Oncology Rehabilitation Special Interest Group- MPTA

We did it!! The Michigan Physical Therapy Association Fall Meeting was this week. The membership voted to create an "Oncology Rehabilitation Special Interest Group".  This is very exciting as Oncology Rehabilitation has grown so large in the state that it is now recognized as a specialty area of our profession.   

Here is the statement from MPTA:

"Oncology Rehabilitation is a rapidly growing specialty among physical therapists in the state of Michigan. Cancer Survivors experience many challenges with the occurrence of multiple side effects and adverse events from the treatments for cancer. Physical Therapists are essential and one of the most qualified health professions to treat those side effects.  Oncology Rehab programs are currently at all different levels of development throughout Health care Organizations and Outpatient clinics throughout Michigan. "

We believe that an Onlogy  Rehalitation ecial Interest Group will increase communication and collaboration achieving three goals:

1.       Increase quality of life for cancer survivors throughout the continuum of care.

2.       Increase awareness and evidence of practice to health care professionals andministrators to increase referrals for oncology rehab and facilitate the development of more oncology rehabilitation programs.

3.       Advocate for our profession to bring more awareness to the public about the role of physical therapy from the moment of diagnosis and throughout the survivorship continuum of care.

The Emotional Toll of Cancer

Yesterday I had the privilege of working with two cancer survivors. One woman had been diagnosed with triple negative breast cancer and the other woman had been diagnosed with lung cancer.  They are very strong women and warriors battling the emotional and physical side effects of losing body parts and experiencing severe fatigue, nausea, vomiting, insomnia, weakness, pain, neuropathy and mental fogginess.  During each of their individual evaluations, tears flowed, sometimes to the point of bodily tremors trying to deal with the emotional and physical changes that have occurred so quickly and totally changed their lives.  These women were both very active and vibrant women prior to their diagnosis. 

However, it was a comment that both of them shared that made me tremor inside.  Each shared how medical professionals and family members had told them “don’t cry…that is being negative….you have to be positive to get through this….you’re crying too much…you need to take an anti-anxiety pill….”

What I shared with these beautiful survivors and what I share with every survivor and every medical professional that I present to about Oncology Rehab (in the area of “What Not to Say to a Cancer Survivor”) is this:

1.       “DON’T EVER tell a survivor to just be positive…EVER… Unless you have walked in their shoes , you have no idea what it feels like to have body parts removed and your life turned upside down in a moment.  People who are positive die also.

2.      Crying is a great way to get rid of toxins from their body and release a lot of stress.  I hand survivors a box of Kleenex and tell them to cry it out as much as they want to. 

a.      Medical professionals and family members feel bad because their patient or loved one is crying and they don’t know what to do. We must be very careful.  We may be feeling uncomfortable as health care practitioners or family, however, our discomfort does not require the survivor to block or suppress their emotions to make us feel better.

3.      AND PLEASE DON’T SUGGEST MORE MEDICATION as the first line of intervention…These survivors are already taking a lot of medication. More medication should not be considered until all other avenues of evaluation and treatment have been considered.


a.      What is the baseline Vit B12 and Vit D levels…Low Vit B12 can cause neuropsychological effects (read the pharmaceutical insert)and can cause a person to cry at dog food commercialsI know…I was one of them.  In eleven years of treating cancer survivors, 99% of them had low Vit B12 and low Vit D levels.  It is not standard of practice to automatically test those levels. Consider checking these first.  Just bringing those levels up may change physical and emotional status.

b.      Exercise is the most effective treatment for the emotional and physical side effects of cancer treatment.  AND it gives survivors back some control…..something they can do during the craziness of treatment.  There are NO ADVERSE EVENTS as a result of exercise that is prescribed and monitored by a physical therapist.  There is a plethora of research to prove this and I have hundreds of anecdotal stories from eleven years of working with cancer survivors to prove its worth.

c.       In Oncology Rehabilitation, we evaluate then EDUCATE, EDUCATE, EDUCATE….. Knowledge is power. This is power that gives survivors emotional and physical strength.

d.     If you want someone to be positive, give them something to be positive about. Give survivors strategies for getting through the painful and traumatic treatments for cancer.  Give them hope by helping them to see and look forward to the life after cancer. That is what we do in Oncology Rehab.

As a result of the philosophy of oncology rehab to empower survivors, both women left my office with a list of strategies and things that they could do to get through the weeks they had left with chemo or radiation. They had smiles on their faces as they knew there was a hope and a real life after cancer that they could look forward to.  And it won’t end with this treatment.  I will work with these survivors throughout their chemo and radiation and keep empowering them so their quality of life only improves.

They are already embracing their hummingbird courage! - Deb Dohery

Exercise and Chemotherapy: Critical Information

There are 3 animal studies that show the incredible power of exercise along with chemotherapy treatment. Whether you are a survivor or a clinician, this information is crucial. Let's all advocate for treadmills, bikes and upper extremity ergometers right in the infusion clinics so that survivors get the most of every ounce of chemotherapy.

Exercise just before infusion or just after infusion could improve your outcomes. Let's all get the word out!!

1. Combining exercise and chemotherapy shrank tumors more than chemotherapy alone (doxorubicin). The theory is that exercise increases blood flow to tumor bringing more of drug to the site of the tumor Libonati, et al. Exercise boosts tumor-fighting ability of chemotherapy. 2014. Amer J Physiol. doi.org/10.1152/ajpregu.00082.2014

2. Exercise statistically significantly reduced tumor growth and was associated with apoptosis (which is cell death) 1.4 fold increase compared with sedentary controls. 3. Exercise plus chemotherapy prolonged growth delay compared with chemotherapy alone. 
Betof et al. Modulation of Murine Breast Tumor Vascularity, Hypoxia, and Chemotherapeutic response by exercise. doi:10.1093/jnci/djv040.

3. Mice that exercised with chemotherapy showed significantly slower growth in tumors than in sedentary mice and 1.5 times higher tumor cell death. Exercise stimulated significant improvements in number & function of blood vessels around tumors, improving oxygen flow to the cancer site. Not only does cancer not live in oxygenated area but chemotherapy, (cyclophosphamide) drugs delivered to tumor quicker. 
Dewhirst, Montana. J National Cancer Institute (2015; doi:10.1093/jnci/djv040).

You Can Do It!

As a breast cancer survivor myself, this month brings back tears and joy. I still remember those scary words "you have breast cancer" and the tears started flowing. My mind couldn’t shut down trying to figure out Plan A, Plan B, Plan C…how do I get through this, what will it mean for my family, is this a death sentence…

Now eleven years later, I wake up every morning with joy in my heart. I am healthier now than I have ever been. Although, I am one boob short of a pair, it is a minor detail as I am so blessed with my life, my family, and my purpose. 

For those of you who have just been diagnosed, I send you hugs every day.  If you ever need to talk, please call me.  For those receiving treatment currently, hang in there, you can do it.  I’m cheering for you every day.  For those who have completed treatment.  High five to you all!!  I knew you could do it. 

After going through my own journey and treating hundreds of cancer survivors over the last eleven years, I have learned a thing or two and I would love to share that knowledge with you.  Although once diagnosed, it feels like we are at the whim of the medical community and have no control over anything, I can tell you that you have a lot that you can control.  There is so much that we can do to help our bodies thrive during and after treatment.  I know that sometimes it is overwhelming to think about physical activity, smart nutrition, getting more sleep, decreasing stress, but these are just four of the many things that we can all do on a regular basis to help make it through the treatments and improve our quality of life.

I’m here to help if you would like to talk. 

I send you all prayers, blessings and big hugs!

Michigan Ovarian Cancer Alliance (MOCA)

I had the privilege this morning of listening to a presentation by the Michigan Ovarian Cancer Alliance (http://www.mioca.org/) at Oakland University to the Doctor of Physical Therapy Students.  This incredible group of Ovarian Cancer Survivors take their stories and the facts about Ovarian Cancer to students in all medical programs throughout Michigan. They share their heart wrenching discovery of their cancer and their challenging journeys through diagnosis and treatment.  It is a powerful presentation.  The personal stories are also intertwined with facts about ovarian cancer.  This remains a silent disease as so many of the symptoms mimic other much less serious illnesses, like bloating, loss of appetite, and urinary problems as well as many more.

I want to thank and honor those courageous women!  As a physical therapist I am also disheartened by the few referrals to physical therapy for these survivors.  Surgery for ovarian cancer can result in severe myofascial restrictions in the pelvis,  and lymphedema; chemotherapy can result in fatigue, cardiotoxicity, cognitive impairments, and radiation can result in tissue fibrosis and problems with the colon, bladder and sexuality challenges,  

I hope and pray that as survivors or families and caregivers of survivors, we can all advocate for ovarian cancer survivors to be evaluated and treated by a physical therapist to prevent many of the side effects from cancer treatment.  Ovarian Cancer Survivors deserve a good quality of life.  

A Life Less Cancery

I stumbled across this article in Cure by Jen Sotham and thought this beautifuly summarized, well, making your life a little less cancery! This is a great read!

She writes, "A cancer diagnosis and treatment can take over your whole world. Here are a few ways to reclaim parts of your life and ease some of the emotional stress that cancer brings."

Click Here to Read More

Why the Hummingbird?

Why the Hummingbird? Author, Alberto Villoldo, in his book entitled “Courageous Dreaming”, discusses what Hummingbird Courage and hummingbird consciousness is. On page 100 he states, “in hummingbird consciousness, we engage life from the level of the soul, just as that tiny birdfinds the valor to take his monumental journey, we can discover the courage to perceive ourown lives as a journey of growth and discovery, of spiritual maturation. We don’t fuss aboutthe details of our flight…we’ll make it to our destination.”

He continues on with “the hummingbird isn’t even supposed to be able to fly given the shapeand weight of his body. Likewise some of feel that we weren’t made to soar…but despitethinking that we don’t have enough …..”wings”, we each have a great journey that’s availableto us should we choose to accept the invitation from life and respond to the call”.

These words spoke volumes to me. When Alberto talked about how hummingbird courage “canempower us to rewrite our stories” and “look at life as a journey of discovery and growth”, itbrought tears to my eyes. That is what being a cancer survivor has been for me, a journey ofdiscovery and growth.

After the shock of the cancer diagnosis, I struggled through the world of decision making andquestioning every step of my journey, completed surgery and recovery, waited for the phone callto tell me whether I had cancer in my lymph nodes, prayed and prayed and prayed for help andcourage and then spent five years dealing with side effects of hormonal therapy to preventcancer recurrence.

I kept reading on and Alberto stated that “as determined hummingbirds willing to trust that we’ll have all we need on our journey… we can start to paint a very different picture of who weare and what the events of our existence mean”. I did just that. My new journey began with mydiagnosis. Along this journey I have met some amazing people that I would not have had theopportunity to meet otherwise. What a blessing for me.

But Alberto didn’t stop there, on page 102, he states “the saga of a loss or illness can now be one of initiation into the tribe of survivors, who can wisely guide others through this passage.” Iknew that I had a purpose in life and that I could use the skills and knowledge I had acquired asa physical therapist and educator to help in the fight for quality of life for cancer survivors.

My dear husband has always kept a hummingbird feeder at our home during the summer. Mymother had given me a hummingbird feeder that hangs outside my office window. Here I’vebeen surrounded by signs of hummingbird courage and didn’t even realize the power that it hadgiven me. I do now.

I challenge you to accept the invitation from life, respond to the call….

Embrace your Hummingbird Courage!