Monday, October 29, 2007

Suffering Is Optional

Be curious about your pain and you'll find that though it may not be optional, the pain of your reaction is.

By Christina Feldman

Aging, sickness, and moments of pain are intrinsic to the life of all of our bodies. Bodily pain comes in many guises—some of it is chronic, some temporary, some unavoidable. Our first response is to resist it. We have numerous strategies to ward pain off, to avoid it, or to camouflage it with distraction. Aversion, terror, and agitation interweave themselves with the experiences in our bodies and we are easily lost in dread and despair. Our bodies may even be seen as enemies, sabotaging our well-being and happiness. When we are enmeshed in this knot of fear and resistance, there is little space for healing or compassionate attention to occur.

And yet we can learn to touch discomfort and pain with an attention that is loving, accepting, and spacious. We can learn to befriend our bodies, even in the moments when they are most distressed and uncomfortable. We can discover that it is possible to release aversion and fear. With caring and curious attention, we can see that there is a difference between the sensations occurring in our bodies and the thoughts and emotions that react to those sensations. Instead of running from pain, we can bring a curious and caring attention into the heart of pain. In doing so, we discover that our well-being and inner balance are no longer sabotaged. Surrendering our resistance, we find that pain is no longer intimidating or unbearable.

No one would suggest that learning to work skillfully with pain is an easy task, however, or that meditation is a way to fix pain or make it go away. Sometimes we are overwhelmed and we can learn to accept this too. In moments when the intensity of pain seems unbearable it is fine to take our attention away from it and connect with a simpler focus of attention such as breathing or listening for a time. When our hearts and minds have calmed and feel more spacious, it is the right moment to return our attention to the areas of pain in the body.

There are also times when it is often possible to dissolve the layers of tension and fear that gather around pain and to embrace it with greater spaciousness and ease. We may even find a deep inner balance and serenity in the midst of pain. These are moments of great possibility and strength. Working with pain, learning to accept and embrace it, is a moment-to-moment practice in which we release helplessness, despair, and fear. This is in itself healing and teaches us the way to find peace and freedom within the changing events of our bodies.

When pain or distress arises in our bodies, our conditioned reaction is to pin it down and solidify it with concepts. We say "my knee," "my back," "my illness," and the floodgates of apprehension are opened. We predict a dire future for ourselves, fear the intensification of the pain, and at times dissolve into helplessness and despair. Our concepts serve both to make the pain more rigid and to undermine our capacity to respond to it skillfully. We are caught in the tension of wanting to divorce ourselves from a distressed body while the intensity of pain keeps drawing us back into our body.

Meditation offers a very different way of responding to pain in our bodies. Instead of employing strategies to avoid it, we learn to investigate what is actually being experienced within our bodies calmly and curiously. We can bring a compassionate, accepting attention directly to the core of pain. This is the first step towards healing and releasing the agitation and dread that often intensify pain.

Turning our attention directly toward the distress or pain, we discover that the pain we had previously perceived as a solid mass of discomfort is in truth very different. Sensations are changing from moment to moment. And there are different textures within those sensations—tightness, heat, pressure, burning, stinging, aching... As we ask, "What is this?" the label "pain" becomes increasingly meaningless.

Within all pain and distress we discover there are two levels of experience. One is the simple actuality of the sensation, feeling, or pain, and the other is our story of fear that surrounds it. Letting go of the story, we are increasingly able to connect with the simple truth of the pain. We discover that it may be possible to find calm and peace even in the midst of distress.
Fear Factor

Pain in our body, particularly chronic and acute pain, has an inevitable emotional impact that can be equally debilitating. Blame, fear, self-condemnation, despair, anxiety, and terror can arise in the wake of physical illness and root themselves in our bodies, further hindering our capacity to heal and find ease. Our emotional reactions of fear and resistance often lodge themselves in our bodies alongside the pain, to the point where they are almost indistinguishable. Learning to notice the distinction between pain and our reaction to it, we begin to see that although the pain in our bodies may not be optional, some of the pain of our reactions is optional.

The natural desire to avoid pain is translated in our minds and hearts into turbulence and anxiety, and our sense of inner balance is swept away in the avalanche of those feelings. Even when we are fortunate in that our body recovers, without mindfulness the emotions associated with illness or pain linger much longer in our bodies and minds. We may begin to live in a fearful way, treating every unpleasant sensation as a messenger of doom, assuming it signals a return of the pain or illness. The damage we do to ourselves in ignoring the impact of our emotional reactions compounds our tendency to feel anxious and afraid.

There is a great art in learning to be present with pain, just as it is, in the moment when it arises. But with mindfulness, we can learn to make peace with pain. We can learn to be present one moment at a time and so liberate ourselves from the dread of what the next moment may bring. We can learn the kindness of acceptance rather than the harshness of denial.
Extracted from Heart of Wisdom, Mind of Calm, by Christina Feldman, published by HarperThorsons.
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Saturday, October 13, 2007

Think to yourself that every day is your last - Horace

Think to yourself that every day is your last;
the hour to which you do not look forward
will come as a welcome surprise.


Quintus Horatius Flaccus, (December 8, 65 BC - November 27, 8 BC), known in the English-speaking world as Horace, was the leading Roman lyric poet during the time of Augustus.

Friday, October 12, 2007

Thursday, October 11, 2007

Breast Cancer Chemo Drug for Whom?

Drug, Called Taxol, May Only Benefit Certain Women With Breast Cancer
By Miranda Hitti
WebMD Medical News
Reviewed by Louise Chang, MD

Oct. 10, 2007 -- The breast cancer chemotherapy drug Taxol may not help most breast cancer patients, researchers report in The New England Journal of Medicine. The key finding: Adding Taxol to a chemotherapy regimen may only benefit women who have HER2-positive breast cancer, in which breast cancer has a high level of a protein called HER2.

That's about 15% to 20% of all breast cancer patients, according to the researchers, who included the University of Michigan's Daniel Hayes, MD. Hayes' team isn't recommending that any breast cancer patients abandon Taxol. "We think the stakes are too high" to change treatment recommendations until further research is done, Hayes says in a news release. But cancer doctors "have a responsibility to patients to be aware" of the study, states a journal editorial.

"The days of 'one size fits all' therapy for patients with breast cancer are coming to an end," writes editorialist Anne Moore, MD, of New York's Weill Cornell Medical College.

Taxol for Breast Cancer

Hayes and colleagues reviewed data from a breast cancer study conducted in the 1990s.
Though the data weren't new, the analysis was, and it was "appropriate" to look back at that data, according to editorialist Moore. The study included 3,121 women whose breast cancer had spread to their lymph nodes and who had already had breast cancer surgery. All of the women got two chemotherapy drugs -- Adriamycin and Cytoxan. Afterward, about half of the women got further chemotherapy treatment with Taxol.

Taxol and HER2

Over the next five years, women with HER2-positive breast cancer who got Taxol were more likely to survive without breast cancer recurrence, compared with those with HER2-positive breast cancer who didn't get Taxol. But those Taxol benefits only included women with HER2-positive breast cancer, the study shows. In women with HER2-negative breast cancer, Taxol didn't appear to affect survival or recurrence. The findings weren't affected by whether the women's breast tumors were sensitive to the hormone estrogen. In the journal, several of Hayes' colleagues report financial ties to Bristol-Myers Squibb, the drug company that makes Taxol.

Chronic illness costs the economy more than $1 trillion a year

SFGate: San Francisco Chronicle
Victoria Colliver, Chronicle Staff Writer
Wednesday, October 3, 2007

Americans who have common chronic health conditions cost the U.S. economy more than $1 trillion a year, a figure that could jump to nearly $6 trillion by 2050 unless people take steps to improve their health, a study released Tuesday found.

According to the report by the Milken Institute, a Santa Monica think tank, the economic impact of chronic illness goes far beyond the expense of treating disease. It takes an even greater toll on economic productivity in the form of extra sick days, reduced performance by ill workers and other losses not directly related to medical care.

But veering onto a path that emphasizes changing lifestyles along with prevention and early detection of disease could reduce the number of illnesses by 40 million cases and save $1.6 trillion by 2023, the report said.

"The public is telling us the No. 1 domestic issue is health," said Dr. Richard Carmona, former U.S. surgeon general and now chairman of the Partnership to Fight Chronic Disease, in a news conference in Washington on Tuesday releasing the report. "The disease burden is mounting, the economic burden is mounting and the trajectory we're on is unsustainable."

The study looked at seven of the most costly chronic illnesses: the most common forms of cancer, hypertension, mental disorders, heart disease, diabetes, pulmonary conditions such as asthma and stroke.

"More than half of Americans suffer from chronic disease. Every year, millions of people are diagnosed, and every year millions die of these diseases," said Ross DeVol, the Milken Institute's director of health and regional economics and principal author of the report.

Treatment for those diseases, based on 2003 data, cost $277 billion. But lost productivity cost far more: $1.1 trillion.

Combined, the economic impact of the diseases added up to more than $1.3 trillion. Cost calculations, which are based on various studies of companies, also included economic losses generated by caregivers.

The study found some conditions create a greater economic burden than others, regardless of the number of diagnoses or cost of treatment.

For example, far fewer people suffer from cancer than pulmonary conditions. But the overall economic impact of cancer is greater because, while treatment is expensive, cancer patients also tend to be more debilitated and lose more work time than those suffering from many other chronic conditions, researchers said.

If the country does nothing to address the problem, the number of cases diagnosed in those seven disease categories will increase by 42 percent by 2023 for a total economic impact of $4.2 trillion, the report said.

"The data to stay the course is not a particularly attractive option," said Ken Thorpe, executive director of the Partnership to Fight Chronic Disease and a professor at Emory University.

The country needs to shift its focus from trying to reduce health expenses to lower rates of illness, Thorpe said.

Lifestyle changes could have a major impact on our country's price tag for chronic disease, the report said.

Curbing obesity alone by close to 15 million cases could translate to a savings of $60 billion by 2023 and improve the country's productivity by $254 billion, the report said. Other changes include lowering smoking rates and increasing early detection and disease-management efforts.

The report looked at the impact of geographical differences on chronic illness, which varies by habits, age and other demographic issues.

California generally is healthier than much of the rest of the country, ranking sixth in a score of all states for percentage of chronic disease by population. The lowest levels of disease were found in Utah, followed by Alaska, Colorado, New Mexico and Arizona. The sickest states in the survey were West Virginia, Tennessee, Arkansas, Kentucky and Mississippi.

Despite California's relative health ranking, the state's large population means it has both a lot to lose and a lot to gain in future costs.

"For many of the chronic diseases, California has a lower prevalence than other states, but we're such a large state - the largest state in the country - we have a lot to be gained in avoiding treatment of these disease as well as improving the quality of the workforce," said DeVol, the study's author.

California has the opportunity to prevent about 4.2 million cases of avoidable chronic disease by 2023, which would increase productivity by $98 billion and lower treatment costs by $18.9 billion, DeVol said.

"The cautionary tale, when I look at California, is looking at our children and obesity rates," DeVol said, adding that the rising obesity levels are especially dramatic among young Latinos. "If we don't address the rising obesity problem, we have a huge potential problem in the future."

The study was funded in part by a grant from the Pharmaceutical Research and Manufacturers Association of America, the drug industry's trade group. The Milken Institute declined to reveal the amount of the grant.

Online resources

To view the complete report:
To see an interactive Web site with national and state-level detail:

Source: The Milken Institute's "Unhealthy America: The Economic Burden of Chronic Disease" relied on data from the Medical Expenditure Panel Survey (2003), U.S. Census Bureau, the Behavioral Risk Factor Surveillance System and the National Health Interview Survey.
Unhealthy numbers
Key points from the Milken Institute's report, "Unhealthy America":

-- More than 109 million Americans have one or more common chronic condition, for a total of 162 million cases.

-- In 2003, productivity losses associated with chronic disease reached almost $1.1 trillion, and treatment cost $277 billion.

-- California is home to more than 16.3 million cases of chronic disease, for a total cost of $133 billion.

Source: Milken Institute

This article appeared on page C - 1 of the San Francisco Chronicle
© 2007 Hearst Communications Inc.