The Faces of Stress

RALPH BLUM

Whether you are newly diagnosed with prostate cancer, or coping with bone metastases, learning about chronic stress and its negative impact on your body is almost as critical to your healing as whatever treatment you choose.

Short-term stress, a single episode of acute stress, generally doesn't cause problems. However, chronic emotional stress, caused by situations or events that last over a period of time, takes a significant toll on the body.  Furthermore, this kind of prolonged stress suppresses the immune system, profoundly affecting its ability to detect defective or cancerous cells and destroy them.

Persistent feelings of fear, anxiety and unrelieved stress trigger the fight-or-flight response system that our ancestors relied upon.  When a threat is recognized, heart rate and blood pressure skyrocket, sugar pours into the blood, muscles tense for quick action, and the whole metabolism goes into survival mode. This is great if you're on the African savannah and you hear a lion growling outside your tent.  However, Nature never intended this "On your mark! Get set! Go!" response to last more than a moment or two.  So when the brain sends a threat message for which there is no swift resolution, the fight-or-flight system stays stuck on "Get set!."  As a result, the immune system is locked into protection mode and is no longer capable of performing the remedial function that is our most powerful defense against cancer.

So when we feel unable to manage or control the changes in our lives caused by prostate cancer, it not only reduces our quality of life, but it is associated with poorer clinical outcomes.  In fact, studies in mice, and in tests in human cancer cells grown in the laboratory have found that prolonged psychological stress can enhance a tumor's ability to grow and spread.

There is always the temptation to alleviate the stress overload of a potentially life-threatening diagnosis with risky behaviors such as drinking alcohol in excess, taking drugs, and over-eating. But this kind of "stress management" only further inhibits immune function. However, maintaining a healthy lifestyle—which means eating well and staying physically active--supports the immune system.  As do coping strategies such as relaxation techniques, meditation, yoga, and visualization.  And don't forget laughter—the ultimate antioxidant.

Here's how the Discovery Health Web describes the impact of laughter on the immune system: "When we laugh, natural killer cells which destroy tumors and viruses increase, along with Gamma-interferon (a disease-fighting protein), T cells (important for our immune system) and B cells (which make disease-fighting antibodies).  As well as lowering blood pressure, laughter increases oxygen in the blood, which also encourages healing."

So find out what works for you so that stress does not get the best of you.  If you can’t seem to get a handle on it, laugh your way back to health!

Stress in Our Lives

BY RALPH BLUM

Sometimes stress leaves a path as distinct as a hurricane. Its onset can usually be tracked from the moment cancer is diagnosed.

If someone asked you if you were feeling stressed, and if so, what were the symptoms, how would you describe your condition? Signs of stress vary, and may be cognitive, emotional, physical, or behavioral. And often the symptoms overlap.

If we start with “cognitive” symptoms, we encounter difficulty concentrating, a negative approach to simple matters, anxious thoughts, excessive worrying, and unusual memory lapses.  When I was first diagnosed, I felt as if I was in a stupor. A daze. I lived in fear that my impaired memory and brain function would be noticed by the people I was working with. I was sensitive to loud noises. As one guy I know put it: “I couldn’t exercise at my gym because they had 8 TVs playing different stations and music piped through the entire exercise floor. The amount of information overload was more than my brain could handle. Too much sound and light made me feel both angry and anxious.”

Emotional symptoms are fairly obvious: Moodiness, and irritability, short temper, inability to relax, feeling overwhelmed and depressed. Some people have a sense of loneliness and isolation. Others feel a frightening loss of control. My stress made me feel paranoid. I took things personally that had nothing to do with me. I found myself overly sensitive to the criticism of other people.

If someone didn’t respond to a text or call me back immediately, I assumed they didn’t want to interact with me and didn’t want to be my friend. If someone didn’t smile or say “Hi” as I walked by I took it personally and began to analyze what I did wrong. I kept all my friends at arm’s length because of an inordinate fear of being rejected or not included.

Physical symptoms from stress are also very common. They vary from person to person and run the whole range:

• Aches and pains
• Diarrhea or constipation
• Chest pain, rapid heartbeat
• Frequent colds
• Indigestion\
• Loss of sex drive (whatever was left of it)
• Low blood sugar
• Nausea, dizziness

Behavioral symptoms present in a variety of ways, again depending on personality type. They would include irregular eating habits and sleep habits, neglecting responsibilities, isolating oneself. You can probably come up with other aspects of the “hurricane.” Just know that you are not going crazy, that the symptoms you are experiencing are normal for anyone after a diagnosis of prostate cancer, and that with proper counseling stress can be eased. Whether you choose to attend a Support Group, work with a therapist, find solace with prayer and meditation, or try Relaxation Therapy, it is important to do something to master your stress so that you can continue to manage your everyday life as well as make the right decisions to fight the cancer.

Did You Know: Stress Comes in Three Shades

BY RALPH BLUM

Our central nervous system, endocrine and immune systems communicate constantly with each other to maintain homeostasis—a healthy balance that promotes health and healing. Then at moments of perceived threat, these systems respond almost instantaneously with a chain of physical responses commonly known as fight-or-flight.

Originally evolved to protect us from acute physical danger—like an attack from a wild animal—the fight-or-flight system is a brilliant mechanism for handling acute, concrete threats, and then returning to homeostasis when the threat has passed. However, this emergency response system was not designed to be continuously activated, and when it receives a threat message for which there is no swift resolution, the result is chronically elevated levels of stress hormones that repress the action of the immune system. In fact, according to Bruce Lipton, Ph.D. stress hormones are so effective at curtailing immune function that doctors provide them to recipients of transplants so that their immune systems wouldn’t reject the foreign tissues.

In today’s world, the challenges most of us face have shifted from immediate physical threats to unending or chronic emotional ones. The term “stress” has become a generic term that we commonly use instead of specifically describing feelings as varied as frustration, exhaustion, anxiety, worry, grief, fear and despair. Yet these emotions, generated by stress, can trigger the same flight-or-fight response system that our body deploys to survive a close encounter with a lion, without, however, the release of escaping from that encounter and restoring homeostasis.

There are three distinct categories of stress which, taking my cue from Dr. Scholz’s Blue Shades of prostate cancer, I have designated GREEN, BLINKING YELLOW and FLASHING RED to indicate the different stress levels.

It is important to point out that not all stress is harmful. Brief episodes of stress heighten our alertness, sharpen our senses and actually improve immune function. It is what the flight-or-fight response was designed for and I consider them as GREEN stress responses.

The second category—BLINKING YELLOW—is referred to by researchers as “tolerable stress.” This is stress that could become harmful, however we have the capacity to recover though relationships, and through practices like regular exercise, meditation, healthy eating and adequate sleep. Though we are still disturbed by episodes of BLINKING YELLOW stress, if we recognize and respond to them at their onset, we are able to regain and restore internal balance.

Prolonged or toxic stress is the FLASHING RED variety.  In the grip of toxic stress, we don’t fully regain our equilibrium because the healing relationships and practices that may have worked with tolerable stress are insufficient and thus no longer successful. If it accumulates in our bodies, toxic stress “dysregulates” the systems that protect health and healing.

Some wags have suggested that a few large margaritas or smoking dope might help! But the hard fact is: When the BLINKING YELLOW occurs you need to act, to use available remedies so you do not progress to the toxic, FLASHING RED degree of stress. Strange to say (And I found it a pleasant surprise) activities like meditation and yoga seem to do the most to reestablish homeostatic balance. 

Fighting Stress: The Amygdala as Super-Hero

BY RALPH BLUM

Writing about “Stress Management” has been a Pandora’s box for me. I am convinced that, along with taking charge of my own recovery, an understanding of stress—it’s nature, how it operates, how to manage it—has served me well in facing the dragon of prostate cancer. Whether you are newly diagnosed or coping with bone metastases, I hope my exploration of stress will serve you—and give you renewed hope.

 

Stress is a poisonous compound of worry, anxiety, exhaustion, regret, fear, despair, and all the other toxic tourniquets that bind us to the wheel of suffering. In most people’s lives, these negative feelings are registering in our bodies chemically and organically much of the time. So let’s take a close look at the factor of stress in our lives, and see how it weighs down and impedes the process of recovery.

 

Really ancient, the word “stress” is a form of the Middle English destresse, which is in turn derived, through Old French, from the Latin stringere, “to draw tight.” Used first in physics to refer to strain on a material body, by the 1920s stress was being applied in medical circles to refer to mental strain, or harmful environmental “agents” that cause illness.

 

In 1926, Harvard Physiologist Walter Cannon used the term “stress” for its clinical significance, describing external factors that disrupted what he called “homeostasis,” a steady state or  equilibrium ideal for our well-being and healing. Moreover, Cannon’s book, The Wisdom of the Body, was the breakthrough in understanding that we actually have a capacity to self-correct from stress, and restore homeostasis.

 

It goes without saying that a potentially life-threatening situation, like cancer creates the kind of stress that persists over time, taking a significant toll on the body and seriously disrupting homeostasis. So what can we do to alleviate chronic stress?

 

While I was looking for fresh ways to manage stress in my life, I came across an exotic “game” created by high school teacher and psychologist, Justin Galusha.  His game asks you to create 17 “Superheroes, Villains and Sidekicks” for "17 areas of the human brain.” In order to “play,” you need a name for the character, a description of that character’s super powers and/or weaknesses, the brain area where the character is found, and what it actually controls in the brain. Among the areas (and characters) he includes Cerebellum, Thalamus, Hippocampus, Temporal Lobe and the Amygdala. Since we’re not playing the game, we don’t have to look at all seventeen,  focusing on just one—the one that coordinates all the others—the amygdala.

 

I was already aware of the power of the amygdala to process emotions and manages stress, particularly when feelings of anxiety or fear are involved. Seated at the center of an exquisitely tuned and coordinated emergency response system, the amygdala is a small almond-shaped structure, buried deep within the temporal lobe, part of the brain’s limbic system.  For his game, Galusha describes the amygdala as “governing emotions related to self-preservation . . . in particular stimuli that are threatening to the organism.” And he means life threatening, So that’s what this is all about—self-preservation.

 

In Galusha’s brain game, here is how the role of the amygdala—dubbed “Amyg’DaMan”—is described:

Blessed with a heightened amygdala thanks to a freak accident in the Vidal Sassoon mouse testing facility, Amyg’DaMan knows when he can win a fight or when he needs to take flight . . . With only his superhuman ability to read facial features and govern emotions, Amyg’DaMan never gets in over his head. He sports a caveman like costume as a shout out to his ancestors. . .  Had it not been for their amygdalas they wouldn’t have known when to run from predatory trolls with extra arms or stay and slaughter innocent docile foes. This one’s for you Amygdala guy—and the quick judgment that saves your life.

The whole idea—including a hairy caricature of his club-wielding caveman hero—made me laugh. And while the conventional fight or flight options described here are not available to a man with newly diagnosed with prostate cancer, the primitive emotions are the same. Stress is the result. Laughter is one antidote. And self-preservation is the objective.

 

I’d say laughing at the vision of Amyg’DaMan whooping those four-armed predatory trolls is good anti-stress activity.

 

In my next blog I will consider stress as three-tiered, one toxic, one tolerable, and one (I was surprised to learn) both positive and useful, capable of improving the function of the immune function.

Stress Management

BY RALPH BLUM

Shining a light on stress from a different angle always yields new insights. The very term “stress management” is like a suitcase you can unpack layer by layer.

There can be no doubt that emotional factors influence biology. Some studies indicate that stress plays a role in causing the occurrence and recurrence of prostate cancer. In fact, most major illnesses have been linked to chronic stress.

Receiving a diagnosis of cancer, and living with cancer, can cause an enormous burden of stress. While experiencing feelings such as depression, despair, anger and fear is totally understandable, if those feelings are not recognized and  “managed,” they put endless wear and tear on the body until eventually the immune system—our most powerful defense against cancer—is no longer capable of performing its job efficiently.

The body has its own stress inhibitors.  Consider cortisol. Known as the “stress hormone,” cortisol is synthesized from cholesterol, produced in the adrenal cortex, and secreted during a stress response. Among cortisol’s primary functions are: to aid in fat and protein metabolism, and to redistribute energy to those regions of the body that need it most; for example, to the brain and major muscles during a fight-or-flight situation. Most important, cortisol helps to regulate the body’s inflammatory response to stress, which it does by increasing blood sugar through the process known as  gluconeogenesis. However, during long periods of chronic stress, cortisol is over-produced, and when cortisol levels are too high, the result is a disruption of its anti-inflammatory function.

Led by Sheldon Cohen, professor of psychology and director of the Laboratory for the Study of Stress, Immunity and Disease at Carnegie Mellon University, a teamof researchers found that chronic psychological stress was associated with the body losing its  ability to regulate its inflammatory response and fight infection. They found that, over a prolonged period of stress, body tissue becomes desensitized to cortisol and the hormone loses its effectiveness in regulating inflammation. As a result, disease can prosper.

The links between psychological stress and metastatic growth of disease suggest that stress management should be an integral part of cancer treatment—and possibly the treatment of all inflammatory diseases.

After I completed six weeks of Intensity Modulated Radiation Therapy (IMRT) at St. John’s Health Center in Santa Monica, California, part of the post-procedural concern was monitoring levels of inflammation. For that reason I continued to take Avodart, a drug that both inhibits the transition of testosterone to the more pernicious dihydrotestosterone and acts to keep inflammation levels down. At the same time, I began consciously to monitor my own stress levels and mindfully work to diminish them.

Practically speaking, one thing we can we do is to consider the potential benefits of “mind-body medicine,” which embraces such practices as relaxation therapy techniques, yoga, meditation and tai chi, all of which have been found to be useful as de-stressing activities.

For those of you who think of meditation as an exotic eastern exercise, check out Meditation for Dummies by Stephan Bodian (Wiley Publishing). On the other hand, some people respond well to biofeedback or hypnotherapy. Moreover, it seems that just stroking your pet cat or dog for a few minutes each day has a significant calming effect.

At the very least, adding some form of stress management to whatever conventional treatment you elect to undergo will certainly improve your quality of life—and at the same time enhance your chances of recovery.

Stress: Romancing the Immune System (Part 2)

BY RALPH BLUM

Thanks to having to find a way to co-exist with prostate cancer for nearly a quarter of a century, I found myself enrolled in “Stress 101.”  And as I don’t have Mark’s scientific background, my take on how to alleviate the inevitable stress of dealing with this disease revolves mainly around mind-body interaction; in particular, the ways in which our chronic fears and concerns inhibit immune function and thus jeopardize our recovery.

Around three thousand years ago, King Solomon declared that, “A joyful heart is good medicine, but a broken spirit dries up the bones.” And I learned from Mark that the “wet” part of the bones—otherwise known as the bone marrow—is where the immune system is located.

In Invasion of the Prostate Snatchers I reported that, due to my refusal to redo a botched biopsy, there was no “proof positive” that I had prostate cancer. So, despite a urologist’s report evaluating the lump in my prostate as “suspicious for well-differentiated adenocarcinoma,” I returned to my home on Maui where I spent nine peaceful years enjoying my life. I had no idea at the time that those worry-free years in upcountry Maui supported and even strengthened my immune system. I am now convinced that they helped to keep the cancer dormant, on hold.

But then a series of life circumstances left me chronically stressed and depressed. I began to worry that perhaps I had been a fool not committing to treatment. And sure enough, that was when my PSA began to climb and the tumor began to grow.

My ignorance about the immune system at that time was monumental, but when I started to find out what makes it tick, I realized that my brain was constantly sending my immune system chemical messages which, for better or worse, influenced its ability to function. There is no doubt that good nutrition and staying physically active play a role in supporting a healthy immune system. My problem was I have never been big on raw foods, low carbs or a high intake of leafy greens. And I have an aversion to most forms of exercise. So I decided to focus on “romancing” my immune system by sending it benign signals.

In my next blog I will go further into what I have termed positive emotional-chemical text messages.

Stress: The Battlefield of Recovery

BY RALPH BLUM

When you are dealing with any kind of cancer, one of the really big questions is, “What can I do to help myself?” Well, one of the most important things you can do is look at the role stress plays in your life. Especially chronic stress.

There are many definitions of stress. The dictionary simply defines stress as pressure or strain. Hans Selye was the first to use the term “stress” in a biological context, defining it as a “state of prolonged tension from internal or external stressors.” Joan Borysenko, Ph.D. describes stress as the expectancy that bad things are going to happen and the expectation that we may not be able to cope with the fallout.   A diagnosis of cancer is a prime stressor, and causes a whole slew of emotions including fear, anxiety, grief, and resentment, all of which cause dramatic changes in the body’s hormones that suppress immune function. How does this occur? A fearful thought like, “Oh God, I think I’m going to die!” activates a primitive circuit known as “fight-or-flight.” When a threat is recognized, heart rate and blood pressure skyrocket, sugar pours into the blood, muscles tense for quick action, and the entire metabolism goes into survival mode.

This is great if you’re on the African savannah and you hear a lion growling outside your tent. However, Nature never intended the fight-or-flight response to last more than a moment or two. So when the brain sends a threat message for which there is no swift resolution, the fight-or-flight response stays stuck; you begin to put needless wear and tear on your body, and your immune system is no longer capable of performing the remedial function that is your most powerful defense against cancer.

Way back in 1964, Dr. George Solomon published a landmark article entitled “Emotions, Immunity and Disease: A Speculative Theoretical Integration.” Ten years later, Solomon’s findings were no longer regarded as speculative. There is no doubt today that living in chronic emotional stress inhibits immune function. According to Bruce Lipton, Ph.D., stress hormones are so effective at curtailing immune system function that doctors provided them to recipients of transplants so that their immune systems wouldn’t reject the foreign tissues.

So what can you do to counteract the inevitable stress of a cancer diagnosis and take an active part in your recovery process? In Invasion of the Prostate Snatchers I talk about “Emotional-Chemical Text Messaging” to the immune system. Because it possesses no analytical filter, the immune system acts on what it is, in effect, “told” by the brain. Although body cells possess intelligence, their only “knowledge” is the information they receive.  So you can either send messages that evoke a positive biochemical response in the immune system, or you can send messages that suppress immune function.

In my next Blog I will tell you how you can “romance” your immune system. In the meantime, as you make your way through the medical minefield, remember Deepak Chopra’s famous words: “Every cell in your body is eavesdropping on your thoughts.”

The Legacy of the Saber Tooth Tiger: A Few Unkind Words About Stress

BY RALPH BLUM

Whatever the problem—heart, cancer, diabetes—stress is arguably Public Enemy #1 for half of what ails this nation. And when it comes to immune system health, stress rings cash registers. Advertising budgets dedicated to pushing the stress button are worth what Ted Turner would call “serious cash money.” The root briar of an estimated 20 billion dollar a year volume of advertising, stress is Big Business.

It is now more or less common knowledge that the most potent immune system suppressor is stress. Especially chronic stress—the kind suffered by all of us from the moment are diagnosed with prostate cancer. So manufacturers of specialty foods, supplements, herbs and minerals are climbing onto the bandwagon and claiming that their products are “immune system boosters.” However, if you look carefully you will see that 90% of their claims are laced with hedge-your-bet qualifying terms like “might,” “perhaps,” “could” and “can sometimes.” This is the stuff that scams are made of these days.

So when you don’t know whether your job is being abolished, and you are seeing your savings dwindle to nothing, and your anxiety over your children’s future is keeping you awake at night, and then, on top of all that, you are diagnosed with prostate cancer, how can you hope to cope with this kind of chronic stress barrage? What can you do that will genuinely assist your immune system to function efficiently?

The three tried and true stress busters are simple enough. They are diet, exercise, and meditation. You don’t have to pump iron or run marathons, or subsist on tofu, berries, and leafy greens. But in order to fight cancer successfully, you do need to eat a healthy diet and find a type of exercise you enjoy. And, at least as important, you need to find some kind of meditation that you can live with—it can be as little as fifteen minutes a day!—because it does reduce the stress that inevitably ramps up with a cancer diagnosis.

If you’re interested, you might check into the fairly new field of Psychoneuroimmunology. You’ll learn about the legacy of the saber tooth tiger, and how to distinguish the activity of the adrenal system from that of the immune system. Because there are two distinct conditions: there’s growth and there’s protection, but you can’t have both at the same time. And when any threat mobilizes the body with the old “fight or flight” response, the adrenal (stress) hormones directly repress the action of the immune system. Result: almost every major illness has been linked to chronic stress.

It is now fairly well established that what goes on in our minds absolutely affects our bodies.  There is no question that our thoughts and our beliefs generate a cascade of chemicals that can act to either harm us or heal us. So my best recommendation to you is to believe wholeheartedly that whatever treatment you decide on will be totally successful. And when the stress gets to you, you don’t have to sit crossed-legged on the floor and repeat a mantra provided by a guru in the Himalayas. Just turn on some relaxing music, breathe slowly and deeply, and imagine yourself walking on a beach, or in a forest—whatever works for you—and see yourself relaxed and healthy. Relieving the chronic stress of living with prostate cancer is arguably taking a long step on the road to recovery.