Encouragement (In Suffering, Pain, and Witnessing Both…) #13: Just Being PRESENT

The older I get, the more suffering and pain I’ve experienced; and the more of both I stand witness to. From my wife’s (and many, many of our friends and coworkers) battle against breast cancer; to my dad’s (and the parents of many of our friends and coworkers) process as he fades away as this complex disease breaks the connections between more and more memories, I have become not only frustrated with suffering, pain, and having to watch both, I have been witness to the suffering and pain among the students I serve as a school counselor. I have become angry and sometimes paralyzed. This is my attempt to lift myself from the occasional stifling grief that darkens my days…

Sometimes encouraging someone requires us to close our mouth, sit down, and just BE with them.

When my wife went in for her double mastectomy and after all of the chatty words, most of the time was spent in silence, waiting. When my daughter had a fluid-filled cyst removed right after she got pregnant, our little group in the waiting room bantered for a while, but after hours had passed, we simply fell into silence. It wasn’t an UNCOMFORTABLE silence; it was, if I may be so bold, an expectant silence.

The Bible has three specific instances where monumental events fell into simple, companionable silence.

In Job 2:11-13, his friends hear of his suffering and show up for him, “ Now when Job’s three friends heard of all this adversity that had come upon him…they made an appointment together to come to sympathize with him and comfort him. When they lifted up their eyes at a distance and did not recognize him…they sat down on the ground with him for seven days and seven nights with no one speaking a word to him, for they saw that his pain was very great.”

In Exodus 2:1-4, Moses’ sister kept silent watch over him after his mother released him to God, “Now a man from the house of Levi went and married a daughter of Levi. The woman conceived and bore a son; and when she saw that he was beautiful, she hid him for three months. But when she could hide him no longer, she got him a wicker basket and covered it over with tar and pitch. Then she put the child into it and set it among the reeds by the bank of the Nile. His sister stood at a distance to find out what would happen to him.”

In Luke 10:38-42, “Now as they were traveling along, He entered a village; and a woman named Martha welcomed Him into her home. She had a sister called Mary, who was seated at the Lord’s feet, listening to His word. But Martha was distracted with all her preparations; and she came up to Him and said, ‘Lord, do You not care that my sister has left me to do all the serving alone? Then tell her to help me.’ But the Lord answered and said to her, ‘Martha, Martha, you are worried and bothered about so many things; but only one thing is necessary, for Mary has chosen the good part, which shall not be taken away from her.’”

There is also good psychology behind the importance of “just being there” as a form of encouragement. Among the reasons, “it’s more relaxing for your body and brain than listening to music – as measured by a lowering of blood pressure and increased blood flow to the brain.” As well, “Lowering sensory input helps us to restore our cognitive resources. We stop feeling overwhelmed…When we allow ourselves this quiet reflective time we find that, as Herman Melville wrote, ‘All profound things and emotion of things are proceeded and attended by silence.’”

A quote attributed to Abraham Lincoln notes that it is “‘Better to remain silent and be thought a fool than to speak and remove all doubt.’ This last point is that we need to learn that silence is often the best strategy not only for ourselves but for others, too.”

Sometimes, just being silent doesn’t FEEL like you’re being helpful, but I can attest that there are times when I just wanted the people around me to stay close and just “be with me”; the best of my friends knew that.

Resources: https://www.psychologytoday.com/us/blog/handy-hints-humans/201704/10-reasons-why-silence-really-is-golden

Image: http://www.quoteambition.com/wp-content/uploads/2017/04/encourage-quotes-destiny.jpg

ENCORE #141! – Exercise Reduces Metabolic Hormones and Inflammation! (Huh?)

From the first moment my wife discovered she had breast cancer in March of 2011, there was a deafening silence from the men I knew. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in April of 2012.

Doctors harp on exercise.

Despite the harping – or in my case, perversely because of it – I avoid exercise like the plague.

Even so, as I read more and more sites promoting the “exercise makes you better if you have breast cancer” meme, I found that almost none of them give any kind of evidence as to WHY exercise fights cancer and promotes healing.

So I dug into the sites and finally found some evidence supporting this wild, “Do this one weird thing…” kind of meme. This week, it’s number:

1)                  Physical activity may decrease risk for various cancers by several mechanisms including reducing metabolic hormones and inflammation

First of all, what are metabolic hormones?

Let’s back up and start fresh. What is metabolism?

Metabolism is the collection of chemical reactions that happen in the cells of the body that sustain life – things like growth, reproduction, structure maintenance, and response to the body’s environment. These reactions are controlled by things inside the cells and things outside of the cells.

Hormones come from outside the cell and are “messengers” that travel through the blood and attach themselves to specific landing sites on the outside of a cell then pass their “message” into the cell.

Among the hormones that control the metabolism of cells are Insulin (controls glucose or sugar uptake); Thyroxine and Triiodothyroxin (controls the basal metabolism rate [BMR] – what we’d call the “resting state” of the body);Growth Hormone (obvious); Cortisol (stimulates the making of sugars and causes a decrease in sugar uptake); Estradiol (has a complex job in that it controls female body structure, protein synthesis, blood coagulation, and the amount of LDL and HDL fat in the blood).

“…exercise is one of the major links between the hormonal modulators of energy intake and output. [These hormones] directly affect adipose metabolism and metabolic hormones that influence adipose metabolism. Acute low- and moderate-intensity exercise causes hormonal changes that facilitate lipolytic activity. Exercise training reduces these hormonal responses, but the sensitivity to these hormones increases so that lipolysis may be facilitated.”

In other words, the more you exercise, the more fat is metabolized (duh!); but the more you exercise, the LESS these hormones work (huh?); but because of exercise, you don’t need as MUCH of the hormone to do the work of fat destruction (“lipolytic activity”); therefore, there are fewer hormones to drive cancer cell growth. (The last sentence is a layman’s interpretation of everything I’ve read. I’m NOT a doctor. I am a biology major and I’ve read constantly and regularly both popular and scientific articles. None of the articles says this outright – but I believe that it is implied.)

How about the inflammation?

Inflammation is part of an extremely complex reaction in the human body basically aimed at removing some sort of damaging event so it can start healing. In the human body, inflammation is caused by vasoactive amines, eicosinoids, cytokines (antiviral, immunoregulatory, and anti-tumor properties), growth factors, reactive oxygen species and hydrolytic enzymes.

“Inflammation orchestrates the microenvironment around tumors, contributing to proliferation, survival and migration. Cancer cells use selectins, chemokines and their receptors for invasion, migration and metastasis. On the other hand, many cells of the immune system contribute to cancer immunology, suppressing cancer.”

Regular physical activity is reported to decrease markers of inflammation although the correlation is imperfect and seems to reveal differing results contingent upon training intensity…long-term chronic training may help reduce chronic low-grade inflammation…low-intensity training can reduce resting pro-inflammatory markers (CRP, IL-6), while moderate-intensity training has milder and less-established anti-inflammatory benefits.”

Therefore exercise, while it is NOT a miraculous cure for breast cancer CERTAINLY has the following positive effects on lowering metabolic hormones and inflammation:

• more fat is metabolized
• you don’t need as MUCH of the hormone to do the work of fat destruction
• fewer hormones to drive cancer cell growth
• decrease markers of inflammation

Resources: http://en.wikipedia.org/wiki/List_of_human_hormones , http://www.ncbi.nlm.nih.gov/pubmed/15896089 , http://en.wikipedia.org/wiki/Inflammation
Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71

ALZHEIMER’S RESEARCH RIGHT NOW! #9: Factors That Can Increase OR DECREASE Alzheimer’s Disease!

From the first moment I discovered my dad had been diagnosed with Alzheimer’s, it seemed like I was alone in this ugly place. Even ones who had loved ones suffering in this way; even though people TALKED about the disease, it felt for me like they did little more than mumble about the experience. Not one to shut up for any known reason, I added a section to this blog…

Every month, I’ll be highlighting Alzheimer’s research that is going on RIGHT NOW! Harvested from different websites, journals and podcasts, I’ll translate them into understandable English and share them with you. Today: What factors increase Alzheimer’s risk?

I’m going to start with the end. After skimming through the published paper online at Journal of Neurology, Neurosurgery & Psychiatry, 2020, I found that researchers concluded: “Twenty-one clinical evidence-based suggestions are proposed, offering clinicians and stakeholders an evidence-based guideline for AD prevention. With credible though inconclusive evidence, the suggestions targeted 10 risk factors including diabetes, hyperhomocysteinaemia, poor BMI management, reduced education, hypertension in midlife, orthostatic hypotension, head trauma, less cognitive activity, stress and depression.”

So, what does that mean in English? The site, ScienceDaily works to make complex research understandable – but as a sort of “summarization” site, that’s not always helpful. So here, I combine information from both sites. This will definitely be helpful for me, I hope it grants you some insight and allows for some targeted planning.

“From analysing these, they proposed 21 suggestions based on the consolidated evidence available that could be used in practice by clinicians to try to prevent Alzheimer's disease.

“Within these, there were what they referred to as "Class I" suggestions to target 19 different factors.

“Nearly two-thirds of these suggestions would involve targeting vascular risk factors (such as high blood pressure and cholesterol levels) and lifestyle, strengthening the importance of keeping healthy to prevent Alzheimer's disease.

“Ten of the suggestions were backed by strong evidence and included receiving as much education as possible in early life, participating in mentally stimulating activities such as reading, avoiding diabetes, stress, depression, head trauma, and high blood pressure in midlife.

“A further nine suggestions had slightly weaker evidence to support them and included regular physical exercise, getting sufficient good quality sleep, maintaining a healthy body weight and good heart health in later life, avoiding smoking, and including vitamin C in the diet.”

Given the above, I STILL couldn’t find an easy-to-read list of the “21 suggestions”, so I’ve distilled them for you below:

Six Factors that Protect Against Alzheimer’s Disease

Stay healthy (Duh…)

Receive as much education as possible in early life (This is REALLY vague…) [Thought for further study: is AD more common among people with less education?]

Do mentally stimulating stuff, like reading

Maintain a healthy body weight

Include Vitamin C in your diet

Exercise regularly

14 Factors That Increase the Risk of Alzheimer’s Disease

High blood pressure AND cholesterol

Stroke

Atrial Fibrillation

Diabetes

Stress

Depression (easier said than done…)

Avoid head trauma (duh…)

Control your blood pressure
Cardiovascular Disease

Maintain good heart health (What’s THAT mean?)

Smoking

Hyperhomocysteinemia (an amino acid that gets into the blood from eating too much meat damaging blood vessels and causing a host of problems with you cardiovascular system)

Disturbed sleep

Cerebral microbleeds (related to strokes)

Common Carotid IMT (what you have before the doctor says you have atherosclerosis (hardening of the arteries)

The chart above does a good job of showing the list in a visual format. I found it a good tool and will refer to it often!

Resources: https://www.sciencedaily.com/releases/2020/07/200720190920.htm, (the actual article) https://jnnp.bmj.com/content/early/2020/06/01/jnnp-2019-321913

Image: https://pbs.twimg.com/media/EddmgvjXYAE8Gfu?format=jpg&name=large

ENCORE #140! – Exercise Reduces Sex Hormone Levels!

From the first moment my wife discovered she had breast cancer in March of 2011, there was a deafening silence from the men I knew. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in March 2012.

Doctors harp on exercise.

Despite the harping – or in my case, perversely because of it – I avoid exercise like the plague.

Even so, as I read more and more sites promoting the “exercise makes you better if you have breast cancer” meme, I found that almost none of them give any kind of evidence as to WHY exercise fights cancer and promotes healing.

So I dug into the sites and finally found some evidence supporting this wild, “Do this one weird thing…” kind of meme. This week, it’s number

1)                  Physical activity may decrease risk for various cancers by several mechanisms, including decreasing sex hormones

My first reaction to this was, “Huh????”

On second examination and with a little reading, it’s become more obvious.

Most of us know that “Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancers have estrogen receptors on the surface of their cells. They are called estrogen receptor-positive cancer or ER-positive cancer.”

My wife has to take a five year regimen of anastrazole pills that scavenge estrogen from her blood. I wrote about that here: http://breastcancerreaper.blogspot.com/2011/12/next-five-years-anastrazole-whats-it-do.html

But are there OTHER sex hormones that affect the growth of breast cancer tumors and can be lowered with exercise? “Exercise affects hormone production in both females and males. According to the December 2009 issue of "Sports Medicine," exercise suppresses production of luteinizing hormone (LH), follicle stimulating hormone (FSH) and hormones produced by the ovaries. A study published in the June 2010 issue of "Journal of Sports Science and Medicine" indicates physical activity inhibits production of sex steroid hormones including estrogen.

According to recent research, “...LH[RH] agonists [a chemical that binds to a receptor of a cell and triggers a response by that cell...often mimic the action of a naturally occurring substance.]...suppress ovarian function and sex steroid production; the reduction in sex steroids is predicted to lead to the prevention of breast cancer... Ovarian hormones (estrogens and progestogens) are critical factors in the genesis of human breast cancer. During the premenopausal years breast cancer risk increases steeply, but after menopause it increases at a much lower rate. Epidemiologic studies have clearly demonstrated that early menopause...substantially reduces breast cancer risk.”

I covered the effects of estrogen both in the essay linked above and in the first one of this series. What effect does LH and FSH and “hormones produced by the ovaries” have on breast cancer? In a recent study, researchers found that: “the more potent hydroxylated tamoxifen metabolite 4OHNDtam (endoxifen) was the only tamoxifen metabolite positively associated with FSH levels suggesting anti-estrogenic effect on the pituitary. This may explain the observed positive association between a better prognosis and FSH levels during tamoxifen therapy.”

All of this means...WHAT????

Exercise suppresses the production of LH, FSH and “other ovarian hormones” like estrogen and progestogens. At MUCH lower levels, exercise can mimic the effect of the anti-cancer drug, tamoxifen. It does NOT mean “QUIT ALL DRUGS, EXERCISE WILL CURE BREAST CANCER!”!!!!!!! It DOES NOT MEAN “Quit all drugs, exercise will cure breast cancer!”

There IS no miraculous, take-a-pill, jump-on-a-treadmill, move-to-Arizona-and-soak-up-sun cure for breast cancer.

It’s hard. It’s ugly.

A breast cancer survivor needs all the help she can get. Exercise helps.

So, just do it!

References: http://www.livestrong.com/article/476775-hormonal-imbalances-exercise/#ixzz1qhGvuOID, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC138786

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg 

GUY’S GOTTA TALK ABOUT…Alzheimer’s #31: Reflecting On the Past, Unforgettable

Dad’s diagnosis of Alzheimer’s stayed hidden from everyone until I took over the medical administration of my parents in 2015. Once I found out, there was a deafening silence from most of the people I know even though virtually all of them would add, “My _____ had Alzheimer’s…” But there was little help, little beyond people sadly shaking heads. Or horror stories. Lots of those. Even the ones who knew about the disease seemed to have received a gag order from some Central Alzheimer’s Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this part of my blog…

As morbid as it might seem, I’ve saved two photos from “the end” of Dad’s struggle against Alzheimer’s.

One is him sleeping in his bed, four days before he died. The other is the apartment him and mom lived in; and passed in; empty of all their worldly possessions after we’d picked over the stuff and took what we wanted.

As an aside, my wife went across the street yesterday to talk to the daughter of a neighbor who passed suddenly…eight years ago. The house is still there, unsold, and my wife found out, still unemptied. Her clothing still hangs in a closet because one of her daughters has been unable to release her into death…I hope she doesn’t come back to haunt somebody, but I can, with my fervid imagination, come up with a wildly weird and creepy story…possibly involving this creepy tree my son took a picture of:

The point of all this is that my wife and I were talking about retirement. I retired a couple of months ago, she a bit more than a year ago. We were reflecting on the amount of time helping Dad had consumed. As the sibling closest to Mom and Dad’s place, I was more-or-less on call at all hours. At first, it amounted to little more than taking Mom and Dad to their appointments (medical and recreational); but as they deteriorated, the “appointments” increased dramatically. After Mom died, it grew worse because she was no longer there to answer Dad’s questions.

It was only mildly irritating at first, but as his Alzheimer’s shifted into high gear and he plunged precipitously over the edge of deterioration, he forgot more and more and was able to function less and less. The virtually daily battle with the television set was perhaps my greatest pain-in-the-butt. He had NO IDEA how to work the remote and it had to be reset almost daily. I tried everything – taping the keys down (he peeled the tape away or reached the back of the TV to mess with the buttons…my brother glued a cover over them and he pried it off.), hiding the remote, anything! That prompted HIM to start hiding the remote. Weekly, I had to search for it, finding it in various places in his apartment (gym bag, bathroom drawers, dresser drawers, pillowcase, bedside drawers…under the couch, in the couch, in the bed…once in the mini fridge he had)

Then there were the constant phone calls. One I remember vividly:

“Guy, I have some bad news.”

“What is it, Dad?” My heart had started to race.

“I think your mother left me,” he answered with grim seriousness. I had to take a deep breath, and in this case, my explanation that Mom had died two years earlier, met with a deep sigh after which he said, “I know. I don’t understand why I can’t remember that. It all seemed to clear to me then…”

While this isn’t an anniversary (except my wife and mine’s 33^rd Wedding Anniversary), it’s a reflection on the fact that Alzheimer’s and its effects don’t disappear. Sometimes, they don’t even grow old or dimmer.

Sometimes, it seems like they will be unforgettable…

Resource:

Image:  https://upload.inkspire.org/uploads%2F1503370874800-Alzheimer-disease-patients.jpg