Junior Cycling Champ Overcomes Potential Career-Ending Condition
09/18/2013

Sophie Weigel
Sophie Weigel
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PLANO, Texas — Elite cyclist and aspiring Olympian Sophie Weigel is not a quitter. But the 14-year-old 2013 Texas State Cyclocross Champion for her age group had to pull out of more than five races this past year. When she reached a challenging pace, Weigel would struggle to breathe so much so that she could not make it across the finish line — a tough pill to swallow for a past IronKids National Champion and fifth-place-finisher in two events at the 2013 USA Cycling Junior National Championship.

“I wasn’t racing up to the standard that I usually was,” Sophie said of her last cycling season. “I just felt out of shape, and I knew I wasn’t out of shape.”

Weigel was suffering from a condition called vocal cord dysfunction.

Vocal cord dysfunction (VCD), also referred to as vocal fold dysfunction, is an abnormal breathing pattern in which the vocal cords close instead of open during inhalation, partially obstructing the airway and making it difficult for one to breathe.

“Your throat feels really, really tight,” Weigel said of her symptoms. “It feels like it starts closing and you can’t get enough air in. It’s like a choking feeling. It’s just not pleasant.”

While it can occur in both athletes and non-athletes, physical activity is the No. 1 trigger for VCD.

“We see this in highly motivated, smart athletes,” said Peter Schochet, M.D., a pediatric pulmonologist on the medical staff at Texas Health Presbyterian Hospital Plano. “These kids are highly motivated. They really want to perform. They do well and push themselves in school and they push themselves on the field or in their sport. They get into bad breathing habits and that’s what gets them into trouble with their vocal cords.”

Schochet and his colleague see approximately five to 10 patients with VCD in their practice each week.

On a broader scale, close to 10 percent of children who have difficulty breathing and shortness of breath associated with exercise will have a diagnosis of vocal fold dysfunction, according to Stephen Maturo, M.D., director of pediatric otolaryngology at San Antonio Military Medical Center.

Maturo helped author a study about pediatric VCD called “Pediatric Paradoxical Vocal-Fold Motion: Presentation and Natural History.” The study’s findings were published in the December 2011 edition of Pediatrics, the official journal of the American Academy of Pediatrics.

Sidelined

“It got to the point where I just couldn’t race and I was really upset about that, because that’s what I do,” Sophie said. “I just love it. When you go down a hill or you go around a turn really fast and get a breeze in your hair and helmet, it’s just a sensation. For me not to be able to do that was quite scary.”

Frustrated and unwilling to give up her passion, the cyclist and her parents turned to the medical community for help. As is often the case with VCD, Sophie was initially misdiagnosed with sports-related asthma. When her prescribed asthma rescue inhaler didn’t curb her symptoms, the family consulted a specialist. Tests performed by an allergist uncovered the true problem.

Experts say an accurate diagnosis is important to avoid unnecessary treatment and for quality of life.

“Many patients with VCD are wrongly diagnosed with asthma that’s poorly controlled and then they get lots of unnecessary medicine to treat it,” Schochet said. “Some potentially suffer complications from that medication. There have been people intubated in emergency rooms as a result of vocal cord dysfunction prior to it being correctly diagnosed.”

Treatable with Therapy

Common VCD symptoms include shortness of breath with exercise, throat discomfort or tightness, noisy breathing and wheezing with exercise and hoarseness.
Common VCD symptoms include shortness of breath with exercise, throat discomfort or tightness, noisy breathing and wheezing with exercise and hoarseness.
Click photo to download hi-res image

Once correctly diagnosed, Weigel was referred to Texas Health Plano, where VCD treatment therapy is offered through the hospital’s Speech Pathology Program. Vocal cord dysfunction can be controlled, even corrected, by learning how to breathe correctly from the diaphragm, according to Tina Chagoya, a speech pathologist and Weigel’s therapist at Texas Health Plano.

“Almost every patient I have seen either does not have any more attacks or, on a scale of zero to 10, 10 being extreme difficulty breathing and zero being no difficulty breathing, they can keep it at a level two using the strategies we teach them and it does not affect their performance,” Chagoya said. “Before they learn the techniques, their breathing had control over them, but now they have control over their breathing.”

An estimated 100 patients will undergo VCD therapy this year at Texas Health Plano, according to the hospital’s director of rehabilitation services.

Therapy consists of a series of three to six sessions in which a speech therapist trains the patient in proper breathing methods, strategies in preventing VCD and rescue breathing techniques to use at the onset of an attack. Patients learn how to breathe from their diaphragm and exhale slowly, proper posture for optimum breathing and relaxation techniques — all to encourage maximum control of vocal cord motion.

In the final therapy sessions, the patient is exercised to the point of an attack while performing his/her sport in order to learn how to properly control breathing during maximum performance. Weigel brought her performance bicycle to therapy in order to simulate her triggering activity as specifically as possible and to learn how to control an attack while riding.

“I practiced the breathing techniques I learned day and night when riding and not riding,” Sophie said. “After a while, I could really see the difference. I could get out of zone two, which is a really easy pace, and actually start working out again without having trouble. And, as silly as it sounds, I was able to blow up a balloon for the very first time in my life after therapy.”

Teens At Risk

Vocal cord dysfunction typically presents itself in adolescents who are high achievers, according to Janice Lougeay, M.A., CCC-SLP, a speech-language pathologist and director of clinical education at the University of Texas at Dallas. Lougeay trains speech-language pathology graduate students in the treatment of VCD and even trained Sophie’s therapist.

Common VCD symptoms include shortness of breath with exercise, throat discomfort or tightness, noisy breathing and wheezing with exercise and hoarseness.

“Classically, people with vocal cord dysfunction will complain their throat is tightening up and it’s hard to get air in,” Schochet said.” They may complain of a knot in their throat. They may make some noise when they breathe in, whether it’s distinct or subtle. They’ll typically have voice changes.”

The cause of VCD can vary. In addition to exercise, VCD can be triggered by post-nasal drip, acid reflux and anxiety.

“In some patients we see in the clinic, VCD occurs after they’ve had a respiratory illness because that causes an abnormal breathing pattern,” Chagoya explained. “When you are sick and have a chest cold you are more of a chest breather and then that carries over after the illness is gone. In some patients, anxiety brings it on. Some patients have always been chest breathers and then when they start doing heavy duty physical activity that abnormal breathing pattern can cause the VCD.”

It is possible Sophie had VCD as a young child, but it went unrecognized.

“We started thinking back when she was younger and competing in triathlons,” Weigel’s father, Tim, said. “As she started getting a little older and doing slightly longer triathlons she was actually having a really hard time getting her breathing under control in the run, which is what spurred her to focus on cycling. In hindsight, we’re wondering if that was the first sign there was an issue and we didn’t recognize it as such.”

Experts say parents of athletes and their coaches need to be aware of VCD and how to help young competitors recover from and control attacks.

“Look at what brings it on,” Lougeay said. “If you have an athlete and the breathing difficulty usually happens on the athletic field and an asthma rescue inhaler doesn’t work, that is a red flag for VCD.”

Olympic Aspirations

Today, Sophie is back on track and competing more confidently than ever before. As for her cycling future, Sophie has her sights set on a stars-and-stripes jersey at the USA National Cycling Championship and a future place on the United States Olympic team.

“It’s just such a relief that I know I can do it now and I won’t have an issue,” she said. “I can count on having that nice feeling when I go for a ride and not having to worry ‘can I even finish this?’”

For more information about Texas Health Plano’s Speech Pathology Program, visit TexasHealth.org/Plano and click the Rehabilitation link under Medical Services. To reach the VCD therapy department, please call 972-981-8185.

About Texas Health Presbyterian Hospital Plano
Texas Health Presbyterian Hospital Plano is a 366-bed acute care hospital and recognized clinical program leader, providing technologically advanced care to Plano and surrounding areas since 1991. The hospital’s services include orthopedics, cardiovascular services, oncology, pediatrics and women’s services. An affiliate of the faith-based, nonprofit Texas Health Resources system, Texas Health Plano has more than 1,600 employees and 1,300 physicians on the medical staff. For more information, call 1-877-THR-WELL or visit TexasHealth.org/Plano.

About Texas Health Resources
Texas Health Resources is one of the largest faith-based, nonprofit health systems in the United States. The health system includes 24 acute care and short-stay hospitals that are owned, operated, joint-ventured or affiliated with Texas Health Resources. It includes the Texas Health Presbyterian, Texas Health Arlington Memorial and Texas Health Harris Methodist hospitals, a large physician group, outpatient facilities, and home health, preventive and fitness services, and an organization for medical research and education.

For more information about Texas Health Resources, call 1-877-THR-WELL, or visit TexasHealth.org.

Doctors on the medical staff practice independently and are not employees or agents of the hospital.