SDCRI is inviting people in the Integrative Oncology & Integrative Therapies community to contribute articles for our Education page. Our goal is to provide new and informative articles for you each month. We are very excited to be able to present these authors and hope that you enjoy what they have to share!
Here are the articles we have to offer today:
Every Organization Has A Story. Here’s Ours. by Dr. Andrea Deerheart with The HeartWay, shared on March 1st, 2021
Integrative Oncology Resources and Daily Ritual Summary, Checklist, and Reminders by Daniel Vicario, M.D., posted on February 1st, 2021
11 Questions to Ask About COVID-19 Research by Jeremy Adam Smith, EMiliana R. Simon-Thomas, published on greatergood.berkley.edu, December 16th, 2020
Medication management for cancer patients and caretakers by SINGLECARE TEAM, updated on November 5th, 2020
Hope Made Visible™, International: An ongoing journey by Alessandra Colfi, PhD, posted on November 2nd, 2020
Breathe Away Anxiety by Lisa Nicholson, posted on October 6th, 2020
Travel during the COVID-19 Pandemic from cdc.gov, posted on September 4th, 2020
Cold Flashes and Breast Cancer by Lisa Nicholson, posted on August 3rd, 2020
Depression in the time of Covid-19 by Paul Brenner, M.D., Ph.D, posted on May 19th, 2020
How Meditation Can Support Your Community and Wellbeing by Nina Fry-Kizler, MA, published on March 27, 2020
The Queen of Pandemics: Corona virus reflection and resources by Alessandra Colfi, PhD, posted on March 27th, 2020
Best Essential Oils 2020 on consumeradvocate.org, updated on February 1st, 2020
FDA warns 15 companies for illegally selling various products containing cannabidiol as agency details safety concerns on FDA.gov, published on November 25th, 2019
The Mountain, Revisited A Tribute to Tate MacDowell, posted on November 5th, 2019
Good Vibes For Better Health: The emerging science of positive emotional state of mind and health by David Muehsam, Ph.D, posted October 2nd, 2019
Digging Out of Debt for Cancer Survivors by Jeannette Moninger, published on August 09, 2019
Healing Grief Thru HeArt by Alessandra Colfi, PhD, posted on August 5th, 2019
Understanding The Connection Between Addictions and Cancer by Patrick Bailey, posted on July 5th, 2019
How Physical Therapy Can Help Ease Cancer Pain by Dr. Brent Wells, posted on June 4th, 2019
A New Frontier for Evidence-Informed Integrative Oncology Care from The Journal of Oncology Practice, shared on May 2nd, 2019
Implementing Integrative Oncology: Hopes and Challenges from The Journal of Oncology Practice, shared on April 2nd, 2019
Putting Integrative Oncology Into Practice from The Journal of Oncology Practice, shared on March 1st, 2019
Food Is Medicine from theconversation.com, published on January 18th, 2019
SDCRI Review for the year 2018 by Daniel Vicario, M.D., posted on January 10th, 2019!
Every Organization Has A Story.
The HeartWay was born out of the work of our Founder and Executive Director Dr. Andrea Deerheart, which encompasses the issues related to optimal wellness of mind, body, and spirit during dying and death–grief and loss, and compassionate, mindful and supportive care. This is her story.
“For over 33 years, I’ve been talking to people about death. I’m often asked “how could you work with the dying?”
My journey on this path began when I was seven. Many family members were dying of heart disease and cancer and I wasn’t allowed to visit them in the hospital or attend the funerals. I can remember my older brother having an accident and I was kept away. I imagined it must be horrific if they wouldn’t even let me see him. I became convinced that illness and death were really, really scary.
I tried to conquer my fear of death by fantasizing what it would be like when I was dead but my imagination only confirmed that death is dark, lonely, scary, and empty. My fear intensified as I grew up and manifested as low-grade anxiety. I lived with the fear the best that I could and pursued my undergraduate studies at San Diego State in marketing and sociology. After what one might call a successful career in marketing for large corporations, I started thinking about getting an MBA. In the meantime, I did everything I could to be safe so that death would not touch me–years of wellness, nutritional studies, vegetarianism, yoga, teaching, and spiritual development followed.
I’ve always wanted to volunteer, to give, and to share with others. My path changed when a dear friend was on the board of directors for a hospice in San Diego county and I asked him if they needed volunteers. Is there a question that one should have significance in the life of someone who is dying – you know, if the door is sprung wide open? So, in I went!
My first person I went to serve who died in my arms changed my life forever. I can still feel that moment, years later. Being present to her death was not at all what I imagined. She slipped away in my arms with a gentle exhalation. I wasn’t scared. I wept and held her. Then I wept some more.
There was no turning back at this moment. I was home. My heart and soul had found a path that filled me with an inner peace I hadn’t yet known in my life. I went back to school, but not for an MBA. I received my first Masters in counseling psychology so I could become a hospice social worker, and upon graduation started working in the hospice system in Orange County. This deepened my connection to the preciousness of life and I love every day. I listened, learned, cared, and became ever more present to death. My fear of death eased and my life became filled with deep heartfelt gratitude.
In the mid-nineties, hospice came under major scrutiny from Medicare and other governing bodies. They became financially dependent on funding to survive and the medicalization (and monetization) of death began. Unfortunately, this detracted from their original mission of providing a holistic approach to end of life which tugged at my heartstrings as I didn’t believe concerns over money should be part of our last breath. It should be a time to say good-bye, love each other, reconcile our relationships, grieve, and honor death.
I’m a strong advocate for hospice services as I believe they are a necessary part of our current medical model of care, but I also believe we have a system that isn’t addressing many of the needs of those facing the end of life. Hearts, desires, and soul yearnings are being untouched, leaving many of the dying alone, fear-laden, shamed, and in an institution in which they may wish not to reside. My deepest vision is that no one dies in unnecessary suffering. I left hospice and continued to do the work that I felt was needed to support those facing the end of life, inclusive of providing compassion, support, education, sanctity, rituals, death with dignity, and love.
My studies advanced to a doctorate degree in mythology and depth psychology. My thesis focused on the cultural, religious, and philosophical practices of death, dying, and beyond. I continued my work as a death doula (someone who cares for the dying, physically, spiritually, and emotionally), advocate, educator, and ordained minister. My practice took me all over the world as I deepened my ability to be present to death. Death is better understood in our psyche and souls when we’re connected to our ancestors in dreams and imagination.
I’ve now held hundreds as they have crossed over the threshold into the unknown. Each person affords me the honor of witnessing a significant piece of the great mystery of this life. The privilege of listening to the echoes of their hearts.
I’ve never charged for my services for those families and loved ones dealing with death. When I’m asked how I can do this work, I answer, “I cannot NOT do this work! The work chose me.” I say this with the deepest of gratitude.
With love from my heart to yours,
Dr. Andrea Deerheart
The HeartWay Executive Director and Founder”
Integrative Oncology Resources and Daily Ritual Summary, Checklist, and Reminders
by Daniel Vicario, M.D.
I’ve had the honor and privilege to work with cancer patients for over 3 decades. During the last few years, I’ve done this as an Integrative Oncologist. I’ve been fortunate to learn so much from them over the years, and I continue to do so with each visit and conversation. I’ve been able to keep a list of tools, empowering and inspiring concepts that continue to evolve. Several of these ideas/experiences I’ve been able to share in the video interviews and as lists of resources detailed in the following summary sheets.
Please share with anyone you believe could benefit from them.
Sending best wishes and blessings to all readers,
Daniel Vicario, M.D.
The following are the Integrative Oncology Resources and Daily Ritual Summary, Checklist, and Reminders lists from Dr. Vicario. Click on the links below for printable PDF versions.
Integrative Oncology Resources
Daily Ritual Summary, Checklist, and Reminders
Integrative Oncology Resources
Here are several recommendations to consider reviewing:
….. 1. Information and resources available on our SDCRI nonprofit website: www.sdcri.org
….. 2. You can watch these three video interviews on Integrative Oncology:
……… a. Conversation with Dr. Paul Mills at UCSD: https://www.uctv.tv/shows/Comprehensive-Cancer-Care-Integrative-Oncology-with-Daniel-Vicario-MD-and-Paul-J-Mills-UC-Wellbeing-Channel-32223
……… b. Conversation with Dr. Mimi Guarneri: https://youtu.be/tjYbLGKIXic
……… c. Zoom video on Friday November 20, 2020 with Dr. Shamini Jain from the Consciousness and Healing Initiative (CHI: www.chi.is). Here is the YouTube link: https://youtu.be/jspzj_T0FqY
………d. Slides shown on the above Zoom video with Dr. Jain from the Consciousness and Healing Initiative: Slide 1 (sdcri.org)
…..3. Educational and inspirational videos on our SDCRI website: https://sdcri.org/edu-art/edu-vids/
…..4. “Commentary on a recent JNCI article about alternative medicine”: https://sdcri.org/edu-art/current-integrative-research-news/commentary-alt-med/
…..5. “INTEGRATIVE MEDICINE” websites:
………a. Academy of Integrative Medicine & Medicine: https://aihm.org
………b. NIH National Center for Complementary and Integrative Health: https://www.nccih.nih.gov
………c. Consciousness and Healing Initiative: https://www.chi.is
………d. T. Colin Campbell Center for Nutrition Studies: https://nutritionstudies.org
………e. UCSD Center of Excellence for Research and Training in Integrative Health: https://medschool.ucsd.edu/som/fmph/research/centers/integrativehealth/pages/default.aspx
………f. UCSD Center for Integrative Medicine: https://medschool.ucsd.edu/som/fmph/research/cim/Pages/default.aspx
………g. UCLA Integrative Medicine Collaborative: https://www.uclahealth.org/integrative-medicine
………h. UCSF Osher Center for Integrative Medicine: https://osher.ucsf.edu
…..6. INTEGRATIVE ONCOLOGY and Integrative Medicine recommended websites:
…..7. Mary Hollander, R.N. nutrition sites:
………a. Mary’s Reality Based Nutrition – San Diego Cancer Research Institute (sdcri.org)
………b. Mary’s Reality Based Nutrition | “Let food be thy medicine and medicine be thy food” Hippocrates
…..8. During challenging moments, you can consider searching online and/or on YouTube meditations with:
………a. Jon Kabat Zinn (founder of mindfulness meditation)
………b. Eckhart Tolle
………c. Belleruth Naparstek
………d. Wayne Dyer, Deepak Chopra and many others you may resonate well
…..9. Nine Surviving and Thriving Beyond Cancer with Belleruth Naparstek: https://youtu.be/9ZnuDXRxYY8
…..10. Deepak Chopra’s YouTube channel: The Chopra Well https://www.youtube.com/channel/UC6d0RMVcoXNCkTpG8PW2dBA
…..11. Deepak interview with Rodrigo Niño on cancer: https://youtu.be/CbdvB3sQjxE
Daily Ritual Summary/Checklist
…..1. Stress management
…..2. Meditation. Visualization. Reflection. Prayer
…..3. Good sleep. Plenty of rest
…..4. Optimizing Nutrition
…..5. Exercise. Yoga. Breathing Techniques
…..6. Honoring our emotions. Allowing them to move through us
…..7. Embracing uncertainty
…..8. Feeling in Control. Empowerment
…..9. Balance. Inner Peace. Homeostasis/Homeo-dynamics
…..10. Grounding. Being in Nature
…..11. Sense of purpose. Gratitude
…..12. Clearing old traumas: ours, our parents, and our ancestor’s traumas that we
carry (epigenetically, etc.)
…..13. Create your own daily “checklist”
…..• Honor all your feelings
…..• Trust your powerful inner wisdom, your intuition.
…..• Be with those who make you feel good, who support your inner peace in the midst of all the challenges
…..• You are unique. Please do not compare yourself with others
…..• Accept help. You are always giving
…..• See medicines, chemotherapy, surgery, radiation, etc. as Healing treatments, tools in your healing journey
…..• Visualize your potential for infinite possibilities and healing • Message of hope: for any condition considered “incurable” at this time, an answer may be around the corner
…..• Miracles do happen. Spontaneous remissions
by Jeremy Adam Smith and EMiliana R. Simon-Thomas
How can you tell if a scientific study about the pandemic is valid and useful? We have some tips.
Debates have raged on social media, around dinner tables, on TV, and in Congress about the science of COVID-19. Is it really worse than the flu? How necessary are lockdowns? Do masks work to prevent infection? What kinds of masks work best? Is the new vaccine safe?
You might see friends, relatives, and coworkers offer competing answers, often brandishing studies or citing individual doctors and scientists to support their positions. With so much disagreement—and with such high stakes—how can we use science to make the best decisions?…
… continue reading this article on Berkley’s Greater Good Magazine website!
by SINGLECARE TEAM, Medically reviewed by GERARDO SISON, PHARM.D.
For cancer patients, medication is a critical aspect of recovery. A patient’s specific mix of medications will be designed in consultation with a care team. Those medications will work best when given at the proper doses and times.
This guide will help cancer patients and caregivers successfully manage the storage, dosage, and special circumstances related to cancer medication.
What are the 5 R’s for medication safety?
Caregivers who follow the 5 Rights of Medication Administration will be the most effective at keeping cancer patients safe and healthy. These are the same steps followed by the care professionals at your clinic or hospital.
- Right drug
- Right dose
- Right time
- Right route
- Right person
As you get ready to administer a drug, first make sure you’re using the correct one. Look at the pill bottle, then read the name of the drug out loud.
A common cause of dangerous adverse drug events is giving an improper dose. This mistake usually happens when caregivers misread or mismeasure the proper amount.
A medication plan will only be successful if the proper medication is given at the right time. The best solution is a written medication schedule.
Cancer medications can be administered as pills, liquids, topical treatments rubbed on the skin, and injectable treatments. Injectable treatments include intravenous (IV) infusions or injections through the vein, intramuscular (IM) injections into the muscle, and subcutaneous (SQ) injections under the skin. Follow the directions given with the medication, and ask for help if you feel you need it.
Pill bottles can look very similar. As a last step before administering the medication, look again at the medication you’re holding to make sure you’re giving it to the right patient.
General tips for effective cancer medication management
Two important strategies will help you give medication safely throughout the treatment process: keeping a medication list and storing medication properly. Medication storage and handling is especially important because some treatments may be hazardous.
A medication list is a critical document that will be consulted by patients, caregivers, pharmacists, and your doctor. Make sure you add any supplements or over-the-counter medications to the list in addition to prescribed medications.
The medication list should include the name of the medication, the dosage or how the medication is taken, when treatment with the medication began, and any concerns you have such as side effects experienced.
Safe storage and organization
Cancer medications are powerful and very dangerous if taken by the wrong person or handled improperly.
If you have anyone at home who might accidentally ingest them (like a child or pet), make sure to store the pills in a high place they cannot reach. You may also want to invest in a pill lockbox. Never store cancer medications in the bathroom—the humidity can lessen their effectiveness.
Ideally, only the person who is taking the medication will touch it. If a caregiver needs to handle the medication, they should only do so while wearing gloves.
Hazardous at-home medications
If any of the medication being taken at home is hazardous, such as chemotherapy drugs like doxorubicin or vincristine, caregivers will need to take additional safety steps.
Caregivers should be given special kits with instructions and materials for cleaning spills, and special containers for disposing of hazardous medications.
These medications can still be present in dangerous amounts in bodily fluids, such as urine, blood, saliva, etc. If any of these fluids are present on the patient’s bed sheets, towels, or clothes, handle them with disposable medical gloves, and wash the soiled fabrics in hot water separately from other laundry.
The patient should take special care when using the toilet. For 48 hours after an injection or IV treatment, the patient should flush the toilet twice after use, wash their hands well, and cleanse any body parts that have urine or feces on them. The toilet water could still contain trace amounts of hazardous chemicals, so children and pets should be kept away from the bathroom.
Powerful cancer drugs, like any medication, must be taken at the proper time in order to be the most effective. Missing scheduled dosing times completely or taking pills at the wrong time could be dangerous.
To make sure you administer all pills at the proper time, set reminder alarms on an alarm clock or timer. If you have a smartphone, consider using an app designed for medication management.
It’s also a good idea to write down the daily medication plan on a sheet of paper. A physical list can be easily copied and shared with other caregivers and health aides, and you don’t have to worry about phone compatibility or a data outage making the medication plan inaccessible.
Having a record of daily medications is also very helpful at follow-up appointments with the patient’s care team. These appointments are the ideal time to discuss adjustments in medication timing that may help reduce side effects experienced. You may discuss moving the timing of a treatment dose closer to a mealtime, for instance, or further away from bedtime. These are just examples. Never make any changes to a medication plan without first discussing them with the assigned care team.
Understanding the prescription bottle label
Typically, a prescription label has eight parts and types of information. Keep in mind that your own prescription labels may look somewhat different, but they will generally have similar content listed for you to reference. Learn to recognize these parts on your own medications.
- Pharmacy information: Key details about the pharmacy that filled your prescription
- Your information: Contact information of the patient
- Prescribing doctor’s information: Contact information of the physician or healthcare provider
- Drug name and strength: Brand, chemical, or generic name along with the measured amount of one unit of the medicine
- Instructions on taking the medicine: How and when to take the medication
- Prescription information: Specific information to aid in planning for getting refills
- Pharmaceutical manufacturer information: Name of the company that manufactured your medication and a physical description of the drug
- Federal caution statement: Prescription warnings mandated by the U.S. government
Many prescription medications also come with medication guides that are approved by the Federal Drug Administration (FDA). These guides have information about issues specific for particular drugs, and may help patients avoid serious side effects.
At-home injections or intravenous treatment
When it is safe to do so, chemotherapy treatment can be given at home. A home health aide will do the procedure, or train a caregiver to do so.
If a home health aide is administering these treatments at home, they will be responsible for learning about and caring for special equipment, like the tubes, lines, ports, and catheters that are used in cancer treatment. There are many different types. Someone at the cancer care facility will train the home health aide or caregiver about the specific equipment before you start any at-home treatments.
Avoid switching pharmacies or doctors
Cancer treatment is a complex process. The care team will be weighing many factors in developing your medication plan, including your past medical history, allergies, the stage of the cancer, and others.
Because the process is so involved, it’s best to stay consistent with the pharmacy you’re using and the doctors you’re seeing. That means sticking to one pharmacy for all your medications, if possible.
Active treatment and maintenance therapy
Many cancers are treated with the goal of eliminating it from the body. When treatment is in this stage, it is sometimes called active treatment. In a best-case scenario, the patient is completely free from cancer at the end of treatment.
Some cancers are chronic in nature. They cannot be fully cured; they’re only managed with ongoing chemotherapy to keep the cancer from spreading or worsening. Such cancers may include ovarian cancer, some leukemias, and some lymphomas.
Once treatment has successfully reduced the signs and symptoms of the cancer, the disease is said to be in remission. When the cancer isn’t growing, it may be called “controlled” or “stable.” Growing cancers are often described as in the progression phase. If a chronic cancer begins progressing, you will likely have to resume treatment.
Homeopathic, alternative, or complementary cancer treatment
Hospitals and cancer care facilities take an evidence-based approach to treatment. The cancer treatments recommended by your doctor have proven effective in clinical trials of cancer patients.
There are other treatments that are not proven to eliminate cancer, but can relieve some symptoms of the disease. Meditation may help reduce anxiety. Tea may assist digestion or reduce nausea. Massage or acupuncture may relieve pain. Many cancer treatment professionals encourage the use of these therapies when used in conjunction with evidence-based treatments.
The side effects of cancer treatment can affect a patient’s ability to stick to their medication plan. For example, confusion or delirium is a serious side effect associated with cancer treatments and pain-relieving drugs. Less serious cognitive lapses during cancer treatment—like forgetting names or dates, or a general feeling of mental cloudiness—are sometimes called “chemo brain.” A patient who isn’t thinking clearly may have a harder-than-usual time remembering to take medication.
Chemotherapy can affect the entire body. Common side effects of cancer treatment include general fatigue, hair loss, constipation, diarrhea, and mouth sores, among others. Other side effects, such as nausea, taste and smell changes, and difficulty swallowing, can make taking medication unpleasant.
Discuss side effects with your care team. If side effects are so severe that the patient can no longer safely take their medication, adjustments to the dose or type of medication can be made.
When to immediately contact your medical team
During most cancer treatments, the patient spends the majority of their time at home. Many medical issues that happen at home can be handled by the caretaker or the patient themselves. But if any of these events occur, reach out to your care team.
- You need a refill of your medication
- You lose, spill, or vomit a dose
- Someone else accidentally takes the cancer patient’s medication
- Any redness, warmth, swelling, damage, or pain at the port or injection site
- Patient can’t take treatment or refuses treatment
- Signs of an allergic reaction to the medication
Safe disposal of cancer-related treatments
With any medication, safe disposal is important. Medications are powerful chemicals that are dangerous if accidentally ingested, or if they get into the soil or groundwater.
Cancer medications are often extremely hazardous. Your care team should give you specific instructions for disposing of these medicines safely if they’re no longer needed. You may also get special equipment like a biohazard container. You should not try to figure out how to dispose of a cancer medication. If you weren’t given specific instructions or don’t remember what the instructions were, call your care team and ask for help.
Cancer is scary, but medication management doesn’t have to be
Aggressive cancer treatment can be a life-altering experience. Pills, needles, and intravenous tubes may temporarily become as regular a part of your life as the daily mail. For caretakers, you’ll be assuming a new role as a part-time nurse. But you have a team of dedicated, full-time medical professionals behind you. They will help you figure out the best home treatment plan for you based on your availability and skills. Educate yourself by reading guides like this one, but don’t hesitate to ask for help. You can do this.
Hope Made Visible™, International
An ongoing journey of healing, compassion, and resilience.
by Alessandra Colfi, PhD
“Only through our connectedness to
others can we really know and enhance self.
And only through working on the self
can we begin to enhance
our connectedness to others”.
— Harriet Goldhor Lerner
Hope Made Visible™, San Diego Cancer Research Institute’s global expressive arts initiative, has received even greater attention since the whole world turned upside down, and outside-in, because of the COVID-19 pandemic. More than ever people have been seeking creative ways to stay connected and feel the support of community while physically distanced and only able to see each other’s eyes in public. Especially for our vulnerable cancer survivors and their families, the elderly or those who live alone, the isolation can be particularly grueling; no hugs, no shaking hands, no getting together for workshops, no group activities, limited travels are taking a toll as we approach the 8-month mark and likely expect prolonged social distancing recommendations will remain in place next year.
The pandemic added a thick layer of anxiety, lack of freedom, irritability, and fatigue to those affected by cancer; patients have been expressing that their view of cancer as the most serious, life-altering experience they could ever experience evolved into a whole new level of emotional and mental stress. More than ever-supportive services, coping skills, and resilience through meaningful engagement need to be enhanced, especially in the prolonged quarantine.
Not only at this time it has been difficult to create a new sense of ‘normal’, but it hit especially hard those who lost loved ones and have been struggling with not been physically present with their loved ones at the end of their lives and gathering with family and friends for the very necessary, soulful rituals of celebrating and remembering their precious lives and relationships.
How do we deal with the heaviness of this time? How do we keep going when so much of our lives is so hard, sad, uncertain, and unpredictable? How do we breathe through the anguish and find joy and gratitude in being alive?
My answer is: community and the arts! Here is a short list of benefits based on extensive research and narrative accounts by participants:
- Art fills occupational voids, distracts thoughts of illness
- Improved well-being by decreasing negative emotions and increasing positive ones
- Improved medical outcomes, trends toward reduced depression
- Reductions in stress and anxiety; increases in positive emotions
- Reductions in distress and loneliness
- Increase in compassion for others
- Improvements in flow and spontaneity, expression of grief, positive identity, and social networks
And here comes Zoom, our ubiquitous virtual meeting platform.
I facilitated Hope Made Visible™ workshop series during the summer for cancer patients and vulnerable community members through UC San Diego Health; with geographical boundaries evaporating thanks to the virtual delivery mode, patients from all over the country joined in, creating additional interest and new personal connections and exchanges.
We have been working together with reminders, tools, mindful attention, and processes that offer a pathway to authentic artistic expression. There is no better time to delve into the depths of ourselves in a safe, supportive group, to explore and express how we feel, and to bear witness to these discoveries with acceptance, in simple accessible ways.
Since 2012 we have collected more than 1,500 unique Hope Made Visible™ flags created by cancer patients and families/friends from all over the world. They are currently displayed as a powerful, moving exhibition at California State University San Marcos ~ Kellogg Library until December 31, 2020.
Now more than ever these soulful flags touch and inspire all of us with hope, connections, and compassion. I cannot wait to read and share thoughts and comments left by visitors in our guest book!
SDCRI has been collaborating with highly respected organizations and practitioners through the years; one of those collaborations in 2015 and 2016 was with Habitat for Humanity in Los Angeles / San Fernando Valley, which focused on Hope Made Visible™ flag making workshops and more Expressive Arts with Veterans transitioning from homelessness, addiction recovery, PTSD.
A new opportunity for Hope Made Visible™ opened up to reach out to the public with the intention of bringing solace and healing, upon invitation by The HeartWay to collaborate at an Expressive Arts initiative to offer Healing Grief Thru HeArt live online sessions to individuals and family who lost loved ones during the pandemic and/or are feeling the psychosocial/emotional toll of the pandemic, as we recognize the experience of PTSD or even Ongoing Traumatic Stress (OTS).
In this challenging time, we want to support those who are grieving, especially if in isolation, and experiencing complex emotions. It is important in order to feel supported and promote healing to validate one’s unique experience, stay connected, and allow grief to be expressed thru a compassionate, safe, non-judgmental medium like simple hands-on art, and share it with others in our virtual community. By giving ourselves permission to create art, by tapping into awe, wonder, and beauty, we invite healing and create potentially transformational shifts.
Art has the Power to Heal Humanity
This new collaboration would start with a hands-on expressive arts workshop via zoom on October 24th; the presentation includes a brief history and inspiration slides featuring special moments involving Hope Made Visible™ and Healing Grief Thru Heart: https://www.youtube.com/watch?v=pBcm1s7wnko
Everyone will be invited and guided through a process to create a flag in remembrance and celebration of the family member or friend they lost, with the opportunity to send the flag to us, to join the growing global initiative, and become part of a future public exhibition.
Participants will also be invited to create larger banners on their own, which individuals and families can hang from their windows or balconies, fostering community connections and solidarity.
Banners and flags have been used throughout history, across cultures and traditions, to symbolically honor the death of a loved one, to express compassion and to enhance healing through individual and collective participation. Our intention is that through cooperation, participation, and HeArt centered creativity, we will inspire a cultural shift to emerge around a community-centered approach to grief and loss.
Our goal with this new collaboration is to gather an additional 1,000 Flags and 500 Banners, as an ongoing opportunity.
How to participate?
RSVP: Please email Alessandra Colfi, PhD at Alessandra@AlessandraColfi.com or text 858.735.5708. We will then send you the Zoom link to join us on Oct. 24th!
1) You do not need to be an artist to participate — your personal style and creativity is welcomed!
– Blank paper
– White or off-white fabric cut in 6” X 10” sections for each Flag
– A paper grocery bag (cut open) or pillowcase for each Banner
– Markers, oil pastels or crayons, acrylic paints, tempera, a paintbrush
– Optional: glitter, embellishments such as buttons, jewels, beads, ribbon, trims, stamps, quotes, natural findings like pods, leaves, twigs.
I am deeply grateful to continue this journey of empathy, hope, compassion, resilience, and community. In closing, enjoy a poem by storyteller, film maker, and poet Nic Askew as a thoughtful and comforting reminder:
THE ADVENTURE OF UNCERTAINTY
There Was A Time When
I Looked For Certainty.
Certainty In The
The Events Of
My Own Life.
And Then I Realized
That There Was
Only One Certainty.
And That Was
That It’s All OK.
That There’s Something
That Could Never Die.
And Now I Realize That
The Total Uncertainty
Of The Events Of Life
Is The Adventure.
And That’s The Wonder. ~ Nic Askew
Breathe Away Anxiety
by Lisa Nicholson
Last week in our breast cancer support group, we talked a lot about anxiety. How it comes up before scans and procedures. How it sneaks into our bedrooms at night and keeps us awake.
Here’s a quick and effective tool for taking anxiety down a few notches. Is it as effective as Atavan? Probably not. But anything which takes the edge off that awful feeling is worth a try.
The technique is called “4-7-8 Breathing”, made famous by Dr. Andrew Weil.
Here’s how you do it:
- Sit or lie down in a comfortable position.
- Inhale slowly through your nose for a count of 4.
- Hold your breath in for a count of 7.
- Then exhale through your mouth with a “whoosh” sound for a count of 8.
- Repeat this cycle for at least 5 breaths.
For a more “advanced” technique, you can hold for a count of 7 after the exhale before inhaling through the nose for the next round.
Why does it work? Our nervous systems can’t be in “fight or flight” and “rest and digest” at the same time. When we feel anxious, our sympathetic nervous system is preparing us to run for our lives. We have tons of energy for a quick burst allowing us to sprint to safety or climb a tree or run into a burning building to save a puppy. The nervous system can’t tell whether the “danger” is a thought in our head or a true threat to our bodies so it reacts the same way to both, giving us that feeling of needing to run screaming from the room along with palpitations, cold sweat, shortness of breath, dilated pupils…you KNOW because we’ve all been there.
What we need to do is “flip the switch” to the part of the nervous system which has us feeling warm and cozy in our safe nest, allowing us to rest and digest – the parasympathetic nervous system.
Slowing down the breath and especially pausing the breath temporarily increases the carbon dioxide in our bloodstream and calms the nervous system. The sighing “whoosh” exhale empties out more of the air from our lungs than we usually do, and the vacuum created allows the next inhale to go deeper which brings more oxygen in. It also tricks the brain into letting go of the need to run for our lives and gives our thoughts a chance to catch up to our physical reaction. The result – a quick and easy way to at least temporarily calm our nervous systems and reduce that feeling of anxiety.
And for an added bonus, there are no chemicals, no interactions to worry about with chemo or radiation, and you can use this technique as often as you want with no consequence except a calmer nervous system.
For more about the power of breathing consciously, check out Breath: The New Science of a Lost Art by James Nestor. It’s just one of the books I’ve been reading this summer, and there are some great information and techniques there.
This holiday weekend, and in the holiday season to come it is extremely important for everyone to be mindful of virus-etiquette while travelling. Cancer patients and healthy people alike are at risk, and need to be concerned for themselves, as well as for their loved ones.
This month in Featured Articles we would like to focus on a piece that is centered around traveling with the pandemic in mind, posted on the CDC’s website. Here is an excerpt below, but please follow the link and lear nmore.
Protect yourself! Protect your loved ones! Protect everyone around you!
Travel increases your chances of getting and spreading COVID-19. Your chances of getting COVID-19 while traveling also depend on whether you and those around you take steps to protect yourself and others, such as wearing masks and staying 6 feet away from people outside your household (social distancing). Airports, bus stations, train stations, and rest stops are all places travelers can be exposed to the virus in the air and on surfaces. These are also places where it can be hard to social distance. In general, the longer you are around a person with COVID-19, the more likely you are to get infected.
Continue reading here!
Cold Flashes and Breast Cancer
by Lisa Nicholson
Yes, COLD FLASHES are a thing! In our Breast Cancer Support Group, we recently talked a lot about thermal dysregulation – all the weird body temperature stuff which comes with menopause whether “natural” or from hormone suppression. One of our members was having chills and goosebumps. She had a full lab workup to figure out what was going on which turned up exactly NOTHING.
I did a bit of research and discovered that cold flashes are actually well documented, especially among breast cancer survivors. Nobody knows exactly why they happen – while there has been a ton of research on the mechanism for HOT flashes, cold flashes haven’t been studied.
Hormone fluctuations of perimenopause, stress, and inflammation can all affect the temperature control center in the brain – the hypothalamus. When the brain gets a signal that the body is too warm, the hypothalamus will drop the temperature a bit. When you’re not REALLY too warm, this will make you feel instantly chilled. Same thing happens with a hot flash, in reverse. The brain gets a signal that the body is chilling, and the hypothalamus sends out a signal to increase the body temperature and send extra blood out to the surface of the skin to warm you up, making you feel hot.
Nobody really knows why we get incorrect temperature signals to the brain. I’ve joked with my husband that my thermostat needs replacing, and while that’s great for humor, we don’t know how to fix a human’s thermostat.
Here’s what the research says:
- women on hormone suppression (tamoxifen, aromasin, arimidex, letrazol, etc.) who experience hot flashes tend to have fewer recurrences of cancer than those who don’t
- estrogen plays a role in dilation of blood vessels, especially at the surface of the body, so lower estrogen levels (or no estrogen) likely have an effect on the body’s ability to regulate temperature through dilating/constricting vessels in the skin
- it appears that the sensation of cold is NOT related to hormone regulation in breast cancer patients) sensation of cold is described in many cancer patients, not just breast cancer patients, and lasts beyond treatment for some patients
- mechanisms being explored include hypoglycemia (low blood sugar), inadequate protein intake, anxiety, environmental stress, dehydration, exposure to toxins such as nickel or cadmium, and chronic low-grade infection
Here’s a link to the article I read in case you want more than my summary – it’s medical research, so be prepared for some Medical-ese. 🙂
Other reasons for chills (besides a fever!) include:
- panic attacks/anxiety
- hypothyroidism (including cases where the thyroid numbers are in the low range of normal)
- actually being too cold or exposure to cold
“Goosebumps” are typically a sign of sympathetic nervous system activation, and they may or may not come with a feeling of being chilled. When you’re too cold, the hair follicles contract to raise the hairs on your body as an extra layer of insulation. But this can also happen when you’re anxious, afraid, excited, or even sexually aroused.
So feeling chilled plus goose-bumps in absence of exposure to cold is most likely due to either dietary stress (low blood sugar, dehydration, or low protein intake) OR a sympathetic response due to anxiety or agitation.
I always recommend that if you are having weird symptoms you can’t explain that you make sure your oncologist knows about it. If you’re having cold flashes please consult with your physician to be sure there’s nothing serious going on! Once you’re medically cleared, try increasing your water intake, making sure you eat a good blend of protein and complex carbohydrates throughout the day so your blood sugar remains level (consult a qualified nutritionist if you don’t know how to do this), and using your tools for managing stress. Acupuncture, massage, neurofeedback, biofeedback, and psychotherapy can all be helpful tools for balancing the sympathetic nervous system and relieving anxiety.
Depression in the time of Covid-19
by Paul Brenner, M.D., Ph.D.
I have been lying around for the past few years as a result of the neuropathic pain of my lower extremities. To begin with, the pain should have been enough to cause depression. For some reason, depression never took hold. For some mystical, magical reason, during the isolation period of our pandemic, my neuropathic pain has slowly diminished. As a result, I have become more mobile and with mobility, I find myself depressed.
Depression has been a foreign emotion in my life up until now. I’ve been aware of this emotion in others but never within myself. With most of my pain being absent, I thought that I would have been ecstatic, but I’ve been amazed that rather than elation, I’m finding myself stuck in a depressive state. So as anyone finding themselves in such a state, I thought that this would be the time for self-analysis.
Why depression now, instead of exaltation for not having the excruciating pain of electrical shocks raging through my legs and intermittently invading my days and nights. In searching through the dusty- attics of my mind, I experienced my first “ah-ha” in a long time. My father owned a bar in Brooklyn since prohibition. He was one tough son of a bitch. How we dealt with pain always elicited a story from my Dad about Brooklynn at the turn of the early nineteenth century. When he was a kid and a young adult, bravery was the Hallmark of survival. The gangs of Brooklyn and New York’s East Side were raging as was bootlegging. Toughness and street smarts were essential for survival, not school. For me, as well as my two sisters, how we dealt with our everyday cuts and bruises were the key to my father’s love or disdain. Admitting to discomfort was the last thing the Brenner kids allowed themselves to experience.
That bit of self-analysis has paid off. When I experienced what I have called “excruciating pain,”
I did not smile through it, although it never lasted for more than 3-4 minutes. Yes, I would scream from the sudden, sporadic pain. It always caught me unexpectedly. Pulling back my emotions into some deep hidden place, I would quickly get back to whatever I was doing, simply saying “it’s over, it’s over.” And quickly resumed some insane task as if nothing occurred. There is no question that I was embarrassed about the scream and wanted to cover it up as soon as I could.
But why the depression now that I had minimal pain. As a result of analyzing my childhood, this also became obvious. Along with pain, I had lost the mobility of my lower extremities. The immobility was not only the result of the neuropathic pain but the weakness of my pelvis and hip muscles. I had multiple fractures of all my hip bones due to prostate cancer and demineralization of most of my bones as a result of the hormonal blockade of testosterone to treat my prostate cancer from reoccurring. I was a mess. But in spite of that fact, I was now able to walk a little with a walker. So, Paul, now that you can walk with a walker farther than laying around in a Lazy Boy, I could walk around the apartment with minimal discomfort. I could now accomplish so much more with my walker. Now there are no excuses for living the way I had been living. “Get out and do something!” My inner voice cheered me on. As a child, teenager, or adult there was no way I could just sit around and not accomplish something. My previous reason for having pain and an inability to walk was at first difficult but in time, I just rested into it. This took a while to achieve because, in my life, rest was never an option.
Now back to Covid-19 and the “new me” in spite of being 87 years old. There really aren’t that many things to do with the “Stay at home! Six feet distancing! Masks! Gloves and hot water dictums. Now I’m also thinking to myself, I can barely walk, by the time I usually get to the entrance of our building, l am exhausted. I always have to turn around. I typically re-enter the apartment, barely get to the lazy boy and pass out, berating myself for not being able to walk farther. I just realized “father “and “farther” are not only close in sound but are close in meaning. Most fathers, the moment they see their child, whether it be in the delivery or waiting room, suddenly become the chosen provider and are driven to achieve more than they ever believed possible. The need to go further in their career now as his provider becomes ignited within moments of seeing their newborn. This brought to mind the quote by Robert Browning, “man’s reach should exceed his grasp”. This nineteenth-century dictum can be an unconscious driving force for so many of us. If we are not doing something when that something “should” be done or the thought of achieving arises, so many of us dealing with Covid-19 enter variable states of depression.
So, I ask all those who may be reading this article, to give yourself a break. Enjoy a break from achieving, doing, and think about how your childhood shaped your life, your emotions.
by Nina Fry-Kizler, MA
We often think of the nervous system as a single structure regulating our body. However, our nervous system has two very different parts, the sympathetic and the parasympathetic. In these stressful times, understanding how our bodies respond to stress, how stress affects our immunity, and the interaction between the two is vital for optimal health.
The human nervous system’s immediate response to stress is based on an animal-like instinct. However, we differ from animals because we have the capacity for meta-cognition — we are conscious and also aware of our consciousness. We have the capacity to reflect on things that we think and feel, which is an important component in managing our stress response.
Our stress response is hard-wired into our nervous system, built into our DNA to enable our survival when we were being chased by a hungry lion. Today, that same hard-wired response is triggered when we are in major physical danger. When we experience stress of this kind, the sympathetic nervous system kicks into gear and does things like increasing our heart rate, dilating our pupils, causing our breath to quicken, and pumping oxygen to muscles that would be needed to flee to survive. To have the energy and resources for all of those important processes, the body shuts down other systems that are not considered critical during a major physical threat, such as digestion, reproduction, and immunity.
Here’s where things get interesting… Nowadays, few people are faced with that intense kind of physical danger, but our stress response will still kick into gear when we have what’s called a “perceived” stressor, like a tight deadline at work, an argument with a loved one, or a fast moving pandemic that has uprooted our lives. Even if we aren’t being impacted directly, our mind can conjure up many different frightening scenarios as to how we (or people we love) might be impacted. Our sympathetic nervous system cannot tell the difference between an actual physical threat and an imagined or perceived threat and it will marshal all the same resources and turn on the same physiological systems even when we aren’t in actual physical danger.
The good news is that our parasympathetic nervous system counterbalances the response of the sympathetic nervous system by managing relaxation, rest, re-building, and the optimal functioning of our immune system. The even better news is that because of our capacity for meta-cognition, if we realize we are in a stress response and we are not in actual immediate physical danger, we can consciously choose to intervene in that process and switch over from a sympathetic response to a parasympathetic response. When our body is in the parasympathetic state, it directs energy towards supporting systems like digestion, reproduction, and immunity. When we take time to consciously relax, our bodies release muscle tension, lower blood pressure, slow the heart and breath rates, and reduce hormones like cortisol (aka – the “stress hormone”).
As a teacher of mind-body medicine for stress reduction and boosting health and well-being, in times like these, I don’t see relaxation or self-care as luxuries; I view them as crucial ways to support our immunity and our health.
How do you help your body switch over to the parasympathetic nervous system and support your immune system to be strong and fully functional? Meditation is an incredibly powerful tool for this. At IONS, we have conducted research on how meditation helps support people’s health in a variety of populations and health conditions, including reducing the stress response, cortisol, and glucose intolerance in pregnant women in our study Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women. We recently completed research phases in two of our studies on the impact of meditation on depression and anxiety symptoms in older adults: iRest (Integrative Restoration) Meditation for Older Adults with Depression Symptoms and Internet Mindfulness Meditation Intervention (IMMI) Improves Depression Symptoms in Older Adults (for all of the papers published on these studies, see the Additional IONS Research section below). Our Director of Research, Dr. Helané Wahbeh has also published a systematic review on Mind-Body Medicine and Immune System Outcomes.
Dr. Wahbeh, who is also a naturopathic physician, is a very skilled meditation facilitator. Try out the short (8 minute) meditation that she recorded at a recent Noetic Global Gathering which specifically guides you into a meditative state that supports your immune system. Additionally, we just completed a free online ConnectIONS Live: Noetic Approaches to Health & Wellbeing webinar that featured experts in the field of noetics discussing ways to support your health and well-being, which also includes additional meditations.
Additional IONS Research
iRest (Integrative Restoration) Study
· iRest Meditation for Older Adults with Depression Symptoms: A Pilot Study
IMMI (Internet Mindfulness Meditation) Study
· Internet Mindfulness Meditation Intervention for the General Public: Pilot Randomized Controlled Trial
· Internet Mindfulness Meditation for Cognition and Mood in Older Adults: A Pilot Study
The Queen of Pandemics: Corona virus reflection and resources
by Alessandra Colfi, PhD, RYT-200, ZIN®
I have been pausing and reflecting on what this pandemic is teaching us. I’m sure I’m not alone in considering this as Nature’s wake-up call to our complacent civilization, to our interconnected lives across the planet, bringing in focus kindness, compassion, and our great responsibility towards one another and Mother Earth.
Flexibility and curiosity are key to resilience, as we shelter at home, restructure our daily lives, morph our work and community to online platforms when possible, as we improvise and creatively problem solve, offer support for those who are sick, homeless, vulnerable, and find quiet moments to recharge and renew.
It’s not easy to keep up with (and often to tune out) the immense amount of content out there from the news outlets to the online resources and groups that are flooding our inboxes daily.
A silver lining? The air and water are cleaner than ever since fewer cars and trucks travel on our streets and freeways. I’ve been pleasantly surprised by a peaceful silence more often than expected.
While it’s been very difficult to suspend in-person classes and programs, and lose sources of income – hopefully temporarily, our community has stepped up in a big way. Here are a few trusted community resources to keep you connected, engaged, inspired, and moving!
-The Center for Mindfulness at UC San Diego Department of Family Medicine and Public Health offers free Mindfulness Resources like guided audio & video sessions in English and other languages here: https://medschool.ucsd.edu/som/fmph/research/mindfulness/mindfulness-resources/Pages/default.aspx
-North County Cancer Fitness transitioned to online ‘live’ classes through Zoom; if you are not on the mailing list, visit the website www.NorthCountyCancerFitness.org and sign up for free. Download the free App at www.zoom.us and when you receive the notification, click on the link to join a class like Gentle Fitness, Gentle Zumba, Gentle Yoga, or Gentle Kick Boxing.
-In addition, to live classes, you can follow my Zumba routines at your leisure on YouTube. Feel free to contact me for free zoom classes like Zoomba on Sundays and more Yoga: Alessandra@AlessandraColfi.com .
If you feel called to donate online, donations are always welcome and appreciated.
My Expressive Arts program will soon be available ‘live’ via zoom through UC San Diego Health – stay tuned!
In the meantime, play with a nature-based art project, suggested by one of my dedicated artists: Make a Flower Mandala arranging leaves petals and pods collected in the garden or on a walk as you get your much-needed dose of Vitamin N! Remember to take a picture when you complete each one and feel free to share.
-Emotional Freedom Technique is a very useful tool that can be easily learned and practiced for a few minutes to help lower stress and anxiety: https://eft.mercola.com/
Research shows that yoga, meditation, moving, cultivating curiosity and mindfulness practices help our minds and bodies cope with stress and anxiety, strengthen the immune system, keeping us healthier and more present and connected, with compassion and gratitude.
Best Essential Oil Brands Based on In-Depth Reviews
Essential Oils can be an excellent tool for improving your physical and emotional health, or even just to change the mood of your day. From incense oils and perfumes to soaps and lotions, or even the occasional ingestible supplements (taken only as directed by a healthcare professional). However you like your oils, it is vitally important to know what is in them. Not all manufacturers have your health in mind, or the health of the planet for that matter.
Consumer Advocate recently ran an in-depth study on several popular essential oil brands. They checked into quality, safety, sustainable sourcing, and educational information offered to consumers by each company:
“With so many essential oil brands out there, it can be hard to find the right one for you. Instead of a top ten list of the best essential oil companies, we took an in-depth look into the industry by reviewing 11 well-known brands.”
Don’t just exercise caution in how you use your oil. Keeping track of what’s in your oil, or what it’s production does to the environment should be deciding factors as well.
Head to their page now for more on what their team of researchers has uncovered for us.
FDA warns 15 companies for illegally selling various products containing cannabidiol as agency details safety concerns
With the legalization of cannabis came a great deal of new stores and products containing the plant-based drug, and in many forms. The question is, are all of these new methods of ingestion safe or healthy? This is a topic that has come under heavy scrutiny as there isn’t enough scientific information regarding the safety of cannabinol in food. The FDA is cracking down on companies that are ignoring the possibilities of health issues that could be caused by their products. Take a look at this article to find out what you need to know!
The Mountain, Revisited
A Tribute to Tate MacDowell
This month we would like to celebrate the amazing life of Videographer, Artist and Poet Tate MacDowell. Tate is an inspiration and hero in the Cancer Warrior community. He conquered the belief that cancer and treatment side effects can limit the life style of patients, and he proved that his spirit was stronger than any mountain. Here’s to him, his accomplishments and the wonderful works he created for us all!
Take the time to read the article with artwork and poem about Tate’s experience with cancer and treatment: “Mountain in the Hallway”. Then, -more importantly- read his blog and see his triumph over the Grand Tetons.
Good Vibes For Better Health: The emerging science of positive emotional state of mind and health
by David Muehsam, Ph.D
first published on February 28, 2018 through www.chi.is
The idea that emotions are linked with physical health is nothing new. 2400 years ago, Hippocrates posited that good health is due to the balance of four bodily humors, which also contribute to one’s temperament (Sternberg 1997). And throughout the history of medicine, the dominant belief has been that mental, emotional and spiritual factors are the primary causes of both health and disease, until this viewpoint was surpassed by advances in modern biology that promoted a chemistry-based view (Kiecolt-Glaser 2002).
Over the last two decades, the idea that emotions and the mind play important roles in health has reemerged in biology. While modern biochemistry has focused on the molecules that make up our bodies, the emerging field of psychoneuroimmunology has provided new insights into the connections between these molecules and our mental and emotional selves. For example, fifteen years ago, a review by Janice Kiecolt-Glaser at Ohio State University concluded that negative emotions such as depression and anxiety are associated with higher risks of mortality, heart disease and cancer, and can contribute to prolonged infection and delayed wound healing (Kiecolt-Glaser 2002). Kiecolt-Glaser also reviewed the biochemical correlates of stress and negative emotions, and showed that negative emotions are associated with increased pro-inflammatory activity and compromised immune and endocrine system responses, all of which can contribute to poorer health (Kiecolt-Glaser 2002). Similarly, a series of studies from the group of Steve Cole at UCLA showed that stress due to social isolation and loneliness is associated with increased pro-inflammatory signaling and reduced immune system responses, and that this psychosocial stress is actually reflected in DNA activity through the expression of the particular genes that regulate these health-critical activities (Cole 2014).
Well, these studies showed that stress and negative emotional states are linked with negative health outcomes. But what about positive emotional states? Could these have positive impacts on health? Could cultivating better emotional health be a path to better physical health?
We’re beginning to have better answers to these questions. Data from a long-term study on aging by the US Veterans Administration showed that overall psychological distress (measured by anxiety) and well-being (measured by happiness and life satisfaction) had opposite effects on DNA activity for genes that regulate the inflammation associated with coronary heart disease (Kim 2015). And another answer may lie in a recent study from Jennifer Stellar of the University of Toronto which linked seven positive emotions – amusement, awe, compassion, contentment, joy, love and pride – with levels of the pro-inflammatory signaling molecule Interleukin-6 (IL-6) in samples taken from freshman undergraduates (Stellar 2015). Participants answered questionnaires that assessed how much they generally experience particular emotions, measured by how strongly they agreed/disagreed with statements such as “I feel wonder almost every day” (awe), or “I am an intensely cheerful person” (joy). Stellar found that awe, joy, contentment, and pride were each correlated with lower pro-inflammatory IL-6 levels, and interestingly, when all of these emotions were pooled together in a group analysis, one of them was found to be the strongest predictor of low IL-6: awe.
I already find it quite awe-inspiring that awe was the emotion most highly correlated with lower IL-6 pro-inflammatory signaling, but Stellar went one step further: she also asked the participants how much awe, wonder, and amazement they felt on the day of the test, and found that the daily values for these three emotions were also correlated with lower levels of IL-6, with awe again being the strongest predictor.
Awesome! Can you bottle that?
Well, but we need more long-term studies to better understand to what degree putting out the good vibes every day could lead to better health, make one live longer, and perhaps treat particular diseases. What we do know today is that our emotional and social wellbeing is indeed linked with our health, and science is beginning to better understand how our inner world of feelings is as real as the atoms and molecules that make up the cells in our bodies.
-Cole SW. Human social genomics. PLoS Genet. 2014;10(8):e1004601.
-Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Annu Rev Psychol. 2002;53:83-107.
-Kim D, Kubzansky LD, Baccarelli A, Sparrow D, Spiro A 3rd, Tarantini L, Cantone L, Vokonas P, Schwartz J. Psychological factors and DNA methylation of genes related to immune/inflammatory system markers: the VA Normative Aging Study. BMJ Open. 2016 Jan 5;6(1):e009790.
-Rush SE, Sharma M. Mindfulness-Based Stress Reduction as a Stress Management Intervention for Cancer Care: A Systematic Review. J Evid Based Complementary Altern Med. 2016 Aug 3. pii: 2156587216661467.
-Stellar et al. 2015 Positive affect and markers of inflammation: discrete positive emotions predict lower levels of inflammatory cytokines. Emotion. 15(2):129-33.
-Sternberg EM. 1997. Emotions and disease: from balance of humors to balance of molecules. Nat. Med. 3:264–67.
by Jeannette Moninger
As you are being treated for cancer the last thing you want to think about is what it is doing to you financially. The cost of therapies has increased as well as the cost of health insurance. Even with the best health insurance there are deductibles & out of pocket expenses. Where can you turn to for help with this debt that you are incurring?
This article shares the financial experiences of cancer survivors & the resources available to help with debt.
Click here to read the article.
Healing Grief Thru HeArt
by Alessandra Colfi, PhD
A mother and her daughter walk in, their faces showing their efforts to cope with the tragic, sudden death of their son and brother, the shock, the sleepless nights, trying to make sense of their devastating loss, trying to forgive.
A gentleman joins in not sure if this grief processing group is for him, certain that no relief or healing is possible after the long illness and death of his wife, his partner through thick and thin, the love of his life; he shows me one of the many poems he wrote to express the love they shared, and to keep his wife present and their memories alive… Others have also lost spouses, children, siblings, parents, close friends; they join in as they open up to a different kind of support, a compassionate, safe place where they look forward to being embraced and to restore hope for a life worth living.
I, too, have lost loved ones; I have lost many patients I have worked with, so I have been focusing on holding a safe, compassionate space for their grieving friends in the cancer community, grief layered with fear, a reminder of their own vulnerability.
Grief is not easy to be with, or to talk about; words seem to lack the depth and nuances of despair, unsurmountable loss, as well as questions and longing for an ever-lasting connection beyond the physical presence. Often various degrees of guilt, challenging family dynamics, and ancestral wounds are present and need to be a part of the transformation as well.
At the end of the 6 weeks-series a mother remarks “Even as a parent who lost a child, I found my voice and some solace”
The Broken Pieces of Our Hearts
The seeds of Healing Grief Thru HeArt program were planted when I engaged patients in the visual journal / altered book series ‘The Artful Book of Wonders’, one of the many expressive arts therapy series I offered at San Diego Cancer Research Institute and more recently at UC San Diego Moores Cancer Center; this format facilitates self-exploration for patients, while validating their experiences and feelings during their cancer healing journeys.
While nurturing the fertile ground of seeking answers and meaning when patients are confronted with cancer’s life-altering experience, and encouraged by my colleagues and mentors, I was presented with strong interest from our friends at The HeartWay to offer expressive arts processes to assist individuals experiencing grief from the death of a loved one.
The non-profit The HeartWay (The HeartWay, Embracing Life. Honoring Death.) provides an integrative approach to the healing of body, mind, and spirit for those confronting a life-threatening illness, critical lifestyle change, or finding themselves caring for someone with a critical illness before, during, and after death. All services are provided free of charge to the requesting individuals and families.
The experience of grief is a subtle, often unacknowledged but powerful presence in cancer patients as life is turned upside down, the body altered by surgeries and treatments, by often limited diets with a change in or loss of appetite, and limited mobility… grieving what was, the healthy self (even if not objectively healthy, but subjectively felt as healthy); one’s identity tied to body image, relationships, a career, is interlaced with challenges in their cognitive abilities (aka, brain fog); fear and anxiety of more pain, decline in quality of life, of ‘losing the battle’, all making it as a deeply personal as one can imagine.
Healing Grief Thru HeArt (HGTHA) program was launched in 2017; it is dedicated to facilitating healing for those individuals, families, and communities working thru grief after a loved one has died. The expressive arts offer short and long-term coping tools while promoting empathy, support, mindfulness, inner peace, healing, and compassion. There is abundant research literature to support the use of the arts as therapy and as an adjunct to other forms of therapy. Participants in the program experience a feeling of revitalization, renewed meaning and connection with life in the broad sense, becoming more active and re-engaging in their communities. In 2017 we completed 3 series of 6 weeks each at a Senior Center in Orange County; in 2018 we held a 6-week series for the residents at an Affordable Housing Community in Los Angeles.
One of the formats used is a unique visual journal created in the pages of an old, discarded hardcover book, playing with any text existing but not interfering with our new images, colors, brush strokes, poems, and collage materials; participants take advantage of the unique, engaging opportunities that the creative process offers, because the therapeutic distance, non-intimidating qualities of using art for self-exploration and self-expression are well known, no matter what artistic abilities or familiarity with art-making they have.
The layered artful pages are generated through the mindful attention of expressive arts processes meant to bypass the logical, rational thought processes of cause-and-effect, expectations, limiting judgment, habitual thinking patterns; instead the artwork evokes wonderment, truth, wisdom, imaginative qualities, personal meaning, and reveals psychic content of present awareness through images, colors, as safety and acceptance are established.
Participants are also supported through breathing exercises, meditation, Emotional Freedom Technique (EFT), inspirational and visually stimulating videos.
This program offers an expressive approach to healing grief outside the paradigm of cognitive therapy. The traditional ‘The Five Stages of Grief’ model was first introduced by Swiss-American psychiatrist Elisabeth Kübler-Ross in her 1969 book “On Death and Dying”, inspired by her work with terminally ill patients. As recent literature and practice inform us, the stages of denial, anger, bargaining, depression, and acceptance are not necessarily experienced in order, but rather they “are a part of the framework that makes up our learning to live with the one we lost. They are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief. Not everyone goes through all of them or in a prescribed order. Our hope is that with these stages comes the knowledge of grief‘s terrain, making us better equipped to cope with life and loss. At times, people in grief will often report more stages.” (David Kessler https://grief.com/the-five-stages-of-grief/)
Landscape of Emotions
I use the expressive arts to engage participants in a non-judgmental, compassionate, and inviting way, by focusing on the process rather than on the finished product. This provides participants the safety of the therapeutic distance to the painful experiences. The experience of grief and our relationship with it are transformed, as meaning takes form and healing occur. The approach of the program is person-centered: flexibility and meeting each group member where they are in the grieving process, emotional/mental readiness, abilities, group harmony, and mutually supportive atmosphere are all key elements to my client-centered approach, with supportive and helpful guidance. Participants learn to see more options and retain a degree of control; “mistakes” can be transformed into meaningful images, empowering opportunities, and unique beauty. The process allows individuals to gain awareness, access and work with their fears and pain, and find meaning to anchor their existence. The intended outcome includes finding comfort in uncomfortable experiences, acceptance, healing, and transformation.
Monthly group sessions are currently offered in Encinitas on Saturdays, with the plan of increasing frequency in the fall, as we anticipate increased interest and awareness.
Individual sessions are also available and encouraged to offer even more privacy, customized processes and to offer the most compassionate support as complex feelings and trauma might emerge.
As a result, participants experience validation of their feelings, explore safe ways to acknowledge, share and process loss, while building coping skills, resilience, and a meaningful life without their loved ones, and a renewed sense of purpose, while able to hold painful and joyous memories.
Here is what some participants share about their experiences with the program:
‘A truly wonderful and healing class; I wish it were longer!! Very grateful to be a part of this group.’ -M.T.V.
‘Thank you for your gentle, thoughtful directions’ -D.G.
‘Alessandra created sacred space to express through art what is alive in my grief and healing’ -J.S.
‘I would highly recommend the class to anyone who is experiencing grief’ -C.A.C.
‘All activities were very pertinent and I found value in each and every one. Alessandra will lead you to places you never knew were part of you’ -B.V.
‘Very healing, loved being embraced.’ – C.O.
‘Loved the classes. So glad this was offered. Lovely connecting with new friends. Alessandra is fabulous.’ -D.S.
‘This class was the highlight of my week during this difficult time…’ – Anon
“Even as a parent who lost a child I found my voice and some solace” – Anon
Recently at The HeartWay we created a HGTHA video to convey the transformative power of engaging with the arts and to validate the courage and compassionate presence of our participants. By sharing this video, we want to encourage others to reach out for support in moving forward with their grief.
Our intention for this program is to support families and individuals thru their grieving process and at the same time to celebrate the lives of loved ones through the expressive arts. Together we observe, validate, and process the many aspects of seeing a loved one die and the complex feelings and emotions that individuals and families go through. Our intention is to cultivate each person’s innate resilience, restore hope, and support life joy and fulfillment.
For information, to participate in a HGTHA group, or for additional resources, please contact Alessandra Colfi, Ph.D., Expressive Arts Therapist, at 858 735 5708 Alessandra@AlessandraColfi.com
Putting the pieces back together
Understanding The Connection Between Addictions and Cancer
by Patrick Bailey
Cancer is caused by multiple factors, however, another risk that is often overlooked are addictions to certain substances. In this post, we will discover the link between addictions and cancer.
On a surface level, substance abuse may be mostly attributed to psychological symptoms–these include changes in behavior, personality, or ability to interact with others. The most apparent complications would be mental health concerns, but it is important to know that the physical risks of taking drugs are just as harmful as the psychological risks.
What are the physical risks of substance abuse?
Substance abuse is a complex mental and physical condition that affects the individual in a myriad of ways. Its risks are mostly seen psychologically in the earlier stages, but in a full-blown addiction, the effects may span towards long-term physical problems.
The risks also depend on the type of addiction that the individual may have. Here are some of the most common types of addictions and the physical risks associated with them:
Long-term smoking primarily affects the lungs and may cause functional problems. Additionally, since the lungs are also vital to the body’s circulatory system, it is possible that an addiction to smoking can cause heart problems as well. Some of the most common physical conditions related to smoking addiction include lung cancer, chronic pulmonary obstructive diseases (COPD), heart attack, emphysema, stroke, heart failure or lung failure.
Addictions to illicit substances or prescribed medications also cause physical complications. Aside from the risk of a fatal overdose, the brain chemistry can be completely altered, causing problems such as Alzheimer’s Disease, Parkinson’s Disease, or stroke. Additionally, the manner of administering drugs may also cause certain types of cancers. Smoking, inhaling, or continued use of needles may alter the body’s immune system, making the people who have a genetic disposition increase their cancer risk.
Alcohol is an addiction that affects the liver. Chronic alcohol abuse is related to increased incidence of liver cancer, cirrhosis, liver failure, obesity and diabetes. When combined with smoking or drugs, alcohol can also be a contributor to many cardiovascular diseases such as heart attack, stroke, or cardiomyopathy.
With these common forms of addictions, it is interesting to note that cancer is a common denominator for each of the physical complications. Cancer can be considered a disease with a strong genetic linkage, but lifestyle factors such as addictions do contribute to its onset and severity.
What is the link between addictions and cancer?
In order to understand how addictions are related to cancer, it is important to initially have a basic knowledge of how cancer cells morph and spread.
Our body is composed of millions of cells. Each cell has a specific function, and they also have particular lifespans. Some of cells die, regenerate, or multiply depending on their type. These processes are relatively consistent yet change in different stages of an individual’s life. A child’s cells may rapidly develop, differentiate and multiply, while an adult’s cells may do these processes at a different pace.
Cancer happens when there is a single or multiple genetic mutation in one of the cells, and these cells eventually multiply and occupy the body. They cause tumors to form–which can either be benign or malignant. Benign tumors do not cause harm, and will only require intervention when they putting pressure on vital organs such as the brain or the heart. On the other hand, malignant tumors which are often diagnosed as cancers are those which invade the body’s tissue, affecting the function of the organs.
Now, the initial mutation is the trigger that causes cancer. These initial mutations are caused by several things such as:
- Genetic disposition – some types of cancers run in families. Blood-related cancers, those which affect certain organs (pancreas, liver, etc.), or others may affect certain family members of the same gender or age.
- Unhealthy diet – there is a link between cancer risk and people who consume high amounts of processed food and refined sugars. Unhealthy diet combined with genetic dispositions can cause cancers. All types of cells, both healthy or malignant feed on simple sugars as their sourer of energy, and this is why diet is very important for people who want to lessen their cancer risk.
- Exposure to chemicals – another factor that causes initial mutations are exposure to harmful chemicals. Those constantly exposed to radiation, ultraviolet rays, and toxic substances may have a higher cancer risk. These substances can enter the bloodstream and cause mutations in the cells of the body.
- Addictions – like chemicals, substance addictions also introduce foreign elements in the body that can cause mutations. For example, continuous smoking exposes the body to tar, carbon monoxide, and other harmful substances that can alter the DNA makeup of lung cells, causing malignant tumors to grow.
In essence, the constant exposure to substances through chronic addiction is a risk factor in cancer development. When this is combined with other factors such as genetic disposition, or occupational hazards, the risk continuously increases which can speed up the mutations or heighten the severity of the cancer.
Complications of addictions and cancer
Addiction is a condition in itself, and developing a complication such as cancer from it can pose a serious toll on the body. It is important that a person diagnosed with cancer and substance use problem should deal with both conditions as soon as possible. Early intervention for both diseases is important for a positive prognosis.
What should be addressed first, the addiction or the cancer?
Both are life-threatening conditions, and if it is possible, the cancer can be initially treated by undergoing prompt medical treatments combined with rehabilitation from substances. Usually, major cancer treatments come in first followed by substance abuse rehabilitation. In other cases they can be combined when it is medically and logistically possible.
Some types of cancer are detected early, and the patient needs to undergo certain lifestyle changes with surgical or chemo-based intervention to remove the tumor. After the major procedure, the patient can be asked to adopt lifestyle alterations such as cutting out substance addictions, eating a healthy diet, and physical activity.
I am noticing signs of cancer, and I also have an addiction problem. What should I do?
Here are the following steps you can take to address both your addiction problem and a potential diagnosis for cancer.
Talk to your doctor.
The first step you have to take is to talk to your primary care doctor and be open about your addiction problem and signs that you are noticing in your body. If you are predisposed to certain types of cancers or you have been indulging in a lifestyle that poses a high cancer risk, it is helpful to know the common signs of cancer. Your primary care doctor can refer you to an oncologist to help get a clearer diagnosis.
Additionally, your doctor can help refer you to rehabilitation services that can help with the addiction problem once the diagnosis has been finalized. Many substance abuse rehabilitation centers offer a myriad of medical and holistic interventions to help in addiction recovery. Addiction recovery can help you make better lifestyle choices which can also prevent you from having recurring cancers.
Get the support that you need.
It can be tough to receive a diagnosis of two difficult physical conditions. You may often wonder how your life may change, and this challenge is best dealt with if you have a source of support. Support can come in many forms. You can share your condition with a trusted loved one who can empathize with your needs. Additionally, you can also find support groups for those who are currently undergoing cancer treatments or those who are trying to recover from addictions.
At first, you may feel vulnerable in sharing your story. However, you will eventually find strength in knowing that there are people who share in your journey, and you can also draw inspiration from them.
Maintain a healthy lifestyle.
It is never too late to start a new regimen to help in addiction recovery and to prevent cancer from recurring. Some of the best lifestyle changes that can both help in these conditions include:
- Eating healthy, whole foods: Consumption of vegetables, fruits, lean protein and whole grains are all linked to better physical and mental wellness compared to a diet composed of processed foods and refined sugars.
- Regular physical activity: Exercise helps in blood circulation and removal of toxins in the body that may cause cancer or substance dependence. It also rejuvenates vital organs such as the heart and lungs.
- Avoid stress: Stress is a risk factor both for cancer and addictions. When you have a high-stress lifestyle, it is likely that you will have a substance use relapse, which may lead you to go back to unhealthy habits that causes cancers.
Early detection and intervention is key
When it comes to treating substance use problems and cancer, it is best to have early intervention. Doing so can help reduce severe complications, and improve the chances of recovery.
How Physical Therapy Can Help Ease Cancer Pain
by Dr. Brent Wells
Chronic illnesses like cancer can have a dramatic impact on your ability to function in daily life. Your routine may be disrupted due to the pain associated with some of these illnesses. In particular, cancer pain can make your daily routines much more difficult or downright impossible. For many patients, integrative medicine is the best solution to their constant pain. This can include complementary therapies such as chiropractic treatments and physical therapy.
The majority of the world’s population will experience back pain at some point in their lives, whether it’s related to cancer pain or not. Physical therapy can be a great resource to alleviate some of these symptoms from chronic illnesses like cancer. Check out a few of these reasons why you may want to contact a physical therapist today.
Where Does Cancer Pain Come From?
Understanding where cancer pain comes from is essential to developing a thorough treatment plan. Physical therapy is capable of addressing many of the complaints that come from cancer pain. However, most patients do not really understand how it works because they cannot see where their pain stems from.
First and foremost, a growing tumor can be a large source of pain for many patients. The tumor is growing in size which means that it takes up more space in the body. It may begin to press on your nerves, muscles, bones, or organs. This pressure results in chronic pain in the affected area. As the tumor grows, it is also possible that the tumor will begin to emit chemicals that trigger a pain response in the body.
This type of pain can be treated using physical therapy. Improving your physical fitness and staying active offers a multitude of benefits for your cancer pain, including:
- Stronger muscles that are not likely to atrophy
- Reduced risk of osteoporosis
- Improved blood flow to your lower extremities
- Reduced risk of anxiety and depression
- Less fatigue
- Improved quality of life
How Does Physical Therapy Help?
Physical therapy is particularly important for individuals who have chronic pain conditions like those caused by cancer. When you are diagnosed with a chronic illness, many doctors immediately recommend that their patients restrict their activity and increase their bed rest. While you may need to restrict your exercise to low-intensity workouts, this advice could result in a greater degree of pain. Physical therapy can help to combat some of the symptoms seen as a result of excessive bedrest.
Patients who participate in physical therapy are more likely to minimize their deconditioning and myofascial pain associated with their lack of movement, according to research. Physical therapy focused on retaining muscle movement and strength can reduce pain symptoms associated with muscular atrophy.
One of the other major reasons that physical therapy helps cancer pain is by reducing fatigue. Many patients resort to bedrest because they lack the energy to combat their pain and participate in social activities. When they experience greater levels of fatigue, they are more likely to resort to bedrest and to allow their muscles to atrophy. On the other hand, patients who actively participate in physical therapy can greatly improve their energy levels.
Recovery from Surgery
Doctors will often recommend that patients undergo an intense surgery in order to remove the cancerous cells from the body. These procedures can severely limit your range of motion and increase the amount of pain you experience. While it may be necessary to remove the cancer from the body, it will require a lengthy recovery to restore your body to its former state.
Physical therapy is designed to help you restore your range of motion after surgery. Many physical therapists will prescribe static stretching exercises to increase your range of motion. However, there are many other types of stretching and exercises that can be applied to improve your overall ability to move around.
Another side effect of these surgeries is potentially poor posture. Experts say that many people will begin to instinctively position their body to protect the surgery site from further pain. This results in a hunched posture that leads to chronic neck or back pain over time. Physical therapy can strengthen your core muscles and help you to improve your posture, effectively reducing the pain you experience from poor posture.
Types of Physical Therapy for Cancer Pain
Not all physical therapy is created equal. Many patients associate physical therapy with stretching exercises and aerobic activity designed to get your heart pumping. These can be accurate depictions of a physical therapy appointment, but there are other options available. Depending on your unique type of cancer pain, your physical therapist may recommend a different approach to your treatment.
There are two main categories of physical therapy: passive physical therapy and active physical therapy. You may not immediately think of some of these passive strategies for tackling your chronic cancer pain:
- Manual therapies
- Heat and cold therapies
- Electrical stimulation
- Ultrasound therapy
- Dry needling
Active physical therapy requires a little bit more energy on your part. It requires specific movement exercises such as stretching, strength training, or participating in a low-impact aerobic activity. Each exercise is designed to relieve your pain, increase your range of motion, or reduce your overall fatigue in some capacity. Most patients require a combination of both passive and active physical therapy for the best results.
Contacting a Physical Therapist
Cancer pain is likely to be a chronic sort of ailment that needs to be treated by a professional. While there are certainly some small things you can do on your own to alleviate the pain, physical therapy can offer a well-rounded approach to pain-free living. You can improve your range of motion, decrease your pain, and improve your overall energy levels with a few simple physical therapy appointments.
Treatment for your cancer pain is readily available at a physical therapy office near you. Take advantage of all that this form of treatment has to offer. You will be surprised by the end result and how it can impact your pain levels.
Article series from The Journal of Oncology Practice
An Introduction from SDCRI’s Director, Daniel Vicario, MD:
From 1998 till 2014, at the San Diego Cancer Center, with the help of our San Diego Cancer Research Institute, we were able to offer to the cancer patients the best medical approach possible: a truly Integrative Oncology program; a combination of “the best of western allopathic medicine with a long list of evidence-based integrative complementary healing modalities.” This approach dramatically helped the cancer patients not only have a significantly improved quality of life but in some situations, a longer life expectancy. We saw first-hand how effective this truly integrative approach is. As mentioned several times in the past, we are forever grateful to all the volunteers who devoted their time, expertise and wisdom to make this Integrative Program so successful.
As firm believers of Integrative Oncology, we are encouraged to see more articles being published in highly respected journals about the importance of Integrative Oncology.
by Gabriel Lopez, MD
May’s featured article is the last of the three articles suggested by Dr. Vicario. A New Frontier for Evidence-Informed Integrative Oncology Care is commentary on the first article of this series, which we posted in March. Click the title link to find out what Dr. Gabriel Lopez has to say on the practices of Integrative Oncology.
Heather Greenlee, ND, PhD and Zaixing Shi, PhD
For the month of April, we are featuring a short article citing some of the difficulties in providing integrative oncology therapies and information to oncology patients. Integrative and complimentary therapies are in high demand among cancer patients, but not all patients understand what the benefits and limitations of therapies.
Click here to read the article.
by Shelly Latte-Naor, MD1 and Jun J. Mao, MD, MSCE1
For the month of March contributing page, we feature an article “Putting Integrative Oncology into Practice – Concepts and Approaches”, published in the Journal of Oncology Practice from ASCO (American Society of Clinical Oncology) in January 2019. We found it very fitting to our beliefs and our past experience.
Food is medicine: How US policy is shifting toward nutrition for better health
by Dariush Mozaffarian, Jerold Mande, and Renata Micha
In this new year, millions of Americans will make resolutions about healthier eating. In 2019, could U.S. government leaders further resolve to improve healthier eating as well, joining public health experts in seeing that food is medicine?
In 2018, Congress initiated a series of actions that represent a shift away from placing the full responsibility – and blame – on individual people to make their own healthier choices. These actions also show a growing recognition that many stakeholders – including the government – are accountable for a healthier, more equitable food system. This shift in thinking reflects an understanding that government can and should play a role in improving the diet of Americans.
As faculty members at Tufts University, our expertise spans clinical medicine, nutrition science, public health, policy analyses, Congress, federal agencies and government programs. It’s clear to us that the time is right for meaningful policy action to leverage food as medicine.
Why healthier eating is a national priority
Poor diet is among the greatest health and societal challenges of our time, causing death and disability, soaring health care spending, budget challenges for governments and private business, diminished military readiness and population disparities.
Medicare and Medicaid, the government programs that pay for medical care for people over age 65, low-income families, and the disabled, now consume US$1 in $4 in the federal budget. In addition, nearly $1 in $5 in the entire U.S. economy is spent on health care, creating massive threats to the health of the national economy.
Diet-related diseases are major contributors to these expenses. For example, the annual medical and economic costs of heart disease and stroke are estimated at $316 billion; of diabetes, $327 billion; and of all obesity-related conditions, $1.42 trillion. These costs create enormous economic challenges for federal and state governments as well as for private American businesses, families, and individuals through rising health care premiums, out-pocket-costs, missed work and lower productivity.
Diet-related health burdens and costs also influence military readiness. Two-thirds of active duty military forces are overweight or obese, while 71 percent of young Americans are unable to join the military for one or more reasons, with obesity as the leading medical disqualifier.
The overall U.S. food system – including farming and imports, supermarkets and retail, restaurants and cafeterias, and food manufacturers – also reflects and contributes to profound disparities, especially among children. Minorities and the poor often have the worst diets, causing a vicious cycle of poor health, lower school performance, lost productivity, increased health costs and poverty.
Hungry for good food
As policymakers increasingly recognize the depth and breadth of these effects, they are beginning to act. In January 2018, House lawmakers created a bipartisan “Food is Medicine” working group, dedicated to innovations in nutrition policy to improve health and reduce diet-related health costs. Simply the existence of a group in Congress focused on “Food is Medicine,” which hosted multiple briefings for congressional staff on key legislation to integrate nutrition into federal policy, is an advance.
On June 7, 2018, Congress instructed the U.S. Government Accountability Office to perform a comprehensive assessment and accounting of all federal policies related to food, chronic diseases and health care costs. The GAO is the government “watchdog,” providing independent audits of agencies and policies. The GAO has been asked to investigate six specific questions across diverse federal agencies and programs, including the evidence linking diet to chronic diseases, the corresponding national and federal health care costs, and the current strategies and missed opportunities to reduce these risks and costs. A series of GAO reports on food policy will likely come out in 2019 and 2020. The launch of this investigation represents a federal milestone for its scope and recognition of the opportunities in food policy.
The 2018 Farm Bill, signed into law on Dec. 20, 2018, included several important provisions for healthier eating, especially in the Supplemental Nutrition Assistance Program (SNAP), which supports about one in seven Americans. This included expansion of the fruit and vegetable subsidy program to $250 million, a new $25 million Produce Prescription Program and strengthening of SNAP-Education, a $400 million/year nutrition education program. Several of these advances were recommended by the 2018 Bipartisan Policy Center report on healthier SNAP, chaired by former Senate Majority Leader Bill Frist, M.D., and USDA Secretaries Ann Veneman and Dan Glickman.
While there were advances in the Farm Bill, a proposed amendment to include pilot testing for medically tailored meals was rejected. Medically tailored meals are ready-to-eat, personalized meals provided at home to low-income patients with complex medical illnesses like cancer, HIV, diabetes or heart failure. Several recent studies show that providing medically tailored meals to patients is associated with reduced hospitalizations, emergency room visits and overall health care spending. While this is a missed opportunity in the Farm Bill, the state of California is currently testing the effects of medically tailored meals on health outcomes and costs in a $6 million Medicaid intervention across six counties, which will provide new evidence for possible future national expansion.
Your produce is ready
Among the Farm Bill changes, we believe that the new Produce Prescription Program holds special promise. Already offered by some nonprofit and private insurance programs, this new federal program will allow doctors to prescribe not just medications but also subsidized purchases of fruits and vegetables. While the $25 million represents a small relative investment, this direct federal commitment to evaluate produce prescriptions in health care has the potential to provide evidence to support future expansion throughout Medicaid and Medicare.
Together, these congressional activities in 2018 represent an evolution toward incorporating and addressing nutrition, diet-related diseases and their health care costs in federal policy. These actions build upon mounting public awareness of the central role of food in well-being; the accelerating consumer demand for, and corresponding industry shifts toward, healthier foods; and the growing recognition that individual consumers cannot be solely responsible for the current challenges in the food system.
Recommended policy actions
The recent congressional actions toward viewing food as medicine coincide with new scientific evidence on how specific government policies can improve nutrition and well-being, reduce health care costs and reduce disparities.
We believe that meaningful progress on these national challenges will require far more substantive policy changes that can make healthier eating the easy, accessible, less expensive option. Based on recent reviews of the science as well as our new research, particularly promising federal government strategies for consideration include:
- Strengthening of nutrition standards in schools, after school, early childhood education programs and child feeding programs, as well as in cafeterias at federal worksites and other federal facilities, such as prisons and Veterans Affairs hospitals.
- Federal incentives to incorporate nutrition into corporate worksite wellness programs, such as personalized, interactive technology platforms, gameification and economic incentives already available in private insurance and corporate programs.
- A federal excise tax on sugar-sweetened beverages and junk food, especially if tax revenues are used to subsidize healthier foods, making the latter’s prices both more affordable and closer to their true societal value.
- Integrating nutrition into health care, including in the electronic health record, medical education and licensing standards, fruit and vegetable prescriptions, medically tailored meals, provider quality and reimbursement guidelines, and risk-sharing arrangements that incentivize providers to improve the health of their communities.
- Leveraging the $70 billion per year SNAP program for better nutrition for low-income families, for example through further strengthening of SNAP-Education, increased subsidies for fruits and vegetables and a combined food incentive/disincentive program to nudge people toward healthier choices.
- U.S. Food and Drug Administration labeling standards and limits for additives such as salt, trans fat and added sugar; marketing standards to protect children; and evidence-based health claims for products that can help achieve better health.
- Increased federal research funding, including a new National Institute of Nutrition at the National Institutes of Health; as well as economic incentives for transparent public-private partnerships for health-focused food innovation and entrepreneurship.
Policy change is often not linear. Based on the significant impacts of nutrition on disease, health care, the economy, military readiness, disparities and the environment, federal actions in 2018 laid the foundation for nonpartisan federal leadership to create meaningful and lasting solutions.
SDCRI Review for the year 2018
by Daniel Vicario, M.D.
As a medical oncologist, I’ve had the privilege of working with a large number of cancer patients since 1985. It’s been an inspirational journey where I’ve learned so much from my patients and their loved ones that I’ve been feeling the need to share that knowledge from now on. Having been the medical director of two cancer centers for over two decades and being part of a community that created an integrative oncology program back in 1995, I am now able to take some time off from a very busy schedule, to reflect on the many things I’ve learned. This learning came from many teachers: cancer patients and their loved ones, nurses, colleagues, cancer center staff and practitioners of the many different healing arts.
Our San Diego Cancer Research Institute (SDCRI) is a nonprofit organization created in the year 2000 with two divisions: Genomic Oncology, directed by my business partner and dear friend Dr. Mark J. Adler, and Integrative Oncology which will be discussed here.
The integrative program started offering free complementary services in 1995 at the San Diego Cancer Center thanks to the generosity of several successful practitioners of the different healing arts who offered their time and skills as volunteers servicing the community of cancer patients. This program started at the San Diego Cancer Center in Vista and Encinitas with the intention of offering cancer patients the option of experiencing complementary healing modalities that were proven to improve their quality of life. It was open to all cancer patients in the San Diego community. This program was extremely successful, offering services to over 150 cancer patients every month with an average of 100 visits per week. At one point there were 50 active volunteers enrolled in the program. During its last ten years, the program’s coordinator was Mary Hollander, RN. Without Mary’s support and guidance we could not have reached everything the program was able to accomplish. Unfortunately, for the several reasons mentioned in previous news articles on this web site, the SDCRI’s free integrative services facility in Encinitas had to close in December 2014.
The good news is that the San Diego Cancer Research Institute remains active in its mission of education, collaboration and research. Since the closing of the free integrative services facility in Encinitas, SDCRI has continued its education and research collaborative efforts with several other institutions and has remained an active web-based resource. The Integrative program team will continue to update the webpage with news, Integrative and Genomic Research updates, Nutrition and Oncology updates; Dr. Paul Brenner’s videos; the latest info on the Hope Made Visible Project directed by Dr. Alessandra Colfi; educational programs and more. Mary Hollander and Juli Shelton continue to help with SDCRI’s Integrative program and update the website on a regular basis. SDCRI will continue to expand in 2019, continuing its online nutrition program: Reality Based Nutrition by Mary Hollander RN; Dr. Alessandra Colfi’s Hope Made Visible Project; SDCRI’s integrative oncology projects, collaborative research and educational videos.
SDCRI’s Integrative Oncology program continues to collaborate in various broad-based Integrative Research projects. We are working to continue to expand research on the importance of embracing proven integrative healing modalities to support cancer patients. Research projects include the fields of nutrition, exercise, yoga, mind body practices, massage, psychoneuroimmunology, acupuncture, bio-field therapies, art therapy, aromatherapy, and others.
We also have the pleasure of collaborating with practitioners, professionals and researchers in naturopathic medicine, homeopathic medicine, and ancient healing traditions like Ayurveda, Chinese medicine, and Indigenous medicine.
This past Fall I had the honor to be part of a scientific and spiritual trip to India with dear friends and colleagues. One of the main research goals of the trip was to measure the effect of meditation and prayer in Holy sites in southeast India. We used different devices to measure brain wave activity, biofield (energy) and the environment. The trip was a collaborative between several non-profit organizations including: CHI (Consciousness and Healing Initiative); SDCRI (San Diego Cancer Research Institute); Miraglo Foundation; UCSD; Medicine of the Soul Foundation; and several others. I will share some of the results once we have a chance to review all the data that was collected.
Scientific Group at one of the Holy sites in southern India
Using the Bio-Well device (GDV) to measure photo emission/biofield from temple priests
Current SDCRI’s collaborations include:
-U.C. San Diego Cancer Services Encinitas and Vista
-Consciousness and Healing Initiative (CHI): http://www.chi.is/
-Chopra Center and Chopra Foundation: https://www.choprafoundation.org/
-Guarneri Integrative Health: http://pacificpearllajolla.com/guarneri-integrative-health/
-Miraglo Foundation: http://www.miraglofoundation.org/
-UCSD Center for Integrative Medicine (CIM): http://cim.ucsd.edu/
-UCSD Center of Excellence for Research and Training in Integrative Health (CERTIH)
-Scripps Center for Integrative Medicine
-University of California, Los Angeles (UCLA)
-University of California, San Francisco (UCSF)
-Institute Of Noetic Sciences (IONS): http://www.noetic.org/
-Resolution Care: Dr. Michael Fratkin and Team: http://www.resolutioncare.com
At a recent SDCRI board meeting, the following updates were discussed:
- The San Diego Cancer Research Institute, Dr. Dan Vicario and SDCRI’s Integrative Program have partnered with the “Consciousness and Healing Initiative (CHI)” to support its purpose, projects, research and service. CHI is an international collaborative accelerator of scientists, health practitioners, innovators, educators, researchers, professionals, artists, individuals and nonprofit institutions who share CHI’s vision. For details on the “Consciousness and Healing Initiative (CHI)” please go to this link: http://www.chi.is
SDCRI offered CHI administrative support and was its fiscal sponsor until CHI became its own separate nonprofit entity in August 2018.
- SDCRI continues collaborating with UCSD Center of Excellence for Research and Training in Integrative Health (CERTIH) and Center for Integrative Medicine.
- Paul Brenner, M.D., Ph.D. continues with his educational videos and working on research in Epigenetics and his “Family Triangles” method.
- Mary Hollander R.N. continues with her outstanding online nutrition program: “Reality Based Nutrition”, filled with inspiration and wisdom.
- Alessandra Colfi, Ph.D., continues to expand the International Hope Made Visible™ (HMV) project: creating and sharing artful flags among cancer patients, survivors, families/friends, and caregivers. This project has created over 1,200 flags, from all over the USA, Canada, Colombia, Argentina, Guatemala, Ghana, France, Germany, The Netherlands, Italy, and Australia. These flags have been sent for exhibitions in Europe and throughout our communities for display in several venues. Hope Made Visible™ has also collaborated with Habitat for Humanity’s Veterans Program.
- The SDCRI Integrative team continue to meet at their annual “SDCRI Integrative Volunteer Appreciation Day”. They are thanked and reminded of how grateful SDCRI and the community are for their outstanding care and service. The volunteers continue to express their gratitude for the experience they had working with cancer patients over the last 20 years.
- SDCRI has organized collaborative meetings between Dani Grady, Dr. Ralph Greenspan, co-creator of the “Brain Initiative”, Dr. Paul Mills from UCSD CERTIH and Dr. Paul Brenner.
The Integrative program volunteers and the San Diego community continued to be an integral part of SDCRI’s growth in 2018. The SDCRI board remains deeply grateful for all this support and looks forward to its continued growth in 2019.
Daniel Vicario, M.D.