Mind-Body Medicine: How Can Cancer Patients Utilize Supportive Care Tools? | Transcript | Living Well | Patient Power


Mind-Body Medicine: How Can Cancer Patients Utilize Supportive Care Therapy Tools?

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Raquel Forsgren:

Yeah, I definitely will.  First of all, I will say that's a myth.  There's a lot of myths around yoga with not being able to do it, because it's too rigorous.  You mentioned Esther kind of coming from a rigorous running, jogging.  A lot of people think of yoga, and they think of the postures that they see on social media or in magazines or TV or whatever, and they're upside down where they're doing different things, and that's a beautiful aspect of yoga, but it's only one. 

There are so many different things we can do with yoga, the postures, the breathing, the imagery, as Dr. Subbiah talked about, and deep relaxation, which multiple studies have shown that can actually reset and rebalance someone's nervous system.  So talk about mind-body and being able to control that yourself. 

So if you'd like to go you through a few techniques now, we can do that.  What I would do is invite all of you who are viewing the program to do it with us and see if you can sense the difference in just a few minutes of doing some of these very simple practices, and then what you can do after this is recorded come back to this video and watch the practice again and just implement these, like Andrew said, a little bit on your own. 

So what I'll ask all of you to do, even those of you that are on—joining us with Andrew—and Dr. Subbiah, you can do it as well—I'd like all of you to feel really comfortable, just to sit in your chair or if you're watching this in your bed lying on your back, just wherever you are I want you to just simply close your eyes if you feel comfortable doing that.  And immediately feel the surface of whatever it is that's supporting you, the chair, the bed, see if you can sink into it, even 5 percent more than you were initially. 

Wherever your hands are, feel the bottoms of your hands, maybe the bottoms of your feet, your toes, your heels.  Just feel the body itself.  Now notice your breathing and don't judge it, just notice what it's doing, if it's nice and slow and fluid as you inhale and exhale or shorter little breaths or sticky or clunky in any way.  Don't analyze it.  Don't go into any thinking other than just noticing. 

Begin to expand your muscles in your ribs as you take your next inhale.  Just think about expanding your ribs out just a little bit more, taking two more nice, slow inhales and exhales.  And I want you to bring to mind one thing you're really grateful for today.  One thing.  The next before we move on, bring to mind a goal, an intention.  It could be how you want to feel for the rest of the day, emotionally or physically.  How do you want to feel, or what do you need?  Beautiful. 

Softly begin to open your eyes and bring your hands right in front of your heart with your palms placed together.  We're going to do just a few movements of our arms so that you can see what it's like to connect movement, your body and mind and breath together, and also thinking about lung cancer just something that helps expand the lungs and just activate all of those muscles themselves that need to be nourished. 

So as you inhale just open your arms like a cast or goal post.  And you'll need to adjust this.  If you have had surgery along the central plate, take it nice and easy, just open, inhaling.  As you exhale bring your arms together, touching your palms together, elbows and forearms.  Inhale, open the arms again.  Exhale, closing the arms together.  Just take two more only moving with your own breath.  And closing.  One more time just like that, beautifully opening and relaxing.  And releasing the palms back down on your hands. 

Close your eyes one more time.  I want you to notice if anything has changed within your body, your mind or your emotions, and there's nothing wrong if nothing's shifted.  I just want you to notice.  And softly blink open your eyes again, because I want to show you and have you go through with me one of the best anxiety-reducing breathing techniques that can be done.  It's published in the literature. 

It's called alternate nostril breathing.  You can do this while you're waiting at the doctor's office for results, if you starting to feel panicky or anxious, when you're inside an MRI machine or a CT scan, when you are just waking up in the middle of the night with racing thoughts, and you can't seem to shut them off.  So you'll take two fingers, sometimes it's the outer fingers but sometimes with arthritis in older hands it's a little tougher, so I like to use two fingers, you're going to bring them up to your nose, and you'll be closing off one nostril at a time.  And I want you to breathe normally and naturally, okay.  So this isn't anything forced. 

Close off the right nostril first, and just delicately push it.  You don't have to push it clear into your nose.  Just delicately push it.  Exhale all the way out the left side of the nostril.  Then inhale through the left nostril, exhale out the right nostril.  Inhale through the right nostril, exhale out the right nostril.  We're going to do three more of these.  Inhale through the left, exhale out the right.  Inhale through the right and exhale a little longer out the left.  One last time.  Inhale through the left and exhale longer out the right side.

Bring your hands back down to your lap and close your eyes again.  Take a nice normal, natural breath.  And I want you to notice what's different in your breathing, if anything.  Just notice it.  Notice your heart beating.  Come back to that intention or that goal you set for yourself.  And softly blink open your eyes with a smile.  I'm expecting all of you watching to be smiling even though I can't see you.  And Namaste. 

That's in a nutshell what I would say.  So that was about five minutes.  You tell me what you noticed.  How did you feel after doing it? 

Andrew Schorr:

Well, as a patient I'm more relaxed.  I think I need a nap.  I'm worried about—Dr. Subbiah has probably got patients lined up outside.

Dr. Subbiah:

Oh, I'm in a good place, so thank you. 

Esther Schorr:

I can tell you that it steadied my breathing.  It's deeper.  And my heart rate just calmed.  It just calmed.  I mean, it wasn't super agitated before, but as we went through that exercise it's just, I'm like even.  I'm like even.  That's the only way I can explain it. 

Raquel Forsgren:

Yes, that's the most common description.  Thank you. 

Andrew Schorr:

So, Raquel, a few questions.  Okay.  So let's say we have 100 people here who are more relaxed, and they say, well, okay, I get it.  How can I be trained to do this again, either alone with others?  How does that happen?  So wherever people are, and they could be all over the world watching, how do they seek out resources to do this? 

Raquel Forsgren:

Oh, it's such a great question.  I would say across the country, particularly in cancer centers now, especially like MD Anderson and even the clinics.  It doesn't have to be within the context of a big academic institutions, just ask.  Ask the nurse.  Ask your social worker.  I'm working with a lot of social workers now within the context of support sessions, support groups, so we're mixing talk therapy with mind-body.  So just ask your nurse navigator or any of them.  So that's number one. 

Number two, it is important to look for someone that is certified as a yoga therapist because we're trained as a subspecialty in trauma, in serious disease, in cancer.  So that helps.  And you can go to the International Association of Yoga Therapy.  Go to their website and type in your ZIP code, and any number of certified therapists will come up with that information.  So those are two simple ways to find it. 

Andrew Schorr:

Okay.  Dr. Subbiah, okay.  So—and you all picked yoga as the modality you were testing as well.  So, first of all, what's your take on what we just did, and what would you say to our folks as far as making use of that along with other approaches? 

Dr. Subbiah:

So I went along with all of you and did this myself, and so everything regarding the heart rate, breathing, I've experienced it, and I noticed that my shoulders are much less tense.  So that's always something that I notice when I do this in my office. 

So yoga can be intimidating in that some people think that you need to set aside 40 minutes, an hour to do this.  The reality is you can gain benefits really in a very short period of time, and that's one of the elements that we're testing.  Is initially if an intervention, a yoga-based intervention is a 45-minute session, do we still have the same effect when we do a 30-minute session, a 20-minute session?  And we're working on one now that's an 11-minute session.  So we want to see if the beneficial effects in people going through cancer treatment and their caregivers can be experienced by shorter and shorter time sessions.  And so we'll put that data out once we get it. 

Now, the two ways, the easiest ways to access it, are like what was said, which is engage your healthcare team and ask them about resources with integrated medicine within their practice, within their nearby hospital, within the city.  And so at MD Anderson we have a separate department of integrated medicine that's devoted to the alternative and complementary aspects of care of someone with cancer. 

And so the integrative center has classes every day in tai chi, Qigong, multiple—every day that's open to anybody, and so the patients, caregivers, whomever comes with them.  And so we would encourage our patients to take advantage of that, especially if you have an appointment in the morning and maybe an infusion in the afternoon, and there's some time in between the day is to go and spend that time in the integrative medicine center. 

The other resource that I use is the integrative medicine center's web page within MD Anderson.  And so you can access it from anywhere in the world.  Just Google integrative medicine at MD Anderson.  It will come up.  And there we have several videos there with our yoga expert here.  Dr. Alejandro Chaoul is one of the world leaders in yoga in the context of cancer therapy.  And so Ali has several videos where he guides you through this.  So I've done this at home.  I've done this in the office. 

And so you can open it up, do it on your smartphone and try it out.  And you can go back to it as many times as you want.  And don't forgot to go back to it.  It's not a one-time.  The benefit comes from doing it repeatedly over the course of—really it's a lifestyle modification, so. 

Andrew Schorr:

Esther, so you've made this part of your life now.  So I did feel a benefit just doing this.  And I did go to one class with you, so I've got to go again.  But as a caregiver, what do you see?  What change have you seen? 

Esther Schorr:

Well, you know, other than what Raquel pointed out in that demonstration, for me, I've seen myself become physically stronger now, and I'm well aware that cancer patients some of the more advanced parts of yoga, the physicality of it may or may not be appropriate given what your mobility is and your physical being. 

But if it is, whether it's a caregiver or a patient, the really good thing about yoga that I found is it's not a competitive sport.  It is a practice, and it's very individual.  So you can do as much or as little as you want.  The mindfulness part, the breathing, what we just did, everybody can do.  And then you can build on that if for example you've gone through treatment and there are parts of your body that you have strength or you want to build strength yoga is very—it builds on itself, so you can just build it at your own speed. 

And so, for me, I found it's not tough on my body like running was.  It accomplishes to lower anxiety, etc., and at the same time what I found is it strengthened my physical body and my ability to tolerate other stressors. 

Andrew Schorr:

Right.  And as a patient I have definitely seen a change in Esther, which has helped me be calmer as well. 

Esther Schorr:

Oh, I'm glad there's that by product.  That's great. 

Andrew Schorr:

So Raquel, are there video you're—so great.  Are there videos that you're in as well that we can link to that would be helpful?  I'd love to see again. 

Raquel Forsgren:

I do.  Actually, I have a YouTube channel that has just a couple on there that I focused around, a long, deep relaxation, and this is one we didn't talk about today much.  It's about a 25- to 30-minute deep relaxation, and it works through progressive muscle relaxation, body sensing, using the breath, and also really gets into the subtleties of the mind and what you're starting to think about and process emotionally while you're relaxed.  So that's number one, and it's on there.  It's Yoga With Raquel.  That's the name of it. 

The other two that I have put on there were related to anger, grief, and dealing with difficult emotions and how do you welcome those and deal with them and process them.  And some of those I put on because of some people I was working with, was working with at the time, who were just diagnosed, and they had that swarm of emotions and they didn't know what to think about what the oncologist had even told them.  They were angry.  They were sad.  It was just a mix. 

So I created those just off of training I've had with Richard Miller and others to build those and put those out there for people.  And they're free resources that anybody can tap into.  And they're six and seven minutes long, but I would highly encourage anybody, especially I think for care partners, Esther like you and I have talked, you know, you're wanting to be strong and be there for the person, for the loved one.  You don't want them to see you falling apart inside or being afraid, and I think you need an outlet to feel what you're feeling and then be able to go back and be present for the loved one.  And so that's also been behind, in my mind, in creating a lot of these things now for that.  But, yeah, check those out for sure. 

Esther Schorr:

Well, and yoga can be done together, too. 

Raquel Forsgren:

Absolutely.  Absolutely. 

Andrew Schorr:

So, Dr. Subbiah and Raquel and Esther and me, we're getting questions, and if you have a question the best way to do it is to send it to questions@patientpower.info, and Tamara Lobban-Jones, our wonderful producer, will help forward those to us. 

Dr. Subbiah, I just saw a quick question that came in from Canada where someone asked, well, can yoga help with peripheral neuropathy pain?  So, for instance, our myeloma folks, some others, have medicines, and I think of those but there may be others across cancer, where you developed neuropathy in full or numbness, so what about that?  Or are there other ways to manage it, and that's part of your discussion with your palliative care specialist? 

Dr. Subbiah:

Absolutely.  Now, that's a great question, and peripheral neuropathy, it can be anything from a nuisance to debilitating, and so it's—and it's experienced by so many as a side effect of so many different cancer medications and so many of the other medical problems, like diabetes.  And so the impact on lifestyle can be tremendous. 

And so we look at the pharmacological interventions that are out there that you may have worked with your doctor, whether it's the gabapentin (Neurontin) or pregabalin (Lyrica) or duloxetine (Cymbalta).  These words may all ring a bell to some of you who are suffering from peripheral neuropathy. 

The mind-body realm just has some options for peripheral neuropathy, and these work in the same way that most mind-body techniques work, which is in conjunction with something.  And so one of the interventions that we have data for to support its use in peripheral neuropathy, the primary one that comes to mind is acupuncture. 

And so acupuncture, we have small trials that shows an improvement in the pain when compared to those who don't receive acupuncture in their peripheral neuropathy.  So it does have a role when you use it for the management, and it may be that you use it in addition to a medication that you may have been taking that may have helped but not to the extent that you want it to.  So acupuncture has a tremendous role in the management of peripheral neuropathy. 

The remainder of the techniques have a role in anxiety management, and even the distress that goes with having a peripheral neuropathy, so it's not to say that there isn't a role.  The whole concept of this is you have to take care of the whole person, so it's not just about the pain in your left foot.  It's the left foot that's attached to that person who's having to stop running because their left foot is bothering them. 

So mind-body techniques have a very important role, especially as you go later on in your treatment or as a survivor.  Some of these side effects stick around with you for a very long time.  So these mind-body practices, you can take them with you for life. 

Andrew Schorr:

We talked about anxiety, and Esther referred to that as a caregiver.  Previously and at other times we always talked about medication for that or depression as well.  What about some other things that come up?  I know when I went through chemo Esther had me taking ginger.  And I even had one of these little zappers like some pregnant women use for nausea, and that happened me, right?  But there were things like that.  And then I think I was an MD Anderson patient at the time, they even did have some other medicines, even suppositories I used because I couldn't take anything by mouth.  I couldn't keep it down.  And that helped me a lot. 

So but that was in communication with my healthcare team.  So nausea, sleeplessness, anxiety and even diet generally.  I know some people particularly with lung cancer have I think you'd call it cachexia or even myelofibrosis, which I have, where people just are like wasting away, right?  They're not eating at all.  

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on May 21, 2019