Information Session: Wellness at Home

Hi everyone, and welcome to this information session Wellness at Home. I'm Lauren Chiarello, and I'm a cancer exercise trainer and fitness instructor at Memorial Sloan Kettering. I'm also a two-time survivor of Hodgkin's lymphoma. I've been in remission 12 years, almost 12 years, so I understand what it's like to be in our patients' shoes.

Thank you for joining our live video session today. We're so thrilled you're here. We know that this can be a difficult time for our patients at MSK and their loved ones. Staying proactive and on top of your health is often difficult to prioritize.

Today with our panel of experts, we'll share some easy things that you can do at home to improve your overall well-being. We'll also share some of the questions you shared with us in advance of this session. We have some great videos to share with you, and we'll demonstrate some things you can do at home. We invite you to follow along with us today from wherever you're watching.

Before we get to that, I want to share a video about our Integrative Medicine Service at MSK. It lays out the importance of these services, especially for cancer patients.

Cancer really brings about a lot of emotional, spiritual, and physical challenges that, unfortunately, conventional medications don't always address fully. By establishing the Integrative Medicine Center, Memorial Sloan Kettering has really led the way to bring the world of complementary medicine together with conventional care.

It's a holistic approach. We're not bringing it in and just treating your cancer. We're treating your whole body.

We use non-invasive symptom management to help people get through their treatments and feel more like themselves.

Some of the integrative therapies we offer at MSK are acupuncture, massage, mind/body treatments such as meditation, yoga, tai chi, as well as in the inpatient setting we have a very robust music therapy program, dance program, and martial arts program for both adults and children.

If a patient comes in with pain, we could offer them Swedish massage or a neuromuscular therapy session. If they come in with anxiety or nausea, we can use acupressure or reiki. Every treatment is customized for the patient.

The most important thing I can suggest to all patients with a cancer diagnosis is really simply keep moving. By staying active, they maintain muscle strength, they will decrease their level of fatigue, they'll have more flexibility of their joints. The main goal is to improve someone's physical performance so they can get back to a normal lifestyle.

The Integrative Medicine Service at MSK has led many of the studies that begin to build a strong evidence base for many of these therapies. As a physician acupuncturist, I see the benefit of acupuncture every day in my clinical care. I can really help patients to address those cancer-related side effects. As a result, they not only benefit from the clinical outcomes, really, to their cancer treatment, but they have a good quality of life.

The mission of MSK isn't just to cure cancer. It's to help the patients to thrive. Integrative medicine does that.

What I love about my job is to see the change in patients when they come to me. I see them smiling, stronger, happy to tell me that they can get out of a chair without pushing off the arms. The exercise does make a huge difference.

I truly believe MSK will continue to lead integrative medicine for years to come. The work we have done is visionary and has set a new standard for how we take care of people with cancer.

To answer some more of your questions about integrative medicine, I'd like to introduce Dr. Jun Mao, who you just saw in the video we played. Dr. Mao is the Laurance S. Rockefeller Chair in Integrative Medicine and chief of our service at MSK. Thank you so much for joining us today, Dr. Mao. First off, can you share a little bit more about you how we approach integrative medicine at MSK?

Lauren, so great to see you. Everybody else, please stay safe and warm during this wintery storm. At MSK, we have just celebrated the 20th year of Integrative Medicine Service. We have built this really pioneering program bringing evidence-based and patient-centered complementary and internal medicine together with modern oncological care for people with cancer.

Our treatments predominantly consist of physician consultations that really help to understand individual patients' medical and psychosocial needs and to use tools such as lifestyle modifications, fitness, nutrition, sleep management, stress management together with selected mind/body approaches such as meditation, yoga, tai chi, acupuncture, and massage to treat specific cancer treatment-related side effects.

Last but not least, a lot of individuals are very interested in using herbs to help improve health, but herbs in cancer is a complicated issue. We want to make sure people are using it safely, it doesn't cause any herbs and drugs interaction, doesn't increase their risk of bleeding or other toxicity related to herbs. At the same time, to use herbs in a targeted way to improve symptoms and quality of life and cancer outcomes.

We really use a very personalized approach that is informed by science that really values people's choice, preference, and to really work together with oncological team to develop the right approach for each individual patient.

Well, thank you so much for that. I know your specialty is in acupuncture, which is something many of our viewers wrote in to ask about. Can you tell us some of the benefits of acupuncture for people undergoing treatment for cancer?

Lauren, you know, this is a topic dear to my heart. I spent many years doing acupuncture research. Acupuncture is a therapy that originated from traditional Chinese medicine maybe 2500 years ago. We use hair-thin needles that are placed strategically in different parts of the body to help to promote health and if you have specific problems. For patients undergoing active treatments, such as chemotherapy, acupuncture has shown through research studies to help reduce chemo radiating and the nausea and vomiting.

There's also good clinical evidence that acupuncture can help reduce fatigue, improve sleep, and psychological distress. We don't completely understand why acupuncture may work, but there a lot of animal studies as well as functional brain imaging studies beginning to shed light on the mechanism of acupuncture. What we think is the acupuncture actually stimulates our body to release endogenous opioids of serotonin and dopamine. Those are neurochemicals that regulate our mood, help to reduce pain, and improve our sense of well-being. We currently have helped many cancer patients to make their treatment more tolerable so they can go through the treatment while maintaining their quality of life.

Thank you so much. What about people who are in recovery for cancer but may be still feeling a little bit of those side effects from treatment, like neuropathy, for example. How can acupuncture help folks with neuropathy?

Lauren, this is a really great question. A lot of the time, we think the treatment's over, life should just get better on its own, but really for people with cancer, the treatment can be a quite challenging process.

Acupuncture can really help people deal with some of the side effects of the cancer treatment. For example, last year, one of our faculty, Dr. Bao, had led a trial to demonstrate the benefit of acupuncture to improve chemotherapy-induced peripheral neuropathy, this is tinglings and numbness in your hands and feet.

We actually are really fortunate to just receive funding from the National Cancer Institute to conduct the first large-scale randomized controlled trial on acupuncture for CIPN.

In other symptoms, such as hot flashes or joint aches related to hormonal treatments, or insomnia, sleep difficulty as related to cancer or cancer treatment, we have also done studies to show that acupuncture can help patients to recover and to really feel better physically and emotionally so people can return their life to the fullest function they can have.

One viewer asked, "What is the best way to rebuild the immune system after chemotherapy?" How would you answer that?

That's a great question, and a lot of people I see in clinics ask a very similar question. I always say there are four critically important things we can improve our immune systems. They're both easy and hard.

First is physical activity. Later on, you'll hear from Donna Wilson about the important role of sustained physical activities. There's a lot of good research to show that physical activity is one of nature's immune boosters.

Then, certainly, good diet. During chemotherapy, often individuals have to just eat whatever they can to get through, but, really, post-treatment, we have to really think about a healthy, holistic, more plant-based diet to recover and also prevent other health conditions.

The third thing a lot of people tend to ignore is sleep. In our society, we're taught to work hard. Oftentimes, we compromise sleep to accomplish our personal goals. Sleep is a time where our body recovers, our immune system kicking into high gear to really help to really replenish our fuse. We have to really make sure you are having adequate sleep and good quality sleep.

Last but also not least is sometimes during recovery, people will feel this heightened sense of psychological distress, feel a recurrence in emotional stress. Stress is really important for us to manage. If we can actually manage stress using mind/body approach such as meditation, yoga, or tai chi, we can really help to really regulate our stress reactions and to help put our body in a better immune state.

There are definitely things we can do, and some of the programs you'll hear later on really touch a little bit deeper on that. I want to say, going through cancer treatment is not easy, and there are things we can do together. If you need encouragement, you need support, you need guidance, that's what we are here where every faculty and staff at Integrated Medicine are here to support you through this journey.

It's been difficult for our patients who are used to having in-person appointments at MSK. I know we've pivoted a bit this past year. What services do we have available remotely for these patients so they can still get the many benefits of integrative medicine at home?

Lauren, you know, we are all now kind of stuck at home, and we miss our beautiful facility on the 74th Street and First Avenue. I think the silver lining of COVID-19 is that it has allowed us to quickly pivot to develop a large, a brand-new virtual program called Integrative Medicine at Home.

This is a program that you can register with Integrative Medicine. It runs seven days a week. It is membership-based, very affordable. It has live programming ranging from 30 minutes to an hour, including fitness, meditation, yoga, tai chi, music, and dance therapy.

Certainly, everybody may have a little bit different preferences for different things you like to do. I think it's really important during this period of time of social isolation, we have to really put our health at a highest priority. It will help us to stay well through the pandemic. Also, the social connections you'd establish with fellow cancer patients and survivors will help support each other to go through this crisis together.

I couldn't agree more. The community has been incredible. Watching it grow, it's just been really a silver lining, so I agree. Thank you so much for your insights, Dr. Mao, and for sharing all of this wonderful information.

Now I want to turn to exercise, which is an area that many of you wrote in about. I'd like to introduce Donna Wilson, who works with me in MSK as a clinical fitness specialist and personal trainer. Good to see you, Donna, thank you for joining us.

Hi.

Can you start off by sharing some more about our different exercise classes available at MSK, I know we have our group classes and personal training sessions, and just how we've transitioned into these virtual classes?

Well, it's been very exciting. I've been at Integrative Medicine for 18 years, and we started with chair aerobics. From chair aerobics, we went to Strong Bones, which was for women and men. I mean, women after the age of 50, men after the age of 60. We all have to protect our bones because of osteoporosis.

Then I went to Focused Fitness for Women. For women after breast cancer and because of all their chest tightness and poor flexibility, looking at posture. Also, self-image. When you start to feel better about yourself, you just have a better image of everything.

Then we went to PEX, which is a class I developed with one of my other fellow patients on exercise for men after prostate cancer. Then we do a lot of personal training for an hour. I really will really design a program that's just for that particular person.

Now COVID came, and telemedicine was going. Of course, Dr. Mao is the one with all of the insight to say, "How can we do this? How can we put this all on?" Now we've been doing Zoom classes now, very successfully. I do four fitness classes, Lauren does two. We have all these other classes that were mentioned. What happens is that it's very exciting because I had to say, "Okay, how could I change this? How can I make the patient really enjoy this?"

They're in the privacy of their home. They don't have a gym. We do bodyweight exercise. We do resistance training either with using a dish towel or with isometrics. We do have a chair so we can stretch from the chair. We do wall push-ups or push-ups off the chair. We can do chair or standing core work. We've incorporated all that with some music in the background. We make it fun, we make it enjoyable.

I am very passionate about what I do, and I know that you've heard me say this before, that when I see the difference in people, it makes me happy. I know because I love what I do I can easily motivate people and be inspirational. I guess it's shown because I have 150 people in my classes. We stay afterwards and then I give them form tips or we go over something, and it really has been a very successful program. It is really open to everyone, and I really think everyone should join.

Well, I'm in, I'm in. I totally agree with you, Donna. I think your passion and zest for all that we do here just shines through, and it's just a gift to be able to reach more people, right? There's beautiful resources available on our website, and I'd like to share now the importance of breathing correctly when you exercise. Let's follow at home if you'd like.

Hello, my name is Donna Wilson, and we're going to talk about breathing right now and how breathing changes with activities. First, I'd like to say that I know that when you have a cancer treatment, sometimes you're tired, or even post-surgery, you might feel that you can't take a deep breath. Let's work on that. Let's try to work on having you take the biggest, deepest breath you can. Breathing in, half the time is breathing out.

I want you to breathe in for the count of four, hold the breath for the count of seven, one, two, three, four, five, six, seven, and blow out, one, two, three, four, five, six, seven, eight. Take another deep breath in through your nose. Hold. One, two, three, four, five, six, seven. Blow it all out.

You'll notice when you breathe in through your nose, you use the largest muscle for breathing, which is your diaphragm, so you get that nice, deep air into the lungs.

Let's do one more, breathe in. Hold the breath. Blow it all out.

Now I want to tell you that the most important thing to remember is breathing out is more important than breathing in. When you lift something, when you push something, when you pull something, when you bend over, you always breathe out.

Let's go ahead and do a few arm movements and flexibility stuff to get yourself for breathing. Put your arms forward and your thumbs back. You're going to breathe in as the shoulders go up and breathe out as the shoulders go down. Breathe in and breathe out. Breathe in and breathe out. Breathe in and breathe out. Feel that when your arms are back and your thumbs are back, it really opens up your chest.

Now let's put your arms out to the side and let's breathe out as we come forward. Open your chest and breathe in. Again, breathe out through your lips. Breathe in. Arms down.

I will like to mention is that when you're outside and it's very windy or it's very cold, think about breathing in and out of your nose because it's a great filtering system for the air. Also remember that when you're going up steps, which is always very difficult, when you put one foot on the step, you breathe out. When you put your other foot on the step, I want you to breathe out. Think about breathing out as you go up the steps. Remember, never hold your breath. Never hold your breath when you're doing any kind of exercise.

Let's go ahead and do one more. We're going to put our legs out. We'll put our arms out. Breathe out as the arms go up over our head. Breathe in nice and easily. Breathe out as you go up over your head. Down. Remember never to hold your breath during exercises. This is the end of the breathing exercises, and I hope they will be helpful to you.

Thank you. We heard from many of our patients asking how soon they can return to exercise post-treatment or surgery. Can you talk a little bit about the important role exercise plays both before, during, after treatment?

Absolutely, absolutely. First, let's start the answer by saying everyone should keep moving. Everyone. Whether you have a diagnosis of cancer or you're in the process of doing the treatment or after. The key is, is that you want to get yourself in the best physical shape, like Dr. Mao said, it'll improve your immune system. If you go ahead and you have all your cancer treatments, you decrease muscle mass. If you decrease muscle mass, it increases fatigue. Fatigue is the most common complaint that everyone has.

The other thing is you lose flexibility. Then you get anxious and tired and irritable and depressed. You start to exercise, stimulating all those muscle fibers, and then you decrease the fatigue. I say when we look at all that, you can start to exercise before if you know you're going for a surgical procedure.

Even put yourself in a walking program.

Then, the second is during treatment try to do as much as you can. It might be a little harder when you're in the active treatment. You might have to rest a few days after chemo. Then say, "Okay, I'm going to get up today and I'm going to walk around."

Then after treatment, if it's a surgical procedure, I usually tell people anywhere from two weeks after, let's put it this way, the minute you leave the hospital you can go for a walk. That's not a problem.

Once you get your first post-op visit, which is anywhere from two to four weeks after surgery, then you might say, "Can I go back to exercise?" We'll modify things. Obviously, if you had a surgical procedure on your abdomen, we're not going to have you doing any crunches. We're going to do modified things. Yes, soon as you can, come back. The most important thing is, that's what we're here for. We're here to provide you a really safe and excellent exercise program.

Thanks, Donna. Many of our viewers asked for exercises that they can do inside during the winter. What are some good tips that you have to get people moving inside their homes?

Well, the first is, as I said to you earlier, where I'm sitting right now is where I have my little exercise program for every day. You need literally three feet of space. How do you motivate yourself? How do you get yourself going? "Oh, how do I get started?" Well, you know what? Start small. Start with maybe five or ten minutes. Maybe view a couple of things. What did you like to do before? Do you like a walking program? Do you like an exercise program where you're doing more weight training? Think of something small. Tell a friend or family member that you want to start this program. "I want to do it three times a week. Would you just check in on me?" Or use it on your calendar, check it off. Put some really fun music on.

I have to just tell you this little cute story. This morning, I had class and we were doing the twist, old-fashioned twist. Okay, arms are moving, body's moving, hips are moving, feet are moving, and it was fun. You put Chubby Checker on, you know, you're in the kitchen, and you twist around a little bit. It's very easy to get motivated to do it.

Don't think you need a gym to do what you're doing. We have obviously shown you that in COVID now that we can do all these things in the privacy of our home. Think small, share it with a friend, use a calendar, and just start to see the change. Give yourself about 30-day challenge that you want to see, "Oh, are my arms stronger? Can I get out of the chair easier?" Can I do my activities of daily living easier with more fun? The collaboration in the Zoom is spectacular. Those are the very simple, easy steps to do.

Mm-hm. I love the accountability piece. I think that's so important. Of course, you have to have a little fun doing it, right? Another person asked, "What are some tips for maintaining a routine?"

Well, again, as I just said, use a calendar. Find a friend to do it with. Right now, it's not easy, but with Zoom the way it is, you could say, "Okay, let's Zoom each other." We all do it for family meetings. Let's say, okay, let's do 10 squats today, or let's go ahead and do some wall push-ups together. I think the accountability with a friend is very, very key.

Again, think about it as a fun thing to do. Think about what activity in your life you want to improve. How do you want to feel better? Do you want to feel better that when you go up the stairs you're not short of breath anymore? Do you want to feel that you can do these activities and you can go out maybe kayaking in the summer and feel really good about it?

What do you want to do? Then just share that with someone. I mean, you could always ask any of us, and we can sort of suggest, "Well, that really means that you need good leg strength." Or, "You might want to improve your posture."

What exercises that we can do to improve to your posture. Think about how you want to...Make it into your daily routine, okay? Just say, is it a morning exercise you want to do? Don't think you have to exercise 30 minutes to an hour. You can literally do five to ten minutes a day and get a benefit out of exercise.

Mm. I love that, thank you so much, Donna. I feel like when we can just add in these habits and just get ourselves going into patterns and routines and showing up with others, I just completely agree. Thank you so much for all that information, Donna. You're amazing.

Thank everybody for joining, because everybody that's viewing this should be joining the spectacular people I work with at IM Home membership.

Yes, I know. We hope people will learn more and then sign on. That's the hope. Okay, so now I want to turn to diet and nutrition, which is also a topic we got a lot of questions on. In MSK's Integrative Medicine Service, we work closely with our partners in nutrition who have many resources available to patients. I'm super energized to introduce Alicia Gould, who is a registered dietitian at MSK. Alicia, can you talk a little bit about how our dietitians work with patients at MSK and what services do we offer?

Absolutely, hi, Lauren, hi, everybody. Thank you so much for having me. Our team of dietitians offer personalized and evidence-based medical nutrition therapy. We work alongside our patients' multidisciplinary team and their doctors. We specialize in a variety of services. We offer symptom management for patients who are actively going through treatment. We specialize in weight loss or weight management. We also work with patients who are on specialty or restricted diets. Also individuals who are in cancer prevention programs, as well as our cancer survivors.

Amazing, thank you. Let's take a look at one of the cooking demos you've done for our website, which I think will give people a really great recipe to make at home.

Definitely.

This is going to be our black bean, roasted corn, and quinoa salad. We have a couple other ingredients that we're going to be mixing in here. We have a little bit of diced tomato, some diced pepper, some cilantro, a little bit of lime zest, some garlic, and, of course, some olive oil to make it all come together.

For our red quinoa here, red quinoa is a great versatile ingredient and it's really simple to prepare. The first thing you're going to do is you're just going to add it to a fine mesh strainer and just give it a little rinse. Once you give it that little rinse, it's going to take away any bitterness that remains on the quinoa.

Then you're going to add this to a pot with a little bit of water, and you're going to cook it for about 10 to 12 minutes. You're going to bring it up to just about a gentle simmer. You don't want it to be a rolling boil, but bring it up just to a gentle simmer. Once it reaches that, after about 10 to 12 minutes, it's going to be great. You can use it in a hot application at that point in time, but what we're doing here today is we cooled it down previously, so I have some already great cooked up red quinoa here that we're going to use.

I love working with quinoa.

Right, yeah.

It's a great vegetarian option as a protein source. Our vegetarians and vegans out there, this is a great substitute. What's also nice, and for those who might not be familiar with quinoa, it takes on the texture of a rice, so it's a grain, it's also high in fiber and just very versatile.

It's kind of like a rice and yet it has protein, it has fiber, it has a lot of things that you otherwise wouldn't have.

Exactly, it's a great item to work with, and, again, this can be used as a side dish but also amped up a little bit and can be put as the full entree.

Okay. Let's talk about this corn. What other ingredients are you going to add here?

Sure, so I have some roasted corn I just cut right off the husk. Now, corn isn't readily available until the summertime in this market here in New York City. However, it can easily be substituted for canned corn or frozen corn, so you're not stuck to making it just if you have corn on the cob, but I had that availability today so here we have it.

I'm going to take my red quinoa, I'm going to add my roasted corn to it. I'm just going to add all of my other ingredients, and it's going to be as simple as just taking this stuff and mixing it up. Like I said, the beautiful thing about this recipe is that the longer it sits the better it gets. All those flavors are going to come together. The lime, the olive oil, the garlic is really going to just penetrate all the other ingredients, and it's really going to come together, but it's still just as good if you have it right after you first make it.

Right, nutrition and convenience.

Exactly, I could already smell everything, it looks delicious.

Yeah.

Once I have all my ingredients in here, I'm going to have a couple things to finish it off. That's my lime juice right there and a little bit of salt. Just a touch, you don't need a lot, just a touch. Then some olive oil, that's going to bring it all together. That's going to allow all those flavors to really marry each other and then just come together and be a great-tasting side dish. Again, like I said, you can always add some grilled chicken on top of this or shrimp or beef. It doesn't have to be just as a side dish. It can be as a base to a grain bowl that you want to make at home.

Right, right. Again, just like the fajitas, a very controllable portion.

Yes. With this, a little bit goes a long way, so this is a great option for patients and also for the caregivers, because they're tired as well. You throw it all into a bowl and you mix it and there's really not much prep or cleanup to be done once everything's prepared, so this is a great dish.

That's fantastic.

Here it is, it's as simple as that. Something great for our patients and caregivers to make at home. I even love to make it for my family at home.

I think that's a great thing. This is food that everyone can eat, the whole family can eat, and it's great for everybody.

The lime is delicious.

That tastes amazing.

I'm so ready for a little snack after that video.

I know.

We got a lot of questions about food to include in your diet, and also foods to avoid. What's your general advice to cancer patients undergoing treatment, and also to those who are looking to prevent cancer?

Absolutely. When patients are undergoing treatment, we know that there are so many different side effects. There's nausea, there could be decreased appetite, mouth sores. What I really educate my patients on is to liberalize the diet as much as possible and really find foods that work to keep your symptoms at bay. If you're nauseous, that's bland, easy-to-digest carbohydrates, foods that don't have such a strong odor. If it's mouth sores, that would be avoiding acidic foods, crunchy, rough textures, things of that nature.

However, for cancer prevention, we know that there is no one diet that can prevent cancer. However, following a plant-based diet like Dr. Mao said earlier, is what we recommend and what the research shows. That's thinking of your plate coming two-thirds or more of non-starchy vegetables, whole grains, beans, legumes, healthy fats from olive oil, and a third of your plate coming from lean animal protein sources like chicken, fish, turkey, things like that.

Perfect. One viewer asked, "What foods help boost energy?"

Great question. I get this a lot because so many of our patients are experiencing fatigue like they've never felt before. What I tell patients is calories are energy, it's as simple as that. Making sure that you are eating frequently throughout the day. I strongly emphasize small, frequent meals, and a lot of times, patients ask me, "What does that mean?"

That can be eating or drinking something with calories and protein four to six times a day, or even taking it a step further and putting yourself on a schedule and setting an alarm clock for every two to three hours to make sure that you're getting enough calories for energy, and then of course protein is just as important for strength. Again, it's just making sure that you are eating, and even if you're not feeling great, trying to push yourself to take in something with calories.

Thank you. Another asks, "Does intermittent fasting benefit cancer patients?"

This is a great question, and this is such a hot topic right now, it's really new in the field of nutrition research. It's kind of a yes-and-no answer. Intermittent fasting can benefit obese or overweight patients who are looking to create a calorie deficit and lose weight. However, so many of our patients already have altered eating patterns due to symptoms related to treatment. They're already in a decreased appetite setting. They're already at risk for unintentional weight loss or nutritional deficiencies. I would recommend if you are curious or want to learn more about intermittent fasting, reach out to the team and ask to speak with one of the registered dietitians to see if this is a diet or a diet plan that's suitable for you.

Thank you so much for this wealth of knowledge, Alicia, and joining us today. I'm going to flag that recipe, I'm going to make that later this week, it sounds so good.

Yes, (inaudible) fun.

Yes, definitely, I love it. I'm dreaming of the summer, corn on the cob, we'll get there soon. Now I want to turn to pain management, which I know is a topic many of you have questions about. Rocco Caputo is a touch therapist here at MSK. Rocco, super excited to be here with you. What are some of the ways we can help people who may have pain from their cancer treatment?

Thank you, Lauren; I'm so hungry right now after that segment. I didn't realize I was starving, I'm incredibly hungry. Being a neuromuscular therapist and functional movement instructor, I'm forced to see the body as a series of levers, cables, and tubes, and I'm going to invite everybody to look at the body in this way so that we can figure out what pain really is.

Our levers are our joints. These joints, when they're misaligned, it causes pressure in the joints and you have pain. The cables are your muscles. If you have knots in your muscle, it will shorten the cable and misalign the joint and cause pressure in the muscle and in the joint, and that pressure causes pain.

We are also tubes, and our tubes are everything else. Our tubes are our vessels and our nerves and our intestines and pretty much anything that isn't a lever or cable. If your tubes aren't flowing correctly, you build up pressure. I think you've figured this one out: Pressure causes pain. I want everybody to really get an idea that pressure inside the body does cause pain.

How do we relieve the pressure? It's kind of simple. I'm going to give you three really broad things and we'll get more specific a little later.

Exhaling, like Donna was saying, really lets some of the pressure out. When you do a really good exhale, you are signaling every cell in your body to excrete whatever it's holding on to, so your cells also exhale. So that big exhale is really important.

Drinking a lot of water is also really important because you need lubrication in these joints and cables and levers, your joints and your muscles. If you don't have a sufficient amount of water flowing through your body, all these movements create friction. You would not drive your car with half of the oil in it, but a lot of people are walking around with half of the water they should be drinking. When that happens, water is channeled to important places, like your brain and your vital organs. That leaves your joints dry, and that causes pressure and then it causes pain.

The third thing is, keep moving. It's always Donna, right? If you keep moving while you're lubricated with the water and you're exhaling, you can really get some of that pressure to drop and a lot of the pain will feel a lot better.

Thank you. I loved that analogy of the cables and levers, it's super helpful. All right, we get a lot of questions specifically about hand and foot pain, so I want to share this video with some exercises you can do at home if you're struggling with pain in your hands or in your feet. Follow along if you'd like.

Let's talk about hand pain. A lot of hand pain comes from compressions or pinches in your nerves in your shoulder or your wrist. To stretch those, all you have to do is find yourself a wall, or door, or the railing of the bed. You put your elbow at a right angle and then turn away from it and hold this for about 30 seconds. To help with the wrist, you put your fingers on that door or wall or bedrail and then just turn away from your hand. If you don't have a door, wall, or bedrail, you can do it like this. Take our hands and bring them up into the air. Then bring them all the way down to the sides with the fingertips facing the ceiling. Then take a breath in and drop the shoulders...and push the walls away for five, four, three, two, one. Then you can let your arms drop.

All of these stretches give you a little feeling of a pull in your shoulder and your wrist and that's okay. Hopefully, this will help, and it can't hurt to give it a try.

Let's talk about foot pain. A lot of times, pain in the feet comes from when nerves get compressed in your hip or your ankle. A good way to stretch this is taking your ankle, put it on your knee, taking your palms, putting them up, and putting your elbows on your knee and your ankle. Then we'll take a breath and drop our head as we just let ourselves fold forward. We're going to hold this for about 30 seconds. Then, for anything that's going on in the ankle, we can take a hold of the ankle while we're holding our foot and we can make some nice circles.

All of this can be done from a bed also. If you're on a bed, all you have to do is drop one leg off the bed and keep your knee bent and then just bring your whole body forward, drop your head...and do that for about 30 seconds.

So helpful. Rocco, in addition to hand and foot pain, we also get a lot of questions about back pain. What are some ways to combat back pain during treatment?

It's really interesting to know that the movements and the positions that we're in throughout the day usually fall into one of three categories. We have pathological movements, which are movements that create more pressure on places that shouldn't have that pressure. We have neutral movements, which put the right amount of pressure on the places that should have it and there's nothing going on that's bad. Then we have therapeutic movements, and those are really good. They strengthen and they create balance and stability.

You can probably guess what we do mostly. A lot people do a lot of pathological movements. I'll show you what those are in a second. Our goal is to really cut out all of those pathological movements and replace them with either neutral movements or the therapeutic movements that will give stability and strength.

Some of these pathological movements are brushing your teeth over the sink. If you do this, you take your head out of alignment, and that actually causes a lot of pressure in your neck. It also causes pressure in your lower back.

Washing dishes over the sink. This kind of sounds like you should just stay away from sinks. But if you don't put your whole body over the sink and wash dishes in that way, if you get very close to the sink and put your pelvis right up against it and lean back a little bit as you're doing your dishes, this is a lot better.

The problem here is that with these pathological positions that usually cause pain, you don't feel it until it's too late. But when you're going through treatment, everything is a little more sensitive. The cascade of you maybe sitting in a slouched position, or sitting on your sacrum in that down-in-the-chair position. This will put just the right amount of the wrong pressure on the parts of your spine that should not be touching, and this can cause a lot of pain, because the chemos and different medications are actually making you more sensitive.

While you're getting your treatment, you can take a towel, you can always ask them for a towel. Put that behind your neck so that you have a good support for your head. You can get a pillow or fold the towel and have a lumbar support, that would be really good too.

That's while you're actually getting your treatments. But when you're home, sitting on the bones that are called your sitz bones, those butt bones that actually support you, and not slouching, that would be really good.

That position really stretches out all the muscles in the back, and it tightens all the muscles in the front and it throws everything off. That forward head position is the result, and that makes it so that a lot of people feel like they're in pain all the time, various stages of pain.

Checking that and zipping yourself up--when you find yourself in this position, zipping yourself up so that you have this head above the shoulders above the pelvis situation, that is a much better place to be when it comes to posture, and that helps with the back pain.

I love that, it's all about bringing awareness into how you're moving. I feel like you're really preaching that, it's so helpful. You just touched on it, but are there any other techniques you would recommend to help improve posture?

Yes. When you find yourself having a hard time straightening up, if you were to take a throw pillow, something like this, and lay on the floor with the throw pillow just above the small of your back, where--this is the apex, for me, right about there. That's where my back comes out the farthest. If I were to lay on the floor for about eight minutes with the pillow here, that would straighten out my spine just enough so that it doesn't feel so hard to straighten up and sort of strain to have that.

Also, when you're home, if you take a towel, roll it up, lay with it behind your neck right about there, on the floor, again, eight minutes is a really good amount of time for this. I've been playing with this for about 20 years, and it seems that it takes about four minutes for the ligaments to give up and say, "Okay, we'll relax," and then it takes about four minutes for your curve to re-establish itself. You do that once a day and it should really help with posture.

Also, if you're just standing or walking around, if you look down and you don't see anything, your head is way too far forward. You shouldn't be able to see just floor when you're looking down.

We do a martial arts workshop for functional movement, and what we do is we tuck our pelvis, we zip ourselves up and we bring our shoulders back and this is our position, so that when we go through the apartment or the house, when you grab the refrigerator handle, you can give it a pull and rotate, keeping that nice, straight posture. You reach in, grab the milk, you rotate. This is a really good way to work this into your everyday life. Once you do that, good habits will take over, bad habits will wane, and then you should be feeling a lot better.

Thank you, Rocco. One last question here. Another wrote us and said, "I'm sitting more than ever, due to the pandemic, and my body tends to be stiffer and my hips hurt. How can I combat that?"

Okay. If you're working from home, if the computer can be moved to different places, I have a big suggestion of having three different places in the house in a day that you're actually working from that forces you into three different positions. Even if they're three not the best positions, you're not going to just bang one position to death so that you get into a really bad pathological position.

I also think that having the computer up really high and really close forces your head back and forces your shoulders back, and that makes it so that this therapeutic position that strengthens your posture is forced.

One of the nice places that I like to bring the computer is the kitchen, because the counter is a really nice height. I put a little box, and then I put the computer on a box on the counter, and I'm able to stand while I'm on the computer, and I also have all the snacks in my kitchen, which is a bonus, so there's that.

Also, you don't want to be sitting cross-legged all the time, because if you do that, you have a muscle in your hip called the piriformis. It shrinks the piriformis, so then when you go to stand up, it can give you really bad low back pain. My suggestion is three or four different sitting positions throughout the day. I know it's kind of hard, but if you're sitting cross-legged all day, you will have tight hips.

I love the idea of bringing the computer into the kitchen. That's so great--and of course, we've got our snacks nearby. Maybe it's the recipe that Alicia made. Beautiful, thank you so much, Rocco.

You're very welcome.

For our last segment today, I'm energized to bring in music, our MSK music therapist, Alessandro Ricciarelli. Alessandro, welcome. Music therapy may not be something our viewers are as familiar with. How do your sessions work, and what services are available at MSK?

Hello, Lauren. Music is something that almost everybody in the world loves. It's the most universal form of human expression. What we do at MSKCC is, we music therapists, we are three. We have combined experience of 40 years at the center, and we're all state licensed creative arts therapists.

Very simply, we bring music to the room. I heard it said once, music is the absence of illness. Especially our hospitalized patients, I think it can be very overwhelming, and they are often overwhelmed with treatments, symptoms, and side effects, decision-making and doctors, so music helps to bring in a sense of normalcy, a sense of goodness of life, and also a sense of the patient's uniqueness.

What we do to provide that to the patient is we do individual visits to the patient's room, and we have maybe the biggest program in the country, maybe worldwide, of coming to the room. We are all very dedicated to bring music in any form that's helpful to the patient. We all have carts filled with instruments that we push around the floors. We'll knock on the patient's door and offer a kind of reprieve.

Our primary instrument is usually guitar because it's mobile, it's portable, but on the cart, we have drums, keyboards, xylophones in case the patient would like an interactive modality. Many times, we just play soothing music to provide a sense of relaxation, a moment of calm and peace, a moment that has nothing to do with illness and treatment but everything to do with life.

I can share briefly that I was a recipient of one of the music therapists coming in while I was in the midst of a six-week hospital stay, and you were all angels. Like you said, knock on the door, and that experience stayed with me. I am a huge music lover, and it was truly incredible and so healing, and I'm just grateful. Next question is, "What can music therapy be used to help with?"

Well, really, as I said, it's been used to regulate emotions. We all know what music does for us. It helps us exercise. It puts us to sleep, like a mother singing to the baby. Armies march to music. If you're a teenager and you're lovesick, you may think of a song that makes you cry and use that to cry. It's such a fundamental part of life. Weddings cannot be imagined, any celebration.

So what we help with is to restore that sense to the patient, restore the sense of self, yank the patient out of a negative trance that may happen because there's so much going on that has to do with illness and treatment. A sense of isolation, a sense of depression, anxiety, then physical symptoms, like loss of appetite, insomnia. Music can really help with all of that.

Thank you so much. It's almost like, what can it not do? Our next question is in regard to helping to relieve stress and anxiety. Cancer treatment can be difficult under any circumstances, but in the space of COVID-19, we know it can be an overwhelming time for our patients. What are some things that they can do at home to help relieve stress and anxiety?

Well, don't forget that music is there. Sometimes we don't even turn on the radio, and once we turn it on, we have the company of good music. That's one thing, just keep using it.

We all have a habit of listening to music, but nowadays, some people only listen to music in their car, so I think it's something that you can make a conscious effort to incorporate in your life.

Then we have our Integrative Medicine at Home program, which also has music therapy. There, we do singalongs, we do guided meditation with music. These resources are available. Remember how music makes you feel and use it.

I love that, thank you so much for sharing. In a moment, Alessandro will lead us in a live music meditation, so please stay tuned for that. But before we wrap up our session today, I want to thank everyone so much for joining us. I hope you found this session informative and helpful. If you're interested in learning more about our Integrative Medicine at Home service and programs or are looking for more information on health and wellness resources, please visit our website at MSKCC.org.

Alessandro, help us wrap up here with a little sample of a music meditation. Everyone at home, please follow along. Thank you again for joining, and we hope you have a wonderful day.

Okay, thank you, Lauren. Let's take just three minutes of your day and make this into a lovefest for yourself. Just take that time to really direct some love and care, some soothing healing to yourself. If you're sitting in a chair, place your feet flat on the floor, feel grounded. Imagine that there is an invisible thread that connects the top of your head to the ceiling. Feel a gentle stretch. Then, if you feel comfortable in your surroundings...just close your eyes...and begin to observe your breath. Again, in the same spirit of love and compassion for yourself.

Don't feel like you need to change anything. Just observe. This is something we can do together, just observe your in breath. Your out breath. I always feel when I follow my breath that I'm reconnecting to a very deep, maybe the most central part of who I am. It feels like I'm really coming home to myself, I'm arriving. We can practice that together. Breathing in, I say to myself, "I have arrived." And breathing out, I say to myself..."I am home."

We can imagine our breath like a healing energy, a soft, soothing energy that we can point anywhere in our body where we feel we need some tender loving care. So breathing in...I touch with my breath my heart. And breathing out...I smile to my heart and make this a radiant, physical, actual smile. Breathing in, I touch my heart. Breathing out, I smile to my heart, sending healing, loving, soothing energy, and I can immediately sense just how much my heart enjoys this kind of loving attention. Now, after this little snack of love for ourselves, we can prepare to return to a more wakeful state of mind knowing that we can take this peaceful, sunny feeling with us through the rest of today, into the night and to our restorative sleep, and that we can tap into it anytime we decide to take a few moments, sit still, observe our breath, and send some love to ourselves.