didn’t know what was wrong. Hitting a ball out can be resolved by chang- ing your approach or swing, but my breathing attacks seemed unfixable. Although I was disappointed in
my performance, I was mostly disap- pointed in myself. I was letting down my second family – the teammates I encouraged, supported, laughed with (and, occasionally, got mad at) – and blaming myself. I became scared to push myself in practice. The fear of losing control of my breath- ing trumped my desire to better my game. I also felt embarrassed and stressed about being a distraction. Initially, I concluded that the
problem was fitness related, so I increased my weight training, added more core exercises, changed my diet and took supplements. But my struggles continued. After seeking the opinions of multiple medical special- ists, I was diagnosed with asthma. That seemed less and less likely when the medications that help the majority of asthma patients didn’t work. I was then given other diagnoses, including acid reflux, exercise-induced asthma and a problem with one of my arter- ies compressing my trachea. Yet with each new treatment there was no improvement. My pulmonologist referred me to a special-
ized program at National Jewish Health in Den- ver, suspecting the problem might be a condition known as exercise-induced laryngeal obstruction (EILO), a condition also known as vocal cord dysfunction that, according to a 2015 study in Sweden, affects about five percent of teens. This diagnosis was confirmed when I had a procedure called continuous laryngoscopy during exercise. For this procedure, a very small camera was placed through my nose to monitor my vocal cords – while pedaling to the peak of exhaus- tion on a stationary bike. As the attack worsened during the test, the doctor encouraged me to continue, which made me furious. It wasn’t until
Symptoms and
treatments for EILO A typical episode of exercise-induced
laryngeal obstruction (EILO) is character- ized by noisy, almost panicky breathing. The windpipe partially closes at a time it should be open, limited in size by the vocal cords and nearby structures. While oxygen levels are generally perfectly normal, affected athletes feel as if they are not getting the air they need and feel that they are not in control of their breathing. Even though individual attacks are gener-
ally not dangerous, they prevent athletes from performing to their potential. If you have shortness of breath, when
should you consider EILO? • Breathing is noisy. • Medicine for asthma is minimally helpful at best.
• Breathing is scary. EILO is not asthma. It’s frequently misdi-
STRESS TEST: Dr. Tod Olin works in the lab to help patients overcome exercise-induced breathing issues.
later that I understood the benefit. Once I was diagnosed, I began working with speech and language pathologists. I was in- structed to perform various breathing techniques to keep my vocal cords open, but success didn’t come immediately. To evaluate my breathing technique and to
learn new techniques, I completed two sessions of a new procedure that is called therapeutic laryngoscopy during exercise. In this procedure, the same small camera allowed me to watch (and then ultimately control) my vocal cords during very high intensity exercise. Initially, I struggled to keep my throat open and the real-time moni- tor that showed my throat confirmed this. One time, in pure frustration, I began to cry and inhaled sharply. My cords flew open! Eventually, my doctor created a customized
breathing strategy based on the findings from the video. I was soon able to reproduce the technique and my vocal cords remained open. My remaining days at the hospital turned into training sessions to perfect this new technique. My problem was solved. Returning home, I was filled with new- found confidence and was eager to get back to volleyball. For the first month of practices and tournaments, I used a breathing technique that was customized for me exclusively and I didn’t have any attacks. As time went on, I became more aware of my breathing triggers and I was able to breathe normally while exerting myself. If I sensed an attack coming, I used my technique and avoided it. Practices were no longer interrupted by
terrifying breathing attacks. I felt like an athlete again, able to push myself to my limit. Once again, volleyball was fun.
SUCCESS: Dr. Tod Olin and Sarah Graham can breathe a sigh of a relief after working together to improve performance.
agnosed as asthma, but here are some key differences: • It’s rarely a problem until adolescence; asthma is often a problem during illness in early childhood.
• The attacks are usually more frightening and noisy than asthma attacks.
• The attacks are not prevented or resolved by medications for asthma. Many patients with this condition are
appropriately frustrated when basic medical
RIÀFH WHVWLQJ DSSHDUV QRUPDO 6RPHWLPHV this normal testing leads to trials of the wrong medication, referrals to inappropriate specialists or a message that the problem is due to the patient being out of shape. The exact cause of EILO is still unknown,
although contributing factors can be extremely cold or hot facilities, pungent fra- grances or the stress that goes along with important matches. Medical professionals are increasingly
able to diagnose and treat EILO. Continuous laryngoscopy during exercise is a diagnostic test that can be very helpful. It allows doc- tors and patients to observe the vocal cords during attacks, offering clear advantages over simple clinic interviews about throat problems or looking for throat problems with cameras while athletes are not exercising. To treat EILO, breathing specialists or
speech-language pathologists help athletes learn how to keep their throats open in mo- ments of high exercise intensity and stress. Performance psychologists can also be helpful by working with athletes on strate- gies for dealing with the stress of high-per- formance athletics. Therapeutic laryngoscopy during
exercise, which produces real-time throat images, allows patients to perfect breath- ing techniques. In many ways, it’s like using
ÀOP WR SHUIHFW D KLWWLQJ DSSURDFK RU SDVVLQJ technique.
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