Archive for October 2013

From Gracie62   Leave a comment

“This site has literally saved my sanity and restored by sense of well-being while in the throes of perimenopause. I can’t imagine life without it as I log in everyday for a dose of comfort from these amazing women.

Dearest was an incredible woman and a pioneer in extending global help and support to millions of women.

Without her, many of us would be alone, afraid and left to face menopause without a clue as to how to get through it. May she rest in peace.”

Posted October 5, 2013 by MaryO in In Memory

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Hypothyroidism, The Many Myths by Kenneth Blanchard, M.D.   1 comment

THE MANY MYTHS OF hypothyroidism
By Kenneth Blanchard, M.D.

Read the transcript of Dr. Kenneth Blanchard (coming soon!)

blanchardchatThyroid disorders are extremely common and, in my opinion, are often undiagnosed or poorly treated due to a total reliance on laboratory testing and some-long standing but fundamentally flawed principles of treatment. Of the many standard teachings in this area, I believe the most common mistake physicians make in every day practice is to “rule out” hypothyroidism on the basis of laboratory tests .alone, especially use of the TSH (thyroid-stimulating hormone) test. There are few teachings in medicine more sacrosanct than an elevated TSH test as the “gold standard” for a diagnosis of hypothyroidism. I believe that there are millions of patients (mostly women) who would benefit from thyroid hormone but who are not treated because of results from this test.

A common story in popular magazines is “The Diagnosis your Doctor Will Probably Miss”. The story is that many individuals (mostly women) with symptoms like fatigue, depression, muscle aching, constipation, etc., see a physician who orders a T4 test and, on the basis of this, are told that hypothyroidism has been “ruled out”. The “smarter physician” also orders a TSH test because this is more sensitive and often reveals an abnormality even when T4 results are normal. While this scenario can happen, I believe it is far more common to find both T4 and TSH tests registering normal in the face of significant clinical hypothyroidism. In my practice, if the medical history and physical findings are highly suggestive of hypothyroidism, patients are treated with a therapeutic trial of the hormone and the results are overwhelmingly positive. As of early 2001, opinion in this field is still that the TSH test is absolute, although the upper limit of normal has been questioned, which is starting to include more individuals in this diagnosis.

Another common teaching that I believe to be fundamentally wrong is that all treatment should be done with 1OO% T4 hormone L-thyroxine (Synthroid, Levoxyl, etc.). The normal secretion of the thyroid gland contains small amounts of the T3 hormone (triiodothyronine) and I believe that giving some T3 is an important part of effective treatment for most individuals. The standard medical view is the T3 is unnecessary because T4 is converted to T3 in the body. But many patients taking the standard 100% T4 hormone report chronic fatigue, depression, menstrual abnormalities, fibromyalgia, irritable bowel syndrome (IBS), restless legs and other complaints, and these complaints are almost always better when some T3 is added. This particular teaching in medicine has been breached by a paper appearing in the New England Journal of Medicine in 1999 in which patients on standard 100% T4 were given some T3 and all patients felt better mentally and physically. The use of T3 has been standard in my practice since 1990 and I am quite sure it will be routine in the near future, although many physicians at this point still do not use T3 in addition to T4.

Thyroid hormone activity has a variety of complicated interactions with other hormones. For instance, I believe that thyroid hormone treatment is effective in PMS (premenstrual syndrome) despite the fact .that there are major studies in the literature which say this is not true. It is most likely that PMS fundamentally represents a deficiency of progesterone production prior to menstrual flow, but I believe that normalization of thyroid deficiency enables the woman to make more progesterone, thus relieving the symptoms. The woman in her mid-forties who is just starting to have irregular periods and notices some hot flashes, sweats and sleep disturbance at night can often be treated simply by optimal thyroid replacement, specifically including some T3. While such symptoms are commonly regarded as estrogen deficiency and will respond to the use of estrogen, I find that many such women have normalization of symptoms on proper thyroid therapy alone. The fundamental reason for this may well be that normalization of thyroid function enhances estrogen production by the ovaries themselves and by, the increased production of estrogen in fat tissue from adrenal hormone precursors.

If a woman at this age has frequent migraine headaches that are clearly related to the menstrual cycle (essentially premenstrual), these will often respond to balanced T4- T3 treatment, again possibly because of raising and/or stabilizing levels of estradiol. While clinical depression is not an integral part of menopause, there are many issues at this time of life that can cause emotional upset or depressed feelings. Again, use the T3 hormone in a physiologic way can be very helpful. Indeed, much of the current use ofT3 is in the hands of psychiatrists, who. use it as an adjunctive treatment for depression that is not responding well to standard antidepressants. Although this can be extremely effective, psychiatrists tend to use pharmacologic doses rather then physiologic doses. In other words, they exceed the amount needed to reproduce normal hormone balance. For virtually every purpose, a physiologic dose is desirable since excessive doses yield no additional benefits. I also disagree with the use of Armour thyroid by itself for the same reason, that it does not contain a physiologic balance of T4 to T3. The human thyroid produces roughly 95% T4 and 5% T3. Armour thyroid is an animal thyroid that contains 80% T4/20% T3. People who take Armour thyroid usually feel better for a short period of time because they were deficient in T3 but, after a period of time, the Armour thyroid will cause a T4-T3 imbalance at tissue level and a variety of undesired symptoms can then develop over time. One can get a better balance by giving some T4 with the Armour.

Some doctors are reluctant to prescribe (and some women reluctant to take) thyroid hormones in the belief that this will somehow increase the risk of osteoporosis. . I personally do not believe that there is good evidence for this, although my guess would be that excessive thyroid hormone does contribute to bone loss. Since there is no benefit in going above the normal physiologic levels of thyroid hormone, following the TSH result and clinically monitoring the patient will prevent overdose and resultant adverse effects.

Every organ system in the body is affected to some degree by treatment with thyroid hormone. I believe that the proper treatment of hypothyroidism with physiologic amount ofT4 and TI is critical in managing many complex medical problems at mid-life. If treatment is carefully monitored, there are no adverse effects. Management of hypothyroidism with T4 and TI is significantly more complicated than the standard 100% T4 therapy that has been used for the past 30 years or so. TI dosage must be monitored and altered precisely for optimum effect and this must be done by the use of compounded T3 time-release capsules. These are almost always made in units of 1OO capsules for practical reasons. Patients are initially seen every three months in order to adjust the dosage for the next prescription of T3. Another practice that will eventually become standard in this field is the adjustment of thyroid dosage for seasonal change, i.e., higher dosage in the colder weather and reduced dosage in the warmer weather.

Once dosage has been adjusted over 3 to 5 3-month visits and everything appears stable, visits are done at 6-7 month intervals. Patients must be ready to keep their appointments and take the medication exactly as directed. At the present time, there are many patients on a waiting list so that patients who drop out of the treatment plan fall back to the end of the list. Patients who have difficulty with the practices outlined above should stay with their current therapy.

By Power-Surge guest:
Kenneth Blanchard, M.D

Read the transcript of Dr. Kenneth Blanchard (coming soon!)

Read the Power Surge disclaimer

From Wildflowers/Donna   1 comment

Wildflowers on the PS Boards wrote:

PS-logoLong ago my daughter asked me who is Alice in regards to power-surge, I explained Alice in terms of rock and roll stars (something she could relate to at that time..)

 

I said..well…Alice is like Mick Jagger of The Rolling Stones, everyone loves Mick.

I told that story to Alice on the telephone and we laughed and laughed, since then,  when talking to Alice on the phone or chat etc..I’d call her Mick. We both got a kick out of her nickname..Mick.

Daughter then said “You mean, you get to talk to her on the phone, and she chats with you”???,

I said “yep” and she said OMIGOD (she was a teen then..) that is really like talking to the STAR and I said..”sure is”

I told daughter of “Micks” passing and she said “Oh Mom, I now realize (she’s almost 27 now) how much her website and friendship meant to you and how much it helped..”……..

 

 

Posted October 5, 2013 by MaryO in In Memory

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Panic Attacks and Menopause   Leave a comment

People with Panic Disorder suffer from periods of intense fear or anxiety. Physical distress such as not being able to get their breath, racing heart and feeling weak and exhausted, are usually part of “panic attacks.”

Panic attacks start without warning and last for minutes or hours. An afflicted person must cope with the possibility of an attack occurring while shopping, driving, attending church, or being with other people socially.

There has been no agreement among professionals about what causes them. Even today, most professionals who treat panic disorder patients will say that the cause is not really known. Many state that stress or anxiety is a factor.

Most people who have attacks believe that there is something physically or mentally wrong with them, that they are ill. It is a common misbelief that something has happened during the person’s lifetime which was quite fearful, and this deep psychological fear reasserts itself during an “attack.”

It is important to seperate conditions of a psychological nature, such as early life trauma or lack of assertiveness, from the physical manifiestation of panic attacks. Both in clinical practice and in correspondence with many people who have sought help by downloading “How to Treat Your Own Panic Disorder,” there has been no evidence of an underlying psychological condition worthy of a diagnosis.

WHAT IS THE NEW EXPLANATION FOR PANIC ATTACKS?

Only in the last decade has an explanation for panic attacks appeared which explains all the various symptoms. When this explanation is understood by the panic attack sufferer and applied to treatment, control is regained and panic attacks can be stopped.

This explanation is based on evidence that panic attacks result from what has been called “Hyperventilation Syndrome.” Panic attack sufferers all have one thing in common. They don’t breathe properly. There is much to know about faulty breathing and having panic attacks.


People who suffer from panic attacks:

  • Breathe shallowly and rapidly.
  • Breathe using the muscles of the chest, neck and shoulders.
  • Make little or no use of the diaphragm in breathing.

Day in and day out, people who suffer from panic attacks breathe about twice a fast as normal breathers. Every person who has
sought help in my office for panic attacks has been tested for these dysfunctional breathing habits using sensitive biofeedback
sensors. Without exception, all have been found to breathe improperly. Their shallow, rapid breathing causes them to
hyperventilate.

Hyperventilation occurs any time a person breathes in such a way that they breathe out more carbon dioxide than their body is
manufacturing. Medically, this results in a condition known as “hypocapnia.” When the blood’s level of carbon dioxide gets below a critical point, the person begins experiencing apprehension and physical symptoms such as tingling arms and hands and rapid heart beat. If they don’t know what to do at that point, the symptoms become more severe and a panic attack results.

WHAT ARE THE SYMPTOMS OF HYPERVENTILATION?

The symptoms of hyperventilation are said to mimic the symptoms of organic disease. People who suffer from panic attacks are often put through a series of expensive medical tests only to find that there is no physical cause for their symptoms.

The symptoms experienced during panic attacks are not “imagined,” they are real. Hypocapnia (abnormally low level of carbon dioxide in the blood) upsets the normal chemical balance of the body. Changes in the regulation of the heart and breathing
result. Blood flow to the brain has been shown to decrease by 30% to 40% in laboratory studies of hyperventilation. Oxygen
transfer from the red blood cells to the tissues is inhibited, known as the “Bohr effect.” The nervous system is over-stimulated at
first, then under-stimulated as the condition worsens.

Fortunately, the body has numerous ways of protecting itself from death due to a complete loss of carbon dioxide, but the sensation
of dying which many people experience during a panic attack has a physiological basis in actual fact.

WHAT ABOUT PANIC ATTACKS ASSOCIATED WITH PHOBIAS?

Researchers now believe that the fearful symptoms of panic attacks are responsible for the development of phobias. It is not
unusual for many people who suffer from panic attacks to take precautions about being too far from home, medical help or those
who they trust. But phobias and rituals can become a disabling complication for people who have suffered panic attacks over a
long time. They lose the confidence to carry on life in a normal way. They rarely leave the safety of their homes.

When phobias and avoiding any situation which might trigger an attack have become a way of life, they become the most serious
obstacles to recovery. Even treatment which offers the promise of recovery is rarely carried through because of these fears. When
treatment is sought, the patient, their family, doctor or psychiatrist, and therapist need to make careful plans to keep the
treatment going until the patient feels strong enough to do it on her or his own.

COMMON SYMPTOMS OF HYPERVENTILATION AND PANIC DISORDER

  • Light headed, giddy, dizzy, vertigo
  • Faint
  • Headache
  • Blurred vision
  • Tremors, twitching
  • Numb, tingling, prickly feelings, especially in the face and arms
  • Chest pain or pressure
  • Nausea or vomiting
  • Abdominal pain or upset
  • Gas and abdominal extension
  • Lump in the throat
  • Dry mouth
  • Difficulty breathing
  • Weak, exhausted, fatigued
  • Apprehensive, nervous
  • Feelings of unreality
  • Fearful during an attack of dying
  • Going crazy
  • Doing something uncontrolled

These symptoms are essentially the same as those listed for Panic Disorder in the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association.

HOW ARE PANIC ATTACKS TREATED?

Although behavioral approaches such as desensitization are
currently popular, panic attacks are best treated by teaching
victims of this disorder to control their tendency to breathe
shallowly and rapidly. Nearly all persons who learn to change
their habitual and unconscious breathing pattern will experience
considerable control over their attacks in the first few days, or at
most, weeks of practice.

The anxieties, phobias or other disorders which may be
preconditions or a complications of panic attacks should be
treated as soon as the person has gained some control of the
attacks. The help of a competent therapist may be needed but
much can be accomplished through self-help publications listed in
the Bibliography. Many people who use these materials,
especially those whose onset of panic attacks has been recent and
has interrupted an otherwise normal life, will need no further
assistance. They should, however, continue breathing practice for
some time after they have stopped having panic attacks.
Those who have had panic attacks for many years and have
become fearful of going places should not discount the possibility
that these materials will give them the help in controlling their
attacks. More patience and practice may be needed and help
getting over the phobic part may also needed. Phobias should be
discussed frankly with a therapist so treatment can be planned
accordingly.

WHAT ABOUT MEDICATIONS?

Medications can be both a help and a hinderance to overcoming
panic attacks. A medical doctor should always manage a person’s
medications. In the beginning, medications can provide a level of
comfort which makes practice easier.

Because many anti-anxiety medications interfere with learning
and memory, it is necessary to withdraw from them as soon as
some control has been regained over the attacks. Those who have
participated in this program have expressed a desire to be off
medications as soon as possible. Only minor relapses have been
reported by persons who no longer take anti-anxiety medications.
By continuing breathing practice, the possibility of relapse is
minimized. Paradoxically, failures to achieve recovery have been
among those who stayed on even low doses of benzodiazapine
medications.

HOW TO TREAT YOUR OWN ANXIETY AND PANIC

We live in a fortunate time for those who suffer from anxiety, panic attacks
and agoraphobia. The decade of the 1980’s saw advances in research and
treatment in two major areas.

The first was in the devlopment of high-potency tranquilizers, notably alprazolam
(Xanax), which is powerful enough to ward off panic attacks, but does not cure
them. They are the most frequently prescribed drugs in this country.
In spite of the widespread use of drug therapy, it has been shown by
well-conducted surveys that the public and agoraphobic patients don’t like drug
treatments and would like to find some other way to deal with mental and
emotional problems. The relapse rate is close to 100% for those who want to
get off drug therapy.

The second development has come from the research into which non- drug
treatments are effective and which are ineffective. Several effective
interventions have resulted, and, in combination, are the core of treatment
programs around the country. Finding the right program located near enough to
home to be practical, however, can be almost impossible.


So, what is the good news?
It is this. All the most effective treatment
procedures can be learned and practiced at home. One of the things which was
sorted out by researchers studying clinic programs was that those which
encouraged home practice were the most effective.

The idea behind this book is that it brings what you would learn in a clinic into
“the safety and comfort of your own home.” Especially for those who have
developed substantial fears of going out, this can be quite important.

RECOVERY FROM PANIC ATTACKS IS ESSENTIAL

Over the years experimental evidence indicates that what is known as
exposure based treatment for panic disorder, avoidance and agoraphobias is
only successful when it is accompanied by an actual reduction in panic attacks.
Leading researchers now believe that panic is the central feature of
agoraphobia (and panic disorder) and that avoidance is a resulting complication
of panic attacks.

Whereas many programs concentrate on helping patients with their avoidance
behaviors or catastrophic thinking, but ignore or downplay panic, this book
targets panic directly.

How it helps the sufferer to rid him or herself of panic attacks is the unique part
of the treatment or training detailed in this book. It is by fully embracing the
evidence that panic attacks are caused by improper breathing habits which
brings on a condition, for some people, known as Hyperventilation Syndrome.


The proposition is simple:
“If panic is the root cause of phobias, agoraphobia
and panic disorder itself, and breathing is the root cause of panic, then the best
place to start is with breathing.” Studies have shown that when breathing
retraining is added to conventional treatment, the individuals receiving such
training were significantlly better after six months than those who had not.

When dozens of patients who suffered from panic attacks were tested in my
office for breathing problems, all fit the criteria which could lead to having
attacks.

Better yet, those who stayed for breathing retraining overcame their panic
attacks.

There were some who did not completely overcome panic attacks, and from
them I learned some important lessons. The most important lesson, was that
drug treatment, particularly with alprazolam (Xanax), prevents recovery. The
reasons for this and the best way to withdraw from drug treatment are
contained in the chapter on drug therapy.

Note: The Chapter on the usefulness of medications in treatment is not yet
available on these pages.

This book begins with breathing but is not only about breathing. It contains all
of the breathing awareness, reinforcing, early sign recognition, and exposure
exercises which have been proven so effective in helping people who have
suffered from panic attacks. It therefore presents a complete treatment plan for
the agoraphobic and panic disorder patient.

I have tried to write this book from the patient’s point of view. The most help to
my understanding was my association with Joni. Joni was a true victim of panic
and agoraphobia, who in spite of her fears, ventured out and found the answer
to her seven year quest. In the process, she taught me most of what I know of
the real suffering and agony the victims of panic go through.
For this reason, I dedicate this book to Joni.

HOW YOU CAN SUCCEED

Chapter One

Take a minute and think about it. What do you believe, indeed, what have you
been forced to believe about Panic Attacks? If there is anything in the world
which effects you so powerfully, and seems to be completely beyond your
control, it is Panic Attacks. One of the things people feel who have Panic
Attacks is that they are out of control of their own mind and body.

For this reason, a lot of what is in this book is about getting in control. As
reasonable and logical as it seems to believe that Panic Attacks are an
inevitable part of your life, I want to begin by assuring you that just the opposite
is true. Panic Attacks are not inevitable. They can be controlled. For a very few
people who read the first few chapters of this book and do the exercises,
success (meaning they will not longer have panic attacks) will be almost
immediate. For most people it will take a little longer.


This is written for those for whom it will take a little longer.

Joni

Joni started having panic attacks when she was 28 years old. She’s now 36.
With the help of her husband she’s raised a son, but for most of the last eight
years she stayed at home.

Determined to get out, she took a job at an agency which used computers to
keep track of credit reports. The first day, she sat at her work station nearly
paralized — for about a half hour — then ran out and frantically drove home were
she stayed for several years.

Joni tried everything, including alcohol, to find some relief from the attacks
which were a daily occurance, often more than once a day. The list of
medications for anxiety is impressive. She has been to emergency rooms more
than once. She experienced so much dizziness that her doctors gave her a CT
Scan to check for inner ear problems. When medical tests revealed nothing she
began to believe she had a tumor of the adrenal glands that was causing the
attacks.

A few years ago Joni again tried to go to work, and as it happened she was in
front of a computer again taking care of the billing in an office. She wouldn’t
admit that anything was wrong, but at times staying at work must have been
real agony. It so happened that Joni was working for me when I was
serendipitously introduced to the idea of Hyperventilation Syndrome and the
treatment which would help panic attack victims.

Together we found some people who were looking for help and started a group
in the next few months.

I asked Joni a few months before this was written how she was doing. She
replied in writing:

“I DO NOT have panic attacks anymore . . .for almost a year now.
A solution to this problem was and is a Godsend. Miracles can
really happen in the most unusual ways!!”

Joni mentions a miracle. If your are looking for the miracle that Joni is talking
about, it is the one which brought her together with the knowledge of what to do.
You too, now have that miracle. It is in the words which are before you at this
moment.

The real secret to Joni’s success was just plain hard work. Since everything
else had failed to help her, she threw herself into the exercises with a vengence.
Like all the others I asked about their success, Joni still practices, as of this
writing, her breathing as she learned in the group.

Susan

Susan is one of those people who succeeded right away. Susan was never in
formal treatment with me for her panic attacks. She only heard me talk in a
group of people ONE TIME about hyperventilation syndrome and was unable
to come to succeeding weeks of the group in a mental health center because of
vacation plans with her husband.

Mostly I’m going to let her tell her own story as it came to me in a letter a few
months after she returned from her vacation and reported her success.

She wrote:

I am so happy with the results of learning how to breath
diaphragmatically. I wanted to share my experience. It has changed
my life for the better.

I have been a sufferer of panic attacks for over three years. I have
tried everything. I have been to doctors, had all kinds of tests, even
been into urgent care a few times. All they would tell me is that it
was stress. I finally got so that I could go through life as long as I
had my tranquilizers. But I would still experience panic, feel dizzy,
sick, out of control and worst of all a feeling like was loosing my
mind. The only thing that sort of worked for me was to take Ativan
and not do all the things in life that I really wanted to do.
It was while I was at a meeting in Redlands that I met Dr.
Anderson. I was very interested in what he was telling us about
diaphragmatic breathing. It made so much sense, I decided to give
it a GOOD try.

I first started by diaphragmatic breathing before I got out of bed in
the morning. I noticed that I seemed to feel less shaky and more
calm right away. At the time I was on the highest dosage of Ativan
that I had ever taken.

My family was planning a vacation so I took [the time] to practice
my breathing. Every time I could I would practice. By the end of my
vacation I had cut my medication down by two- thirds. I kept
breathing diaphragmatically every time I would think about myself
and how I was feeling, which is pretty often when you suffer from
panic disorder.

When I returned to work, the stress returned too. But breathing
really helped. It really works! I did not want to go back on
medication.

I have had a few panic attacks since. But I try to catch it early. I
know this is hard. But there are signs of stress coming. I also know
after breathing diaphragmatically at least three times I could feel
the panic lift. And the best feeling of all is the feeling that I am in
control again.

I have been totally off medication now for one month. I am thrilled.
I have even been tested pretty good — a trip to the dentist. I just
kept up the diaphragmatic breathing. I really believe in
diaphragmatic breathing. It has changed my life for the better.

Sincerely,

Susan H.

The wonderful thing about Susan’s letter is that she carefully spells out the
steps everyone who suffers from panic attacks should take. As spelled out in
more detail in the remainder of this book, these steps are:

  • Decide to give it a GOOD try.
  • Practice diaphragmatic breathing before getting out of bed in the morning.
  • Practice several times during the day.
  • Begin cutting back on your tranquilizing medication right away. But with the help of your doctor.
  • Use inner cues to remind you to practice breathing.
  • Stay off medication even when the stress increases. Continue to use diaphragmatic breathing.
  • Become aware of the early signs and see how a few breaths will do the trick in turning the symptoms around.

There is a follow up to Susan’s letter several months later which came in
response to my inquiry. She notes that she has the same ability to control
attacks as when “treatment ended” and that she doesn’t have panic attacks
now. Thinking of others, she wrote as follows:

A person needs to stop and think at the first sign of panic what
might be triggering the attack and breathe to slow down the
increasing panic.

Since the TENDENCY to have panic attacks may remain for some time after
the skills of controlling them have been mastered, it is important, as Susan
found on her own, to stay aware of early signs and breath to stop the symptoms.

All of the former patient’s who responded to my questionaire about their
success noted that they continued to practice breathing as a way of controlling
their tendency to have attacks.

COMMON SENSE SUGGESTIONS TO HELP YOU SUCCEED

Be Willing To Take One Step At A Time

No, I won’t say, “Rome wasn’t . . . .”, but I will say that like a lot of things, what
might seem simple at the outset turns into something requiring persistence in
the long run. As you’ve seen, Hyperventilation Syndrome is a complicated
interaction of many things. Several things must be brought together in order to
gain control and live without attacks.

You don’t have to learn “perfect” diaphragmatic breathing to be able to go on
to the next step, but you should be able to mostly do it when you are thinking
about it before taking the next step. So give yourself some time and reward
yourself for a little progress at a time.

Learn To Work Within Your Limitations

For many people, having panic attacks and the fears and phobias which go with
them is severly disabling. They have a lot of limitations which have been built
up over the years.

Working within your limitations means that you will practice at those times you
feel best. If that’s not very good, then accept it as your best time and do what
you can. Go slowly, if you’re in this situation, it’s been a very long time since
you felt anything close to normal.

The same applies to medications. What’s good about them is that they allow you
to function, at least somewhat. You can taper off the medications that you now
take when you have gained some skills to recognize and control attacks. Right
now, the medications provide a window of opportunity which is helpful.

Don’t Ignore The Spiritual Part Of This Problem

When Joni and I would rap about the struggles which she went through and how
panic attacks became the focus on her life, we both recognized the after
breathing, a Twelve Step program such as used by Alcoholic Anonymous would
be helpful.

Breathing will stop panic attacks just like stopping drinking will lead to sobriety.
Like the alcoholic, many panic attack victims suffer the consequences in terms
of personal isolation, having to manipulate others to get their way, and being
fearful of life in general. Don’t overlook the self help groups available to you
and the spiritual teachings of your religion to help you with these attendant
problems.

“Spirit” and “air” mean the same thing. To inspire means to take in air or
spirit, to expire means to let go of air or spirit.
The physical fact that we all live
together in a world filled with air, taking that air into our bodies several times
each minute and giving it back again to the universe has spiritual meaning. No
wonder breathing and being spiritual were seen by ancient people as closely
related. Even today, in some religious traditions, right breathing is understood
as an essential part of the spiritual life.

There is something else which comes to mind when I think of the problems
faced by people who suffer from panic disorder. This comes from my own
religous beliefs. It is “The pearl of great price.” To obtain it, the finder has to
go and sell everything that he has in order to obtain the pearl. There was no
way to play it entirely safe. He or she had to take the risk.

How easy it is to play it safe. To stay at home. To do nothing. There must be
some pushing at the boundaries which this problem imposes. But it must be a
right pushing. To push too hard to function at a high level right away is one
error. To not push at all or be willing to persevere will lead to no solution at all.
Carefully follow the instructions outlined ahead. The Pearl of Great Price is
freedom. Freedom from panic attacks and all the limitations which they have
placed on your life for so long.

Chapter II: “Panic and Hyperventilation Syndrome”

What is contained in this book is a new. It will teach you a way to control and overcome panic attacks which is not yet widely known. It is what I teach people who come to me who are overwhelmed by daily, weekly or monthly attacks which are sometimes so terrible they think they are dying, going crazy or will do something horrible.

People who suffer from panic attacks can’t come up with enough words to describe to others how out of control they feel when an attack “hits”. They feel overcome by some lurking inner madness which periodically reveals itself. They live in fear of the next
attack, but also know that sooner or later they will be overcome just as if someone crept up behind them and put a black sack over their head, drew a tight cord around their neck and left them to struggle for air until they could claw the sack off and, exhausted, be free for awhile until caught once more.

Recently I attended a lecture on Panic Attacks presented by a psychiatrist. When he
began the presentation he asked the people in the audience how many of them had ever experienced a panic attack. A scattering of hands went up. He then admitted that he had also suffered from these attacks. At the end of the lecture, when asked to pin-point the actual cause of the attacks, he did not have a ready answer.

This book does have an answer to the question, “Where do Panic Attacks come from?” Is it the right answer? Researchers don’t yet agree. It’s a simple question, but the answer, I’m afraid, is far from simple.

There is, however, one very good thing about the answer which is given in this book. The treatment based on that answer works for people who seriously try it. Most are able to completely prevent panic attacks from occuring. All but a small percentage are able to be in control and reduce the intensity of attacks, and prevent most of their attacks altogether.

I have been counseling people with emotional problems for over 25 years. Like 99.9% of my colleagues, I was as confounded by the problems of people who sought out my help for their panic and the numerous fears and other problems which accompany this condition.

Just like many other physical and emotional problems, panic attacks probably are not caused by any one thing, or for that matter cured by any one thing. Also, people who experience panic attacks for any length of time become fearful (phobic), learn to avoid any situation where the attacks might be triggered or where they can’t get help. Other reactions to getting safely through life develop to, some of which are very disabling in themselves.


Panic sufferers have to look at a three step process that goes like this:

triggerdiagram

THE PRE-CONDITIONS

The conditions or situations which set-up the eventual victim of panic attacks may
be multiple. Being an anxious person? Stress? (Many panic attack victims are told by the emergency room doctor that it’s just their reaction to stress.) Diet? Bad breathing habits? Grief? A bad heart? Being a perfectionist? Unique brain chemistry? Tight girdles like women wore in the 1890’s, or too- tight designer jeans nowdays?

All of the above have been implicated as possible existing conditions which make the person vulnerable to panic attacks.

THE TRIGGERS

There is some “thing” which triggers panic attacks. It might be an anxious thought or an anxiety producing situation. As I was making the notes to write this section I was sitting at the kitchen on a warm summer morning with the back door open, our Golden Retriever laying nose-on-paws looking languidly into the sunshine. Suddenly, without any warning, he was on his feet, rushing out the open doorway, barking loudly. I jumped in my chair in
reaction, saw it was nothing and went back to my notes. For some people with the right preconditions, that might have been more than enough to start a sequence which would sooner or later lead to a panic attack.

Panic attacks are not preconditions or triggers. In the frame of reference of this book,
the panic attack will come to be understood as something which comes about because of preconditions and triggers, but which can be treated by itself. As you will see in a few pages, attacks are undoubtedly physiological reactions, over which, when we know how, we have a lot of control.

FEARS AND COPING REACTIONS

The fears, anxiety, phobias, social isolation, need to control others and even ritualized obsessive-compulsive behaviors are the most destructive part of the panic attack cycle. Increased anxiety is to be expected at the very least. Anxiety, remember is one of the pre-conditions. In this way the cycle of preconditions, triggers, attacks and fears-anxiety are kept going.

People who have experienced attacks for any length of time usually consider themselves to be anxious people. But is anxiety the chicken or the egg? Was it a precondition which existed before the person ever had an attack? Or, is it the result of having been through emotionally wrenching experiences time and again, sometimes for years or decades? As you will see, it may easily be a result rather than a cause.

Now let’s begin to look at some examples which makes all the theory understandable.

JOHN

John was a patient who was referred to me to undergo therapy to help him with intense anxiety. His managerial job forced him to make presentations at meetings and before groups. At these times his panic became so intense, he was ready to quit his job. After John left my office, I reached for a new professional book which had just arrived in the mail. I opened it and began to read to see if there was anything new that would help me understand how to help my new patient. I was fascinated. The author of one of the chapters, Richard Ley, described John’s problem exactly.

Lay’s article was titled, “Panic Disorder, a Hyperventilation Explanation.” It became clear that John hyperventilated and that led to his feelings of panic when he was called on to lead a meeting or talk to groups. He had begun to fear these attacks so much, he was willing even to quit his job to avoid being put in this position.

The Pre-existing condition for John was that he was, by now, habitually anxious because he good reason to fear a panic attack. He had developed that fear from the time he had the first attack. The pre-condition of the first attack probably was a faulty breathing pattern and not some underlying psychological condition.

The Trigger was knowing that he had to make a presentation or lead a meeting. John had come to fear the fear. His anxious breathing pattern was keeping him on the edge of hyperventilation and the Trigger was enough to push him into apprehension and finally Panic-Fear.

John’s Coping Reaction was to protect himself from the Trigger. He had decided he would quit his managerial job and go into another line of work This was an instance when Science had finally caught up with a problem. Good science rarely makes startling discoveries. Ley had not “discovered” hyperventilation. His article contained an extensive bibliography of papers and books.

Many people who write today about panic attacks go back to an original scientific article titled, “Hyperventilation, The Tip of the Iceberg,” written by Dr. C. M. Lum in the late 1970’s. Over 2,000 patients had been admitted into his program at Papworth and Addenbrook’s Hospitals in Cambridge, England, by the mid 1980’s. 95% of these patients were not only helped, most were cured.

After thirty years and 2,000 patients, Doctor Lum concluded that “faulty breathing”
perhaps along with being a perfectionist if you were a woman or a “Type A” if were a
man, was the real root cause of hyperventilation and panic. After many years of faulty
breathing —> anxiety —> hyperventilation —> panic, you can hardly be blamed for
thinking of yourself as “anxious”. By now “anxious” has gotten to be a habit.

TRACY

It was late in the day when a frantic mother called about her daughter. She had been
having a panic attack for most of the day. She had gone into convulsions, the mother told me. They were afraid of going one more time to the emergency room of the local
hospital. The doctors were definitely not sympathetic. Traci had been there more than once previously. A few weeks before, she was so agitated that she had been given injections of a powerful tranquilizer before she could calm down. She was told that unless she was able to get control of herself the sheriff would be called and she would be taken to the psych ward of our County Hospital. The tranquilizer affected her speech and she was uncoordinated
from the effect of the medication when I saw her four days later.

When mother and daughter got to my office, Traci was gasping for air, she could hardly walk and the muscles in her face were twitching. Her eyes were glazed over from fear and exhaustion and her pupils were dilated. She was unable to concentrate on anything for more than a few seconds, and that made helping her very difficult. What she needed was to get control of her breathing. Little by little, I helped her slow down and deepen her breathing. After
an hour, she was weak but calm. She had gained moderate control.

The panic had passed.

In the throes of a Panic Attack, people usually experience difficulty breathing. Usually,
the breathlessness is thought to be caused by the attack. It is one of the many recognized symptoms of an attack. What is unrecognized is that actual symptoms of panic attacks are brought on by the way the person normally breathes. The breathlessness and gasping experienced during an attack is an extension of a problem which began very quietly and unawarely.

When Tracy first visited my office to begin her training in controlling the attacks, I could not see her breath at all. When I attached a stretch band around her abdomen and put some sensors on her neck and shoulders, all connected to a computer, I could then see her breathing. Only when I looked at the computer screen and saw the graph that was being made from what was being picked up by the sensors. Her breathing was shallow, rapid, erratic, and
she was using only the muscles in her neck and upper chest. Her abdomen wasn’t moving at all. She was breathing at a rate of 22 breaths per minute, about twice as fast as is considered “normal”.

Tracy, like other victims of panic attacks, shows all the characteristics of
hyperventilation syndrome which were recognized by C. M. Lum. Here’s the list of
breathing abnormalities:

They take air into their lungs by using their chest muscles.

They don’t use, or only partly use their diaphragm when breathing.

They usually breath rapidly and shallowly, so it is hard to see them breath unless
they sigh or are requested to take a deep breath.

HABITUAL rapid, shallow breathing (something of which the victim is usually not
aware) keeps the important level of carbon dioxide too low all of the time.

Panic Attacks are triggered by anything which results in more rapid breathing and
drops the carbon dioxide level below a critical point, causing increased
apprehension leading to panic-fear symptoms.

A person is said to hyperventilate when the way they are breathing results in them
loosing carbon dioxide from their blood faster than it is being manufactured by the
body.

THE CRITICAL ACID/BASE BALANCE (pH) OF THE BODY

What most people don’t know, is that breathing is what regulates the acid/base balance of the body. The amount of air we inhale and exhale is continually adjusting by the needs of the body to maintain a constant point on the scale between acidity and alkalinity. What the amount of carbon-dioxide we exhale has to do with the acid/base balance (base and alkali mean the same thing) is that when carbon dioxide is dissolved in water it makes the water
more acid. Since the blood and the human body is 70% water, the right amount of carbon dioxide is essential to maintaining that balance at just exactly the right level.

Maybe you can see that this discussion is already getting too technical. Unfortunately, for the understanding of the people who have panic attacks, it can get a lot more technical.

Here’s a summary of what you should know:

The right amount of carbon dioxide manufactured by the body remains dissolved in
the blood before it is eliminated by breathing.

It is the amount of carbon-dioxide dissolved in the blood which regulates the
acid/base level.

The acid/alkali balance of the blood is, normally, very slightly alkaline.

A slight shift either in the direction of the blood becoming too acid or becoming too
alkaline can have serious consequences.
The consequences can be, and too often are, panic attacks.

WHAT HAPPENS DURING PANIC ATTACKS

Panic attack sufferers are most interested in what happens in the body when too much carbon-dioxide is breathed away and the blood becomes too alkaline.
Just to put it as simply as possible, the following are effected as the blood becomes more alkaline, a condition known as “blood alkalosis.”

THE BRAIN: Breathing control centers are effected along with the panic
victim’s ability to think clearly. As the condition worsens, the brain
processes information from the body too rapidly or not at all. Wrong signals
or none at all are given as the brain shifts into “emergency”. Clear thinking
stops altogether.

THE SYMPATHETIC AND PARASYMPATHETIC NERVOUS SYSTEM:
Adrenaline is discharged into the system, pupils tend to dilate, hands and
feet get cold, and there is a tendency to sweat.

THE HEART: Reduction of the oxygen supply to the muscles of the heart,
changes in the electrocardiogram, increase in heart rate, and increased
blood output by the heart. Blood pressure may be affected (in either
direction) to the point of causing the person to faint, a condition called
Syncope.

THE OXYGEN TRANSPORT SYSTEM: The red blood corpuscles give up
their oxygen to the muscles and organs of the body, including the brain, less
easily. Starved of oxygen, the person feels weak, confused and, rightly, feels
like they are suffocating.

That’s probably more than enough to convince you that when the blood alkalosis gets
serious, you are going to experience that a great deal is wrong. For more information on
any or all of these points, there is a Bibliography of the references mentioned in this
chapter which can be consulted for more complete information.

SUMMARY OF WHAT CAUSES PANIC ATTACKS

Panic attacks and Hyperventilation Syndrome are two terms for the same thing.

Over-breathing creates a shift in the acid/alkaline balance of body in the direction
of being too alkaline.

The physiological and mental consequences of the brain, breathing, heart and
oxygen carrying capacity of the blood and what results from all that are, in reality,
what we call “Panic Attack!”

THE MEDICAL APPROACH TO PANIC ATTACKS

In spite of decades of research and successful treatment programs, your physician
probably doesn’t yet know about the promise which the methods discussed in this book hold out for you. A paper published in New England Journal of Medicine which focused on the increased risk of suicide among people who suffer from Panic Disorder did not mention hyperventilation or suggest treatment protocols which utilize this explanation for the symptoms.

Probably the reason that the medical profession is not up to speed when it comes to
treating panic attacks, is that virually all medical practice for this disorder is focused on which drugs will do the job. Books written my medical doctors for people who have panic attacks, enthusiastically focus on the advances in drug therapy. The treatments used by those who have studied Hyperventilation Syndrome have nothing to do with drugs.

There are problems with some medications most used by physicians to treat panic
attacks. They are physically addicting after a very short time. The side effects bother
many people. And they interfere with the ability to learn or recall what you have learned.

THE STEPS TO OVERCOMING PANIC ATTACKS

The methods for overcoming panic attacks which are detailed in coming chapters are not the invention of any one single person, but have evolved over the years. These methods are based on observations, research and clinical practice which has taken place in hospitals, universities and the practices of many disciplines.

Now that you have been introduced to what is causing the symptoms which you
experience and call “panic attacks”, it is time to get down to how you breathe now, how
you should breathe to prevent panic attacks, and what to do to train yourself to do
exactly that.

These are the steps as presented in the chapters to come:

CORRECT BREATHING, HOW YOU BREATH NOW, BEGINNING TO CHANGE

While you are practicing the beginning exercises, talk to your doctor about how to
reduce medication particularly if you are using any anti-anxiety medication known as
benzodiazapines.”

WARNING: Don’t discontinue any medication without your doctor’s advice.
Some drugs require supervised withdrawal in order to avoid withdrawal reactions such as seizures.

By now most people feel a little more in control. But it’s not enough to overcome panic attacks. The next chapter will tell you how to:


PRACTICE DIAPHRAGMATIC BREATHING AWARENESS

Now it’s time to read about integrating what you’ve learned into your lifestyle. The next chapter is about:

INTEGRATING BREATHING WITH MOVEMENT & EXERCISE

By now your Panic Attacks will be under control and perhaps even gone forever. It’s
time to concentrate on:

LOWERING STRESS: GOOD HABITS OF HEALTH AND RELAXATION

THE RISKS OF GETTING WELL

It wouldn’t be fair to you to not warn you about some risks in undertaking the training in this book. Other than the strictly medical problems mentioned in the CAUTION AND RESPONSIBILITY section, there is a risk that you might temporarily increase your hyperventilation symptoms in the beginning.

It is impossible to foresee every eventuality for everyone who reads these pages and
decides to “give it a go.” Although learning diaphragmatic breathing is learning to
breath as we are meant to naturally, in the beginning it may feel very unnatural. If, due
to practicing something new, you start into anxiety or panic symptoms, stop practicing for that day. Come back to it tomorrow. You’ll probably be able to handle it a little better.

There is one more risk which most people don’t anticipate. If you have suffered from
Panic Attacks for several years, you will have the problem of returning to a normal,
non-anxious lifestyle. For this on-line publication, that is a chapter yet to be written. In
the meantime be content to take one day at a time. The next chapter will get you started on observing your breathing patterns and beginning to change.

chapter three

CORRECT BREATHING. HOW YOU BREATH NOW. BEGINNING TO CHANGE

“Breathe in, breathe out!” The first time I heard this was as a young man from an old doctor who liked to relax his patients with corny jokes while he was preparing an injection. “Do you want to know how to live forever?” he said. “Sure,” I naively took the bait. “Breathe in, breathe out,” he said. “As long as you keep breathing in and out you can’t die.”

Some thirty years later I heard the same words again from another doctor, a Ph.D., who is in the forefront of developing a learning model of retraining people to breathe. The “diploma” which Dr. Erik Peper gives patients and professionals who attend his workshops in breathing is titled, “Breathe In, Breathe Out.”

The sequence and types of exercises in the pages to come are because of Erik Peper’s carefully done research over many years. The specifics, however, are the result of my helping people who suffer from panic attacks.

“BREATHE IN, BREATHE OUT” KNOWING HOW WE BREATHE

The old doctor’s joke wasn’t so silly, because it implied that we have control over our own breathing. Unlike our heart beat, it’s easy to take a breath when we want to or to blow out the birthday candles just when we’re ready. We very consciously take a deep breath and blow hard. Most of the time, though, our breathing is on automatic and we don’t have to think about it. It is likely that we humans have breathing problems because of this part-time
conscious control over our breathing. So we can easily learn to adjust or modify our breathing just as singers, actors and instrument players do. The problems come when we teach ourselves the wrong things, which at the moment don’t have bad effects, but eventually they become bad habits which create the symptoms of anxiety.

The information and instructions which follow are for the purpose of overcoming bad breathing habits. So now it’s time to take a close look at how breathing is “supposed” to be done from an anatomical standpoint.

THE ANATOMY OF NORMAL BREATHING

Although the lungs are a complex maize of air passages and minute air sacks (alveoli) through which an even more complex mesh of arteries, capillaries and veins is intertwined, they (there are two, one on each side of the chest) can be thought of for our purposes as balloons. The balloons are emptied and filled not because of their own actions, but by the actions of the entire torso which encloses the lungs.

Breathing takes place through the air passages leading from the nose and mouth into the lungs. Although the bronchial tubes and lungs are lined with smooth muscles which regulate the flow of air, these are not the muscles with with we breathe.

The chest and ribs which are attached to the spine in the back and the breast bone in the front comprise a somewhat flexible cage in which the heart and lungs are enclosed. The chest cage is narrower at the top, and the neck occupies the opening at the top.

Of particular interest to us is the wide bottom of the
chest cage. The bottom ribs are no longer connected to
the rigid breast bone, but are connected by pliable
cartilage. Attached to the bottom edges of the wide
cage, from front to back is a muscle called the
diaphragm. It is shaped like an inverted bowl or funnel.
Through the middle of the bowl (or neck of the funnel)
run the blood vessels from and back to the heart which
supplies blood to the abdominal organs and lower
limbs. The esophagus on the way to the stomach and
major nerves come through the same area.

The diaphragm muscle should be the main muscle of
breathing, because where it is located in the body it has
the most room to move in a piston-like fashion. Below it are the
soft organs and the belly which
when a deep breath is needed can expand outward. Above it are
the lungs, which are also soft and pliable.

The easiest way to understand how the diaphragm works is to make a relaxed inverted bowl with the tips of your fingers just interlocking.

With your fingers still interconnected, tense your hands and wrists, and, if your doing it right, you’ll see the bowl flatten down. That’s almost exactly how the diaphragm works. When it’s relaxed, the bowl is most bowl-like. To use the piston illustration, the piston is up when the diaphragm is relaxed. It is pushing up on the soft and pliable lungs, and the air in the lungs is forced out — exhaled.

The inhale is of course, the opposite. The diaphragm contracts, just like your fingers and flattens out. That brings the piston down, creating more space in the cage. Air, naturally, is the only thing that can fill the space, so it moves into the lungs, filling them.

Other parts of the body also assist in breathing. If you tighten and pull in your stomach, you push more out of your lungs because you put pressure on the underside of the diaphragm-piston. If you let your stomach pooch out, it gives the diaphragm more room to move down into the area of the soft organs, and more air can be taken in.

But the muscles between the ribs all up and down the chest, especially those between the more flexible lower ribs, can also work so as to make the rib cage bigger. Air comes in, again because there is more space to fill. Even the muscles of the neck, shoulders and upper back assist in the breathing process.

When running hard or doing aerobic exercises, the idea is to breathe hard — to inhale and exhale a lot of air. The more air the body needs, the more of the various breathing muscles go into action to create more space for breathing.

The volume of the lungs is quite phenomenal when breathing is correct. The diaphragm can move up and down as much as six inches. In the process it gently massages the lower organs and aids in the blood’s return to the heart. A large person can have a capacity of five quarts. Even a small adult can breathe in two or more quarts of air.

HABITUAL DIAPRAGMATIC BREATHING

When resting the right way to breathe is with relaxed shoulders, upper chest and stomach muscles, allowing the diapragm and lower rib muscles to carry on the automatic breathing process. When breathing in this way, the body will continually adjust the volume and breathing rate as needed to maintain the acid/base balance of the blood and other factors. Eight to twelves breaths per minute is normal breathing rate.

HABITUAL THORACIC (CHEST) BREATHING

Many, and that may mean most, people breathe in a slightly abnormal fashion. They tend to hold their stomach in all the time, make little use of the diaphragm and breathe mostly with the muscles of the upper chest, neck and shoulders. This style of breathing becomes automatic also and the body adjusts volume and rate as it does in diaphragmatic breathing.

Thoracic breathing, because it depends on the more rigid system of muscle action in the chest and shoulder area, means that the lungs are given less room to expand or contract. As breath volume is lowered, in order for the body to maintain it’s chemical balance, breathing must be speeded up. Probably, most people who habitually breathe mostly with their chest and shoulders will never have panic attacks. Others, however, will.

My own observations of the breathing of panic attack patients confirm what other researchers have discovered, people who have panic attacks chest-breathe. Their resting breathing rate has speeded up to twenty to thirty shallow breaths per minute. They will also try to compensate by sighing frequently, sometimes as often as two or three times a minute. Sighing is likely the result of the small air sacks not being expanded, and the sigh allows enough
air deeper into the lungs to keep the alveoli and airways open. When sighing, or taking a deep breath, it can be observed that
the chest-breather appears to lift the entire chest up away from the diaphragm, thereby creating more space in the chest cage, rather than allowing the diaphragm to pull the air in.

THE GOALS OF BREATHING RE-TRAINING

In order to control panic attacks you will need to become aware of the way you breathe enough so you can begin to switch from chest breathing to diaphragmatic breathing.


THE GOAL IS TO LEARN DEEP, RELAXED, SLOW, DIAPHRAGMATIC BREATHING, EVEN WHEN YOU’RE NOT THINKING ABOUT IT.

You do not have to perfectly reach this goal in order to feel that you can control an attack. Is all you have to accomplish to get that kind of control is to mostly breathe diaphragmatically and slowly when you are thinking about it. It’s a downhill battle from there.

LEARNING TO BREATH WITH THE DIAPHRAGM

Please read the materials about diaphragmatic and thoracic breathing patterns. Be sure you are clear about the following:

How rapid, chest breathing relates to a condition known as “hypocapnia”, the root source of symptoms of panic attacks.

The mechanics of breathing: What the body does in order to get air into the lungs and out again, so another breath may be taken, and so on.

As you know, people who have panic attacks breath in a particular way. This way of breathing seems very natural, and even when demonstrated, its hard for them to believe that there is another way of breathing. It is so hard to believe, that you just have to “give it a good try”, because the only way you’ll really believe it is when you have learned to breath correctly and are able to control your panic attack symptoms.

Give yourself some room to make mistakes. In your trying, you may try too hard and provoke some panic symptoms. This is good only because it help proves the point, breathing is the problem. Its not good, of course, because no one wants to have more or worse attacks.


Important points to remember during these exercises.

PRACTICE WHEN YOU ARE FEELING AT YOUR BEST. YOUR BEST MAY
NOT BE VERY GOOD, BUT THAT’S O.K. THE POINT IS THAT IN THE
BEGINNING THIS IS PRACTICE SO THAT LATER YOU CAN GAIN
CONTROL. DON’T TRY TO CONTROL PANIC ATTACK SYMPTOMS NOW.
RIGHT NOW YOU ARE LEARNING TO CATCH THE BALL, NOT PLAY
BASEBALL. O.K.?

IF YOU START TO HAVE SYMPTOMS DURING ANY EXERCISE, NOW OR
IN THE FUTURE, STOP DOING THE EXERCISE. USE THE EMERGENCY
MEASURES TO CONTROL YOUR SYMPTOMS THE BEST YOU CAN. GET
YOUR MIND OFF YOUR BREATHING AND COME BACK TO IT LATER IN
THE DAY.

THIS IS SO IMPORTANT! IF YOU ARE PHOBIC ABOUT OTHER THINGS,
AND YOU ALLOW SYMPTOMS TO BUILD DURING BREATHING
EXERCISES, YOU’LL SOON BE PHOBIC ABOUT THE EXERCISES AND
NOT WANT TO DO THEM. THAT WOULD BE ONE MORE FAILURE, AND
YOU AND I WANT THESE EXERCISES TO BE A SUCCESS.

ITS BETTER TO WORK WITH THE EXERCISES FOR JUST A FEW
MINUTES NOW AND INCREASE YOUR TIME LATER AS YOU DEVELOP
TOLERANCE FOR WORKING WITH YOUR BREATHING. ALWAYS STAY
IN THE WINDOW OF YOUR TOLERANCE. THE WINDOW WILL GET
BIGGER AS YOU PRACTICE.

You’ll soon learn that whenever you think about your breathing you change it.

Don’t expect to catch yourself breathing rapidly. All the exercises anticipate that
you will change your breathing when you pay attention to it.
Exercise 1 Checking your current breathing mechanics.

For this exercise you will want to use the LOG OF BREATHING PATTERN It will help you if you print this log out right now so you can follow it as you continue to read this text.

Wear loose comfortable clothing. No tight belts or pantyhose around your middle to
restrict your breathing.

Sit upright in a chair.

Place your left hand on your breast bone, just under the notch of the neck. Your hand will go across your chest so your left palm is laying on the left of center, and your fingers on the right. Relax your hand, don’t press.

Place your right hand across your abdomen in the area between the bottom of the
breastbone and navel. Don’t press down. Relax.

Breath normally. As you do this, see which hand moves, or if they both move up and down as you breathe.

Take a few deeper than normal breathes. Take at least one breathe taking in as much air as you can. (More than one or two breathes could start panic attack symptoms. Be careful!) What you’re looking for:

THORACIC BREATHING: Your left hand on your chest only will move up and down
when you breathe. Your right hand will stay still.

REVERSE BREATHING: Harder to detect When you breathe in your left hand will
move up and your right hand will move down or in. It’s “reversed” because you pull your stomach in as you breath in, just the opposite of what you want to do.

COMBINED BREATHING: Your right and left hand both move up or out when you
breath in, and down or in when you breath out.

SHALLOW BREATHING: Although your breathing is under control while you are
doing these test exercises, you can detect shallow breathing.

LABORED BREATHING: When you take a deep breathe, you have to strain your
upper chest, neck and shoulders to get the air into your lungs.

RECORD THE RESULTS OF THIS TEST EXERCISE ON YOUR RECORD SHEET.

All of these breathing patterns are related to thoracic styles of breathing and are typical of the way people breath who have panic attacks or anxiety.
Exercise 2 Checking for other breathing habits. The very first time you ever read this paragraph is the check for an important breathing habit. It is “not breathing”. Are you not breathing or holding your breathe as you’re reading this? At the same time you can check yourself for two other breathing habits.

What you’re looking for:

NOT BREATHING: When you pay attention to something, start to do something, even
to read this, do you stop breathing?


SIGHING:
Do you notice a tendency to sigh frequently? By frequently, that means
perhaps a few times every minute.


YAWNING:
Do you yawn every so often? How often?


RECORD WHAT YOU OBSERVE ABOUT
YOUR BREATHING HABITS ON THE
RECORD FORM.

Not breathing, sighing and yawning are also typical of the breathing patterns of people with panic and anxiety. They are probably ways of compensating for imbalances caused by shallow, thoracic breathing.

EXERCISE #7 Verbal Reward for the Progress You’ve Made

If you’ve made progress, give yourself a verbal reward: “Nice going.” “I did it.” “I knew I could do it!” “I can’t wait to write about this on the record form.”

If you don’t feel you succeeded, don’t put yourself down. Encourage yourself instead by saying: “Rome wasn’t built in a day. I’ll keep trying until I get it.” “Try, try again.” “No one ever did it perfect the first time, why should I expect that of myself. I’ll relax now and try again tomorrow.”

If you do that, say those things to yourself and believe them, then you’ve assuredly have made progress. There’s just as much of a change which needs to take place mentally as there is physically.

Many people have gained control of their panic symptoms having read on-line no further than the Introduction and the three chapters of “How to Treat Your Own Panic Disorder.” You can practice the diaphragmatic breathing exercises described above for the next few weeks without further instruction. You may find that you can gain partial or complete control over panic attacks by doing so.

The next chapter to be brought on-line will be Chapter IV: DAILY PRACTICE IN
BREATHING AWARENESS. As the materials in this chapter are still being organized it may be awhile before you find this material on the site. You might try again after two weeks of practicing what you have already learned.


Emergency Measures

EMERGENCY MEASURES TO CONTROL PANIC
SYMPTOMS

Prepare for using these EMERGENCY MEASURES by printing
out these instructions and putting them where you can easily find
them the next time you have symptoms.


Take steps to control a panic attack as soon as you feel it coming
on.
The longer you wait, the worse it gets, and all the harder to get
control of upward spiral of the symptoms. You can use the
following suggestions in order or choose which are right for you at
any particular moment:


Exercise.
Go for a short brisk walk or use a treadmill or
exercise cycle. While you’re walking or exercising, breathe
as deeply as you can rather than allowing yourself to
breathe faster.

Distract Yourself. Try not to think about your symptoms .
For instance, while walking, look at the scenery, listen for
the sounds around you, say hello to the people who you pass
on the way. Talk to someone. Become aware of your
breathing. Splash cool water on your face.

Massage Your Neck. The carotid artery, which leads to the
brain, when massaged, causes a reflex slowing of your heart
beat. You can feel your pulse from the artery by pressing in
just below the angle of the jaw. Gently massage one side at
a time. Do this while sitting in a comfortable chair or laying
back.

Slow Your Breathing

1. Use the sweep second hand of a
watch to help you get control of your breathing. If your
tendency to breathe is faster than 10 breaths per minute (3
seconds inhale and 3 seconds exhale) you are breathing too
fast. Watching the second hand, slow your breathing
gradually to 3 seconds for each inhale and 3 seconds for
each exhale. Try to breathe so your stomach pooches out.
As you relax, extend the length of time to 4 seconds, then to
5.

Slow Your Breathing II. Use the above technique, but hold
your breath on the inhale for a count of 4. Slowly inhale and
hold your breath, count to yourself 1,2,3,4, then slowly
exhale. Don’t gasp for air but inhale as slowly as you can
and exhale in the same way.

If your symptoms return, don’t get discouraged. It only means that
you have allowed your breathing to speed up again, probably
without knowing it. Each time you succeed in slowing your
breathing and lessening your symptoms using these techniques,
you move closer to your goal of controlling your panic attacks
altogether.

Log of breathing pattern Date________________________ EXERCISE 1 Observing faulty breathing patterns With your left hand on your breastbone and right hand on your abdomen just below the ribs, check breathing pattern as instructed. Observe breathing pattern and check appropriate spaces below: _____All thoracic (chest) breathing _____Reverse breathing _____Combined, part diaphragm, part chest breathing _____Shallow breathing _____Labored breathing EXERCISE 2 Checking for other breathing habits. _____Stop breathing _____Sighing _____Yawning EXERCISE 3 First Steps to Learning Diaphragmantic Breathing Write down your experiences as you practice converting to diaphragmatic breathing while laying down: Does it help to have another person monitor your breathing by placing a hand on your abdomen? YES NO (circle one) Does stretching your arms back above your head help you to use your diaphragm more? Comment:


EXERCISE 4 Stretching arms over head to increase diaphragmatic breath volume.

If another person is available have them gently place their hands over your lower ribs on each side of your body. If you Diaphragmatic Breathe they’ll feel your ribs widen slightly. What do you experience with this exercise?

EXERCISE 5 Using a book as a reminder to continue Diaphragmatic Breathing

Place the book on your abdomen while laying down and practice raising and lowering the book as you breathe.

EXERCISE 6 Practice Diaphragmatic Breathing while laying on your
stomach.

Stretch your arms over your head. Do you feel your abdomen press against the floor as you breathe? It’s O.K. to skip this exercise if you find it too uncomfortable. What do you experience in this position?

EXERCISE 7 Verbal Reward for the progress you’ve made.

Don’t forget the last part of these series of exercises. Reinforce the positive things you have done by telling yourself how well you’ve done.

by Bert Anderson, Ph.D.
Dearest Note: Anxiety, panic attacks and depression are common complaints during the menopause transition. Hormones and nerves all out of whack and your symptoms are all VERY REAL and often very frightening.

Don’t let *anyone* tell you otherwise — not even your doctor. Many of them know only enough about menopause to fill a thimble. And what’s worse, they make you feel like an irrational, emotionally crippled, crazy woman and dismiss you with their, “It’s just your nerves. Here, take this pill and you’ll feel better” — not unlike patting a child on the head and giving him a lollipop. Doctors probably have a few hours (if that much) of lectures about menopause during medical school – a few hours on a major health issue that often impacts every nuance of a woman’s life for 10-15 years. The medical school required curriculum needs serious overhauling.

I hope those of you who made it to the end of this article have done so without having a panic attack from the length of it.

I hope you’ve found it helpful. I recommend reading the transcript of Dr. Bert Anderson’s Guest Chat.

In Memory   1 comment

Please leave your happy memories and condolences in the comments section.

Thanks!

Posted October 5, 2013 by MaryO in In Memory

Tagged with , ,

Anxiety And Meditation   3 comments

bronwynchatby Bronwyn Fox, Power Surge’s Anxiety/Panic Attack Expert”

One of the most common questions we are asked is:

“I am taking medication and/or I am seeing a therapist, but is there anything else I can do to help me recover ?

And the answer is, “Yes! There is.”

The basis of our self help techniques is :

Mindfulness Meditation

Why Meditation?

Because meditation is a fantastic self help technique involving both a relaxation technique and a cognitive technique.

Meditation was how Bronwyn recovered in 1985. Since then Bronwyn has taught thousands and thousands of people with an anxiety disorder to meditate. Bronwyn’s book ‘Power over Panic’ which describes and teaches meditation is a best seller in Australia and her Panic Anxiety Management Workshops won an Australian and New Zealand Mental Health Award.

We use meditation in a non spiritual / non religious way

And we use it in a number of different ways:

  • as a relaxation technique
  • to teach people mindfulness /awareness skills
  • to learn how not to attach to, or empower thoughts which create panic and anxiety
  • as an exposure method to dissociative states including depersonalisation and derealisation
  • as an exposure method for letting go of the need to be in control and/or fighting the panic attack and/or anxiety

This is then transferred over into every day life as a Mindfulness based cognitive technique :

People are taught to:

  • become mindful/aware of their panic/anxiety producing thoughts during the day
  • become aware of the intimate relationship between their thoughts and their symptoms
  • become aware of any tendency to dissociate

This assists people:

  • in seeing how many of their fears and symptoms are being created by the way they think
  • to see they have a choice in what they think about
  • to learn not to attach to or empower their thoughts
  • to learn how to manage and control their thoughts
  • to learn to let go of the need to fight their panic attacks and/or anxiety
  • to learn to let their panic attacks and anxiety happen without resistance
  • to be aware of and manage any personal tendency to dissociate

Many people tell us they can’t relax, that they have never been able to relax. Part of the reason why people can’t relax is that they are too frightened to let go of their overall need to be in control. Or as people do begin to relax they become fearful of the sensations of their body relaxing. The meditation technique we use is specifically designed for people with an anxiety disorder and assists people in being able to learn to let go of the control and to learn to accept the sensations of their body relaxing with out fear.

How does meditation differ from progressive muscle relaxation? Most other relaxation techniques focus on relaxing the body first. Meditation focuses on the mind and the body relaxes naturally as a result.

How does our Mindfulness technique differ from other cognitive techniques? Other cognitive techniques, while being very effective, don’t emphasis the ongoing awareness of thought patterns in the way a mindfulness technique does. Using a mindfulness technique means we can begin to see how it is not just our obvious thoughts, ‘what if I have a heart attack, go insane, lose control, make a fool of myself’ etc that are creating our anxiety and panic. Mindfulness shows us how our low self esteem also impacts on us and how our thoughts about ourselves and the way we interact with other people also perpetuates our anxiety and panic.

It helps us become aware of how we constantly get hooked into feeling guilty about 1001 different situations, how our perfectionist behaviour impacts in our lives. How our need to be ‘all things to all people’ creates so much of our underlying anxiety. Once we are aware of all that we are unknowingly doing to ourselves, Mindfulness then teaches us and shows us that we can have a choice in what we think about and in how we live our lives. Other cognitive techniques usually do not go into as much subtle detail as the mindfulness techniques.

Other cognitive techniques involve changing our thoughts eg the thought…’what if the doctor has made a mistake. What if there is really something wrong with me that they have overlooked’. With cognitive therapy you would be asked to look at this thought and find a more reality based thought..i.e.

“I have seen two different doctors and a cardiologist. All the tests results from each doctor and the cardiologist show there is nothing physically wrong with me.’ and/or ‘ I have been feeling like this now for ‘X’ amount of months, years, if there was something wrong with me I would know it for sure by now..and so would the doctors!”

Mindfulness differs from this approach in so far as the technique doesn’t involve finding a more reality based thought. Mindfulness teaches the reality! With a mindfulness technique people begin to see the intimate relationship between their thought patterns and how this creates their anxiety and panic.

Once we are aware of this relationship we begin to lose our various fears because we can see, step by step, how it is being created. If we dissociate it teaches us to see how this happens and how our thoughts about it create the panic and anxiety.

As we practice Mindfulness we begin to realise that we do have a choice in what we think about. Using the mindfulness technique we can then exercise this choice!

Bronwyn Fox is the author of

  • Power Over Panic: Freedom From Panic/Anxiety Related Disorders
  • and the The 2nd edition, Power Over Panic
  • plus “Working through Panic: Your Step-by-Step Guide to Overcoming Panic/Anxiety Related Disorders” (which you can get on Bronwyn’s Web site
  • and finally, the wonderful audio cassette, Anxiety Panic: Taking Back the Power

Missing You   19 comments

Part of this I wrote already on the About Page:

This site is a labor of love.

My best friend and “sister”, Alice aka Dearest, was the founder of Power Surge – first on America Online, then as a free-standing site for over 20 years. We were best friends for about 18 of those years, talking about every other day for 2-3 hours at a time.

The day of Alice’s funeral, we had a beautiful butterfly just waiting outside the door when I took our dog out.

I have never seen a butterfly like this – no one here in Virginia has seen anything like this either and I never saw it again. It just sat there on the flower pot and “posed” for this picture. I like to think it was Alice saying goodbye to me.

alices-butterfly

It’s several weeks later and I’ve been given Power Surge.  I don’t know if I’ll be able to keep it going or not.  Certainly, it will never be as special a place as it was with Alice at the helm.

I look around the house and see things that remind me of Alice.  Gifts, print outs, silly stuff, memories, the entire AOL message boards on floppy disks…

Alice, I love you and will miss you always…

MaryOOneRose

Posted October 5, 2013 by MaryO in In Memory

Tagged with , , , , , , ,

Dry Skin and Menopause   2 comments

Tips For Midlife Dry Skin Issues
by Dearest

Many women at menopause suffer from dry skin problems. I’ve tried everything including the most expensive and promising creams by Lancome, Elizabeth Arden, Estee Lauder — even a cream called — “Very Emollient Cream” by Clinique. The bottom line with moisturizers is that they CAN’T ADD MOISTURE to your skin. What they do is KEEP IN the moisture that’s already there and my question becomes, if it’s not already there, what’s to keep in?

The bottom line is to drink lots of water! Also, keep oil in your diet.

Some of my favorite products for cleansing and moisturizing have water as their #1 ingredient — they are aqueous products. Aqueous simply means that it’s made from, or by means of, water. Water is the most important moisture we need in our bodies, not just applied externally. That’s why drinking as much water as possible is the most helpful thing you can do for your skin externally and your body’s organs internally. If you look at many skin preparations, water is listed almost at the top of the list of ingredients.

You can also start adding oil to your diet. During the menopausal years, our bodies become depleted of oils. You can take a Tbsp of any of the “good” oils, such as canola, safflower, sunflower, olive and swallow it, add it to your salad, or cook with it. Don’t be afraid of oils. This is not the time of life to deprive yourself of oil in your diet. Go to the recommendations page and read about Omega-3 oils and flaxseed oil and how important they are — not only to your heart and general health, but for your skin.

Aquafor is an excellent product for dry skin — probably good because its #1 ingredient is petrolatum, aka vaseline. The only negative about petrolatum products is obvious – they can feel greasy. If you use a petrolatum-based cream, separate a tissue and use 1/2 to gently blot the skin. An excellent product for dry, patchy areas – that you can carry in your purse and apply any time and there’s no greasy residue is Lubriderm’s Advanced Therapy Creamy Lotion for Extra Dry Skin. It’s inexpensive and lubricates nicely. Lubriderm makes excellent products for dry skin. There’s also Moisturel for hands and body. I don’t use any of these for the entire face, but just certain dry, scaly, patchy areas. Another excellent cream is Cetaphil.

Look for products containing at least one of these ingredients fairly high on the list: petrolatum, water, lanolin, and/or mineral oil. Another excellent product for very dry skin is Eucerin. Their original moisturizing cream or their dry skin therapy plus intensive repair cream.

A REALLY IMPORTANT TIP: After cleaning your face, leave a little of the water on your skin — and then apply the moisturizer while your skin is still damp.

I wash my face with an Aqueous Cream, which I found in England. What I like about an aqueous cleanser is that I can rinse it off with water and it still leaves my skin feeling dewy and clean. Many women don’t care for cleansing creams because they feel greasy even after you tissue off the remaining residue. There are cleansing creams you can either tissue or wash off. One of them is Adrienne Arpel’s Signature Club A’s various Meltdown creams. However, there are many good cleansing creams available. There are other aqueous cleansers, such as Cetaphil Gentle Skin Cleanser.

During perimenopause, I developed dry skin on both sides of my nose, under my eyebrows and on my chin. What I’ve found helps more than anything else is regularly using an exfoliant to peel away the layers of dry, dead skin. I regularly use a gentle Buf-Puff around those dry areas. A product helpful for these areas, and for anti-aging, is called Olay’s Regenerist cream or lotion. You’ll pay almost $20.00 for it in a retail store. I bought 3 bottles for under $30.00 on Ebay. I, personally, prefer the creamy lotion to the cream.

Among my favorite products for skin are those by Adrienne Arpel. She’s been around for many years and is one of the nation’s leading skin experts. In fact, I remember having a skin analysis done by HER at Macy’s years ago. She used to appear at the various department stores demonstrating her products. I’ve never seen a savvier businesswoman in my life. Her skin products are the only thing I’ve ever bought from Home Shopping Network on cable TV. They also they have a Web site. Her products are called “Signature Club A” by Adriene Arpel under HSN. I especially like her Five Essentials Face Cream with Retinol and Alpha Hydroxy and her Advanced Formula – Five Essentials Face Cream with Vinoplex and Grape Polyphenols. At the top of each container of cream is an eye formula as well. I also use her Alpha Hydroxy and Retinol Soft Scrub with Vanilla Bean, which is also an exfoliant. It’s an excellent exfoliant containing little microbeads that clean away dry/dead skin.

Another good exfoliant is Neutrogena’s New Deep Clean Gentle Scrub. It does a nice job exfoliating and the beads are large and powerful (unlike Olay’s exfoliant). I realize you can fill your house with thousands of these products until you find the best ones, which is why I’m sharing the names of those I’ve found that work best.

For dry and normal skin, after using a good cleanser, you should use a toner — even if the dryness is around the mouth. A toner will set the ph of your skin back to the proper balance and make it more receptive to the moisturizer you’re going to apply and at midlife, women really need a good skin moisturizer.

You can also use an exfoliant on your hands. They’re great for making your hands look less dry and, therefore, younger. Take a look at your hands right now. See the small dry lines and how much older they look then they did a few years ago? That’s aging. Exfoliants can work wonders. I use Olay’s Regenerist Cream on my hands and forearms every day.

I’ve also used Lancome creams for years. I started 25 years ago with Progres Cream, which is no longer available. Now that I’m in my 50’s, an excellent Lancome moisturizer is called Renergie – Double Performance Treatment, Anti-wrinkle and Firming Cream. Your skin feels incredibly dewy and soft. If you purchase it in a department store, such as Macy’s, Bloomingdale’s or Nordstrom, the cost for a 1.7 oz. jar is approximately $70.00. I’ve purchased it on Ebay for less than half the retail cost.

It’s important to alternate skin care products and shampoos periodically since our skin and hair have a tendency to become immune to them after a while, and they lose their effectiveness. I recommend alternating the products you use. Also, avoid any shampoo that says “detergent” on it.

For severely dry skin and chapped lips, someone recommended a product called Bag Balm. Believe it or not, Bag Balm is primarily used to keep a cow’s udders moist. While doing some research on the product, I was astonished at how many people used it on their skin. When I’ve developed severely chapped lips that haven’t been helped by the traditional Chap Stick or Blistex, Bag Balm has worked.

Needless to say, continual and/or severe dry skin problems should be looked at by a dermatologist. Dry skin can also come from various medications, from not enough water and/or lubrication in the body and, of course, from low estrogen levels. If skin problems persist, or are aggravated by the use of OTC preparations and creams, see a dermatologist. Dry, patchy, scaly skin could be indicative of any number of health issues including anxiety (yes, anxiety can cause dry skin), allergies, eczema, psoriasis, seborrhea, rosacea and many other skin disorders for which there are numerous OTC and prescription creams.

Important Tips for Midlife/Menopausal Skin:

  • Drink plenty of water (at least 5 – 8 oz. glasses a day)
  • Incorporate *healthy oils* into your diet
  • Cleanse your skin morning and night
  • Avoid soaps, especially deodorant soaps
  • Apply moisturizer morning and night
  • Avoid too much sun exposure
  • Wear sunscreen with at least an SPF25 whenever possible
  • Try to avoid stress
  • Other options for skin improvement: Soy Protein / Isoflavones
    and natural, plant-derived bioidentical hormones.

Polycystic Ovarian Syndrome (PCOS)   1 comment

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS is a health problem that can affect a womanís menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance. Women with PCOS have these characteristics:

  • high levels of male hormones, also called androgens
  • an irregular or no menstrual cycle
  • may or may not have many small cysts in their ovaries. Cysts are fluid-filled sacs.

PCOS is the most common hormonal reproductive problem in women of childbearing age.

How many women have Polycystic Ovarian Syndrome (PCOS)?

An estimated five to 10 percent of women of childbearing age have PCOS.

What causes Polycystic Ovarian Syndrome (PCOS)?

No one knows the exact cause of PCOS. Women with PCOS frequently have a mother or sister with PCOS. But there is not yet enough evidence to say there is a genetic link to this disorder. Many women with PCOS have a weight problem. So researchers are looking at the relationship between PCOS and the body’s ability to make insulin. Insulin is a hormone that regulates the change of sugar, starches, and other food into energy for the body’s use or for storage. Since some women with PCOS make too much insulin, it’s possible that the ovaries react by making too many male hormones, called androgens. This can lead to acne, excessive hair growth, weight gain, and ovulation problems.

Why do women with Polycystic Ovarian Syndrome (PCOS) have trouble with their menstrual cycle?

The ovaries are two small organs, one on each side of a woman’s uterus. A woman’s ovaries have follicles, which are tiny sacs filled with liquid that hold the eggs. These sacs are also called cysts. Each month about 20 eggs start to mature, but usually only one becomes dominant. As the one egg grows, the follicle accumulates fluid in it. When that egg matures, the follicle breaks open to release the egg so it can travel through the fallopian tube for fertilization. When the single egg leaves the follicle, ovulation takes place.

In women with PCOS, the ovary doesn’t make all of the hormones it needs for any of the eggs to fully mature. They may start to grow and accumulate fluid. But no one egg becomes large enough. Instead, some may remain as cysts. Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a womanís menstrual cycle is irregular or absent. Also, the cysts produce male hormones, which continue to prevent ovulation.

What are the symptoms of Polycystic Ovarian Syndrome (PCOS)?

These are some of the symptoms of PCOS:

  • infrequent menstrual periods, no menstrual periods, and/or irregular bleeding
  • infertility or inability to get pregnant because of not ovulating
  • increased growth of hair on the face, chest, stomach, back, thumbs, or toes
  • acne, oily skin, or dandruff
  • pelvic pain
  • weight gain or obesity, usually carrying extra weight around the waist
  • type 2 diabetes
  • high cholesterol
  • high blood pressure
  • male-pattern baldness or thinning hair
  • patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs
  • skin tags, or tiny excess flaps of skin in the armpits or neck area
  • sleep apnea – excessive snoring and breathing stops at times while asleep

What tests are used to diagnose Polycystic Ovarian Syndrome (PCOS)?

There is no single test to diagnose PCOS. Your doctor will take a medical history, perform a physical examópossibly including an ultrasound, check your hormone levels, and measure glucose, or sugar levels, in the blood. If you are producing too many male hormones, the doctor will make sure itís from PCOS. At the physical exam the doctor will want to evaluate the areas of increased hair growth, so try to allow the natural hair growth for a few days before the visit. During a pelvic exam, the ovaries may be enlarged or swollen by the increased number of small cysts. This can be seen more easily by vaginal ultrasound, or screening, to examine the ovaries for cysts and the endometrium. The endometrium is the lining of the uterus. The uterine lining may become thicker if there has not been a regular period.

 

How is Polycystic Ovarian Syndrome (PCOS) treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatments are based on the symptoms each patient is having and whether she wants to conceive or needs contraception. Below are descriptions of treatments used for PCOS.

Birth control pills. For women who donít want to become pregnant, birth control pills can regulate menstrual cycles, reduce male hormone levels, and help to clear acne. However, the birth control pill does not cure PCOS. The menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone, like Provera, to regulate the menstrual cycle and prevent endometrial problems. But progesterone alone does not help reduce acne and hair growth.

Diabetes Medications. The medicine, Metformin, also called Glucophage, which is used to treat type 2 diabetes, also helps with PCOS symptoms. Metformin affects the way insulin regulates glucose and decreases the testosterone production. Abnormal hair growth will slow down and ovulation may return after a few months of use. These medications will not cause a person to become diabetic.

Fertility Medications. The main fertility problem for women with PCOS is the lack of ovulation. Even so, her husbandís sperm count should be checked and her tubes checked to make sure they are open before fertility medications are used. Clomiphene (pills) and Gonadotropins (shots) can be used to stimulate the ovary to ovulate. PCOS patients are at increased risk for multiple births when using these medications. In vitro Fertilization (IVF) is sometimes recommended to control the chance of having triplets or more. Metformin can be taken with fertility medications and helps to make PCOS women ovulate on lower doses of medication.

Medicine for increased hair growth or extra male hormones. If a woman is not trying to get pregnant there are some other medicines that may reduce hair growth. Spironolactone is a blood pressure medicine that has been shown to decrease the male hormoneís effect on hair. Propecia, a medicine taken by men for hair loss, is another medication that blocks this effect. Both of these medicines can affect the development of a male fetus and should not be taken if pregnancy is possible. Other non-medical treatments such as electrolysis or laser hair removal are effective at getting rid of hair. A woman with PCOS can also take hormonal treatment to keep new hair from growing.

Surgery. Although it is not recommended as the first course of treatment, surgery called ovarian drilling is available to induce ovulation. The doctor makes a very small incision above or below the navel, and inserts a small instrument that acts like a telescope into the abdomen. This is called laparoscopy. The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But these effects may only last a few months. This treatment doesn’t help with increased hair growth and loss of scalp hair.

A healthy weight. Maintaining a healthy weight is another way women can help manage PCOS. Since obesity is common with PCOS, a healthy diet and physical activity help maintain a healthy weight, which will help the body lower glucose levels, use insulin more efficiently, and may help restore a normal period. Even loss of 10% of her body weight can help make a woman’s cycle more regular.

How does Polycystic Ovarian Syndrome (PCOS) affect a woman while pregnant?

There appears to be a higher rate of miscarriage, gestational diabetes, pregnancy-induced high blood pressure, and premature delivery in women with PCOS. Researchers are studying how the medicine, metformin, prevents or reduces the chances of having these problems while pregnant, in addition to looking at how the drug lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.

No one yet knows if metformin is safe for pregnant women. Because the drug crosses the placenta, doctors are concerned that the baby could be affected by the drug. Research is ongoing.

Does Polycystic Ovarian Syndrome (PCOS) put women at risk for other conditions?

Women with PCOS can be at an increased risk for developing several other conditions. Irregular menstrual periods and the absence of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Without progesterone, which causes the endometrium to shed each month as a menstrual period, the endometrium becomes thick, which can cause heavy bleeding or irregular bleeding. Eventually, this can lead to endometrial hyperplasia or cancer. Women with PCOS are also at higher risk for diabetes, high cholesterol, high blood pressure, and heart disease. Getting the symptoms under control at an earlier age may help to reduce this risk.

Does Polycystic Ovarian Syndrome (PCOS) change at menopause?

Researchers are looking at how male hormone levels change as women with PCOS grow older. They think that as women reach menopause, ovarian function changes and the menstrual cycle may become more normal. But even with falling male hormone levels, excessive hair growth continues, and male pattern baldness or thinning hair gets worse after menopause.

Menopause and Migraine Headache, What are they and how can they be treated?   Leave a comment

MIGRAINE HEADACHE

What is it?

A common symptom of perimenopause is increased headaches and often debilitating migraines.

A migraine headache is a recurrent, throbbing headache generally felt on one side of the head. Migraines usually begin in early childhood, adolescence, or young adult life.

What causes it?

Migraines are caused by a rapid widening and narrowing of blood vessel walls in the brain and head. This causes the pain fibers in the blood vessel wall to become irritated. Blood vessels in the scalp are often involved. The following items and events (precipitants) have been reported to cause migraine attacks:

  • Hunger
  • Cheese
  • Changes in weather
  • Nuts
  • Fatigue
  • Avocados
  • Oral contraceptives
  • Chocolate
  • Menstrual periods
  • Menopause
  • Foods cured with nitrates (e.g., hot dogs)
  • Emotional stress
  • Meat tenderizers (e.g., MSG)
  • Alcoholic beverages.
  • It is not known why some individuals have migraines and others do not.

What are its common symptoms?

There are many forms of migraine headaches. The classic migraine and the common migraine are the two main types:

CLASSIC MIGRAINES — There is usually a warning (aura or prodrome) of an approaching headache attack. Eyesight may suddenly change. Bright spots or zigzag lines are seen. Many people experience double vision or temporary, partial blindness. The change in eyesight is often followed by numbness and tingling of the lips, face, hands (on one or both sides), weakness of an arm or leg, dizziness, unsteadiness in walking, drowsiness, slight confusion of thinking, and inability to speak or slurred speech. Any given person may have only one or a few of these symptoms, and they tend to occur in the same combination in each attack. The symptoms may last for 5 to 15 minutes or more. As these symptoms disappear, a throbbing headache begins on one side of the head. The severity of the headache builds. Once the headache becomes very painful, people often have nausea, vomiting, and sensitivity to light and noise.

COMMON MIGRAINES — A throbbing headache begins suddenly without warning of an attack. The location of the headache varies. The pain may be on both sides of the head, or it may shift from side to side. Nausea, vomiting, and sensitivity to light and noise usually accompany the headache. Children who have migraines experience mostly common migraines and, therefore, do not have any warning. In addition to the headache, some children experience abdominal pain, which gets better after vomiting.

Is it contagious?

No.

How long will it last?

Migraines can last from a few hours up to several days.

How is it treated?

Treatment for this problem consists of two important parts:

  1. What you can do, and
  2. What your health care provider can do.

What can you do?

There are many measures you can try to reduce the pain :

  1. Some people find relief by applying heat to the area of the head where the pain is most severe. Apply heat in the form of a dry towel warmed in the oven or use a heating pad set on a low setting. Other people gain relief by applying an ice bag wrapped in a towel to the painful area.
  2. Lying down in a dark, quiet room at the first sign of an attack may also decrease the pain.
  3. Many people find a relaxation technique helpful when they are lying down.
    Concentrate on a soothing thought or image and take slow, deep breaths.
  4. Dearest Recommendations: Try breathing into a small paper bag when in the throes of a migraine, or when you feel one coming on. The paper bag cuts down on the oxygen (organ stimulant), and increases the carbon dioxide intake during inhalation (organ relaxant). Inhale/Exhale for about 30 seconds to one minute. It has served me well during severe headaches/migraines, as well as during anxiety ridden moments – such as holiday shoppingAnother recommendation for treating migraines is to take 500 mg. of magnesium at the first onset of a migraine.
  5. Record on a calendar the date of the migraine, the time it started and ended, and the amount of medication you took. Remember to bring this record with you on follow-up visits to your health care provider. It will help in your treatment.

What can your health care provider do?

Medications are needed by some individuals. Your health care provider may prescribe one or more of the following medications.

  • Analgesics — These medications reduce the pain of a migraine.
  • Ergotamine preparations — These medications interfere with the widening of the blood vessels in the head and decrease the pain of migraines. Note: To enable your body to use most of the medication, it is important to take the medicine at the first sign of an attack. Special arrangements are necessary for school-age children to allow them to take the needed medicine in school.
  • Other medications — Biofeedback is another method being used successfully by some people to reduce migraine attacks and their severity. Your health care provider may refer you to a specialist in biofeedback therapy.

Can you prevent it?

Because migraine headaches may recur for years and constant use of medication can lead to serious side effects, prevention is a key aspect in the management of migraines:

  1. Pay close attention to your diet. See if a migraine can be prevented by avoiding certain foods (e.g., nuts, cheese, avocados, chocolate, bacon, ham, hot dogs, cold cuts) and tenderizers used in food preparation. If hunger precipitates a migraine, eat frequent small meals on a regular basis. Women who have migraines just prior to their menstrual period should lower the salt in their diet. This helps to decrease water retention associated with precipitating attacks. Avoid alcoholic beverages. Alcohol causes the blood vessels in the body to widen, which contributes to the pain of migraines.
  2. If stress or emotional conflict triggers the onset of a migraine, it is important to find ways to reduce the stress in your life. Regular exercise (e.g., walking, biking, swimming) and relaxation techniques (e.g., yoga, meditation) may help you. Exercise and relaxation not only reduce stress but, in addition, decrease the severity of the pain and frequency of the headaches. A trained counselor can be helpful in providing assistance to identify stresses in your life and to make suggestions to resolve the problems.
  3. A regular schedule for sleep is necessary if fatigue precipitates attacks.
  4. Fatigue may become exaggerated at times of weather change.
  5. Women with a history of migraine headaches should avoid oral contraceptives. Your health care provider can suggest alternative forms of birth control.

Common myths

It is a myth that only women get migraines. Men do suffer from migraine headaches. However, migraines occur in women about four times as often as in men. It is also a myth that all bad headaches are migraines. There are many causes for headaches. A tension headache can be as painful as a migraine. People who have head pain should have a medical evaluation.

Follow-up

It is important to return for your follow-up care as advised.

Resources

Call your local community center, YMHA, YWCA, or adult education program for information about classes in yoga, meditation, aerobic dance, or other exercise classes. A community mental health center can assist in an evaluation for stress and make a referral to a counselor for you.

Remember…..Notify your health care provider if you have any of the following:

  • Headaches that last longer than 2 days
  • More than 3 migraine attacks in 1 month
  • Warning symptoms of a headache that do not disappear when the headache begins
  • Marked change in the severity of the headache
  • Questions concerning the symptoms you are experiencing

Reference:

  1. Shamansky, S., Cecere, M. C., & Shellenberger, E. (1984). Primary Health
  2. Care Handbook: Guidelines for Patient Education. Boston: Little, Brown & Co.
  3. This information has been provided to you via Med Help International (a non-profit organization).

Posted October 5, 2013 by MaryO in Educate Yourself

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