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Medical Forum / Diseases and Disorders / Asthma / July 2004

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Will a routine physical catch asthma?

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George - 15 Jun 2004 17:16 GMT
I'm fairly convinced my wife (age 59) has untreated asthma.   Last fall she
had some kind of a cold/flu or lung infection that had her in urgent care
several times because of a disabilitating cough, during one of the visits a
nurse casually mentioned that she had asthma.   She was given one inhaler
prescription and some antibiotics and eventually the acute systems went
away.   For many years -- decades -- every couple of years she'll get some
kind of a bronchial infection (presumably viral) for which after several
rounds of it she doesn't even bother to go to the doctor since the treatment
is always the same:  over-the-counter cough syrup and rest.  (This time it
was bad enough that didn't work.)  When all this was going she told me how
when she was a chld she overheard a hushed conversation between her mother
(who was a nurse) and her (my wife's) doctor in which the word "asthma" was
mentioned and she got the distinct impression she wasn't to be told she had
it because at that time asthma labelled you as an invalid.   After the
episode this fall and that conversation I gently tried to get her to take
seriously the idea she had asthma, but no luck.  Because of that particular
episode she was unable to engage in her usual exercise routine of a daily
walk, blaming the cold weather (we're in a northern state).  While she has
now this spring been able to resume it, it is clearly a struggle, especially
given that not walking during the winter put 25 pounds on her.   She even
gets out of breath just going up and down stairs.   (I think that is more
than just the weight gain at work.)

She has her annual phsyical this Thursday.   My question is this -- is it
likely the doctor will suspect and diagnose asthma during the course of it
if she doesn't mention it to him (which she probably won't.)

--
George
Evgenij Barsukov - 15 Jun 2004 18:29 GMT
> She has her annual phsyical this Thursday.   My question is this -- is it
> likely the doctor will suspect and diagnose asthma during the course of it
> if she doesn't mention it to him (which she probably won't.)

Doctors can well detect asthma if you describe the symptoms in particular
way, they dont want by any means to underdiagnose asthma. However, what do
you want to achieve by that? Prescription of bronchodilators
and steroids + realization of your wife's worst fear and giving her an already preconditioned
label as invalid with obvious pshichological consequences.
   I think with her attitude she would much more benefit from an alternative treatment
which addresses wide variety of respiratorial illnesses, such as long term antibiotics
treatment or (my preference) breathing exercises. Later adds extra physical activity which
is beneficial by itself. Suitable would be Strelnikove exercise, see self-learing guide in
my web-site, see sig. This way your wife will not have to get phichologicaly detrimental assignment
as asthmatic (you can "sell" excercises to her as treathment against cold, and from
your description she is good with following exercise routine), and yet treat
the condition as good if not better as traditional treatment with steroids. As I understand,
she does not have acute asthma attacks, so you do not need drastic measures at this stage.

Regards,
Evgenij

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ARoberts - 16 Jun 2004 11:11 GMT
> > She has her annual phsyical this Thursday.   My question is this -- is it
> > likely the doctor will suspect and diagnose asthma during the course of it
[quoted text clipped - 17 lines]
> Regards,
> Evgenij

Sorry, but this is some of the most dangerous advice that I have seen here.
You are asking someone to pretend that his wife could not possibly have
asthma so that she can be spared dire "psychological consequences?"   If she
does indeed have asthma, then she needs to be properly assessed and treated
before it can become life-threatening.  Asthma is too serious to ignore, or
to indulge in experimental, home-brew remedies from the 'net.

Try to talk to the doctor in advance about your suspicions (and your
dilemma), so that he can possibly include a Methacholine challenge test
among the other diagnostics.  This test is the "gold standard" for detection
of asthma.  If indeed, this is asthma, your wife will have a chance to get
it under control before airways can be permanently remodeled (damaged).

If it isn't asthma, then that's great, but at least you'll know.

One wouldn't avoid proper treatment for cancer on the fear of being "labeled
an invalid", why should asthma be any different?   I haven't heard of anyone
here who considers themselves an "invalid".  Nonsense.
George - 16 Jun 2004 16:03 GMT
> Sorry, but this is some of the most dangerous advice that I have seen here.
> You are asking someone to pretend that his wife could not possibly have
[quoted text clipped - 14 lines]
> an invalid", why should asthma be any different?   I haven't heard of anyone
> here who considers themselves an "invalid".  Nonsense.

Thanks, I agree with your comments.   My guess is that since this has
probably gone on at a low level ever since childhood -- she does remember
what in retrospect sounds like a moderately severe episode in grade
school -- there probably has been permanent change and we'll just have to do
the best we can.   She had polio at age 4 (no evident lasting effect,
although she does suspect post-polio syndrome) and both she and her doctors
have blamed any lack of energy or episodes of shortness of breath on that.
She has always been characterized as having "weak" or "sensitive" lungs and
one of the reasons I stopped smoking (pipe) early in our marriage was on a
doctor's advice that it was irritating to her.    But nowhere along the way
(until just last fall) was the word "asthma" ever used!   Anyway, when I
asked her today if she'd bring it up she said she would -- I think the
impact of whatever it is on her level of physical activity has finally
become too annoying for her.   Other perhaps than a quick spirometer  they
may not do much diagnostic work as part of the physical  tomorrow since it
was scheduled to be a routine one and there's just enough time for whatever
standard pokes and prods and thumps  and listens and looks and needle sticks
are scheduled.  (The urgent care facility she was treated at last fall is
part of the same health care provider  as her primary care physician whom
she'll be seeing so there is a good chance everything there is part of her
record and accessible to him .  But I should mention that she mention that
to him specifically.)

George
Evgenij Barsukov - 16 Jun 2004 17:57 GMT
> She has always been characterized as having "weak" or "sensitive" lungs and
> one of the reasons I stopped smoking (pipe) early in our marriage was on a
[quoted text clipped - 3 lines]
> impact of whatever it is on her level of physical activity has finally
> become too annoying for her.

At least there is no harm to introducing alternatives to her. Specialy
as you mention her missing the physical activity - exercises of Strelnikova
_IS_ a physical activity (equivalent to half-hour walking) and is clinicaly
shown to show improvement of asthma conditions (and definetely no agravation, as opposite
to other kinds of physical activities).
  So, this is definetely a physical activity she can immediately start to
practice, regardless to her decision to pressure doctor for asthma diagnose
or not.

Regards,
Evgenij

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Knox JT171 - 05 Jul 2004 08:36 GMT
Which is worse?  Realizing that you have asthma and getting treatment for it?
Or going through a lifetime thinking that you're physically weak and
out-of-shape and sickly?

Isn't it better to know the truth, get good treatment, and conquer your
weaknesses?  Or would you rather put a blindfold on and live in denial,
pretending that you're simply less capable than other people?

It's time to face up to the condition, get it treated.  Rather than be weak and
fearful and pretending that you're just incapable.  The idea of her gaining 25
pounds in the winter from inactivity is inexcusable.  It leads to lower self
esteem, not to mention all of the physical risks that comes from having that
much extra weight.
Evgenij Barsukov - 16 Jun 2004 17:46 GMT

> One wouldn't avoid proper treatment for cancer on the fear of being "labeled
> an invalid", why should asthma be any different?   I haven't heard of anyone
> here who considers themselves an "invalid".  Nonsense.

He clearly stated that this is the attitude his wife has since
she was a kid. Underestimating psichological effects in a
treatment is a huge sin, I hope you are
not a practicing doctor if you have such low consideration of
what patient is going to feel about himself.

He also stated that the condition is not accute, so use of life-saving bronhodilators is
not required at this stage. As for steroids, she did not take it all life
and if this did not lead to "restructuring" of the bronchs so far, there is
not much chance it is going to happen sudently. So she has about as much
chance to improve her (not too bad anyway) condition by doing breathing
exercises as by using steroids, of cause with added bonus of having no
side effects, neither physical not psichological.

Regards,
Evgenij
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George - 16 Jun 2004 19:04 GMT
> He also stated that the condition is not accute, so use of life-saving bronhodilators is
> not required at this stage. As for steroids, she did not take it all life
[quoted text clipped - 3 lines]
> exercises as by using steroids, of cause with added bonus of having no
> side effects, neither physical not psichological.

It is clear she has some kind of lung sensitivity -- at least twice in
recent years being exposed to just a whif of incense almost had her
paralyzed.  (I wonder if there are any true asthmatics left in Russia?
Those Russian Orthodox services would probably have killed them off a long
time ago!)  Somehow I don't think breathing exercises are going to deal with
that.  I also am very skeptical of something that seems to claim it is a
cure for almost anything -- I looked at the Strelnikova website, as well as
for any commentary -- if it is as valuable as you claim it is you'd think
people would be praising it all over the place;  they aren't.  Sorry, but
I'm extremely skeptical and it doesn't seem worth the mental energy, much
less the physical time and effort, to consider seriously.

George
Evgenij Barsukov - 16 Jun 2004 21:14 GMT
> > He also stated that the condition is not accute, so use of life-saving
> bronhodilators is
[quoted text clipped - 11 lines]
> Those Russian Orthodox services would probably have killed them off a long
> time ago!)  

Russia has its own load of bureocracy and idiocy. Few exercise programs
have advanced rather in spite of existing inadequate system then because of
it. They were also not widely known in soviet time and only becoming
available to wide masses recently. For book describing Strelnikova
exercises became 3rd highest besteller in 2001, which does not indicate
a lot of prior knowledge of it. Besides, knowing how to do something does
not mean actualy doing it.

>Somehow I don't think breathing exercises are going to deal with
> that.  I also am very skeptical of something that seems to claim it is a
> cure for almost anything -- I looked at the Strelnikova website, as well as
> for any commentary -- if it is as valuable as you claim it is you'd think
> people would be praising it all over the place;  they aren't.  

Well, let's see - what is the most valuable treatment to reduce chances to die from
diabetis, cancer and heart disease by 2/3? Aha, it is moderately reducing the weight, eating
mixed foods and exercising 30 min a day.

  Is it better then medications? Of cause. There is not a single medication
against above mentioned diseases, which has proven at least 10% improvement
in life expectation. Medication with 60% improvement towards all this
diseases, with absence of side effects would make the company making it rich
beyond wildest imagination.

  Is it well proven? Yes, see recent joint statement of official diabietis,
cardiavascular and cancer societies of USA:
http://www.news-medical.net/default.asp?id=2516

   Is it followed "all over the place"? Nope. Not even close. In fact during
last several decades all of above beneficial activities have declined, despite
widespread knowledge of their usefulness. So, you have to agree - proven effectiveness
does not mean wide following. It is up to You to decide for yourself.

   As for widespread effect claimed for Strelnikova gymnastics - this is
general future of any kind of exericise to be genericaly beneficial. This one is
specificaly training lungs, so in addition to shot-gunning all illnesses by
being _an exercise_ as such, it also specificaly targets respiratorial ilnesses.

>Sorry, but
> I'm extremely skeptical and it doesn't seem worth the mental energy, much
> less the physical time and effort, to consider seriously.

There is 4 clinical trials that were performed in russia (links on my page)
that has shown that the exercise is beneficial. It included 2 trials in childrens
hospitals, military hospital and tuberculosis hospital, all recomending this
treatment and citing improvement in physical measures such as spyrography.

You will be surprised how little mental energy is needed to learn it (as
I learned it with 4-years old in one day), and if you noticed, it is free.
This particular exercise is as pleasent and immediately gratifying as any other.
  As for physical time and effort - your wife did not seem to mind other
type of physical activity. Without any physical activity
at all, I am sorry, people can not function - refering back to
the above mentioned study.

Regards,
Evgenij

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ARoberts - 17 Jun 2004 02:23 GMT
> > One wouldn't avoid proper treatment for cancer on the fear of being "labeled
> > an invalid", why should asthma be any different?   I haven't heard of anyone
[quoted text clipped - 5 lines]
> not a practicing doctor if you have such low consideration of
> what patient is going to feel about himself.

You are presuming that having asthma is shameful; it is not.  You seem to
insist on stigmatizing it.

I am not a doctor, but I expect any doctor with whom I consult to be honest
with me about my condition, the treatment options that are available, and
their associated risks.  Honesty is not necessarily insensitivity, but a
doctor's withholding such vital information as someone's having asthma is at
the very least, unethical.

You have taken it upon yourself to diagnose someone by remote control, via
the internet, and have decided that your "patient" needs a treatment to
which you seem predisposed--breathing exercises.  This pronouncement is made
in a vacuum, without the benefit of examination--just a brief description in
a usenet posting.  Why not let a doctor who has examined her decide what is
needed?

Fortunately, the original poster is logical and analytical enough to have
dismissed the perfunctory approach that you have offered.
Evgenij Barsukov - 17 Jun 2004 17:36 GMT
> You are presuming that having asthma is shameful; it is not.  You seem to
> insist on stigmatizing it.
I am not presuming it, georgy _explicitely_ stated that this is his
wife feeling.

> I am not a doctor, but I expect any doctor with whom I consult to be honest
> with me about my condition, the treatment options that are available, and
> their associated risks.  Honesty is not necessarily insensitivity, but a
> doctor's withholding such vital information as someone's having asthma is at
> the very least, unethical.

As far as I remember we discussed her a completely different issue,
namelly _pressing_ the doctor to consider the diagnose which he
did not consider himself. And, as you well know, you can be sucsessuful.
Doctors relay significantly on the way how information is presented,
and if you just read guidlines about asthma simptoms and present your
simptoms in a way that resembles the guidlines, doctor will be almost
forced to make this diagnosis. There is a very subtle difference between
the accents placed on different symptoms that can swing doctor to one
or another direction.
So far the person in question has never withould any information to
doctors, and no doctors so far diagnosed asthma. And this is no surprize,
as she does not have wheezing, which would raise red flag right away.

So, now you would suggest her to artificialy alter the way how information
is presented so that asthma is considered? This definetely can be done,
but I am not sure of the wisdom of such presentation.

> You have taken it upon yourself to diagnose someone by remote control, via
> the internet, and have decided that your "patient" needs a treatment to
> which you seem predisposed--breathing exercises.  This pronouncement is made
> in a vacuum, without the benefit of examination--just a brief description in
> a usenet posting.  Why not let a doctor who has examined her decide what is
> needed?

I agree here in general - no amount of aditional information can be harmful,
it is the subsequent treathment that by all means can be harmful if unnecessary
agressive or inapropriate due to wrong diagnosis cause by artificialy mispresented
symptoms.
I do not advise _not_ to go to doctor for testing and additional information
(as she have already done many times), I only advise not to try and swing the
doctor in certain direction.
As for breathing exercise, I am convinced that it is beneficial for any
respiratorial condition and therefore can be started right away regardless
of diagnosis.

Regards,
Evgenij

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ARoberts - 18 Jun 2004 13:36 GMT
> > You are presuming that having asthma is shameful; it is not.  You seem to
> > insist on stigmatizing it.
> I am not presuming it, georgy _explicitely_ stated that this is his
> wife feeling.

Yes, but you are perpetuating it:  You said:

"Doctors can well detect asthma if you describe the symptoms in particular
way, they dont want by any means to underdiagnose asthma. However, what do
you want to achieve by that? Prescription of bronchodilators
and steroids + realization of your wife's worst fear and giving her an
already preconditioned
label as invalid with obvious pshichological consequences.
   I think with her attitude she would much more benefit from an
alternative treatment"

> > I am not a doctor, but I expect any doctor with whom I consult to be honest
> > with me about my condition, the treatment options that are available, and
[quoted text clipped - 9 lines]
> simptoms in a way that resembles the guidlines, doctor will be almost
> forced to make this diagnosis.

Then you don't understand how asthma is diagnosed.  Objective
tests--spirometry and Methacholine challenge--are performed, and the
diagnosis is based on those results.

>.  Why not let a doctor who has examined her decide what is
> > needed?
[quoted text clipped - 3 lines]
> agressive or inapropriate due to wrong diagnosis cause by artificialy mispresented
> symptoms.

"...no...additional information can be harmful..." is an interesting way of
justifying that you have been recommending treatment without benefit of
information.

> I do not advise _not_ to go to doctor for testing and additional information
> (as she have already done many times), I only advise not to try and swing the
> doctor in certain direction.

Really?  You said:

"Doctors can well detect asthma if you describe the symptoms in particular
way, they dont want by any means to underdiagnose asthma. However, what do
you want to achieve by that? Prescription of bronchodilators
and steroids + realization of your wife's worst fear and giving her an
already preconditioned
label as invalid with obvious pshichological consequences.
   I think with her attitude she would much more benefit from an
alternative treatment"

> As for breathing exercise, I am convinced that it is beneficial for any
> respiratorial condition and therefore can be started right away regardless
> of diagnosis.

Here, we agree.  Breathing exercises can be beneficial.  However, they are
only an adjunct, not a substitute for conventional treatments.  The website
and method which you have been promoting makes some absurd claims about the
numbers of diseases that can be treated, which makes me view them as quacks.
Helping Hand - 16 Jun 2004 14:38 GMT
If it's active they'll know if not they probably won't unless the word
got back to them from the other doctor.  Word sometimes get around.
Your wife needs medicine if she wants to stay out of the hospital but
she can get to the point that she doesn't have to use them just have
them just in case just learn to avoid her triggers that helps with not
having to have to use medicine all the time.  I know the hospital is the
last place I wanna be.
-Helping Hand
CBI - 17 Jun 2004 03:35 GMT
> I'm fairly convinced my wife (age 59) has untreated
asthma.  ..
<snip>

> She has her annual phsyical this Thursday.   My question is this --
> is it likely the doctor will suspect and diagnose asthma
during the
> course of it if she doesn't mention it to him (which she
probably
> won't.)

Probably not.

If she is wheezing during the visit it should be heard but
most asthmatics don't wheeze most of the time so this is not
likely. Chest x-rays and pulomonary function testing is not
routine and will probably not be done unless she mentions
some respiratory symptom. The doc should ask specifically
about respiratory symptoms but many cut corners on the
"review of symptoms". Of course, even if he does ask she
will still need to admit it to him.

Why not just call the office and ask the secretary to put a
note in her chart saying that you are concerned and asking
the doc to specifically discuss it with her? They won't be
willing to tell you anything but they should be willing to
let you tell them something.

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George - 17 Jun 2004 15:46 GMT
We'll have to see how it goes.  She has every intention of saying her
biggest concern right now is that ever since the bronchitis (or whatever it
was) last fall her difficulties with breathing have severely limited her
level of physical activity.  (Yes, there is a cough with it too -- we could
hope that manifests itself when she's there.)  But she is easily intimidated
by authority and if he starts off on some completely different tack I don't
know if she'll be able to change the direction of the conversation.  I
reminded her to mention the suspicion in urgent care that she might have
asthma ("have you ever been diagnosed with asthma?) but who knows if she
will.   If nothing comes of it I'll call her doctor myself, explain the
situation, and get a referral to the pulmonary/asthma/allergy specialists.
(As I read the fine print I think we could actually do a self-referral and
make the appointment directly ourselves.)  I'll know in a couple of hours.

George

> > I'm fairly convinced my wife (age 59) has untreated
> asthma.  ..
[quoted text clipped - 24 lines]
> willing to tell you anything but they should be willing to
> let you tell them something.
George - 17 Jun 2004 18:48 GMT
> We'll have to see how it goes.

She got her point across.  They took x-rays and had her blow into the
spirograph (I assume that's what it was) three times -- lung function is
just fine (over 100% of what they'd expect -- she says singing in choir is
good for something!)  General guess is that her shortness of breath on
exertion is simply the extra weight (she's lost three pounds already now
that she's gotten back to walking) but they want to rule out anything else,
so she's scheduled for an echocardiogram/stress test next Wednesday.  BP is
OK -- on the high end, as it has been, but no change that they remarked
upon.   She's pretty sure he did pull up the records from the urgent care
visits.  (She mentioned them and he spent some time on the computer.)
Current cough is likely allergy-induced post nasal drip.  (It's been a very
wet spring here.)

George
ARoberts - 19 Jun 2004 05:26 GMT
> > We'll have to see how it goes.
>
[quoted text clipped - 12 lines]
>
> George

That's good news.  Post-nasal drip can really stir up the lungs.  We've had
a wet spring in our area as well, and the air is loaded with mold
spores--not good for asthma...

I guess that any of us (asthma or not) who are carrying a few extra pounds
would serve our respiratory and circulatory systems well by dropping our
weight   :-)
Michael Stults - 20 Jun 2004 05:28 GMT
> > We'll have to see how it goes.
>
[quoted text clipped - 12 lines]
>
> George

I have had the recurrent bronchitis for 10+ years.  I have always been
healthy and did not go to doctors.  Just no need to.
As I got older (42 now) it got harder to overcome the bronchitis.  I have
coughed for 4 months at a time.  I used over the counter
cough medicine but the side effects of being sleepy and draggy interfered
with work.  I would usually start with a head or
chest cold and then when that was over in a few days it led to an upper
respiratory infection and sometimes laryngitis.
I'm not a doctor but I knew what was happening.  The progression was very
predictable.  Finally, two years ago I gave up
when I had a worse than usual bout.  The doctor said rhynitis, bronchitis
and laryngitis.  He gave me steroid and antibiotic shots
oral antibiotics and cough medicine with hydrocodone.  That helped for a few
days.  In two weeks I was worse again.  When
I called for another doctor's appointment, the doctor I had seen was out of
town.  On such short notice, I could only see a Nurse
Practitioner.  I have been seeing her since.  Last year, I took 6 rounds of
antibiotics.  I do not like the idea of taking so much.
For the last three months, she has had me on Advair, Singulair, Nasacort and
Allegra.  I use Albuteral when needed, usually when
exercising .  I had never been diagnosed with ashtma, but like I said I have
never been one to frequent the doctors.  Even as a child,
I was extremely short of breath.  Did not play sports.  I don't think I
could have.  I can walk a great deal, but running is out of the question.
My PFT was normal and even when I have a severe case of bronchitis, my O2
level is good.  The doctor says it is probably asthma
and maybe COPD.  I know they are closely related.  I'm still not completely
convinced.  The doctor can't believe I have never smoked.
It seems they are always trying to make a diagnosis based on family history.
I can live with the wheezing and shortness of breath.  I would
like to find a way to avoid the bronchitis.  I am hoping the medicines will
do that.  I am really curious as to the meaning of the normal
PFT.  I haven't really got a satisfactory answer from the doctor about that.
Maybe she thinks I'm a hypochondriac.  She really listens
though and seems to have the patience to find a solution.  I am not
self-conscious as you say your wife is about being labeled.  I want to
know what the problem is and if there is any way to lessen the symptoms.
The only thing I worry about is having problems with insurance
after being diagnosed with asthma.  However, they already know the history
of office visits in the last couple of years and that would
probably be a problem anyway if I were to change insurance, which I am not
planning to do.  The bottom line is it sounds like your wife
is having a lot of the same problems that I have had for many years.
Evgenij Barsukov - 21 Jun 2004 14:32 GMT
> It seems they are always trying to make a diagnosis based on family history.
> I can live with the wheezing and shortness of breath.  I would
> like to find a way to avoid the bronchitis.  I am hoping the medicines will
> do that.  I am really curious as to the meaning of the normal
> PFT.  I haven't really got a satisfactory answer from the doctor about that.

It looks like you are realy a candidate for a wide-shot respiratory problems
treatment, as your problems appears to be non-specific and doctors have hard
time to pin-point to culpit. If you followed this group, you would probably
guess that I would point you to breathing exercise, which is such a non-specific
treatment, helping with overal respiratory symptoms. Of cause, it is completely
parallel to other things you are doing to improve your condition.
It definetely is not going to harm, as it is a physical activity which is
beneficial in general, and it is clinicaly shown to help people with asthma,
bronchitus and tuberculosis. In particular, it never causes an attack or agravation
of condition, different from outher types of exercise.
You can find most you need to learn it here:
http://sudy_zhenja.tripod.com/strelnikova_exercises.htm

Regards,
Evgenij

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