I CAN’T breathe, everything is closing up and I can’t breathe!” were the words down the phone to me after I took the call from a patient who had called up the surgery in an emergency.
As my receptionist transferred the call to me, the problem solving began. I quickly looked up their records on the computer and could not see any significant health problems. An otherwise fit and healthy individual who had not been seen in recent years – a good sign but also a worry for why the emergency.
As I listened to them down the phone line, I could hear how rapidly they were breathing. On average, people with no underlying respiratory conditions take around 12-15 breaths per minute but my patient was going much faster than that. With no previous records of respiratory problems, ie no asthma, COPD, it was unlikely to be an exacerbation of that. This was new.
They were understandably panicking which was making the breathing worse. Time is precious in such urgent situations and over the phone especially, where I cannot see them, I need to ask questions to be able to decide what to do next. However, in order to get any answers in that moment, I had to help them slow down the breathing so they could speak. Whatever was wrong with them I wondered?
“Are you having any chest pain?” I asked. The first thing you always want to do is rule out any life-threatening condition. “No,” they said, “I’ve just lost my job, I don’t know what I’m going to do. I can’t breathe,” is what I could make out. It became clear that this patient was having a panic attack.
Anxiety or panic attacks are fairly common and can affect anyone at any stage in life. They occur as a response to perceived fear and must be taken seriously. In the everyday, we become unaware of our breath and its power. Like right now, you reading this, have probably been unaware of your breathing because we do it so unconsciously. We take it for granted until something goes wrong. Being able to breathe effectively is also something we are not taught about and so it is only when you are faced with a situation where your breathing becomes compromised, that we become aware of it.
Breathing involves not the nose and mouth, but also the lungs, the intercoastal muscles and the diaphragm which all work in unison to allow effective transfer of oxygen into the body and to emit carbon dioxide out of the body. This allows the healthy functioning of all our cells and organs but when we breathe ineffectively, too fast or too slow, the balance of air exchange becomes disrupted.
In the case of my patient, who was hyperventilating, they were not allowing enough oxygen in and were blowing off too much carbon dioxide which can make you feel lightheaded and if left untreated can cause an increased heart rate, sweating, chest tightness, palpitations, weakness, tingling or numbness in limbs and even confusion.
The key is to try and calm the person down; this is where breathing exercises come in – something we should all practice for general wellbeing but can also help someone if they’re having a panic attack.
There are many types of breathing exercises but the ones that I recommend not just to my patients but also practice regularly myself during my meditation practice, are pursed lip breathing and belly (diaphragmatic) breathing. The first exercise involves breathing in slowly through the nose whilst keeping the mouth closed for two seconds and then breathing out as if you’re whistling or trying to blow out a candle slowly for four seconds.
When our breathing is done so unconsciously and often shallow as we rush about our everyday business, taking out a few minutes to try this will really help relax you but it also carries benefits like lowering your blood pressure, slowing down the heart rate and boosting good quality air around the vital cells and organs in the body.
The second exercise involves engaging the diaphragm. Put both hands over your belly so you can feel the rise and fall of each breath and again, keeping the mouth closed, take a slow breath in through the nose and feel the belly inflate right up against your hands. Then breathe out slowly through the mouth, making sure it’s longer than the inhale and you can feel that belly sink right in.
I asked my patient to open the window to let in some fresh air and to take some sips of water. I then got them to do the first breathing exercise. Within a couple of minutes, they were breathing properly again, felt calmer and that moment of fear passed.
I have learned that one of the most powerful medicines is when someone feels they have been seen and heard. When we can validate what someone is feeling, especially with mental health, we can help them in more ways. When people are going through a panic attack, the fear is not fabricated, it feels very real to them and helping them to restore calm and seek help if needed, is vital.
We had a long chat about their circumstances and about potential options which they had not considered. It’s amazing what talking to someone impartial can do. In the end, they were ok.
I share this because we all forget how powerful a basic tool like breathing effectively can be. We gladly do physical workouts but forget about the mental workouts for which daily breathing exercises can play a significant role.
Is there anything you’re too embarrassed about to ask your own doctor? No question is a silly question for our columnist. E-mail your questions for Dr Krishan to [email protected] glasgowtimes.co.uk Remember advice given is general and you should always consult your own GP.