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Empowerment Tools for Nurturing Your Health During Stress

The pandemic has distorted our livelihood and forced many of us into teleworking whether we were willing or unwilling. We’re plastered to our computers not just in the home office, but at our kitchen tables, or on the bed. We find ourselves having to make adjustments on a regular basis. Responsibilities may have been added to your already hefty plate. Your new work environment may not be favorable. Maybe you simply can’t concentrate. We just can’t seem to escape the pings and alerts from work colleagues. Working from home is new to many of us. However, the concept of work-life balance is not. Yet, instead of home being a sanctuary, it has become a boundless environment for work and stress. Through this journey, we can relearn what work-life balance is, and how intervening factors like stress meddle with our body and mind. We can learn the value mindfulness has in creating boundaries that benefit our health and productivity, and be empowered with tools to build and sustain our immunity.

In the moments we’re experiencing stress we don’t stop to think about the effects it can have on our mind, body, and soul. Being overworked, getting familiar with remote working conditions, or trying to make child-care arrangements can be awfully difficult during a pandemic (Harnois & Gabriel, 2002). Stressors such as these can drive workers into depression, cause sleep disorders, body aches and headaches, and lead to other short- and long- term effects. Job-related stress can affect our immune system by lowering our resistance to infections. Brace yourself, we’re about to hop on the science train, but only for a few stops so you’ll be fine.

Who turned off the lights?

Stress flips the switch on the central nervous system causing it to go into defensive mode (Han, Kim, & Shim, 2012). The body reacts in efforts to regain homeostasis or regain balance. As previously mentioned, stress has the ability to cause depression, sleep disorders, body aches, and a lower immune system. Did you know that stress, sleep, and immunity are related (Han, Kim, & Shim, 2012)? Small immune signaling proteins called cytokines aid in regulating sleep. When these proteins fail to perform properly due to stress, this interrupts phases of sleep. When experiencing this stress, an irregularity in the secretion of the hormone Cortisol occurs.

Depression is a common and complex disorder with the ability to affect your daily life including work and productivity (National Institutes of Health, 2016). The hippocampus, amygdala, and the prefrontal cortex are three parts of the brain that seem to have major roles in depression (Cirino, 2017). When we experience depression, Cortisol secretion increases causing chemical imbalances which can lead to the reduction of brain cells (neurons). In a Korean study published in Stress and Health, individuals who experience work-related stress are at a higher risk of experiencing major depressive issues (Lee, Joo, & Choi, 2013). Symptoms associated with work-related stress include a reduction in the ability to concentrate, fatigue, insomnia, and feeling counterproductive.

An increase in proinflammatory cytokine levels can cause inflammation within the body (Leonard, 2010). This can lead to major depression followed by type 2 diabetes and other inflammatory diseases. Cytokines are involved with adaptive immunity and have been linked to COVID-19 infections (Costela-Ruiz, Illescas-Montes, Puerta-Puerta, et al, 2020). Weakened immune responses have been linked to patients with comorbidities. While the available information regarding COVID-19 is ever changing, what we do know is severe pre-existing conditions, including pregnancy, are linked to weakened immune responses placing these individuals at a higher risk of contracting the virus.

Road to Redemption.

Now that we have a better understanding of stress, learn to set your boundaries to alleviate it. Establish boundaries in all aspects of your life, especially with work. This ensures that your needs and your health are placed at the forefront. Think of them as safeguards for yourself. As difficult as it may be to establish them, understand that they are without question essential for your efficacy in and out of work. Working without boundaries is when stress raids the mind, body, and soul creating an imbalance. Here are a few practices to reclaim your balance: be mindful, create a workable workspace, listen to your body, reevaluate your time, say no.

Being mindful is having that ability to find calm in times of chaos. Be conscious and aware of the moment, relax, and BREATHE. Only you are in control of you. This is a type of meditation that can be implemented in your daily life at any moment. Let’s take a few moments to practice. Stop what you’re doing, turn off the TV, put your laptop to the side, get comfortable, and gently close your eyes. Take a deep breath in, then slowly exhale. If you hear noises, leave them be, continue to breathe. Do this for about 5 minutes. This practice is to help you find your calm, clear your mind, and become hyperaware. This method of nurturing your mind and body has the ability to mitigate stress, anxiety, improve sleep, and improve attention (Mayo Clinic, 2018). There are many practices for mindfulness which can be found on the Complete Guide to Mindfulness.

We are no longer in our offices or confined to our cubicles so we must create workable workspaces, and implement our boundaries. Yes, your new comforter was just shipped from Amazon, but allow the bed to be a place for rest not work. Create a space to enhance productivity yet allow comfort. Here are tips to transform a section of your home into a conducive workspace:

1. Invest in a quality chair and desk/or small table

  • Maintain good posture. If you feel yourself slouching, readjust or move around We want to avoid body aches, so listen to your body. Be aware of its needs.

2. No desk?

  • Use the kitchen table or counter, a coffee table (make sure you have some sort of back support).
  • If you must use your bed because your room is the only place of silence, ensure your bed is made. Sit on top of your new comforter with your back against the headboard

3. Good lighting is a must.

 

4. Keep your workspace organized using bins and folders

  • Disorganization is distracting, limits movement, affects motivation, reduces your performance, and shows lack of control (Roster & Ferrari, 2019).

5. Do not let work leave your workspace. The rest of your home should be designated a non-working area.

Listening to your body is an aspect of creating boundaries. Do not let work interfere with your health. Know when to get up to stretch, grab water, have a snack, or take lunch. If you must, inform your team of the time you will take lunch daily. Having good nutrition is the first thing that will ensure we’re energized and healthy. Instead of ordering something to go for lunch, try meal prepping. Use Sunday as the day to prepare and organize your meals for the week, including your snacks.

Restock on the elderberry! Since we’re all being hyperconscious of where we venture in the world, incorporate things to boost your immune system such as Emergen-C and elderberry. Elderberry is a substance extracted from the elder tree which many use as a dietary supplement to help boost their immune system. It can be consumed in the form of syrup or even gummies. Disclaimer, before the use of any dietary supplement it is best practice to consult your healthcare provider.

Reevaluate your time. You may find that during this time you have accumulated more than 40 hours a week. It’s fine to work additional hours sometimes, but this takes away time from caring for yourself. It interferes with your work-life balance. Although we’re home, this shouldn’t equate to extra time to tap on computer keys. Reevaluating your time takes a level of mindfulness to understand the importance of taking care of you: your mind, your body, your soul.

Saying no can be difficult, especially to a loved one or your boss. However, you should listen to your mind, be aware of what you are capable of, and respect your time. Knowing when to say no in some respects may be less difficult than others. Saying no is powerful. It is the ultimate boundary we can create for ourselves and it is okay.

Our fight with this global pandemic has yet to near the end. If we are equipped with the tools to tackle our stress and adjust as needed, we may be equipped to continue our lives teleworking. We have learned to understand the deteriorating effects stress has on our health. It can disrupt sleep patterns, make us susceptible to depression, and weaken our immune systems. Each one of these conditions are tightly tied together by stress which we must keep unbound. However, the tools to reclaim our balance will aid us in this situation. Being mindful, creating the awareness we need to breathe and focus for productivity in work and life, will assist us in creating needed boundaries. Whether these boundaries are centered around a conducive workspace, listening to our bodies, reevaluating our time, or simply saying no, it is a necessity to properly control and lessen the amount of work-related stress we experience in these crucial times.


References

Cirino, E. (2017). The effects of depression on the brain. https://www.healthline.com/health/depression/effects-brain#1

Costela-Ruiz, V. J., Illescas-Montes, R., Puerta-Puerta, J. M., Ruiz, C., & Melguizo-Rodríguez, L. (2020). SARS-CoV-2 infection: The role of cytokines in COVID-19 disease. Cytokine & growth factor reviews, S1359-6101(20)30109-X. Advance online publication. https://doi.org/10.1016/j.cytogfr.2020.06.001

Han, K. S., Kim, L., & Shim, I. (2012). Stress and sleep disorder. Experimental neurobiology, 21(4), 141–150. https://doi.org/10.5607/en.2012.21.4.141

Harnois, G. & Gabriel, P. (2002). Mental health and work: impact, issues, and good practices. https://www.who.int/mental_health/media/en/712.pdf

Lee, J., Joo, E., & Choi, K. (2013). Perceived stress and self-esteem mediate the effects of work-related stress on depression. Stress and Health, 29(1), 75–81. https://doi.org/10.1002/smi.2428

Leonard B. E. (2010). The concept of depression as a dysfunction of the immune system. Current immunology reviews, 6(3), 205–212. https://doi.org/10.2174/157339510791823835

Mayo Clinic (2018). Mindfulness exercises. https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/mindfulness-exercises/art-20046356

National Institute of Health (2016). Depression basics. https://www.nimh.nih.gov/health/publications/depression/index.shtml

Roster, C., & Ferrari, J. (2019). Does Work Stress Lead to Office Clutter, and How? Mediating Influences of Emotional Exhaustion and Indecision. Environment and Behavior, 1391651882304–. https://doi.org/10.1177/0013916518823041

Can Diet and Exercise Reduce MPN Symptoms?

Can Diet and Exercise Reduce MPN Symptoms? from Patient Empowerment Network on Vimeo

What can YOU do to make a positive impact on your overall MPN care? Researchers Dr. Jennifer Huberty and Ryan Eckert review the latest research on how movement and diet can benefit people living with myeloproliferative neoplasms (MPNs).

Dr. Jennifer Huberty is an Associate Professor at Arizona State University. She focuses her research on the use of complementary approaches to manage symptoms and improve quality of life for patients living with myeloproliferative neoplasms. More about Dr. Huberty here: chs.asu.edu/jennifer-huberty.

Ryan Eckert currently works at Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center. Ryan is the Research Coordinator for the MPN QoL Study Group and assists in research related to complementary health approaches in myeloproliferative neoplasms and other hematological disorders. More about Ryan here: mpnqol.com/research-team.

See More From the The Path to MPN Empowerment

Related Programs:

Am I Meditating Correctly? Getting the Most Out of Mindfulness

Expert Tips for Managing MPN-Related Anxiety

Improving Life with MPNs: The Latest Research and How to Get Involved


Transcript:

Ryan:

So, as far as the benefits of exercise for MPN patients, there’s many, and so, I guess starting with cancers as a whole, there’s a lot more research that’s been done in recent decades that looks at the effects of various forms of exercise and physical activity on other cancers. They just tend – researchers tend to do a lot more of that work in breast cancer, lung cancer, colon cancer, et cetera.

And so, the research in exercise for MPN patients is actually really new, and nobody outside of Dr. Huberty in conjunction with Dr. Mesa and a few other researchers have done any research related to exercise specifically in MPN patients. Our yoga studies that we’ve done have been the first venture down that route for MPN patients. But, what we do know in general is that exercise has obviously systemic effects across the whole body.

So, you’re gonna get health benefits just in general from exercise, but as far as for MPN patients specifically, some of the things that we’ve seen with our yoga studies, which is obviously a form of physical activity, is that we’ve seen sleep improve in MPN patients, so we’ve seen a reduction in sleep disturbances or disruptions in their sleep, a quicker time to fall asleep, and then, less waking up throughout the night – so, just better sleep in general.

We’ve seen some reductions in fatigue that have been reported by MPN patients who have gone through our yoga studies, and then, we’ve also seen a few other reductions in some other symptoms, such as anxiety and reduced depressive symptoms, a little bit of reduced pain is another one we’ve seen. So, just in general, we’ve seen some of those effects on MPN patients through some of our yoga studies.

Dr. Huberty:

So, in terms of adding to what Ryan just said, I would just say that exercise – maybe yoga or walking – is good for your body. It’s good for your health. It’s a recommendation that we get 150 minutes of moderate-intensity activity every week. The more that MPN patients can be achieving that goal towards 150 minutes – yoga counting at that – the better off they’re gonna be, and it doesn’t have to be going for a run.

It can simply be going for a walk around the block. It can be standing at your desk when you’re working instead of sitting all the time. That’s not necessarily activity per se, but it is moving your body and less sedentary. So, I think just focusing on the more that patients can move their body every day, the better off they’re gonna be.

Dr. Huberty:                

So, yeah, the role of diet in MPN patients – so, this is the beauty about the quality of life study group, because we have all these wonderful investigators that are part of the team, and we do have Dr. Robyn Scherber, who’s at Mays with Dr. Ruben Mesa. She’s doing some work with keto diet right now, so it’s very new, so I don’t know if you’re familiar with the keto diet, but it’s very high-fat and very low-carbohydrate, extremely low levels of carbohydrates. I wouldn’t tell any patient to go start doing those things unless they’ve talked to their physician for sure, but we do know that based on how you eat does certain things to your body.

So, MPNs have high inflammatory markers, and so, we wanna decrease inflammation; we probably wanna eat foods that are going to be anti-inflammatory. So, berries, let’s say, is a good example of fruits that are anti-inflammatory, almonds are anti-inflammatory, and I’m not a dietitian by any means, it’s just that things that I know to be true for my own diet because everybody should be thinking about having an anti-inflammatory diet.

Processed foods are not healthy. They are higher-inflammatory. Breakfast foods, eating out, and the foods that you get when you eat out a lot are going to be more inflammatory than not. So, just those small things – lots of vegetables. Vegetables are very good. Lots of greens. But, there is research going on – again, just like exercise and yoga, it’s in its infancy because MPN has been an under-studied population for years, and we’re trying to power through and make that difference.

Tackling Medicine’s ‘Taboo’ Subjects

Many people feel reticent to speak about their personal medical problems and for 3% of Americans, the problem is so extreme that they feel they cannot speak to a doctor at all. While most concerns lead to nothing serious, there will be occasions where an inability to speak up can lead to further problems. Empowering people to feel confident is important, and there are stages to breaking down the barriers to this.

Improving Awareness

One important step to creating a safer environment for speaking freely is through improving awareness over conditions. Simply put, there are almost no conditions that significant numbers of people won’t have experienced and that doctors won’t see as run of the mill. Diseases concerning sensitive parts of the body and, similarly, venereal disease, are a good example of this, with literally millions being diagnosed every year according to the CDC.Despite this, studies have shown that many men and women are reluctant to discuss their symptoms with doctors.Teaching awareness of these sorts of facts, and outlining how nobody is going to judge, is an important base layer.

Getting Information Out There

Part of the reasons some people will refuse to approach a doctor is through fear of diagnosis, or of invasive diagnostic processes. A great way to combat this is through having as much medical information available online as possible. Services like Mayo Clinic and Healthline have done a lot to aid this in recent years, but more work can be done, especially with more obscure conditions.

De-Stigmatizing

Most crucial is the process of de-stigmatizing all illness. Regardless of the cause, condition or outcome, illness remains the same and should be treated with sensitivity. The effect of stigma on illness is clearly felt. Anonymous polls of men by the NCHS found that 10% of men had experienced feelings of anxiety or depression, but less than half had sought treatment. This fear of stigma has led to men being 3.5x more at risk of suicide than women. De-stigmatizing is key, both for mental health and for conditions across the board.

Illness should never be something to be ashamed or scared of broaching the subject of. Instead, it should be something that people feel confident and free to talk about with a doctor, with no worry of abuse or shame. Through awareness, dispersing information and tackling stigma, society as a whole can create an environment in which people of all ages are happy to pursue their medical issues.


Resources:

https://health.usnews.com/health-news/patient-advice/articles/2014/07/01/how-to-overcome-extreme-fear-of-doctors

After Cancer, Ambushed By Depression

At some stage in all our lives there comes a time when feelings of sadness, grief or loneliness gets us down. It is part of being human. And after all, what’s more human than feeling down after such a life-changing and stressful event like cancer? Most of the time, we bounce back; but what happens when the blues stick around and start to interfere with our work, our relationships and our enjoyment of life?

Dana Jennings, whose writings in the New York Times about his treatment for prostate cancer, so eloquently captured the mix of feelings which cancer survivors face after treatment ends, wrote that while he was “buoyed by a kind of illness-induced adrenaline” during treatment, once treatment ended, he found himself “ambushed by depression.”

Jennings’ words will have a familiar ring to many of us who have struggled with that unexpected feeling of depression and loneliness that creeps up on us after treatment is finished. For some survivors, depression kicks in shortly after diagnosis or at some stage during treatment; for others it may ambush them weeks, months or even years after treatment ends.

What Causes Depression?

Depression is a word that means different things to each of us; people use it to describe anything from a low mood to a feeling of hopelessness.  However, there is a vast difference between clinical depression and sadness. Sadness is a part of being human; it comes and goes as a natural reaction to painful circumstances, but it passes with time. Depression goes beyond sadness about a cancer diagnosis or concern about the future.

In its mildest form, depression doesn’t stop you leading your normal life, but it does make things harder to do and seem less worthwhile. At its most severe, the symptoms of clinical depression are serious enough to interfere with work, social life, family life, or physical health.

Incidence of Depression in Cancer Survivors

Research shows that cancer survivors are more likely than their healthy peers to suffer psychological distress, such as anxiety and depression, even a decade after treatment ends. Although estimates of the frequency of depression in cancer patients vary, there is broad agreement that patients who face a disruptive life   event like cancer have an increased risk of depression that can persist for many years.  While most people will understand that dealing with a chronic illness like cancer causes depression, not everyone understands that depression can go on for many months (and even years) after cancer treatment has ended.

The Challenge of Identifying Depression in Cancer Patients

Some research has indicated that depression has been underdiagnosed and undertreated in cancer patients.  This may result from several factors, including patients’ reluctance to report depression, physician uncertainty about how best to manage it, and the belief that depression is a normal part of having cancer.

Several of the characteristics of major depression listed below– like fatigue, cognitive impairment, poor sleep, and change of appetite or weight loss—are hard to distinguish from the common side effects of cancer treatment. This makes it harder to tease apart the psychological burden of cancer, the effects of treatment, and the biochemical effects of the disease.

Are You At Risk of Depression?

Depression can occur through a combination of factors, with some of us being more prone to depression than others.  Factors such as a history of depression, a history of alcohol or substance abuse, and a lack of social support can increase the risk of depression in both the general population and among cancer patients.

Even if a person is not in a high-risk category, a diagnosis of cancer is associated with a higher rate of depression, no matter the stage or outcome of the disease.

Distress over a cancer diagnosis is not the same thing as clinical depression – it is important to recognize the signs and get treatment. The first step is to identify if you are experiencing symptoms of depression.

Try answering the following two questions.

Have you, for more than two weeks (1) felt sad, down or miserable most of the time? (2) Lost interest or pleasure in most of your usual activities?

If you answered ‘YES’ to either of these questions, you may have depression (see the symptom checklist below). If you did not answer ‘YES’ to either of these questions, it is unlikely that you have a depressive illness.

Depression Checklist*

(Tick each of the symptoms that apply to you)

  • Trouble sleeping with early waking, sleeping too much, or not being able to sleep
  • On-going sad or “empty” mood for most of the day
  • Finding it hard to concentrate or make decisions
  • Feeling restless and agitated, irritable or impatient
  • Extreme tiredness and lethargy
  • Feeling emotionally empty or numb
  • Not eating properly; losing or putting on weight
  • Loss of interest or pleasure in almost all activities most of the time
  • Crying a lot
  • Losing interest in your sex life
  • Preoccupied with negative thoughts
  • Distancing yourself from others
  • Feeling pessimistic about the future
  • Anger, irritability, and impatience

Add up the number of ticks for your total score: _______

What does your score mean?

  • 4 or less: You are unlikely to be experiencing a depressive illness
  • 5 or more: It is likely that you may be experiencing a depressive illness.

NB This list is not a replacement for medical advice. If you’re concerned that you or someone you know may have symptoms of depression, it’s best to speak to your doctor.

Depression – The Way Forward

It’s common to experience a range of emotions and symptoms after a cancer diagnosis, including feelings of stress, sadness and anger. However, some people experience intense feelings of hopelessness for weeks, months, or even years after diagnosis. If you continue to experience emotional distress from your cancer, it’s very important to know that help is available, and to get the help you need.

The first step on the path to recovery is to accept your depression as a normal reaction to what you have been through –don’t try to fight it, bury it or feel ashamed that it is there.  Think of your depression as just another symptom of cancer. If you were in physical pain, you would seek help, and it’s the same for depression.  There are many people willing to help you but the first step is to let someone know how you are feeling. Finding the courage to talk to just one person, whether that’s a loved one, primary care physician, or specialist nurse will often be the first step towards healing.

The psychological effects of cancer are only beginning to be studied and understood. In time, doctors will not only treat the body to kill the cancer, but will treat the mind which suffers the consequences of the disease long after the body has healed. When you’re depressed it can feel like you are barely existing. By obtaining the correct medical intervention and learning better coping skills, however, you can not only live with depression, but live well.

A Note on Helping a Loved One with Depression

Perhaps you are reading this because you’re concerned about a loved one who might have depression.   You may be wondering how you can help. For people who have never experienced the devastating depths of major clinical depression, it may be difficult to understand what your loved one is going through. Depressed people find it hard to ask for help, so let your friend or family member know that you care, you believe in them and that you’re there for them.

The best thing you can is to listen. Don’t offer preachy platitudes about things never being as bad as you think, or suggesting the person snap out of the depression. Our culture doesn’t encourage people to talk about their emotional pain. We’re taught to suppress our feelings, not to show weakness, to get over things quickly. Most people, when they feel upset, benefit greatly by talking to someone who listens with empathy and without judgment. Most of the time the person who is depressed is not looking for advice, but just knowing that someone cares enough to listen deeply can make all the difference.


*References: American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed (DSM-IV). Washington, DC: APA, 1994; and, International classification of diseases and related health problems, 10th revision. Geneva, World Health Organisation, 1992-1994.

Mental Health Challenges for Aging Americans

Editor’s Note: This blog was originally published for the Georgetown University Online FNP Program and can be viewed here.


While there’s many benefits to enjoy during your golden years, including time spent with loved ones after retirement, the American Psychological Association  (APA) says that aging “also comes with unique challenges: the loss of close friends and family members; complex and debilitating medical issues, such as sight and hearing loss; and increased financial pressure.” Identifying these challenges is becoming more important: Although recent research published in the Journal of Clinical Psychology found that people tend to be happier as they age, it is estimated that 20 percent of the 65 and older population meets the criteria for some type of mental health disorder.“While seniors are less likely to be depressed than younger people,” Suzanne Allard Levingston writes in an article for The Washington Post, “the size of the baby boom population will demand new strategies to care for them.The most common mental health disorders for aging Americans are depression and anxiety, which are also leading risk factors for suicide. Nursing@Georgetown created the following infographic to help illustrate some of the common signs and risk factors of depression among aging Americans.

View the text-only version

 

Symptoms of depression include persistent sadness, withdrawal from previously enjoyed activities, difficulty sleeping, physical discomfort, self-medication via substance misuse, and feeling lethargic, according to the CDC. They go on to note that depression is not considered a normal part of growing older, and while it is normal to experience sadness, grief, loss, and mood swings, depression that impacts a person’s ability to function requires treatment and support.

Anxiety often goes hand in hand with depression, according to a publication from the CDC and the National Association of Chronic Disease Directors (NACDD . The report goes on to highlight how almost half of older adults who are diagnosed with depression also meet the criteria for anxiety. The effects of anxiety include persistent worry along with physical symptoms that can include muscle tightness, restlessness, difficulty sleeping, stomach problems, and nausea all lasting for an extended period of time.

The APA outlines how serious the physical consequences of depression and anxiety can be: “The feelings of hopelessness and isolation that often spur thoughts of suicide are more prevalent among older adults, especially those with disabilities or confined to nursing homes.”

The rate of suicid  among both men and women ages 65 to 74 has steadily increased over the past two decades. In 2014, the highest suicide rate in the country was among people 85 years or older.

The Role of Primary Care

There are several reasons why treating depression in the elderly poses a unique challenge. Common among patient’ concerns are: “inadequate insurance coverage, stigma around mental health… denial…and lack of transportation,” according to the APA . Systemic reasons include things like a shortage of trained geriatric mental health providers and miscommunication between health care providers.

In addition, when older adults visit their primary care providers, they tend to focus on physical symptoms rather than talk about how they’re feeling or what they’re experiencing mentally and emotionally, according to a fact sheet from the Illinois Department of Public Health. This can lead to mental health issues that go unrecognized, untreated, or undertreated. For example, the AARP External points out that depression is sometimes misdiagnosed as dementia.

The good news is that there are effective treatments for depression, and adults with depression can improve from treatment if they receive it. Primary care providers such as Family Nurse Practitioners play an important role by identifying at-risk older adults and taking necessary follow-up actions by implementing routine mental health screenings and treating symptoms that negatively impact quality of life.


Please note that this blog post is for informational purposes only. Individuals should consult their health care professionals before following any of the information provided. Nursing@Georgetown does not endorse any organizations or websites contained in this blog post.

Notable News: February 2018

Sometimes, even the most seemingly unrelated of symptoms can be a warning sign of cancer, says nytimes.com. While some might associate depression as a side effect of cancer, it can actually be a sign of cancer growth in the body. Some cancers actually trigger depressive symptoms. The phenomenon was first noted in 1931 with pancreatic cancer patients and more recent research supports the findings. The invasion of the cancer cells causes the body to release cytokines which are messenger chemicals that when released by certain cancers create an inflammatory immune response in the body along with the neurological response that causes depression. The theory is that when the cancer is removed from the body, the depression will gradually be reversed. This story emphasizes the importance of listening to your body and not ignoring symptoms that something more serious might be going on. Learn more here.

A new treatment for a common, but often not discussed side effect of breast cancer is showing positive results, says npr.org. Lymphedema, a condition that is common after cancer treatment, can cause painful swelling of the soft tissue of the arms and legs and can increase the risk of infection and can be life threatening. It is often the result of the removal of lymph nodes and radiation used to treat cancer. Some surgeons are experimenting with repairing or recreating a healthy lymph system for patients who develop lymphedema. The surgery, which has been around for about ten years, but has recently been perfected due to advances in body imaging, involves transferring lymph nodes from parts of the body that weren’t affected by the cancer treatment. Another type of surgery is designed to prevent lymphedema altogether. When the lymph nodes are removed, instead of cutting off the vessels they are reattached to a vein so that the drainage system has as little interruption as possible and the risk of lymphedema is reduced. You’ll find more about lymphedema, the surgeries to prevent it, and some patient stories here.

There’s new research from the National Cancer Institute, says dailymail.co.uk, that might make you stand up and take notice. It turns out that even just one hour of sitting increases your risk of getting nine types of cancer, including lung, and head or neck, in addition to breast and colon cancers. The information was reported at the American Association for the Advancement of Science conference in Austin, Texas earlier this month by Charles E. Matthews, an epidemiologist at the National Cancer Institute. Matthews says that eliminating health risks requires four to five times more exercise than previously thought. While exercising more is important, says Matthews, even more important is less sitting. Matthews recommends adding in light household chores or taking a walk instead of watching television. Get more information here and you can also watch a short video reporting the findings here.

Finally, February is Cancer Prevention Month. According to moffitt.org, research and studies continue to show that the majority of cancers are the result of lifestyle choices and environmental factors that could be changed or avoided to prevent between 70 to 90 percent of the gene mutations that cause cancer. Fortunately, some of the ways to prevent cancer are pretty easy and painless. You can find six strategies from Moffitt Cancer Centers here and seven tips from mayoclinic.org here. Of course, whether it comes to prevention, treatment, or support, you will find some of the best resources available right here with Patient Empowerment Network. Check out our programs here.

Feeling Poorly and Living With Neck Cancer…

Real patient experiences shared privately at www.TreatmentDiaries.com.  Read more, share if you like or join in the conversation.  Making sure you feel less alone navigating a diagnosis is important.  Connecting you to those who can relate and provide support is what we do.


The past few days haven’t been great health-wise. I’ve been feeling really flu-like and have been spending a lot of time on the couch. It seems like, each time following treatment for my neck cancer, my muscles get really weaker, the tremors get worse, I get random startling muscle/body jerks, my joints feel really achy, I can’t think, headaches get worse and more consistent, I’m usually nauseous, my skin gets more sensitive, I’m more dizzy, get long periods of relentless neck spasms, etc. I often forget what I’m saying a few words into a sentence, but now I stop talking after one word, often unable to remember what I’m going to say at all. The tremors at the point where typing is much more difficult, and I can’t seem to put my cat’s food into a bowl without twitching and spilling it. Now that I think of it, the tremors aren’t as bad right now–just worse than they normally are. I’m constantly finding myself blankly–seemingly without a thing on my mind–staring at the screen for a long time before writing anything. I guess this is something that happens normally, but I definitely don’t think it’s usually this bad.

I would love to say what caused this post treatment episode, though I don’t think I can pin it down. It did seem to begin a day after my partner stayed over for two days. During those two days, we stayed up until 4 or 5AM and went on several walks. The thing is… I don’t crash like this every time I walk and/or stay up late. It isn’t consistent, no matter how much I wish it was. The causes of these episodes are probably a complicated mix of things that will take lots of time and energy to figure out–if I do ever figure them out. At this rate, it doesn’t feel like I will. Of course, this could explain why my depression might be getting worse with the intensity of my treatments over time, though it also seems to correlate with my brain feeling blank and sluggish. Plus I spend a lot of time on the couch.

That reminds me… The recent episodes of “neck spasms” (or whatever you call involuntary muscle clenching) are a main reason I’ve been lying down so much. It gets to the point where my neck is clenched for so long that I have a very hard time holding it up. So I end up having to lie down, but doing so doesn’t seem to help with the pain too much. My neck is still tightening to some extent, leaving me feeling like I’m constantly holding my head up, even when something else is supposed to be holding it up. I’ve tried a soft neck collar in order to try sitting up for longer. Can’t say that was too helpful either. I might try to find one that provides more support for the back of my neck because it seems like that’s what my current neck collar was missing. It’s to the point where I’m considering trying my hard neck brace again, even though it might’ve triggered a bad vertigo episode.

Oh, and when I get the flu-like symptoms, my acne and other skin issues seem to get worse. Coincidence?

On the bright side, I was able to get in a decent amount of food (kind of) despite being nauseous most of the day. I still needed to take two Zofran to get to that point, though. But hey, I’m grateful that I have it! When I was sitting up, I spent time playing Rust (a multiplayer survival game) with my partner. He was even able to convince me to play with some “friends” (in quotations because I’m not sure what they think of me), even though I protested the idea quite a bit. It was a bit stressful because the OCD-like symptoms started acting up, and I felt overwhelmed about not being able to do things like I used to. I also felt regretful after every time I talked, though my mind has a habit of forgetting many of the things I’m regretful of, so I’m not too upset about it now. I honestly can’t remember what happened or what I’ve done for most of the day. Definitely better than being overwhelmed, though, so I’m at least a little grateful for that and still hopeful I can beat this cancer!

World Health Day 2017: Depression – Let’s talk

World Health Day is celebrated on April 7th every year to mark the anniversary of the founding of WHO (World Health Organization). This day provides us with a unique opportunity to mobilize action around a specific health topic of concern to people all over the world.

About WHO

The World Health Organization is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, headquartered in Geneva, Switzerland. According to WHO’s website:

“Our goal is to build a better, healthier future for people all over the world. Working through offices in more than 150 countries, WHO staff work side by side with governments and other partners to ensure the highest attainable level of health for all people.

Together we strive to combat diseases – infectious diseases like influenza and HIV and noncommunicable ones like cancer and heart disease. We help mothers and children survive and thrive so they can look forward to a healthy old age. We ensure the safety of the air people breathe, the food they eat, the water they drink – and the medicines and vaccines they need.”

Theme

The theme of 2017 World Health Day campaign is depression. You can check out the campaign toolkit here.

Depression affects people of all ages, from all walks of life, in all countries. It causes mental anguish and impacts on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living. At worst, depression can lead to suicide, now the second leading cause of death among 15-29-year olds.

Yet, depression can be prevented and treated. A better understanding of what depression is, and how it can be prevented and treated, will help reduce the stigma associated with the condition, and lead to more people seeking help.

About Depression

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration (WHO 2012). Globally more than 300 million people suffer from it. Women are affected by depression twice than men. Depression can lead to suicide. Depression can produce huge economical and social burden also. The WHO characterizes depression as:

  • By persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks.
  • Loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.
  • Something that can happen to anybody.
  • Not a sign of weakness.
  • Treatable, with talking therapies or antidepressant medication or a combination of these.

What You Can Do

The WHO organizes international, regional and local events on the Day related to a particular theme. World Health Day is acknowledged by various governments and non-governmental organizations with interests in public health issues, who also organize activities and highlight their support in media reports. Examples of events include conferences for health worksers, briefings for local politicians, and informational displays for children and young people. Public marches and demonstrations, as well as free or easy access to medical tests, can also take place on the day. Check out how you can get involved here.

Coping With Anxiety and Depression

An expert panel discusses different methods to cope with anxiety and depression through all the phases of a cancer journey. Jane Williams, MSN, RN, FNP, says one of the best ways is to communicate openly with your healthcare team and loved ones. Letting them know how you feel and what you need can lead to you feeling better. Remember that you’re not alone in your journey, and sharing your emotions can help you figure out what works best for you, whether that be running, meditating, etc. Watch the full video below for all the panel’s advice on coping with anxiety and depression.

Coping With Anxiety and Depression from Patient Empowerment Network on Vimeo.

Robin Williams’ Death: A Message About Depression

We were all shocked by the sudden loss of actor and comedian Robin Williams. Just today I had breakfast with an old friend from Marin County, California. She went to high school with Robin and would run into him often in her home town of Tiburon. People in that area knew him and his family. I even once attended a party with his mother. But whether you lived in the Bay Area or not, Robin Williams’ death too soon seemed personal, as he made us laugh for so many years. Last night, our family, during a reunion, re-watched “Good Morning Vietnam.” He was an incredible talent.

Robin Williams didn’t die of natural causes. He died by taking his own life. Deep depression, in some cases an ongoing illness and in other cases an onset of deep anguish, must have made him feel hopeless. There are times when many of you reading this, perhaps with a cancer diagnosis or because a loved one has been diagnosed, feel hopeless too. I remember, a few years ago, seeing a friend off in the distance sitting under a tree drinking from a bottle of scotch. I walked over. He said, “It’s hopeless, I’ve just been diagnosed with pancreatic cancer.” The man was bewildered and as low as one could go. He hadn’t told his family yet and didn’t know if he could. True, as it turned out he did not have a long life. But increasingly, that is changing for some, and it is a very variable road for any of us on our cancer journey. Some beat the odds, and in more and more cases – especially some blood cancers now – the odds are improving greatly.

But no matter what, the diagnosis can send you reeling and unfortunately, some people fall into deep depression or even take their own life. This is so sad because there are treatments, and there is help. I know in myself, I work hard to see the positive in each day. But if depression was part of my illness, I would need help doing that. If you feel like your health is failing in this regard, don’t be ashamed to ask for help. And if you are a “support partner” of someone with a serious diagnosis like cancer, don’t be ashamed to ask for mental health help for the person you care about.

At major cancer centers now there are typically oncology social workers. Ask to meet one at the center or in your town. In the U.S., there are social workers at the Leukemia and Lymphoma Society and at CancerCare in New York. Their services are usually free. And check out our recent interview about how a social worker can help.

Other organizations provide such services in other countries. Dealing with the diagnosis and medicines for cancer are tough. The goal is to cure us or, if that can’t be done, to allow us to live well for an extended time. Don’t let depression dampen that time. And please, please, if you have thoughts of shortening your time on your own, get help! The National Suicide Prevention Lifeline: 1-800-273-TALK and the Crisis Text Line: www.crisistextline.org are both important resources.

We are a community and need each of us to work together to get well individually and as a group.

The death of a celebrity draws tremendous attention to an issue. In Robin Williams’ case, it’s depression and suicide. These are real and so unfortunate. But if we confront this in our own lives and families maybe, in a strange way, Robin Williams will have given us one last gift.