How empowering your brain can empower your life along the cancer journey. At talk presented at InspireHealth.

InspireHealth is a world-class integrative cancer centre. The government of British Columbia funds medical physicians and complementary practitioners to provide individualized counselling and services for people diagnosed with cancer. They do research on complementary techniques, and publish a monthly research update written for the lay public. They have a great website InspireHealth.ca and offer webcasts and other services for free.

I love presenting at InspireHealth because the people who attend the talks really 'get it'. They've done enough groundwork along the self-empowerment path that I can take them to the deeper levels of acceptance, peace and love.

I was quite excited giving this talk because I could include the recent brain science I had been studying.  Here it is, enjoy: https://www.youtube.com/watch?v=Hf08wyeB7UI&list=UUJ2xpeSPwmrloNTGynL240A

"Take a deep breath … but not too deep" by Dr. Rob Rutledge

Take a deep breath … but not too deep

The room fell silent. We each slowly breathed in and out, being very curious about the sensations of a simple breath. I could feel my body relaxing more and more with each breath.  I looked up at the middle-aged woman and her daughter. Their eyes were closed, their faces softened and content. Even Ben, the medical student, seems to have found a moment of deep peace after a hectic clinic day.

Fifteen minutes earlier, the consultation had started out in a routine fashion. Margaret had been through an uncomplicated breast cancer surgery, and was to see me for radiotherapy.  Dressed immaculately in a soft cream-coloured suit, she stood to greet me, beaming and holding my hand in hers.  “It’s such a pleasure to meet you. I feel so grateful. I’ve read about you online and really like your holistic approach….” She is gushing with enthusiasm, speaks of nursing her mother through a recent diagnosis, and the wonderful care she received at the cancer centre.  The lines come one after another. She also admits she’s anxious, takes the occasional nerve pill, has always been scared of hospitals.  I listen and we joke, enjoying each other’s company.

Her daughter, a lovely woman in her late thirties, sits beside her Mom smiling. She’s travelled from afar to be there around the time of the surgery and radiation.  The young woman winks at me, as if to say ‘I know my Mom is anxious’ and when I begin my physical exam by feeling her Mother’s neck from behind she chirps in “Look Mom, you’re getting a free massage too.”

Her mother in the meantime is trying to settle herself down by doing a deep breathing exercise. Her shoulders heave under my hands, and I notice that she continues to hyperventilate with her eyes closed when I ask her to lie down.  My inclination is to let her know ‘you’re breathing is making you feel worse’ but I wait till we are sitting down again.

Margaret tells me she’s claustrophobic and wants to take a valium prior to each treatment. I describe that people lying on the radiation machine have lots of space around their faces (not like an MRI scan). I suggest she can learn a relaxation and visualization technique from a psychosocial specialist that she could practice to reduce any anxiety she might have prior to or during her treatment.  Ben agrees to take Margaret on a tour of the radiation treatment machines so that she might feel less anxious about the unknown.

Margaret’s daughter pulls out her cell phone to show her mother a simple animation to teach the relaxation breath. A ball rises up for five seconds in a tube of slowly bubbling water, then drops slowly down to the bottom of the column over the next five seconds. The pattern continues. This app can be adjusted for varying times of up-phase and down-phase. Margaret peers into the phone and tries to time her breathing to correspond with the ball movement. Again her chest is heaving with each in-breath.

I have to stop the exercise. I’m delighted that they are so pro-active in empowering themselves to learn this essential healing skill – but Margaret’s technique is not helping her.  I offer a short explanation before we practice the breathing technique again.

Learning to tap into the relaxation response when we feel stressed is an essential healing skill. The concept is to activate the parasympathetic nervous system, invoking relaxation, by tricking our mind into believing everything is completely fine using the body’s ability to engage a specific breathing technique. This is what I call the body-mind connection (the signals go from the body to settle the mind).  When we breathe slowly and deeply into the abdomen (instead of breathing into our chests), we engage the diaphragm (the muscle that separates our lungs from our abdominal organs) and the vagus nerve that stimulates the relaxation centre in our brain.  If the out-breath is longer than the in-breath, then the relaxation effect is further enhanced.  The point here is that using the upper chest and ribs and lifting the shoulders to breathe causes more of the stress reaction.  Meanwhile, breathing into one’s belly instead of one’s chest promotes relaxation. 

I take Margaret, her daughter, and the medical student through the following technique:

1.   When you recognize you’re stressed, press the ‘pause’ button

2.   Become very curious about the sensations in your body (stay curious).  Let go of the thoughts about the situation.

3.   Take four slow breaths deep into the abdomen (or belly). Allow the shoulders and upper chest to be still or quiet.  Try lengthening the out-breath compared with the in-breath.

4.   Use the kind and wise part of your brain to direct your thoughts and actions.  You may hear reassurance like “I can get through this situation with peace and love” or “I’ve gotten through tough scenarios before and I can get through this one”.

5.   Keep coming back to the breath and your inner guide as need be.

Practicing relaxation everyday by meditating, or prayer, or positive affirmations/self-talk is a great way to reset the stress-o-meter to a much more peaceful level.  When or if we run into stressful situations, it’s easier to regain that grounded and loving state through a ‘relaxation breath’ technique as described above.

PS- Thank you, Margaret, for providing the inspiration to create this blog entry and for sharing in wonderful moments of mutual learning, peace and joy!

"I could never meditate…." by Dr. Rob Rutledge

Joanne, a Radiation Therapist, seems especially calm today.  Her dark eyes shine and her voice is soft yet confident. We’re working together in the CVsim where we take x-rays of patients in preparation for their treatments. As we work, we share stories about our kids, laughing about how work is the only place where people actually listen to what we’re saying.

I comment on how peaceful she is and ask if she meditates to help find calm in the midst of her very busy life. “I could never do that” she says matter-of-factly. “My mind would be all over the place.”

Christine, another wonderful high-energy Therapist, is listening in now. She has been going to a masseuse to help relieve the painful muscle knots in her neck and upper back that have stopped her from sleeping well for years. I can see that we can all use the teachings that Tim, my partner in the weekend retreats, offered me many years ago. So I tell Joanne and Christine about my meditation practice.

Every morning I get up about 30 minutes earlier than I would otherwise. I kneel on a pillow in a small room, and begin to focus my attention on the sensations of my breath. About two seconds into starting I start to think about what I need to do that day…. “I have a meeting at 4:30 with the radiation oncologists, and I’ll need to present the new procedure of getting patients with cancer in their bones in earlier….” At some point I realize I’m thinking about something else and, without judging myself, I bring my mind back to concentrating on my breath. Then about three seconds after that my mind starts to wander… “At the meeting yesterday, when Peilong said that we’d have to update the software on the medical record system, I cracked that joke, but everyone thought I was being serious, why don’t I just shut up, I’m such a goof sometimes…” Again at some time I can see that I’m thinking about something else and I bring my mind gently back to focusing on my breath. And 3-4 seconds later I’m off on some other thought. And back and forth I go dozens of times in a single session.  

I’ve been meditating somewhat regularly for 15 years – i.e. nothing has changed, really. Most mornings by the end of the session I do experience a sense of settling into my body, a feeling of my energy being grounded in my body. I can see my body, my emotional energy, and the thoughts that come and go – and an awareness that holds the human experience (which I believe we all share). The days I meditate I feel much calmer, happier, and I think I’m a better physician. I can focus on the person in front of me, pay greater attention to them and allow natural compassion to come through my words and actions. And I’m more efficient because I can do one thing at a time and focus my attention – and when I see my mind wandering off to something else, I can bring it back to the task at hand – just like during the morning practice.

As I’m talking to Joanne and Christine I realize I could talk for 30 minutes more on the recent science showing how meditation actually rewires the brain and all of its proven benefits but instead I summarize my monologue with “Meditation is going to be the new ‘exercise and healthy diet’ of the future”

Joanne nods her head “I think you should teach meditation to all the therapists.” We start to figure out how this could happen in our busy cancer centre when Christine asks the obvious question “Could we learn to meditate on our own?”

I offer this advice. It’s best to find a teacher or a group that meditates regularly because there is a wonderful palpable energy when people get together to meditate. But it is possible to teach yourself by watching or listening to YouTube videos in which the teacher who explains a simple technique like focusing on the breath. Then practice with or without the audio – even just 5 minutes in the morning or before bedtime can have a powerful effect on how you feel and how you sleep.  

“I could never meditate because my mind goes a hundred miles an hour” is a common theme I hear in my travels. But for me the time we spend in silence is all meditation – not just the moments when the mind settles and we experience peace. Meditation is also about becoming friends with ourselves. The emotional energy is going to vary from day to day and even within a single session.  We can begin to see that our thoughts are going to come and go – and we don’t need to get so attached to them.  It’s natural. And we can learn to love ourselves for our full humanness just as we are.

Befriending the Monster at the Door - By Rob Rutledge MD

Dr. Rutledge was a guest speaker at the Young Adult Cancer Conference on June 7th in Toronto. After hearing Travis Gobeil speak at the conference, Dr. Rutledge wrote this article:


Befriending the Monster at the Door

“It’s like there’s a huge monster at the door and he’s so scary that I don’t even know what he looks like”. Travis, a young man in his early thirties, tells a group of cancer survivors what it’s like to live with the anxiety and the panic attacks that he has suffered since his diagnosis of Hodgkin’s lymphoma, over eight years ago. 

“If the monster started knocking at the door, I would just cower in the basement, covering myself up with blankets, hoping he would go away.” He speaks figuratively about the first few years after the diagnosis when, at seemingly random times in his life, he would suddenly be overwhelmed with such a heart-pounding sense of dread, he thought he would die. Trying to ignore the feelings or escaping what was happening by distracting himself with video games simply wasn’t working. “It just felt like every time I didn’t acknowledge him, he would come back even stronger and uglier. His pounding just got worse and worse.”

The leader of the session explained the difference between a defensive mechanism and a conscious strategy of working with anxiety. A defense mechanism is a way for the psyche to simply suppress the overwhelming feelings so that we can continue to function – usually only just well enough to get by. Suppression happens mostly at a subconscious level, and does not allow the psyche to process, come to terms, or even potentially reframe or overcome the source of the anxiety. Developing a conscious strategy to work with the anxiety takes deliberate intention and work – and ultimately will allow the brain to rewire itself.

The first step is to acknowledge, and with time, accept that anxiety is a natural part of life. (Of note: anxiety significantly affects at least 20% of people affected by cancer). Our ancestors developed these deeply seated psychological mechanisms to learn from fearful situations so that we humans wouldn’t repeatedly expose ourselves to predictable/known risks. ‘Once bitten, twice shy’ stops us from re-provoking an aggressive dog and increases our chance of survival. Anxiety and panic attacks become problematic when they persist unnecessarily and cause us debilitating symptoms.

Travis then describes the classical desensitization process. “Finally, I got some help. I learned that if I heard the knocking at door, instead of running away, I would actually go to the front door. At first, I’d look through the peephole at the monster – even just for a moment. It helped me to see him as a large red bull -horned beast – it’s both visual and visceral – and it gave me a sense of control. Over time, I could open up the front door just a crack and I’d tell the monster to go away. We weren’t really friends. As the years went by, I’d hear the monster there, and kind of shout out to him ‘OK. I hear you. Thank you. You can go away now.’ And his knocking got a lot quieter.”

The work here is to accept whatever feelings and thoughts are knocking at our inner door. To stay with the most difficult feelings. Simply Stay. Acknowledge. Even befriend the monster at the door. Like the 15^th century Sufi mystic Rumi suggests in his poem The Guest House (translation Barkman Coles) the difficult emotions point us to something bigger in ourselves.

This being human is a guest house

Every morning is a new arrival

A joy, a depression, a meanness

Some momentary awareness arrives as an unexpected guest

Welcome and entertain them all!

Even if they’re a crowd of sorrows who violently

sweep your house empty of its furniture

Welcome and entertain them all

They may be clearing you out for some new delight

The dark thought, the shame, the malice

Meet them at the door laughing

and invite them in

Be grateful for whoever comes

For each has been sent

as a guide from beyond.

One of the many benefits of a meditation practice is that it can help to bring a sense of spaciousness and awareness that can hold whatever is coming up in the level of our mind. Brain science shows that meditation empowers the left prefrontal lobe which is responsible for dampening down over-exaggerated emotions. Our brains become wired to gently hold all of our experiences with a greater sense of equanimity and compassion for ourselves.

Travis’ final words to the group offer great wisdom. “I don’t think you want give the monster a big hug right away. It takes time. Lots of time. And I think the monster will be part of my life from now on.” Then Travis’ tone gets really serious as he looks directly at all the people in the room. “I can’t say how important it was for me to get some professional help. So if you have any issue I really think it’s best to see a councillor, or social worker or whoever. It makes all the difference in the world.”

Health Care Outreach Mount Allison generously donated $2,100!

This student-led group first heard about the Healing and Cancer Foundation through Dr. Simon Walling who recommended the Healing Circle book for an outreach project. After research into the foundation they were “more than impressed with the unique integrative approach to cancer care” that we encourage. 

Health Care Outreach has been involved in developing and working with various health-related initiatives and organizations over the past few years. They believe in the importance of mind, body and spirit for overall well-being, health, and healing.

We are truly honoured by this wonderful group’s donation which contributed towards our “Skills for Healing” Cancer Weekend Retreat in Sackville, New Brunswick.

Dr. Rutledge's Article in CBCN Network News

See Dr. Rutledge's article "Soothing facts about stress and breast cancer" on page 12-13 in CBCN Network News.http://www.cbcn.ca/documents/network_news/NetNews-Spring14EN.pdf

Happy New Year !

Happy New Year! (and Merry Belated Christmas….. oops, a bit slow in getting this out this year). Hope you had a great Holiday break.

I’m sitting at a hockey rink overlooking my son Graham’s hockey practice. Graham, age 13, has suffered three mild concussions in the last 6 months – and this is his first practice back with the team. The first one happened at the cottage while skating backwards on in-line skates. The second, while trying to get past a very large defenseman at a hockey tournament six weeks ago – and the third in hockey practice, three weeks ago, in which the coach was trying to teach the forwards how to forecheck – and Graham played the dutiful guinea pig. Since then he has had grumbling headaches- though we can take solace in the fact he got 100% on his math test a few days after the hit.

The worry about how/when Graham will recover is probably the one outlying stress in my life. I hope he doesn’t have to give up hockey too early because he absolutely loves it. He loves the competition. He loves training. He loves setting a goal for himself.

(Frankly, I hope he doesn’t have to give it up because of the joy it has brought my life. I love being outside shooting shots in the driveway with him, and playing keep-way on the front yard rink. And the rink is just a make-work project, an excuse to get outside and putter).

I guess I’m just mourning the loss of his childhood and the fun we have had together. Though, the flip side of mourning the losses we experience each day is that we can appreciate the life we do have that much more.

Heading the list is family.

I’m really happy for Jeremy, now in grade 11, who has finally hit his stride. He transferred from a private school to the ‘IB’ program in the public system. My impression is the IB teachers are amongst the best in public school and given the volume and difficulty of the material the kids are expected to master (the physics they covered in first two months matches what the advanced ‘non-IB’ physics class will cover in 2 years), Jeremy’s classmates are often as serious about school as he is. (Frankly, I’m jealous of the quality of education he’s receiving).

More than the academics, Jeremy has made some great friends in the larger school. Gabbie, a true friend, just adores him. She took him shopping yesterday to spruce up his wardrobe. I’m happy because she is very bright and very hard-working (which I’m hoping will rub off on Jeremy).

Jer still hosts the ‘improv’ club (2 guys, 2 girls) at our house every week or so. They may not do any improv games – but they watch youtube clips, play games, and have lots and lots of laughs. Again, I’m jealous – way more fun than I ever had in High School.

To fill out a very busy life, Jer is still taking voice lessons with Paula (yet another wonderful person in his life) and is singing in both the high school and regional choir (visit http://www.youtube.com/watch?v=nKl1Znn3J54&list=UUBopEbN5Cjz49OMJMA9J7UQ&index=1&feature=plcp to see a Christmas concert song). He loves singing and his choir mates are great people.

Jer got his driver’s licence (he’s a very good driver– cautious and natural ability – and a similar likelihood of drinking to excess as his father ie 0%)

Jer got his black belt in Karate – a test he did I front of about 80 people. I was very proud of him – he’s persisted through four years of training – partly because I go with him, and partly because he likes one of the girls in the class.

Jer and I are also going to the gym together. This started with Jer saying he didn’t know what to do in a weight room –and would like to learn before going to university. So I hired a personal trainer in the early fall who taught us a basic program which we’ve been following about three times a week. For me, it’s yet another opportunity to spend some time with him – at 16, there’s not much advice that he’ll take from me, but the snippets of conversation we have going to and from the gym are the best I get all week.

Cara is her perennial great self – she’s still working from home (mostly the books for my company/ our household). Graham is stuck resting these last few days and Cara is in reading books, and playing audiobooks for him. She is the master organizer of holidays – including our scuba vacation a year ago and the family bike tour in France this past summer. (Gee, so much happens in a single year, it’s hard to convey the fullness of this life). Of France, I can say it was a good thing we were biking 40-60km per day to make up for our daily consumption of 5000 calories of French pastries and fine dining. It was absolutely beautiful and peaceful – and especially enjoyable as sister Lou and family joined us there.

In my other worlds – as a Radiation Oncologist and as the leader of a charity www.healingandcancer.org – all is well. As much as I love support groups and speaking in public I think I would miss the direct patient contact if I quit my day-job. It’s just a very concrete way of helping people. I think Radiation Oncologists are a very satisfied group because the results of the treatment (like lessening of pain) are dramatic and often persistent. I am so fortunate to be paid for what I love to do. (Lovely 9min video on radiation oncology that I help produce this year: visit http://vimeo.com/32336225)

My charity work has been challenging (ie leading an organization while having so much work and family responsibility) and we’re hoping to raise some major funds to sustain our work for the next few years - please say a prayer for me. I do believe that persistence will pay dividends eventually – For instance I gave a webcast ( visit http://vimeo.com/33700823 ) on ‘complete prostate cancer care: how to integrate the best of conventional and complementary medicine’ which was viewed live by 127 computers/people across Canada in early December. And we just found out that we received a $63K grant from the Atlantic chapter of Canadian Breast Cancer Foundation to create an 8DVD set, 45min documentary, and short public service announcement – from the footage of an upcoming retreat for women affected by breast cancer. For more of what’s going happening on this front visit www.twitter.com/healingncancer

So life is fulfilling for me now. And this I hope from deep in my heart for you this year and beyond.

Lots of love to you and yours.

Robr