Tag: physical therapy

Radiation Fibrosis

Radiation Fibrosis

by bridewitt ♥ 0 Leave a Comment

Radiation therapy is used as an adjunct treatment for cancer to kill off any remaining cancer cells in the surrounding tissues which are often called “micrometastases.” Radiation therapy is not appropriate for all cancer patients, but for those who do have treatment plans which include radiation, the short and long-term effects can be difficult to tolerate. Today, I want to share more about one long-term effect of radiation therapy called radiation fibrosis.

What is Radiation Fibrosis?

Radiation fibrosis (RF) refers to tissue changes which occur locally after someone goes through radiation therapy. Tissues which are most often affected are the skin, subcutaneous tissues (fat, muscle, bone), organs such as the lungs or heart, or the gastrointestinal/genitourinary tracts depending on the part of the body that is irradiated. Ions from radiation beams cause DNA damage and localized inflammation around the tumor site as well as in the surrounding normal tissues. The degree of damage often depends on each individual’s sensitivity to the radiation itself as well as the dose given and area of tissue treated.

Who is at Risk for Radiation Fibrosis?

Anyone who undergoes radiation therapy as part of their cancer treatments is at risk for RF. Some factors that increase susceptibility of developing RF include:

  • Those who also have concurrent chemotherapy or surgery
  • Those with pre-existing connective tissue disorders (scleroderma, lupus, or Marfan’s syndrome)
  • Those with a genetic mutation in the ataxia-telangiectasia (ATM) gene which assists to repair damaged DNA

How does Radiation Fibrosis Present?

RF onset can be immediate, early delayed (0-3 months after treatment), or late delayed (>3 months after treatment), however most find that symptoms begin to show up 3-4 months after treatment ends. Symptoms usually come on gradually and they are, unfortunately, not reversible.

Some of the symptoms include:

  • Thickening of the skin
  • Muscle tightness or atrophy
  • Limited joint mobility
  • Lymphedema
  • Mucosal fibrosis (mouth, throat, GI tract, genitourinary tracts)
  • Pain

What Treatments are Available for Radiation Fibrosis?

Physical therapy is proven to increase range of motion lasting up to six months post-treatment (and probably longer if the person continues their exercises)! PT’s can use manual therapy or prescribe specific exercises to mobilize the skin and myofascial tissues, increase range of motion in affected joints, improve strength, and manage lymphedema (if they are a lymphedema specialist – if not, then they should refer you to someone who is a certified lymphedema specialist).

For reproductive/colorectal cancers in particular, seeing a pelvic floor physical therapist may be indicated to ensure independence with toileting (especially bowel movements) or to assist with sexual concerns like pelvic pain or tightness.

Other potentially-beneficial treatments may include hyperbaric oxygen therapy, pentoxyfilline (a drug that helps to improve blood flow to the tissues) with or without the addition of vitamine E (a powerful antioxidant), and botox injections – but the research is still pending on the true benefits of these treatments!

If you or someone you know is going through radiation therapy, let them know about RF & send them to a physical therapist to help with any mobility concerns they may have!

Aloha ❤

References:

  1. Radiation-induced fibrosis: mechanisms and implications for therapy (Straub, et al. 2015)
  2. Supervised physical therapy in women treated with radiotherapy for breast cancer (Braz da Silva Leal, et al. 2016)
  3. Radiation Fibrosis Syndrome: Neuromuscular and Musculoskeletal Complications in Cancer Survivors (Stubblefield, et al. 2011)
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 ❤

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 ❤

Pink October

Pink October

by bridewitt ♥ 1 Comment

Today is October 1, and there are so many things to celebrate this month! Before I get carried away – I want to remind you all that the first of the month is a great time to schedule or do your preventative screenings including your breast self-exam! Performance of routine self-exams help to identify cancerous tumors in earlier stages and can save your life! Go ahead and #FeelItOnTheFirst, and if you haven’t yet, schedule your annual mammogram!

Fun fact: 40% of all breast cancers are discovered by a self-exam!1

October has always been one of my favorite months for many reasons, but as a pelvic floor PT, I am thrilled that I get to celebrate National Physical Therapy Month and Breast Cancer Awareness month in one shot! I consider myself an “educator” by nature, and I always look forward to sharing information with my family and friends about the benefits of physical therapy, especially for our breast cancer thrivers and survivors.

I have several posts lined up for the next few weeks regarding breast cancer surgery, rehabilitation, and complications as well as some common pelvic floor concerns during breast cancer treatment. I look forward to sharing how a physical therapist can play an important role for our oncology patients as I experience my first Breast Cancer Awareness Month as someone living through breast cancer.

I also wanted to bring some awareness to something I hadn’t really given any thought to before I was diagnosed with breast cancer. It’s no secret that every October, things turn pink all over the place. I’m talking pink products in stores, pink foods, pink cleats in the NFL…you catch the drift. Companies all over the place are eager to jump on board with Breast Cancer Awareness Month, and yet, not all of these companies have the best intentions in mind.

In fact, many companies profit tremendously by slapping a pink label on their product and saying that a certain amount of proceeds go to breast cancer research. We call this “pinkwashing,” and as it turns out, many companies are capitalizing on this terrible disease and only donate a small portion of their sales (or none at all) to support breast cancer research or patients.

Unfortunate as it is, I ask that if you do want to support those who are or who will be affected by breast cancer (remember 1 in 8 women will be diagnosed with breast cancer in their lifetime), please do your research on which companies provide support to breast cancer research or directly to breast cancer patients before you buy that pink label.

Let’s turn Awareness into Action! Here are a few of my favorite breast cancer organizations to support:

  • Breast Cancer Research Foundation – your donation goes to sponsor research grants in many areas related to breast cancer. BCRF is recognized by Charity Watch as a top-rated cancer fundraising organization.
  • TNBC Foundation – your donation will go to improving research and quality of life and education for those living with Triple Negative Breast Cancer. I personally have benefited tremendously from the community associated with the TNBC Foundation and the educational events this foundation hosts!
  • METAvivor – your donation will go to improving research for those living with stage IV metastatic breast cancer.
  • Compassion that Compels – if you’re looking to donate to a smaller organization that provides direct support to cancer thrivers – this is a great one! Your donation will go to providing emotional support, chemo care packages, and prayer to women with breast cancer. I loved receiving a Compassion Bag from this lovely organization!

I hope you are as excited about the possibilities in October as I am! I am also on track to complete chemotherapy at the end of the month (actually, I completed #13/16 TODAY) so it’s going to be a party for sure! Take care of yourselves and I look forward to sharing a TON of good info with you this month!

Aloha ❤

Round 3

Round 3

by bridewitt ♥ 2 Comments

On Thursday, I completed my third of four AC treatments, and it feels soooo good to know I only have to do one more round! Despite the spike in COVID cases on Oahu (& everywhere), Justin is still allowed to come to my appointments with me and I’m very grateful that he can.

Before I went into this round, I made up my mind that it was going to be easier than the past two. I wanted less nausea, less fatigue, and better appetite. Guess what, everyone – I got it. The mind is so powerful, and manifesting your goals and desires is an amazing tool no matter what you are going through.

My last AC treatment will be in two weeks, and then I’ll get two weeks before starting taxol treatments, which will be weekly, on August 6. While everyone says taxol is the easier one, I’m really not looking forward to weekly treatments, and I’m praying that it really is “a piece of cake” like my oncology APRN said.

Otherwise, there is not much else new. We are still social distancing quite a bit as COVID still lingers around. My immune system in the first week or so after chemo is really crappy, so it’s just better to be safe than sorry. My mom was hoping to come down to Hawaii the first week of August, but it’s looking like that may get pushed back a bit due to tourism restrictions.

That hospital parking garage lighting, though…

I still get to work from home a few days of the week, and next weekend I get to take an online continuing education course for oncology rehab that I’ve been wanting to take for months now!

I’d love to start up a more comprehensive oncology rehab program for our cancer patients at the hospital where I work. This is something that one of our inpatient therapists has been very passionate about and got me on board with as well. Hopefully, in the next year, we’ll have a good system to get more oncology patients in for baseline testing and guidance before, during, and after their treatments. I know that exercise has been one of the most important things for me during chemo, and I hope to help others understand the importance as well.

I hope you all have a really great weekend!
Just a little P.S.A. before I go…No matter what you hear on the news or Facebook, wearing masks is a VERY important step to reduce the contagion rate of COVID-19 (if it weren’t, none of your healthcare workers would bother with them, trust me). It’s true, the death rate from COVID is very low, but the high rate of contagion is the scary part. Please wear your masks to protect those around you – don’t be selfish. Mahalo!

Sending love to you all ❤

xo

Welcome

Welcome

by bridewitt ♥ 1 Comment

Today, I’m out on my lanai drinking my favorite Yogi tea, and sitting down to write out some of what’s been going on in my life over the past month.

To give you a little background, I grew up in Butte, Montana, attended college at University of Montana and achieved my Doctorate in Physical Therapy from Eastern Washington University. Since then, I moved with my husband to Honolulu, Hawaii. In the past 5 years, I’ve grown in my practice as a pelvic health physical therapist. I’ve also learned the true meaning of ALOHA which I hope to carry with me through all life’s adventures.

I wanted to start this blog for multiple reasons. Primarily, so my family and friends can stay updated on my medical journey, but also so I could share my knowledge with others.

As a pelvic health physical therapist, I’ve had the unique privilege of working with breast cancer patients to help them maintain independence and wellness during their treatments. I have more to give than to just tell my story and leave it at that, so this blog will contain updates on my personal journey as well as physical therapy tips for patients with breast cancer, pelvic floor concerns, and orthopedic conditions.

I hope that my perspective will be unique and helpful. Thanks for following along!