Getting the air you need: A practical guide to coping with and managing shortness of breath PD 6619 – 11/2015 wpc/pted/LrgBook/ShortnessBreathJCC-th.doc dt/November 4, 2015 Adapted and written by the oncology nurses from the Juravinski Cancer Centre: Lorraine Martelli-Reid, RN(EC), NP-Adult, Sue Cole, RN, Sally Hapke, RN, Marilyn Miscione, RN, Janet Poirier, RN and Nancy Ross, RN with Theresa Harper, RN, Patient Education Specialist Thank you to MacMillan Cancer Relief and Wessex Cancer Trust for permission to adapt their book “Coping with Breathlessness Due to Cancer”. Juravinski Cancer Centre 699 Concession Street Hamilton, Ontario L8V 5C2 www.jcc.hhsc.ca Getting the air you need … Notes: When you are short of breath, it is hard to do your regular activities such _____________________________________________________________ as getting dressed, cooking a meal, and doing the things that you enjoy. _____________________________________________________________ When you are short of breath, you may: _____________________________________________________________ 1. Tighten up your chest muscles to breathe. _____________________________________________________________ 2. Breathe faster. _____________________________________________________________ 3. Have feelings of fear, anxiety, panic or general unrest. _____________________________________________________________ As someone living with shortness of breath, you may find that you are _____________________________________________________________ more tired, worried and anxious. You may be upset about your condition and may wonder if anyone else feels like this. _____________________________________________________________ They do! _____________________________________________________________ This book has information to help you learn about: _____________________________________________________________ what you can do to get the most out of your breathing _____________________________________________________________ what to do when you are short of breath _____________________________________________________________ ways to cope if you are feeling down or anxious _____________________________________________________________ _____________________________________________________________ Let us know what works and does not work in making breathing and coping easier. We are here to help you, please talk with us about _____________________________________________________________ your concerns. _____________________________________________________________ Your health care team _____________________________________________________________ Getting the air you need … Getting the air you need … Progressive muscle relaxation Contents 1. Once you are in a comfortable supported position, slowly draw Topic Page your shoulders up to your ears. Hold them there for as long as it When should I call my health care team? .................................. 1 is comfortable for you. If this is uncomfortable, try drawing up one shoulder at a time. Will oxygen help me? ............................................................. 1 How do the lungs work? ......................................................... 2 2. After you feel tension in your shoulders, gently lower them and feel What is abdominal breathing? ................................................. 3 them relax. Be aware of a release in tension as you do this. Getting the air you need ......................................................... 5 How do I slow down my breathing? .......................................... 7 What can I do every day to help with shortness of breath? ......... 10 If you work gently through all the muscles, starting with your toes and Planning activities ............................................................. 10 working up to your head, you will experience a sensation of warmth or heaviness as you relax. Sitting to standing ............................................................ 11 Walking and managing gentle slopes and stairs .................... 12 You may feel that you are floating or spinning. If this is unpleasant then Arranging things around the house ..................................... 12 stop and open your eyes, slow your breathing and then continue. Lifting heavy objects ......................................................... 13 You may want to set aside 20 to 30 minutes during the day to enjoy a Dressing .......................................................................... 13 full relaxation of all the muscle groups. Or, find that repeating some form Bending ........................................................................... 14 of relaxation for 5 to 10 minutes, 2 or 3 times a day, helps prevent tension Showering or bathing ........................................................ 15 from building up. Gardening ........................................................................ 16 Talking on the telephone ................................................... 17 Intimacy and sexual activity ............................................... 17 We are here to help … Pacing yourself ................................................................. 19 What kind of exercise should I do? ........................................... 20 There is a lot to learn about getting the air you need. I feel down and anxious. Is this normal? ................................... 23 Practice helps, and it takes time to figure out what What are some ways to help me relax? .................................... 26 works for you. Please let us know your concerns. Page - 27 Getting the air you need … Getting the air you need … When should I call my health What are some ways to help me relax? care team? Learning ways to help you relax can reduce muscle tension and anxiety, When your breathing has become more difficult over a short which will help with shortness of breath. period of time. Go to http://www.youtube.com/user/ManagingSOB - Select the videos Along with breathing problems, you feel dizzy, you notice an “Progressive Muscle Relaxation” and “Guided Imagery”. increase in your heart rate or your skin is very pale. One of your blood counts may be low and you may need a blood test. You are struggling to breathe and feel very nervous. First … You have sudden, new or increasing chest pain. • Find yourself a quiet place where you will not You have a fever 38°C or higher. be disturbed. When you wake up you are suddenly short of breath. You have a new or increasing cough. • Make yourself comfortable, either in a chair or Your breathing is noisy. propped up in bed and breathe gently. • You may choose to play music or sit in silence. • Focus on something like a flower or a picture, consider using Will oxygen help me? visualization such as an open space or simply close your eyes. • Be aware of your breathing just for a moment, checking that you Oxygen through a mask or nasal prongs may help are using lower chest or abdominal breathing. when the oxygen level in your blood is too low. • Aim to maintain this steady gentle breathing throughout the The oxygen level in your blood can be measured easily relaxation period. by placing a sensor over one of your fingers. This can be done when visiting your health care provider. If your oxygen level is good, then extra oxygen from a Then … tank may not help you breathe easier. The next few steps are part of a process called progressive muscle To help you breathe easier: relaxation. This involves tensing and then relaxing separate muscle groups use a fan blowing gently on your face when you are short of breath. throughout the body one after another. The steps aim to help you relax your It can go a long way to relieve your sense of breathlessness shoulders and chest but they can be applied to any muscle group. use the positions and breathing ways described in this book to help you manage every day activities. Page - 1 Page - 26 Getting the air you need … Getting the air you need … Feeling depressed How do the lungs work? You may be depressed because of your illness and being short of breath. Everyone can feel down or anxious at times but sometimes these feelings Lungs carry the air that you breathe in and out. Oxygen is in the air you do not seem to pass and can become worse. breathe in. You have two lungs located in your chest, one on each side. Depression can come on gradually. It can slowly sneak up on you. You may When you breathe in, the air flows in through your mouth or nose and down not think that you are depressed. a series of tubes starting with the trachea (windpipe). The trachea branches into two smaller tubes called the bronchi. This branching to smaller tubes Here are some signs and symptoms which may help you see if you are continues until the air reaches tiny air sacs called the alveoli. There are becoming depressed. You may experience some of them from time to time millions of these in each of your lungs. It is here that the air releases oxygen without actually being depressed, but if they persist and last for more than to the blood which is taken throughout your body. 2 weeks, talk to your nurse or doctor. Signs and symptoms of depression: feelings of sadness or feeling down most of the time less interested and less able to enjoy the things that once gave you pleasure feel tired or without energy most of the time have trouble sleeping or sleeping too much Trachea finding it hard to concentrate or make decisions increase or decrease in appetite or weight feelings of worthlessness or guilt Bronchi feeling like you just cannot go on,