promote the transcription of inflammation and, therefore, high levels of vitamin C, such as the kind one might get from a supplement, may prove to affect the immune system in a way that is counterproductive. Because Vitamin C affects the immune system in yet-unknown ways, supplementation is contraindicated.

An incentive spirometer is a medical device used to help patients improve the functioning of their lungs. If your activity level is low and you are unable to tolerate mild exercise, use of this device to expand pulmonary tissues may excercise the lungs to promote a more even bacterial kill during the process of recovery. The patient breathes in from the device as slowly and as deeply as possible. An indicator provides a gauge of how well the patient's lung or lungs are functioning, by indicating sustained inhalation vacuum. The patient is generally asked to do many repetitions a day while measuring his or her progress by way of the gauge.

Incentive spirometers are widely available for purchase.

A nebulizer is a compressed air machine used to administer liquid respiratory medication in the forms of a mist. Some patients with respiratory problem find it easier and more pleasant to breathe their respiratory medications with a nebulizer than with an inhaler. Unlike inhalers, nebulizers may deliver a dose more accurately and the cost is paid for by Medicare. Some pulmonologists will administer mucomyst by high-flow nebulizer to attempt to thin secretions, the same principle behind guaifenesin pills or syrup and may be helpful.

There were several ways my immune system reactions affected my symptoms and breathing:

Your cough is a symptom that flares when you are experiencing immunopathology, and it becomes less intense as you have slowed your immune system reaction. You will be gaining experience by managing your immunopathology around this signal symptom. Tolerable immunopathology is sustainable, and is the level to aim for at all times.

1. My throat could tighten so I couldn't inhale correctly. I had to pay attention to the warning signs that would precede “throat tightening.” The most obvious signal was that my voice would get tighter and higher-pitched before my throat would tighten.
2. My chest muscles could get sluggish and be hard to move. Chest muscles prompt breathing by expanding to provoke lung inflation. I found I was more likely to have sluggish chest muscles in the afternoon or evening, when fatigue was more of a problem. Sometimes my chest muscles felt swollen - the swelling was actually visible - and I would get muscle twitches. I learned to rest more and take a nap when I encountered this sort of problem. In early treatment, I had supplemental oxygen, which I used during these times.
3. I had enlarged lymph nodes in my chest that pressed on my airways. On some immunopathology days, the pressure from inside my chest was worse and made it harder to breathe. It was sort of like that feeling of not having enough “room to breathe” that occurs when you are very pregnant (if you've ever had that experience), although the pressure came from inside my chest instead of from below (as in pregnancy).
4. I was able to wean off supplemental oxygen and use it only when the immune system reaction was severe, until I weaned off oxygen completely. I can still get short of breath now, even though I walk 3-4 miles per day. If I walk with a friend and talk a lot or walk and talk while climbing stairs, I can get SOB. Or if I walk outdoors on a bad ozone day, I feel like I can't get enough air. So, I walk indoors when ozone warnings are in effect.

My experience is with sarcoidosis, which can cause decreased lung volume. But originally, I was “diagnosed” with “asthma” due to complaints of shortness of breath (SOB) and coughing (in spite of the fact that I had a lot of other symptoms that would indicate sarc instead). Sometimes, but not often, I had wheezing or crackling sounds from my lungs. When I breathed, sometimes my lungs felt “squishy,” the way your feet feel when walking in wet tennis shoes. Inhalers didn't help me, but unfortunately physicians can assume people don't use inhalers properly. It was only when I had complete pulmonary function tests, with testing before and after bronchodilators were used, that doctors were finally convinced bronchodilators didn't help.

Did you assume you have a decrease in lung volume, or did you get results from pulmonary function tests (PFTs) indicating a decrease in lung volume? It may be that immunopathology might temporarily cause some changes, but they might not show up on any tests. If I had it to do over again, I would insist on having PFTs done before accepting a diagnosis of asthma.

To sum up my experience, before I started the MP, I coughed pretty much all the time. (It drove everyone around me crazy!) That intense coughing left my chest muscles exhausted, and I relied on supplemental oxygen by early afternoon many days. Originally, my PFTs indicated both restrictive (reduced volume) and obstructive lung disease (due to lymph nodes impinging on airways). Now I no longer have obstructive lung disease (the lymph nodes decreased in size) and have only a mildly-restrictive pattern on PFTs. My doctor withdrew supplemental oxygen after I was on the MP for about a year and a half.

If bronchodilators didn't change your PFTs, you should probably bring it to your doctor's attention if he persists in wanting to treat you for asthma. It's something you will want to discuss with him. The fact that bronchodilators didn't relieve your problem would seem to indicate your experience may not be asthma.

I still suspect immunopathology is making this old symptom flare. Can you think of any other factors that might be contributing? For instance, I had more trouble breathing when it was very humid, and cool humid air was *the worst*. Also, any upper respiratory problems (like a stuffy nose or sinus blockage) may make breathing more difficult.

Do you monitor the air quality in your area, to see if there are any air quality warnings? If you live in an area with air problems such as smog or high ozone, you should monitor that to see if your symptoms correlate with bad air quality days. The AQI is not something you can tell by looking outdoors. The Environmental Protection Agency calculates the air quality index. Where I live, our air quality has been rated orange lately, which means “unhealthy for sensitive groups.” Any time I feel like I have to exert more energy to breathe, it's because our AQI is either orange or red.

Getting tired makes it more likely to experience the shallow breathing, too. It's good to rest more when experiencing an immune system reaction. After all, the road to recovery is a long road. So, go easy on yourself.

My coughing was usually unproductive. My chest would feel tight, heavy and even painful and the cough came from so deep down it felt as if I might cough up my toes. But more often than not, nothing came up. That's why they say the sarcoidosis cough is unproductive; no phlegm comes up. Unless the mucous is draining from the sinuses, it's probably not in a place you can cough it up.

It may help you to understand that sarcoidosis often inflames the tiny air sacs in the lungs, the alveoli.

Using supplemental oxygen reassured me that my heart and lungs were less likely to be oxygen deprived.

Belinda, MarshallProtocol.com