Tuesday, 27 June 2017

All I need is the air that I breathe...


Mindfulness incorporates the breath into a lot of the act of being present. It is the anchor to "the now", and is a perfect example of the present, the past and the future. Each breath we take is a new batch of air, a fresh moment which comes to us whether we control it or not; each breath we exhale is taking away what we no longer need, as our body does its bit to use the air inhaled, take it around the body, sweep up the tail-end of the waste-products of respiration, and release it. Breathing is a natural act, governed by the pons, part of the brain stem and sympathetic nervous system, is largely automatic (in the sense that that one breath will naturally follow the next, although we can influence how deep and rapid it is), and will happen whether we control it, or not, unless something interrupts the process. 
The breath is a perfect tool for helping us to keep present, not just as a reminder to keep within the moment, but because physiologically, the breath can affect our emotions and our feeling of control. If we are stressed, our breathing rate increases. This then sends a clear signal to the brain to initiate the "flight or fight" response, so hormones like Cortisol and Adrenalin are released which increase the heart rate, blood pressure and the respiratory rate. The body becomes flooded with stress hormones, which is great for:
a) running away from the threats of impending death in Neanderthal days gone by

 but not so great for:

b) the forthcoming driving test
c) dental extraction 
d) job interview
 e) you and your overtired-and-wired toddler desperately searching for their one and only essential, most favourite, number one teddy and comfort snug, which, unless it is within sniffing distance of your delightful bundle of squishy loveliness, will result in a night of horrific sleepless woe, comparable to everyone's worst nightmare - before you realise it has been left at your friend's house three hours drive away (This will only happen once, for it is a steep and painful learning curve for all). 
This stress response can be a good thing, though, as in short-term moments it can boost performance, improve memory and be a great motivator, but it can become harmful when it is prolonged, causing effects on sleep, performance and concentration. It's all about balance.

So conversely, taking deeper, slower breaths stimulates a nerve called the Vagus nerve, a companion of the parasympathetic nervous system, which runs from the brain-stem through the trunk of the body down to the lower abdomen. This nerve, when stimulated, sends messages back to the brain to reduce heart rate, respiratory rate and blood pressure, resulting in the "stand-down" of the stress hormones, which then evokes that sense of calm back into balance, again. Meditation and yoga, in which deep breathing exercises are involved, can stimulate the vagus nerve, increasing "vagal tone". You can also see the examples of this in babies and children, just watch them as they fall asleep and they are taking lovely deep relaxed breaths to their abdomen. Practice it for yourself at bedtime - if you're having trouble dropping off, just take the breaths down to your abdomen and feel it rise as you breathe in, and notice how it changes your state of awareness.
As a nurse I often teach the patients in acute pain with whom I'm working with to focus on their breathing as part of my clinical toolkit, to help them manage their pain, helping as a distraction but also to physiologically manage the stress hormone response. As a Connected Kids™ meditation tutor I teach children of all ages how to use their breath to help them with worries, to help focus, and for relaxation. It is a very effective, accessible tool to use at any time.

So as an asthmatic with a passion for running, I am at a stage where I'm at a loss as to where to go from here, to manage my symptoms. I am increasingly frustrated with the way in which my body is reacting to my attempts to keep healthy and fit - it's almost akin to the rebellious teenager who is fighting the adult in getting out of the house and getting some fresh air on a bright sunny day.

I first began running about 8 years ago, but struggled beyond 200m or so before wanting to collapse in a heap on the pavement. I gradually overcame it and have been running mid to long distances ever since, including a marathon, which as an asthmatic, I consider to be one of my greatest achievements. However, the problem is that I cannot get my asthma under enough control to be symptom-free whilst I run. I hate the first 20 minutes or so, as I struggle with bronchospasm, which feels a little bit like someone is squeezing my bronchi and trachea with a pair of red-hot hands. No matter what I do, how I manage my treatment or organise my timing of taking preventer and reliever inhalers, I still feel this for every run, or sudden burst of activity such as a fast pace up one of the many hills in the town where I live, or when I'm running after the ice-cream van (actually that never happens, I just put it there to see if you're still reading this article and paying attention).
I have a diploma in asthma management, so I'm quite up on treatment plans and managing my symptoms as a patient. But I am very dismayed that I am now taking all this medication to try to control my symptoms. The latest addition is pretty much the end of the line for me, I honestly don't know what else to do if this doesn't work. I am experimentally trying to improve my lung capacity by singing whilst running. I doubt it's helping my asthma, but I am able to hold a note for a bit longer, these days! I'm also not particularly happy about the hoarse quality to my voice, which is a result of the steroid inhalers - I sometimes sound quite alluring, but at other times it is annoying, to say the least! Still, I can't allow this to stop me from taking the medication, as I clearly need it, at the moment.

Giving up exercise is not an option, neither is moving somewhere where hills do not exist, and I won't ever stop in my quest for the enjoyment of ice cream (which, incidentally, also provokes bronchospasm).

So what do I do, other than take the concoction of medication you see in my picture, just to be able to get me into my trainers and out of the front door, for a liberating, beautiful trail run in deepest, rural Dorset, whilst mindfully breathing and working through the agony of asthmatic apices? And it's not just my lungs that are affected: my shoulders and neck compensate for the pain and difficulty in breathing, too, so I am having to work mindfully on these areas, as well. I am lucky in the sense that it could be so bad I wouldn't be able to run at all, but personally I'd rather not have to suffer any of this, or comply with impending polypharmacy as an otherwise healthy adult in my 40's. Hmph.

If anyone out there - especially the elite athletes with asthma, can suggest anything, I would be very grateful. Not that I consider myself to be an elite sportswoman - a fast shuffle around the hills and fields of Purbeck is as good as it gets for me - but I would really love to be able to run without feeling impeded by this.

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