Resilience: Overcoming Adversity with Success

Have you been bullied, rejected, criticized or traumatized?  When I was a child, my grandmother shared her wisdom of bouncing back despite the harsh reality of the suffering in life.  Although she would describe her life as a series of tragic events, those events not only shaped her resilient character but impacted mine as well.  Despite losing her parents and being bullied as a child and undergoing years of raising a family in internment during the war, she was able to persevere like the Daruma doll that held a place on her dresser before she developed dementia and passed.  Her stories of overcoming the odds continue to give me hope and inspiration.
Nana korobi yaoki | Fall down seven times, Get up eight
This Spring set of posts have been designed to bring awareness to overcoming just a few challenging life experiences (e.g., self-injury, alcoholism, dementia, cancer).  We all have our own challenging life experience to share that shapes our character.  This article presents some resiliency strategies to bouncing back from major adversity or trauma. Developing resilience is a personal journey. People do not all react the same to traumatic and stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies. The recommendations presented should not replace the role of a qualified health care professional.  If you are struggling through difficult times, it is important to have a strong support network which should include your health care provider.  Many studies show that the primary factor in resilience is having caring and supportive relationships within and outside the family. Relationships that create love and trust, provide role models and offer encouragement and reassurance help bolster a person's resilience.

What is resilience?

After the Civil War and following the death of three of his children to spinal meningitis, Dr. Andrew Still, the founder of osteopathy, made it his life work as a physician to discover why certain people succumb to illness while others don't when confronted with the same attack, injury, or exposure to a tragic event.  He found the orthodox medical practices of his day ineffective, and sometimes harmful. Amidst the grieving of his own children as a physician, Dr. Still evolved his medical practice to include the following discovery regarding resilience: the body contains all the elements to maintain health if properly stimulated.  Being resilient doesn't mean going through life without stress or pain but rather being able to work through these difficulties in a healthy manner.  The key is to identify ways that are likely to work well for you as part of your own personal strategy for fostering resilience.

Connect with Self & Others

Encourage a positive self-image.  Developing confidence in your ability to solve problems occurs through willingness to fail before succeeding.  Trusting your instincts and appreciating your gifts and strengths helps build resilience.
Be willing to self-discover. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality and heightened appreciation for life.
Make connections with trusted individuals. Healthy relationships with close family members, friends or others are important. Accept help and support from those who care about you and will listen to you. Some people find that being active in civic groups, faith-based organizations, or other local groups provides social support and can help with reclaiming hope. Assisting others in their time of need also can benefit the helper.

Harmonize with Healthy Values

Avoid seeing adverse events as hopeless problems. You can't change the fact that we all have our challenges and problems arise, but you can change how you interpret and respond to these experiences. Resilience involves adapting to future similar situations by learning from past struggles. Note any subtle ways in which you might already feel somewhat better as you deal with difficult events.
Keep things in perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.
Maintain a hopeful outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.

Integrate Change in your Lifestyle

Take decisive actions. Act on adverse situations as much as you can. Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away.
Accept that change is a part of living.  Certain goals may no longer be attainable as a result of adverse situations. Maximize your potential by accepting circumstances focusing on circumstances that you can alter.
Move toward your goals. Develop some realistic goals. Do something regularly — even if it seems like a small accomplishment — that enables you to move toward your goals. Instead of focusing on tasks that seem unachievable, ask yourself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?"

We can all be the change we want to become.  

It is just a matter of having the strength and courage to rise to the challenge knowing there will be struggles and obstacles along the way.  In order to succeed, we must be willing to fall down and get back up.

Exercise with Control

Physical activity is critical for overall health at every age and the benefits to daily exercise far outweigh the risks. Moderate intensity exercise is safe for most people, even those that have had previously sedentary or unactive lifestyles. Exercise, however, is not always without its risks. 
Many people are unaware of the high incidence of injuries that occur while exercising at home. According to data collected by the US Consumer Product Safety Commission, almost 460,000 people were sent to the hospital in 2012 for injuries related to exercise equipment, the vast majority involving a treadmill. An estimated 428,000 of these injuries were treated and released for their injuries—but the remaining 32,000 needed to be hospitalized for further careor even worse - were dead on arrival. The US CPSC further reports “about 19,000 people went to the emergency room from treadmill related injuries in 2009, including almost 6,000 children”. Most recently, Survey Monkey Chief David Goldberg passed away from a head injury acquired from falling on his treadmill at home. For these reasons, it is important to take the proper precuations to decrease your risk of injury. 
The Physical Activity Guidelines for Americans 2008 offers these guidelines for staying safe while exercising
1. Start with activities that match your fitness level: When you begin a new exercise program, it is a good idea to ease into a workout so as not to push your body too far and put yourself at risk for injury. 
2. Warm Up & Increase activity gradually. Moderation is the key to safe exercise. Gradually build up in intensity, frequency, and duration. Protect yourself by warming up to prepare for exercise. Warming up will get your heart rate and blood flow going, and loosen up your muscles, joints, and ligaments so they are ready for action. 
a. Use the proper equipment – Make sure you are wearing the proper footwear and loose-fitting, comfortable clothing that is breathable and will release excess body heat. 
b. Pay attention to the weather – If the weather is hot outside, make sure to hydrate and wear breathable clothing. Drink enough water to prevent dehydration and heat exhaustion. Drink 1 pint of water 15 minutes before you start exercising and another pint after you cool down. If exercising in cold weather, dress in layers to keep your body warm. 
3. Take your Time. During stretches or strength training, move through the full range of motion. Never stretch to the point of pain or beyond what is comfortable. Remember to breathe regularly to make sure your heart, brain, and lungs are receiving adequate blood flow and oxygenation.
4. Rest. Listen to your body. Take days off from exercise when you are feeling fatigued. 
5. Let your doctor know about your chronic medical conditions or if you are pregnant: Your doctor can help you tailor a fitness plan that is safe for you. 


Resources 


Chemotherapy-Induced Peripheral Neuropathy

By Mana Baskovic, Osteopathic Physician Candidate 2016

You have CANCER! Arguably, one of the most frightening statements you can find yourself on the receiving end of. This one word can, within seconds, cast a shadow of fear, uncertainty, questions, anger, and sadness upon a person and their entire family. But, we now also live in an age where perhaps many cancers can be cured or treated. Women with breast cancer are now living well beyond the five-year time-point, where at five years you are considered to be in “remission” and cancer free (where the risk of the cancer returning is reduced to single digit percentages). So with all of the remarkable advances in cancer treatment, why is it that we find remnants of the disease that persist long after the cancer is removed; case in point, chemotherapy-induced peripheral neuropathy. 

What is Peripheral Neuropathy? The term “peripheral neuropathy,” “polyneuropathy,” and “neuropathy” are used interchangeably, even though each describes a unique entity of neurological disorders. Broadly, the terms refer to a generalized process affecting many of the peripheral nerves, while distal nerves are more greatly affected, specifically the nerves providing sensation to the fingers and toes. 

What Causes Peripheral Neuropathy? While there are numerous factors that can cause peripheral neuropathy, some of the more common culprits include platinum-based chemotherapy drugs, long-term diabetes, alcohol abuse, and less common neurological accidents and/or disorders. 

How Do I Know If I Have Peripheral Neuropathy? The symptoms of peripheral neuropathy usually include symmetrical loss of sensation, tingling, burning, and/or weakness. The symptoms are most prevalent in the fingers/hands and toes. However, some patients report having nerve symptoms in other locations as well.  The symptoms can lead to difficulty walking, as we rely on our toes for movement, and trouble with daily activities that require intricate use of our hands, for example typing, opening containers, combing hair, etc. The pain and discomfort of peripheral neuropathy are often times accompanied by sleep and mood disturbances, fatigue, and difficulties carrying out everyday life activities. 

Connect With Your Nerves

The central nervous system is made up of the brain and spinal cord. Information is transmitted to and from the central nervous system via nerves, similar to telephone wires. These “telephone wires” are called “peripheral nerves” in the human body. Peripheral neuropathy is characterized as any disorder that prevents the proper functioning and transmission of information through nerves. This damage can lead to decreased sensation or over-sensitization where the smallest stimuli, that may normally be painless, can cause severe debilitating pain.

 What is Chemotherapy-Induced Peripheral Neuropathy (CIPN)? Commonly used chemotherapy drugs that have been linked to CIPN include ixebepilone, the vincaalkaloids (vincristine and vinblastine), the taxanes(paclitaxel and docetaxel, and platinum-based regimens (cisplatin, oxaplatin, and carboplatin). While some patients with CIPN appear to recover after treatment is discontinued, the same is not true for patient treated with platinum-based drugs. Researchers have found that 30-40% of patients undergoing chemotherapy go on to develop signs and symptoms of peripheral neuropathy. CIPN generally begins to rear its ugly head after the first dose of chemotherapy and the symptoms tend to worsen with each additional treatment/cycle, simply put the symptoms and damage become additive. The unfortunate reality of platinum-based chemotherapy drugs is that the damage that is caused to the peripheral nerves is usually long lasting, if not permanent. 

What are Possible Preventative Measures? According to the National Cancer Institute, the following preventative measures have shown promise in limited clinical trials. 
Glutathione | Low levels of glutathione have been found in “wasting and negative nitrogen balance,” as observed in diseases such as cancer. Glutathione acts as an antioxidant reducing and eliminating reactive oxygen species. 
Intravenous Calcium and Magnesium | In recent studies, researchers have found that only 4% of patients treated with IV calcium and magnesium, before and after each chemotherapy treatment, had to discontinue treatment due to neurotoxicity, compared to 33% that were treated with placebo only. Also, the same study found that of those patients treated with calcium and magnesium who went on to develop CIPN, the onset of symptoms was often delayed and lesser in intensity. 
Interleukin-6 (IL-6) | IL-6 in the human body is secreted to stimulate the immune response, ie. during infection or other tissue damage (cancer therapy). In recent animal studies, IL-6 has been found to prevent peripheral nerve damage. 

What are Possible Medical Treatment Options?
Gabapentin (Neurontin) | A medication used for both prevention of seizures and pain management. This drug is currently FDA-approved for use in seizure disorders and neuropathic pain following shingles. However, off-label use of the drugs has become common place in treatment of CIPN. 
Valproate (Depacon) | This drug is an anticonvulsant (anti-seizure) medication used in the treatment of many disorders including anorexia, panic disorder, anxiety, post-traumatic stress disorder (PTSD), bipolar, and migraines. This drug is also prescribed “off-label” for the treatment of diabetic neuropathy and hence why it has also been used in CIPN. 
Antidepressants | Another off-label use includes that for the antidepressant venlafaxine (Effexor) used in the treatment of CIPN. However, it is uncertain whether the drug actually combats the damage to the peripheral nerves or if the anti-depressant effects play the larger role. 


Harmonize With Your Body

What lifestyle changes can help? 
Stay Active | It has long been proven that patients who are active, within reasonable means, before, during, and after chemotherapy treatment tend to do better overall. The thought is to “move your body every day,” even if it is a short walk, gentle stretching, or anything with reasonable intensity. Listen to your body. 
N-Acetyl Cysteine | This supplement can help your body produce more glutathione, which as mentioned, is an incredible antioxidant that helps to detoxify your body as a whole. 
Alpha Lipoic Acid | This antioxidant in most natural health stores is found to be effective in CIPN prevention. 
Omega-3 Fatty Acids | This powerful antioxidant found in fish, but also available in tablets, reduces inflammation throughout all of the tissues of the body. 

Integrate Complimentary Integrative Medicine

What can be expected during an osteopathic manipulative treatment? 
Your osteopathic physician will begin by assessing your symptoms, both from a medical and lifestyle perspective. The physician will increase lymphatic circulation with various maneuvers to encourage elimination of waste and proper cleansing of the tissues.  Strain patters will also be addressed and released to allow increased blood supply and nerve conduction to various tissues. Another technique that can be of benefit is myofacial release of strains in the fascia (connective tissue below the skin), muscles, and joints. 

References:
1. http://www-uptodate-com.proxy.westernu.edu/contents/overview-of-polyneuropathy?source=search_result&search=neuropathy&selectedTitle=1%7E150#H3
2. https://www.columbianeurosurgery.org/conditions/peripheral-nerve-disorders/
3. http://www.cancer.org/acs/groups/cid/documents/webcontent/002908-pdf.pdf
4. https://www.caring.com/articles/peripheral-neuropathy-treating-it-the-natural-way





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