Chapter 11

Questions and Answers (Q & A)

Question-1

I just have a question about the symptoms of anxiety or panic attacks. A few months ago, I saw blood in my sputum. After several tests, I was told I have Chronic Bronchitis and Emphysema that resulted in the blood in my sputum. They assured me that I have no cancer. However, I keep worrying about it. At times my mouth dries out and I hyperventilate to a small degree. Could the dry mouth and slight elevation in my blood pressure be caused by panic or anxiety. I was given anxiety medication, but I still feel anxious.

Answer

It is important that you discuss your symptoms with your doctors. Also, tell them about your worry problem. When we are diagnosed the first time, it is a shock. We go through extraordinary stress for a long time trying to sort it out in our mind what it all means for the rest of our life. I have been advocating a brief psychosocial support for a few visits for every newly diagnosed patient so they can digest the news and figure out all the new stuff that is coming on to them.

Note that anxiety is nothing but stress.

Dry mouth is a symptom of anxiety and stress.

Blood pressure can rise with stress. The connection between stress and blood pressure is well studied.

In a panic attack, blood pressure can rise dramatically.

Hyperventilation can also result from stress and anxiety.

Make sure you take advantage of any patient education and pulmonary rehabilitation that is available.

Also, make full use of any local and/or online support groups you can find.

The more you will know about the condition and connect with the people who have the condition, more confident and less anxious you will feel

Question-2

In reading your presentation on Anxiety and Panic in COPD, I found it very interesting how you explained what takes place, physically, when we get anxious. "The Anatomy and Physiology of a Panic Attack" is fascinating. Anyway, my question is, what are some ways we can keep our suffocation alarms from getting out of control? Sometimes anxiety is like a ball rolling down hill. Once it gets away from you and starts on a roll, there's no way you can stop it!

Answer

"Suffocation alarm" is one of the major explanations but not the only one. However, let us see what we can do to bring it under control if the alarm has gone out of control.

I would give example of "house smoke alarm" which has gone bad. Say, the two wires in the smoke alarm are touching each other and it keeps giving false alarm. You run to the kitchen and check and there is no real fire. Or, may be there is just a little bit of smoke from something you had put on the oven but there is no real fire. Actually, there is no real danger.

Here are some steps to get on top of this problem:

1. Suffocation alarm like the house smoke alarm is intended to alert us from danger so we can keep ourselves safe. Our understanding and belief that the safety alarm is for our safety and not meant to scare us is the first step.

2. Keep reminding yourself that panic is caused by our overreaction to a body signal that is bad but it is not dangerous and not life threatening. Therefore, over breathing, rapid breathing, chest tightness, chest pain, heart pounding and the like are uncomfortable but not life threatening. So, try to be cool about it and tell yourself it will blow over in a few minutes if I calm down and do breathing

3. Remember to do your Pursed Lip Breathing (PLB) from your abdomen and relax your neck and shoulders

4. If you need to take some medical type of action, do what you need to do. But, you will still be better off if you continue to calm yourself and do your corrective breathing and try to do mental and physical relaxation.

5. IMPORTANT: WHEN YOU BECOME BREATH AWARE LIKE A YOGA PERSON AND KEEP MONITORING YOUR BREATH. YOU WILL NOTICE WHEN BREATH CHANGES EVER SO SLIGHTLY AND CORRECT IT RIGHT AWAY, YOU WON'T REACH UP TO A PANIC ATTACK. YOU TAKE CARE OF IT RIGHT AWAY BEFORE IT REACHES THAT POINT

Question-3

How can somebody with COPD or other chronic lung disease tell if they're having "just" a panic attack or if what they're experiencing is more physical in nature? In other words, how does somebody know if it is safe to try to get themselves to relax at home, and "talk themselves down" from a panic episode or if their lungs are actually so tight from inflammation and bronchospasm that they are in danger and they should go to the emergency room?

Answer

First things first! First, we have to make sure that the person is in continuing care of a physician/pulmonologist and medically stabilized and has been educated in the signs of COPD exacerbation, color of sputum, force of coughing, or ongoing wheezing etc. to determine if breathlessness and breathing distress is resulting from the lung condition. If that is the case, call the doctor or go to the hospital E.R.

If that is not the case, then we look at the possibility of a panic attack. Whether it is a panic attack, or dyspnea (breathing distress and breathlessness) resulting from the COPD exacerbation or a combination of the both (that is, panic attack and COPD exacerbation). In all the three possibilities, we still need to do the following:

1.Calm our anxiety

2. Say calming and self assuring words to ourselves (mental calming or 'talking down to ourselves as you say)

3 Use Pursed Lip Breathing (PLB) and make sure we are doing abdominal breathing.

4. When we have done all that and symptoms have not come under control, we need to call the doctor or in case of doctor not being available, go to the E.R.

In summing, what we as persons with COPD can do at our end is still the same in all the three possibilities. We use mental calming and correct breathing techniques mentioned above. But when the symptoms still continue, we check in the medical facility.

Good news is that the panic attack articles we have posted and the information and education health professionals can provide about panic and anxiety and COPD or asthma exacerbations, the easier it will become for a person to differentiate between a panic attack and a medically-caused exacerbation

Question 4

How can we control and manage our emotions in our everyday life? How do we prevent our illness from taking over our life?

Answer

It is a vast subject so know that I am just giving a brief answer.

Emotional work, like any other part of self-care or medical care, requires us to constantly work on it. For instance, one might be taking medicine "A" 3 times a day, Medicine "B" twice a day and an "inhaler" as soon as one notices something coming on. Likewise, we keep ourselves giving emotional medicine of several difference kinds through out the day. Remember emotional work is never completed. You just keep getting better at it if you constantly keep working at it.

Therefore, surround yourself with positive people, books, quotations, affirmations, visualizations, pictures, objects, and above all, your own thoughts and emotions to remind you all the time that you must spend as much time staying in the positive mental attitude as possible.

Don't focus on what you have lost, but on what is left!

Find a positive meaning of your life and your disease!

When you experience troubling symptoms, see yourself getting past them and getting better, such as mucus clearing, cough subsiding, breath calming down and wondering how it all got better.

Keep a calm attitude even when you are experiencing troubling symptoms by constantly telling yourself something like "If I get more angry, frustrated, anxious or depressed, it won't be helpful. If I stay positive and somehow manage to get a smile on my face or find something funny to laugh about, I will be helping the healing forces."

Yes, there is something in the age old saying, "Mind over matter!"

Question 5

I worry far too much. I can't remember not worrying about something or another. I'm afraid a worry quickly spreads its tentacles and strangles me. How do I break a pattern that is so ingrained in me and keep getting worse as my lung disease progresses. I can generally manage my worries but when I get another respiratory infection and don't feel well, it gets harder to fight the worries with positive thoughts. I feel like I have no energy left to keep fighting the ugly beast of worry. What should I do when my mind and body feel overwhelmed and tired?

Answer

Congratulate yourself for what you already have been doing to manage your worries. You have been making some progress in controlling worries in spite of your severe medical condition.

Let me now come to your question as to what to do. To begin with recognize that "work of controlling worries" is energy saving and not energy wasting. Fighting with the disease and the symptoms is very exhausting but the less energy you spend on worries, fears, and distress over why it is happening to you is the energy you save to do other work.

Here are four suggestions to get you started:

1. Come to terms with the "final stage of growth" that is, death.

Personally, I don't fear or feel bad about my death but I hope and pray that my last phase is not too painful or too long.

2. Immerse yourself in spirituality and spiritual growth. Note that spirituality is different from religion. For example, spiritual belief is that God is one but people and religions call him (or her) by different names and that we are all one whether we see ourselves one or not.

3. Don't try to "stop worrying!"

Instead, get really good in diverting your thoughts and emotions to something good such as love and/or compassion.

When worry hits you, recognize it right away and say, "Worry! My old friend!" Right ways start sending your love to each and every loved ones of yours or feeling compassion and sending love for all the people you heard on radio or TV being afflicted by floods, hurricanes, tornadoes, starvation, etc. Of, for example, pray for everyone else you know or hear about being sick

4. Do some helping act for someone else, which you can do even when you are confined in bed, like prayers, sending love, writing a card, etc.

Believe in the power of the positive! Disbelieving in it is a nonstarter! Miracles happen to those who believe in miracles!

Question 6

I have lung and heart disease which have been causing much pain and suffering and with the progression of disease will continue to grow much worse. As I become more disabled, my wife has to bear the entire burden at home. My wife is the sole bread earner. Guilt, Guilt, Guilt! When I get thinking about the trouble this will all become I sometimes worry that I may not die soon enough. We don't have insurance. Is my thinking normal or am I becoming a wacko?

Answer

Your thoughts about your situation are pretty normal. I think you are a brave person! It takes great courage to fight with such major conditions as yours!

I am sure you love your wife. As long as you love her, don't feel guilty. I am sure your wife doesn't want you to feel guilty or burdened. Only thing you can and should do is to keep taking care of your own self the best you can. Keep loving her and take care of her to the best of your ability. Just giving her smiles every now and then and asking her how she was doing amounts to taking care of her.

However, many people don't feel anxiety, panic attacks or depression and that is perfectly normal.

It is also perfectly normal to experience these emotions!

Questions 7

I notice that terrible memories of my past directly affect my condition. These are memories of my life before the disease and of past acute exacerbations and medical crisis that would result in hospitalization. Sometimes those memories can pop up suddenly and flood me with fear and other emotions that affect my breathing. It helps for me to talk myself through the feelings and try to focus my mind on today and how much God truly cares about me, regardless of those old mental tapes that say differently. Is there a direct correlation between horrible memories of my past and my asthma and COPD?

Answer

I believe anxiety is the real culprit here. The memories of terrible past are stored with anxiety, fear, shame and other negative emotions. Severity of asthma or COPD symptoms cause can cause severe anxiety. When the body and mind experience anxiety, the anxious memories are triggered.

It is an over simplified example, but the point is that the anxiety linked with these memories can cause panic attacks and chronic panic attacks can cause abnormal breathing patterns.

Discover more and more of your inner strength!

Question 8

I have read your article on "Anxiety and Panic Attacks in Emphysema/COPD. It seems that in some cases, you're saying that just thinking or visualizing something can actually help. My question is this: How does this work? If you have tight muscles and bad lungs, how can just "thinking" about something improve your health?

Answer

It is not "just thinking and visualizing of something" it involves the whole mind and body in a very constructive process. When we picture a relaxing and calming event or an image in our mind, our body and mind become calm and relaxed. Likewise when we remember a pleasant event or a time when we were in the company of people we love and doing things we enjoy, our mood begins to brighten up. Visualizing and thinking about positive, constructive and joyful things, muscles relax, breathing becomes fuller and deeper and mind becomes calm. It is an inner fountain that we can learn to turn on over and over again. Depending on the total state of the mind and body, such visualization and thinking may have a big impact on your thoughts, mood and muscles and at times only modest improvement. But the point is that it STOPS the negative process and STARTS off a positive change and that is a big deal.

Remember even if you make a small gain by such visualization, relaxation, positive thinking, meditation or some other mind body techniques, "Something is better than nothing." When you begin to practice these mind body techniques regularly and habitually, you begin to notice the change that is more than temporary.

Question 9

I have heard yoga is good for stress management and mood management. Does it really help you feel healthier, more relaxed, and just better in general? What do you teach in your program "Yoga for COPD?"

Answer

Thank you for asking me about the subject that is closest to my heart!

Yoga is not just positive thinking and visualization. That is one part of it. Yoga includes 8 different parts, let me mention three parts out of the eight which are most relevant for most people with COPD:

1. Psycho-emotional and behavioral guidelines (Yama and Niyama) for positive mental attitude, lifestyle and relationships

2. Muskelo-skeletal exercises (Asanas) some of which can be very beneficial for general flexibility and endurance and spinal flexibility and strength (good for muscles of respiration) without raising the heart rate and can create mental effect of calmness and relaxation and sense of well-being. The ability to stretch, exercise and relax the upper body is very important for people with COPD. People with COPD carry a lot of tension in the shoulders and chest. Likewise, it is crucial to stretch, relax, bend, twist and elongate the spine for increasing the efficiency of breathing.

3. Breathing technique (Pranayama) which has hundreds of techniques and some of them can be very beneficial for slowing the breathing and lengthening the exhalation and thus for more efficient emptying of the lungs. We practice coordinating the breathing with spinal movements which is particularly good for the breathing and spine

4. Concentration and mind-training techniques (Dharna and Dhyana) which too can be highly beneficial for relaxation and mental and emotional control which can have effect on your own healing powers.

What is unique about yoga is that you may just do the muskelo-skeletal exercises alone and not bother with any other parts of yoga and you will still derive physical and mental benefits, increased breathing efficiency, sense of well being and improved outlook and mood.

However, you have to know which exercises are particularly good and how to coordinate it with your breathing. Some of the exercises specifically adapted for people with COPD are provided in my DVDs "Stretching and Breathing Adapted for People with COPD" This is not a sales pitch but that is the only yoga based stretching and breathing DVD for COPD that I know of.

Question 10

I am interested in taking a yoga class. How do I know that the yoga teacher is well-trained and reputable and not just somebody who has no idea what they're doing and just wants my money? Moreover, I have COPD. I am limited in my exercise ability and I might need special instruction. How should I go about finding a good yoga teacher?

Answer

Your concern is very valid. There are a lot of untrained as well as highly trained yoga teachers in U.S.

Here are a few guidelines:

1. Only go to a teacher who is registered with Yoga Alliance (a credential evaluation body) at least 200 hours, preferably at 500 hours level, which means that they have received teachings in Yoga for 200 hours or 500 hours.

2. Go to a teacher who teaches "gentle" yoga, soothing and nourishing yoga rather than strong, power, or challenging yoga

3. Go to a teacher who teaches coordinating breathing with yoga poses. Some teachers would only focus on yoga poses and that is not good

4. If they have seen my DVD or attended my workshop in "Yoga for COPD" that would be an added bonus

IMPORTANT: A YOGA TEACHER OR PERSON WITH COPD SHOULD NEVER ADVOCATE THAT YOGA ALONE IS ALL YOU NEED. PEOPLE WITH COPD NEED YOGA, SOME AEROBIC EXERCISE (WALKING OR TREAD MILL) AND SOME RESISTANCE TRAINING SUCH AS WITH WEIGHTS

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Copyright 2009, Mind Publications 
Posted January 2009