What is it like when the PT becomes the patient? Our very own Jes Davies, a highly regarded physical therapist received a diagnosis of breast cancer 2 years ago. Her experience as a hands-on manual physical therapist, yoga instructor, and now breast cancer survivor provides us with a perspective that is insightful and helpful. One of the many things she learned in this process was the value of physical therapy in restoring her body to efficient and painfree function. Read from her Q & A below and follow the link to the video below to see the 3 video series done by the Milwaukee Journal Sentinel for breast cancer awareness month. You can schedule an appointment with a Body Mechanics physical therapist in Milwaukee (414) 224-8219, Pewaukee (262) 695-3057, or Madison (608) 422-5085.
Click this link to watch all 3 videos in the Milwaukee Journal Sentinel In Motion series: http://www.jsonline.com/search/in%20motion%20breast%20cancer%20series/
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1. How does breast cancer surgery, radiation, chemotherapy, and other treatment affect movement?
Treatment for breast cancer looks different for each patient. From a surgical standpoint, a lumpectomy to remove the tumor can be large or small, but most of the time is unobtrusive to movement after surgery. A mastectomy on the other hand is very extensive. I joked the day after my surgery that my chest wall felt like it did 1,000 pushups the day before. For a few weeks after surgery I needed help washing and dressing because of how difficult it was to move my arms.
Whether you are recovering from lymph node resection, chest wall radiation, or breast reconstruction, the most difficult movements to restore are elevating your arms forward, sideways and backwards. In simple terms, any movement that lifts arms overhead requires lengthening of these tissues that get tight from treatment. Breast cancer patients are very prone to rotator cuff impingement and other shoulder, neck, and back breakdown if they are not purposeful in regaining range of motion and strength. I was weak as could be for a long time following surgery. It made teaching my yoga classes difficult. I don’t like lifting weights, so I joined a gym to make sure someone was holding me accountable to lifting and progressing my strength. Today I am stronger than ever before!
2. Is there enough emphasis on movement and exercise after or during treatment for breast cancer?
Whether we are talking about breast cancer, or recovery from any other injury or surgery, insurance limitations often prevent us from being followed to 100% restoration. I saw a physical therapist at the hospital who specializes in mastectomy patients that helped me monitor my incisions and start gentle stretching and soft tissue work. In addition my lymph node resection caused some nerve damage to a segment that wraps around my back to my shoulder blade. I had severe nerve sensitivity where it felt like my skin was on fire or like my shirt was rubbing on a sun burn. So that therapist also explored some modalities to desensitize (rubbing with rough cloth, vibration).
I saw that therapist for a few weeks with a primary goal of making sure my incisions healed and that I returned to basic movement. From there I transitioned to a private practice PT who deals with athletes. He was new to mastectomy patients, but I could help him fill in those blanks so that we could start progressing me to higher level function. He helped to continue soft tissue work, but was appropriate in selecting the proper exercises I needed. We checked in every few weeks until I felt ready to work with trainers at the gym.
My other companion through my recovery was my yoga mat. I have taught classes for 14 years, and my mat was a useful tool. I would go to group classes for the benefit of breathing and being with people, even during the times I could barely move. Being around people, and supportive people, was important to me during my recovery. I learned so much about how to move with modifications. I think it helped me both as a teacher and as a physical therapist.
3. Is home exercise enough? What would a specialized physical therapist do to help?
Home exercise may be enough as long as full mobility and strength are restored within a few months after cancer treatment. If you continue to have weakness, pain, or stiffness when trying to move your arms overhead to full range you may benefit from manual physical therapy sessions to specifically free up muscles, connective tissue, and nerves that are stuck down and not gliding efficiently. The specificity of manual work by one of our physical therapists allows your home exercises to work better. At Body Mechanics our PT’s have advanced training and can feel the biomechanics of your motion with their hands and see with our eyes where you are limited and not moving efficiently. We work to mobilize with our hands, train efficient movement with manual methods, and focus your home exercise on activities that are individualized and helpful to continue progress.
4. Is physical therapy for this condition painful?
No, in fact movement for me helped to resolve pain. When I hurt early on, I walked and felt better. When I felt tight early on, I breathed and regained motion. And the same with my exercise progression...the more I moved the better I felt. As a physical therapist, I often hear my patients describe it as a “good hurt” or like it feels like what needs to be done. Everything we do is guided by patient tolerance.
5. How often should one see a physical therapist for this condition, how many visits are likely, and how much does it cost?
During my acute stage I followed with my therapist 1x per week. Even though I had a high deductible policy, by the time I went through my expensive surgery I met my deductible so those visits were covered for me. And from a medical justification standpoint, it was easy for that therapist to show my need for treatment. Most breast surgeons, plastic surgeons, and radiation oncologists are huge advocates for PT.
During my subacute stage, I followed up with my therapist every 2-4 weeks. I went a total of 6 visits. For me those costs were also covered. If I would have been responsible for those costs, I still would have invested in that care because it was so helpful for me. At Body Mechanics, regulations allow us to provide a reduced rate for private pay clients. Depending on quantity of visits purchased visits are $150-$160/hour or $80-$90/half hour at the pay-at-time-of-service discount which is approximately at 50% discount.