Thursday, February 20, 2014

The Relaxation Response, Stress, Meditation, Smoldering Myeloma

As I have written about previously, I am currently in a clinical trial at the Benson-Henry Institute for Mind Body Medicine at the Massachusetts General Hospital in Boston. The study is measuring the genomic and psychosocial affects of their mind/body program on patients with MGUS and SMM. I receive daily emails from Dr. Mercola (who I have mixed feelings about ;)), and today there was an article written by Dr. Kelly Brogan explaining the science of meditation: how meditation affects your mind, and how meditation alters genetic expression.

Here is the link to the article, which also includes a very interesting Ted Talk: "How Meditation Can Reshape Our Brains". I copied the two sections from this article, "The Science of Meditation" and "Meditation Alters Your Genetic Expression" below the link:

How Meditation Affects Your Health and Wellbeing

The Science of Meditation

Since we have come to appreciate the power of genetic expression as more than simply the 20,000 genes you're born with, we can now harness tools that optimize the "good" and suppress the "bad."
It turns out that our in-born DNA interfaces with an "exposome" or elements in our environment, and our conscious behavior, dictating exactly how the book of you will actually be written. With one fell swoop, things like spices, exercise, and relaxation can accomplish what pharmaceuticals could only fantasize about.
Some diligent researchers out of the Benson-Henry Institute for Mind Body Medicine1 in Massachusetts have begun to illuminate the mechanisms of meditation's effects, specifically the relaxation response which can be achieved through various forms of meditation, repetitive prayer, yoga, tai chi, breathing exercises, progressive muscle relaxation, biofeedback, guided imagery, and Qi Gong.
According to Dr. Benson, the relaxation response is, "a physical state of deep rest that changes the physical and emotional responses to stress (e.g., decreases in heart rate, blood pressure, rate of breathing, and muscle tension)" and is characterized by:
  • Metabolism decreases
  • Heart beats slow and muscles relax
  • Breathing slows
  • Blood pressure decreases
  • Levels of nitric oxide increase

Meditation Alters Your Genetic Expression

Forty years of research support these claims. Only recently have the tools to assess gene-based changes been available. Far from summoning their inner monks, subjects in the Institute's studies simply pop in some ear buds and listen to a 20-minute guided meditation, passively. The Benson-Henry Institute has sought to quantify the benefits of the relaxation response by assessing gene expression before, after 20 minutes, after eight weeks of practice, and after long-term meditation routines.
In a series of papers, they walk us through the anti-inflammatory effects of this intervention. Genetic study2 of eight-week and long-term meditators demonstrated evidence of changes to gene expression – specifically antioxidant production, telomerase activity, and oxidative stress – as a result of the relaxation response.
They theorize that NF-kappa B gene sets may be the messenger between psychological and physical stress wherein the body translates worry into inflammation. It appears that the relationship between gene expression optimization and relaxation response is dose-related, so that increasing amounts confer increasing benefit. Even after one session, changes were noted, characterized by:3
"Upregulating ATP synthase —with its central role in mitochondrial energy mechanics, oxidative phosphorylation and cell aging — RR may act to buffer against cellular overactivation with overexpenditure of mitochondrial energy that results in excess reactive oxygen species production. We thus postulate that upregulation of the ATP synthase pathway may play an important role in translating the beneficial effects of the RR."
These changes represent an orchestra of base and high notes that synergize into a body-balancing harmony. The experience of the relaxation response also appears to change brain plasticity or cellular connections in areas of the brain associated with stress response.
These changes occur based on internal recalibration of the nervous system – with no manipulation of circumstantial conditions, meaning stressors remain the same. According to neuroscientist, Dr. Lazar,4 long-term meditation practice appears to be associated with preferential cortical thickening:
"…brain regions associated with attention, interoception and sensory processing were thicker in meditation participants than matched controls, including the prefrontal cortex and right anterior insula" and that these findings were further validated by an eight-week intervention trial.5
Clinically, mindfulness-based meditation practice has been demonstrated in randomized trials6 to improve depressive symptoms in fibromyalgia and to have lasting anti-anxiety effects after only eight weeks of group practice.7




There was also a recent article on meditation and managing stress from the ASCO Post:

Stress and Tumor Biology: Insights Into Managing Stress to Help Improve Cancer Care


This part of the article really stood out to me:

"The health-damaging effects of chronic stress are well documented in the medical literature, and research indicates that chronic stress affects almost every biologic system. With regard to cancer, there is little convincing evidence that chronic stress affects cancer initiation. However, there is extensive evidence that chronic stress can promote cancer growth and progression."


When I was first reclassified as smoldering myeloma, after being diagnosed with MGUS about 3 years prior, Dr. R stressed to me the importance of reducing stress. He told me that he had "seen" in other patients what stress can do as far as causing progression from the precursor states to full blown myeloma. He encouraged me to do yoga twice a day, go to mass every morning...do WHATEVER I had to do to reduce and manage stress. Well, I'm proud to say I'm working on that as we speak!

Tuesday, February 4, 2014

High Fives at the Farber & Aspirin

Last week I was at Dana-Farber for my first round of testing for 2014. Fairly uneventful visit. And, it was actually by far the shortest wait time I've ever had since being a patient there! We reviewed my labs and 24 hour urine from the week before. My m-spike is up slightly, free light chain ratio down slightly, and everything else is fairly "stable" as Dr. R likes to say. In the appointment he actually said, "Rock solid!" and gave me a high-five. Ha. ;)

Last spring Dr. R had recommended I start taking aspirin. He was hoping that daily aspirin would help settle down my fevers. He also mentioned that there had been studies that have shown that daily use of aspirin helps fight/prevent cancer. I wrote about that visit in this post last year: Hospital evacuation, 2 specialists down, and aspirin. He told me that they were in the process of planning clinical trials for MGUS and SMM patients using aspirin.


Well, hopefully the aspirin that I have been taking is making a difference because check this out:

Long-term aspirin use decreased risk for multiple myeloma

Regular aspirin use and risk of multiple myeloma: a prospective analysis in the Health Professionals Follow-up Study and Nurses' Health Study


Dr. Durie wrote about it in his blog as well:

Dr.Durie: Can an Aspirin a Day Keep the MYELOMA away?



I will return to Dana-Farber in April for labs andddd NO 24 HOUR URINE (I convinced him to let me skip since I've had 10/11 24 hour urine collections that were normal and could really use a break from the orange jug. I'm sure I'll repeat the test for the July visit. I have a repeat DEXA scan scheduled in April to see how my bone density is doing. We will review those results and decide next steps as far as repeating more imaging, bone marrow biopsy, and if I am going to begin zometa infusions. This will all depend on my results, in particular if I will have to repeat the bone marrow biopsy. Dr. R said that he doesn't want to "poke me" if the results will essentially be the same as they were in July and December 2012. He was very excited that I am participating in the Mind/Body trial for SMM at Mass General. He actually said that I seemed, "much more relaxed than usual."

Hmm, what's that supposed to mean? ;)


Thursday, January 30, 2014

Relaxation Response Resiliency Program Session # 4 - half way there!

I can't believe session 4 of the 3RP program is tonight. Wow, time has flown by! I feel very lucky as a smoldering myeloma patient to have the opportunity to be a part of this and I am really enjoying the program/study. As much as the focus of the program is learning different ways to elicit the relation response through mindfulness, meditation, and other methods, what I really appreciate about the program is that it truly is a comprehensive "mind/body" approach to managing stress. The focus is not only on eliciting the relaxation response (though, a very important aspect!), but also on how to improve other important areas of life: social connectedness, nutrition, sleep, and exercise. Through this program I am learning about acute and chronic stress as well as the physical, cognitive, emotional, behavioral, and relational components/warning signs of stress. The program also has great information about optimizing social support and how there are different forms of social support such as emotional, informational, tangible, self-esteem/affirmational, and belonging.

This week, our "homework" was to continue daily practice of eliciting the relaxation response, record 3-5 appreciations daily, work toward 3 goals related to nutrition, exercise, sleep, or social support, and practice "mindful awareness" in daily living. Practicing "mindful awareness" could be many different things - even "mindful awareness of others" or "mindful eating" or "mindful exercise". In the session last week we practiced "mindful eating" with a Hershey's dark chocolate kiss. We examined the wrapper and tag, noticed the smell, and slowly ate it. During times of stress I often do "mindless" eating, meaning eating lots of (junk) food and not even tasting it! Hopefully being more mindful while eating (all the time, but even more in times of stress) may help me manage that particular stress response in my life.



Friday, January 24, 2014

And the "relaxation" begins!

Let's recap: Last summer Dr. R told me about a clinical trial starting in the fall for high risk MGUS and smoldering myeloma patients at the Benson-Henry Institute for Mind/Body Medicine at Mass General Hospital in Boston. The study was going to, "Measure the genomic and psychosocial effects of the Relaxation Response Resiliency Program (3RP) on patients with MGUS and Smoldering Multiple Myeloma". Well, I'm in the study and so far so good!

More information, from the clinical trial listing:

"This research study is evaluating the effects of a mind body medicine intervention called the Relaxation Response Resiliency Program (3RP) on stress and stress related symptoms in patients with monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM). This research study is a supportive care trial. This means that the intervention program may improve general well-being and comfort, but is not considered a treatment or "cure" for MGUS or SMM. It is considered an investigational intervention because the investigators are examining the effectiveness of a new program - the 3RP - on reducing stress and stress-related symptoms in patients with MGUS and SMM. Standard management of MGUS and SMM involves regular monitoring without chemotherapy. Mind-body medicine, as defined by the National Institutes of Health, "focuses on the interactions among the brain, mind, body, and behavior, and on the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health." The 3RP is a newly designed group therapy program that through a variety of mind body principles and self-care interventions seeks to buffer stress and promote psychological resiliency and physical well-being. This study will examine the effectiveness of the 3RP in reducing stress and symptoms associated with stress in patients diagnosed with MGUS or SMM. Data from this study will also be used to assess changes in gene expression that result from 3RP intervention, particularly genetic pathways that are known to be dysregulated in MM."


Here is a little background on the Relaxation Response, from the Benson-Henry Institute's website:

The Relaxation Response

In the late 1960s, in the same room in which Harvard Medical School's Walter Cannon performed fight-or-flight experiments 50 years earlier, Herbert Benson, MD, found that there was a counterbalancing mechanism to the stress response. Just as stimulating an area of the hypothalamus can cause the stress response, so activating other areas of the brain results in its reduction. He defined this opposite state the "relaxation response."

The relaxation response is a physical state of deep rest that changes the physical and emotional responses to stress (e.g., decreases in heart rate, blood pressure, rate of breathing, and muscle tension).

When eliciting the relaxation response:

Your metabolism decreases
Your heart beats slower and your muscles relax
Your breathing becomes slower
Your blood pressure decreases
Your levels of nitric oxide are increased

If practiced regularly, it can have lasting effects. Elicitation of the relaxation response is at the heart of the BHI's research and clinical mind/body programs.


So, I was actually accepted into the study in October but I was randomized to the "wait" group. I passed the psychological evaluation (heh) and the program just started a few weeks ago. I have been to the first three sessions of the 3RP program. I have never really meditated before - or tried to elicit the "relaxation response" as BHI calls it - so this has been very new and different for me.

During each of the sessions the psychologist leads the group through a few different methods of eliciting the relaxation response. We also discuss our goals and progress as each participant has to set goals related to exercise, nutrition, sleep, and social connectedness -  social support and prosocial behavior. During the week in between sessions, we have to work on 3 SMART goals related to those areas. Each day we record progress toward those goals, as well as what we do each day to elicit the relaxation response. We were given CDs with guided recordings that we can listen to, but we can also use other recordings via YouTube or other sources that we find that we may prefer. Another part of the "homework" is to record 3-5 "appreciations" each day. Last week we also had to keep a sleep diary and record the time we went to bed and woke up, how many times we woke up in the night, how we felt when we got up, how alert/tired we felt the next day, and how many hours of sleep we got each night. I realized how bad my sleep habits are and how little sleep I get!

I am hopeful that throughout the next several weeks while I am in the program I will gain a lot of tools that I will use for the rest of my life. I'm learning both traditional/formal and simple/practical ways to elicit the relaxation response to counter the stress response. AND... hopefully influence the genetic pathways dysregulated in myeloma. Wouldn't that be nice?!

Monday, January 13, 2014

TED Talk: All it takes is 10 mindful minutes



I love TED talks. I found this talk featuring Andy Puddicombe which compliments what I'm learning in the mind body supportive care trial for smoldering myeloma. It's definitely worth watching and it's short... less than 10 minutes! ;)

Thursday, January 9, 2014

No, no, no doctor - I'm not crazy!

I am headed to Mass General for my second blood draw and to fill out another set of worry / stress / anxiety inventories before starting the 3RP mind/ body supportive care trial for smoldering myeloma. I also have to meet with the psychologist who is running the program. Hmmm. I was told this was just for her to get to know me and my goals for the study.

Fingers crossed after the psych eval they don't kick me out of the study! ;)







Thursday, January 2, 2014

Mind Over Medicine

A good friend of mine gave me a book called, "Mind Over Medicine: Scientific Proof That You Can Heal Yourself" by Dr. Lissa Rankin, MD.

Now, after just reading the title I was already a bit skeptical! But, since I am participating in a Mind/Body Supportive Care Trial for Smoldering Myeloma, I should probably learn how the mind affects the body, right? After reading this book, I am in no way abandoning the world of Western Medicine, but some parts of the book did give me pause.

This is a little summary of the beginning of the book:

"Through her research, Dr. Rankin discovered that the health care she had been taught to practice was missing something crucial: a recognition  of the body's innate ability to self-repair and an appreciation for how we can control these self-healing mechanisms with the power of the mind. In an attempt to better understand this phenomenon, she explored peer-reviewed medical literature and found evidence that the medical establishment had been proving that the body can heal itself for over 50 years. 

Using extraordinary cases of spontaneous healing, Dr. Rankin shows how thoughts, feelings, and beliefs can alter body's physiology. She lays out the scientific data proving that loneliness, pessimism, depression, fear, and anxiety damage the body, while intimate relationships, gratitude, meditation, spirituality/religion, and authentic self-expression flip on the body's self healing processes."


This book contains tons of stories about the placebo and nocebo effects and spontaneous remissions. Just a couple of the examples, which I found absolutely fascinating:

An article from the New England Journal of Medicine featured an orthopedic surgeon who specialized in surgeries for patients who had debilitating knee pain. "The patients in one group of the study got Dr. Moseley's famous surgery. The other group of patients underwent an elaborately crafted sham surgery, during which the patient was sedated, three incisions were made in the same location as in the real surgery, and the patient was shown a prerecorded tape of someone else's surgery on the video monitor. Dr. Mosley even splashed water around to mimic the sound of the lavage procedure. Then he sewed the knee back up. As expected, one third of the patients getting the real surgery experienced resolution of their knee pain. But what really shocked the researchers was that those getting the sham surgery had the same result! In fact, at one point in the study, those getting the sham surgery were actually having less knee pain than those getting the real surgery, probably because they hadn't undergone the trauma of the surgery. What did Dr. Moseley's patients think about the study results? As one World War II veteran who benefited from Dr. Moseley's placebo knee surgery said, 'The surgery was two years ago and the knee has never bothered me since. it's just like my other knee now.' "

"One study showing that patients in a control group for a new chemotherapy drug were given nothing but saline, yet they were warned it could be chemotherapy, and 30 percent of them lost their hair. In another study, hospitalized patients were given sugar water and told it would make them throw up. Eighty percent of them vomited." 


This is just a small sampling of the studies referenced in the book. Mind Over Medicine also references the "relaxation response" which was discovered by Dr. Herbert Benson of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, where I am completing the smoldering myeloma mind/body study using the Relaxation Response Resiliency Program (3RP). Dr. Benson named the physiological changes that meditating people experienced "the relaxation response," which is the counterbalance to the "fight or flight response." These physiological changes that occur during the "relaxation response" include sharp drops in heart rate, respiratory rate, metabolic rate, and blood pressure.

Something to think about! ;)