When Beverly Levinson\u2019s doctor noticed two unusual spots on her dense breasts, she was sent to The University of Texas MD Anderson Cancer Center for a lumpectomy\u2014a surgical procedure to remove abnormal or cancerous tissue along with a small portion of the surrounding healthy tissue.<\/p>\n
Levinson, 64, wasn\u2019t as concerned about the surgery as she was about undergoing general anesthesia. She had received general anesthesia for previous surgeries, but because of her temporomandibular joint (TMJ) disorder, she suffered severe jaw pain from opening her mouth wide enough for the breathing tube to be inserted down her throat.<\/p>\n
Luckily, an unconventional solution presented itself to Levinson. Her surgeon approached her about an ongoing clinical trial that would allow her to avoid general anesthesia by using hypnosis. Levinson, who had been hypnotized for jaw pain years ago, immediately jumped at the opportunity.<\/p>\n
\u201cIn my eyes, I had nothing to lose,\u201d Levinson said. \u201cI could try something new or I could go the old-fashioned way. I\u2019m the middle child. I always try new things. That\u2019s my personality.\u201d<\/p>\n
Led by Lorenzo Cohen, Ph.D., director of the Integrative Medicine Program at MD Anderson, the ongoing clinical trial aims to determine whether or not a method of deep relaxation, called hypnosedation, is safe and effective for patients with stage 0\/1 breast cancer who are undergoing lumpectomies with or without sentinel lymph node dissections. The study, still in its pilot phase, will examine 50 patients who are randomly selected to receive either general anesthesia or a combination of local anesthesia and hypnosedation before and during surgery.<\/p>\n
In both cases, a patient has an intravenous line placed in her arm and an anesthesiologist is present to administer a cocktail of drugs used to put her under. For patients receiving hypnosis, the anesthesiologist monitors their vitals, calculates the appropriate dose of local anesthetic medication, administers medication for pain and nausea and stands by to convert to general anesthesia if the patient experiences any discomfort.<\/p>\n
\u201cOver the past couple of decades there is a very solid evidence base that incorporating hypnosis during invasive conscious sedation medical procedures reduces anxiety, helps to control pain, decreases recovery time, and helps lower medical costs,\u201d Cohen said.<\/p>\n
General anesthesia is still the standard approach at MD Anderson, even for smaller surgeries, such as lumpectomies. But the drugs used for general anesthesia can potentially weaken the body\u2019s immune system and slow the recovery process, Cohen said. Cancer patients, in particular, cannot afford to have their immune systems compromised. Cohen and his team want to find out if hypnosedation would be a viable replacement for general anesthesia during smaller, less invasive surgeries.<\/p>\n
* * *<\/p>\n
The practice of hypnosis, in one form or another, has been around for centuries. But it wasn\u2019t until the mid-19th century that it came to be defined as a kind of \u201cnervous sleep\u201d that could alleviate anxiety or pain during medical procedures.<\/p>\n
In the 1840s, Scottish neurosurgeon James Braid developed a technique of deep relaxation and visual fixation to guide patients into a trance and help alleviate their pain. He coined the term \u201chypnosis\u201d and defined it as \u201cthe induction of a habit of abstraction or mental concentration, in which \u2026 the powers of the mind are so much engrossed with a single idea or train of thought, as \u2026 to render the individual unconscious of, or indifferently conscious to, all other ideas, impressions, or trains of thought.\u201d<\/p>\n
Although hypnosis is often associated with parlor tricks and stage magicians, the practice itself has been used clinically to address several conditions, including smoking, anxiety and overeating. For Levinson, it was a great option. A week before surgery, Levinson met with Rosalinda Engle, a mind-body specialist at MD Anderson Cancer Center who would perform the hypnosedation, in a small conference room in the hospital.<\/p>\n
\u201cDo you have a place where you feel really comfortable and at ease?\u201d Engle asked Levinson in her soothing, mellifluous voice. \u201cIt could be your grandmother\u2019s house. It could be a vacation you\u2019ve enjoyed, a vacation spot. It could be anywhere, any place in nature. Close your eyes and call that up.\u201d<\/p>\n
As Levinson focused on the task, Engle continued to offer instruction.<\/p>\n
\u201cBreathe in deeply. Experience your breath from the tip of your nose. Feel as your breath moves through your body. Imagine breathing into the palm of your hands. Now exhale. Breathe out through your fingers, the soles of your feet, your toes. Relax.\u201d<\/p>\n
Slowly but surely, Engle lulled Levinson into a state of deep relaxation.<\/p>\n
\u201cI felt very, very safe,\u201d Levinson said, when it was over. \u201cIt was like [going] into someone\u2019s house where they\u2019re baking a cake. It smells good, and they welcome you in. You just have a warm feeling.\u201d<\/p>\n
Engle guided Levinson through what to expect on the day of the surgery. The room would be sterile, with five or six people at hand. The lights would be bright. Engle would sit beside her throughout the procedure to keep her calm and relaxed.<\/p>\n
\u201cMy sole job is to sit at the head of the bed and focus on the patient,\u201d Engle said. \u201cAny changes to breathing patterns [or] facial muscles will alert me that I need to check in. Periodically, I\u2019ll ask the patient, \u2018How\u2019s your comfort level?\u2019\u201d<\/p>\n
On the day of the surgery, doctors injected local anesthetics\u2014 lidocaine and bupivacaine\u2014to numb Levinson\u2019s right breast and made a 1-inch incision to remove some of the tissue. As promised, Engle sat next to Levinson for the duration of the surgery, helping her maintain a state of deep relaxation.<\/p>\n
\u201cI didn\u2019t feel anything,\u201d Levinson said. \u201cYou\u2019re in a calm state. You\u2019re in a safe state of mind. You\u2019re being reassured. It was great.\u201d<\/p>\n
Throughout the surgery, Levinson recalled feeling pressure on her breast as the surgeon operated, but said it didn\u2019t hurt any worse than getting a filling at the dentist.<\/p>\n
Less than an hour after her surgery was complete, Levinson was out of bed, dressed and walking around. She skirted the unpleasant side effects of general anesthesia, recovered faster and didn\u2019t require any post-operative painkillers.<\/p>\n
For hypnosedation to work, Engle said, the patient must be receptive to it.<\/p>\n
\u201cAll hypnosis is self-hypnosis,\u201d Engle said. \u201cYou\u2019ll go as deep into this trance state as you are willing to allow yourself to go.\u201d<\/p>\n
Engle points to shifts in attention and consciousness that people commonly experience throughout the day. Ordinary moments\u2014such as zoning out while driving or becoming so engrossed in a conversation that you\u2019re able to block out surrounding noise\u2014are examples of how the mind can tune out distractions.<\/p>\n
\u201cPointing out these everyday shifts and our capacity for absorption is important to let the patients know they are in control and driving this experience,\u201d Engle said. \u201cThey can train themselves to be as relaxed and calm as possible. They can guide themselves. They can walk through this experience with surgery and take it throughout the treatment process, the whole continuum of cancer care.\u201d<\/p>\n
While general anesthesia is very safe for most people, it can have unpleasant side effects. The most common are temporary nausea and vomiting, dry mouth, a sore throat and grogginess. Older patients who receive general anesthesia are more likely to experience longer-term cognitive and memory impairments, a condition called post-operative cognitive dysfunction (POCD) that can last anywhere from a few days to a few months. Those with a history of POCD have a higher risk of experiencing the condition again with repeated anesthetic.<\/p>\n
\u201c[Hypnosedation] is a nice alternative,\u201d said Elizabeth Rebello, M.D., associate professor in the department of anesthesiology and perioperative medicine at MD Anderson. \u201cThe patient doesn\u2019t require an extended period of time in the recovery room. They\u2019re able to go on with the rest of their life.\u201d<\/p>\n
* * *<\/p>\n
According to Cohen, more than 34 clinical trials and numerous papers published in scientific journals have shown that hypnosedation works. But he says there is still some doubt among his colleagues.<\/p>\n
\u201cAlthough a physician may think, \u2018I don\u2019t believe in hypnosis,\u2019 that is a scientifically unsound statement. Science is not about personal belief. It\u2019s about evidence,\u201d Cohen said. \u201cYour religious practices are part of a belief system. Science is evidence-based. Unfortunately, there are some people who approach science from a belief perspective, as well, and they\u2019re wrong.\u201d<\/p>\n
Most surgeons were initially reluctant to participate in the clinical trial, said Dalliah M. Black, M.D., a breast surgical oncologist at MD Anderson. Because the standard approach at MD Anderson is to use general anesthesia for surgeries large and small, most surgeons are accustomed to having their patient sleep throughout every procedure.<\/p>\n
\u201cSurgeon interest was very slow up front, but I would offer them to come in to watch my cases,\u201d Black said. \u201cMany colleagues have been so surprised.\u201d<\/p>\n
Using hypnosedation, patients like Levinson can gain some semblance of control during an otherwise stressful experience.<\/p>\n
\u201cIt\u2019s amazing how complex we are as humans and how complex the mind is. A lot of times, it\u2019s mind over matter,\u201d Black said. \u201cHypnosedation is a way we\u2019ve applied mind over matter to a situation in the operating room for a specific population of the patients here. That mental fortitude and the strength that we have, that has to be carried through and has better outcomes if we use that path throughout our cancer care.\u201d<\/p>\n
No matter how effective the clinical trial shows hypnosedation to be for surgeries, Rebello stressed that hypnosedation will not become a new standard approach for pain management.<\/p>\n
\u201cI think there\u2019s a concern that this is going to replace general anesthesia. It is not<\/em> going to replace general anesthesia,\u201d Rebello said. \u201cBut for a certain niche of patients, there are certainly some benefits that could exist and we need to find out if that is, indeed, the case.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":" When Beverly Levinson\u2019s doctor noticed two unusual spots on her dense breasts, she was sent to The University of Texas MD Anderson Cancer Center for a lumpectomy\u2014a surgical procedure to remove abnormal or cancerous tissue along with a small portion of the surrounding healthy tissue. Levinson, 64, wasn\u2019t as concerned about the surgery as she […]<\/p>\n","protected":false},"author":15,"featured_media":11300,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[1],"tags":[2488,418,2491,2490,2486,2485,2494,2487,2493,23,2489,2492],"yoast_head":"\n