EIA, medication and effect on heartrate
Per Elmsäter
quite a relief to find out why I was the only one almost suffocating after
hard sprints on our club bicycle rides. I'd always wondered how the other
riders could talk to each other going uphill etc. All of a sudden when I
started medicating all of this changed. I didn't feel like suffocating, my
windpipes were quiet, I could continue a conversation with the rider next to
me when we climbed a hill etc. Life was wonderful.
My medication is an inhaler called Bricanyl ( Terbutaline )
http://www.astrazeneca.com/productbrowse/6_90.aspx
GOTO SUMMARY if you can't handle detailed description ;)
I didn't notice any side effects at all except that the very first time I
took it my HR ( heart rate ) went up to more than 95% of HRmax on a training
ride that wasn't real intense. It felt OK so I didn't think much about it.
The next ride my HR was back to normal. Ie expected bpm.
However as the season progressed I started riding more and more and also
taking my inhaler more and more. Maybe 5-8 rides a week. About midseason I
noticed my HR never could make it above 80% of HRmax. That was annoying
especially in places where I needed to go all out and usually would have a
HR of very close to HRmax. I quit taking my medication for exactly one week
and soon my HR was back to normal, even when I medicated after exactly one
week. I held off another week and then medicated again on a fast club ride.
Dang there my HR went up to almost HRmax again ( where it wasn't expected
to ) and I still didn't have any Power left for the sprint.
:SUMMARY
So what I'm wondering is. Has anybody else experienced that their medication
affects their Heart Rate? Would this be symptomatic of Terbutaline? If so
what other kind of medications are there to consider. If there is anybody
else out there with EIA I'd really appreciate hearing from you and how you
handle the sports you are involved in.
One reason I'm asking here is that my Doctor doesn't seem very interested in
helping me find a good solution to this. I always have the feeling that he
thinks this is some kind of luxury problem. Like I'm probably three times as
fit and healthy as most of his patients and I shouldn't even bother him. It
might not be like that, but that's the impression I get. I hear many people
almost dying have the same complaints ;-))
Thankful for any and all feedback
--
Perre
Merlin
medication for these kinds of problems comes with hidden cost.
If you consider that you have a sensitivity problem of some kind which
is exacerbated by extremes of body behaviour including extremes of
blood circulation and thermal skin sensitivity/dissipation then it may
well be better to consider how that sensitivity might be reduced
naturally, rather than masking the problem medically.
Reducing the situation where the bloodflow is most extreme or reducing
any possible causes of sensitisation needs more consideration.
Do you have any idea if any substances are involved with your problem,
if so what forms of avoidance might you have considered?
In that you mention cycling when the problem occurs easiest, we are
obviously discussing roads and possibly vehicle exhaust problems and
those things associated with petroleum substances.
Have you considered this kind of area?
Do you have any inherent congestion retention?
Do you feel any kind of dopiness when the problem occurs?
Do you have other stress or extreme emotive kinds of problems?
Do you find that you are excessively prone to viral kinds of things in
comparison to others?
I am not a medical person but do have an interest in how these things
happen and often can suggest ideas to help address the problem.
Cheers, Merlin.
Per Elmsäter
I wish I could find an external reason for this, but so far nothing has
clicked.
Ever since I was young I've had these problems when exercising hard, I just
didn't know it was EIA. People would just comment like. Wow you really are a
fighter, or , Dang you really go all out.
As for cycling. I live in Sweden, northern Europe which is probably one of
the few places not *badly* polluted yet. Our bicycle rides are done on small
rural roads with next to no traffic on them. At home just walking up the two
flights of stairs to my apartment leaves me breathless for a couple of
minutes. Enough so that I cannot talk. This doesn't make sense since I'm
very fit. Like I'll place in the top 500 out of 17000 on a 300 km long
bicycle race, with a time of 9 hours 20 minutes.
When not exercising I seem to have no asthmatic problems. The only other
respiratory problem I have is that I can seldom use my nostrils for
breathing except when sitting absolutely still. As soon as I start even
walking around the house I have to breath through my nose.
In the wintertime I use a heat exchange mouth piece when exercising outside.
That has helped me immensely and winter is no longer a torture. Like my
lungs and windpipes would hurt for days after a mid winter training session
before I found this mask.
http://www.lungplus.se/
I of course have also medicated at the same time.
I've tried not medicating on my training rides lately, just during races. It
kind of works but I cannot go all out on my training rides. Have to hold
back or I'll screw up my windpipes again. This will eventually cause loss of
form, which feels not so good, especially considering all that time I put
into training.
--
Perre
I gave up on SPAM and redirected it to hotmail instead.
NorthShoreCEO
"Per Elmsäter" <per...@hotmail.com> wrote in message
news:3N6Ze.34599$d5.1...@newsb.telia.net...
>
> I wish I could find an external reason for this, but so far
> nothing has
> clicked.
> Ever since I was young I've had these problems when exercising
> hard, I just
> didn't know it was EIA. People would just comment like. Wow you
> really are a
> fighter, or , Dang you really go all out.
> As for cycling. I live in Sweden, northern Europe which is
> probably one of
> the few places not *badly* polluted yet. Our bicycle rides are
> done on small
> rural roads with next to no traffic on them. At home just
> walking up the two
> flights of stairs to my apartment leaves me breathless for a
> couple of
> minutes. Enough so that I cannot talk. This doesn't make sense
> since I'm
> very fit. Like I'll place in the top 500 out of 17000 on a 300
> km long
> bicycle race, with a time of 9 hours 20 minutes.
You're confusing having a disease with being fit. Some of our
greatest athletes in the U.S. have asthma.
> When not exercising I seem to have no asthmatic problems. The
> only other
> respiratory problem I have is that I can seldom use my nostrils
> for
> breathing except when sitting absolutely still.
Why are you looking for an external reason for having exercise
induced asthma, but not looking for a reason you can't breathe
through your nostrils? That's not normal. If you can't breathe
through your nostrils, something is wrong. Time to see a doctor
and have xrays and cat scans to determine what's going on. This
alone may be contributing to your problem.
As soon as I start even
> walking around the house I have to breath through my nose.
I'm assuming you meant to type "....I have to breathe through my
mouth", is that correct? Again, that's not normal.
> In the wintertime I use a heat exchange mouth piece when
> exercising outside.
> That has helped me immensely and winter is no longer a torture.
> Like my
> lungs and windpipes would hurt for days after a mid winter
> training session
> before I found this mask.
> http://www.lungplus.se/
> I of course have also medicated at the same time.
>
> I've tried not medicating on my training rides lately, just
> during races. It
> kind of works but I cannot go all out on my training rides.
> Have to hold
> back or I'll screw up my windpipes again. This will eventually
> cause loss of
> form, which feels not so good, especially considering all that
> time I put
> into training.
>
>
> --
> Perre
> I gave up on SPAM and redirected it to hotmail instead.
>
>
It's not safe to exercise without taking medication if you have
any form of asthma. Bricanyl, something I remember taking a
hundred years ago when I was younger and had asthma, may not be
the best medication for you - but it sounds like your doctor
isn't very compassionate or helpful, based on things you
previously posted. I would either challenge his attitude or
find a new doctor. And your should definitely pursue having your
sinuses checked.
Per Elmsäter
> "Per Elmsäter" <per...@hotmail.com> wrote in message
> news:3N6Ze.34599$d5.1...@newsb.telia.net...
>>
Since this post is getting a bit long now. I've pasted the very last lines
up here. As I find them most important. However the rest of the post
contains interspersed comments.
> find a new doctor. And your should definitely pursue having your
> sinuses checked.
Sinuses? How could they be involved in this? I do have Sinusitis every three
or four years. Bad enough so I have to take penicillin. I feel my sinuses
pretty constantly though.
>> I wish I could find an external reason for this, but so far
>> nothing has
>> clicked.
>> Ever since I was young I've had these problems when exercising
>> hard, I just
>> didn't know it was EIA. People would just comment like. Wow you
>> really are a
>> fighter, or , Dang you really go all out.
>> As for cycling. I live in Sweden, northern Europe which is
>> probably one of
>> the few places not *badly* polluted yet. Our bicycle rides are
>> done on small
>> rural roads with next to no traffic on them. At home just
>> walking up the two
>> flights of stairs to my apartment leaves me breathless for a
>> couple of
>> minutes. Enough so that I cannot talk. This doesn't make sense
>> since I'm
>> very fit. Like I'll place in the top 500 out of 17000 on a 300
>> km long
>> bicycle race, with a time of 9 hours 20 minutes.
>
>
> You're confusing having a disease with being fit. Some of our
> greatest athletes in the U.S. have asthma.
>
No I'm not confusing these two things, probably just a bit unclear. What I
was trying to say was that at the level of fitness I'm at I shouldn't react
this way going up two flights of stairs without having a disease. And the
reason I said it was probably because I was trying to show that it had
nothing to do with air pollution ;) As I see it.
>
>
>> When not exercising I seem to have no asthmatic problems. The
>> only other
>> respiratory problem I have is that I can seldom use my nostrils
>> for
>> breathing except when sitting absolutely still.
>
>
> Why are you looking for an external reason for having exercise
> induced asthma, but not looking for a reason you can't breathe
> through your nostrils? That's not normal. If you can't breathe
> through your nostrils, something is wrong. Time to see a doctor
> and have xrays and cat scans to determine what's going on. This
> alone may be contributing to your problem.
>
I've had surgery already where they straightened out my nostrils after a car
crash many years ago. But still many years after I was starting to have
respiratory problems when exercising heavily.
>
> As soon as I start even
>> walking around the house I have to breath through my nose.
>
>
> I'm assuming you meant to type "....I have to breathe through my
> mouth", is that correct? Again, that's not normal.
>
Of course. Speed writing on my part. And the reason I wrote it is because I
also don't think it's normal.
Sinuses? How could they be involved in this? I do have Sinusitis every three
or four years. Bad enough so I have to take penicillin. I feel my sinuses
pretty constantly though.
00doc
> Last year I was diagnosed as having EIA Exercise Induced Asthma. It was
> quite a relief to find out why I was the only one almost suffocating after
Terbutaline (also known as Brethine in the US) is a beta agonist similar to
albuterol (aka salmeterol in Europe). It is a derivative of epinephrine (aka
adrenaline) that is supposed to stimulate the receptors in the lungs more
than the receptors in the heart. As you are discovering there is some
cross-reactivity and the drug can make the heart race. Different people have
different sensitivities to this effect. So the direct answer to your
question is that this is a common side effect of the drug. One possible
solution would be to try just using one puff (I'm assuming you are using the
usual dose of two).
While the heart racing is not unusual and easily explained I'm not sure why
you would have the trouble with not being able to raise your heart rate
later on. With constant exposure to beta agonists cells do downregulate the
beta receptors and become less responsive to stimulation (called
tachyphylaxis) but that usually takes much more than what you are taking.
Again, maybe you are just particularly sensitive. If you stay on the
medication and are having this it might be interesting to have an EKG done
and make sure there is no element of heartblock but I'm clutching at straws
there.
Other possible medication solutions would be to try salmeterol to see if you
don't have a better time with it. You could also try a mast cell stabilizer
(like Intal/cromolyn or Tilade/ nedocromil). These don't work as fast or as
well as albuterol in preventing EIA and they are not dilators so they have
no role in treating attacks and you will still want to carry a rescue
inhaler like terbulatine or salmeterol for when you start to wheeze. They
have fallen somewhat out of favor but used to be widely used for
pretreatment in EIA and do have some effectiveness and should not affect
your heart. You also might want to see if going on regular doses of an
inhaled steroid (or nedocromil) might just take the whole thing away.
Another dilator that is usually used more in emphysema but may help and
shouldn't affect the heart so much is Atrovent (ipatropium).
Non-medical things to try include wearing the mask to warm the air as cold
air is another similar trigger to EIA and does make it worse. Also having a
brief warm-up, to the point of just starting to tighten, and then resting
for about 30 minutes can put you in a refractory period where the EIA does
not return.
As for the sinuses: There are several ways that they can be contributing.
Air that goes through the nose is warmed, moistened, and filtered and not as
likely to trigger EIA as air through the mouth. I know that you will not be
able to strictly nose breath during all out hills no matter how clear your
nose is but the more you can breath through the nose the better.
An open nose just plain lets more air in.
Post nasal drip can irritate the larynx and make the airway more
hyperresponsive. The nasal mucosa is similar to and continuous with the
respiratory mucosa. Many people think that treating inflammation there
(usually with an nasal steroid or an antihistamine - or anitbiotics in the
case of an infection) helps with asthma.
--
00doc
Per Elmsäter
> "Per Elmsäter" <per...@hotmail.com> wrote in message
> news:EHWYe.34555$d5.1...@newsb.telia.net...
>> Last year I was diagnosed as having EIA Exercise Induced Asthma. It
>> was quite a relief to find out why I was the only one almost
>> suffocating after hard sprints on our club bicycle rides. .....
>
Thanks for your thorough reply 00 ;)
You've given me lots of things to think about and some angles to pursue
further.
Good to know that the abnormally high HR is a known side effect. My own
personal theory is that the medication speeds up overtraining symptoms. The
symptom of not being able to raise the heart rate is typical of overtraining
and goes away with resting. This has happened but I've also lightened up on
my medication. I don't think I was overtrained but my body started to act up
like it was. At the moment I have gone down to one puff as you mentioned,
still has my heart racing though. Also trying to only use it twice a week.
However that leaves me with a lot of unmedicated riding and I will look into
alternatives, including finding a new doctor.
Yes a thorough warm-up is more or less a must for me, medicated or not.
Richard Friedel
For me a little asthma drug at a rate of about one can a year was a
boon, but when the asthma got out of control I took on a very
pessimistic attitude about the whole "asthma industry". I guess I
was "in denial" about having the disorder, but in a sort of
creative way.
An important point about asthma drugs is that they cause reflux (GERD)
that in turn worsens asthma, so you're in a vicious circle and a sort
of laboratory animal.
A further disturbing fact is the heavy reliance of docs on the worst
case scenario and on the spectacular effects of some asthma drugs.
Then there is the usual explanation of breathing emphasizing the lungs
and the muscles for inhalation. The story seems just trimmed to the
needs of elementary schooling and is a neat, teacher-friendly (and
doctor-friendly) story.
On making a study of oriental breathing techniques such as zen and
taekwon do it may be seen that an important principle is abdominal
pressure squeezing ("milking") the vena cava inferior which
modulates cardiac output. The difficulty with this, and the reason for
its not being recommended as an asthma cure, is that tuning the
abdominal muscles to get the right time-pressure profile is tricky and
there is no instant effect on asthma. Generally oriental breathing
seems too mystical, despite its success in the marital arts and games
such as tennis. However the US Congress has given a form of approval to
yoga, see
http://wwwc.house.gov/international_relations/109/99819.pdf
109TH CONGRESS 1ST SESSION H. CON. RES. 34
"Whereas at age eight, Yogi Bhajan began yogic training, and
eight years later was proclaimed by his teacher to be a
master of Kundalini Yoga, which stimulates individual
growth through breath, yoga postures, sound, chanting,
and meditation;"
Specifically focussing breathing on the tanden (hara, tantien) a point
felt as being about 2 centimetres below the navel instead of on the
bronchi and maybe equivalent to one's guts ("got the guts to do
it") will with practice following the many martial arts descriptions
on the Internet lead to bronchospasm being overridden. Another term
used is the "complete breath" in yoga.
I use qigong to overcome chest congestion caused by reflux, for example
moving my arms together in a circle as slowly as slowly as possible to
entrain breathing. I get down to around 4 breaths a minute for 5
minutes. It causes a "qi" (ki) sensation, vaguely like the shudder
going through one's body with a long satisfying yawn.
As applied to cycling I initially do as many pedal strokes as possible
per breath to overcome congestion, if any.
To sum it all up, asthma only seems incurable on mainstream
medicine's model of respiration. Mainstream medicine may be gold
standard in most respects, but on breathing and heart function it seems
to be omitting important aspects. Regards, Richard Friedel
jackm...@webtv.net
I wish we could all get such affable and comprehensive advice from our
personal physicians.
Thank you.
<<<
Re: EIA, medication and effect on heartrate
Group: alt.support.asthma Date: Sat, Sep 24, 2005, 2:42pm From:
00...@comcast.net (00doc)
Per Elmsäter
> Hi Perre,
>
> For me a little asthma drug at a rate of about one can a year was a
> boon, but when the asthma got out of control I took on a very
> pessimistic attitude about the whole "asthma industry". I guess I
> was "in denial" about having the disorder, but in a sort of
> creative way.
>
> On making a study of oriental breathing techniques such as zen and
> taekwon do it may be seen that an important principle is abdominal
> pressure squeezing ("milking") the vena cava inferior which
> modulates cardiac output. The difficulty with this, and the reason
> for its not being recommended as an asthma cure, is that tuning the
> abdominal muscles to get the right time-pressure profile is tricky and
> there is no instant effect on asthma. Generally oriental breathing
> seems too mystical, despite its success in the marital arts and games
> such as tennis. However the US Congress has given a form of approval
> to yoga, see
>
I've been doing Tantra Yoga for many years and it's good for what it's meant
to do. Ie spiritual development. In some cases fringe benefits may be had as
enhanced concentration and a more harmonious mind. However I'm not so highly
developed yet that I can do my mantras in the middle of a bike race ;) I
kind of have to make sure I don't crash and I would not recommend yoga and
meditation in a traffic situation ;)
> As applied to cycling I initially do as many pedal strokes as possible
> per breath to overcome congestion, if any.
>
Interesting. I'll look into that. the only breathing technique I've been
able to apply so far is to force my breath out and let it flow in naturally.
This seems to help me get rid of C2O thus leaving more space for oxygen.
However I'm not so sure this is asthma related as anybody ought to benefit
from this.
> To sum it all up, asthma only seems incurable on mainstream
> medicine's model of respiration. Mainstream medicine may be gold
> standard in most respects, but on breathing and heart function it
> seems to be omitting important aspects. Regards, Richard Friedel
Yes it feels like it. Or maybe I simply need to find a physician that is
really interested in asthma and EIA.If I was an Olympic candidate and not a
55 yo retiree prospect, then maybe it would be easier ;)
Richard Friedel
You might like to consider Autogenic Training, see:
http://www.maps.org/psychedelicreview/v1n5/01559mau.pdf
and the extract below. The mantras of yoga are simply renamed formulas
( it is breathing me for asthma) and there is only one chakra - the
solar plexus.
You speak of forcing your breath out - which might be like a silent
kiai yell in karate, which one supposes acts on the vena cava by
increased pressure. Most asthma professionals believe that the back
pressure (pursed lips) keeps the airways open, though this is disproved
by modern research.
I could fax you some pages from "Oriental Breathing Therapy" by
Dr. med. Takashi Nakamura" His exercises for tuning the abdominal
wall to get the right pressure on the vena cava etc. results in a
stronger candle-blowing breath. This seems to be a healthier approach
than the unnatural (but in some cases invaluable) peakflow method. See
pages 54-64 and 71-77.
For a detailed proof of the function of abdominal pressure on cardiac
output, see "Die große Kraft des Atems" by Yoga author André
van Lysebeth, chap. 19. I could fax this as well. Regards, Richard
Friedel
>From "Zen Buddhism: A psychological review", pages 81-82,
"............ some other methods are more indirect and require no
such conscious control of the musculature. Schultz's autogenic
training, which derived originally from auto-hypnotic techniques, is
one of these. This method while well-known and widely used in Germany,
is virtually unknown in this country. The first presentation of the
method in English (Schultz and Luthe) appeared as late as 1959, but it
lists over six hundred clinical and research reports on its use during
the past thirty years.
The method is as follows: the subject sits or lies down and assumes a
relaxed state of mind. He concentrates on a "training formula," such as
"my right arm is heavy," while maintaining mental contact with that
portion of his body. An attitude of "passive concentration" - of
focused awareness but unconcerned indifference to the functional
outcome - is important in producing effects. Initial sessions may be
as short as five minutes with one minute periods of concentration
punctuated by one minute periods of rest. The full standard series of
formulae proceeds from heavi¬ness in one arm, then both arms, then
both legs, to warmth in the extremities, "heartbeat calm and regular,"
"it breathes me," "my solar plexus is warm," and "my forehead is cool."
Each formula is added only after preceding ones are well-established.
Since the kind of mental contact involved has very real con¬sequences
for the circulation, blood pressure, and so on in the body parts
concerned, careful supervision is maintained to avoid
undesirable physical reactions. These are primarily of two kinds: (1)
the trainee's mental contact may be incorrect (for example, the hand
rather than the whole arm may be the area of focus), in which case a
variety of minor symptoms may appear; (2) in the case of special
irritability of certain body parts, such as psychoso¬matic conditions
involving the heart or respiration, serious com¬plications may occur
unless formulae involving these areas are approached carefully.
Thorough mastery of the series ordinarily takes from one to eight
months.
The trainee should be capable of "switching on" the many various
standard exercises effectively and almost in¬stantly by applying the
following pattern of formulae: (..............) As a result of the
quick (20-30 second) and effective application of the standard
formulae, most trainees will experience the body as a resting mass
which is heavy and warm. Slow pulsation of the heart and deep and slow
respiration may be perceived. The head is usually experienced as being
"separated" from the rest of the body. (Schultz k Luthe, 1959. pp.
95-96.)
Per Elmsäter
> Hi Perre,
>
> You might like to consider Autogenic Training, see:
>
> http://www.maps.org/psychedelicreview/v1n5/01559mau.pdf
>
> and the extract below. The mantras of yoga are simply renamed formulas
> ( it is breathing me for asthma) and there is only one chakra - the
> solar plexus.
>
> You speak of forcing your breath out - which might be like a silent
> kiai yell in karate, which one supposes acts on the vena cava by
> increased pressure. Most asthma professionals believe that the back
> pressure (pursed lips) keeps the airways open, though this is
> disproved by modern research.
>
Thanks Richard for taking so much of your time to write all this info down.
Some of it is known to me and some is not. At this time of my life I don't
have the time needed ( my priorities ) to spend with a full time Yoga
program. When I get deep into my Tantra Yoga it will usually take 3 hours a
day. This is about what I'm spending working out in the gym and on the bike.
However I will most certainly keep looking into alternative methods of
keeping my EIA under control without medication. As for now I will only
medicate once or twice a week at the most, which will leave me with several
workout sessions per week where I will have to be very conscious of my
breathing not to get caught up in an Asthmatic state.
I will also check out the pollution angle with my local health department.
Again
I really appreciate the time all of you that have replied have given me. I
definitely have a few new things to ponder ;)
NorthShoreCEO
As for now I will only
> medicate once or twice a week at the most, which will leave me
> with several
> workout sessions per week where I will have to be very
> conscious of my
> breathing not to get caught up in an Asthmatic state.
Is there a reason you're rationing your medication?
Per Elmsäter
Yes
If you read my first post, you'll see that I was complaining about my
medication affecting my heartrate. Actually if you read the subject line ;)
If I don't take it for a week or two and then medicate when exercising my
HR will be very close to HRmax ( maximum heartrate ) at a medium intense
workout intensity.
If I take it more than twice a week, or something like that haven't quite
gotten the scheduling fixed, it will affect my HR quite the opposite. Ie it
seems that after some time my HR will refuse to rise above say 85% of HRmax,
even in a competition. After about 3 months into my cycling season I
couldn't barely get it above 80%. When I quit medicating for a week my HR
was immediately back up to normal.
This was a side effect of this medication according to some of the replies I
got. And now I'm trying to learn to live with them as well as look into
different medication and alternative methods in the meantime.
Per Elmsäter
I was speed reading before replying to you. I just realized that you were
already involved in this discussion from the beginning. Sorry.
Which leads me instead to ask.
Why do you ask this question?
NorthShoreCEO
I knew your medication was giving you a problem, but I don't
think it's wise to ration any medication that's needed. I don't
know how healthcare works in your country, but here in the U.S.,
I would call my doctor to explain the problem and suggest we try
a different medication.
Then again, you've got EIA, which is different than chronic
asthma, which is what I had.
Per Elmsäter
Yes there is a distinct difference. I can choose to take it easier when
exercising without medication, which will lead to losing form over time. Or
I can choose to go all out when exercising whithout medication, which will
kill my windpipes and have me suffer for days after each workout. Not to
mention that I have a new workout scheduled the next day. Neither of these
are very good alternatives and I'll probably end up with some kind of crummy
compromise, which won't be very optimal either. At least racing season is
over and I've got some time to work this out over the winter.
I'll definitely lurk here even if I don't join the usual NG bantering ;)
NorthShoreCEO
>
> Yes there is a distinct difference. I can choose to take it
> easier when
> exercising without medication, which will lead to losing form
> over time. Or
> I can choose to go all out when exercising whithout medication,
> which will
> kill my windpipes and have me suffer for days after each
> workout. Not to
> mention that I have a new workout scheduled the next day.
> Neither of these
> are very good alternatives and I'll probably end up with some
> kind of crummy
> compromise, which won't be very optimal either. At least racing
> season is
> over and I've got some time to work this out over the winter.
> I'll definitely lurk here even if I don't join the usual NG
> bantering ;)
>
> --
> Perre
> I gave up on SPAM and redirected it to hotmail instead.
>
>
Well, perhaps you will consider asking for a different
medication, as both choses don't seem very pleasant.
Per Elmsäter
online. He decided that I could try out two alternate medications. First he
prescribed me Bricanyl at half the strength I had been taking. Ie it might
not affect my heart rate as much and hopefully be enough to keep my
windpipes open. Number two was another medication altogether called
pulmicort. I don't know anything about it at all, but it wasn't supposed to
affect heart rate at all.
Well I've got all winter to try it out.
NorthShoreCEO
That's great, and I know the fans of Pulmicort here will weigh
in.
Maureen
Richard Friedel
Yes, my last posting was a bit mystical.
Maybe the following argument more like a theorem in geometry will be
more satisfying.
Nakamura ("Oriental Breathing Therapy") shows how intensive
training of the abdominal muscles can benefit breathing. You lie on
your back and breathe with increasing weights on your abdomen You
start with one pound and end up with five in periods as long as 30
mins. Then in another exercise you sling a long length of cloth around
your waist and get used to the feeling of the cloth's slipping in
response to breathing.
This training improves the ability to blow out candles at an
increasing distance.
Then you do synchronized breathing in more and more energetic
exercises, i.e. synchronized to something like waving the arms in a
circle. The physical effort for each cycle is gradually increased.
You experience improved breathing with controlled abdominal pressure.
This it seems clear to me is using the Frank-Starling mechanism to
increase pulmonary blood flow by increasing venous return - squeezing
the vena cava.
Speaking as a sort of hopefully honest, investigative, former sufferer
from lung disorders, adopting this approach does produce a surge of
blood into the lungs, which corrects regional mismatch between lung
ventilation and lung blood supply - a principal symptom of asthma
etc. I can take a deep breath in a vastly improved manner. There is a
feeling of a wave moving upwards from around the navel to a full
expansion of the upper chest and slight lifting of my shoulders. The
heart beats more powerfully.
QED!
Note:
a) Nakamura does not himself say this is a treatment for asthma.
b) There are probably some side effects - worsening of pulmonary
hypertension in some cases - but Nakamura's orderly presentation is
very impressive.
Regards, Richard Friedel
Appendix:
Nakamura pages 75-77.
.......................................
Relationship between breathing and the abdominal pressure
We have already learned that the purpose of the breathing exercises is
not only to promote air exchange in and out of the body but also to
introduce a form of stimulus to the abdominal region. This stimulus,
resulting in increased abdominal pressure through the strengthened
muscles, drives extra blood, stagnant around the mesentery, into the
veins. How exactly should one impose pressure on the lower abdominal
region effectively?
Before dropping off to sleep each night, stretch your legs out fully on
the bed. Be sure that the body is relaxed, and concentrate. Inhale from
the nose deeply, and hold the air for a while, and, while pushing it
toward the lower abdominal region, exhale gradually next. When
inhaling, count one; when exhaling count two. In this way, count your
breaths as it is believed to be a very effective measure in calming the
mental state and in being quietly inspired.
Counting your breaths means concentrating your mind on the respiratory
activities. Count the number from one to four consecutively, and then
return to one again. Repeat this for about 500 rounds each night.
The following points must be followed in breath counting exercises:
1) Inhale from the nose and try to push air down toward the lower
abdomen from the chest and the upper abdominal region. Keep remember to
expand the abdomen a little and make it slightly hard. Do not, however,
try to conduct valsalva breath holding by closing the throat in an
attempt to harden the abdominal part. This rushes blood up to the head,
face and the neck regions. When inhaling, take as much time as is
naturally possible.
2) After inhaling from the nose, take a pause for a few seconds.
After holding the breath, exhale gradually.
3) Exhale air as slowly as possible, from the bottom of the lower
abdominal region through the upper abdomen and the chest, and through
the nose. When exhaling, remember to lower the abdomen a little bit
more than usual and pull its muscles in.
4) Having exhaled from the nose, hold your breath counting from one
to four. Pause between each count.
5) Repeat the exercise. Generally, four respiration cycles are
completed per minute. Therefore, conduct this exercise for 15-30
minutes. This means a total of 60-100 rounds of inhaling and exhaling
are to be completed before one is allowed to rest. Make it a rule to
conduct three sets of this 15-30 minute exercise per day. This means
that 300 rounds of the respiration exercise are to be conducted every
day.
6) One may stand upright, sit on a chair, or stretch out full length
on the floor to perform this exercise. One may even walk or sit on the
floor while doing it. Once you are accustomed to this exercise, you can
conduct it while doing needlework in the dining room or while cooking
in the kitchen. It is also possible to be practicing it while engaged
in office work or reading. One thing to remember regarding your posture
when carrying out the exercise, though, is to keep it erect in one way
or another. Also, if walking, walk at a stable pace with the length of
each step equaling the length of your shoulder. Keep the upper body
straight. Furthermore, if sitting on a chair, sit in deeply and stretch
your backbone upright. Hold up the head and fit it there. Set your eyes
on a certain object. Join your hands and set them on the knee; using
them to count when sitting is suggested.
When standing, place both arms flat on the sides of the body. If lying
on your back on the floor, thrust both feet out and place both hands on
the underbelly.
For beginners, it is necessary to keep close track of whether the lower
abdominal muscles are being put to full use. Therefore, place, both
hands inside the belt.
7) It is vital that the upper body be relaxed while undergoing this
exercise. The muscles in the neck, chest, shoulders, face, head, and
hands are all be totally loose. The waist, the legs and the abdominal
region, however, must be concentrated on fully. Unless the points
mentioned above are paid attention to, especially by beginners, a rush
of the blood to the head or dizziness may occur.
Continuous pressure is to be imposed on the lower abdominal part when
undergoing this exercise. How can this pressure prove effective?
Physical pressure on the abdomen is caused by contraction and tension
imposed on the diaphragm, the abdominal muscles, the waist muscles, and
the backbone. This pressure gradually concentrates in the central part
of the body, between the fourth and fifth lumbars and on the median
line. This pressure activates movements, as well as the muscles in the
waist and the abdomen. The intensity of this pressure is in proportion
to the relaxation of the movement and muscles in the chest, shoulder,
hands, neck, head, and face. In particular, the abdominal pressure
stimulates the sensation of motion in the heels and the big toes of the
feet.
This is caused by the activation of the vagus, which consists of the
pelvic ganglion, the sympathetic ganglion, and the inferior mesenteric
ganglion at the center, stimulates the central autonomic nervous
system, and promotes a sense of balance and coordination throughout the
body. The activation also works to intensify the coordinated activities
of the autonomic nervous system.
Accordingly, the cerebrum, which directs the body's sense of balance,
is stimulated with the introduction of pressure on the abdomen.
Furthermore, the pressure excites the sensory area of the brain proper
through thalamic radiation, which is brought on by the stimulation of
the cerebrum. The pressure thus leads to total activation of the
sensory aspects of the brain.
The total activation of the perception in turn leads to coordination of
senses, vital in memory functions. At the same time, simultaneous
awakening of the central autonomic nervous system enriches emotional
functions. The network of nerves controlling movement works to solidify
the will when the system is totally coordinated throughout the body.
Therefore, it is said that abdominal pressure gives physiological
grounds for the purification of the will.
Interrelationship between Breathing and Abdominal Pressure
What is the relationship between breathing and abdominal pressure? In
broad terms, they are as closely related to one other as two wheels on
an axis. Respiratory training automatically means intensive exercises
involving the abdominal pressure.
The main aspects of breathing exercises are as follows: The time spent
in exhaling must be more than that spent when inhaling. Each
respiratory cycle must be carried out fully and calmly. Pressure both
inhaling and exhaling must be conducted rhythmically. Breathing should
be conducted through the nose. When respiration is involved, the
various muscles in the chest as well as the diaphragm and abdomen all
take part in the process. Specifically, among the muscles involved in
the respiration process are external intercostal muscles and internal
intercostal muscles.
Among the auxiliary muscles taking part in the process of inhaling are
anterior, medial, and posterior scalenus muscles, serratus posterior
superior muscles, major and minor pectoral muscles, sternocleidomastoid
muscles, levator scapulae muscles, and rhomboideus muscles. The muscles
in the diaphragm take part in the process of exhaling. When these
muscles are moved in coordination with the movements of the diaphragm
in order to intensify each respiratory process, vital capacity of
functions is increased, thereby improving the alveoli of the lung and
hastening the circulation of both blood and lymph.
Remember that the abdominal pressure must be exerted in upright
postures, be it when one is standing, sitting or lying down. While
undergoing the exercises, the walls of the chest are to be lowered
slightly, and strength must be exerted in the waist region. The upper
body must not lean forward or backward nor should it bend sideways.
(Thrusting the hips out and tightening the anus helps.)
The main part of the therapy is to strengthen the abdominal muscles
during the process of exhaling. With all your might, exert efforts to
strengthen the muscles while exhaling slowly from the nose. Keep the
anus tight. The abdominal muscles can be worked out to maximum limits
in this way.
Per Elmsäter
> Hi Perre,
>
> Yes, my last posting was a bit mystical.
>
> Maybe the following argument more like a theorem in geometry will be
> more satisfying.
>
Thanks a whole lot Richard. Very interesting reading. I already try to
employ the Valsalva breathing techniques when doing heavy Deadlifts or
squats in the gym. I've never run across such a structured analysis of how
it is done though. Definitely an article copied to My Documents ;) I'll keep
a lookout for the whole book too.
One question. You mention pulmonary hypertension. Would that be the same as
high blood pressure or what? Personally I suffer from low blood pressure so
anything that will raise my blood pressure is welcome ;)
> Snipped extensive explanations
Per Elmsäter
> That's great, and I know the fans of Pulmicort here will weigh
> in.
Why is there a Pulmicort fan club ;)
I'm curious to know why those that choose to use it, did.