DEPRESSION AND CANCER

Hi DR Ryan here, medical oncologist AND PROFESSOR AND RETIRED COLONEL AND CANCER SURVIVOR and this is when tumor is the rumor and cancer is the answer.

I am sure you are familiar with our opening song   from chariots  of fire. A man has a plan and in a day it is crushed…… so it is when you have been told you have cancer ,thoughts of loss of control, soul sucking anxiety, what about your family and the list goes on as it hits  you like a ton of bricks.

He rose above it in the film  and so you to will be a hero ………I have seen no exception no matter how afraid you are, and that is what we are going to talk about today …your attitude when first diagnosed and through your course of therapy.. What about Depression

 

. We will take our time so feel free to write in your questions or comments at www.w4cs.com and i will try to get to them

Depression and Anxiety Disorders in Patients With Cancer

 

OVERVIEW

Over 15.5 million cancer survivors are alive today in the US, which is similar to the populations of New York City, Los Angeles, and Chicago combined.

 

The number of survivors continues to grow, not just because of earlier detection and treatment AND AGING OF THE POPULATION , but because of revolutionary new therapies that have been emerging over the past decade.

Now, patients with poor-prognosis metastatic cancers such as lung cancer and melanoma can live many years with good quality of life while on active treatment. For many individuals, this changes the landscape from a terminal illness to more of a chronic illness.

 

Concurrent with advances in cancer treatment, the importance of psychosocial care of individuals with cancer is being increasingly recognized. In 2008, the Institute of Medicine published Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, which documented under-detection and failure to optimally manage psychiatric disorders and psychosocial needs in patients with cancer and their families.

 

Unmet needs can have negative consequences for quality of life, treatment adherence, and survival. Subsequently, the American College of Surgeons Commission on Cancer started requiring cancer centers to screen patients for psychosocial distress as part of accreditation, and the American Society of Clinical Oncology developed practice guidelines for managing depression and anxiety.

 

THEY ARE NOT ALWAYS FOLLOWED OR SCREENING DONE SORRY BUT THAT IS REALITY AND RESEARCH SUPPORTS THAT

 

 

Although most cancer centers provide some psychosocial services, increased attention to the psychosocial needs of patients with cancer may result in increased referrals to mental health professionals . Some basic knowledge about a patient’s cancer and treatment are essential for psychiatric management.

 

Studies have documented that a cancer diagnosis results in high levels of emotional distress. Patients go through an adjustment period for about 4 to 6 weeks after diagnosis. SOME LONGER AND EXPECT THAT Cancer for many patients is synonymous with death and debilitating treatments, with images of a prolonged painful dying process. Patients often say they feel overwhelmed trying to assimilate medical information and make treatment decisions—all while continuing to manage family, work, and other responsibilities.

 

However, for the majority of patients, once they receive a plan of action and begin treatment, their emotions tend to level out. Yet, cancer should not be considered as one discrete crisis, but rather as a series of crises that may occur at any time in the disease trajectory from diagnosis, treatment, cycles of recurrences and remissions, post-treatment, and sometimes palliative care.

 

In terms of psychiatric disorders among cancer patients, there is significant variability in the prevalence rates reported due to different assessment methods (clinical interview versus standardized measures), diagnostic criteria, type of cancer, and stage of disease among other variables. Recently, Mehnert and colleagues reported a 31% prevalence rate for any psychiatric disorder in cancer patients. Adjustment disorders tend to be the most commonly diagnosed, with the rates ranging from 11% to 35%. Rates for depression vary from 11% to 37%, and anxiety disorders show rates from 2.6% to 19.4%. The rate for depression in the general population is 7%—and thus lower than among cancer patients—but the rates for overall anxiety disorders seem to be comparable WHICH I DO NOT BELIEVE IT IS UNDER REPORTED.

 

 

Assessment and treatment

The Case Vignette presents specific issues important for psychiatrists to consider when treating patients with cancer.

CASE VIGNETTE

Mrs. T is a 53-year-old postmenopausal married woman with 2 teenage daughters who recently received a diagnosis of stage IV breast cancer metastatic to pelvic bone. Up until 2 months ago, she had been working full-time as an attorney but had to stop because of severe pain that progressively worsened. A medical workup showed an HIGHLY TREATABLE BUT INCURABLE LONG TEERM POSSIBLE SURVIVAL CANCER.

She does not have a psychiatric history or comorbid illnesses. Soon after starting THERAPY, she began to feel very sad, anxious, irritable, and fatigued; cried easily; and had trouble sleeping because of hot flashes. She ruminates on dying and leaving her daughters. She denies hopelessness and suicidal ideation, and quite the contrary she very much wants to live.

 

Depression and Anxiety Disorders in Patients With Cancer: Page 2 of 3

SIGNIFICANCE FOR THE PRACTICING PSYCHIATRIST

 

Coordinating with the oncology team. With the patient’s permission, consulting and informing the oncology team of your involvement is critical. As mentioned earlier, psychiatrists need to understand the patient’s cancer diagnosis, staging, treatments, adverse effects of treatment, and prognosis to appreciate the challenges the patient is coping with throughout treatment as well as survivorship or end-of-life. Medical concerns can cause or exacerbate depression and anxiety.

 

For example, in this case, knowing that survival with metastatic breast cancer can be years is critical in providing psychiatric care for the patient. Remaining silent as the patient expresses fear of death within the next few months can be taken by the patient as agreement and can exacerbate anxiety. Psychiatrists contribute to oncology care by providing information to the oncology team regarding the patient’s emotional status and potential barriers to care and treatment adherence.

 

 

Pharmacotherapy. While there may be overlap between symptoms of depression and anxiety and cancer- and treatment-related adverse effects (fatigue, changes in sleep and appetite), treatment of the psychiatric disorder is primary rather than a focus on differentiating the causes of the symptoms. The most prescribed antide­pressants in cancer patients are SSRIs, At times the choice of an antidepressant is made based on the antidepressant adverse-effect profile.

 

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Some psychiatric medications may adversely affect the efficacy of commonly used systemic cancer therapies.

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Be aware that some systemic cancer treatments are associated with psychiatric adverse effects. DRUGS TO TREAT leukemia and some lymphomas, may cause depression. Interferon at high doses can cause depression and even suicidal ideation. SOME CAN CAUSE can cause lethargy, depression, mania, confusion, and hallucinations. THEY can potentiate the effects of alcohol, opioids, and tricyclic antidepressants.

 

Glucocorticosteroids such as prednisone and dexamethasone are widely used in cancer care. They can cause a range of psychiatric symptoms, from emotional lability, depression, anxiety, restlessness, irritability, and insomnia to paranoia, delusions, and hallucinations. Symptoms may develop within a couple of days of the start of treatment and are also common if the dose is rapidly tapered off. But psychiatric symptoms can develop even on a stable dose.

Mindfulness Practice Reduces Cortisol Blunting During Chemo

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Mindfulness practice during chemotherapy can reduce the blunting of neuroendocrine profiles typically observed in cancer patients, according to a study published online April 7 in Cancer.

) — Mindfulness practice during chemotherapy can reduce the blunting of neuroendocrine profiles typically observed in cancer patients, according to a study published online April 7 in Cancer.

David S. Black, Ph.D., M.P.H., from University of Southern California in Los Angeles, and colleagues assigned 57 English- or Spanish-speaking colorectal cancer patients to either mindfulness, attention-control, or resting exposure at the start of chemotherapy. Four saliva samples were collected at the start of chemotherapy and at 20-minute intervals during the first 60 minutes of chemotherapy. Self-reported biobehavioral assessments after chemotherapy included distress, fatigue, and mindfulness

An area-under-the-curve analysis showed a relative increase in cortisol reactivity in the mindfulness group, after adjustments for biological and clinical measures (P = 0.03). From baseline to 20 minutes, more than twice as many patients in the mindfulness group displayed a cortisol rise, compared to controls (69 versus 34 percent; P = 0.02). Mindfulness scores were inversely correlated with fatigue and DEPRESSION (P < 0.01) and distress scores (P < 0.01).

 

 

 

 

Pain management. Suffering from uncontrollable pain is one of the most common fears of cancer patients. Unfortunately, pain is under-recognized and undertreated in patients with cancer. Bone pain experienced by cancer patients can be excruciating, and explaining to the patient that at times she may need to use opioids under the care of her oncologist without fearing addiction can prevent the patient from suffering unnecessarily. Poorly managed pain can lead to depression and anxiety. Once pain is appropriately managed, depressive and anxiety symptoms often diminish or resolve.

While some psychiatrists and oncologists have expertise in pain management, others may not and are reluctant to prescribe the necessary medications at the appropriate doses. AND SOME OVERPRESCRIBE Speaking with the oncology team and helping to get appropriate referral to a cancer pain specialist or palliative care team is crucial to the quality of life of cancer patients, especially those with advanced disease.

 

 

Before the patient’s visit with the pain specialist, it is helpful for the psychiatrist to provide education and correct some common misconceptions. The following 3 key issues should be considered regarding referral for pain management:

1) A majority of cancer patients do not have a history of addiction and actually fear becoming addicted to pain medications

2) Patients view the taking of pain medications as associated with death and dying: “Only a patient who is dying takes morphine”

3) Patients may need education on the difference between addiction and tolerance, in order to comply with prescribed pain medications

 

Psychiatry appointments

The traditional paradigm for psychiatric treatment may require a more flexible approach to scheduling to adjust to the reality of the patient’s needs during treatment. Patients may initially need more frequent appointments as they are adjusting to the diagnosis. New patients may be unsure when to make follow-up appointments because they have many upcoming oncology visits. Letting the patient know that scheduling psychiatry visits shortly after the oncology visits provides an opportunity to review the new medical information during the session.

 

 

During treatment, patients may need to cancel or reschedule appointments because of the adverse effects of treatment. Depending on the specific patient’s clinical situation, exceptions may need to be made to policies about late cancellations and no-shows. As the disease advances, patients may become hospitalized and are too weak to make office visits. Accommodating shorter inpatient visits may be indicated for continuity of care.

 

Patients often include their family in oncology visits, and some assume that this practice also occurs in psychiatric visits. Psychiatrists in cancer centers frequently see patients with their family members in the room. It would not have been out of the ordinary for Mrs. T to have her husband or another family member join her for her psychiatric evaluation. Providing effective support and treatment of patients with cancer will often entail providing support and education to their spouses, children, and significant others. Family members may need support in coping with their own concerns and often need education in how best to support the cancer patient.

 

 

Concluding OVERVIEW thoughts

 

Cancer care will continue to change over the next several years, sometimes rapidly. While psychiatrists cannot be expected to stay up to date with all of the emerging cancer treatments, they do need to learn about the ones that their patients might be receiving. Many resources are available for learning more about the psychiatric care of individuals with cancer. The American Psychosocial Oncology Society (www.apos-society.org) has published quick reference handbooks on psychosocial care for adults, children, and elderly adults with cancer and produces webinars on particular topics, such as sexual health and cancer.

 

7 Physical Clues You Could Have Depression

 

Many people who suffer from chronic illnesses also suffer from depression. Depression isn’t something that should be overlooked; it should be brought to your doctor’s attention so that it can be treated. But how do you spot depression?  With help from prevention.com, we’ve put together a list of some of the most common physical signs that someone is suffering from depression.

 

Aches and Pains

Although many chronic illnesses have their share of aches and pains, depression can also make muscles and joints feel sore or exacerbate the problem. People who are happy or content generally feel pain less than those who have depression.

 

Difficulty Sleeping or Waking Through the Night

Not being able to relax enough to fall asleep or frequently waking up during the night and finding it difficult to go back to sleep could both be signs of depression. Lack of sleep or disturbed sleep can have a profound effect on mood and the ability to concentrate.

 

Changes in Weight

Loss of appetite or comfort eating are both associated with depression, but you may not realize you have either until you step on the scale and notice a difference. In addition, if you’re not sleeping well because you’re anxious or depressed, this can also mess with your appetite leading to weight loss or gain.

 

Skin Complaints

Because depression affects hormones, this often becomes apparent in our skin. Depression can lead to skin complaints like acne, psoriasis, and eczema and treating the depression can help with the skin complaint.

 

Stomach Problems

Mood definitely affects the gut, and people with depression may suffer from symptoms like nausea, constipation, diarrhea, heartburn and indigestion.

 

Headaches and Migraines

People with depression are more likely to experience frequent headaches or migraines. Although this could also be a side effect of medication or treatments you take for your chronic illness.

 

Oral Problems

Dentists in Australia have found people with depression are more likely to need dental work such as tooth extractions and cavities than those who don’t. The thought behind this is that if you’re depressed, you’re less likely to be as diligent about oral health.

 

Depression questionqaire IS KEY

 

Suicide

 

 

LONDON, England, AND I MENTIONED THIS BEFORE – British researchers have found that people who are frequently depressed or anxious may run a higher risk of dying from certain types of cancer. THERE ARE SEVERE PROBLEMS WITHIS STUDY AND IT HAS NOT BEEN REPLICATED LOOK AT COMLIANCE, SYMTOM COMPLAINING, ALCOHOL, QUALITY OF LIFE ISSUES, AND SUCH

In THIS study published in the BMJ medical journal, the scientists were cautious in their conclusions, pointing out that a statistical link does not necessarily signify a cause-and-effect relationship between mood and cancer.

Their findings nevertheless added to the growing body of evidence that mental and physical health do not function on separate planes, and that one can influence the other.

While earlier research had shown that chronic depression and anxiety could help trigger heart disease and stroke, attempts to forge similar links between states of mind and cancer have yielded mixed results.

 

It has already been established that depression can disrupt hormonal balance to the extent of boosting natural cortisone concentrations and inhibiting DNA repair mechanisms – both of which weaken defences to cancer.

 

It is also well known that emotionally distressed people are more likely to smoke, drink and become obese – all of which are associated with a higher cancer risk.

 

.

The scientists could not discount the possibility that depression could be a result, rather than the cause of cancer, however.

 

“Distress might be a consequence of the early stages of the malignancy rather than a potential predictor,” they said.

 

THE AUTHORS noted that further research was needed to confirm the link and tease out the causal connections.

 

 

 

Seeing Cancer Through a Sibling’s Eyes: What We Don’t Know Can Hurt Them

SO LETS DRILL DOWN TO WHAT WE HAVE LEARNED

 

Depression and Anxiety Disorders in Patients With Cancer

AGAIN

7 Physical Clues You Could Have Depression

 

Many people who suffer from chronic illnesses also suffer from depression. Depression isn’t something that should be overlooked; it should be brought to your doctor’s attention so that it can be treated. But how do you spot depression?  With help from prevention.com, we’ve put together a list of some of the most common physical signs that someone is suffering from depression.

 

Aches and Pains

Although many chronic illnesses have their share of aches and pains, depression can also make muscles and joints feel sore or exacerbate the problem. People who are happy or content generally feel pain less than those who have depression.

 

Difficulty Sleeping or Waking Through the Night

Not being able to relax enough to fall asleep or frequently waking up during the night and finding it difficult to go back to sleep could both be signs of depression. Lack of sleep or disturbed sleep can have a profound effect on mood and the ability to concentrate.

 

Changes in Weight

Loss of appetite or comfort eating are both associated with depression, but you may not realize you have either until you step on the scale and notice a difference. In addition, if you’re not sleeping well because you’re anxious or depressed, this can also mess with your appetite leading to weight loss or gain.

 

Skin Complaints

Because depression affects hormones, this often becomes apparent in our skin. Depression can lead to skin complaints like acne, psoriasis, and eczema and treating the depression can help with the skin complaint.

 

Stomach Problems

Mood definitely affects the gut, and people with depression may suffer from symptoms like nausea, constipation, diarrhea, heartburn and indigestion.

 

Headaches and Migraines

People with depression are more likely to experience frequent headaches or migraines. Although this could also be a side effect of medication or treatments you take for your chronic illness.

 

Oral Problems

Dentists in Australia have found people with depression are more likely to need dental work such as tooth extractions and cavities than those who don’t. The thought behind this is that if you’re depressed, you’re less likely to be as diligent about oral health.

 

Depression questionqaire IS CRUCIAL

 

Suicide TWICE THE RATE

Elderly patients with cancer

 

are far less likely to be diagnosed with depression than patients in any other age group for two primary reasons: There is an overlap between cancer symptoms/treatment side effects and the diagnostic criteria for depression, and older adults are more likely to present with anhedonic “depression without sadness,” according to Chris Nelson, PhD, Associate Attending Psychologist at Memorial Sloan Kettering Cancer Center in New York.

 

 

According to Dr. Nelson, self-report instruments tend to underestimate the severity of depressive symptoms, and many depressed older patients with cancer are completely overlooked. “There is clearly a need to better understand, quantify, and treat depression in older cancer patients,” he said at the 2017 American Psychosocial Oncology Society (APOS) Annual Conference in Orlando, Florida.1 “This represents a significant public health concern that will grow in importance as the U.S. population continues to age.”

 

Diagnosing Depression

Common symptoms of depression—fatigue, diminished concentration, thoughts of death/suicide, weight loss/gain—are confounded with side effects from cancer treatments or, potentially, the cancer itself.

 

The literature suggests that two gateway symptoms—depressed mood and loss of interest—are most valuable in diagnosing depression in cancer, but according to Dr. Nelson, identifying these symptoms is not necessarily useful in older adults.

“The gateway questions come off the table as less than usefull useful diagnostic criteria when we combine cancer and aging,” he said. “So we’ve been trying to identify additional symptoms that are useful for diagnosing depression in older adults with cancer.”

 

He and his colleagues conducted a study aimed at identifying the phenomenology of depression in older cancer patients and developing a set of indicators to identify, assess, and treat depression in this population. They performed a literature review and interviewed eight experts in the fields of oncology, social work, psychiatry, and psychology to assist in identifying important constructs.

 

Based on input from the experts and findings from the literature review, the researchers conducted qualitative interviews with 12 depressed and 12 nondepressed cancer patients older than age 70. Depressed patients were identified by referral and subsequently interviewed by the panel of experts to confirm their depression.

 

Major and Minor Themes

The researchers identified four major themes in distinguishing depression in older cancer patients: anhedonia depressed mood without sadness , reduction in social relationships/loneliness, loss of meaning and purpose, and lack of usefulness and sense of being a burden.

 

Four minor themes also emerged: attitude toward treatment, mood, regret and guilt, and physical symptoms and limitations.

 

 

In the patient interviews, the experience of anhedonia was nuanced and involved a lack of initiation of new activities in addition to difficulty maintaining existing activities, he reported.

 

Another central issue was, reduction in social relationships and loneliness, varied based on the range and depth of patients’ social engagement, but depressed patients tended to have limited meaningful relationships and were socially isolated and withdrawn.

 

Loss of meaning and purpose in life was salient in the depressed group, and they displayed an inability to adjust to their new limitations. “Patients in the nondepressed group didn’t need to be engaging in anything particularly purposeful, but what they did in the past carried over and was still important to them,” he noted. THIS IS CRITICAL AND THEY GO BACK TO IT OVER AND OBVER AGAIN Lack of usefulness and sense of being a burden was also displayed in all depressed participants.

There was no difference between depressed and nondepressed participants in terms of their willingness to engage in treatment, but their attitude toward treatment was the nuanced difference. “

 

The nondepressed were much more proactive regarding their treatment, whereas the depressed were resentful, angry, and upset about their treatment,” he said. Mood also varied more in the depressed group, with some patients citing worse mood in the morning, when the demands of the day were in front of them.

 

Both groups looked back at their lives and experienced some level of regret, but the amount of guilt experienced was the differentiating factor between the nondepressed and the depressed. “The depressed patients seemed to ruminate on their regrets, whereas the nondepressed were able to put their regrets in a tolerable perspective,” he said.

 

No actual difference in physical limitations was observed between the two groups, but a difference was noted in how they coped with those limitations. Two aspects of coping were deemed to be specifically useful to older cancer patients: acceptance of the limitations associated with aging; and adaptation—changing and modifying one’s lifestyle and activities—to adjust to those limitations.

 

Of the four major and four minor themes recognized by the researchers, only two—the major theme of anhedonia DEPRESSION WITHOUT SADNESS and the minor theme of mood—are identified in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria for depression. Based on their findings, the researchers conclude that the DSM-5 criteria might not apply in identification of depression in older patients with cancer. We missed the boat perhaps According to Dr. Nelson, a new patient-reported outcome based on these symptoms we have talked about may be beneficial in identifying depression. ■

 

Cancer survivors show patients how to overcome the ordeal WITH COMPEMATRY AND ALTERNATIVE MEDICINE FOR WHICH THERE IS SCANT TO NO PROOF REMEMBER ANECDOTE DOES NOT MEAN ANTIDOTE

THESE ARE CLAIMED HEAD FOODS

Diet may a huge role in Depression. There are a number of lifestyle factors that contribute to Depression but one cannot overlook what you put in your mouth. The following foods are THOUGHT to lift the mood by working at the cellular level:

Chamomile Tea: One of the most recommended bedtime soothers. Pennsylvania university tested chamomile supplements on 57 participants suffering from Depression for eight weeks and found that it led to a significant drop in symptoms. Pour a cup of boiling water over 2 to 3 heaping tablespoons of the dried flowers (you can buy chamomile either loose or in tea bags at health food stores) and steep for 10 minutes. Try having a cup every night: Turn off the TV, computer, and phone and settle down for a peaceful end to the day. It’s nice iced, too.THIS WAS POOORLY DONE STUDY AND NOT CORROBORATED

 

Chocolate: Therapy for Depression, especially if it is dark chocolate. The antioxidants boost up not just the heart health but PERHAPS the mood. Dark chocolate is known to lower blood pressure, adding calmness. It contains MORE polyphenols and flavonols than some fruit juices. WHAT THAT MEANS IS UNCLEAR

 

Garlic: Surprised?. But garlic is packed with antioxidants which neutralise free radicals (particles that damage cells). It has allicin, said to fend off heart disease, cancer and common cold.AGAIN NOT PROVEN Depression weakens our immune system, but garlic IS CLAIMED TO mend it back. Have raw in the morning, saute it in broth, or add to all the meals, it is an enemy of depression.

Green Tea: Yes there’s caffeine but green tea also has theanine, an important amino acid IS THOUGHT TO fights Depression. in addition to ALLEGEDLY protecting against cancer, this slimming food is a brain booster as well, enhancing mental performance. Have two cups a day.

 

Oatmeal: The humble oat is actually a complex carbohydrate which compels the brain to produce serotonin, a feel-good chemical. Children on oatmeal breakfast stay sharper through the morning. AGAIN NOT FULLY CORROBORATED IN CONTROLLED STUDIES Beta-glucan, a soluble fibre in oatmeal, promotes satiety. THAT IS TRUE The whole grains release the glucose slowly in the blood stream hence keeping the blood sugars levels optimum. Stabilised blood sugar help the person to have a stable mood too PERHAPS BUT NO [ROVEN ROLE IN DEPRESSION.

 

Tomatoes: Contain folic acid and alpha-lipoic acid, both of which are good for fighting Depression. AGAIN SAME ANSWER NOT PROVEN

According to a paper in the Journal of Psychiatry and Neuroscience, an elevated incidence of folate deficiency is shown in patients suffering from Depression. About one-third Depression patients are deficient in folate. AGAIN NOT PROVEN TO HAVE ANY CAUSE AND AFFECT

 

Fatty Fish: When it comes to omega-3 fatty acids, no food source is better than fatty fish like mackerel, bluefish, wild salmon and tuna. The fatty acids found in these fish not only have ALLEGED UN PROVEN specific brain-boosting properties AND WHAT DOES THAT MEAN to fight depression, but also are good for overall health TRUE. They REDUCErisk of heart disease. For those who cannot or do not consume fish should have dietary supplements of fatty fish of high quality.

Berries: All the berries like strawberries, raspberries and blackberries BUT ESPECIALLY DARK BERRIES are the high antioxidants sources. These antioxidants are also called as DNA repairmen AGAIN UNPROVEN. They ward off the free radicals which are toxic and affect our mood UNPROVEN and the sense of well-being THEY TASTE GOOD AS WELL. These food products go around fixing your cells and prevent them from getting illnesses. AGAIN NOT REALLY PROVEN BEYOND GENERAL HEALTH

Mushrooms & Onions: ARE ALLEGED AND AGAIN UNSTUDIED REPOSIBLY AND UNPROVEN TO promote healthy gut bacterium. Nerve cells in our gut manufacture 80-90% of our body’s serotonin the neurotransmitter NOT REALLY which keeps us sane & happy.A WHOE BUNCH OF INTERACTIONS AND TRANSMITTERS ARE U INVOLVED AND SEROTONIN ALONE IS NOT ENOUGH

Dark Green leafy vegetables ARE HEA;THY FOR YOU Spinach and kale are THOUGHT TO FIGHT DEPRESSION Depression and cancer. GBOMBS stands for greens, berries, onion, mushroom, beans & seeds.

Apple: Is a rich source of antioxidants NOT THAT RICH and helps prevent and repair oxidation damage NOT PROVEN and cellular inflammation WHAT DOES THAT MEAN

 

THE KEY IS DO NOT BELIEVE ALL YOU HEAR. YES DIET HAS VARIOUS ROLES BUT DO NOT DO NOT DO NOT DEPEND ON THEM FOR TREATMENT OF SEVERE DEPRESSION IT CAN END WITH SUICIDE IT MAY NEED COUNSELING AND MANY OTHER PROVEN MODALITIES [PEOPLE WANT THIS TO WORK BUT STUDIES TO PROVE THEY HELP IGNORE THE 13& PPLACEBO EFFECT AND TREATING MILD TRANSIENT MOOD DEPRESSION NOT CLINICAL DEPRESSION. CALIMS ABOUT MEDICAL SPECIFIC MECHANISMS OF ACTION ARE ALMOST ALWAYS CA CA AND UNPROVEN CRITICALLY

 

I promised you stories and this one is filled with depression, hope and my only miracle—believing in miracles is miraculous enough for me

The Gift

 

 

It was as if her soul was branded cruelly at birth, “Kick Here”. It was not that she was dealt bad cards so much as she never had much of a prayer to be in the game of life. Alcoholic and abusive parents spawned this only child almost three decades ago and rendered havoc on her congenitally frail spirit and teetering health. Not surprisingly, she was cursed from the beginning as a severe diabetic. This had withered away her adolescence in angry diabetic comas  and multiple illnesses  as her family rambled helter-skelter across the country lashed to the whims of a drunken, oft-unemployed father.

Now a mother herself, Maria was at most a trembling waif of a young woman. She was murderously robbed of childhood innocence, weaned on despair, suckled on disappointment. Against the odds for severe diabetics she had amazingly survived pregnancy with very healthy twins.

She had escaped her hell of a family only to find herself in a ramshackle marriage to a pestilence, not a man. Wife beater and child abuser, her enlisted military husband was a belligerent brooding hulk for which fatherhood was a grave inconvenience and blot on his life.

I have come to believe that it was not by chance that one of our sage senior physicians happened to pull E.R. duty the day she walked the miles to our hospital carrying her precious cargo shivering in her arms. Both of her babies had fevers and to the discerning eye, it was clear that evil had pitched its tent in their home. Incessant apologies from a terrified tearful mother, scarred blistered skin from burning cigarettes pressed into innocent skin and classic fractures wailed as a wounded plaintiff cry for a savior, for justice.  Clearly both she and her children had been abused. She collapsed out of catharsis and  at least a momentary reprieve from fear and overwhelming grief when the emergency room team were marshaled to gather them all into our protective bosom. Simultaneously the search was set for her stain of a husband.

In short order, it was painfully clear that the tragedy had no bounds. It was soon obvious that Maria was ill. Evaluation in the emergency room showed that she had rapidly worsening kidney failure from what was soon learned to be malignant masses in her abdomen choking off her kidneys and eating voraciously through her pelvis.

I was drawn to this wounded pup. The ache of seeing such unfairness from a world which offers no guarantee of freedom from suffering  was a constant companion for many of us tending to her care. Our clinical bond and trust falteringly evolved. Leveraging the lifeboat of her children, I painstakingly strained to encourage in her a glimmer of hope and perhaps flame the fading flicker of fighting for her life, for her children.

We all have bucket lists of dreams unfulfilled and longed for. Her dream was common enough. She longed to have simply played with her children, to frolic with fantasy, unburdened by dread. Now she was resigned to a painful death; it was all she expected. Only the irrepressible devotion to her babies and the possibility of their future being so uncertain carried her on. However, it quickly became clear that the cancer would agonizingly strain the last beats of life from her.

We had raced through the diagnostic evaluation and the hurried dash to save her kidneys and numb what had to be blinding pain. There was never the slightest whimper, the faintest flinch from her. Through wounded eyes she watched disaffected, rallying only when her babies were safe and near. It was for them she allowed the tubes into her kidneys, for them she tolerated the invasion of her belly to knit together her perforated strangulated bowels, for them she bloodlessly whispered a vacant “yes” to chemotherapy. If only she could have just a moments peace.

A few years ago, I suffered through the disaster of a rental condominium in Orlando while visiting the magical mouse that only Irma Bombeck could rightly do justice. It was absolute architectural anarchy. If water should have passed through it, it did not, if designed to support weight, it would not, if it controlled the environment, it could not. It was simply a massive disappoint and grand inconvenience.

Therefore, one day the stuff of fairy tales landed in my mind. I fashioned a story and made the calls. Perhaps I was serving my need to somehow save her, perhaps not. By the time the smoke cleared, it was all arranged, clearly by the hand of a force far greater than mine; Airfare, a rental car, lodging and Disney World admission was waiting, free of charge for Maria and her babes.

Yet she was  giving up and dying. I eagerly told her of the scheme to whisk her away to fantasyland. I was stupefied by her visceral response. Life beamed in her eyes and for the first time of what was to become an adorable habit, Maria smiled. I could almost hear her soul snap into action barking orders to finally fight the beast eating her body. Her husband safely spirited away, a battered and bruised young, very alive mommy made it home for a long weekend for the first time. Irrespective of my personal faith, I was ill prepared for what lay ahead for Maria and her children.

A few Mondays later my nurse hovered in my doorway, seemingly buoyed by joy, wet eyed and spiritually transfigured. Stammering, she parsed out “It is Maria, Maria, she, ah, she is so alive “. I am sure I fumbled out something only to have my nurse return, “No, it’s Maria, You don’t understand what’s happened.” In an instant, she was gone and I was confused.

Then I saw the glow of life as never I have seen before. Guided by grace this beautiful woman glided into my office and settled into the chair. I was steeped in the warmth issuing from this vision. It looked like the Maria God would have fashioned were he to meddle mercifully in her miseries. She spoke serenely, “I stopped taking the narcotics, they made me sleepy and I have no more pain. I am eating everything in sight and my sugars seem okay. Dr.? Dr.? Are you okay?” Aghast and afraid that I might burst the bubble I beckoned her in to the exam room. It was normal, unbelievably normal.

A lump was growing in my throat and my voice grew strangely hushed. I vaguely remember calling the chief of radiology for the urgent CAT scan but I do remember his return call after it was done He was incredulous, questioning me. “I do not know what you pulled, but the scan I have here, well its normal – no tumor, and healing bone”. Gone too was the bowel obstruction, the blocked kidneys, all of it gone. The physical exams, CAT scan, blood tests; all were normal. Softly, before I could gather myself, she spoke as if the hand of God was gently stroking my disbelief, “I know”, and then silence. I was in the presence of grace.

I had no problem getting through on the phone to make all the arrangements final and in moments, it was done. She would leave for Orlando that weekend. The sweat of my soul slid down my face to  as my nurse handed me a tissue and floated out with our miracle.

On a Monday, some weeks after the joy of a lifetime with her children in Orlando, she appeared in my office. She was gaunt, wasted and desperately pleading “Tell me my babies will be OK; tell me what will happen to them. Tell me.” We spoke until the ache lifted from her spirit and she reached some manner of closure with the cancer that had so quickly returned to ravage her body. Abruptly she stopped, rose to face me  and gently put her arms around my neck without a word. I saw that she knew it was over and her children would be safe.

There was no sorrow that Friday in the hospital. Her babies lay besides her in her arms, sleeping, as God called his angel home.

 

This is Dr Kevin Ryan author of the book when tumor is the rumor and cancer is the answer, a comprehensive text for newly diagnosed patients and their families signing off radio www.w4cs.com and iheart  the cancer support radio program

See you Next Tuesday at noon PST when we will look at depression and cancer

 

Now for any questions

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