Question
Dear Dr.:

  A little over a year ago I was diagnosed with pleurisy after an x-ray in the emergency room, and the doctor said it was caused by my weight (my stomach pushing on my ribcage or something).  At the time I weighted 203 pounds (at 5?2?.  I immediately began a slow process of watching what I ate and exercising (walking daily on the treadmill and increasing the time weekly (week one 5 minutes, week two 6 min, etc)) however after week four my pleurisy began acting up making breathing very difficult (basically any movement of my ribcage caused me pain).  The good news is I have lost 25 pounds this past year (I was hoping for more).  
I am not worried so much by the food aspect of dieting as I am the exercise one.  I have talked to my Internist about this and she recommended water aerobics, however I have no pool and live in a small town and making exercise convenient makes me all the more eager so driving 20 minutes to wear a bathing suit is not going to push me like the exercise room I have in my home.  I do not have to work and my husband takes care of the house.  I walk an average of 2000 steps a day.  However when we go out shopping or what not for too long 3000- 3500 steps the next day my pleurisy acts up.  I have a very supportive husband and he is very health and in excellent shape.  In fact he is 20 years older than me and is often told how he never seems to age. (I was 116 pounds when we met 8 years ago, after graduating college 6 years ago I gained my first 10 pounds, and then 3 years ago I was diagnosed with high triglycerides 291, I weighed 168)  I just want to continue to loose weight, be healthy.  
After this long spiel, what I wish I knew was more about pleurisy.  I have done research however nothing tells me how to exercise with out aggravating it.  Please help.  Thank you!  

Answer
Hello, sorry to hear of your chronic pleurisy.

Pleurisy, the disease/ condition/ diagnosis of pleurisy is not treated by Doctors of Chiropractic.  Actually, as a DC, I am prohibited from treating any patient with this condition.

If someone came into my office with this condition, or I suspected this conclusion in my examination; I would make recommendation to go to a Pulmonary Specialist MD.  In Staten Island, my own primary physician is a pulmonary specialist.

This being said, understand I would not treat pleurisy in my office. I would recommend pulmonary MD care.

Just as to some points of information, which are available through public sources, and not the practice of medicine or chiropractic; you may already know of some nutritional supplementation said to support lung tissues and combat inflammation.

The Pleura is actually a lining inside the ribcage and around the lungs.  This lining allows the lungs and ribs to move during breathing.  Pleurisy is usually secondary to something else, ie: after a cold, lung infection, chest injury, some kind of infection, insult or trauma that causes inflammation of the pleura (chest wall).


It seems from your question that your doctor has done a good job  with you.  It seems your extra weight and the way you carried that weight could have irritated and inflamed your chest wall.  So your efforts at losing weight will help in the long run by removing the initial irritating factor.  With limited or no exercise losing weight will be an especially slow process. But losing weight is the right thing to do for you- apparently not only for your pleurisy, as your MD states your weight caused the pleurisy, but also for your health in general.

Pleurisy, inflammation of the chest wall, then boils down to 'inflammation'.  NOT specifically for pleurisy, but just as general information as to anti-inflammatory nutrition and lung support, you may already know of these certain supplements.  And of course you should check out anything you try with your Pulmonary Specialist Medical Doctor.

Certainly you should avoid smoking, second hand smoke, air and environmental pollution.  Drink plenty of pure water. Avoid refined processed foods.  Eat plenty of organic fresh raw fruits and vegetables.

N-acetyl cysteine (NAC) increases glutathione production, a potent antioxidant that protects the lungs.  NAC also helps break down mucus and has been shown to improve symptoms in bronchitis patients.

Vitamin A helps maintain healthy tissues in the respiratory tract.  High dose vitamin A is contraindicated in pregnancy and liver disease.

Vitamin C with bioflavonoids protect the lung tissues.  Higher dietary levels of vitamin C have been shown to reduce the occurrence of bronchitis.

Coenzyme Q10 increases oxygen supply and may help patients with pulmonary disease.  Patients with COPD (chronic obstructive pulmonary disease) have been shown to have decreased blood levels of coenzyme Q10.

Antioxidants (beta carotene and mixed carotenes, vitamins E and C, and selenium) fight free radicals that can damage the lungs.

Increased intake of fish oils is associated with reduced risk of chronic obstructive pulmonary disease (COPD) (N Engl J Med 1994;331:228?3).

A multi vitamin and mineral supplement may be beneficial to counteract nutritional deficiencies.

Magnesium may be beneficial to relax the bronchial tissue.  COPD patients have been shown to be deficient in magnesium.

L-carnitine helps improve exercise tolerance (breathing response is enhanced) in people with lung disease (Int J Clin Pharmacol Ther Toxicol 1988;26:269?2).

Inflammation is often combated nutritionally through proteolytic enzymes and omega 3 essential fatty acids.

As to the exercise portion of your question, from a common sense perspective you seem to have the right idea.  Slow, progressive increase in exercise should be acceptable to your body.  Obviously when you start to hurt, stop.  Perhaps by implementing some anti-inflamatory and lung support nutrients, over the long run, you may be able to increase your activity level.

As stated at the outset, none of this is to treat your pleurisy or anyone else's pleurisy.  Pleurisy should be treated by a Pulmonary Medical Doctor Specialist.

The discussion in this article is just a general explanation of pleurisy (inflammation of the interior chest wall and lungs), lung nutritional support, and anti-inflammatory supplements.  A general discussion- Just because we were in the 'neighborhood' of inflammation and the lungs, tangential to "pleurisy". None of this is prescriptive, specific, nor even a recommendation concerning Pleurisy, only the treating MD could do any of that.

Thanks for the thought provoking question.  If it was me, I would go to my Pulmonary Specialist.

Good Luck in your continued improvement.

Victor Dolan, DC
http://www.DocDolan.net