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By Rachel Winters, Staff Writer

A couple's ability to maintain a healthy relationship post-cancer relies, in part, on their ability to interact, relate and be intimate as the patient makes the challenging and life-affirming transition to breast cancer survivor.

"The majority of the women whom I see say that their partners are very understanding throughout their treatment," says Mary Hughes, a clinical nurse specialist in M. D. Anderson's Department of Psychiatry. "Some of the women who are further out from their treatment, however, have trouble with intimacy due to the appearance of their breast(s), or they say they would like to be more interested in sex."

Conquering body image together

Once a woman has had a mastectomy, regardless of her decision about whether to have breast reconstruction, she may develop a poor body image due to the appearance of the new or missing breast or because of scarring.

While some women are comfortable with letting their partner see the scar, others want to hide their breasts. Although it is perfectly natural to have a difficult time accepting any change to the body, it is extremely important that women not project their own negative images onto that of their partners.

"What a woman needs to remember is that she usually is more upset about the changes to the breast(s) than her partner," says Leslie Schover, Ph.D., professor in the Department of Behavioral Science.

"I've talked to a lot of partners, and the truth is that they're just happy that the woman they love is alive," Hughes says. "They're not concerned about the scar or an imperfect breast. A woman shouldn't think her partner isn't ready. It's her that might not be."

Bringing life back into the bedroom

Women who have had a mastectomy often lose sensation in their breast(s) due to nerve tissue damage. While their breasts were once erogenous zones, they now lack sensitivity, which can interrupt or change patterns of sexual behavior.

Some young women may have trouble due to the early onset of menopause as a result of chemotherapy, which lowers their estrogen levels. This can lead to severe vaginal dryness, pain with intercourse and a loss of elasticity in the vaginal walls.

"Without understanding how to avoid pain, many women lose interest in sex because it is traumatic and painful," Schover says.

Partners of women who are experiencing such side effects need to be understanding and know that with time and work, the woman's libido will return.

Expert tips on intimacy for breast cancer survivors:
 
•    Build self-esteem by doing things that are good for your body, like eating good food, exercising and making an effort to look your best.

•    Wear a tank top or a camisole when making love if it makes you feel more sexual, or invest in sexy lingerie that hides the scar.

•    Spend more time engaging in foreplay.

•    Schedule weekly sexual encounters at times that you are less tired and make a commitment to your "special time." This will cut down on wondering about when the next encounter will be and help both parties relax.

•    Invest in both a water-based lubricant and an over-the-counter vaginal moisturizer. Incorporate the lubricant into your sexual routine, and insert the moisturizer into the vagina a few times a week to help counteract the effects of chemotherapy.

•    Don't be in a hurry or try to force your intimate relationship.

•    You may also consider seeking professional help or counseling.

"Remember that regaining a powerful sexual relationship with your partner isn't a race," Hughes says. "It's like a train ride. It's a journey. Be creative, and do what feels natural."
 
Related articles:
Improving Intimate Relationships for Cancer Survivors

Sexuality and the Cancer Patient (webcast)

Q&A: Sexual Relationships and Cancer


M. D. Anderson resources:
Sexuality and Cancer


Additional resources:
Join the YSC Community (Young Survival Coalition)
www.youngsurvival.org

Exploring Self-Esteem and Intimacy (American Cancer Society)

 

By Deborah E. Thomas, Staff Writer

Tibetan Bon meditation comes from Tibet's oldest Buddhist tradition. A mind-body practice, it uses the breath to first calm the mind and body, then working with your breath lets you form sacred sounds to release obstacles and permit centering. Sound acts as a connector, allowing dialogue between the mind and body, explains Alejandro Chaoul, Ph.D., adjunct assistant professor in the Integrative Medicine Program at M. D. Anderson.

Chaoul says the vocalized sounds are called sacred because they are "a way of connecting to yourself in a deeper way." They help to clear away obstacles to achieve a more balanced life. The idea is to clear away the uncomfortable relationship one has with these obstacles, acknowledging, but not judging them.



Once that space has been created, there is room for nurturing to move in, taking the form of love, joy, compassion, etc. The next step is to bring the qualities gained from the meditative practice into one's own everyday life, where it is needed most.

Chaoul teaches Tibetan Bon meditation with sacred sounds at M. D. Anderson's Place ... of wellness.


Resources
Ligmincha Institute

Meditation may potentially alleviate cancer-related cognitive impairment

By Bayan Raji, Staff Writer

For some cancer patients, reactions to certain medications and treatments create tingling sensations -- similar to when you sit on your foot too long -- that don't go away.

This tingling, known as neuropathy, typically begins on the palms of the hands or the soles of the feet. Eventually, it may become painful and debilitating.

About half of cancer patients who receive chemotherapy drugs experience neuropathy. In about one-eighth of patients, the pain may become chronic.

Drugs may play a role

Neuropathy can be caused by radiation, surgery or chemotherapy drugs, including taxanes, platinum, Oncovin® (vincristine) and Thalomid® (thalidomide). It often is irreversible and even may worsen over time.



Common symptoms of neuropathy include:
•    Numbness
•    Tingling
•    Prickling
•    Burning, shooting or pinching pain
•    Cramping

Patrick Dougherty, Ph.D., professor in the Department of Anesthesia and Pain Medicine at M. D. Anderson, says patients should bring these symptoms to the attention of their doctors.  

Cause may be elusive

Some doctors believe neuropathy is caused when the interaction between nerve endings and the surrounding tissue is affected during chemotherapy. However, no concrete evidence exists to explain the origins of the neuropathy some cancer patients experience.

"The cause may be difficult to determine because these drugs are very different from one another, and they work differently to kill the cancer cells," Dougherty says.

Trial and error may be necessary

Allen Burton, M.D., chair of the Department of Pain Medicine, says doctors may try several methods to reduce neuropathy symptoms.

"When the symptoms are acute, and the patient is receiving, or has recently finished, chemotherapy, the oncologist may lower the dose or extend the time between doses of the drug that are suspected of causing neuropathy," Burton says. "Often, the problem drug is a component of a combination chemotherapy regimen."

Drugs used to treat severe or chronic neuropathy cases include:
•    Opioids (pain medications)
•    Anticonvulsants such as Neurontin® (gabapentin) and Lyrica® (pregabalin)
•    Antidepressants such as Cymbalta® (duloxetine) or Elavil (amitriptyline)

These medications, in conjunction with physical therapy, often help reduce pain and restore the patient's ability to function, Burton says. Occupational therapy may be useful if the patient's hands are affected by neuropathy.

Alternative therapies may help

In addition to medication, doctors may advise patients to try integrative medicine approaches. These may include:

•    Physical therapy
•    Acupuncture
•    Aromatherapy
•    Heat therapy

Dougherty recommends patients work down the list to find therapies that work for them. The most helpful place to access information to these and other alternative therapies is a multidisciplinary pain center, he says.

"It's important to note that certain methods may work really well for some patients but make the pain worse for others," Dougherty says.

Risk isn't clear

Doctors aren't able to determine fully who is at risk for neuropathy. Dougherty says his general impression is that younger patients are more likely to experience it than older patients, but no real explanation exists.

Clinicians at M. D. Anderson are working to develop a pain level chart to better categorize the sensations of neuropathy.

In addition, researchers are conducting several clinical trials for patients with or at risk for neuropathy. Contact askMDAnderson at 1-877-MDA-6789 for information.

Related articles:

Bridging the Divide (Conquest)

Cancer and Neuropathy (Patient Power webcast)


M. D. Anderson resources:
Peripheral Neuropathy

Department of Pain Medicine


Additional resource:
Peripheral Neuropathy Caused by Chemotherapy (American Cancer Society)

By Dawn Dorsey, Staff Writer

Getting a good night's sleep when you have cancer can be a challenge. In addition to treatment side effects and anxiety, a condition known as restless leg syndrome (RLS) gives some sleepers fits.

As many as one-tenth of adults are affected by RLS, according to the American Academy of Sleep Medicine. It's likely that figure is even higher among cancer patients.

What is RLS?

RLS, which happens most frequently at night when a person is at rest, causes a strong, undeniable urge to move the legs. Many people with RLS also have paresthesia,  uncomfortable feelings deep in the legs that often are described as burning, tingling or prickling.

Many people with RLS also have periodic limb movements, in which muscles tighten, twitch or flex when they are resting. These movements may wake them or another person sleeping nearby.

RLS and its accompanying conditions are roadblocks to sleep quality and quantity, which is so important to the health of cancer patients. Among other dangers, sleep disruption may affect the immune system and endocrine (hormonal) function, since hormones are produced during certain levels of sleep.

Triggers are varied

RLS causes may include:

•    Iron deficiency
•    Medications including:
•    Nonprescription allergy and cold medicine like Benadryl®
•    Antidepressants like Elavil® and Prozac®
•    Major tranquilizers like Haldol®, Mellaril®, Thorazine®
•    Family history of RLS

Solutions depend on severity

For mild cases of RLS, try:

•    Establishing a regular daytime exercise program
•    Taking hot baths
•    Getting leg massages
•    Using a heating pad
•    Avoiding alcohol
•    Doing stretching exercises like yoga or Pilates late in the day

If your iron levels are low, talk to your doctor about oral or intravenous iron treatments.
More severe RLS may be treated with drugs including:

•    Requip® (ropinirole) or other dopaminergic agents
•    Benzodiazepines, such as Valium® or Xanax®
•    Opiates, such as Vicodin®

If you experience RLS symptoms, tell your doctor or health care provider.

Related article:

Cancer Patients Need to Treat Sleep Disorders

It's been 10 years since the Children's Art Project at M. D. Anderson Cancer Center published a story book, but this year they're at it again with "Our Shadow Garden."

The latest story book is both educational and an interesting read. The storyline focuses on a grandmother who loves to garden, but has been prohibited from being in the sunlight. Her young grandchild and husband conspire to make her happy again, coming up with a special garden that blooms at night.

Hence, "Our Shadow Garden" is planted. In the book there are sidebars where young readers can learn about special plants that thrive in the nighttime, and nocturnal birds, bats and bugs. There's even a gardening glossary and instructions on how to plant a seed.





The text, which is written by certified Texas Master Gardener Cherie Foster Colburn, is based on Colburn's own issues with a disease that kept her out of the sunlight for a time. Colburn is a landscape designer and owner of Nature's Tapestry. In addition, she is also a freelance garden writer and has been a garden/feature writer for numerous publications. Colburn is owner/developer of www.GardenStops.com, a site for Texas gardening info and a frequent speaker for various organizations, including garden clubs and community groups. "Our Shadow Garden" is her gift to the children of the M. D. Anderson Cancer Center's Children's Art Project, to show the love and healing power inherent in gardening.

The artwork in the book has all been created by young patients in the Children's Cancer Hospital at M. D. Anderson. While some of the art is new, inspired by the Children's Art Project's educational classroom curriculum in the Children's Cancer Hospital, other art has been previously published before finding a new use in "Our Shadow Garden." 

The Children's Art Project at M. D. Anderson began in 1973 with a mission of making life better for children with cancer. This volunteer-driven project blends business and caring to do just that. Through worldwide sales of young cancer patients' artwork featured on seasonal note cards and gifts, the project has funded educational programs, college scholarships, summer camps, ski trips, the Child Life program and other exciting activities that benefit cancer patients and their families.

Each child with art in the book is a current or former cancer patient at M. D. Anderson. The artwork they create is often featured on the products produced and sold by the Children's Art Project. Since CAP began, more than $26 million has been returned to M. D. Anderson to support many psychosocial programs.

"Our Shadow Garden," which retails for $20, and other CAP products are available through the Children's Art Project at its Uptown Park retail store in Houston, online at www.childrensart.org or by calling (800) 231-1580 to place an order or receive a free catalog.

A carefully controlled program of progressive weight training benefited women with lymphedema, a study out today in the New England Journal of Medicine reports.

Clinical trial results out of the University of Pennsylvania offer hope for women with the debilitating condition that arises after surgery or radiation therapy for breast cancer. When lymph nodes are removed or blocked during treatment, lymph fluid can build up in the upper arm, causing pain and swelling.

The study is a substantial contribution to the accumulating evidence for weightlifting, a reversal in conventional wisdom that women with lymphedema should avoid such activity, notes Wendy Demark-Wahnefried, Ph.D., professor in M. D. Anderson's Department of Behavioral Science in the Division of Cancer Prevention and Population Science.  

Demark-Wahnefried's accompanying editorial in the New England Journal of Medicine notes that women have been advised to avoid any vigorous, repetitive arm movements (scrubbing, pushing, pulling or hammering) or lifting more than 15 pounds. "But what should a woman do if, after her treatment, she returns home to a houseful of toddlers or has to push a mop for a living?"

The Penn study, distinguished from previous research by its larger size and longer duration, compared patients receiving usual care with women who followed a specific workout twice a week while wearing a custom-fitted compression bandage over the affected arm. All patients had a history of breast cancer treatment and clinically confirmed lymphedema.

Those in the weightlifting program reported improvement in their lymphedema symptoms and demonstrated increased lower and upper body strength, without a significant increase in arm swelling.

Cost analysis was not part of the study, Demark-Wahnefried writes, but weightlifting has the potential for cost savings by reducing direct health care costs, potentially reducing the risk of disability and  allowing women to return to work full time, whether in or outside of the home.

Lymphedema results when the lymph nodes are removed or blocked due to treatment and lymph fluid accumulates causing chronic swelling in the upper arm.
    
 

By Deborah Thomas, Staff Writer

Awareness of your body's movement and how it communicates with your brain are the main foci of the Feldenkrais Method®. This healing art and movement education process may help people deal with cancer treatment-related side effects.

Method retrains body

The Feldenkrais Method was conceived by Moshe Feldenkrais (1904-1984), a physicist and martial artist, mainly to recover from his own sports-related knee injury in the 1920s. He learned to decrease pain and improve performance when he paid attention to how his body moved.

Prior to his findings, most people believed it was difficult to retrain the body to do an already-learned activity once a person reached a certain age. But, Feldenkrais concluded the brain continues to develop throughout life and retains the ability to relearn. His findings have been confirmed by research in neuroscience.



Movement is relearned
MaryBeth Smith, director of the Feldenkrais Center of Houston, teaches free Feldenkrais Awareness Through Movement classes for patients and caregivers at M. D. Anderson's Place ... of wellness.

When she works with a student, Smith says, she doesn't dwell on what hurts or what obstacles are in the way. Instead she discovers what brings pleasure to that person. Through being aware of movement, the student learns to perform everyday actions (for instance, gardening, singing or just being comfortable) using a new pattern that works better with current life circumstances.

Best way to move is individual
"Feldenkrais is different from physical therapy," she says. "We're not trying to fix something that is 'wrong' or to conform to an ideal.

 "We gently assist the person to find his or her own best way to move, and it may not be like anyone else's. Improvement in strength, flexibility and range of motion often result." Once the student finds the ideal movement for what he or she is trying to accomplish, the activity is relearned and incorporated into everyday living.

Awareness Through Movement at Place ... of wellness is underwritten by the C. G. Jung Educational Center, Houston, through funding by The Houston Endowment.



M. D. Anderson resources
Place ... of wellness

Integrative Medicine Program at M. D. Anderson


Additional resources
The Feldenkrais Center of Houston

The Feldenkrais Method of Somatic Education (The Feldenkrais Education Foundation of North America)

By: M. Kay Garcia, DrPH, MSN, RN, LAc, Advanced Practice Nurse, Integrative Medicine Program*

It's important to have realistic expectations about acupuncture. People either don't expect it to work at all, or they expect it to be a "magic bullet" and completely resolve all their health problems. Acupuncture isn't a "magic bullet" and certainly doesn't work for everyone. Most people do get some benefit. Some get a lot of benefit with only a few treatments, while others get a little benefit even after multiple treatments.

Cancer survivors know that the effects of the disease and its treatments aren't merely physical. While each person is unique, many cancer survivors share some common concerns.

One of the most basic is the fear that the cancer will recur. It's important to remember that while you can't control whether cancer recurs, you can control how much you let the fear of recurrence impact your life.

A first step in coping with fear is to try not to feel guilty or ignore feelings in hopes that they'll go away. Instead, there are certain things you can do to help cope with this fear:

• Talking often reduces fears and anxieties. Talk with your health care team or friends, or join a support group.

• Try writing down your thoughts and feelings in a journal.

•  Try other complementary modalities like yoga, music therapy, tai chi, guided imagery, reflexology and massage. There are reputable centers all across the country that offer classes in these disciplines.

M. D. Anderson Resources

M. D. Anderson's Place ... of wellness provides a service where persons touched by cancer may enhance their quality of life through programs that focus on the mind, body and spirit. It offers more than 75 complementary therapy programs, most are free of charge.

Place ... of wellness is open to anyone touched by cancer, their family members and caregivers, whether or not they were treated at M. D. Anderson. No physician referral is required. For more information, call 713-794-4700


Other Resources
Yoga Bear Blog 
Integrative Therapies at Dana Farber
Integrative Therapy Classes at Sloan Kettering
Integrative Services at Cleveland Clinic

For some reason, I have a track record for working in areas of cancer medicine that are fundamentally patient-centered, difficult to understand based on their labels and challenging to briefly explain. Three examples: palliative care, general oncology and integrative medicine. What do these topic areas mean to you? 

I arrived at M. D. Anderson in November 1999. I had been trained in internal medicine and hematology/oncology, and had spent the first two years of my career as an academic oncologist focusing on the care of genitourinary malignancies. But I had decided to pursue my interests in issues related to symptom management and quality of life, so my job position here was in the Department of Palliative Care and Rehabilitation.

The department was new, and I would be asked by faculty and staff on a frequent basis, "what is palliative care, anyway?" I would babble something about quality of life and helping people live better, but I couldn't explain it coherently before the questioning colleague got off the elevator or veered in a different direction. So I decided to find a succinct definition that I liked, and rehearse and memorize a version of it. Here's what I memorized:

"Palliative care is comprehensive, interdisciplinary care for patients with life-limiting illness, where the focus of care is enhancing quality of life and reducing suffering for the patient and family."

OK, so what's general oncology? It's the ultimate paradox at our institution, which is well known for incredible subspecialty expertise in so many areas. Why would M. D. Anderson want "general oncology?"

On our main campus, general oncologists have a role in the initial evaluation of complex international patients as they're evaluated and cared for in preparation for the appropriate subspecialty, multidisciplinary team. Moreover, they're often called upon to help navigate complex care when multiple specialty teams are involved. General oncologists provide care in our Integrative Medicine Clinic as well.

Our Department of General Oncology leads the medical oncology care at Lyndon B. Johnson General Hospital and at our community-based clinical care centers. Also, general oncologists often lead and participate in patient-oriented research projects and clinical trials that address issues cutting across different diseases, and collaborate on other projects and clinical trials that are led by subspecialists.

Finally, if general oncologists evaluate patients in the Integrative Medicine Clinic, what exactly is integrative medicine? According to the Consortium of Academic Centers in Integrative Medicine, it's "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals and disciplines to achieve optimal health and healing."

To me, that sounds exactly like good medical care -- just the kind of patient-centered care that people expect. The thrust of the care in integrative medicine is tailoring to each individual patient a program that improves his or her health and well-being, above and beyond the disease-focused expert care provided by other care teams.

In 2007, I was diagnosed with prostate cancer. After radical prostatectomy surgery, radiation and two years of hormone therapy, I have learned that "attitude matters."

My mother died of colon cancer when I was just entering college. What I best remember of her 15-year fight was her attitude. When family and friends were trying to pull themselves together after each surgery, my mother was always trying to get back to work, back to her garden, back to living. My dad had a rich life and, at age 78, died of prostate cancer. On his last day, he walked around the block carrying his oxygen bottle and stopped to listen to the cardinals sing.

As a wellness coach I've worked hard to take care of my body, but my cancer journey has taught me that a body disconnected from the mind-spirit connection can easily get lost. One of my favorite body-mind-spirit authors, Brian Luke Seward, has written many books and articles about stress management, resilience, meditation and attitude. In his book "Stand Like Mountain, Flow Like Water" he suggests that our "attitudes are the paintbrush with which we color the world."  

What paintbrush have you colored your world with today? Some days our self-talk can become so negative or fear-based that our thoughts become what I call "stinking thinking" or "toxic thoughts." This negative thinking not only affects the way we feel, but also how we act and treat ourselves and others.  

How do you stop stinking thinking? The experts say there are several things we can do to shift to a positive mind-set. The one I like the most is GRATITUDE. One of my favorite little books on gratitude is M.J. Ryan's "Attitude of Gratitude." It's 180 pages packed full of stories and affirmations. Remember that gratitude is like a flashlight, lighting up what's already there and then we no longer take it for granted.

Try this. Next time you walk around M. D. Anderson, take a look at how the physical environment has been set up to have a positive effect on attitudes. I bet, like me, you have a favorite painting? I love the canyon series that hangs in our Cancer Prevention Building. Then there are the panels in the hallways that tell the stories of patients' cancer journeys and employees' dedication to our mission. Those always inspire me. I also really love the fish tanks, as they provide an instant getaway. They are so big that I often imagine I am scuba diving, which instantly turns my attitude.  

The Place of ... wellness also provides many classes and creative opportunities for patients and families that positively affect attitude.  

As a cancer survivor and wellness coach, my life experience has taught me that attitude is a big part of my cancer journey and how I greet, meet and grow each day. This is a journey we all share with so many others, and M. D. Anderson has an attitude about fighting cancer.

Fighting cancer takes more than good diagnoses and the best treatments. It also takes a staff with an attitude of being the best at what they do and creating an environment in which patients are not just empowered, but are given a cancer-fighting attitude that they share with others as they walk their cancer journeys.

Resources
Cancer and Attitude (American Cancer Society)
The Right Attitude for Fighting Breast Cancer (Yahoo Health)

By Bayan Raji, Staff Writer

The eyes have been called the windows to the soul, but the hands and feet are often the first parts of the body to experience something, perhaps the softness of a blanket or hot sand on a beach.

 The importance of hands and feet make them the focal point of reflexology, a healing art historians believe was used first in China more than 5,000 years ago. It focuses on pressure points of the hands and feet and can be used by anyone, but it may be especially beneficial to cancer patients.

 
Pressure applied to hands, feet
Reflexology may help relieve symptoms often related to cancer treatment such as nausea, insomnia and stress. The technique also is believed to have a generally beneficial effect on a person's health and well-being.

Reflexology therapists use their hands - usually their thumbs or forefingers - to apply pressure to areas of the hands and feet that they believe are connected to specific zones of the body. Stretching and movement techniques also may be used. They may open or close the session with a gentle hand or foot rub.


Symptoms may be helped
Margaret Harle, a registered nurse, holistic health consultant and reflexologist, teaches classes about reflexology to patients and caregivers at M. D. Anderson's Place ... of wellness. She answers questions about the technique and demonstrates reflexology for those who are interested in using it at home.

Harle says that during private sessions reflexologists generally work on the hands or feet for 30 to 45 minutes. Most patients find the sessions relaxing, and many experience temporary symptom relief.

 Some patients notice mild temporary, uncomfortable after-effects, including:

    * Nausea
    * Fatigue
    * Need to urinate more often

 
Check with your doctor first
Reflexology should be part of a comprehensive health care plan, Harle says. Some people with certain side effects of cancer or cancer treatment, including lymphedema and neuropathy, should avoid reflexology. Be sure to check with your health care provider.

 Reflexology should not be considered an alternative to medical treatment.

 
M. D. Anderson resources:
Integrative Medicine Program


Other resouces:
Manipulative and Body-Based Practices: An Overview (National Center for Complementary and Alternative Medicine)