Get on your mat! Yoga to ease the symptoms of menopause

I came across this article about the benefits of yoga for peri-menopausal and post-menopausal women.  I just had to share!

The study was done by researchers in Germany,  and examined groups of women in the USA, India, Brazil, China, South Korea and Germany.  What is really interesting about the breadth of the study groups is that the women would have had vastly different lifestyle and diet habits.  So, the observed positive effect must come from something outside of existing diet and lifestyle.  In this case, the researchers conclude that yoga helps specifically with night sweats and hot flashes.

I worked for twelve years in rehabilitation of women who have had breast cancer.  As you may know, many breast cancers are sensitive to oestrogen, so one of the therapeutic strategies is to provoke a chemical menopause.  This may sound harsh, and it is, for the ladies.  Later, the woman may take a hormone disruptor (aromatase inhibitor or similar) like Tamoxifen for a period of five to ten years.  So, I have seen my share of ladies going through the menopause, believe me. The hot flashes and night sweats are very disruptive.

I myself have been crossing this particular juncture in the past two years and the night sweats thing comes and goes.  But, as a practising yogi, I will say that my transition has been smooth, and I am not overly bothered by the symptoms.  If anything, I feel lighter in my body and more stable in my mind.  I did not expect to have a relatively early menopause (I am only 45), but I did expect that my symptoms should be bearable.  And in fact, yes, they are.

It is worth noting that the positive effect of yoga might also lie in the way the women perceive the symptoms.  It is now known that the intensity of pain or physical discomfort is partly an issue of perception.  “A study from the University of Colorado at Boulder released on Jan. 12, 2015, reports that the ability to use your thoughts to modulate perceptions of pain utilizes a completely separate brain pathway than the pathway used to send the physical pain signal to your brain. This discovery is a breakthrough”

So, let’s just sum up, shall we?  Yoga seems to be effective at easing symptoms of menopause, even adjusting for diet and lifestyle difference.  Yoga is a safe and practical solution.  Viniyoga, which adapts the practice to the individual, not the individual to the practice, is a style that can help women who might have co-pathologies like osteoporosis/osteopenia, overweight/obesity, arthritis, and so on.

Have I convinced you yet?  Don’t worry, I will keep trying if not.  Why?  Because I care about your health, even if I don’t know you (yet).

Love, Rachel

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Best Diet To Prevent Cancer? Paleo? Ketogenic? Vegan? — Breast Cancer Authority

What is the best diet for preventing cancer? Does the paleo diet stop cancer? What about the ketogenic diet and cancer? Can a wholefood plant based diet prevent cancer? Can we be healthy if we don’t eat meat? Do we need meat to be healthy and cancer free? What about free range, organic, grass fed […]

via Best Diet To Prevent Cancer? Paleo? Ketogenic? Vegan? — Breast Cancer Authority

PMPS: Post Mastectomy Pain Syndrome

Introduction  

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Among breast cancer patients, a common complaint is numbness or tingling in the upper-inner arm.  This is called neuropathy and is often down to damage to one particular nerve:  the intercostobrachial nerve.

ICBN

The intercostobrachial nerve (ICBN) is connected to the brachial plexus and innervates the axilla, medial arm and anterior chest wall.  The brachial plexus is a group of nerves that originate in the neck and whose basic function is to move the arms.  (plexus definition:  a network of nerves or vessels in the body. an intricate network or web-like formation.)

It is well known that many breast cancer survivors have problems with mobility, strength and sensation in the arm of the affected side.  Today, we are going to talk about the specific complaint of tingling, numbness, pain and loss of sensation in the armpit and the inner arm.  Here is an image, lifted from the pdf whose link is in the references section, that illustrates perfectly the areas of skin that are innervated by the ICBN.

icbn skin innervation
Area of skin innervation by the ICBN

PMPS

Intercostobrachial neuralgia, also known as Post-mastectomy Pain Syndrome (PMPS) is estimated to occur in about 33% of breast cancer survivors. I can’t find reference to whether these are 5-year remissions,  or longer or shorter intervals, but 33% seems to be the agreed upon figure, and this is for PMPS that persists for longer than three months after the breast surgery.  There are other nerves involved in PMPS, but it appears that the the ICBN is the main nerve affected in most cases.  Thus, some people say it is more correct to refer to Intercostobrachial neuralgia.  However, as that doesn’t exactly roll off the tongue, let’s stick to PMPS and try not to think about PMS (ouch!).

Why does it hurt?

 

axilla dissection
Axilliary lymph node dissection.

The origin of the pain is either:

  • nerve damage during surgery, or
  • scar tissue around the nerve.

Surgery in the axilla is usually to remove lymph nodes, and these are deep to the ICBN. Here is an image of the technique that is used to remove lymph nodes.  I lifted it from the medscape article that is cited in the references section.  Radiation therapy (RT) tends to damage nerve tissue and promote the formation of fibrosis, is also a cause of the PMPS.

Here is a wonderfully concise description of the surgical reasons for PMPS:  

“The most commonly cited theory of chronic postoperative pain in breast cancer patients is the intentional sacrificing of the intercostobrachial nerves. These sensory nerves exit through the muscles of the chest wall, and provide sensation predominantly to the shoulder and upper arm. Because these nerves usually run through the packet of lymph nodes in the armpit, they are commonly cut by the surgeon in the process of removing the lymph nodes.” (http://www.cancersupportivecare.com/surgerypain.html)

I tried to understand what a “lymph node packet” might be, as this isn’t a term that we use in MLD speak.  I think that it is a surgical term for the bundle of lymph nodes that is excised.  [An article unrelated to PMPS and ICBN contained this phrase “We prospectively assessed 61 pelvic lymph node dissection specimens (packets) in 14 consecutive patients undergoing radical cystectomy.” ]

What to do?

As usual, when we use yoga therapy for breast cancer rehabilitation, we must respect limitations.  Firstly, PMPS won’t be cured by practising yoga.  But, it can be helped.  Secondly, there is variability in the extent and severity of pain and impairment to range of motion.  So, adopt a personalised approach and be patient.  Use simple, slow movements with breath synchronisation to achieve optimum results.  If you are a yoga teacher, you probably believe in prana.  I certainly do, and no matter how scientific the tone of my posts, I will absolutely vouch for the healing effects of good prana circulation.  So, when teaching, keep your students focused on the practice, not on the results.  Also, use your own healing energy and direct it towards them.  Wish them well.  Ask for guidance and the blessing of whatever guiding energy you believe in.  

Here are a few suggestions for sequences that you can integrate into your own practice and bring some flexibility and mobility to the chest and inner arm region.  Note that all sequences mobilise the brachial plexus in general.   

ICBN PMPS sequences
ICBN PMPS sequences

 References

Yoga therapy for the pericardium

a grey and purple mandala
Harlequin Mandala

Radiation therapy (RT) has improved life expectancy for many cancer patients.   However, it is well known that RT has long-lasting side effects that can range from mild to severe. Breast cancer patients treated with RT are at risk of damage to any of the structures near to the breast.  This includes the heart, lungs, pericardium, skin, lymphatic vessels and nodes, and skeletal muscles.  Today we are going to talk about the pericardium, what it is, how it may be affected/damaged in yoga therapy students, and how we can present a hatha yoga class to benefit and rehabilitate the pericardium.

What is the pericardium?

The pericardium is “a fibrous sac that attaches to the central tendon of the diaphragm and fuses with the adventitia of the great vessels superiorly.”  The great vessels are the large blood vessels that carry blood to a from the heart.  The adventitia is the outermost layer of the wall of a blood vessel.  So, the pericardium is:

  • A fibrous sac (two-walled, in fact, with fluid in the space between).
  • Attached to the central tendon of the diaphragm (the main muscle of breathing).
  • Fused with the outermost walls of the big blood vessels of the heart.

What does the pericardium do?

The pericardium has four functions.

  • It protects the heart from infections,
  • It protects the heart from knocks and jolts (this due to the fluid in the space between the two sacs),
  • It lubricates the heart and
  • It prevents excessive swelling of the heart in the case of a sudden increase in blood volume, which is usually associated with other illnesses or problems with sodium levels in the blood.

Unsurprisingly, given its roles, in Traditional Chinese Medicine, the pericardium is also referred to as the heart protector.  The pericardium meridian runs down the inner arms, between the two tendons of the inner forearm, crosses the palm and then runs along the middle finger, terminating at its tip.  Anyone who has treated secondary lymphoedema of breast cancer will observe that the affected areas coincide spectacularly with the pericardium meridian…

What happens to the pericardium during cancer treatment?

Fibrosis is the thickening and scarring of connective tissue usually as a result of injury.  The injury in this case is a radiation burn. Bear in mind that there are diseases that cause a primary fibrosis (cystic fibrosis, for example).  We are not talking about yoga therapy for such diseases here, although some of the underlying theory may be applicable.  We are discussing yoga therapy for breast cancer patients who may have pericardium fibrosis caused by RT.  This would be a secondary fibrosis, just at the lymphoedema seen in breast cancer patients is secondary to lymph node excision or what have you.

RT has a tendency to burn the surrounding tissue as well as the tumour.  The pericardium is already defined as a “fibrous sac” and the fibrosity that can develop as a result of radiation burns is our main concern here.  Bear in mind that different RT techniques will have greater or lesser probability of damaging the pericardium.  I observe that women with deep tumours often have RT tattoos on the other side of the chest, meaning that at least one ray had to cross the chest the get to the tumour.  Shudder.  Indeed, this article (from 2010) says that 20% of oncology patients who have had RT in the chest develop constrictive pericarditis.  This is called “radiation-induced constrictive pericarditis.” Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the hearts ability to function normally.

Let’s also take a moment to recall that chemotherapy often damages the heart.

Yoga poses for the pericardium.

Spinal extensions, backbends, outwards arm rotations, held inhales, arm raises with inhales and basically anything that stretches the chest and moves the diaphragm will be therapeutic for the pericardium.  However, as usual, there are limitations and contraindications that must be considered.  A glance at this page is useful in that it demonstrates a number of poses that quite frankly could not be used in the classes that I give.

Firstly, recall that fibrosis is not reversible.  It can be improved and loosened, but under normal circumstances, it is chronic.  I mention this to help you pace your program and not expect miracles.  I also warn strongly that overwork and tears are not desirable.  So, work within your students’ limits.

Referring back to the last page I mentioned, the “puppy dog pose” could be modified to a cat-cow sequence, breathing out with rounding the back and in when arching.  Another typical viniyoga sequence is moving slowly between cat pose and child’s pose.

cat-child's pose sequence
cat-child’s pose sequence

Another typical sequence is alternating between standing on the tiptoes with the arms reaching up (keep to shoulder height in some cases, elbows may also need to bend, ideal is palms facing at the top) and a half-squat with a spinal twist.  If you alternate sides and breathe in when you go up and out when you go down, you get a really nice loosening effect in the mid-trunk without really running risk of injury.

twist utkatasana - tiptoes sequence
twist utkatasana – tiptoes sequence

What can be interesting is using breath retentions to increase the lung volume and mobilise the intercostal and the serratus anterior muscles.  Next week I will post a sequence that I use and love.  Right now, I have to go.  It’s been a long post and I think that I have communicated what I set out to.

To yog is to live.  Keep at it!!!

Let your yoga sing

Why practise?

It is well and good to analyse the physiological and anatomical reasons for practising hatha yoga.  It is well and good to tell you why you ought to practise and what you ought to do. Yet, there is another way to saying the same thing and it is much simpler.  

Dear reader, happened upon this blog, you should practise yoga just because.  Just because yoga makes your body sing.  Because when you become very very still and very, very quiet, you can hear that miracle of your own song, your very own vibration.  You can connect with a timeless quality that is nonexistent in practically every other sphere of your existence.

 You should start practising yoga right now, even if it’s nothing more than sitting in a straight-backed chair, breathing in and raising your arms to shoulder height, then breathing out to lower them slowly down again.  Even this simple movement, isolated from any other posture, breath or sequence, repeated with enough intention and presence will bring you into a place of peace that you cannot know under different circumstances.  It is as simple as being quiet enough to listen, quiet enough to hear, your own song.  

Why, you may ask, ought I listen to my song?  There is music on the radio, on the TV, on Spotify…there are so many things to listen to, surely it’s not that important.  You err, I will reply.  You don’t know what you don’t know until you know it.  You are deaf to the chorus of your bodysoul and if you choose not to even look, then you are cowed and craven, too.  This is not to insult, not to chivvy, but yes, I would like you to wake up.  No matter how hard I try to detach from my longing to awaken each and every one of the beautiful human souls on this planet, no matter how unrealistic and even juvenile this deeply held longing may appear, it is there, it is real.  I want you to wake up and the best tool I can offer you is yoga.

 Why hear your song?  Why listen?  Because then you can hear all the messages from within and without.  You can then hear your body tell you which foods give life and which foods burden you.  You can then hear your soul’s messages about which company to keep, and for how long, and which relationships are toxic and which are good.  You can hear the live-giving messages from Nature, the chant of the wind and the whisper of the trees.  

And why might this be important for breast cancer survivors?  Well, because your song is your life singing.  And your life – so rudely threatened by disease – is pretty darn important to you, I will wager.  Yoga integrates movement, breath and mind/thought to bring about harmony in all three spheres.  I do not say this it should be practised to the exclusion of all other sports or creative activities.  But, it complements so well anything else you do that it should be practised alongside your other activities, and not left until last but given priority and done with constancy.  

Why practise?  Because you can.   Because you are here.  Because you are alive.  Because yoga makes you feel more alive.  Because yoga has been around forever and keeps coming out tops from practically every angle.  I yog just to know that I am alive.  Om. Peace out.

softones mandala
softones mandala

Yoga and the Endocrine System – Peace in the poses

A mandala
A mandala in shades of yellow

The practice of Hatha Yoga uses postures, breath and mental focus to bring about peace.  By peace, we refer to the physical peace derived from flexible muscle and joints, free of pain, good quality sleep, proper oxygenation brought about by correct breathing and mental restfulness, a state of alert calm, wakeful quiet.

There are scientific studies being done on the effects of yoga on the endocrine system – the hormones.  This is very promising work.   For a long time, people have tried to tie yoga nadis to the nervous system, and it is certain that some parallels can be drawn between nerve plexi and the chakras.  But this will never give the whole picture of just why a sustained hatha yoga practice, over years, brings about such overall good health and humour.

The Endocrine System

The endocrine system is composed of glands, organs and the substances they produce, known as hormones.   Hormones are secreted or excreted in miniscule quantities, but they have far-reaching effects.  Any woman who has ever taken hormonal birth control or even had a period knows this.

HPA Axis

Of great interest to those working with breast cancer is the so-called HPA axis, or Hypothalamo-Pituitary-Adrenal axis.  This is basically a cascade within the endocrine system in which one gland signals another.  The HPA helps control our reactions to stress, among other things.  The hypothalamus and the pituitary glands are nestled beside each other, and the link between the nervous system and the endocrine system is right here.  Basically, the hypothalamus secretes hormones that cause the pituitary to secrete hormones.  The hypothalamus receives information from the brain stem, that is, information from our body.  The anterior pituitary gland is where the hormones are secreted, and has been found to be activated by GABA.   Pituitary hormones then signal the adrenal glands, where cortisol is produced.

HPG Axis

There is yet another hormone axis called the HPG axis, or Hypothalamo-Pituitary-Gonad axis.  This axis signals and controls the sex organs.  The majority of breast cancer patients are menopausal or peri-menopausal at diagnosis, and those who are still menstruating have their periods suppressed in a bid to reduce oestrogen production.  The crux of the matter is the the Hypothalamus signals the Pituitary and this released two hormones, LH and FSH.  FSH does the final conversion of androgen to oestrogen, but LH helps produce the androgen, which coverts to oestrogen.  This process uses an enzyme called aromatase, and you may have heard of aromatase inhibitors, a class of drugs used in breast cancer patients with hormone-sensitive tumours.

Cortisol

One of the hormones that is of interest to yoga practitioners is cortisol.  Cortisol is produced in the adrenal glands and secreted into the blood.  Almost all cells of the body have cortisol receptors (these are like antenna or tunnels on the cell walls and they all the cells to transport the cortisol into the cell, where it can exert its effect.)  So, if you have high cortisol levels, you may see a wide range of effects in the body, including:

What is cortisol?  In it’s normal function, cortisol helps us meet life’s challenges by converting proteins into energy, releasing glycogen and counteracting inflammation. For a short time, that’s okay. But at sustained high levels, cortisol gradually tears your body down.  Cortisol is one essential we can’t live without.  But too much of a good thing is not healthy.

Sustained high cortisol levels destroy healthy muscle and bone, slow down healing and normal cell regeneration, co-opt biochemicals needed to make other vital hormones, impair digestion, metabolism and mental function, interfere with healthy endocrine function; and weaken your immune system.

Adrenal fatigue may be a factor in many related conditions, including fibromyalgia, hypothyroidism, chronic fatigue syndrome, arthritis, premature menopause and others. It may also produce a host of other unpleasant symptoms, from acne to hair loss.

(https://www.womentowomen.com/hormonal-health/the-destructive-effect-of-high-cortisol-levels/)

Here is a summary of the scientific studies substantiating the fact that the practice of Hatha Yoga reduces blood cortisol levels.

GABA

Another hormone of interest to yoga practitioners is GABA (Gamma-amino butyric acid). Low GABA levels in the brain are linked to anxiety and depression.  Anyone who has had cancer treatment knows that depression is rarely far away.  In my opinion, it is a very natural reaction to the physical trauma of treatment and the emotional trauma of facing your own mortality.  But depression cannot be allowed to continue unchecked, and the practice of Hatha Yoga helps regulate mood.  For example:

In a German study published in 2005, 24 women who described themselves as “emotionally distressed” took two 90-minute yoga classes a week for three months. Women in a control group maintained their normal activities and were asked not to begin an exercise or stress-reduction program during the study period.

Though not formally diagnosed with depression, all participants had experienced emotional distress for at least half of the previous 90 days. They were also one standard deviation above the population norm in scores for perceived stress (measured by the Cohen Perceived Stress Scale), anxiety (measured using the Spielberger State-Trait Anxiety Inventory), and depression (scored with the Profile of Mood States and the Center for Epidemiological Studies Depression Scale, or CES-D).

At the end of three months, women in the yoga group reported improvements in perceived stress, depression, anxiety, energy, fatigue, and well-being. Depression scores improved by 50%, anxiety scores by 30%, and overall well-being scores by 65%. Initial complaints of headaches, back pain, and poor sleep quality also resolved much more often in the yoga group than in the control group.

http://www.health.harvard.edu/mind-and-mood/yoga-for-anxiety-and-depression

Conclusion

I really could write all day, but my daughter will get mad at me, and Sunday is Sunday.  I will leave you to think about this:

Hatha yoga reduces blood cortisol, stimulates the vagus nerve and just darn well calms us down.  The brain stem recognises our altered physical state and sends this information to the Hypothalamus.  The Hypothalamus says to the Pituitary “all is good, settle down”.  The HPG and HPA axes find homeostasis and we establish a feedback loop of calm and settledness.  To any scientists reading this, I know it sounds facile.  But I think that your research – and our practice- will lead us to this conclusion.

In the meantime, keep practising.  We find peace in the poses.  Om.

Read on…

For your reading pleasure, a few curated links to articles discussing Yoga and the endocrine system.

http://www.bu.edu/news/2012/03/07/researchers-find-yoga-helps-ease-stress-related-medical-and-psychological-conditions/

http://www.studiodeeyoga.com/docs/MedicalHypothesisPaper-3.pdf

http://breastcanceryogablog.com/tag/gamma-aminobutyric-acid/

http://www.forbes.com/sites/alicegwalton/2011/06/16/penetrating-postures-the-science-of-yoga/

http://www.researchgate.net/profile/Vinod_Subramani/publication/23974308_Effects_of_a_yoga_program_on_cortisol_rhythm_and_mood_states_in_early_breast_cancer_patients_undergoing_adjuvant_radiotherapy_a_randomized_controlled_trial/links/549ad1da0cf2fedbc30e35a4.pdf