Microsoft word - sugar or stress.doc

By Brian G.M. Durie, MD on March 1, 2012 4:26 PM| Sometimes it takes very bad news to get people to make necessary changes in their lives. Someone diagnosed with lung cancer might finally give up the 2- pack-a-day habit they've had since high school. Someone who experiences a heart attack might finally cut some fats from their diet and increase their So what kinds of changes should myeloma patients be ready to make?
In April 2009, the International Myeloma Foundation's advocacy efforts led to FDA and Medicare approval of crucial myeloma diagnostic tests, including the use of PET scans for diagnosing myeloma. The reason PET scans are successful in diagnosing multiple myeloma is because myeloma cells love to "eat" sugar, a practice which becomes visible using PET scan technology. So does that mean that by limiting sugar intake, one could essentially
"starve" the myeloma cells? There are two crucial points to consider: first,
the sugar pathways in the myeloma cells are not directly linked to the sugars that you eat. Second, any sugar you eat is immediately countered by insulin, which regulates, along with many other hormones, the uptake and use of The sugar/insulin balance is under very tight control in the body. One key point is to avoid what is called "glucose intolerance," when sugar and insulin levels are out of sync. Dexamethasone and other steroids push the body toward glucose intolerance. That is why patients taking dexamethasone need to track blood sugar and use medication such as metformin (Glucophage) to control insulin/sugar levels as needed. The relationship between sugar and insulin may be important and related to myeloma cell growth, since insulin has been shown to trigger sugar uptake and myeloma cell growth in laboratory experiments. A recent study aired as part of "60 Minutes" showed that breast cancer patients taking metformin to control diabetes had better outcomes from the breast cancer.This is in line with a recent laboratory study that showed metformin slowing cancer cell growth especially in tumors with the 17p (p53 deficient) chromosome pattern--just like high risk myeloma. So stay tuned for further updates on all of this. A second key point is that regularly including high sugar items, such as soft drinks, in your diet is not a good idea. Recent research indicates that high intake is associated with increase risk of cancer as well as heart disease as well as, of course, obesity and sugar diabetes. Soft drinks contain not only sugar in the form of fructose, but also a variety of other chemicals such as glutamate, which may be additionally harmful. What does this mean for the myeloma patient? It means that having a doughnut or an extra scoop of ice cream, while probably not the best choice for your overall health, will not have any significant impact on myeloma. However, it is very important to eat as well as possible, and Michael Pollan's "Food Rules: An Eater's Manual" provides an excellent guide. Eat "real food" and "don't eat anything your grandmother would not recognize." (Rule #1) So what about stress? Stress can be a very destructive force when it comes
to myeloma. Stress really disrupts the immune system and myeloma is a cancer of the immune system. In addition, the stress hormone noradrenaline (the "flight" hormone, versus adrenaline, the "fight" hormone) can actually trigger cancer cell growth directly. Although this has not been shown for myeloma cells, it has been for lung and other types of cancers. Hans Selye, a Hungarian scientist who worked in Montreal, Canada, showed that a chronic "alarm state" (anticipating problems requiring "flight") leads to an "exhaustion state" For a patient newly diagnosed with multiple myeloma, it might seem difficult to reduce stress, but that's where the IMF steps in to help. Our education and support programs are designed to help alleviate some stress by providing clear plans for myeloma management, thus reducing fear and alarm and providing hope to help you move forward in a constructive fashion. So while it is extremely important to be cautious about your sugar intake for your overall health, it may be equally important to reduce your stress level in order to achieve the best results in myeloma treatment. Click on the following links to learn tips for reducing sugar
intake and stress levels.
1. Be aware that sugar intake and blood sugar levels are important, but that minor, short fluctuations are 2. Check your sugar status: Is your fasting blood sugar level normal? Does anyone in the family have sugar diabetes? Was there ever a time when your blood sugar went out of range? 3. Are you overweight? There is some linkage between obesity and the likelihood of developing myeloma in the first place. In addition there is a higher tendency for acquired secondary type II diabetes especially with steroid use. 4. Are you taking dexamethasone or prednisone (both steroids) as part of your anti-myeloma therapy? If yes, discuss with your MD plans to track your blood sugar over time. 5. If your blood sugar becomes elevated, review your options carefully: Steroids can be decreased or stopped, if feasible, without having a negative impact on treatment response. Conversely, a drug such as metformin can be used to control blood sugar, and continue the needed dose of steroids. 6. If you were overweight and/or you have gained weight during therapy, look closely at your diet. Getting the myeloma under control is always the top priority, but weight control will make you healthier across the board. Be especailly aware of sweet soft drinks which contain fructose and other chemicals such as glutamate. 7. Don’t go overboard! Try the best you can. Be aware that an occasional indulgence is okay. It is the longer- term pattern that counts – chronic glucose intolerance – sugar and insulin levels that are out of sync. 8. Figure out which doctor is going to help you with these issues. Sometimes the hem/onc will help. Other times you will need to seek out an internist or dietary specialist. 9. Talk to other patients to find out what works and what doesn’t work. Get the support you need to make 10. As always, be in touch with the IMF! International Myeloma Foundation 800/452-CURE (2873) TEN STEPS TO STRESS CONTROL - FROM FEAR TO HOPE
1. Be open to the idea that stress reduction is achievable and is a worthwhile objective. 2. Identify non-cancer-related stresses in your life that may be having a negative impact, such as worry about 3. Use a scale of 1 - 10 (1 being lowest/10 highest) to assess your stress levels. Was the level of stress significant enough to have had a negative health impact? 4. Assess the level of stress you experience when you are fearful. As you await test results to see if treatment is working. When you are starting a new type of therapy. 5. Talk to your doctor about your options. Be honest with your doctor, and don’t be afraid to get a second or 6. Reduce stress where you can. This might call for drastic steps—don’t be afraid to 7. Let others help you. It will help them feel better too. 8. Have confidence that the treatment will work! Novel therapies and new approaches to treatment do work. 9. Be open to the healing power of hope—it is right there for you: From your fellow patients who are doing well, 10. Turn to the IMF for information and guidance. Use the free IMF publications to guide you


"acerca de los actos consentidos", ll 2005-c, ps. 12/15.

"Acerca de los actos consentidos", LL 2005-C, ps. A PROPÓSITO DE LOS ACTOS CONSENTIDOS Estela B. Sacristán publicado en LL 2005-C, ps. 12/15. El caso objeto de esta breve nota es sencillo; no obstante ello, permite formular algunas reflexiones sobre la llamada “teoría del acto consentido”, cuya aplicación suele inspirar objeciones del plano constitucional. En lo

Microsoft word - suspension trauma.doc

SUSPENSION TRAUMA Suspension trauma, or orthostatic intolerance, is a natural human reaction to being upright and immobile, where a complex combination of blood pooling in the legs and cardiorespiratory restriction leads to unconsciousness. It can be caused by suspension in a harness (deliberate or accidental), when trapped in a confined space, when secured to a vertical stretcher or litter -

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