IntheKnowIssue25

know in the

understanding the cancer experience

Issue 25 complimentary magazine

pain management From traditional treatments to alternative medicine, explore your options for dealing with pain

BOARD OF DIRECTORS Gordon L. Black, M.D., Honorary Michele Aboud Robert Ash Patricia Carter, RN Ted Edmunds Sam Faraone Jeanne Foskett Monica Gomez Dan Olivas Irene Pistella Shelly Ruddock Ruben Schaeffer Ken Slavin Polly Vaughn Patti Wetzel, M.D. Steve Yellen EXECUTIVE DIRECTOR Patricia Tiscareño PROGRAM OFFICER Jutta Ramirez DIRECTOR OF MARKETING AND COMMUNICATION Izzy Mora

in

this issue: Welcome to the first issue of 2013 of In the Know: Understanding the Cancer Experience. As we begin our 6th year of publication, we’ve made some subtle and hopefully, welcome changes to the content of our award-winning magazine.

We’ve added a couple of new offerings, amended some of the favorites and put a new spin on

some of the departments.

In this issue, we take a look at the topic of pain, especially cancer pain. Everyone experiences pain at one point or another. It’s often an indication that something is wrong; a warning sign to look further into the source. For cancer patients, pain can be the result of a tumor causing pressure on tissues, bones, nerves or organs, poor blood circulation, metastasis, infection or inflammation or side effects from surgery, radiation or chemotherapy. Cancer pain can be very different from any other.

Michelle Brown visits with some of the pain management clinicians in El Paso about dealing with cancer pain; the most common prescribed medications and all the ramifications their use can bring about.

You might recognize Dr. Armando Gonzalez-Stuart from our issue on food and nutrition. Among his many fields of expertise, Dr. Gonzalez-Stuart has served as the Herbal Medicine Research Coordinator at University of Texas at El Paso and has authored books on the subject. In this issue, he provides some enlightenment on natural, homeopathic and alternative approaches to pain relief.

In a new feature “The Expert is In the Know”, we asked

David McQueen, a certified advanced practitioner of the Rolfing technique, for a tutorial. A process of connective tissue manipulation, Rolfing has been used in helping cancer patients who have completed treatment to restorative health.

We are now featuring Survivor Stories from local cancer patients. This month we spotlight Christine Jakuta, a 3-year breast cancer patient. A speech pathologist in the El Paso Independent School District, Christine is also actively involved in El Paso non-profits. An actress, HIV/AIDS advocate and community volunteer, it is her zest for life that has been a contributing factor in her recovery.

HPV is the focus of our newest department “An Ounce of Prevention”. The Human Papilloma Virus, a prevalent and often undetected concern can be responsible for or lead to a cervical and/or ovarian cancer diagnosis. Izzy Mora helps us understand how to avoid this preventable problem.

There is always something happening at the Rio Grande Cancer Foundation – look through the magazine for Save The Date information on our upcoming Sgt. Pepper’s Wondrous Wigorium fundraiser in May and Cancer 180 a unique one-day conference for young adult survivors of childhood cancer in June. Also, Save The Date for the 5th annual Keep on Dancing Cancer Survivor Conference on Saturday, August 24, 2013 with our new and improved format and content.

We are grateful to our new partners who will be serving as host locations for distribution of our magazine and appreciate your patronage of their local goods and services.

Stay Well!

Patty Tiscareño, Executive Director, RGCF

OFFICE MANAGER Cindi Martinez ADMINISTRATIVE ASSISTANT Maggie Rodriguez

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in the

know

FEATURES

is published by the

Rio Grande Cancer Foundation 10460 Vista del Sol, Suite 101 El Paso, TX 79925 (915) 562-7660 fax (915) 562-7841 www.rgcf.org by

Snappy Publishing Ted Escobedo, Publisher 240 Thunderbird • Suite C El Paso, Texas 79912 (915) 820-2800

Tell us where it hurts

Putting the patient first

What are your options?

Coping with pain can be made easier with a frank and honest conversation with your physician. In this feature we offer some sound advice as to how to begin the process with your doctor and how to start to feel better.

Palliative care has become a popular and effective method for dealing with a patient’s needs. Here we offer insight and advice for people who are struggling with a serious illness.

Complementing your physician’s plan with alternative medicines has been effective for some patients. Here we break down some common alternatives to treating pain.

DEPARTMENTS In The Green House

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A Survivor’s Story

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Those submitting manuscripts, photographs, artwork, or other materials to In the Know for consideration should not send originals unless specifically requested to do so by In the Know in writing. Unsolicited manuscripts, photographs, and other submitted materials must be accompanied by a self-addressed overnight delivery return envelope, postage pre-paid. However, In the Know is not responsible for unsolicited submissions. ©2013 Rio Grande Cancer Foundation. All rights reserved. No part of any article or photograph contained in this magazine may be reproduced in any way without the written consent of In the Know.

In the Know assumes no responsibility whatsoever for errors, including without limitation, typographical errors or omissions in In the Know. Editorial or advertising content in In the Know does not necessarily reflect the opinions of the publishers. In the Know assumes no responsibility for the products or services advertised in this magazine. Publisher reserves the right to edit any material or refuse any advertising submitted.

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By Michelle Brown

improving your quality of life

pain

management

Communication with your physician about your pain is the first step toward alleviating it FREQUENCY “When people are diagnosed with cancer, pain remains one of the most feared symptoms for both the patient and their families,” says Charles H. Weaver, MD, in an article published in the British Journal of Cancer. From the time of diagnosis through the intermediate phase of illness, 30% to 45% of cancer patients will experience moderate to severe pain. If the disease advances, pain incidence increases to 70% to 90%. Recent research indicates that cancer patients may be under-treated for pain, making proper pain management an integral component to cancer treatment.

Similarly, clinical studies of pain suggest that about one-third of patients currently receiving cancer treatment experience moderate to severe pain, and 60% to 90% of people with advanced disease report a similar amount.

There is good news however. According to the Abramson Cancer Center of the University of Pennsylvania, a study from the World Health Organization reports that 70% to 90% of all cancer pain can be controlled. Experts stress that patients need to communicate the intensity and amount of pain to their physicians adequately, and physicians need to be vigilant about trying to treat pain.

Education and awareness arm patients with the tools needed to maintain positive physician dialogues so that together, doctors and patients can make the most informed decisions possible about therapy regimens.

CAUSES The symptoms of cancer pain vary from person to person as the amount of pain present may depend on the type of cancer, the stage or extent of the disease, and the person's pain threshold (tolerance for pain). Pain can range from mild and occasional to severe and constant.

Although there are many causes of cancer pain, most cancer pain occurs when a tumor presses on nerves or body organs or when cancer cells invade bones or body organs. Cancer treatments such as chemotherapy, radiation, or surgery also may cause pain.

Cancer can also cause "bony" pain, which occurs when tiny cancer cells get inside bones and damage their structure.

Frequently, irradiating the bone treats this type of pain. The radiation therapy destroys most of the tumor cells, allowing the bone to start healing.

Pain can also occur when cancer grows directly into a nerve, making the person feel like pain is coming from any place that nerve goes. This is an example of "referred pain," the term used to describe pain felt at a place different from that where the injury is occurring. Sometimes a nerve block, or the process of making the whole nerve numb, can be used to treat this type of pain. Again, all of these types of pain may be treatable with combinations of surgery, radiation, and chemotherapy to reduce the tumor itself.

KNOW MORE NEXT PAGE> PAIN TREATMENTS

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6 improving your quality of life

pain

management

Although cancer pain is usually treated with medicine, surgery to remove a tumor or radiation therapy to shrink a tumor can be used along with medicine to provide additional pain relief.

drugs do not require a prescription, but some do.

Patients should check with a physician before using these medicines, especially if chemotherapy is being administered. NSAIDs can slow blood clotting.

In most cases, according to The Cleveland Clinic Neuroscience Center. doctors treat cancer pain with pain-relief medicines called analgesics or with non-drug treatments such as physical therapy and rehabilitation, imagery, biofeedback and relaxation techniques.

Moderate to Severe Pain

Other treatment options for cancer patients include nerve blocks, which involve the injection of pain medicine into or around a nerve or the spine; and neurosurgery, a procedure in which pain nerves are cut to alleviate pain.

Mild to Moderate Pain NSAID pain relievers: Tylenol® and a group of pain relievers called nonsteroidal antiinflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Motrin® and Aleve®) can treat mild to moderate pain. Many of these are over-the-counter

Narcotic pain relievers: These drugs include Morphine, Actiq, Duragesic, Dilaudid, Oxycodone (sold under the brand names OxyContin®, Percocet®, and Tylox®) and Codeine. Narcotic pain relievers require a prescription and may be used along with mild pain relievers for moderate to severe pain.

Norpramine® are antidepressants prescribed to treat pain.

Anticonvulsants (antiseizure medications): Despite the name, anticonvulsants are used not only for seizures, but also to control burning and tingling pain, painful symptoms of nerve damage. Tegretol® and Neurontin® require prescriptions Other drugs: Corticosteroids such as Deltasone® are used to lessen swelling, which often causes pain.

Breakthrough Pain Onset narcotic pain relievers: Onset narcotic pain relievers, which require a prescription, are used to treat break-through pain (a flare-up of pain characterized by rapid onset, severe intensity and short duration). Immediaterelease oral morphine is among these drugs.

Tingling and Burning Pain Antidepressants: Antidepressants are used to relieve pain whether or not the person is depressed.

Elavil®, Pamelor®,

In addition to traditional therapies, physicians may recommend certain nondrug treatments to supplement pain medication. These treatments may help to make medicines work better and relieve other symptoms, but they should not be used in place of prescribed medications.

Talk to your physician about all treatment options.

Non-drug pain treatments include: Biofeedback: A technique that makes the patient aware of bodily processes that are normally thought to be involuntary (such as blood pressure, skin temperature and heart rate). The technique enables the patient to gain some conscious voluntary control of these processes, which can influence a patient's level of pain.

Breathing and relaxation exercises: Methods used to focus the patient’s attention on performing a specific task. The patient concentrates on the task instead of their pain.

Distraction: A method used to divert the patient’s attention to a more pleasant event, object or situation.

Heating pads and hot or cold packs: Using temperature to facilitate pain control.

Hypnosis: A focused state of consciousness that allows the patient to better process information.

Imagery: A method used to teach the patient to make mental images of something soothing.

Focusing on these positive images allows the patient to relax.

Massage, pressure and vibration: Methods that physically stimulate muscles or nerves. These methods facilitate relaxation and relieve muscle spasms or contractions.

Transcutaneous electrical nerve stimulation (TENS): A technique using a mild electric current applied to the skin at the site of the pain.

Rest: Of course rest is one basic, and necessary, tool to restore the body’s immune system.

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Comfort Care: Palliative care puts the patient’s comfort first.

This life quality approach helps prevent, alleviate & manage pain & stress

Compiled By Michelle Brown

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s an international movement promoting quality of care in the relief and prevention of patient suffering, palliative medicine continues to expand in El Paso, especially for cancer patients.

Palliative medicine specializes in medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis--to improve quality of life for both the patient and the family. Palliative medicine and care services can be offered to any patient without restriction to disease or prognosis. It can be appropriate for anyone with a serious/complex illness whether he or she are expected to recover fully, to live with chronic illness for an extended time, or to experience disease progression.

Palliative care treats people suffering from serious and chronic illnesses such as cancer, cardiac disease, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis (ALS) and many more. It focuses on symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping and depression. It also helps you gain the strength to carry on with daily life. It improves your ability to tolerate medical treatments. And it helps you have more control over your care by improving communication so that you can better understand your choices for treatment.

Know more>

Comfort Care:

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lthough the concept of palliative care is not new, most physicians have traditionally concentrated on trying to cure patients.

According to the Center to Advance Palliative Care (CAPC.org), the focus on a patient's quality of life has increased greatly during the past twenty years.

In the United States today, 55% of hospitals with more than 100 beds offer a palliative-care program, and nearly one-fifth of community hospitals have palliative care programs.

A relatively recent development is the concept of a dedicated health care team that is entirely geared toward palliative treatment.

A palliative-care team includes physicians, nurses and social work palliative care specialists. Massage therapists, pharmacists, nutritionists, chaplains and others may also be part of the team that spends as much time as necessary with you and your family. They provide support every step of the way, not only by controlling your symptoms, but also by helping you to understand your treatment options and goals. Working together with your primary doctor, the palliative care team provides close communication, expert management of pain and symptoms, help with navigating the healthcare system, guidance with difficult and complex treatment choices and emotional/spiritual support.

The first United States hospital-based palliative care programs began in the late 1980s at a handful of institutions such as the Cleveland Clinic and Medical College of Wisconsin. Since then there has been a dramatic increase in hospital-based palliative care programs, now numbering more than 1400. And, 80% of US hospitals with more than 300 beds have a program, according to CAPC. Following this tradition, Texas Palliative Center-El Paso is the newest facility providing palliative medicine for people who face illness-related suffering and helping those with serious advanced illness find symptom relief and quality of life care. “Personnel and staff base services on collaborative knowledge as well as research, while activities are guided by ethical principles of autonomy, justice, truth and confidentiality,� states the Center.

Palliative care works to achieve the best possible quality of life for patients and their families. For example, symptom control involves therapies for nausea and vomiting, dry mouth and stomatitis, excessive pulmonary secretions, radiation mucositis and proctitis, and wound care.

Working in conjunction with palliative care, pain management specialists are licensed medical professionals who use various approaches to prevent, evaluate and treat acute chronic pain disorders. Pain management specialists may be trained in a number of specialties, including orthopedic surgery, neurology, physiatry (physical medicine and rehabilitation) and anesthesiology, or may work alongside surgeons.

Pain management is essential because even when the underlying disease process is stable, uncontrolled pain prevents patients from working productively, enjoying recreation, or taking pleasure in their usual roles in the family and society. Chronic pain may have a myriad of causes and perpetuating factors, and therefore can be much more difficult to manage than acute pain, requiring a multidisciplinary approach and customized treatment protocols to meet the specific needs of each patient.

Optimal treatment may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA (N-methyl-D-aspartate) antagonists. Some block pain

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Palliative care (from Latin palliare, to cloak) is an area of healthcare that focuses on relieving and preventing the suffering of patients. Palliative medicine is appropriate for patients in all disease stages, including those undergoing treatment for curable illnesses and those living with chronic diseases, as well as patients who are nearing the end of life. Palliative medicine utilizes a multidisciplinary approach to patient care, relying on input from physicians, pharmacists, nurses, chaplains, social workers, psychologists, and other allied health professionals in formulating a plan of care to relieve suffering in all areas of a patient's life.

Know more: Traditional Pain Medication transmission or reduce it as well as decrease tolerance to and the need for opioid analgesics. By combining various agents that utilize different mechanisms to alter the sensation of pain, physicians have found that smaller concentrations of each medication can be used.

If pain is not relieved, you may feel tired, depressed, angry, worried, lonely or stressed. However, when cancer pain is relieved, you are more able to be active, sleep better, enjoy family and friends, eat well, and prevent depression.

Local pain management centers focus on managing symptoms and effects. These centers specialize in the diagnosis and treatment of chronic pain, acute pain, and cancer pain management. While the aim of pain medicine is concerned with the prevention, diagnosis, treatment and rehabilitation of painful disorders, this specialty is practiced by physicians who are able to draw from a wide range of therapeutic modalities to design a treatment program tailored to your specific needs. Treatment options may include oral or injected medications, nerve blocking/stimulation, physical therapy, acupuncture, nutritional support and emotional support/counseling, among others.

Some physicians may incorporate integrated medicine, or practice rational poly-pharmacy, which is the use of a welltargeted combination of medications. Other ‘non-traditional' treatments that are now widely used may include holistic approaches such as relaxation techniques (to lessen tension, reduce anxiety, and manage pain), biofeedback, imagery and distraction or hypnosis. Many of these are used along with pain medicine, but they can also be used alone for mild pain or discomfort. Some patients report they can take a lower dose of pain medicine when using these techniques.

Patients may need the help of health professionals -- social workers, physical therapists, psychologists, nurses, or others -- to learn to use these techniques. Family and friends can also help.

To find out who specializes in these techniques and which organizations know about them, speak with your physician or nurse or contact your cancer treatment center or pain clinic.

For mild to moderate pain Non-opioids: Acetaminophen (Tylenol) and non-steroidal antiinflammatory drugs (NSAIDs), such as aspirin and ibuprofen, are often used.

You can buy many of these over the counter without a prescription.

For others, you need a prescription. Check with your doctor before using these medicines. NSAIDs can slow blood clotting. This may be a problem if you are having surgery or getting chemotherapy.

NSAIDS may also cause harmful effects if you take them while you take certain other medicines.

For moderate to severe pain Opioids (also known as narcotics): Morphine, fentanyl, hydromorphone, oxycodone, and codeine You need a written prescription for these medicines. Non-opioids may be used along with opioids for moderate to severe pain to get the best effect.

For breakthrough pain Rapid-onset opioids: Fast-acting oral morphine; fentanyl in a lozenge or "sucker" form (These forms of fentanyl are absorbed from your mouth as you suck on them -- they are not swallowed.)

You need a written prescription for these medicines. A short-acting opioid, which relieves breakthrough pain quickly, is often used with a long-acting opioid for chronic pain.

For tingling and burning pain Antidepressants: Amitriptyline, nortriptyline, and desipramine You need a prescription for these medicines. Antidepressants are prescribed to relieve certain types of pain. Taking an antidepressant does not mean that you are depressed or have a mental illness.

Anti-convulsants (anti-seizure medicines): Carbamazepine, gabapentin, and phenytoin You need a prescription for these medicines. Despite the name, anti-convulsants are not only used for convulsions (seizures), but also to control burning and tingling (nerve) pain.

For pain caused by swelling or pressure Steroids: Prednisone, dexamethasone You need a prescription for these medicines. They are most often used to lessen swelling, which often causes pressure and pain.

Source: American Cancer Society www.cancer.org

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pain cancer

Cancer pain can almost always be relieved or lessened

management

There are many medicines and methods that can be used to control cancer pain. You should expect your health care team to work with you to keep you as comfortable as possible. But no one doctor can know everything about all medical problems, and sometimes pain is a subject they don't know as much about.

If you are in pain ask your doctor for a referral to a pain specialist. These specialists may be oncologists, anesthesiologists, neurologists, neurosurgeons, other doctors, nurses, or pharmacists. A pain control team may also include

Compiled By Michelle Brown

psychologists and social workers.

If you have trouble finding a pain program or pain specialist, contact a cancer center, a hospice, or the oncology department of your local hospital or medical center. They should be able to recommend someone to you.

Controlling your cancer pain is part of your cancer treatment.

Your doctor wants and needs to hear about what works for your pain and what does not. Knowing about the pain will help your doctor know more about how the cancer and the treatment are affecting your body. Talking about pain will not distract your doctor from treating the cancer.

Keeping pain from starting and keeping it from getting worse are the best ways to control it.

Pain is best relieved when treated early.

You may hear some people refer to this as "staying on top of the pain." Do not try to hold off as long as possible between doses. Pain may get worse if you wait.

Then it may take longer, or you may need larger doses, for your medicine to give you relief.

You have a right to ask for pain relief.

Talking about your pain is not a sign of weakness. Not everyone feels pain in the same way. There is no need to "tough it out" or be "brave" if you seem to have more pain than other people with the same kind of cancer. In fact, as soon as you have any pain you should speak up.

Remember, it is easier to control pain right when it starts rather than waiting until it becomes severe.

People who take cancer pain medications the way the doctor or nurse prescribes them rarely become addicted.

Addiction is a common fear of people taking pain medicine. Such fear may even keep people from taking the medicine. Or it may cause family members to encourage you to hold off as long as you can between doses. Addiction is defined as uncontrollable drug craving, seeking, and continued use. When opioids (also known as narcotics) -- the strongest pain relievers available -- are taken for pain, they rarely cause addiction as defined here. When you are ready to stop taking opioids, the doctor will lower the amount of medicine you are taking over a few days or weeks. By the time you stop using

it completely, your body has had time to adjust. Talk to your doctor, nurse, or pharmacist about how to take pain medicines safely and about any concerns you have about addiction.

Most people do not get "high" or lose control when they take cancer pain medicines the way they are told to.

Some pain medicines can cause you to feel sleepy when you first start taking them. This feeling usually goes away within a few days. Sometimes you become drowsy because now that the pain is under control, you are able to catch up on the much-needed sleep you missed when you were in pain. Sometimes, people get dizzy or feel confused when they take pain medicines. Tell your doctor or nurse if this happens to you. Changing your dose or type of medicine can often solve these problems.

Side effects from pain medicines can be managed and often even prevented.

Some medicines can cause nausea and vomiting, itching, constipation, or drowsiness. A few can cause liver or kidney damage. Your doctor or nurse can help you manage these side effects. But some of these problems go away after a few days of taking the medicine. And many side effects can be managed by changing the medicine, the dose, or the times when the medicine is taken. Others, like constipation, can often be prevented with stool softeners and other measures.

Your body does not become immune to pain medicine.

Pain should be treated early, and stronger medications should not be saved for later. It is important to take whatever medicine is needed when it is needed. Over time your body may get used to the medication so it may not relieve the pain as well as it once did.

This is called tolerance. Tolerance is seldom a problem with cancer pain treatment because your doctor can increase the amount of medications you are taking or add others. This alarms some people because they are afraid it means they are addicted, but it is not the same thing. It only means that your body has learned to adjust to the drug in your system over time.

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12

Know your

alternatives

Complementary and Alternative Supplements for Pain

By Armando González-Stuart, Ph.D. Pain can be a symptom in itself or a secondary effect originating from another abnormal or pathological condition.

Regardless of the modality (conventional or alternative) employed to relieve pain it is of first importance to find out exactly what is the cause of the pain in order to treat not only the symptom, but rather its origin.

What is Complementary and Alternative Medicine?

Complementary and Alternative therapies cover a wide array of options for the management of various health conditions, including pain. First of all, let’s define what is meant by “complementary

and alternative medicine”. According to the National Center for Complementary and Alternative Medicine (NCCAM), the definition is: “A group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine”. The term “conventional medicine” means “Western”, mainstream or allopathic medical approaches as currently practiced by physicians.

CAM can be applied to pain management in a variety of ways. Some of them can be manipulative techniques, such as chiropractic, massage therapy with essential oils, yoga, and Rolfing, just to name a few. However, one of the most important “alternative” therapies is scientific herbal medicine, also known as

phytotherapy. In this article we will mention some of the main plants and supplements with regard to pain management used in herbal medicine.

What is Phytotherapy?

The word comes from the Greek phyton which means “plant”. The term “phtytotherapy” was coined in the late 19th Century by the French physician Henri Leclerc, to denote therapies based on plants and plant products to treat a wide array of diseases and ailments.

Phytotherapy takes into account the valuable empirical or practical knowledge obtained from traditional herbalists, but goes one step further in validating their use based on chemical analyses as well as controlled clinical trials in order to elucidate the health effects of their

13 bioactive ingredients, known as “phytochemicals”.

What are Phytochemicals?

When you bite into a hot jalapeňo chili or a clove of garlic, as well as when you taste pure cinnamon or ginger, your taste buds immediately respond to the plants’ phytochemicals. It is precisely these phytochemicals which can have therapeutic properties for a variety of ailments.

Phytochemicals known as sulphoraphanes are commonly contained in closely related plants such as broccoli, Brussels’ sprouts, and cabbage, for example. These sulfur-containing natural compounds have been shown to possess cytotoxic activity against cancer cells in laboratory experiments.

Plants and Pain Indeed, some of the most important medications employed by conventional or Western medicine for various types of pain include various compounds derived from plants including the opioids from the poppy plant (Papaver somniferumPapaveraceae) Novocaine and Lidocain from the Coca plant (Erythroxylum coca –Erythroxylaceae), as well as the precursor of aspirin, commonly known as Meadowsweet (Spirea ulmaria-).

Unfortunately the most powerful plant –derived analgesics can also be addictive.

For this reason, we must look for safer alternatives which will not cause dependence as well as other negative side effects.

Chili peppers and Arthritic Pain Pain, inflammation, and sometimes deformation are landmark symptoms of osteoarthritis and, especially, of its autoimmune version, rheumatoid arthritis.

A few plants, such as chili, for example, contain compounds which may help to reduce pain. Chili (Capsicum spp.Solanaceae) also known as “Cayenne pepper” contains an irritating compound known as “capsaicin” which can serve the useful purpose of interfering with a painsensation neurotransmitter known as “substance P”.

It is interesting to note that some people may experience pleasure and even euphoria from eating chili peppers which have a high content of capsaicin.

Supposedly this is due to the painstimulated release of endorphins (natural compounds produced in our brain which convey a pleasurable sensation).

Capsaicin can be applied externally as an ointment or a high-dose dermal patch to relieve the pain of peripheral neuropathy which occurs in diabetic patients as well as people suffering from an attack of herpes (shingles). The cream/ointment is applied externally (topically) for the temporary relief of minor aches and pains of muscles and joints associated with arthritis, in concentrations from 0.025% - 0.15%. It is important to note that although capsaicin will give temporary relief form pain, it does not have anti-inflammatory properties.

Make sure that you wear gloves when you apply the cream/ointment or wash your hands well after you use it as capsaicin can be very irritating to the mucous membranes.

Frankincense a Gift from the Magi or Ayurveda?

Boswellia Serrata, also known as Frankincense, is a tree that grows in Asia whose compounds can have antiinflammatory action and may help relieve the pain associated with arthritis. The resin for the tree has been used in Ayurveda (one of the oldest systems of medicine) in India for the treatment of arthritis. Clinical studies show that extracts of Boswellia have been used with success to treat osteoarthritis and joint function, especially for osteoarthritis of the knee. Positive effects have also been seen in chronic inflammatory diseases including rheumatoid arthritis.

Chamomile for Gastrointestinal and Premenstrual Pain Chamomile (also known as manzanilla) tea is one of the oldest herbal remedies.

The tea, made from the flower heads is usually taken for colic, premenstrual syndrome, and anxiety. The phtyochemicals in chamomile have both anti-inflammatory as well as antispasmodic (reduce the muscular spasms caused by intense pain) actions, helping to reduce the pain. Additionally, chamomile acts on receptors in the brain to help us relax without feeling groggy.

Migraine and other Headaches Feverfew (Tanacetum partheniumAsteraceae) is plant belonging to the chamomile or Daisy botanical family has been used for many years in traditional medicine to treat migraine headaches.

Some studies have found feverfew to be superior to placebo in reducing the pain associated with migraines, but further clinical trials are needed. This plant seems to be more effective as an extract taken in capsules, compared to taking it as a tea.

Make sure the product you buy is standardized to a compound known as “parthenolide”.

Can too much sugar cause pain?

Many studies have shown that when cells, especially nerve cells, have a sugar overload, they begin to experience important changes in their structure and function. This is especially true for diabetic patients who commonly experience what is called “peripheral neuropathy”. Some of the usual symptoms related to damage to nerve cells include muscle weakness, cramps, and spasms.

Damage to the sensory nerve can produce tingling, numbness, and a burning pain.

Loss of balance and coordination may also occur with this condition.

For this reason it is vitally important to limit our consumption of sugar, especially in its refined form (white sugar and highfructose corn syrup, for example in order o reduce the effects of pain and inflammation throughout our body.

Dr. Armando Gonzalez-Stuart, an expert in the field of health and nutrition. Dr. Gonzalez-Stuart is a graduate professor with the faculty of animal science and ecology at the University of Chihuahua where he has undertaken research in toxic and medicinal plans used in traditional Mexican medicine. His office is located at 5301 Sun Valley and he can be reached at 915-822-1106 or by email: naturadoctor@aol.com

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Acupuncture

A frequently asked question by patients undergoing cancer treatment is, "Can acupuncture help me?"

Its pierce can stop a 200 pound athlete in his tracks or reduce a new mother to tears.

It causes fear and trepidation in high school students returning to school and can even keep an educated person from visiting the physician’s office. It even has its own unique names… aichmophobia, belonephobia, or enetophobia. But most people just call it “needle phobia or fear of needles”.

So when a cancer patient, seeking relief from the side effects of traditional cancer therapy, inquires about acupuncture it is often spoken tentatively and fearfully.

“Can acupuncture help me?” is a frequently asked question with patients undergoing cancer treatment, says Elisabeth Bouchard, licensed acupuncturist, a practitioner of the ancient art. Since cancer is not just one disease but many different malignancies, each with its own cellular pattern and behavior, many different kinds of procedures are required to fight it, says Bouchard. The issue then

becomes: is there a place for acupuncture in the vast field of cancer with its diverse treatment modalities?

The answer, according to Bouchard, is a resounding “Yes”.

Acupuncture is part of traditional Chinese Medicine, a complete medical system that originated thousands of years ago. It is proposed that acupuncture achieves its effects by regulating the nervous system, thus aiding the activity of pain-killing biochemicals such as endorphins and immune system cells at specific sites in the body. In Chinese medicine, health is believed to result from the free flow of energy, called chi, in the body. Illness is attributed to blockages in this energy flow, which can be relieved by the placement of thin needles at various points in the body.

But what about those needles? The theory behind acupuncture is that the insertion of acupuncture needles at these strategic points encourages the healing

get in the know about:

Acupuncture Points and Meridians The acupuncturist decides which points to treat by observing and questioning the patient in order to make a diagnosis. In Traditional Chinese Medicine, there are four diagnostic methods: inspection, auscultation and olfaction, inquiring, and palpation.

and cancer powers of the body. The body has many healing powers that will regenerate and cure. Acupuncture aims at promoting this healing and regeneration. The skilled professional who is trained in acupuncture must know the strategic points in the body that will be useful when these needles are inserted.

Elisabeth Bouchard contends that the acupuncture needles are thin but powerful.

She says that “most patients feel little or no discomfort with the procedure” in which the practitioner inserts and manipulates fine filiform needles into specific points on the body. (See sidebar on acupuncture points) “Acupunture can be a useful tool in combating the dreadful nausea and fatigue that accompany traditional cancer treatment”, says Bouchard. Oncologist Dr. Eugene Mak writes that the role of acupuncture works in both the curative and palliative treatments. It is effective for control of pain, of local swelling postoperatively, for shortening recovering and

minimizing side effects of medications.

That acupuncture is a powerful tool for general pain control is widely known, says Dr. Mak. Less known is its successful use in some care-related pain and in reducing narcotic use and thereby minimizing the side effects of confusion, behavioral changes, nausea and severe constipation.

Acupuncture has also become popular with those who want to quit smoking or lose weight.

Acupuncture and traditional Chinese Medicine is now taking its place on the stage along side conventional cancer treatment. It complements Western medical care with a holistic focus on the mind, body and spirit and is now being offered as part of supportive cancer care at major cancer treatment centers throughout the United States, including Stanford, UCSF Medical Center, Johns Hopkins, and the M.D. Anderson Cancer Center.

So close your eyes, relax and just forget about those needles!

• Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge.

• Auscultation and olfaction refer, respectively, to listening for particular sounds (such as wheezing) and attending to body odor.

• Inquiring focuses on the "seven inquiries", which are: chills and fever; perspiration; appetite, thirst and taste; defecation and urination; pain; sleep; and menses and leukorrhea (vaginal discharge).

• Palpation includes feeling the body for "ashi" (tender) points Most of the main acupuncture points are found on the twelve main meridians, pathways through which Qi and "Blood" flow. Treatment of acupuncture points may be performed along several layers of pathways, most commonly the twelve primary channels, or mai, located throughout the body.

Photos: Devon Bonaguidi and Elizabeth Bouchard

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know&tell

pain management the fascia, correcting misalignment and restoring balance throughout the whole body.

The focus on manipulating fascia is part of what distinguishes it from chiropractics, which deals with bones, and from therapeutic massages, which works on muscles. That also explains why Rolfing has a reputation for being aggressive, even painful at times. Fascia is stubborn material, particularly if it is marked by knots and scar tissue. Rolfers gouge with knuckles and knead with fists, contort limbs and lean into elbows to loosen tendons and ligaments.

WHAT ARE THE BENEFITS Rolfing assists the person in “remembering” that which had been “dismembered.” At most, this integration of your body will transform your life. On a more practical level, 1) most of your joints will decompress which may make you taller but will make you feel taller. 2) Your muscles will move more efficiently with less effort. 3) Stored fat may be repositioned. 4) Your breathing will become easier and fuller. 5) Pain which is a result of postural imbalances may diminish or disappear, but most importantly your body will become your native land instead of a foreign country.

Rolfing: Balance and optimize both the structure and function of the entire body

By David McQueen WHAT IS ROLFING Over a period of 40 years, Ida Rolf, who received a PhD in bio-chemistry from Columbia University in 1920 and who died in 1979, expanded and refined her knowledge of the human body until she systemized it into a method of connective

tissue manipulation.

She called her method, Structural Integration. In the 1950’s she began to teach others her method, but it wasn’t until the late 60’s when she was teaching at the California growth center, Esalen, that her method became known as Rolfing.

Dr. Rolf focused on the role of the fascia, a form of connective tissue that envelops different muscle groups, allowing them to move freely in relation to each other and often across several joints. When an injury occurs, she theorized, the fascia tightens around that injury, somewhat like a cast or band-aid. Even after the injury heals, the fascia stays in that rigid position, often causing chronic pain and discomfort.

Structural Integration is a form of deep tissue massage that stretches and opens

WHO GETS ROLFED Individuals of all ages seek Rolfing, but the common denominator of their motives is the desire for transformation. Some seek help with chronic pain, impaired joint mobility, or stressed-out bodies. Others seek to enhance their appearances, their athletic or artistic performances. And still others seek Rolfing for personal growth.

But they all seek to transform themselves, much in the way that the caterpillar seeks to become the butterfly.

WHAT TO EXPECT IN A ROLFING SESSION Rolfing is a scientifically validated system of connective tissue manipulation which facilitates the integration of your body’s structure so that gravity will support your body instead of tearing it down.

Through a sequence of ten sessions, the Rolfer nudges your body into an integrated structure. The first seven sessions focus progressively in certain segments of your body; the last three sessions organize your body into a balanced, integrated whole.

The Rolfer accomplishes the integration of your body by first evaluating your structure. Then dressed in your underwear or something comparable, you lie on a

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padded table, and the Rolfer applies the right amount of pressure to the restricted areas of your body. In order to assist your body in freeing and realigning itself, the Rolfer may ask you to breathe into the area that is being worked, to move it, or to imagine the area changing.

BeneFItS FoR CAnCeR PAtIentS I would not recommend Rolfing for patients who are undergoing cancer treatments.

Palliative bodywork like Swedish massage, cranial sacral therapy, therapeutic touch, etc. would be more appropriate during that phase. Rolfing would be helpful as a restorative therapy after treatment has been completed. The patients’ responses to the trauma of cancer and the accompanying treatments would create compensation patterns that disorder their body images and their bodies’

structures. The pain, the scar tissue, the edema that accompanies the treatments make you adjust yourself to deal with that.

But after the treatment, those patterns will continue unless you change them. Rolfing will help you change them, restoring familiar patterns to your body image and your body.

Your bodies return to being homes instead of battlefields.

InSuRAnCe CoVeRAGe Coverage is dependent upon the wording of the policy and the necessity of the primary health care practitioner to prescribe Rolfing as a necessary medical treatment.

Perhaps in the fall when the health insurance exchanges go into effect there will be uniformity in covering complimentary medicine. But now there isn’t.

know more> “Should I be Rolfed?”

Rolfing changes you, if you’re happy where you are, don’t get Rolfed. On the other hand if you are seeking change, then Rolfing is the quickest way I know of for facilitating change.

“Does it hurt?”

Yes it can. Rolfing is an intense experience. But I don’t work beyond the threshold of a client’s availability. In other words, if you can’t relax into the pain, then it is too much, and I would back off my pressure.

“How often?”

Once a week is minimum, but for some that is too quick. Too much change over a brief period of time can stress the client. Regularity to the interval between the sessions is beneficial. Two or three weeks between sessions are fine; four weeks can produce some problems. My average time frame for the basic series is six months.

“Is there maintenance?”

Depends on the client. You will never need to redo the basic ten

series. The connective tissue remembers the work and so future change can be accomplished far more quickly with fewer sessions.

Post ten work usually includes one or three sessions. Eventually the client may want to do the advanced series of five sessions.

“What conditions can be helped?”

It is more practical to think of Rolfing as education than as therapy. In this way Rolfing can benefit most physical complaints. I have had varying degrees of success with repetitive motion injuries, whiplash, back strains and sprains, multiple sclerosis, fibromyalgia to name just a few.

KnoW tHe AutHoR David McQueen was first Rolfed between 1979 and 1981. The experience had such a profound effect that he decided to change his career from teaching college English to being a Rolfer*. In the process of becoming a Rolfer, he first became a massage therapist, graduating from the New Mexico School of Natural Therapeutics in 1984. For several years, he practiced massage therapy at the Central YMCA of El Paso. In 1990, he became certified as a Rolfer, having studied with Gael Ohlgren and Stacey Mills who between them had over a half-century of Rolfing experience. His further studies led him to be certified as a Rolfing Movement Teacher and in 1997 as an Advanced Rolfer.

He is currently a member of the Rolf Institute and American Massage Therapy Association, is nationally certified in massage therapy and body work by the National Certification Board of Massage Therapy and Bodywork, and is a Texas licensed massage therapist. He is presently studing Visceral manipulation, the assessment of the structural relationships between the viscera, and their fascial or ligamentous attachments to the musculoskeletal system through the Barral Institute .*only those individual who are trained by the Rolf Institute and are members have the legal right to call themselves Rolfers.

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know&tell

pain management Medicinal Uses of Marijuana (Cannabis): More medicine-less politics

By Armando González- Stuart, Ph.D.

Perhaps you’ve never heard of medicinal products derived from Marijuana or Cannabis known as Sativex, Marinol or Cesamet, for example, but they are of great importance to many people suffering from various diseases.

The pharmaceuticals afore mentioned are prescribed by physicians in various countries, and the trend for amplification of the medical use of Cannabis seems to be expanding. All this for good reason: Marijuana appears to be a promising plant for the extraction of biomedical natural compounds (known in herbal medicine as “phytochemicals”) to treat a wide array of illnesses, ranging from glaucoma to Alzheimer’s disease.

Various species of Marijuana (Cannabis sativa and C. indica, for example) have a very long history of medicinal use for the treatment of a wide array of afflictions in both humans and animals. Recorded Cannabis use as medicine is mentioned in ancient Chinese and Indian (Ayurvedic) medical texts dating back hundreds, if not thousands, of years.

Strategies for Coping with Chronic Pain

Marijuana was once a very important plant included in the pharmacopoeias of many nations (including the United States and Mexico). Unfortunately, Cannabis has been unjustly maligned and ostracized (seemingly more for political reasons than anything else) from the medical community.

Many research studies have demonstrated that Marijuana , when properly used, can have various beneficial effects for health including the following: • Decreasing nausea and vomiting, especially in cancer patients undergoing treatment with radiation and chemotherapy • As an anti-anorexic (to stimulate appetite) in AIDS as well as cancer patients

Relaxation Chronic pain is both physically and emotionally stressful, and this physical and mental tension can, in turn, make the pain worse. Planned, purposeful relaxation can help break the painstress cycle by lowering heart rate and blood pressure, relaxing tense muscles, reducing anxiety, and giving you a sense of control and well-being.

The type of relaxation referred to here is different from the way we commonly think of as relaxing when we take time to read a book or watch TV. While these activities can be pleasurable and may play an important role in reducing

• For the treatment of glaucoma (Cannabis and its derivatives can lower intraocular eye pressure) Although the medicinal use of marijuana is currently illegal in many countries, various governments, including that of the United States, do permit (at least limited) treatment of various health disorders with low doses of one or more synthetic derivatives of Marijuana , known as “cannabinoids”.

If more interest is shown for research into medical Marijuana ’s positive health effects and less credibility is placed on the truculent and murky politics related to the legislation prohibiting Cannabis, we can perhaps find cures for a variety of illnesses using this important medicinal plant.

your daily stress, the relaxation referred to here involves learning ways to calm your body and mind.

Tips for Relaxing Find a quiet place free of surrounding distractions. Darken the room. Take the phone off the hook.

Dedicate this as time to yourself to not be interrupted. Playing a tape of soothing music or nature sounds may be helpful although some relaxation therapists suggest no background music.

Sit comfortably. Sit in a comfortable position on a chair or the floor.

Practice relaxation for at least 10 minutes. Deep breathing, progressive muscle relaxation, guided imagery, meditation, or other relaxation methods should be practiced for a minimum of 1020 minutes on a daily basis (see descriptions below).

Search through the health section in your local library or bookstore to learn more about strategies for relaxation.

You'll also want to explore relaxation tapes & CDs. Some offer soothing sounds and music while others provide instructions for you to follow along during your session.

Deep breathing In a relaxed position, take a slow, deep breath, and slowly release your breath.

You may want to count to five for your inhale and five for you exhale to establish a slow rhythm of breathing.

Feel your stomach expanding and releasing with each long inhale and exhale.

Continue breathing in and out, focusing exclusively on the sounds and experience of your breathing.

While deep breathing is a great lead in to a 10-20 minute relaxation session (minimum recommended length), deep breathing is also a great technique to use for a quick one minute relaxation break at various period during the day.

Progressive Muscle Relaxation Progressive Muscle Relaxation (PMR) is an easy and effective technique for relaxing your body and mind. PMR involves deliberately tensing specific muscle groups for a short period of time and then releasing the tension.

Start by tightening one group of muscles (e.g. lower arm) and hold the tension for 8 seconds. Then quickly release your tension, letting all the pain and tension flow out as you exhale.

Repeat the tension-relaxation cycle with the same muscles then proceed to other muscle groups.

With each release, focus on feeling your muscles relax and become loose and limp.

Guided Imagery Use your imagination to take you to a calm, peaceful place. Take a walk through a country lane, around a mountain lake, or along a pristine beach.

Hear the soothing sounds of nature--the sounds of the birds, the rustle of the leaves on the trees. Feel the gentle breeze on your face. This is what guided imagery is all about, and the results can be wonderful.Your local library or bookstore has tables that can assist you with this technique. For more on guided imagery, go to: http://health.yahoo.com/health/Alternative _Medicine/Alternative_Therapies/ Guided_Imagery Exercise Exercise is an important component to your pain management program. Regular exercise improves your flexibility, your aerobic conditioning, and your muscle strength. It can also serve to boost your self-confidence and lessen anxiety and depression. Improving your overall fitness helps to keep you healthy and reduces your risk for further injuries while also helping to control your pain Tips for Starting an Exercise Program • Consult with your doctor. Be sure to discuss with your doctor what an appropriate level of physical activity is for you.

• Start slowly. Whenever beginning a new exercise program, start with just a few exercises and slowly add on more.

• Listen to your body. Be sure to listen to your body while you exercise and afterwards, as well. If you begin to have too much pain, stop doing the exercise.

• Learn to recognize the appropriate level of exercise for you. Discuss your exercises and symptoms with your doctor or physical therapist to learn the difference between normal discomfort and too much pain through exercise. soource: http://www.healthauthority.com/painmanagement.htm

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know&tell What to know about: HPV

by Izzy Mora

“Denise” recalled feeling shocked and numb when she was told she had HPV or the Human Papilloma Virus.

“My first thoughts were ‘Why me?’ I’ve only had two sex partners in my life.

How could this happen?” These were the thoughts that began her education about the virus most commonly known as HPV. HPV is one of the most common sexually transmitted infections in the United States. An even more staggering picture is the fact (National Cancer Institute-NCI) that HALF of sexually active people are infected with one or more HPV types and there are over 150 related viruses, 40 of which can be easily spread through direct skin-to-skin contact during vaginal, anal and oral sex. To illustrate how common these infections are we cite from the NCI these numbers: 42.5 percent of women have genital HPV infections and 7 percent of adults have oral HPV. Women are not the only ones affected by HPV; 1% of all sexually active males in the U.S.

have genital warts at any one time (Center for Disease Control- CDC).

There are two categories of HPVs: Low-risk HPVs which do not cause cancer but DO cause skin warts on or around the genitals or anus and then there is the High-risk HPVs which CAN cause cancer. These cancers include cervical cancer, cancer of the vulva, vagina, penis, anus, and oropharynx (back of the throat including the base of tongue and tonsils).

Now that the facts have been established and you are properly alarmed and perhaps swearing off any sexual activity ever, one snaps-to and asks the next question: Can HPV be prevented?

Because there are no symptoms of HPV until one has developed warts or the cancers mentioned above, there is little way to know whether you or your partner have contracted HPV. This means that if you are in a

monogamous relationship and your partner tests positive for HPV, you should not assume infidelity because they or you may have had the virus for a very long time. It is best to request a standard sexually transmitted disease test to find out. Beyond that, the use of male condoms does provide some protection but not total because there is still skin to skin contact around the areas not covered by the condom. A more effective form of protection would be the female condom as it provides more surface area protection.

Still neither is fully protective but it sure does give one a good chance at NOT contracting the virus.

The Food and Drug Administration (FDA) has approved two HPV vaccines: Gardasil® for the prevention of cervical, anal, vulvar, and vaginal cancers, precancerous lesions in these tissues and genital warts; Cervarix® serves to prevent cervical cancer and precancerous cervical lesions.

Know where to go: YOUR IMAGE BOUTIQUE, INC. HPV (short for human papillomavirus) is a virus that could affect your son or daughter.

Breast Prosthesis, Mastectomy Wear and Lymphedema Sleeves

By Cindi Martinez of bra fitting experience. Having been in this business for years, they are familiar with insurance coverage and can help you with questions you might have.

There are about 30-40 types of HPV that can infect the genital area. And, according to the Centers for Disease Control and Prevention (CDC), there are approximately 6 million new genital HPV disease cases in the United States each year.

What does a mastectomy fitter do? A mastectomy fitter will measure a patient for a proper fit, adjust breast prostheses, bras and related supplies, and order what is best for you. Trained and certified mastectomy fitters are essential to the physical and emotional well-being of patients. Elizabeth and Susan provide instruction and training on how to properly use and maintain post-mastectomy devices.

An estimated 74% of them occur in 15- to 24-year-olds. That's about 12,000 teens and young adults each day.

The vaccine can be administered to boys and girls as young as 9 years of age and recommendations from the Advisory Committee on Immunization Practices (ACIP) of the CDC recommends routine immunizations with the vaccine in girls and boys ages 9 – 26. Much controversy has surrounded the use of these vaccines.

It has been the topic of high political debate including public accusations that it causes mental retardation, a claim that has been refuted by the CDC and countless medical experts.

Another major block is the discomfort parents feel about vaccinating their children for a virus that is passed through sexual intercourse.

“I just finally don’t care what people think of me because I have HPV”, says Denise. “I think there should be dialogue about this preventable disease and the vaccines created by modern science to protect against it”.

If you know you have HPV, a good way of taking care of someone you love is to talk the talk and walk the walk. http://www.healthmap.org/news/hpv-vaccinecontroversy-and-solution http://www.cdc.gov/std/hpv/stdfact-hpv.htm http://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm http://www.cancer.gov/cancertopics/factsheet/Risk/HPV http://www.cancer.org/cancer/cancercauses/othercarcino gens/infectiousagents/hpv/humanpapillomavirusandhpvv accinesfaq/hpv-faq-can-hpv-be-prevented

Most women who undergo treatment for breast cancer probably know more about the disease and the procedures used to fight it than what to do about recovery.

The physical aftereffects of breast cancer treatment and surgery vary from recovering from a double mastectomy, asymmetrical breasts due to limited breast surgery, to relieving the pain from a lumpectomy. While every woman’s experience is unique, the good news is that women can now actively participate in choosing how to manage the challenges of resuming their lives to a sense of normalcy through postmastectomy wear.

Subsequent to undergoing a mastectomy, many women are faced with purchasing a post-mastectomy garment. A poorly-fitted bra can ride up and/or irritate the surgical site and when having breast reconstruction, cup sizes that do not fit properly can irritate your breasts and cause discomfort. The ultimate goal is to attain the most natural look possible with proper shaping and support.

Your Image Boutique, located in the central area of the city, is a valuable resource in the community that offers mastectomy bras, lymphedema sleeves, hats and turbans to wear during chemotherapy. As you walk in you marvel at the grandeur of a historic home and the ease of an environment that lends itself to privacy and comfort. Elizabeth Martinez and Susan Gomez are certified mastectomy fitters who have been accredited through the Board of Certification (BOC) and have many years

Lymphedema Sleeves - Many patients are prescribed garments that provide compression for an affected arm with lymph nodes. The garments help to keep fluid from accumulating in the limb. These garments have specific amounts of pressure and can be worn on the legs, hands, feet, or arms. The garments are made of a tight stretchy fabric. Elizabeth and Susan are certified to measure and fit lymphedema sleeves for women seeking a professional fit. Measurements are taken, and a patient must try on the sleeves to make certain that they have a comfortable fit. The garments are usually used in combination with therapy or as a preventive or maintenance measure. The sleeve may wear out with continued daily use and must be refit and replaced on a regular basis (approximately every 3-6 months). Over time with washing and wearing they lose their compression.

They are familiar with insurance company coverage and can help you with questions and forms.

Your Image Boutique, Inc. places great importance on providing each customer with a suitable product that works well with every woman’s unique personality.

Elizabeth Martinez and Susan Gomez reflect a highly personal approach that sets them apart. They bring a sense of passion to their work and a commitment to quality.

Your Image Boutique, Inc. is located on 3401 Montana Ave. El Paso, TX 79903 Tel. (915) 564-5923 Fax (915) 565-1310

know&tell In the Greenhouse Book selections from the J. Leighton Green Cancer Resource Library

Mom’s Marijuana

SATURDAY, JUNE 22

ASCARATE PARK CHECK-IN: 6AM RUN: 8:30AM WALK: 9AM COLOR PARTY: 10AM Feb 22-24: $35 Feb 25-Mar 31: $40 Apr 1-Jun 21: $45 Jun 22-$60 CHOOSE YOUR CHARITY Child Crisis Center Rio Grande Cancer Foundation Paso Del Norte Childrens Development Center Border Aids Partnership

by Dan Shapiro With some touting marijuana as a palliative to chemotherapy's side effects, which the author smoked as he combated Hodgkin's disease, one might expect Shapiro to explore the controversies surrounding the issue of grass-as-medicine. Besides briefly relating how his mother cultivated hemp in the backyard, he never allows the subject to impinge on his potpourri of cancer survival memories. Diagnosed at age 20 with a tumor, Shapiro details the biopsies, I.V. drips, radiation sessions, and blood draws alongside his characterization of the doctors, technicians, and nurses who managed his care. Interleaved with this commentary about the antiseptic quality of modern hospitalization are Shapiro's deeply drawn recollections of growing up and pursuing a career in psychology. Regrettably this volume lacks a thematic linkage to Shapiro's myriad memories of dreams, his walk along the precipice of death, and his amour.

Nevertheless, the book's origin as NPR pieces and the author's lectures to oncology organizations will most likely generate interest.

The Pain Survival Guide: How to Reclaim Your Life

By Dennis C. Turk, Frits Winter If you suffer from chronic pain, this proven 10-step program brings hope and relief, showing you how gradual changes in specific behaviors can lead to great improvements in your ability to cope. Psychologists Turk and Winters’ recommendations are based on solid research that shows what works and on their success with thousands of patients. Unlike the authors of other pain books, they promise no miracle cures, but they do help you learn "not to let your body push you around" so life becomes enjoyable again. The key lessons in this book include • Uncovering some of the myths about pain and the deceptive ways it fools your body into unconstructive behavior • Pacing your activity, so you build strength without overdoing or underdoing it • Learning how to induce deep relaxation so you can begin to enjoy life again • Dealing with disturbed sleep and chronic fatigue • Improving your relations with family and friends, and soliciting support • Changing your habitual behaviors in ways that reduce pain • Combating the negative thinking that often accompanies pain • Regaining your self-confidence and trust in yourself • The power of goal-setting and humor • Dealing with the inevitable relapses and setbacks once improvement has set in • Workbook exercises, behavior logs, and suggested readings help you integrate these lessons into your daily life and learn to live well despite pain.

Where to get ‘In the Know’ This 5K Run/Walk will benefit four El Paso Not-for-profits.

Register online at: erace3.com

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Visit rgcf.org for past issues of In the Know

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al

A survivor’s story Christine Jakuta Definition: survivor sur·vi·vor [ sər•vi•vər ] In the world of cancer, a survivor is defined as anyone who has been diagnosed with cancer, from the time of diagnosis through the balance of his or her life.

The number of cancer survivors in the U.S. is growing for several reasons, including doctors' ability to find cancer earlier, diagnose cancer more accurately, and treat cancer more effectively.

In the Know is pleased to feature a survivor in each issue.

I have learned that I can persevere and there is always an upside, even to cancer.

My name is Christine Jakuta and my story starts in September 2009. I was working as a speech language pathologist in an elementary school in EPISD and on call at Sierra-Providence. Through this journey, I learned that “ Faith, it does not make things easy, it makes them possible.” Luke 1:37. When I went for my routine mammogram, everything went well as far as I knew. Then again, what did I know, it was only the third one I had ever had.

I guess I didn’t know, as it came back suspicious and I needed a biopsy.

Actually, I had three biopsies. But I wasn’t scared, I had dense breast tissue.

The biopsy seemed like a very good precaution. As it turned out, I had Ductual Carcinoma In Situ in my left breast. But my story doesn’t end there.

When I met with my surgeon, Dr. Mark Landeros, he calmly asked if anyone had mentioned the lump in my right breast.

Ah, the upside! Dr. Landeros had found more cancer. That tumor was Stage 2B, ER positive, HER-2 negative. He was the first one to detect anything else wrong. So, by the end of September, with my brother, Dan, his wife, Lisa, my sister, Nancy and all my friends sitting at the hospital, I had a bilateral mastectomy and reconstruction of both breasts.

Another upside, if you ask me, as my

‘chichis’ had been hanging pretty low.

Dr. Herbert Nassour, my plastic surgeon, was able to give me two new uplifted breasts. I am so comfortable with the new breasts that I cannot, frankly, remember how the old ones looked or felt.

By October, I was in chemotherapy receiving TAC through Texas Oncology with Dr. Portillo. I had put together my team from experts who I had personally known. Dr. Raul Portillo had worked with my mother 15 years ago as she battled colon cancer. He has the ability to present the information I needed to know in an upfront and honest way. I knew what to expect in chemotherapy because my close friend, Joy Nevarez, had been previously diagnosed and was close to finishing her own treatment. She showed me the ropes. Even chemotherapy had its upside. I went to six sessions with six different sets of friends taking me. My friends joked with me and kept me company. Those visits were fun and encouraging. It was those visits with my loving friends that made chemo easier for me. It was over before I knew it.

Through all of this, I continued working as a speech language pathologist. I continued teaching catechism at St. Luke’s. I worked on the board of Border AIDS Partnership and the El Paso Playhouse. It was vital to me

that I participate in all the activities that had filled my life prior to my diagnosis.

I enjoyed being an active participant in life and breast cancer was not going to stop me!

Today I am three and a half years post diagnosis, surgery and chemotherapy. I attend all my follow up appointments and faithfully attend Rio Grande Cancer Foundation’s Keep on Dancing. I spend as much time as possible with my family and friends. I am always striving to improve my spirituality, nutrition and life. I try to help other survivors including my friend, Christina Maxwell, with their journeys. I answer any questions to the best of my ability (chemo and anesthesia brain sometimes prevent my memory from recalling every detail). As my friend Joy did for me, I am here to support Christina and anyone else in a positive, uplifting way.

I read recently that perhaps strength doesn’t reside in having never been broken, but in the courage required to grow strong in the broken places. I believe that my journey as a breast cancer survivor has shown me how to persevere and to see the upside of every situation.

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