Posts Tagged ‘deep breathing’

Why the nicotine patch fails, and what to do about it.

December 17, 2017

The smoker should take part of a straw

Through which, when breathing, should draw

For the smoking cessation

It bring relaxation

And that, with the patch, is the flaw.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. A month in the Arctic followed a month in Iowa followed 3 months in British Columbia, to which we have returned. Any identifiable patient information has been included with permission.

 

I hate tobacco with a passion which I restrain to as to not alienate patients. I ask people, on a scale of 1 to 10, how ready they are to quit.  If they say 1 or 10 I move to another topic.  If they say anything else, I ask them to tell me why they aren’t LESS ready to quit, and to name the best three things about smoking.

Smokers most commonly say “stress relief” as the best thing about smoking. I used to argue, pointing out that smokers smoking have the same level of stress as non-smokers at baseline; the stress the patient felt, I would say, comes down to nicotine withdrawal.

That approach didn’t help anyone quit; if anything it hardened the person’s commitment to death by tobacco.

Recently, I have started to point out that if a person wants stress relief, the deep breathing exercise that every smoker has mastered brings half the stress relief of smoking. Inhale like you’re getting the best drag of the day, I say, and your stress level will go down.

(Recently the FDA approved a device to treat high blood pressure.   Really an app, it gets people to slow their breathing.)

I think the nicotine patch fails so often because the people don’t get the stress relief of deep breathing.

Today, a patient who had already figured out that strategy announced he planned to get some straws and to breathe through, to give him something to do with his hands.

And, just like that, within an hour I had two more patients intending to quit smoking.

I advised both to get a soda straw, cut it in half and carry the half where they carry their cigarettes. And to breathe through the straw as if smoking a cigarette.

This simple, brilliant technique will answer the habit strength question, help with stress management, give the person something to do with their hands which also includes the mouth, and give the person much the same velocity of air as breathing in through a lighted cigarette.

 

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Lower blood pressure with deep breathing

July 5, 2017

It’s a technique, and I don’t mean to brag

But when the smoker lights the first fag

And breathes deep and slow

Though the smoke is the foe

They’re champs at that very first drag.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I see a good number of people with high blood pressure, some better controlled than others. If the pressure is too high, I repeat the reading.  A second round of measurement less than 5 minutes after the first will give a falsely elevated reading.

Most of those with hypertension (a blood pressure greater than 140/90) smoke tobacco and drink more than healthy amounts of alcohol. I point out to the smokers that they have a valuable tool, that they didn’t realize they had.

I was still working for the Indian Health Service when I had a conversation with the worst nicotine addict I ever met. She had quit 4 packs per day about 10 years prior.  Half the relaxation of the cigarette, she said, is the deep breathing technique that goes to taking the first drag.  Every meditation system in the world stresses the deep breathing that all smokers have taught themselves.

Breathing can change blood pressure a lot. The FDA approved a device to teach people to slow their breathing down; the studies showed it safe and effective for blood pressure control.

So I tell the patient to pretend they’re taking the first puff of the day, to breathe slow and deep, and I breathe with them.

I repeat the blood pressure measurement after 6 deep, slow breaths, and almost always the top number drops by 30 points and the bottom by 15, good enough for most people. Whether the improvement is adequate or inadequate, I tell the patient to breathe slow and deep for 20 minutes a day, whether in one chunk or twenty.  For those current smokers, I point out that they could get half the calming effect of tobacco just by doing the breathing exercise that they already know how to do.

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I had call last night. With light traffic in the ER I managed to get back to the hotel early, but I got called back at 10.

As far north as we are, I walked to the hospital with the setting sun in my eyes. Forty-five minutes later, I walked back in the twilight, thinking that I should have brought the bear spray with me.  I crossed the highway with literally not a single vehicle moving.