Step #1 Rapport Building ( Get to know the person and make them feel at ease and that they can trust you, and that you have their best interests at heart, elicit cooperation)
Hi, Good Morning! My name is _____________.You must be Mr._________. Its an honor to work with you Mr. _________ . Can I call you___________? Well, _________, I’m part of the surgical team and I’m here to talk to you about getting you through this as easily, comfortably and quickly as possible. Would you like to spend a few minutes with me learning some extremely effective tools you can use to make your experience more enjoyable? …(get response)
Step #2 Orientation to the Technique ( Explain, sometimes using embedded commands and hypnotic language, the process; get them to feel that they are part of the team; ask a few questions, elicit commitment)
Great! Well that’s what I’m here for. My job on the surgical team is to teach you some easy-to-use, tried and true methods for stress reduction and relaxation that have been proven effective to reduce discomfort and speed your recovery. Your job, as part of the surgical team, is to be the one that enjoys using them as often as you want. And, by the way, since you really are part of this surgical team, if you have any questions or comments, please be sure to let me know. It may be reassuring to know that you’ve already done the most important thing you could do, which is to get here. You are safe now, and what I’m going to teach you works. And if you have any refinements or suggestions as to how it could work even better for you, that is excellent. Your unconscious mind knows what’s best for you and you can trust your feelings to help us tailor these methods to fit you perfectly. You know, what you think makes a great deal of difference. (Have you ever seen a person blush? Well, you know nothing has happened except a thought, an idea, and all the little blood vessels in the face responded. So, what you think in your mind will make a great deal of difference in your body.) And you really can use your thoughts to relax deeply.
There will be lots of times when relaxation will be beneficial, for example, when you waken up from the anesthetic, you’ll find yourself on the breathing machine. This is a routine procedure for all surgery patients and is only temporary, until you fully wake up from the anaesthetic and can breathe on your own. You’ll have a tube in your mouth and throat and the machine will be breathing for you. Have you ever experienced this before? (…get response…) Well, the machine will have a rhythm, and if you will allow your body and mind to find this rhythm, your lungs and heart will begin to work together very quickly.
After you are breathing on your own, it is important to breathe deeply to keep your lungs open. This stretches the chest wall and accelerates the flow of air to your heart. And you can clear your lungs by coughing. The most important thing is to allow the chest to fully expand and contract so that a normal healing takes place. That’s important, for a natural reaction is to try to protect the incision. Your cheat and lungs can handle it, so its worth it to let go of your concern and keep your lungs clear, by breathing deeply.
Now I’m going to ask you a few questions:
What’s the biggest obstacle you’ve overcome in your life?
What are you looking forward to doing after this is all behind you
What’s the positive effect this is having on your life?
Is there anything you want me to know?
Step #3 Teach Relaxation Response ( teach the induction and practice it with them)
OK, let’s begin. Ready? You know, the national Institute of Health recently recommended Meditation, Bio-feedback ad Hypnosis for stress relief and pain reduction. We’ve found that a similar method of mental conditioning and relaxation will reduce your stress and allow you to be calm and relaxed, thus reducing you need for drugs and will speed your recovery time.
NOW, its a very simple and straight forward method that we use here because we’ve eliminated any extraneous bells and whistles and streamlined the process for maximum effectiveness and ease of use. That way you’ll remember to do it for yourself and enjoy positive results. Sound good? Great. So what we’ll do is learn the technique first, practice it a bit so you feel comfortable with it, and then see how you can use it. This is how it goes: I’m going to count to 3. On 1, close your eyes… At 2, with your eyes closed, look up as if you’re trying to see the inside of your head… And as you keep looking up there, take a deep breath in and hold it for a count of three…1 – 2 – 3. and at three, just let go… exhale, let your eyes relax and let your body go all limp, like a rag doll, loose and lazy-like, your limbs heavy – that’s right. O.K.? Any questions? Great lets try it again for practice………………………..(Repeat above process)
OK, one more time for good luck…………….(Repeat again)
Step #4 Utilization of the Trance ( future pace use of relaxation response, ego strengthening suggestions, direct and indirect, metaphors for endpoints)
And now you can just stay relaxed this time, and I’ll tell you a few things that are important. You’ll hear everything you need to hear, and remember everything you need to remember. In your mind’s eye, I’d like you to go to a comfortable place that you find relaxing. A place where you can goof off, cool out and regroup. For some people, this could be a body of water like a lake or the ocean, it could be a garden, or your favorite room; it could be real or totally imaginary. So when I say your “comfort place,” I mean a safe, peaceful place, enjoying yourself, totally free from responsibility, just goofing off, relaxing. Doing nothing or whatever it is you like. Be there now, and with every breath, get more and more in touch with that place. See all the beauty that’s there through your own eyes as you are there now, the sky if you are outside, what ever setting is there if you are inside. Hear all the sounds that you would hear there, the sounds of the water, or the birds singing, or whatever is true for you at your particular place. Touch your surroundings. What does it feel like? Use all your senses, are there any fragrances there that you enjoy? Feel the good feelings of being there now fully, and thoroughly enjoy how good that makes you feel.
And as you continue to relax, you don’t even have to pay attention consciously to my words, you can just listen to the sound of my voice, and rest assured that part of your mind will continue to listen, to record and utilize any and every positive suggestion, …thought, …idea, that I offer you. And you can forget about anything for a time. You can forget what feels bad, when you think about something else. And its reassuring to recognize that that is what your imagination is for, and you’ve been doing that your whole life. Like daydreaming in school. The teacher teaching 2+2=4, 4+4=8, etc. and your mind is thinking about being outside playing baseball or something. Your body can be here, but you can be somewhere else. And that can be useful. If you’re waiting to be seen, you can be quietly off enjoying whatever you want, until you’re needed. The staff all know what this is about and will help you to be as comfortable as you need to be. In fact, every time you see a nurse or doctor, that will deepen your experience of sailing comfortably through this – easily trans-porting yourself through. And when you hear the different machines, noises and voices around you, those sounds will also serve to deepen and expand all the internal experiences you can have. And you can be curious about just what will happen next in there, and wonder about it all, so easily, lazily – just goofing off.
Sometimes sights or sounds that are unusual at first can become routine and normal, even expected and comforting. As an example, I have a friend who lives next to a highway, and for him the traffic sounds have become like the sounds of waves at the beach. In the same way, when you hear the beeps and motors of the monitor, you can drift ever more comfortably, ever more deeply into your healing, stress-free state. And when you see a nurse, you can go even more thoroughly to a place of peace and calm, away form any distractions. Everything in the recovery room will remind you that you are being well cared for and caring for yourself from head to toe. You can even have these responses when you are awake. That will be nice, won’t it? What a nice surprise, to discover that you can relax any time you want and know that all is as it should be.
You know that’s a good thing for the rest of your life too, to change negatives on the outside to positives on the inside. And go to your deepest resource, to Internal peace and quiet – the people and things that are important to you. Now… you enjoy this experience.
You’ll have all the time you need – you know, a moment of pleasure can last for hours – and time stands still, when you need it to. Next thing you know, you’re walking out of here under your own steam.
During the surgery, you can relay on your abilities, your natural biological abilities, that everyone has, and you have too, to keep the bleeding to a minimum… just enough to keep the incisions and the area that the doctor works in, clean and fresh, bringing just the right amount of oxygen. Your body knows how to do this. And your body knows how to bleed and how to stop bleeding – you’ve done it hundreds of times in the past. You’ve maybe cut yourself shaving and that bleeding stopped. You can ask yourself to provide just the right amount to help the doctor’s work and then just the right amount for healing, recovery and your everyday need. Your body knows how to do this, it does it all the time – Like everything else, it is nice to be asked, so ask your body to provide this help.
When you’re changing an oil pump , you want a nice clean working area – when everything is installed in just the right way, all the gaskets in place, its so nice to know you can trust the work and have everything flowing smoothly, the way it’s designed to.
Every time air enters your lungs, you’ll be reminded to relax and take it in fully. When the operation is over and you’re coming out of the anesthetic, as you become aware of the sounds of the breathing machine, you will become more relaxed in your mouth and throat and jaw and chest. Each sound and each breath will remind you to relax more and more. You can go to your “comfort place” now and goof off. The machine will be doing your breathing for you and that’s O.K., time will pass very quickly. Before you know it, at the right time, the machine will be removed. With each breath, as you breathe in, you can relax a little more. And with every breath, as you exhale, you can relax a little more deeply, letting go, limp and languid, your throat, jaw and chest learning to let go and allow healing to continue. And you can continue to relax any time with a three count.
When you need to cough, just hold your pillow to your chest and clear out those lungs. Just hold your chest. There’s something comforting about that.
You are in good hands, and can turn over your care to the staff who will be monitoring everything very closely.
At this time, you can remember that in your “comfort place,” your body knows how to do the right thing to protect you, and you don’t have to know how consciously. Just like bears and squirrels, who hibernate in the winter – and wake up when the time is right. And you can do that, too. You can hibernate, you really can, while your heart adjusts, finds the rhythms that are right for you – and its comforting to to know that when adjustments are needed, or the synchronization is off, there is a natural warning sign that occurs as a fluttering. If that occurs, that will be your signal to deepen your trance state and let your body make the adjustment. You can hibernate just like the bear, or fly south, if you prefer. You see, these are natural, biological synchronizing activities, just like daytime or nighttime. And there are other cycles just like that, that get out of synch temporarily, like in jet lag when a person’s whole system can be off for as long as ten days. That’s a long time. Everything in this hospital stay is a lot shorter. Difficulties and discomforts go away in a short time. Irregular heartbeats can be adjusted internally, when the stress is removed.
Hummingbirds are called that because the rhythm of their wings makes a hum in tune with their internal timer. You also have an internal timer, which is found, was deep down beneath the normal stresses of everyday life. The hum that all the other activities arise from. So, go to your comfort place, deep, deep during the recovery as often as you need.
Your body knows what’s right for you. You need not know how, you just need to know that you know deep down in the feel of it. That quiet relaxation at the beach, or your favorite activity, when all is well, where you renew and re-create your way. Throats relax, jaws relax, the face gets calm, chest muscles let go and relax as lungs clear, hearts synchronize. Everything becomes coordinated, in time, in the right time. And you can help keep the wound clean and dry and free of infection, just by asking that it be done, in that comfort place. In recovery, a person needs recovery hormones flowing though his body – a guy who’s running a race needs other stuff that doesn’t help now.
1 – 2 – 3 You will have all the comfort and survival reactions you need, available to you – and every time you see a staff member and hear the sounds in the recovery room ,these will act as cues to deepen your recovery processes and let your worries or anxiety fly out the window, while you stay, comfortable, easy, trusting and flowing along with the recovery – You are in exactly the place you need to be, and everything is as it should be for you. And you have the power to trans-port yourself through this journey. For you will learn a lot unconsciously and consciously, that will bring you through in all the right ways for you. And you will carry your learning with you in the future, into all your activities – your health and your pleasures, your ambitions and desires.
Step #5 Reorientation (give them the option to come out of trance or not,since they’ll be using this on tape)
And now, if you are listening to this tape recording you can choose to follow my voice back to full waking consciousness now, as I count from 5 back to 1, or you can just let yourself drift even deeper into a comfortable trance state, or even drift off into a deep and restful sleep. That’s OK. Whatever is appropriate for you… , …gently returning, , …in your own time and at your own rate, , …its OK to bring those feelings of comfort with you, it might be nice to realize that you can enjoy these feelings and be awake at the same time, , …and you might want to take a deep breath or two, and , …that’s right …Excellent.
By Kathleen Doheny
FRIDAY, Dec. 13, 2013 (HealthDay News) — Women fighting an aggressive form of breast cancer may benefit from adding certain drugs to their chemotherapy regimen, and taking them prior to surgery, new research finds.
This pre-surgical drug therapy boosts the likelihood that no cancer cells will be found in breast tissue removed during either mastectomy or lumpectomy, according to two new studies.
The approach, called “neoadjuvant” chemotherapy, is being given to an increasing number of women with what’s known as triple-negative breast cancer. Currently, the approach results in no identifiable cancer cells at mastectomy or lumpectomy in about-one third of patients, experts estimate. In such cases, the risk of a tumor recurrence becomes lower.
“Chemotherapy does work in triple-negative breast cancer. What we want to do is make it work better,” said study researcher Dr. Hope Rugo.
Rugo is director of breast oncology and clinical trials education at the Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco.
Triple-negative cancers have cells that lack receptors for the hormones estrogen and progesterone. In addition, they don’t have an excess of the protein known as HER2 on the cell surfaces. So, treatments that work on the receptors and drugs that target HER2 don’t work in these cancers.
In two new studies, researchers got better results by adding drugs to the standard chemo regimen prior to surgery. However, both studies are phase 2 trials, so more research is needed.
Both studies are due to be presented Friday at the annual San Antonio Breast Cancer Symposium.
Rugo compared standard neoadjuvant therapy — paclitaxel (Taxol, others), doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan, others) — to standard therapy plus the drugs veliparib (investigational) and carboplatin (Paraplatin).
Of the 38 women with triple-negative cancer in the study, 52 percent of those getting the extra drugs with the standard approach had no cancer cells identified at surgery, compared with 26 percent of those on the standard therapy.
In a second study, Dr. William Sikov, at the Alpert Medical School of Brown University, and colleagues compared the standard chemotherapy using anthracycline- and taxane-based drugs with three other regimens. These added carboplatin, bevacizumab (Avastin) or both to the standard regimen.
The researchers randomly assigned 443 patients with triple-negative breast cancer to one of the four groups. Those in the combination groups were more likely to have no breast cancer cells found at surgery than those in the standard groups. While 42 percent of those in the standard group had no breast cancer cells identified at surgery, 50 percent to 67 percent of those in the combination groups did not.
Genentech, which makes Avastin, funded Sikov’s study. Other supporters included the U.S. National Institutes of Health and the Breast Cancer Research Foundation.
The research presented by Rugo is funded by a variety of sources, included unrestricted funding from several pharmaceutical companies.
“Every time we have studies like this, it tells us we are on to something,” said Dr. Joanne Mortimer, director of women’s cancer programs at the City of Hope Comprehensive Cancer Center, in Duarte, Calif. She reviewed the findings. While the approaches warrant further investigation, she cautions that ”both these studies have very small numbers.”
Complicating the issue, she said, is that “triple-negative is not a single disease.” There are several subtypes, and patients respond differently to treatments. “This is very interesting, but until we know which actual specific patient’s tumors are going to benefit, it’s hard to apply this to the population,” Mortimer said.
Studies presented at medical conferences are considered preliminary since they have not yet had the independent scrutiny required for publication in most medical journals.
Copyright © 2013 HealthDay. All rights reserved.
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SOURCES: Hope Rugo, M.D., professor, medicine, and director, breast oncology and clinical trials education, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco; Joanne Mortimer, M.D., director, women’s cancer programs, City of Hope Comprehensive Cancer Center, Duarte, Calif.; Dec. 13, 2013, presentations, San Antonio Breast Cancer Symposium
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