This is the year you take control of your health, learn to work smarter, and live more simply. From now on, you're saving your energy for the things you want to do.
Here's how to make that happen.
Stop smoking now! Yes, your doctor already told you. But the point can't be stressed enough.
"It's never too late to stop," says Henry Gong, M.D., professor of medicine at the University of California, Los Angeles, and associate chief of the Pulmonary Division at UCLA Medical Center. "Even if you stop in your fifties or sixties, you'll help slow down the deterioration of your lungs." Another plus: You may immediately increase your capacity to exercise.
The leading theory on how smoking causes emphysema is this: Cigarette smoke incites neutrophils, the disease-battling warriors of the white blood cells, to migrate selectively to the lungs. "Apparently, they extrude their enzymes, which can digest lung tissue," says Dr. Gong. "In normal people, there is a balance between that enzyme and antitrypsin, the one that blocks."
In rare cases, nonsmokers get emphysema, too. Victims of a rare inherited protein disorder, they lack sufficient levels of antitrypsin.
Stay away from passive smoke. If the smoke from your own cigarettes can harm you, so can the smoke from your spouse's cigarette or air in a smoky dance hall. A nonsmoking spouse can develop lung cancer by inhaling the cigarette smoke from a smoking spouse after many decades of living together, says Dr. Gong.
Avoid allergens. If you have known allergies and they affect your breathing, it's doubly important to stay away from them when you have emphysema, says Dr. Gong. (For more on allergy control, see Allergies, page 7.)
Control what you can. You can't repair your airways. What you can do, says pulmonary specialist Robert Sandhaus, M.D., Ph.D., consultant for the National Jewish Center for Immunology and Respiratory Medicine and other health facilities in Denver, Colorado, is increase how efficiently you breathe, use your muscles, and approach your work. If you can rearrange your kitchen, for instance, so that you can do in five steps what used to take you ten steps, so much the better, he says.
Exercise. All our experts agree that regular exercise is vitally important to the emphysema sufferer. What kinds are best?
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Walking is probably the best overall exercise," says private practitioner Robert B. Teague, M.D., a clinical assistant professor of medicine at Baylor College of Medicine. "You should also exercise to tone the muscles in your upper extremities. Try using 1- or 2-pound hand weights, and work the muscles in the neck, upper shoulders, and chest." This is important, he says, because people with chronic lung diseases use their neck and upper respiratory chest muscles more than other people.
People who have asthma and emphysema seem to really benefit from swimming, because the activity allows them to breathe very humidified air, says Dr. Teague.
Eat a little and often. As emphysema progresses and there is more obstruction to airflow, the lungs enlarge with trapped air. These enlarged lungs push down into the abdomen, leaving less room for the stomach to expand.
That's why six small meals will make you feel better than three large ones. Your best bet, says Dr. Teague, is to reach for foods that pack a lot of calories into a small volume, like high-protein selections.
Be aware, too, that prolonged digestion draws blood and oxygen to the stomach and away from other parts of the body, which may need them more.
Maintain your ideal body weight. Some emphysema sufferers gain a lot of weight and tend to retain fluid, says Dr. Teague. It takes more energy to carry extra body weight. The closer you are to your ideal weight, the better for your lungs.
"The true emphysema patient tends to be very skinny," adds Dr. Teague. "Because they have to breathe harder, they expend more energy." If you're underweight, conscientiously add calories, says Dr. Teague. High-protein foods are a good source of calories.
Become a champion breather. There are several things you can do to get the maximum oomph from each breath you take. They include:
Make your breathing uniform. When Dr. Teague and his colleagues studied 20 patients with advanced emphysema, they found that even under normal conditions their subjects had "very chaotic breathing patterns. Their breathing was all over the map—big breaths, little breaths. We taught them normal breathing patterns and it helped, at least in the short term."
Breathe from your diaphragm. This is the most efficient way to breathe. Babies do it naturally. If you watch them, you'll see their bellies rise and fall with each breath.
Not sure whether you're breathing from your diaphragm or your chest? Francisco Perez, Ph.D., a clinical assistant professor of neurology and physical medicine at Baylor College of Medicine, tells his patients to lie down, put City of Houston-size phone directories on their bellies and watch what happens to them when they breathe.
Keep those airways open. You can strengthen your breathing muscles if you blow out slowly through pursed lips for 30 minutes a day, says Dr. Gong. Try to exhale twice as long as it took you to breathe in. This will help you rid the lungs of stale air, so fresh air can get in.
You can also buy a device from your pharmacy that offers resistance when you blow against it. "It looks like a little plastic mouthpiece with a ring on the end," says Dr. Sandhaus. "When you turn the ring, the opening at the mouthpiece changes size. You start with the largest opening, take a deep breathe in and blow out. Once you master one setting, you move on to another one."
Try vitamins C and E. Dr. Sandhaus advises his emphysema patients to take a minimum of 250 milligrams of vitamin C twice a day, and 800 international units of vitamin E twice a day. (Of course, don't practice this or any vitamin therapy without your doctor's okay and supervision.)
Dr. Sandhaus says that the vitamin therapy is unproven, but it can't hurt. He thinks vitamins C and E may be helpful because they're antioxidants. "We know that the oxidants in cigarette smoke are what damage the lungs," he says.
Allow yourself to grieve. Your life with emphysema won't be the same as your life before emphysema. Allow yourself to move through each stage of the grieving process, says Dr. Perez. "There are some losses. But then you recognize that you have control over it.
"The ultimate stage in adapting is compromising," he says. "That involves give and take, instead of seeing things in black and white."
Relax. "If you cognitively view the disease as a threat, you'll arouse some physiological mechanisms that can make your emphysema worse," says Dr. Perez. "When you're in a constant state of alarm, you're demanding a lot of oxygen in the process. Alarm is created by the thought process, which you can control. That means you can also control the physiological mechanisms."
Shift your focus to the present. When you find yourself feeling guilty that you brought on your disease, shift your orientation to the present and concentrate on what's happening now, says Dr. Perez. "You can't deal with events that happened in the past. You can only learn from them."
Anger and self-blame are normal, he says. Your best bet is to talk about it and then let it go.
Set small goals. One way to shift your focus from "emphysema is incapacitating" to "emphysema is something I have control over" is to set realistic small goals for yourself, says Dr. Perez.
Exercise is a great way to boost your confidence, he says. "Set some real objective goal based on the physical evidence. Use charts and graphs to measure your progress. This gives you a very objective measure of your ability to do something."
Join a rehabilitation group. Consider joining a pulmonary rehabilitation group, says Dr. Gong. If you can't find one locally, contact your nearby American Lung Association chapter. A group can educate you about your condition and provide social support. "Statistics show that these programs can decrease the number of hospitalizations," says Dr. Gong.
Have a family member play "coach." Have your significant other become your coach and help you through those times when you're short of breath, suggests Dr. Perez. "A coach can help you go through the basic relaxation technique. They can sit down with you and ask you about your thought processes just before and during the attack. Psychologically, emphysema patients are very normal," he says. "Once they verbalize what they're thinking, they can see it's pretty ridiculous. The moment they start laughing, they relax and their breathing comes back."
Don't isolate yourself socially. "You need to avoid generalizing about the shortness of breath," says Dr. Teague. "Some emphysema sufferers think, 'Well, I probably can't do this.' Because they're scared they might get out somewhere and get short of breath, they quit going places they'd normally enjoy." Don't let it isolate you.
Pace yourself. "The other thing emphysema sufferers have to learn to do is to take their own time," says Dr. Teague. "They really can do what they want to do but they have to do it at their own pace. That is not an easy thing to do, to learn to walk slower."
Work smarter. Little things can make a big difference. Can you rearrange your work spaces so you can get more done with less effort? What about setting your table with dishes directly from the drying rack instead of putting them away?
The American Lung Association also suggests that you obtain a three-shelf utility cart to help you with your housework. Small efficiencies like these pay back with extra energy.
Coordinate your breathing to your lifting. According to the American Lung Association, housework will be easier if you remember to lift while you exhale through pursed lips. Inhale while you rest. Similarly, if you have to climb steps, climb while you exhale through pursed lips and inhale while you rest.
Don't use unnecessary sprays. You don't need to add to your respiratory problems by inhaling unknown substances, says the American Lung Association. Use liquid or gel-type hair dressings and roll-on or solid deodorants. Avoid aerosol-spray household cleaners.
Let loose. On your clothing, that is. Choose clothing that allows your chest and abdomen to expand freely. That means no tight belts, bras, or girdles, says the American Lung Association. Women may find camisoles more comfortable than bras. Men and women might substitute suspenders for tight belts.
Often new introductions are offered for a short spurt of time and then they disappear. A new favourite is an annual begonia called “Firecracker”. The plant is aptly named. Mine is still a little small, but on a mature plant the explosion of intense red-hot blooms is amazing. This gem was available (though not widely) this spring. But, who knows about next year? Like fashion, things come and go. I want to make sure I have it for next year.
And then, there is the matter of money. I spent more money than I want to admit to on a novelty begonia called 
