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Medical Hypnosis Demystified

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By Ian Lipski, M.D., and Lorenzo Cohen, Ph.D.

Hypnposis tree in fieldYou know that feeling of being so wrapped up in a good book or great movie that you lose track of time or self? That's very similar to what hypnosis is like; it's a state of highly focused attention that allows a patient to concentrate on a self-created image so that the awareness of his or her current environment becomes less important and less clear.

In the context of cancer treatment, it involves the use of imagery and relaxation to reduce anxiety or pain or overcome some other obstacles.   



Medical hypnosis
Hypnosis within a medical setting involves a shift in consciousness precipitated by a self-induced concentration exercise. Medical hypnosis empowers patients who are faced with a perceived loss of control and generally improves satisfaction with medical procedures and the hospital experience.  

Extensive research indicates medical hypnosis can decrease pain and anxiety and the amount of medications needed in the interventional radiology suite. It can also shorten procedure time.

For claustrophobic patients undergoing MRIs, it has been shown to decrease the non-completion rate for some scans. Relieving pre-operative anxiety has been shown to lower intraoperative anesthetic requirements for some surgeries. 

Managing Menopausal Symptoms without Hormones

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Mind Over Hot Flashes: Part 1
By Leslie Schover, Ph.D., and Andrea Bradford, Ph.D.

Hot Flashes FanMenopausal symptoms, including hot flashes, night sweats, and vaginal dryness, affect many women who receive chemotherapy, radiation to the pelvis, or surgical removal of the ovaries. These symptoms also affect women who were already postmenopausal at the time of their diagnosis, since survivors of several types of cancer (e.g., breast cancer, endometrial and ovarian cancers) are often advised to stop taking hormone replacement therapies containing estrogen.

Hot flashes are the most common symptom prompting women to seek treatment. Although estrogen replacement is the most effective solution, many women don't want to take hormone replacement. Also, estrogen is usually not recommended for survivors of hormone-sensitive tumors. Fortunately, several non-hormonal medications may help, including antidepressants like venlafaxine [Effexor], and the blood pressure-lowering drugs like clonidine, and gabapentin, whichare commonly used to treat neuropathic pain. Although they aren't as effective as estrogen, these drugs offer relief too many women.

Mind over menopause
Two new studies suggest that a form of psychological treatment called cognitive behavioral therapy (CBT) also can improve menopausal symptoms and quality of life in breast cancer survivors.

What do MD Anderson Dietitians Eat?

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by Adelina Espat, MD Anderson Staff Writer

Carrots in a bowlYour food choices can impact your chances for developing cancer.  And if you're being treated for cancer, what you eat can affect your treatment outcomes.

Every day, MD Anderson dietitians teach patients and survivors how to make healthier food choices. They do this to reduce the possibility of a cancer returning or to increase the chances for successful treatment.

So, what are MD Anderson dietitians eating to stay cancer-free?

To answer this question, we spoke with Rachel Murphy, senior clinical dietitian in MD Anderson's Department of Clinical Nutrition, and Clare McKindley, clinical dietitian in MD Anderson's Cancer Prevention Center.

Here's what they had to say.

How do you get your fill of fruits and vegetables each day?

"Dried fruits are my go to or 100% juice. Dried fruit I can easily add to cereal or just have it as is. Because I don't always tolerate milk well and I'm not as good with my fluid intake, despite my active schedule, I drink an 8 oz glass of calcium fortified orange juice (100% juice). This keeps me hydrated, meets my dietary calcium needs and supports my fruit intake.

"For vegetables, I pre-slice bell peppers to snack on during the day. For example, I'll take the sliced veggies with me to a Mexican restaurant I go to after climbing. I use the vegetables to dip in the salsa. Or, when I go to a pizza restaurant, I'll order lasagna and a salad (no dressing because I generally do not like the taste.) Then, I place a small square of the lasagna on top of my salad. These two techniques help me to maintain my vegetable intake goals." Clare McKindley


Meditation Reduces Stress and Cultivates Inner Peace and Well-being

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By Alejandro Chaoul, Ph.D., and Lorenzo Cohen, Ph.D.

meditationfeb24.jpgThe belief that what we think and feel can influence our health and healing dates back thousands of years. The importance of the role of the mind, emotions and behaviors in health and well-being was part of many ancient cultures, from the Greeks to the Chinese. 

When people are in a state of stress, we enter what some Tibetan teachings call the "monkey-mind" mode; our minds go from thought to thought and emotion to emotion, like a monkey travels from branch to branch.  The monkey-mind pervasive even when people are not experiencing stress. 

When experiencing stressful life events -- situations that pose challenge, harm, loss, or lack of control -- the monkey-mind is our default and our fight-or-flight instinct takes over, and increases stress levels even further.

The fight-or-flight response is useful in managing acute stressors, but when the stressors become chronic the response becomes destructive to our health and overall functioning. 

Chronic stress literally has a negative effect on every physiological system in the body. It has been well documented that stress influences all cells in our body -- changing gene expression and the tumor microenvironment to create a more hospitable terrain for tumor growth.

Newly Renovated Integrative Medicine Center Reopens

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IMC Exterior.jpgMD Anderson's Integrative Medicine Center, formerly known as Place ... of wellness, has moved back to its renovated space and reopened on Floor 1 of the Main Building, near The Aquarium.

Before the renovation, the center had only three treatment rooms. Now, there are six treatment rooms built for versatility of the different treatment options. Each room has wood laminate floors and beds with wheels, making the rooms easy to rearrange to serve multiple purposes.

"I'm very excited with our newly renovated clinic," says Richard Lee, M.D., medical director of the Integrative Medicine Center. "We can now better meet the needs of patients in a way that enhances the care of every person we touch -- physically, mind-spiritually and socially."

The addition of a vital signs room allows the center's workflow to be streamlined, enhancing patient care and the center's efficiency. The renovation includes a workroom for faculty and clinical employees that features six new workstations, updated fixtures and new furniture.

"Before the renovation, we became very creative in the art of workspace sharing," says Andrea Warren, program manager, Integrative Medicine Center. "In a space big enough for one person, you would often find two or more. Now, we have room and resources for all of our staff."

Sleep Center Offers Patient Good Night's Rest

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abcde.jpgTorris Hornsby is a walking miracle.

Diagnosed with urachal cancer, an extremely rare bladder cancer, the Newton, Texas, resident has lived longer than anyone expected, even his oncologist, Arlene Siefker-Radtke, M.D., associate professor in the Department of Genitourinary Medical Oncology at MD Anderson.

Hornsby's resolve to live outweighed his prognosis, but there would be other hills to climb in this journey.

A restful sleep
On one of his inpatient visits to the hospital last year, Hornsby forgot his sleep apnea machine at home about two hours from Houston. Feeling tired and what he called "washed out," he was referred to MD Anderson's Sleep Center. It had been six or more years since his last evaluation, so he participated in a sleep study and got a new machine.

From clinical care to clinical research
Started in 2006, the Sleep Center is a four-bed laboratory available to all cancer patients. Its director, Dave Balachandran, M.D., says the center was established because 80% of cancer patients experience fatigue.

Cancer-Related Fatigue: Integrative Therapies Can Help

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integrated.jpgBy Alex De Alvarado and Lorenzo Cohen, Ph.D.

If you're a patient with cancer, most likely you've experienced fatigue -- and you're not alone. Fatigue is one of the most common cancer-related symptoms described by cancer survivors.

The National Comprehensive Cancer Network defines cancer-related fatigue as "an unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning." For people with cancer, chronic fatigue can be distressing and can dramatically interfere with quality of life.

Understanding the causes of fatigue and finding the right approach for managing it could help to improve your quality of life and daily functioning.

Modern Day Aphrodisiacs: Hype Versus Reality

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By Leslie Schover, Ph.D., and Andrea Bradford, Ph.D.

Women frequently ask physicians or sex therapists for a pill to increase sexual desire. Low sexual desire is the most common sexual problem in women and one of the top sexual complaints among cancer survivors.

So far, the promise of a quick fix for low desire remains unfulfilled. In this post we discuss some medications touted as "performance enhancers."

Viagra for women: why not?

Drugs to treat men's erection problems work by increasing blood flow to the penis. Sexual arousal in women also involves increased genital blood flow.

However, in clinical trials, erectile dysfunction drugs (e.g., Viagra and Cialis) offered no more relief than a placebo to women who lacked physical excitement during sex. Since most women in these studies also had little interest in sex, better blood flow would be unlikely to help.

Recently, drug developers have turned their attention to sexual desire problems.

Bradford.jpgBy Leslie Schover, Ph.D., and Andrea Bradford, Ph.D.

According to a recent report from the Livestrong Foundation, 46% of cancer survivors have experienced a problem with their sexual function. Sound familiar? A survey at M D Anderson also found that 49% of men filling out the questionnaire had developed erectile problems since their cancer treatment and 45% of women had a loss of desire for sex and/or pain with sex.

Unfortunately, sexual health is not always "on the radar" in oncology health care, even at MD Anderson. But times are changing. As the number of cancer survivors in the United States approaches 12 million, their long-term health concerns are being recognized.Two clinical psychologists at MD Anderson are launching a series of posts on Cancerwise to share news, tips and important information about sexual health for cancer survivors.

Music Therapy Helps People With Cancer

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music.jpgBy Alex De Alvarado, Michael Richardson, M.T.-B.C., Ingrid Sevy, M.A., M.T.-B.C., Richard Lee, M.D., and Lorenzo Cohen, Ph.D.

For many people, music connects them to their emotions and is often a way to be socially connected. That is why music can be an effective form of therapy for people with cancer.

The use of music as a therapeutic tool in health and medicine dates back to ancient times.  In modern Western medicine, music therapy started being formally used in the 1950s and is now often incorporated into conventional medical care. Music therapy is a key therapeutic tool used within most integrative medicine programs at large cancer centers around the nation.

When used in conjunction with conventional cancer treatments, music therapy has been found to help reduce pain and discomfort; improve mood and diminish stress; increase quality of life; and allow patients to better communicate their fears, sadness or other feelings.

The Cancer Journey and the Road to Wellness

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By Matthew T. Ballo, M.D., associate professor, Department of Radiation Oncology, MD Anderson Regional Care Center in the Bay Area

ballo.jpg"Medicine should be seen primarily as caring for people's health rather than as fighting a war against disease."
                - Virginia L. Warren, Ph.D
                From the 'Medicine is War' Metaphor*

I first read these words almost 20 years ago and the message has had a lasting effect. The idea that we should think of our clinics as environments for caring for patients, rather than arenas for fighting, would seem obvious but does require some effort.


The thought of waging a war against cancer has an appeal to physicians and patients, for it raises images of an aggressive attack on an unrelenting enemy. It fulfills for physicians the desire to apply their skill in treatment, while for patients their desire for cure.

However, even with the best of intentions, the military metaphor overlooks the fact that patients sit at the center of this battlefield and disregards the gravity of collateral damage. Rather than speaking of how we are going to eliminate a patient's cancer, the conversation should focus on returning that patient to normal -- where cure is only one of many essential objectives.  


Taking the high road
Three years ago, we created a lifestyle rehabilitation program (The Road to Wellness Program) as part of a caring environment for patients receiving cancer treatment. The idea was to promote wellness, prepare patients for life without cancer, and reduce stress and fatigue -- all through education aimed at exercise, nutrition, stress management and smoking cessation.  

While this concept may not seem particularly groundbreaking in the era of survivorship and patient advocacy, it has required some change in our approach to patients receiving radiation treatments.

Traditionally, if a patient develops a specific need during radiation treatment, it is addressed by consultation with the appropriate ancillary care service. This model of intervention works well and serves the immediate needs of patients and care providers. However, it often does little to prepare patients for issues that may arise after treatment is compete. The motivation behind this model is reaction and the primary focus is to facilitate completion of treatment.  


Striking a balance
In the alternative model where caring is stressed, long-term patient needs, be they physical, psychological, social, spiritual or economic, are addressed proactively. General wellness is stressed just as much as radiation treatment, so that one is not viewed as more important than the other.  

A simple change in mind set where medicine is not viewed as a battle can permeate the treatment phase of the cancer journey and have lasting effects on our patients. When we consciously avoid the "medicine is war" metaphor and focus on wellness, we leave behind the negative imagery of destruction and create an environment where patients are returning to something familiar rather than moving into something unknown.

Source: *Warren, VL. HEC Forum 1991;3:39-50



Teaching Our Brain Flexibility: Meditation to Manage Stress

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By: Lorenzo Cohen, PhD, Sarah Prinsloo, Ph.D., Alejandro Chaoul, Ph.D.

Stress generally occurs when an event or situation (stressor) places demand upon us that exceeds our coping abilities.  

Stressors in our lives are many and varied, but usually are characterized by an event that is challenging, harmful, induces fear or represents loss. 


Our hardwired physiological response to stress results in an increase in sympathetic nervous system activity. For example, when we need to get away from danger quickly, our heart rate increases, we breathe faster and shallower, we perspire, blood is shunted to our muscles and we engage for action. 

Under stress, other body systems tend to decrease function, for example digestion, so that more energy can be spent on those systems that will best help the body deal with the stressor. We often refer to this physiological response as "fight or flight."  

To counter-balance the sympathetic response once the stressor is over, the parasympathetic system engages, decreasing heart rate, slowing breathing and relaxing muscles. This allows us to return to our pre-stressor balanced state of functioning.  

Our bodies naturally lean toward a parasympathetic state, but when stress becomes chronic we end up living under a constant sympathetic state. The health damaging effects of this chronic stress state are well documented in the medical literature.

Stress and the brain
The brain responds in the "fight or flight" way and, in fact, may be viewed as the major orchestrator of the response; the conductor if you will. 

The brain usually shifts into a high-alert, brain-wave activity state while the stressor is present and then shifts back to more relaxed activity once the stressor is gone (usually slower; parasympathetic tone).

Under chronic stress, it becomes more difficult for the brain to switch between sympathetic and parasympathetic arousal. So, the brain and the rest of the body rarely get a chance to recover, even if the stressor is no longer present.  

A key factor to managing chronic stress is teaching the brain to become more flexible to help maintain a healthy balance between sympathetic and parasympathetic arousal. Meditation is one method to increase brain flexibility.

meditattoon.jpgHow mediation helps
Meditation has been described as "a wakeful hypometabolic physiologic state" in which the practitioner is extremely relaxed, yet alert and focused.

Although meditation methods can vary, most types of meditation share common features. These include the focused, controlled regulation of breathing and control over thoughts and feelings that come to mind, whether the goal is to inhibit and/or acknowledge and release external thoughts and feelings.

Given the continuous attention-based processes involved in initiating and maintaining a meditative state, meditation has been proposed to be an attentional training exercise.

Meditation, among other things, helps bring awareness to the relation between the mind and body -- acknowledging the constant dialogue and bidirectional effect that the mind and body have on each other.

The impact of meditation on the brain
Meditation may help the brain invoke the parasympathetic response to chronic stress, to balance the sympathetic strain. Brain activity is 98% electrical, and brain rhythms are classified into groups according to the speed that they relay information:

  • Delta is the slowest and is predominant in sleep states.
  • Theta can equal a state similar to daydreaming.
  • Alpha is associated with relaxation
  • Beta is associated with attention and intellectual activity.  
Brain research has shown that the mechanisms of meditation induce electrical frequencies that are thought to be in part the switch between hyper-arousal and relaxation. For example, under meditation conditions the brain often produces the alpha wave. Alpha triggers mental relaxation and is an idle rhythm of the brain, as it waits for cues from other parts of the body and the environment.

This and other brain electrical rhythms affect neurotransmitters, such as dopamine and serotonin, which are also essential in maintaining a healthy balance between sympathetic and parasympathetic arousal and managing the stress response.    

Meditation, therefore, helps regulate relaxation in the body through a bidirectional conversation between electrical and chemical messages in the brain and the translation of those messages by the rest of the body.

A feedback loop follows, where the brain receives signals from the rest of the body about the current state of arousal. As meditation with awareness continues, the body continues to relax and achieve a better balance of its functional systems. Consequently, meditation can help to regulate chronic stress, facilitating the integration of the mind and body.

Overall health effects

Meditation research is finding that mind-body practices have an effect on all systems in our body (e.g. immune, hormone, neurotransmitters and even gene expression to name a few), improving aspects of quality of life, and creating fundamental beneficial changes in the way the brain works. The neurological effect of meditation demonstrates the brain's profound ability to change itself through experience.

This new frontier of medicine is revealing how important it is to manage chronic stress and how influential our behaviors are on how our brain works and our overall health and well-being. 

Meditation is one such healthy behavior to achieve balance and teach our brain flexibility. Meditation techniques are many and varied. Find a form that works for you and practice daily.


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