/In no particular order:

In no particular order:

I’m not obsessed

I’m really not obsessed and I promise to let it go after this post. No more tirades about mouth breathers and how their deficiencies go far beyond breathing difficulties making them amoral, unhygienic, cave dwelling, unrepentant and irredeemable blasphemies in the sight of the Almighty.  Starting tomorrow, or right after this, I will take the high road, turn the other cheek, or some other generic self satisfying way of saying “I’ll stop pointing out everyone else’s faults and worry about fixing my own”. Promise.

Feeling like a dead duck

Do you still remember
December’s foggy freeze
When the ice that clings on to your beard
It was screaming agony

Hey and you snatch your rattling last breaths
With deep-sea diver sounds
And the flowers bloom like
Madness in the spring

I have done a little research on the internet to ease my suffering regarding the breathing habits of one of the other residents of my house. The torment inflicted upon the other residents ought to be punishable by forced surgery to repair god-only-knows what is wrong with him. It is cruel and inhumane that I am forced to listen to these abominable sounds. My only recourse is to blast music at high volume through headphones and use earplugs while I sleep. If I was any less balanced I might take a lesson from poor Vincent…

If you find yourself having tremendous difficulty breathing normally, eating and breathing at the same time, yawning, coughing, gurgling and claim not to be sick, be sure to do an accurate self diagnosis, here is a helpful link, http://www.rightdiagnosis.com/sym/irregular_breathing.htm

In no particular order:

  • Wheezing – Wheezing describes breathing sounds that are more musical in nature than normal breathing sounds – bronchial and vesicular breathing. It is either high pitched or low pitched.Indicates that the airway is narrowed, either by a solid mass, mucus plug, bronchospasm or bronchial wall swelling. The narrowing may be more prominent upon expiration (breathing out) than inspiration.
  • Stridor A stridor is a monotone whistling noise that is high pitched and often mistaken for a wheeze. It can vary from being musical in tone to rough and raspy and in most cases, it is more pronounced upon inspiration (breathing in). A stridor indicates a partial obstruction usually in the upper respiratory airways (pharynx, larynx) and upper part of the trachea. Due to vocal resonance, it may also be heard in the chest, however, it is loudest over the throat and is often audible without a stethoscope.
  • CrackleCrackles are loud, popping or snapping sounds that are almost explosive in nature and most prominent upon inspiration (breathing in). It is non-musical and discontinuous often interrupted by normal breathing or even other abnormal breath sounds.
    • Bronchiolitis – heard early in inspiration.

      Baptêmes pieds-lourds organisés par le Club de Plongée de Plan-les-Ouates
    • Bronchiectasis -rough inspiratory and expiratory crackles
    • Pulmonary edema – crackles of a bubbling nature more prominent in mid-inspiration
    • Pulmonary fibrosis – heard late in inspiration (towards the end of inhalation)
    • Tuberculosis (TB) – bubbling sound
    • Asthma – bubbling sound with wheeze
    • Bronchitis – bubbling sound with occasional wheeze
    • Pneumonia – bubbling or crackling noise
    • COPD – coarse, sometimes bubbling noise
    • Lung abscess – grating noise, often with wheeze or stridor depending on the location
  • Rales – Rales are abnormal lung sounds characterized by discontinuous clicking or rattling sounds. They can sound like salt dropped onto a hot pan or like cellophane being crumpled.
  • Rhonchi (gurgles)Rhonchi are rattling, continuous and low-pitched breath sounds that are often hear to be like snoring. Rhonchi are also called low-pitched wheezes. They are often caused by secretions in larger airways or obstructions. Rhonchi can be heard in patients with pneumonia, chronic bronchitis, cystic fibrosis or COPD (chronic obstructive pulmonary disease). Coughing will often clear rhonchi.
  • Pleural friction rub – A pleural rub is a squeaking or creaking sound like a stiff object creaking under stress. It is a result of the two pleura, lining the lung cavity, rubbing against each other when inflamed. A pleural rub is often accompanied by pain and and is absent if there is fluid around the lungs between the two pleura (pleural effusion). Another associated term is a pleuropericardial rub which indicates that the pleura are also rubbing against the pericardial lining (heart lining).
    • Pleuritis (pleurisy)
    • Pleural fibrosis
    • Mesothelioma
    • Lung abscess
    • Pneumonia
    • Pulmonary infarction
  • Pneumothorax click – Air between the two pleura adjacent to the heart causes a clicking sound that is often heard upon contraction of the heart (systole).
  • Stertor – This is the crackling or bubbling sound heard over the upper airways as a result of mucus accumulation in these areas.
  • Vesicular breathing -However, the movement of air from the upper respiratory tract may resonate in the lung tissue itself and cause a quiet, wispy sound that is more pronounced on inspiration and almost silent on expiration.
  • Kussmaul Breathing: Deep, rapid respiration with no end-expiratory pause. Causes profound hypocapnia. Seen in profound metabolic acidosis, i.e. diabetic ketoacidosis
  • Cluster Breathing: Groups of irregular breathing with periods of apnea that occurs at irregular intervals. General a reflection of lesions in the low pons or upper medulla. Differs from cheyne-Stokes pattern because there is no increasing and decreasing depth of respirations
  • Central Neurogenic Hyperventilation: Exhibits very deep and rapid respirations. Usually seen with lesions of the midbrain and upper pons. Respirations are generally regular and the PACO2 decrease due to the hyperventilation
  • Biot’s Breathing: Also called Ataxic breathing. Characterized by unpredictable irregularity. May be seen with respiratory depression and brain damage at the level of the medulla
  • Apneustic Breathing: End-inspiration pause before expiration. Reflection of Pontine damage.
  • Cheyne Stokes Breathing: Tidal volume waxes and wanes cyclically with recurrent periods of apnea.Causes include CNS dysfunction, cardiac failure with low cardiac output, sleep, hypoxia, profound hypocapnia



An Expert Opinion

In Their seminal publication “Cheyne-Stokes Respiration in Congestive Heart Failure”, Drs. Lieber and Mohsenin detail one of these particular conditions and my current favorite to be the cause of horrific breathing, coughing, et al exhibited by patient X (in order to protect his identity).[Lieber C, Mohsenin V. Cheyne-Stokes respiration in congestive heart failure. The Yale Journal of Biology and Medicine. 1992;65(1):39-50.]

“Cheyne-Stokes respiration is an abnormal breathing pattern which commonly occurs in patients with decompensated congestive heart failure and neurologic diseases, in whom periods of tachypnea and hyperpnea alternate with periods of apnea. In the majority of these patients, the ventilatory patterns may not be recognized, and the clinical features are generally dominated by the underlying disease process. Cheyne-Stokes respiration may, however, have profound effects on the cardiopulmonary system, causing oxygen desaturation, cardiac arrhythmias, and changes in mental status. Treatment of Cheyne-Stokes respiration in congestive heart failure with supplemental oxygen or nasal continuous positive airway pressure, in addition to conventional therapy, may improve the overall cardiac function and perhaps the patient’s prognosis.”

Leave the surgery to the real quacks

Robert Liston achieved a legendary 300% surgical mortality rate. Wellcome Images, CC BY

A notable 19th century surgeon was Robert Liston. The Scottish surgeon was certainly quick – he could amputate a leg in less than three minutes – but also very bloody. He is the only surgeon to have achieved a 300% mortality rate as a result of an operation. In his most famous amputation case, the patient, his assistant (who lost a finger while holding the patient down) and an observer died. The first two from infection of their wounds and the observer from fright, believing he had been cut when really it was only his coat that had been cut.


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