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A chapter of this length cannot do justice to the history of theories of stress and stress reduction and the ways of life that arose to accomplish this. Nonetheless, stress reduction, albeit under different names, has always been of interest to humans and has received close scrutiny in the twentieth century after the chemical link between stress and hormones was delineated. Thus, various ways to reduce stress have been discovered-or rediscovered.
Kathleen Houlihan describes her plans for reducing stress and bringing her entire body into the healing process:
I'm scheduled to have my next round of chemotherapy a week later than usual to give my white cells a little longer to recover. Meanwhile, we're back into our routine here, and I'm trying to add some meditation, visualization, and joumaling to all the normal day-to-day stuff.
The following sections list, in alphabetic order, techniques that many have found useful for reducing stress. Not all of these will work for anyone person; in fact, it's possible that none of these will work for you during particularly stressful times, such as periodic checkups, or if you have a symptom that might indicate recurrent lung cancer. We hope, though, that the following ideas will help you discover your own ways to unwind.

Acupuncture
Acupuncture is a versatile way to reduce stress and pain and is particularly good at relieving certain kinds of pain.
The ancient Chinese mapped the flow of energy in our bodies through pathways called meridians. These pathways are thought by Western medicine to be neuroelectric, although there continues to be discussion about the exact nature of these meridians. Eastern medicine believes that the misdirected flow of energy through these meridians accounts for most of the imbalances that occur within our bodies and that these imbalances cause illness and can be detected in twelve pulses.
The central nervous system produces hormones for which receptors exist on the surfaces of white blood cells. Recent gains in knowledge regarding this interaction of the central nervous system and the immune system may explain more fully some of acupuncture's mode of action.

An experienced acupuncturist will spend at least an hour taking a comprehensive medical and emotional history; will use few needles, perhaps no more than six; may prefer Japanese to Chinese needles because they're thinner; and will be skilled at using the needles in a way that is not perceptibly painful, or barely so.
The needles come in packets for single use only. You'll be able to see your practitioner opening these packets, which is reassuring if you have well-justified doubts about the reuse of needles. All body surfaces on which needles are used are cleaned first with rubbing alcohol.

Certain acupuncture treatments call for the burning of an herb called Moxa that may irritate your lungs. Tell your acupuncturist if you prefer to avoid this phenomenon.
Shoes should come off last and go on first. The easiest and most regrettable way to find a tiny, thin, lost acupuncture needle on the floor is with your bare foot.
It's becoming increasingly common for health insurance companies to pay for part or most of an acupuncture treatment, although they generally pay less for psychological diagnoses (such as stress) than they do for medical diagnoses (such as migraine or endometriosis) .
In some states, an acupuncture practice must be supervised by a medical doctor. Verify the licensing and credentials of your practitioner with your state health department.

Biofeedback
Biofeedback is a way to relearn how to relax, usually monitored by a psychiatrist or psychologist.
During initial biofeedback sessions, sticky sensors are attached to various muscle groups on the part of your body that seems tense or is in pain, and a graph of muscle tension is displayed on a screen that is similar to a home computer screen. Relaxation tapes or the guiding voice of a therapist are used to establish a calm atmosphere.
When you have relaxed these muscle groups, you can tell you've succeeded because the indicators on the screen have changed.

After a few sessions with the sensors and the screen, you no longer need them for echoing success, and you switch to doing relaxation exercises on your own. It is important to rehearse this stage of independence over and over with a therapist so that soon you can do the exercises independently in any setting.
As with acupuncture, its becoming increasingly common for health insurance companies to pay for part or most of biofeedback treatment, although they generally pay less for psychological diagnoses (such as stress headache) than they do for medical diagnoses (such as migraine).

Counseling
Counseling sessions with a mediator or therapist who is experienced in cancer survivorship issues have proven very helpful to many people. Three randomized studies, including Dr. Spiegel's work with breast cancer survivors, have shown increased survival among melanoma and breast cancer survivors who received counseling.
Group counseling or support with other cancer survivors is a wonderful way to reduce stress. The group generates camaraderie, reduces feelings of isolation, offers practical as well as sympathetic support, and can become the source of many new friendships. See Chapter 16, Getting Support, for more information.
A counselor might be a psychiatrist, a psychologist with a PhD or a masters degree, or a licensed social worker. Some insurance companies pay a larger percentage of the cost for sessions with a psychiatrist or psychologist, but social workers often charge less to begin with.

Exercise
Modest regular exercise is a wonderful, well-documented way to reduce stress as well as improve overall health. Exercise also generates endorphins, the body's natural opiates, which reduce pain and ease depression.
Kathleen Houlihan wisely realizes that exercise will help her:
My husband Holt decided he wanted to go hiking in Utah last week. I was still feeling a little off, but I decided to go with him and just hang out and read or meditate while he went hiking. But he ended up choosing a trail we had been on before with our friends]S and IS, so we knew it was mostly level, along a mesa top. And there was a cloud cover and occasional light rain, so it was cool. So I hiked, too-l hour out, rested and ate lunch for an hour while Holt did the scrambling at the end to check out the Anasazi ruin, and one hour back. I was a little tired, but quickly recovered after we got back to the car: That's about when I started feeling really good again.
Be careful, though, not to be too strenuous, for very strenuous exercise, such as training for a marathon, can lower white blood cell counts for about 24 to 48 hours. Do only what feels good, stopping before the point of exhaustion. Check first with your oncologist before starting a new exercise regimen, especially if you have had radiation therapy in the chest area. This treatment, if given in high doses, entails a risk of cardiac damage.

Family
Of all social support factors that appear to contribute to the positive outcome of an illness, including cancer, the support of family or very close friends appears to be highest. This effect has been shown most clearly in studies of white males recovering from heart conditions, though. The beneficial effect is less clear when other illnesses, females, and members of nonwhite ethnic groups are studied.

Most people are both blessed and cursed with family Cancer survivors report family members who range from saintly, indispensable soul mates to those seemingly hatched by Fate as an example of how not to behave. Nonetheless, at times there's something uniquely comforting about being surrounded by those who resemble you and share your body language and your mother tongue, regardless of their inclination, or lack of inclination, to offer support. If nothing else, the less helpful ones can unintentionally provide wry entertainment.
Occasionally, people have family members who need more support than the cancer survivor does or who are tooth-grindingly insensitive to what they're going through. And once in a while, stories surface about family members who actually blame the cancer survivor or family "rivals," such as a daughter-in-law, for the cancer.
Don't berate yourself if you find you frequently need a vacation from family members who put themselves first at all costs. Often, these unhealthy imbalances in family dynamics were present all along, but remained subtle and bearable until the cancer experience highlighted them.

Friends
Few other stress reducers are as good as having sympathetic, listening friends. Kathleen Houlihan is very happy with the support she's received from friends and sees her cancer experience as a catalyst:
The brightest silver lining so far in this cancer cloud is that I am back in close touch with so many dear friends and relatives, many of whom I had been pretty much on a Christmas-card-only basis with for quite a while. One of these people is my dear friend MD. My husband Holt and I met M and her husband R at a party shortly after we moved to a new city. We became good friends after we learned that they were actually at the Game of the Century (Texas-Arkansas) in 1969 in Arkansas. Holt and I had watched it in Austin, and met the victorious Longhorns at the airport that night when they returned. Oh, that Cotton Spire! Anyway, M recently emailed me a great "visualization." She said, "Like a tug of war rope we are pulling hard against this cancer thing on the other end. I know you and Holt are at the front of the line and you have a huge string of people pulling real hard, so please visualize how strong you and we all are." I really like that image.
When friends offer to help, don't be too noble to say yes. Keep in mind that often they don't know quite what to say when they learn of your cancer, especially at first, so they may prefer to act instead.

If they're good listeners, let them know if you do, or do not, feel like talking about cancer today-and that tomorrow might be different. Undoubtedly there will be days when reducing stress means talking about cancer, and other days when one more word about cancer will make you want to run for cover. Try to sense or ask if they feel like listening, too.
Far too many cancer survivors report that friends, even very good friends, disappear when cancer appears. These friends are speechless, sad, frightened, self-righteous, or guilty that they're healthy-never mind that perhaps we're much more sad and frightened than they might be.

Each of us has to decide on a way to handle this abandonment that meshes with our system of ethics. Many cancer survivors say that they just don't need additional sources of sadness, stress, or blame in their lives, and they move on to find new friends, often in cancer support groups. Other cancer survivors try to keep their old friends by never talking about cancer. Bear in mind, though, that for those who are very fearful about cancer, just being around someone with cancer might be frightening.
If you have healthy friends who have remained a presence in spite of cancer lawn mowing, grocery-buying, baby-sitting friends; friends who have listened to you when you're scared; or friends who have just spent time with you if talking about cancer is not your style-you're very lucky. Show them that you're glad they're around.

Take solace, too, in the goodwill of those you may never meet. The daffodils that appear in hospitals during the American Cancer Society's Daffodil Days in March, for instance, are from someone who wants you to feel better.

Gaining knowledge
Not surprisingly, a book such as this supports the belief that gaining knowledge about your cancer, and thus gaining some control over your cancer experience, is an excellent coping mechanism. Learning about your illness and your options has been proven to reduce anxiety and stress and may be the crucial factor in your illness and its outcome. Not only can obtaining a correct diagnosis and learning about new, more effective treatments result in sound choices, but animal studies have shown that those who perceive that they have a means to escape stressful situations maintain higher white blood cell counts than those who perceive otherwise. Bear in mind as well that although our doctors often must master information about a broad variety of cancers or are immersed deeply in their own research projects, we have the opportunity to go narrow and deep, learning a great deal about our own illness.
If your doctor seems unreceptive about things you've learned, seek a second opinion or consider changing doctors. An excellent book on this topic, Working With Your Doctor, by Nancy Keene (O'Reilly, 1998), is available.
Worthy of mention is the observation that some doctors react badly to the idea that their patients find information on the Internet, because the information available on the Net ranges from abysmal to superb. If you use the Internet to research your illness, avoid using the word Internet when discussing your findings with your oncologist. Instead, use terminology that credits the sources on which your findings are based: Medline, the PDQ database of the NCI, Cancerlit, certain reputable medical journals, and so on.

Hobbies, volunteer work
As a form of healthy denial and, in some cases, a form of exercise, hobbies are an excellent stress reducer. Immersed in an activity you enjoy, you're likely to forget cancer, breathe and laugh more easily, and feel capable.
Hobbies are especially important for reducing the stress that may be linked to the lowered self-esteem of those who are temporarily or permanently unable to return to work.

Laughter
In his book, Anatomy of an Illness as Perceived by the Patient (WW Norton, 1979), the late Norman Cousins says we should take humor seriously Cousins was diagnosed in 1964 with ankylosing spondylitis, a degenerative disease of the connective tissue that causes disability and pain. He undertook to improve or cure his condition by focusing on positive, happy thinking, and he believed he succeeded.
Funny friends, books, and movies are good ways to forget about cancer for a while and can invoke some of the healthy bodily changes that come about when we laugh and relax. Two studies have found that mirthful laughter reduces blood levels of the hormones associated with stress.
Massage therapy
The backrubs and neckrubs given to you by loved ones will release endorphins that reduce pain and depression.
The lymphatic strokes practiced by massage therapists, on the other hand, are location-specific and might utilize a lot of pressure. Always check with your doctor before having deep massage therapy, because massage is thought by some researchers to hasten the spread of certain cancers through lymphatic vessels.
Your doctor may determine that professional therapeutic massage of certain parts of the body, those that appear unaffected by lung cancer, is acceptable.
Massage therapy is licensed by some states and recognized by a national organization, the American Massage Therapy Association (AMTA). In some states, massage therapy can be performed only under the supervision of a doctor, nurse, physical therapist, or chiropractor. Your local phone book will list the nearest chapter of the AMTA for verifying your practitioners credentials. You can contact the national office by phone at (847) 864-0213, or at their web site http://www.amtamassage.org .

Meditation
Meditation is a way to interrupt negative, cyclic thinking by focusing on one soothing word or peaceful scene. Those who practice meditation regularly eventually are able to lower their blood pressure and levels of stress hormones. These reductions persist beyond the end of the meditation session and sometimes well beyond.
Lowering of blood pressure is beneficial for those who have cardiac or vascular damage.
Kathleen describes her meditation and visualization:
At this point, I hereby declare that our team has won the Tug of War against the cancer. In my visualization, my friends have pulled me so far away from the cancer that it has receded to a small speck in the distance. I think we can quit tUgging. I thank all of them, from the bottom of my heart, for the major role they have played in the saving of my life. I thank them and pray for each of them every day. We do need to maintain some level of vigilance, though, to be sure and keep it at bay. Maybe some will remain on duty to see that the rope doesn't slip. Or maybe someone can suggest a new visualization I can use to keep me cancer-free.

Minivacations, healthy denial, and escapism
Denial is a healthy coping mechanism as long as is doesn't cause us to neglect the care we need for cancer. Some healthy ways to take a minivacation from cancer are:
• Drive to work along a prettier route.
• Schedule day trips away from daily stress.
• Buy your favorite author's latest hardcover book instead of waiting for the paperback or library version.
• Grant yourself permission not to worry for one hour, one day, or one week.
• Take a nap on your lunch hour.
• Buy a pair of wild golf pants or lipstick that "isn't your color."
• Spend all day Saturday in your bathrobe reading old New Yorker cartoons.
• Write a limerick and mail it anonymously to a friend.
• Odd though it may sound, you might enjoy celebrating the parts of your body that still work.
Kathleen Houlihan tells of her techniques for putting cancer aside:
During my checkup at the Cancer Treatment Centers of America, I went to the nutrition class, taught that week by Dr. Quillan. I always find his talks inspiring and uplifting. He usually ends by telling us to get happy and surround ourselves with beauty, music, poetry, etc., and reminds us "it's not what you're eating, it's what's eating you that matters." Then lunch with my friends LW and AW and we were off by about 2:00. A full schedule. We stopped at Red Rock Canyon State Park,
just west of Oklahoma City, to look around, and spent the night in Elk City, OK, as we did last time. It's a nice little town with good Mexican food and reasonable motel rates. Friday we visited the American Quarter Horse Museum in Amarillo and checked out Conchas Lake State Park in New Mexico on the way home. We're trying to stop and smell more roses along the way.

Music, song, and dance
Dr. Albert Schweitzer once said that he couldn't imagine life without music or cats. Schweitzer was an extremely productive, altruistic, humorous man who lived and worked in a difficult setting well into old age. He was a strong believer in the doctor within each of us and thought of himself as only the facilitator of our own healing processes.
Music can lower stress and enhance emotions. You can experiment with music to see which type suits your needs at different times. Some people find the relaxing or soulthrilling effects of classical music best; others find that loud pop or rock music numbs pain and that its relatively simple, repetitive rhythms and singable melodies interrupt incessant worries. Still others enjoy rediscovering the ethnic music they may have abandoned in the past. Listening to a type of music we've never heard before, such as the Australian didgeree-doo or Tibetan chord-singing, might distract us from the worries of cancer.
Singing can release cares from your soul, might realign anxious breathing, or might improve lung capacity Singing out loud in the car when you're alone, like screaming, can lower tension levels.
Classes in dance for people of all ages and both genders are available in many community centers. If you feel that you need greater control in your life, ballets discipline, controlled breathing, and classic beauty may make you feel better. If, on the other hand, you feel there's too much control in your life, jazz or aerobics may allow you to set free some inhibitions. Flamenco might help you rediscover the sexuality that may have gone to sleep when you heard the word cancer. Yoga, t'ai chi, and Feldenkreis movement, all of which span the disciplines of exercise and dance, are fine ways to stretch and relax.

Nutrition
In general, the diet that is recommended for those without cancer-a diet high in vegetables, fruits, and whole grains-remains the best diet for those with cancer. Please note, though, that those who are losing weight, suffering from loss of appetite, or recently recovering from surgery should consult their oncologists before substituting vegetables for meat.
A few nutritional factors seem to have some effect on mood:
• A diet high in animal protein has been linked to anxiety and panic attacks. Other studies have found that certain flavonoids, compounds found in plant but not animal tissue, are similar to Valium in their relaxing action. This might mean that it's not reducing meat intake, but increasing vegetable intake that lowers anxious episodes in some people. If you're suffering from severe anxiety symptoms related to your cancer diagnosis, you might try modifying your diet to contain more vegetables and grains-but check first with your oncologist.
• Drinking milk at bedtime or eating turkey for dinner is known to help with relaxation. These foods are high in tryptophan, an amino acid that aids sleep. Tryptophan is used by the body to make serotonin, a neurotransmitter that affects mood and is the target of many of the newer antidepressants.
• Low blood levels of zinc have been correlated to treatment-resistant depression and to an increase in the undesirable immune system inflammatory response sometimes seen in depressive patients.
• Cachexia, the weight loss experienced by some cancer patients, has been linked to depression, which is thought to be triggered by nutritional deficits or by the tumor's commandeering of dietary substances otherwise needed for the manufacture of brain neurotransmitters.
Always verify a change in diet first with your oncologist.

Pets
You may find that your pets, considered family members by some, are a unique solace to you through the cancer experience. Animals seem to have a knack for knowing when we need help, and they don't care if we smell funny or if our hair is missing. They don't become instantly bashful because of our diagnosis, and they aren't afraid they'll catch cancer from us. How many humans will sit by us for an hour in the bathroom while we're sick, as our cats will? And who's funnier than the puppy who barks at the wig on the dresser?

Positive thinking and visualization
Positive thinking and visualization have been shown to increase immune system function in some studies. Oddly, one study has shown that when cancer survivors visualize an immune system attack of the tumor, using attack images that are incorrect according to what is known today about immune system function, immune system parameters still improve. This may reflect the "taking charge" phenomenon: the belief that you can escape stress tends to lessen the effect of stress on the immune system.
Visualization can be used as described above to attempt to direct inner forces against the cancer, or to relax by calling to mind pleasant experiences, places, or dreams. Initially, it might be useful to practice visualization in a quiet, relaxed atmosphere, but eventually you can do it anywhere.

Reading
As a form of escapism, reading is a good way to reduce stress. As a means of learning more about your illness, reading may make you feel more stressed temporarily, but this stress may be offset by long stretches of peace of mind after you're able to make better medical decisions based on what you've learned by reading.
If you have a personal computer, reading from and writing to the various lung cancer discussion groups on the Internet can provide a cathartic outlet for you. See "Support groups" later in the chapter.
Relaxa tion training
This technique is similar to biofeedback, and it incorporates visualization techniques described under "Positive thinking and visualization"

Sleep
Research shows that even one night of missed sleep lowers levels of natural killer (NK) white blood cells that attack tumors. Although NK counts recover quickly once sleep is restored, persistent lack of sleep is an opportunity for illness.
Animal research on the artificial shifting of the phases of lightness and darkness shows that the immune system is depressed by the shifting. Fishes that occupy parts of the ocean that receive low light in winter experience an additional breeding cycle if artificial light is increased, and simultaneously, their white blood cell counts decrease.

Snuggles and smooches
Being kissed, hugged, and patted by people who love you causes endorphins to be released within the central nervous system. Endorphins are natural opiates produced by our bodies, capable of reducing pain and depression and producing feelings of well-being.
Hugging and kissing your partner can be enjoyable and healthy, even if you're feeling too tired or pained at the moment to enjoy all of the sexual activities you enjoyed before diagnosis.

Spirituality, religious beliefs
Your religious beliefs may provide comfort when little else is making sense. Some people find that their spiritual beliefs sustain them in spite of a seemingly arbitrary infliction of suffering, either because their religion provides answers for the question of human suffering or because of independently developed theological beliefs.
A survivor describes how his faith helped them:

After surgery, the nursing supervisors tried to ask me how I felt about it being cancerous. It just kind of hits you in the face. The word cancer is a big thing. I have a lot of faith. I told the nurse, "It's in the good Lord's hands." She responded, "Well, the good Lord has sent a lot of doctors to help you." After I got out and was on pain medications, I depended a lot on faith.
Other cancer survivors, however, experience a crisis of faith after their cancer diagnosis. They find it difficult, for instance, to reconcile the emergence of a seemingly undeserved, life-threatening illness with their belief in a kind, nonpunitive deity.
On a more human level, the support that fellow church or temple members furnish to those who need help is clearly an asset in stress reduction. Support might take the form of emotional support (cards, calls, hugs, or visits), prayer, practical support (drives to and from the doctor or casseroles for supper), or financial support for someone who is underinsured.
The May 1995 issue of the Joumal of the American Medical Association contains an article showing a correlation between religious practice and prayer and increased good health. At least one other study has shown that a person who is prayed for improves when ill, even if he is not aware that prayers are being said.

Larry Coffman describes his strength through faith:
Remember that lung cancer is survivable, although I have to agree that I would be looking through rose-colored glasses if I didn't balance all this by saying that there are those that don't make it. I turned the entire matter over to the Lord a couple of weeks after diagnosis. I got very tired of living with the fear and have been at peace since. This has allowed me to concentrate on both my spiritual as well as physical and mental healing. Keep on fighting the "dragon" and empowering yourself so that you can make informed and educated decisions. I can't speak for others, but take each day as it comes and cherish the same.

Support groups
For some of us, support groups can be the difference, literally, between life and death. The opportunity to exchange information with those who have already weathered lung cancer can provide you with everything from emotional support to the knowledge to question your treatment and seek medical help elsewhere. Support groups are an immeasurably useful way to do this, bringing together a variety of skills, sometimes including medical and legal knowledge.
Moreover, Dr. Spiegel's work with breast cancer survivors shows longer survival among those who were part of support groups, a serendipitous finding from a study intending to highlight other aspects of survival.
Support groups are offered locally in many areas by organizations such as the American Cancer Society, the Wellness Community, or local hospitals. If you have Internet access, support groups are also available on the Internet. See Chapter 16 for instructions about subscribing.

Water
In the 1930s, marine biologist Sir Alister Hardy noted that humans have features in common with water mammals, features not found in any other primates, such as a subcutaneous layer of body fat; hair that grows in one direction, which reduces water resistance; a protective dive reflex within the respiratory system; a nose that blocks water during a dive; residual webbed toes; and fully webbed toes in seven percent of humans. He argues that humans might have spent a period of evolution in water.
Anthropologists may settle this point eventually, but for our immediate use, it means that, for some of us, water is a wonderful way to relax. A good swim or a warm tub with salts and a good book can make you briefly more than just human.

Writing
If you have an urge to write, you'll be encouraged to know that those who write very honestly and emotionally about their frightening, negative experiences increase the function of their white blood cells. Writing can be in a range of formats. You can write for yourself in a journal, write letters to friends, write letters for your children to be read when they're older, or write email to cancer discussion groups on the Internet.

Stress medications
Stress associated with cancer responds well to antianxiety and antidepressant medication. Research has shown, though, that these medications are most effective when used in combination with counseling and behavior modification training.
There are many drugs to choose from to ease anxiety or depression or to aid sleep. The newer drugs available today have fewer side effects and are less likely to be addictive than drugs used just a few years ago.
Your oncologist should review all stress medications prescribed by any physician, including a psychiatrist.

I always reduce my stress by listening to music. And sometimes by listening to music i feel asleep and when wake up, feels very fresh and stress gone forever.

Try to breathe and count to 10, (it really does work)
Try gentle excersises or yoga
Meditate
Reading stress books helps too