COPD

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COPD

• IDENTIFYING AND EXPRESSING OUR EMOTIONS
• AND
• IF WE SMOKE
• WHAT ARE OUR ALTERNATIVES?

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Presenter

• John Hoysted R.S.W.
• Merrickville District Community Health Centre
• 613-269-3400 ext. 237
• E-mail john_at_mdchc.on.ca

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• We are here today to support your attempts to
  live in a healthy way with your chronic disease,
  COPD.

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Three Self Management Tasks

• 1. Taking care of your illness.
• 2. Carrying out your normal activities.
• 3. Managing your emotional changes brought about
  by your illness.

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Focus on Emotional Changes

• Frustration
• Helplessness
• Hopelessness
• Distress
• Fear
• Anger
• Depression

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Emotional Distress

• Emotional distress does not cause chronic lung
  disease.
• However, it can make the symptoms worse by
  causing the airways to tighten and breathing
  becomes rapid and shallow
• Learning how to manage your disease helps you
  feel more in control and less distressed

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Learning to express our Emotions

• When you are diagnosed as having a chronic
  illness, your future changes and with this comes
  changes in plans and emotions.
• Many of these emotions are negative.
• We need to learn skills to work with these
  emotions.

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Challenging Emotions

• Frustration
• Helplessness
• Hopelessness
• Distress
• Fear
• Anger
• Depression

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• You have loss of control over your body.
• There is loss of independence in life.
• This creates feelings of frustration,
  helplessness and hopelessness
• Leading to distress and fear

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Negative emotions lead to ANGER

• Anger is a normal response to having a chronic
  condition. Part of learning to manage the
  condition involves acknowledging this anger and
  finding constructive ways to deal with it.

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• You may be angry at
• Yourself
• Your family
• Your doctor

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• Express your anger constructively
• Or else, it gets turned in on ourselves and we do
  one of two things
• Get depressed or
• We blow up

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Make I statements

• We need to express ourselves by using I
  statements which allows the energy to be released
  out and up, rather than us dumping our feelings
  on another person.

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If we are having difficulty

• Get supportive counselling
• Join a support group

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• Changing our expectations helps change our
  perspective
• Instead of dwelling on the 10 we cant do,
  concentrate on the 90 that we can
• e.g. we think like a rabbit we move like a
  turtle

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• Find new activities and replace the old ones
• Exercise, write, journal, music, painting

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Depression

• Feeling sad, blue, and down is a normal reaction
  to chronic disease.

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• Several emotions lead to depression.
• Frustration, helplessness, hopelessness,
  distress, fear and anger
• Loss of control over life

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13 Common Signs of Depression

• 1. Loss of interest in friends/activities
• 2. Taking pain medication (may cause
  depression.
• 3. Change in eating habits
• 4. Unintended weight gain
• 5. Loss of interest in personal care and grooming
  
• 6. General feeling of unhappiness
• 7. Loss of interest in being held or in sex

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• 8. Suicidal thoughts
• 9. Frequent accidents
• 10.Low self image
• 11.Frequent arguments or increased irritability
• 12.Loss of energy
• 13.Inability to make decisions

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• If you are depressed, force yourself into action
  and if need be, get someone to help you

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13 Things You Can Do When Depressed

• 1.If you feel like hurting yourself or someone
  else, contact someone who can be of support. Do
  it. Dont wait.
• 2.If you are drinking alcohol, stop
• 3.If you are taking narcotics for pain, consult
  your doctor. They may be causing depression.
• 4.Continue with your daily activities
• 5.Visit with your friends, even if you dont feel
  like it
• 6.Join a group
• 7.Volunteer

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• 8.Make plans and carry them out
• 9.Dont move to a new location until you visit
  and check out resources
• 10.Take a vacation with relatives or friends
• 11.Do 30 minutes of physical activity each day
• 12.Make a list of treats for yourself
• 13.Use positive self talk

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• Depression feeds on depression, so break the
  cycle
• If you believe things will go well, they more
  than likely do.

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Practice Breathing and Relaxing

• Breathing and relaxation exercises can help
  prevent the worsening of symptoms
• Guided imagery
• Visualization
• Deep breathing
• Mindfulness Meditation
• Positive self talk
• Prayer

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• Take Control
• and become smoke-free
  
• Smoking is the principal cause of chronic
  bronchitis and emphysema and a major trigger of
  asthma.

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Some chemicals in cigarettes

• Nicotine addictive drug
• Cyanide rat poison
• Formaldehyde preservative in labs
• Ammonia toilet bowl cleaner
• Arsenic rat poison
• Acetone paint stripper
• Methanol jet engine fuel
• Toluene poisonous solvent
• Carbon monoxide lethal gas

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People Learn

• Conditioned behavior
• Repeated pairing of rewarded
• cues behaviors
• Example After a meal, I always feel like having
  a cigarette.
• Example Enjoying a coffee break with a friend
  who smokes.

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Dopamine Neurotransmitters

• Nicotine stimulates release of dopamine
  activating pleasure pathway.
• Smoker becomes dependent on nicotine for rewards.
• Pleasurable feelings from natural sources is
  decreased.

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Tolerance Develops

• Number of nicotine receptor sites in brain
  increase.
• Smokers require more and more cigarettes to get
  same initial effect.

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When you stop smoking

• Nicotine deprivation causes two reactions
• Psychological Cravings
• Physiological Withdrawal Symptoms

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Possible Withdrawal Symptoms

• Cravings
• Mood swings
• Depression
• Anxiety
• Irritable, frustrated and angry
• Tiredness
• Weight gain (average is 5 lbs.)
• Cough
• Constipation

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When the brain is recovering

• Withdrawal symptoms are normal process of healing
  and recovery from nicotine addiction.
• Average length is 3 4 months.
• The first week may be the most difficult.
• Intense cravings last 3 5 minutes, but will
  lessen in frequency and duration during recovery.
• Abstinence Violation Effect (AVE)

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Who Wants to Quit?

• 20 of Canadians are smokers.
• Of these smokers
• 49 consider quitting in 30 days.
• 57 consider quitting in next 6 months.
• 64 tried to quit in last two years.

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Strategies for longer intervention

• 1. Decisional Balance Tool
• Weigh pros and cons of staying the same
• Weigh pros and cons of quitting
• Two most important areas are
• Pros of not altering
• Cons of changing

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Decisional Balance Tool
Smoking Changing
Benefits
Costs
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2. Motivation Scale

• How important is it for you right now to change?
• 0..10
• a) Why are you at x and not at 0?
• b) What would need to happen for you to get to
  10?

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Confidence Scale

• If you decided to change, how confident are you?
• 010
• a) Why are you at x and not at 0?
• b) What would need to happen to get to 10?
• c) How can I help you get to 10?

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3. Pack Wraps

• Provides baseline of smoking behavior
• Identifies triggers
• Helps calculate daily dose of nicotine

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Pack Wraps
Time Activity Where Feeling Need
1. 7 am coffee home edgy 3
2. 730 am driving car angry 2
3. 830 am speaking with friend at work/store relaxed 1
4.
5.
6.

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Why Test Score Card

• It stimulates me
• I want something in my hand
• It feels good
• Its a crutch
• Im hooked
• Its part of my routine
• Im a social smoker

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Nicotine Replacement Therapy

• Does not require prescription.
• Helps reduce withdrawal symptoms.
• Costs less or same as 1 pack/day.
• Consult physician if pregnant or have medical
  concerns.
• Risks of using NRT are much lower than continuing
  to smoke, and NRT may be used in many situations
  where an individual is likely to return to
  smoking.

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Nicotine Patch

• Do not smoke when using patch.
• Supplies small steady dose of nicotine through
  skin patch during 24 hours.
• Different strengths most start with 21 mg
  patch.
• Taper using 14 then 7 mg patches.
• Side effects skin irritation, headache,
  light-headedness, sleep and stomach upset

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Nicotine gum

• 2 strengths 2 mg 4 mg.
• Nicotine absorbed by lining of cheek.
• Used for cravings.
• Used during periods when smoking not allowed.
• Average use is 10 20 pieces/day to start.
• Taper usage over 3 to 6 months (manufacturer).
• Side effects sore mouth or jaw, hiccups,
  irritability, sleep or stomach upset, headache,
  light headedness.

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Nicotine inhaler

• Mouthpiece with nicotine vapor cartridge.
• Puff 5 10 minutes when craving.
• Nicotine absorbed by lining of mouth and throat.
• One cartridge lasts 20 minutes.
• Average use is 6/day.
• Side effects mouth throat irritation, cough,
  upset stomach.

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Zyban

• Does not contain nicotine.
• Targets addiction centres in brain to reduce
  withdrawal and cravings.
• Prescription drug. (antidepressant) speak with
  your doctor about its appropriateness for you
• 150mg for 3 days, 150 mg bid thereafter.
• Start Rx 1 - 2 weeks before quit date.
• Side effects dry mouth, sleep upset, shakiness.
• Use can be prolonged.

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Weight Control

• Take one step at a time.
• Drink plenty of water.
• Eat low calorie snacks when craving.
• Include exercise program.
• Most weight gain is limited to 5 pounds.
• Plan to take off any weight gained later.

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Help is available

• Smokers Helpline
• 1-877-513-3333
• www.smokershelpline.ca

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Strategies for longer intervention

• List reasons for quitting.
• Understand reasons for smoking
• and monitor smoking behavior to
• identify triggers.
• Find healthy substitutes for smoking.
• Learn from past quit attempts. Each past quit
  attempt is important and teaches something new
  about triggers.

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• Four Ds
• Delay urge to smoke and it will pass.
• Deep breath
• Drink water
• Distract yourself to take mind off smoking and do
  something else that is healthy.

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Good News about Quitting

• 20 minutes Blood pressure drops and your pulse
  returns to normal. Temperature of hands and feet
  stabilizes.
• 8 hours Carbon monoxide level in blood drops.
• 24 hours Chance of having a heart attack
  decreases.
• 48 hours Ability to smell and taste improves.

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Good News about Quitting

• 72 hours Lung capacity increases, breathing
  becomes easier.
• 2 weeks to 3 months Circulation improves,
  walking becomes easier and lung functioning
  increases by up to 20.
• 1-9 months Coughing, sinus congestion, fatigue
  and shortness of breath decrease. (Cilia comes
  back to life to clear lungs)
• 1 year Risks of heart disease are cut in half.

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