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Doctor Detective on the Case: Breathing Problems Aren’t Always Respiratory Issues

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If there’s a basic truth about life, it’s that breathing is a good thing. Yet Victor Kunisada, now in his 70s, cannot remember a time when breathing was not a problem.

“I had asthma all my life,” he said. “Then, when I was in my 40s, I was diagnosed with COPD.”

COPD, chronic obstructive pulmonary disease, is an umbrella diagnosis that includes a boatload of respiratory and lung problems. “Of course, it didn’t help that I smoked for about 30 years,” Kunisada said.

Victor-Jeanne 

Respiratory patient Victor Kunisada shows his winning Poker strategy while playing with friend Jeanne McShane. Being diagnosed correctly and getting his myasthenia gravis effectively treated has made retirement recreation a lot easier and much more fun.

“Smoking was a problem,” acknowledged John C. Lincoln neurologist Islam Abujubara, MD. “It was even more of a problem that Mr. Kunisada was misdiagnosed for much of his life. He was treated for COPD, but that was not his only disease.”

As a result, Dr. Abujubara said, the medications and medical procedures that Kunisada received over a 20-plus year span, never solved all his breathing problems. “He was treated with bronchodilators like Theophylline and Albuterol, both of which helped him breathe. But because his true disease was undiagnosed, his breathing problems eventually just got worse.”

Kunisada’s true diagnosis, Dr. Abujubara said, is a neuromuscular disease called myasthenia gravis. “I never heard of that before Dr. Abujubara told me I had it,” Kunisada said. Most people have not.

As in all autoimmune disorders, antibodies interfere with normal body functions. In myasthenia gravis, the antibodies inhibit the signals between the brain and muscles by blocking receptors in the neuromuscular junction where neurons normally stimulate muscle fiber contractions. This causes varying degrees of weakness that increases during periods of activity and improves after periods of rest. Muscles that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often involved.

Although it only affects 14 to 20 people per 100,000 population, or approximately 36,000 to 60,000 patients in the United States, it is the nation’s most common chronic autoimmune disorder and health experts suspect that, as in Victor Kunisada’s case, it is probably under diagnosed and its prevalence is probably higher.

“I believe Mr. Kunisada’s breathing problems were misdiagnosed for 20 years,” Dr. Abujubara said. “I think the correct diagnosis had been missed because Mr. Kunisada never complained of muscle weakness in his limbs or double vision, which are the two most common symptoms of myasthenia gravis.