Category: Exercise

Aerobic Exercise during Cancer Treatments

Aerobic Exercise during Cancer Treatments

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Aerobic exercise (a.k.a. “cardio”) has many proven benefits for all humans. Cardio relates to cardiac, meaning it’s for the heart! For cancer thrivers, aerobic exercise can have many excellent benefits (including improved survival rates and decreased rates of recurrence!) and should be recommended for all oncology patients. Read on to learn about the benefits and general recommendations for aerobic exercise during cancer treatments.

Benefits of Aerobic Exercise

  • Increase your sensitivity to treatment = better tumor cell destruction!
  • Prevent muscle loss and build strength (including your heart muscles)
  • Reduce treatment-related side effects
  • Reduce depression and anxiety
  • Improve your sleep
  • Reduce your recurrence and mortality risk significantly (up to 50% for some)
  • Improve your quality of life

Psstttt… if you’re not convinced already, I’m not sure what will get you on board this point!

Types of Aerobic Exercise

  • Walking
  • Riding your bike
  • Running*
  • Interval Training
  • Swimming**

*If running was part of your pre-treatment routine, it may be ok to continue, BUT as some treatments can put you at risk of cardiac dysfunction, it may be best to stick with more gentle cardio until your heart gets stronger. Always check with your doctor or physical therapist!

**Avoid swimming in the ocean or public pools if you are neutropenic, have recently had surgery, or have open wounds/blisters from radiation therapy due to increased risk of infection!

Aerobic Exercise Guidelines

We’ll use the FITT principle for aerobic exercise guidelines:

  • Frequency: 3-5 days per week
  • Intensity: RPE 2-3 – keep it light for cardioPROTECTIVE benefits!
  • Time: 10-60 minute sessions for total of 150 minutes per week
  • Type: Choose your favorite from those listed above!

What is RPE, you ask? RPE, or Rate of Perceived Exertion, is a measure of how hard you feel you’re working. Use this Modified Borg Scale to guide your intensity during your workouts!

Modified Borg
Scale
0RESTING
1VERY EASY
2SOMEWHAT EASY
3MODERATE
4SOMEWHAT HARD
5HARD
6
7VERY HARD
8
9
10VERY, VERY HARD

Special Considerations

  • Understand if the chemotherapeutic agents you received can cause cardiotoxicity. If so, be sure to request a baseline cardiac workup. Know that low-intensity exercise may have a cardioprotective effect during treatment!
  • Monitor your vital signs!
    • Use your fitness tracker to monitor your heart rate OR here’s a video on how to check your heart rate manually!
    • Report any significant or unusual shortness of breath to your physician.
    • Watch for swelling that may be early signs of lymphedema or cardiac dysfunction.
  • Monitor lab values! Generally, if your lab values fall in the following ranges, you should check with your provider before exercising:
    • Neutrophils (ANC) <1.5 x 10^9/L
    • Platelets < 20,000 cells/uL
    • Hemoglobin < 8g/dL (anemia)
  • Be cautious if you know you have any of the following:
    • Bone or lung metastasis
    • Osteoporosis
    • Abnormal sensation or dizziness/imbalance which may increase your fall risk

Now you know some general guidelines for aerobic exercise for cancer patients! By the way, these general guidelines apply to those without cancer as well! Always seek medical advice before starting a new exercise program and remember: All information shared on this page is for educational purposes only. If you are thinking of starting an exercise program, consult with your physical therapist or physician to determine what is right for you!

Aloha ❤

Resistance Training during Cancer Treatments

Resistance Training during Cancer Treatments

by bridewitt ♥ 2 Comments

You’ve probably heard the old saying, “If you don’t use it, you lose it,” right? Well, it’s true! For oncology patients in particular, resistance training is an important way to maintain strength, balance, and quality of life during and beyond cancer treatments.

Benefits of Resistance Training

  • Maintain functional STRENGTH to continue to do the activities you love
  • Improve or maintain MUSCLE mass
  • Improve or maintain BONE health
  • Improve QUALITY OF LIFE
  • Reduce MORTALITY risk by 33% [Hardee, et al, 2015]

Types of Resistance Training

  • Bodyweight Training
  • Pilates
  • Yoga
  • Weightlifting (free weights, machines, resistance bands, etc.)
  • TRX / Suspension Training

*Pro tip: Choose a type of exercise you enjoy to make it fun and something you look forward to!

Resistance Training Guidelines

  • 2-3 days per week
  • Focus on major muscle groups
  • Moderate Intensity
    • 40-60% of maximal effort
    • RPE 3-6

What is RPE, you ask? RPE, or Rate of Perceived Exertion, is a measure of how hard you feel you’re working. Use this Modified Borg Scale to guide your intensity during your workouts!

Modified Borg
Scale
0RESTING
1VERY EASY
2SOMEWHAT EASY
3MODERATE
4SOMEWHAT HARD
5HARD
6
7VERY HARD
8
9
10VERY, VERY HARD

Special Considerations for the Oncology Population

Take extra precaution AND work with a specialist if you know that you have:

  • Bone Metastasis
  • Osteoporosis
  • Abnormal sensation or dizziness/imbalance which may increase your fall risk!

Now you know some general guidelines for resistance training for cancer patients! By the way, these general guidelines apply to those without cancer as well! Always seek medical advice before starting a new exercise program and remember: All information shared on this blog is for educational purposes only. If you are thinking of starting an exercise program, consult with your physical therapist or physician to determine what is right for you!

Aloha ❤

Chemotherapy: Stretches for Health

Chemotherapy: Stretches for Health

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Before beginning any exercise program, please check with your physician or physical therapist! Not all exercises or stretches are appropriate for everyone – please read my full medical disclaimer here before trying any of the exercises listed below.

It’s no secret that it can be difficult to stay active during chemotherapy. While exercise has been proven to have many physical and emotional benefits during cancer treatment, some days it’s just difficult to get moving. I’ve designed this short stretching compilation to stretch the spine and major joints of the body to promote mobility and circulation on even the most difficult chemo days. Make these stretches part of your daily routine or use them to loosen up after a nap or before bed!

Watch the video for a full demonstration:

*Note: Video plays at 2x speed! Take your time when you’re stretching!

Child’s Pose

From a kneeling, or seated position, slide the hands forward until you feel a stretch in the shoulders and lower back. Hold for 30-60 seconds as tolerated.

Modifications: For greater stretch of the side body, walk the hands to the left or right.

Cat/Cow

Begin on hands and knees in a neutral spine position with hips stacked over knees and shoulders stacked over the wrists. Inhale and slowly drop the belly to arch the back, lifting the breast bone. The, exhale and round the back from the tailbone to the neck, broadening the space between the shoulder blades. Alternate moving into each position for 5-10 repetitions.

Modifications: Perform in a seated position, reaching forward as you round the back, and allowing the arms to reach behind you as you lift the chest.

Hip Flexor Stretch

In a kneeling position, square your hips and tuck your tailbone until a gentle stretch is felt across the front of the hip. Perform deep breaths. Hold 30-60 seconds as tolerated.

Modifications: Perform in a standing partial lunge position, hold onto something for balance. To increase the depth of the stretch, sidebend the body away from the bottom/back leg.

Hamstring Stretch

In a kneeling or seated position, stretch one leg out in front of you. Square the hips and straighten the knee as you hinge from your hips to deepen the stretch along the back of the leg. Try not to round the lower back to allow for the best stretch. Hold for 30-60 seconds as tolerated.

Modifications: Lie on your back and use a strap/towel to pull a straight leg up toward the ceiling. Flex your foot to deepen the stretch.

Butterfly Stretch

Sit with the soles of your feet touching and knees dropping down toward the floor. Perform deep breaths. Hold for 30-60 seconds as tolerated.

Modifications: Place pillows or yoga blocks under the knees to reduce strain on the hips, lean forward to deepen the stretch.

All stretches are designed to be gentle, but can be progressed if they become too easy. Stretches can be performed 1-3 times per day as needed.

Happy stretching!

Aloha ❤

Breast Surgery: Post-Op Stretches

Breast Surgery: Post-Op Stretches

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Before beginning any exercise program, please check with your physician or physical therapist! Not all exercises or stretches are appropriate for everyone – please read my full medical disclaimer here before trying any of the exercises listed below.

After both breast-conserving surgeries and mastectomies, people often find they have difficulty reaching overhead or behind their back, washing or fixing their hair, or feeling tightness throughout the chest wall. The following stretches are helpful to improve range of motion and help you restore your ability to complete your usual daily tasks!

These stretches should be done after a sufficient amount of time has passed post-operatively so all incisions in the breast, chest, or axilla (armpit) have healed. Be sure that any incisions are well-healed before attempting these stretches without guidance from a healthcare professional. Normal soft tissue healing of the skin and underlying tissues takes about 4-6 weeks. Stretching might be uncomfortable as you push into tight areas, but you should not typically experience pain >5/10 while performing stretches.

Watch the video for a full demonstration:

*Note: video plays at 1.5x speed – take your time when you stretch!

Shoulder Stretches

In a kneeling, or seated position, slide the hands forward until you feel a stretch in the shoulder or axilla. Perform gentle repeated stretches (10-15 repetitions) or hold for longer durations (30-60 seconds) as tolerated.

Modifications: For greater stretch of the side body, walk the hands to the left or right.

Cat/Cow

Begin on hands and knees in a neutral spine position with hips stacked over knees and shoulders stacked over the wrists. Inhale and slowly drop the belly to arch the back, lifting the breast bone. The, exhale and round the back from the tailbone to the neck, broadening the space between the shoulder blades. Alternate moving into each position for 5-10 repetitions.

Modifications: Perform in a seated position, reaching forward as you round the back, and allowing the arms to reach behind you as you lift the chest.

Sidebend Stretch

In a seated or standing position, grasp your affected arm with the opposite hand and gently lean away to stretch the shoulder and side body. Breathe deeply into the ribs on the affected side. Hold 30-60 seconds as tolerated.

Modifications: Lie on the unaffected side over a pillow or foam roller and gently stretch the affected arm overhead, limit the range of motion as tolerated.

Pec Stretch

Lie on your back and allow one or both elbows to fall out to the side. For mastectomy patients, perform only one side at a time until cleared by your physician to perform both sides together. Do not allow the back to arch away from the floor or bed. Hold for 30-60 seconds as tolerated.

Modifications: place pillow/s or a yoga block under the elbow to allow tight shoulders/chest walls to relax during the stretch. This stretch can also be performed standing with forearms placed against a doorframe.

Open Book Stretch

Begin lying on the unaffected side with knees bent to 90 degrees to protect the low back. Place the affected arm behind the head and allow the body to rotate and open up the front of the affected shoulder/chest. Breathe in as you open and exhale to return to the starting position. Repeat 5-10 times.

Modifications: Straighten the affected arm for a greater stretch or circle the arm over the head to stretch in various angles.

All stretches are designed to be gentle, but can be progressed if they become too easy or maintained if full range of motion is achieved. Stretches can be performed 1-3 times per day as needed.

Happy stretching!

Aloha ❤

5 Things I Learned from A Naturopath

5 Things I Learned from A Naturopath

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It’s no secret that I am freakishly in-tune with my body and that I also value knowing exactly what’s happening behind the scenes of my symptoms. Even before I was diagnosed with breast cancer, I knew something was off with my body, and I’d started to research root causes and naturopathic/functional medicine approaches to help me with some things I’d been experiencing. Then, cancer came into my life and between the 85 million appointments (not exaggerating…), I decided to hold off on seeing yet another practitioner.

Now that I’m approaching the end of active cancer treatment, I decided it’s time to get some additional support and testing done. A few things I was concerned about include the health of my digestive system, support for my thyroid, and restoring equilibrium for my female hormones. I chose to see a naturopath (ND) based on recommendations from friends and based on her experience level and social media content (never underestimate the power of social media!). Here’s a few things I’ve learned after my initial consultation and lab work:

Get that Good Gut Health

Chemo is designed to destroy cancer cells which are typically rapidly dividing and multiplying in our bodies. Well – guess what else rapidly divides and multiplies? Healthy cells in our digestive tracts! Side effects from chemotherapy tend to hit the GI tract hard and can include mouth sores, nausea/vomiting, heartburn, and diarrhea or constipation. Seeing as I had several of these symptoms during my 16 rounds of chemo, I knew my gut was going to need support and healing.

First of all, the GI tract is full of trillions of happy, healthy bacteria typically referred to as the gut microbiome. These bacteria help us to digest food and maintain a strong immune system. It’s all a bit complex honestly, but a lack in diversity of these bacteria can lead to a whole host of health issues, including mental health concerns.

My ND recommended a few important things to get me started: a good probiotic to promote microbiome diversity and a drink called GI Revive which supports the intestinal lining and promotes regularity. It’s also crucial to eat a diverse, supportive diet that includes plenty of fiber, vegetables and whole grains, and fermented foods.
*Side note – if I’d known GI Revive existed, I would have started it during chemotherapy. However at that time, I did use L-glutamine supplements which helped me prevent issues in my mouth and lower GI tract.

Altogether, I feel like things are coming back around to normal after chemotherapy with this added support. I imagine that the more my gut heals, the more I’ll see my immune system improve and I’ll be able to maintain low levels of inflammation in my body.

Clarity on Chemopause

I started chemo on June 9, 2020, and that was also the first day I received a Zoladex injection. Zoladex is a hormonal therapy designed to stop the ovaries from creating follicles which release estrogen. The ovaries have a high rate of cell turnover like the GI tract, so chemotherapy can lead to infertility if not protected by hormonal therapy. Modern medicine is truly incredible, and I’m grateful that as a 30-year-old woman going through chemo, I had the option to try to save my fertility in this way.

Joke’s on me though, because after 6 months of this hormonal therapy, I am officially in chemopause (a medically-induced menopause), and I have all the symptoms to show for it. I specifically asked my ND for post-chemo baseline labs for my estrogen, progesterone, and testosterone levels. No surprise here, but my labs confirm I’m in a menopausal state and that explains the hot flashes, joint pain, dyspareunia (learn more here), and amenorrhea…

Now, true menopause means a woman has had no menstrual cycle for >12 months. Being only two months out from my last Zoladex injection, I’d say there’s still hope for my ovaries to bounce back. Most women who’ve been on this type of treatment have seen their menstrual cycles return after 5-6 months on average. In the meantime, I need to be supportive of my body! I attempt to exercise 3-5 times per week (walking, resistance training, and stretching) to relieve joint pain and both my ND and OB/GYN have recommended vaginal moisturizers to prevent vaginal atrophy until my estrogen levels improve. (If this is TMI for my family & friends reading this – sorry, but it’s just #RealTalk!)

I’ll continue to monitor my labs every few months to be sure things are trending in the right direction. Chemopause isn’t necessarily permanent, so here’s hoping my body can pull through!

The Thyroid Needs to Thrive

About seven years ago, while I was deep in PT school, I began having unnatural fatigue. I ended up being diagnosed with an underactive thyroid gland (hypothyroidism). The thyroid gland produces hormones which help regulate our metabolism, and if the thyroid isn’t functioning optimally, you can have symptoms like fatigue, dry skin, hair loss, weight gain, constipation, or feeling like you’re always cold. Every body system relies on the thyroid so it’s a priority to take care of it!

Trying to find the root cause of my thyroid dysfunction has always been something I was curious about before my cancer diagnosis, and after treatment I wanted to know if there was: a) any additional support needed for my thyroid after chemo, and b) if there was an underlying cause for my hypothyroidism. After running a full thyroid panel, my ND diagnosed me with Hashimoto’s thyroiditis, an autoimmune condition in which my own immune system is attacking my thyroid. She educated me that Hashimoto’s is actually the most common cause of hypothyroidism and affects about 5 in 100 people.1 It seems that Hashimoto’s is a combination of genetic factors and environmental factors such as food sensitivities or heavy metals toxicity.

My next step is to try to determine what may have triggered this autoimmune condition. The more I know about my condition, the better I can treat it or avoid any sensitivities that may make my condition worse. It might seem like I am seeking out more health problems, but my intent is really to understand my own body and how I can best support it to remain healthy and cancer-free. I will likely always have to be on thyroid medication, but I’d like to try to prevent the condition from progressing as much as I can (I plan on living a long life, you know?!).

Sometimes You Just Have to Supplement

In all honesty, I’ve never been a fan of supplements because I just can’t remember to take them every day! I now understand, however, that there are certain vitamins and minerals that I’m unable to get enough of through a vegan/vegetarian diet (like vitamin B12 which is only found in animal products), and also, based on my recent lab work, we found that some others (like my vitamin D and zinc levels) were significantly depleted for me during chemotherapy.

There are certain supplements I need to be cautious taking during radiation therapy as high levels of antioxidants (like those in vitamins A, C, and E) can interfere with the treatment itself. For now, I am supplementing with:

  • B vitamin complex to improve my energy levels and cognitive functioning
  • Vitamin D3 which promotes bone health and has been shown to reduce the risk of cancer metastasis
  • Omega-3 which helps to reduce inflammation and supports brain and heart function
  • Zinc which supports the immune system
  • A probiotic and the GI drink I mentioned earlier for gut health

It sounds like a lot, but I’m currently finding it very worthwhile. Some of the brain fog that started during chemo has lifted since I started supplementing more regularly, my GI system is more settled, and my hair is growing back much faster than I anticipated! Maybe eventually I won’t need so much supplementation, but I feel now is the time to be very supportive of my body and it’s healing.

The Cost of Collaborative Care is: Priceless.

I know what you’re all thinking – this all sounds expensive! And it is to some extent. Supplements can be pricey & aren’t covered by insurance like most pharmaceuticals. When providers don’t contract with insurance companies, the costs can add up. I don’t need to explain myself, but I just want to let you all in on my thought process at this point.

Seeing an ND and using supplements and acupuncture to support my healing have brought me immense benefits and peace of mind both before and after my cancer diagnosis. I personally feel that seeing a fee-for-service provider is excellent because they are not held to unreasonable standards that insurance companies often dictate. These providers can spend more 1:1 time with their patients, can recommend tests and treatments that can be run through insurance companies, and can provide a more holistic approach to your care. I personally feel it worth every penny to have this kind of care.

If you don’t have your health, you have nothing. This year my body has been through the ringer and besides feeling physically unwell, I saw my mental health and my relationships challenged. I was hardly able to concentrate on anything besides getting through treatment and managing my symptoms. My husband became a “caregiver” and most of our life revolved around what I could and couldn’t do with friends during a pandemic when you’re immunocompromised. I haven’t been able to treat patients for almost a year and so my sense of purpose got a little muddy at times.

Now is the time for me to heal from all of that. I am beyond grateful for good health insurance that got me through treatment without any debt, family and friends who contributed to my GoFundMe so I can seek out alternative care options as I continue to heal, and for my super-supportive coworkers who’ve donated time off and kept me in the loop at work so I don’t feel like a complete outsider. These things may seem small, but they can mean the world to someone living with a complex illness.

Again, my purpose here is to share my journey in case someone else going through this can benefit from what I’ve learned. Much of this info is very personal, and I choose to be open about this. I’ve said this before, but just because someone is considered “cancer-free” doesn’t mean they’re not still experiencing some of the long-term effects of treatment. We use fire to fight fires in cancer care and there are often side effects of side effects!

Please be kind! If you know someone in treatment (or if you know someone who may just need a little extra help), reach out today and see how you can support them – we’ve all got to have each other’s backs.

Aloha ❤

*This post is not intended to provide medical advice or recommendations. I am simply stating what has worked or been recommended to me on my personal journey. For more information, read my full disclaimer here.

Frozen Shoulder & Capsulitis after Breast Cancer Surgery

Frozen Shoulder & Capsulitis after Breast Cancer Surgery

by bridewitt ♥ 4 Comments

Staying on topic with complications after breast cancer surgery. The two I’ll discuss today are common and can be disruptive to daily life. You’ve probably heard of frozen shoulder (adhesive capsulitis), but you may not have heard about breast capsulitis after breast reconstruction. Let’s dive in a little deeper.

What is capsulitis?

Capsulitis is inflammation of a joint capsule or the capsule around a breast implant that can lead to scar tissue adhesions and stiffening or immobilization of the joint or breast capsule. Uncomfortable – yes. Functionally limiting? Also, yes.

Frozen shoulder

While frozen shoulder (adhesive capsulitis) can occur after any shoulder injury, it can occasionally occur without any injury, and is more common in females and in people with diabetes mellitus or hypothyroidism. Frozen shoulder typically presents as a significant loss of motion in the shoulder with or without pain. To read a bit more about frozen shoulder, click here.

After breast cancer surgery, frozen shoulder is also common. For women aged 50-59, women who had mastectomy, or women who had breast reconstruction, the risk of developing frozen shoulder on the affected side is approximately 10%.1

Functionally, frozen shoulder leads to difficulty getting dressed, showering, combing your hair, lifting and carrying objects, driving, sleeping, and a whole lot of things we do on a daily basis.

Physical therapists treat frozen shoulder using manual therapy like joint mobilizations, teaching passive stretches and gradually strengthening around the joint as motion improves, and educating patients on healing timeline and ways to modify daily activities to improve use of the arm and reduce pain.

Rehab for frozen shoulder can sometimes take close to a year before a person feels “back to normal.” If caught early enough (i.e. during the “freezing phase” when motion loss begins to occur), a steroid injection can help to minimize the symptoms and restrictions. See your doctor right away if you notice a major loss in joint motion after breast cancer surgery.

Post-reconstruction capsulitis

Post-reconstruction capsulitis or capsular contracture can occur when fibrotic changes occur in the tissue capsule that forms around new breast impants. The breast around the new implant hardens, can become painful, and the breast shape can become distorted. To read a bit more about capsular contracture, click here.

Risk for developing capsular contracture is higher after radiation therapy or following infection, hematoma, or seroma that develops around a new implant. It is not clear whether smooth versus textured implants play a role in development of capsulitis.

Typically, if capsulitis occurs and is painful, distorts the breast shape or an underlying infection is present, revision surgery is needed. In Australia, approximately 39% of revision surgeries each year are due to capsular contracture.2 With early stage contracture, a physical therapist can use manual therapy to try to restore motion and prevent further fibrosis of the breast. A PT will also be sure to address shoulder, neck, and chest wall motion which could be compromised with post-implant capsulitis.

For both frozen shoulder and post-reconstruction capsulitis, getting into see a physical therapist early is important to prevent loss of motion and to reduce pain. Ideally, PT’s would love to see breast cancer patients within 4-6 weeks after breast surgery or reconstruction. Developing a relationship with a physical therapist during and after breast cancer can be a great asset to your health and wellness beyond cancer. Ask your surgeon for a referral or find a PT in your area here.

Aloha ❤

Lymphedema after Breast Cancer Surgery

Lymphedema after Breast Cancer Surgery

by bridewitt ♥ 1 Comment

Lymphedema, a type of swelling in the arm, is an unfortunate complication after breast cancer surgery. I hope this blog will give you a better understanding of the lymphatic system and how to recognize early signs of lymphedema if you’ve recently had or are about to have breast cancer surgery.
*Technically, lymphedema can occur in any limb after lymph nodes are removed, but to keep it simple, I’ll focus on upper extremity lymphedema today.

Overview of Lymphatic System

The lymphatic system is a network of nodes, vessels and organs that function as the body’s immune system. Lymphatic fluid (or lymph) is a protein-rich fluid which contains white blood cells. Lymph carries bacteria and viruses to be filtered through the lymph nodes and helps to prevent infection in the body.

Unlike blood, which is circulated around the body, lymph only flows one way (toward the heart) and requires a pressure gradient and muscular contractions to flow efficiently.

Anatomy of the Lymphatic System
Photo borrowed from Merck Manual1

Lymphatic Disruption after Breast Surgery

From my last post, you know that surgery for breast cancer usually involves removal of the tumor itself as well as removal of lymph nodes in the axilla (underarm). Lymph node removal is done because cancer cells can break off and travel through the lymphatic system and those nodes in the axilla are usually the first place they go.

To be sure the correct nodes are examined, the surgeon uses a radioactive dye to determine which nodes drain directly from the tumor site. Procedures to remove lymph nodes can range from removal of only a few nodes in a sentinel lymph node biopsy to many nodes (up to 20 nodes) in an axillary dissection.

With any amount of nodes removed (but especially with >5 nodes removed), there can be disruption to lymphatic flow through the axilla. In some cases, the lymph is unable to drain from the arm, resulting in lymphedema.

Lymphedema presents as a “swollen” arm, but this is not your usual swelling for two reasons. One, because lymphatic flow is a one-way street, the extra fluid needs to be physically cleared in some way (more on this in a minute…) and, two, because lymph is full of protein and fats that won’t drain into the venous system the way typical swelling does. The limb can actually grow and harden if left untreated.

Stages of Lymphedema – Photo borrowed from Sigvaris2

Studies show that lymphedema occurs in 0-3% of people who choose lumpectomy and up to 65-70% of those who have a modified radical mastectomy.3 Radiation therapy also seems to increase the risk of lymphedema. While many people will develop symptoms in the first 3 years after surgery, lymphedema can take up to 5 years to develop after cancer treatments. Be sure to ask your doctor or physical therapist what your risk for developing lymphedema is and learn about risk reduction practices.

Signs & Symptoms of Lymphedema

  • Swelling in the arm (usually only on side of surgery)
  • Heaviness/tightness of the arm
  • Reduced range of motion of the joints in the affected arm
  • Thickening/hardening of the skin

Physical Therapy Treatment for Lymphedema

A trained lymphedema physical therapist can be an incredible asset to someone who develops lymphedema. Ideally, a physical therapist will be able to work with a patient pre- and post-operatively to monitor girth measurements of the limb and identify lymphedema early on. Stage I lymphedema is potentially reversible, and both stage II and III can demonstrate significant reduction, so seeing a PT sooner than later is key in managing this condition!

With development of lymphedema, a physical therapist can perform or recommend the following interventions:

  • Bandaging of the limb or prescription of compression garments
  • Manual Lymphatic Drainage (specialized lymphatic massage)
  • Exercise prescription (progressive muscle pump, aerobic activity)
  • Patient education on proper skin care and prevention of infection

It’s important to see your doctor or physical therapist as soon as possible if you notice signs/symptoms of lymphedema. Here is a great resource to find a lymphedema specialist in your area. As always, feel free to reach out to me with any questions!

Aloha ❤

Big thanks to Joanne Zazzera, PT, DPT, WCS, for sharing her knowledge and editing this blog!

Physical Therapy after Breast Cancer Surgery

Physical Therapy after Breast Cancer Surgery

by bridewitt ♥ 3 Comments

Ever since Angelina Jolie publicly addressed her preventative bilateral mastectomy in 2013, many women have the idea that removing both breasts is typical care for breast cancer. While a bilateral mastectomy is still a popular option (both to prevent recurrence and to reduce anxiety about recurrence), there are actually many options for women with breast cancer to consider.

Breast Surgery Overview

The goals of surgery are to remove as much of the cancer as possible and also to examine the lymph nodes nearby to determine how much the cancer has spread locally. Thus, a breast cancer surgery often includes one incision on the chest where the cancer is removed and one in the underarm where the lymph nodes are removed for biopsy. There are also options for breast reconstruction (which is usually multiple surgeries), should someone desire it for cosmetic purposes.

  • Options for breast surgery include:
    • Breast-conserving surgery or BCS (lumpectomy, partial mastectomy, etc.) – removal of part of the breast which contains cancer and a margin of normal cells surrounding the tumor.
    • Mastectomy
      • Simple – removal of all breast tissue including nipple and areola (and usually some skin, but it is possible to have skin- and/or nipple-sparing procedures).
      • Modified radical – removal of all breast tissue along with all lymph nodes under the arm.
      • Radical – removal of all breast tissue and the chest wall muscle (this surgery is rarely done unless the cancer has spread into the chest wall).
  • Types of lymph node removal include:
    • Sentinel lymph nose biopsy (SLNB) – removal of the lymph node(s) to which the cancer would likely spread first
    • Axillary lymph node dissection (ALND) – removal of many (usually less than 20) lymph nodes from under the arm
  • Optional breast reconstruction can include:
    • Implants
    • Autografts – tissue from another part of the body is used to recreate the breast (Reconstruction options are a whole post in itself!)

Many breast surgeons now push for breast conserving surgery (BCS) because having a more aggressive surgery doesn’t always result in better quality of life or reduce cancer survival rates significantly. In fact, having BCS in combination with radiation therapy has been proven to be equally, if not more, effective at improving survival rates than a mastectomy alone.1, 2 This information is especially important for those with triple negative breast cancer who do no have the option of hormonal therapy.

Of course, cancer stage (how large the tumor is and whether the cancer has spread) and grade (how quickly the cancer is growing) both influence the type of surgery and treatment someone may need. Discuss with your oncologist and surgeon which option is the best for you in your recovery.

Physical Therapy

No matter the type of surgery a person chooses for breast cancer treatment, a physical therapist is an integral part of post-surgical recovery. PTs help to maximize the body’s natural healing process, restore range of motion to the shoulder, neck and chest wall after surgery, perform scar mobilization and soft tissue work to the affected muscles, and (most importantly) help people to return to their usual activities!

Some post-op considerations for physical therapy after breast cancer include care of post-surgical drains, observance of proper wound care at the incision site, monitoring for signs of infection, and protecting sensitive skin with post-operative radiation. While all PTs are able to treat a patient post-surgically, there are oncology physical therapists who have more training to look for other complications, especially early signs of lymphedema and cording (stay tuned for my next post).

If you or a loved one are interested in trying physical therapy after breast cancer, ask your doctor for a referral. Most oncologists and breast surgeons work closely with physical therapists and they can send you to a PT they trust in your area. If you want to do some research on physical therapists who are familiar with breast cancer rehabilitation in your area, you can use the APTA PT Locator or search through the APTA Academy of Pelvic Health.

Hope this information is helpful – go schedule with your PT today!

Aloha ❤

Round 11

Round 11

by bridewitt ♥ 1 Comment

Just wanted to leave a quick update today – I completed my 7th paclitaxel/carboplatin infusion yesterday which is my 11th cycle of chemo overall. I can now officially count down on 1 hand the number of infusions I have left. My white counts continue to be iffy and were a bit low this week so two more GCSF injections it is! Fortunately, with reduction of the paclitaxel dose and adding milk thistle supplements, my liver counts are improving so I’m thankful for that!

Otherwise, all is well. Trying to get enough sleep and exercise to keep my immune system as strong as possible. I probably should write a whole post on sleep at some point here…stay tuned! Also, our governor finally announced that he’ll be lifting the transpacific travel quarantine beginning October 15, so that means my family can finally come down to visit without the hassle of having to quarantine for 2 weeks! Looking forward to seeing my mama ❤

Justin and I watched The Social Dilemma on Netflix last week. I highly recommend it and would love to discuss it with anyone who has thoughts on the good and bad effects of social media on the people in our society. It’s an important ethical discussion and may make you realize why there is so much division in our nation right now. Let me know what you think!

For those of you still exercising at home, here’s a link to a beginner/intermediate Pilates class that I taught last week for my sister. Justin bought me the cute rainbow tapestry in the background so I was inspired to create a routine around rainbows! Enjoy!

Hope all is well and everyone is staying healthy! Please continue to wear a mask to protect your kupuna (elderly) and those with health conditions that put them at high risk. We’re not out of the woods with COVID-19 yet so please be considerate of those around you!

Aloha ❤

Lymphatic Drainage Techniques for Detox

Lymphatic Drainage Techniques for Detox

by bridewitt ♥ 1 Comment

As you all know, chemotherapy involves a lot of heavy pharmacology. These medications are absolutely life-saving, but they can also take a toll on our body’s natural detoxification processes and can leave anyone feeling sluggish, tired, or generally unwell. This post is for anyone going through chemo, but also for anyone who lives on planet Earth right now. We are exposed to so many chemicals daily and we need to keep our bodies healthy!

Our body’s immune system includes the liver, spleen, thymus gland, bone marrow, and all of the lymphatic nodes and vessels.1 Its primary function is to DETOX our body and protect it against infection and disease. The lymph is the circulating component and thus a very important player in ridding our body of waste products.

An important thing to know about lymph is that it needs some help to flow. Unlike blood vessels, lymphatic vessels do not have smooth muscle that helps to pump it throughout the body, so lymph relies on things like muscle contractions, gravity, etc. to promote a 1-way flow through our bodies.

Read here or watch the video at the end of this post to learn about my favorite ways to perform lymphatic drainage at home:

Diaphragmatic Breathing

Diaphragmatic breathing, or belly breathing, helps to gently stimulate the cisterna chyli. The cisterna chyli is a large lymphatic collecting vessel in the abdomen where lymph from all 4 limbs begins to collect. Stimulating lymphatic flow here can help promote circulation of toxins OUT of the body. Since it’s close to the heart, I like to clear this region first so nothing gets “backed up” if the flow is a little sluggish through here.

Manual Lymphatic Drainage

Manual lymphatic drainage is a gentle, stroking type of massage that helps promote lymphatic flow. There are many ways to do this – with gentle massaging strokes as described in the video below or by using a dry brush or jade roller. The key is to keep the pressure light – lymphatic vessels run close to the surface of our skin so it doesn’t take much to get it going!

Bowel Massage

I finally get to talk about poop (a pelvic PT’s dream)! The liver relies heavily on regular bowel movements to clear out waste and toxins from our bodies. If you are constipated, your liver is working overtime. Typically, we should have a bowel movement every 1-3 days. Before resorting to laxatives or stool softeners if you’re backed up, be sure you are getting enough fiber in your diet and try bowel massage to get that stuff moving! Check out my recommendations for bowel massage in the video.

Acupressure / Acupuncture

During this last round of chemo, I found myself going back to a few key acupressure points that my acupuncturist recommended to assist with lymphatic drainage. I’ve been working two points primarily – one near my right elbow and one on my left shin. Also, check out the P6 point on the wrist, which helps significantly with nausea (even for pregnant women and those who get motion sickness).

Exercise

Finally, my favorite way to get that lymph flowing – exercise! I recommend aerobic exercise, specifically, to increase circulation. It should be low intensity (you can still have a conversation while doing it) over a longer duration (20-30 minutes at a time), and you can pick your favorite activity like walking, biking, or swimming.

I hope this video helps you learn a a bit more about how to implement lymphatic drainage into your everyday life! Feel free to reach out to me with any questions you may have!

xo