• End of Life Issues - From the mail box
  • Mariam Meek saves every issue of her Second Wind and shares them with the others in her complex for the elderly and even with her doctor. She admits that at first, her doctor wasn't too keen on getting her literature but now he too reads us on his computer. The residents of her complex have been discussing end of life issues. She writes that the words of Dr. Petty in the January 2004 issue are the wisest that she has read. She has saved every issue of her newsletters to read again and again, but shares them with the others. Thank you for letting us know how much the article and our newsletter have helped you, Miriam!
  • Panic Attacks
  • "My mother, age 59, has been diagnosed with COPD. Her pulmonary function test showed that she has very little lung capacity left. You can imagine how frightened she and the rest of the family were when we heard this. She is in a rehabilitation program and has managed to remain healthy except for the disease itself. One of the biggest problems is continuing reoccurrence of panic attacks. She has them every morning when she gets up, and some times during the day. She is on a regular regime of inhalers, breathing treatments, takes Zoloft daily, and uses Zantac when unable to get it under control. Do you know of anything that might help? She is so healthy other than this. Her quality of life would improve dramatically if she could get the attacks under control."
  • What a good question. We'll try to offer some general suggestions to her and to the many others who suffer from this problem. Obviously, you have first discussed this problem with the pulmonologist since only he or she is in a position to know what is really going on. Perhaps respiratory medications need to be increased or altered. Sometimes the doctor can prescribe a more effective medication at bedtime that will last all night and still be of help in the morning. It is a little-known fact that lung function has a regular variation over a 24 hour period and is consistently worse in the early morning hours. Many bronchodilators that are taken before going to bed are completely gone by the time you wake up. Newer long-acting bronchodilators may be of help because they work through the night. Serevent (salmeterol) and Spiriva (tiotropium) when taken as directed give a higher level of lung function on awakening in the morning. The combination of the two likely works even better.
  • The use of a rescue inhaler (a short-acting bronchodilator) on awakening might be encouraged. If there are a lot of secretions, postural drainage should be done an hour before going to bed to help remove secretions, which tend to build up at night. The staff at the rehab program should also be involved in helping. I suspect she needs more practice in proper breathing techniques, energy conservation and pacing herself. She can rapidly run out of oxygen if she moves too quickly, even if she is on supplemental oxygen!
  • Moving too quickly or poor breathing techniques are often the cause of panic attacks. When patients try to overcome shortness of breath by breathing too fast and not concentrating on breathing out twice as long as breathing in they feel much worse.
  • Let's see what else we can suggest to help all those who have this problem. First, keep an inhaler at the bedside to use before getting out of bed. Then start nice, slow, easy, pursed lip breathing (PLB) before rolling to the side, continuing to PLB. Slowly push up, with one arm, to a sitting position, exhaling with effort through pursed lips. Stop again and do PLB until there is no shortness of breath. Slowly stand, being sure to exhale, or blow out, while doing so. Again, pause and do slow, easy PLB. Do this until there is no shortness of breath. Then walk slowly to the bathroom. Are you beginning to see the pattern here? Many people jump out of bed in the morning, and walk into the bathroom as fast as possible to get there before they get short of breath. Instead, they may start to panic, and maybe even loose control of their urine. This really can be prevented with proper breathing techniques and better pacing. Sometimes a commode can be put next to the bed temporarily until better pacing, and breathing techniques, are learned.
  • During the day, notice what causes panic. Let her know that she does have control. She can prevent panic if she slows down physically, slows down breathing, breathes out 2 or 3 times longer than breathing in, and uses the rescue inhaler as prescribed by the physician. We've exaggerated how slowly this should be done, but at first, this may be necessary. As this pattern of slowing down and breathing properly becomes more of a habit, she probably will be able to move more quickly.
  • Check our Website (use the new GOOGLE search from the front page) for more on exercise, breathing techniques and pacing. Be sure to look at the old newsletters we have archived. You'll find a lot more information. Your mom is fortunate to have such a caring family! We hope these suggestions help.
  • Importance of Exercise
  • Kenneth gave us permission to write up his success story, which we will paraphrase for you. He wants you to know that YES, there is something you can do about the diagnosis of COPD! A little over a year ago he went to a VA hospital for a check up and collapsed in the waiting room. They put him on a breathing machine, which was a wake up call for him. He knew he had to do something. The doctor told him his condition was serious but didn't suggest anything but some inhalers. So, he started to help himself all on his own. At first, he couldn't walk more than 50 ft. He is now up to 5 miles a day! While walking, he does pursed lip breathing, which he learned from his niece, a nurse. He knew his weight was a factor in his breathing difficulty so, while sitting at the computer, he puts his hands behind his head and has worked up to 50 sit-ups while sitting in the chair. [We'd suggest starting with hands down, or even braced on the chair arms, or your thighs.] He also bends forward and alternates touching each elbow to his knees. Was he able to do all of this when he first started? Of course not! He started very slowly. With exercise and a diet, he went from a 45 inch waist down to a 31 inch waist, and has regained 10% of his breathing ability! The VA was so impressed by his improvement that he was asked how he did it. They didn't believe it was possible and are planning to monitor this closely for the next few years. With the idea of encouraging similar programs in other COPD patients, we hope! Kenneth tells us that he now feels better than he has in the past 10 years. He is 68, doesn't wheeze anymore, and can do anything he wants to do without fear of running out of air. He hopes his words help all of you out there reading this. He knows how you feel because he has been there.
  • What impresses us so much is not just the improvement, but that he did this all on his own without any help. That is what makes this such an inspiring story. Kenneth, we salute you!

  • Do you have a question about respiratory disease that has been bothering you? If so, feel free to write and ask us, either through our web site or by mail. We answer all of your letters.