Why does Ativan help SOB.

[jim]

After reading some of your posts about Ativan use and SOB, I thought it might help if you understood what was most likely happening. I came to the conclusions that Ativan could not have a direct effect, but only a secondary one, then searched around and came up with the following medical opinions.

cancergrace.org/forums/index.php?topic=7678.0

[sandy07]

Yes. That's why we take it.

[David]

I was wondering about Ativan helping with shortness of breath. I really believe it would help me. I am very short of breath and can't walk very far. I get out of breath and panic a lot during the day.

Only problem is I doubt my Pulmonary Doctor will prescribe Ativan. My pulmonary doctor would rather watch someone suffer before he prescribes something for anxiety or insomnia or pain.

I will talk to my Primary Doctor about this. He has a little more compassion.

[jim]

Good luck with your Primary Doctor David.

[mary57]

That's how it works, by controlling the 'tightness' anxiety you can then better control your breathing.

[muggsmom]

I can't read the article, it says I'm blocked as a possible BOT (automated source of network abuse). Anyone else have this problem?

[barb7330]

No Muggsmom it opened up for me and I was able to read it....

[John]

Thanks Jim ; That is exactly why we take it! There isn't much worse than a panic attack from sob . which causes more sob . speechless-smiley-040

[jim]

For anyone who is interested, here is a bit about panic attacks in general, mostly the ones started by a random transient change in ones chemical profile.
I hope this may help some of you have some control over the attacks and help you to prevent them from escalating, and use meds only as a last resort like I do.


Panic Attacks.

Extracts from- What You Can Change and What You Can't.- By Martin E. P. Seligman.

Panic attacks.

The defining feature of the disorder is simple; recurrent, awful attacks of panic that come out of the blue. They are accompanied by feelings of overwhelming dread and thoughts that you are going to die, that you are having a heart attack, that you are loosing control, or that you are going crazy.

Inducing panic. panic attacks can be created by a chemical agent. patients who have a history of panic attacks are hooked up to an intravenous line. Sodium lactate, a chemical that normally produces rapid, shallow breathing and heart palpitation, is slowly infused into their bloodstream. Within minutes, about 60 to 90 percent of these patients have a panic attack. Normal controls, subjects with no history of panic, rarely have attacks when infused with lactate.

Genetics of panic. There may be some heritability of panic. If one of two identical twins has panic attacks, 31 percent of the co-twins also have them. But if one of two fraternal twins has panic attacks, none of the co-twins are so afflicted. More than half of panic-disorder patients, moreover, have close relatives who have some anxiety disorder or alcoholism.

Panic and the brain. The brains of people with panic disorders look somewhat unusual upon close scrutiny. There neurochemistry shows abnormalities in the system that turns on and then dampens fear. In addition. PET scans show that patients who panic from the infusion of lactate have higher blood flow and oxygen use in relevant parts of their brain than patients who don't panic.

Drugs. Anti-depressant and anti-anxiety drugs both work better than placebos. Panic attacks are dampened, and sometimes even eliminated. General anxiety and depression also decrease.

Psychologist David Clark put forward the theory, that panic may simply be the catastrophic misinterpretation of bodily sensations.
For example, when you panic, your heart starts to race. You notice this, and you see it as a possible heart attack. This makes you very anxious, which means your heart pounds more. You now notice that your heart is really pounding. You are now sure it's a heart attach. This terrifies you, and you break into a sweat, you feel nauseated, short of breath - all symptoms of terror, but for you, they're confirmation of a heart attack. A full-blown panic attack is under way, and at the root of it is your misinterpretation of the symptoms of anxiety as symptoms of impending death.


This psychological theory handles the biological findings well.
* Sodium lactate induces panic because it makes you heart race. It creates the initial bodily sensations that you then misinterpret as catastrophe.
* Panic is partially heritable because having a particular noticeably bodily sensation , such as heart palpitations, is heritable, not because panic itself is directly heritable.
* Brain areas that prevent the dampening of anxiety are active because this activity is a mere symptom of panic.
* Drugs relieve panic because they quiet the bodily sensations that get interpreted as a heart attack.

David Clark's Therapy.
Patients are told that panic results when they mistake normal symptoms of mounting anxiety for symptoms of heart attack, going crazy, or dying. Anxiety itself, they are informed, produces shortness of breath, chest pain, and sweating. Once they misinterpret these normal bodily sensations as an imminent heart attack, their symptoms become even more pronounced because the misinterpretation changes their anxiety into terror. A vicious circle culminates in a full-blown panic attack.
Patients are taught to reinterpret the symptoms realistically, as mere anxiety symptoms. Then they are given practice right in the office, breathing rapidly into a paper bag. This causes a build-up of carbon dioxide and shortness of breath, mimicking the sensations that provoke a panic attack. The therapist points out that the symptoms that the patient is experiencing - shortness of breath and heart racing - are harmless, simply the result of overbreathing, not a sign of a heart attack. The patient learns to interpret the symptoms correctly.
One patient, when he felt somewhat faint, would have a panic attack. He became afraid that he would actually faint and collapse, and interpreted his anxiety as a further symptom of imminent fainting. This escalated to panic in seconds.
"Why?" Clark asked him, "have you never actually fainted?"
"I always manages to avoid collapsing just in time by holding onto something," replied the patient.
"That's one possibility. An alternative explanation is that the feeling of faintness you get in a panic attack will never lead you to collapse, even if you don't control it. In order to decide which possibility is correct, we need to know what happens to your body for you to actually faint. Do you know/"
"No."
"Your blood pressure needs to drop," said Clark. "Do you know what happens to your blood pressure during a panic attack?"
?Well, my pulse is racing. I guess my blood pressure must be up," the patient responded.
"That's right. In anxiety, heart rate and blood pressure tend to go up together. So you are actually less likely to faint when you are anxious than when you are not," said Clark.


"But why do I feel so faint?"
"Your feeling of faintness is a sign that your body is reacting in a normal way to the perception of danger. When you perceive danger, more blood is sent to your muscles and less to your brain. This means there is a small drop in oxygen to the brain. That is why you feel faint. However, this feeling is misleading because you will not actually faint since your blood pressure is up not down."
The patient concluded, "That's very clear. So next time I feel faint, I can check out whether I'm going to faint by taking my pulse. If it's normal or quicker than normal, I know I won't faint."
"this simple therapy appears to be a cure," Clark told us. "Ninety to one hundred percent of the patients are panic free at the end of therapy. One year later, only one person had had another panic attack."

Treatments.
Cognitive Therapy.
Drugs.

Drugs.
Improvement ------------- 60 to 80%
Relapse ------------- moderate to high
Side effects ------------- moderate
Time scale ------------- days/weeks
Overall ------------- useful

Cognitive Therapy.
Improvement ------------- 80 t0 100%
Relapse ------------- 10% or fewer
Side effects -------------- none
Time scale -------------- weeks
Overall -------------- excellent

[mary57]

Thank you Jim, that is a good description of 'panic' anxiety, I'm sure it will help many of us who suffer from this. I have learned to talk myself through them and now rarely have one. I do use clonazepham for SOB when it's bad.

[David]

Thanks Jim. I still plan on asking my primary Doctor about trying Ativan. I will make an appointment soon. I stayed out of his office all Winter cause I figured it was a bunch of sick people in there I had the flu shot but I don't need to take chances.
Now that Spring is here it might be safe to go in there.

[izzie]

Hi Jim...thanks for starting this thread. I thick it's important to understand how stress affects us, especially if we feel panicky about being SOB or anything else that might be happening in our lives. Some of us can have a major event in our life, but not be physically well enough to cope with it and the bodies response is typically a fight or flight response.

The natural steroids that are manufactured in our bodies generally rise to the occasion...like cortisol, adrenaline, etc. The Thyroid Gland is for this reason, a very important gland in producing those stress responders.

One of the effects of smoking cigarettes is that our bodies don't manufacture enough Taurine, which is manufactured by the body when we eat foods that contain the Amino Acids called Cysteine and Methionine.
That is why NAC works for people with COPD, except that is only one component of Taurine production. We need both Cysteine and Methionine in equal amounts and Avocado is a good source, along with the Omega Fatty Acids.

Does Ativan cause the body to produce some of stress hormones and/or natural steroids? Anyway, I have a few articles from the internet that I would like to attach for your perusal, but I haven't learned how to attach them to a thread.

[jim]

Thanks for this Izzie, it is interesting. thumbsupde1

If you want to put the article in here, copy the link and then paste it on the page. If you still have problems, I can help you as soon as my wrist gets better, typing is hard for me at the moment.

[David]

I don't know how true this article is but it is worth thinking about.

I still plan on trying Ativan if my Doctor will prescribe it to me. I don't really have a problem with exacerbations and pneumonia.
Last time I was in the hospital with pneumonia was in 1983 when I was diagnosed with the beginning of Emphysema.

Older people with COPD taking benzodiazepines more likely to experience adverse respiratory outcomes mnt.to/4mR8

[Blossom/Jackie W.]

Well guys..... gotta tell you. Over the past number of months I have learned a LOT about anxiety, living with/through, dealing with, where it can put you and meds for same..... Believe me when I tell you it can get pretty darn intertwined and complicated unless you suffer from just mild and ocassional anxiety.

AND; the big dread (or NOT)...... respiratory arrest which we tend to group with (right or wrong)

In due course it's one of the articles I want to re-write on for the site. Soon as this little brain and body finsihes healing ...... at least I hope it'll mend.... !

[skate4life]

My own personal experience with Ativan in Sept hospitalization was that it blocked my memory every day it was given to me. Yes, I was in need of BiPap rescue several times a day and was in MICU the first couple of days. Since I had very limited personal support (1 neighbor, 1 'friend')I did not remember many of the things I was told, people when they visited including docs & nurses, etc. It was a blank week with only flashes of memory. It took paying big money to get my complete medical record to learn all that happened - discharge papers did not say I was given annual flu shot and a pneumovax shot, so several weeks later got them from PCP - double protection?
Did it help my SOB? I really don't think so. I flatly refused it during the AECOPD hospitalization in February. At least I kept 95% of my memory:) My best help is 1/2 tab of Vicodin as it slows my breathing allowing for longer exhalations, therefore less stacking/SOB and mentally it relaxes me. If PLB doesn't help, I can tell when I need to use my BiPap as 'rescue.' Five minutes on BiPap and I am much better!
Of course, I am known for never presenting or reacting to many meds in the 'normal' way
But my biggest concern was the amnesia that the Ativan gave me and without a personal support person, I am left in a black hole.....
Every one is different. If I ever had to be intubated, I want a Propofol drip! It is protocol in my hospital:)

Sorry for long post, but just want you all to be aware of other effects from Antianxiety meds, each person may react differently, and it may take trying different ones to find the best for you.

[jim]

Thank you all for your contributions, I have another busy day, so I'll try to come back to this soon.

[David]

I went to the General Practice Doctor and it was very productive. I told him about Ativan and told him I would like to try it and see if it helps me. He listen to me and it didn't go out the other ear. He wrote me a script for 22 Ativan to try and see if it helps. I will go back next month and let him know.

He couldn't access my Lung Function Test for some reason but he did get the report from the x-ray. Things look pretty good there.

Findings: The heart is normal size, and the lungs are free of infiltrate. There is some hyperexpansion with flattening of the diaphragms consistent with obstructive lung disease.
Today's exam appears unchanged from prior study of 05 April 2013. A nodular lesion is noted on the lateral view, which on the PA view, lies adjacent to the right heart border. This is also unchanged from 2012 and 2013 exams.

Impressions:
1. Moderate to severe obstructive lung disease with no acute abnormalities noted.
2. Granuloma in the medial basl segment of the right lower lobe.

I will try and get the correct numbers from my Lung Function Test from the Hospital.

He told me if he was me he would go to another Pulmonary Doctor. Kind of like get a 2nd opinion. I told him I have been thinking about it but I will try the Ativan and I plan on going to the exercise place at the Hospital and start exercising. I think it is around $30 a month.

Then make a decision next month if I don't see any change.

[sandy07]

Okay...so nothing serious showed up. That's good. Now just need to carry on with the rest of the plan. I'm sure you'll notice a difference after 30 days of exercising. Good luck and have fun.

[Blossom/Jackie W.]

I could certainly be wrong but..... it may not have been the ativan Skate...
BTW; Proppfol is dubbed/slanged..... Milk of Amnesia....Something to keep in mind..

David; I'm glad to hear you're trying the Ativan. I don't know what the dosage/frequency is or whether it's the sublingual or another variation of.... Either way; do be careful. Dependency can occur with constant use within a week. And; if you're going to be looking at ultimately long term/ongoing use, you might be better of off Clonazepam. On-going/slow release. At lest something to discuss again with your Dr.

And folks..... please stop worrying so much about the resp supression issue and benzos. Don't get me wrong it's very real BUT; it's not as "unsafe" under controlled circumstances as you may think and kept in moderation and channeled for the individual it can be a life saver for many. (If you've been reading just abstracts; they're notorious for not listing all the study perameters becasue they want you to "purchase" the entire piece.)

All in all; sounds like you had a decent check up though David and that's great! If you don't mind my suggesting, perhaps a CT wouldn't hurt if you didn't want to get a 2nd Pulmo opinion?

Meanwhile...... get exercising and encourage us all along!!!

[skate4life]

Yes Jackie, Propofol is an amnestic and great for things like colonoscopy If I ever had to be intubated, that would be the drug of choice to tolerate to tube. I was not intubated during either hospitalization, just BiPap and they used the Ativan only during the Sept. admission....no Propofol.

Dave - I think looking for a different pul doc is very reasonable. Have you given any thought to seeing a cardiologist? It may take awhile to get any appointment, so starting pul rehab might get you on the road to monitored exercise. Even pul rehab programs sometimes have waiting lists. Hope your breathing is getting a little easier. Did you read the synopsis of the webinar for exercise recently posted? I liked the idea of short time = rest time. I'll have to try that too.

[David]

Skate, I have seen a cardiologist in the past and he said I was good. I had a CT scan and the test where they look at your heart on a screen. All was good and the Cardiologist said I did not need to come back. Only if I feel like I have problems in the future.

I went through the Pulmonary rehab program back in 2006 and had a 'scholarship' to access the exercise equipment after I graduated from the program. I went for a few years but faded out and did my walking by the beach. I will go talk to them Monday morning and see if I am eligible to come back. I will pay if I have to. It use to be $30 a month. Hopefully it has not gone up.
They have moved the equipment so it is easier to get to so this time it might be easier on me. In the past just getting there was a strenuous exercise.

Jackie, I wrote that down what you said about the Clonazepam. I will discuss with my Dr. Last night was the best sleep I have had in years and I woke up feeling refreshed. I needed that. Still early to tell but I feel like it has made a difference after the first 2 pills.

I am suppose to take 1/2 to 1 pill twice a day as needed for anxiety or panic attack. The dose is 1 MG.

I sure hope it helps me cope Dyspnea.

[sandy07]

Did you start with 1/2 first? I take 1/2 just once a day. There's been a few occasions that I took another 1/2 later in the day but there was a bunch of stuff going on and my breathing was bad. The anxiety affects my breathing more than my sleeping.

I'm glad you're sleeping better.

[David]

No, I take one in the morning and one at night. I might start taking 1/2 later on but for now I needed to nip it in the bud.
This has been a God send to me. My life is so much better. 4 days now I haven't felt not one time like I had been shot into Space where there is no oxygen. No panics for 4 days now. I actually can do a little more than I had been able to do. I am still short of breath but minus the panic attacks. Which is a big relief.

I went to the Cardio/Pulmonary Community Center at the Sacred Heart Hospital and signed up this morning for Wellness Rehab.

Was approved and started working out this afternoon. I have known the girl who runs it for 8 years so I am in good hands. She was glad to see me come back.
I plan on going every afternoon and see if I can get myself back in shape.

[sandy07]

exerzie bike Sounds great David and it sounds like you're anxious to go. Have a good time there. Meet some new people.
Strengthen those muscles.