Siobhan’s Breast Cancer Level 4 Exercises, week 3 of 52, started with dynamic warmup (Desikachar’s Yoga practice 1), then HIIT on app “7”, see first 4 exercises below finished with a recovery walk. I took recovery days in between workouts this week.
In course 3.10 of the 3rd module “Overview of Breast Cancer Rehab”, we discuss the “Self-Care” that physiotherapists can teach breast cancer survivors. Click the link to view and register in the e-Learning Academy in Breast Cancer Rehab for Physiotherapists and Health Care Professionals https://theoreillycentre.thinkific.com
After discharge from the hospital there are key Self-Care Practices that physiotherapists can teach breast cancer survivors to do at home and when going on winter or sun-filled vacations. These “practices” are most relevant to breast cancer survivors whose cancer treatment included an axillary lymph node clearance (ALND) more than for those after a sentinel lymph node dissection (SLND), when a few nodes were sampled.
In this context, a “practice” is an activity breast cancer survivors learn to do routinely as part of their everyday self-care. Today’s practices are part of the meticulous skin care group of practices. The benefits are worth it, as they reduce both the risks of cellulitis and the risks of progressing breast-cancer-related-lymphedema. We have selected 4 practices from course 3.10 just to give you an idea of what these practices are all about, for example, breast cancer survivors who have had a total lymph node dissection may consider the following:
1. Keep a well-stocked first-aid kit handy to treat bites, skin cuts and nicks, e.g. an anti-bacterial and an anti-itch cream and band aids to keep the skin clean.
2. Donn protective gloves when using an oven and when gardening especially when pruning thorny rose bushes.
3. Protect yourself from sun burns and skin cancer by donning sun hats and sun-glasses to protect your face, ears and eyes; long sleeve shirts and swim suits with arm sleeves to protect the skin of the chest and arms; and before going out into the sunshine apply sun block with an SPF > 50.
4. Before going on holidays, especially those locations with mosquitos and bugs, bring repellent spray to prevent bites in the first place and ask your GP for a script for Penicillin that you can fill and pack if you do get bitten and so can self-manage cellulitis early.
Just finished my daily exercises … a “dynamic warm-up” with Desikachar’s Yoga Practice 1, then did an intense 7 minutes of HIIT aerobics with the app “ 7 “ and “cooled down” with a 20 minute “recovery walk”. Today’s walk was at the mouth of the River Leannan and on the western shore of Lough Swilly, Co Donegal.
In our e-Learning Academy in Breast Cancer Rehab for Physiotherapists and Health Care Professionals https://theoreillycentre.thinkific.com we have 5 courses covering early-stage-lymphedema. The aim of these evidenced based courses is to enable “at risk” patients to reduce their risks and to manage early-stage lymphedema so it doesn’t progress. The courses include:
A patient with breast-cancer-related-arm-lymphoedema brought these gloves in to the clinic to share with me and with others living with lymphedema and using compression garments. Bernadette says she finds these gloves “superb” and they are making it easier for her to pull up her compression arm sleeve each morning. To read more … https://arion-group.com/arion-products/easy-grip-gloves/
A wonderful book by my friend and fellow breast cancer survivor Meg Stafford. Told with humour, heart and grace, ‘Topic of Cancer’ helps us to realize that we are all able to make decisions that are right for us during any kind of journey, medical or otherwise. Told in real time, we can follow along as she makes clear what is helpful from others, and what may change on any given day. The reader moves from laugh out loud funny passages to tender moments by turn, each rendered with an honesty that draws us in. Come ride with Meg!
The top list of symptoms experienced by people living with Long
Covid may include fatigue, shortness of breath, brain fog and anxiety. Many
people are really struggling to recover at home and with very little support. Living
with the symptoms of Long COVID is also challenging because it will take time
to establish evidenced based best practice to guide physiotherapy and rehab.
Fortunately there is evidence that Peer Support works and appropriate to
recommend to clinicians, students and all people living with Long Covid. Peer
Support “is about understanding another’s situation empathetically through
shared experience of emotional and psychological pain” (Mead, 2003). physio-pedia.com/home/ prepared
this list of Peer Support groups using Twitter and Facebook for convenient
access anytime from home. The groups are from different cultures and in many
languages and includes kids and adults. Please share this list with your physiotherapy
colleagues, friends and family living with Long Covid so they may access invaluable
support to help them through this. Thank You. Siobhan
Siobhan O’Reilly (59) starts her day with a run on the pink sand of Killahoey Beach not far from Dunfanaghy in Co Donegal. It’s not unusual for her and her six-year-old cockapoo Bo to have it all to themselves for their 30-minute run.
It’s a big change from being a partner in a busy New York City physiotherapy practice where Siobhan worked for many years, raising her two children.
As well as running her own practice just off Wall Street, she was also director of a hospital department and in the middle of a Masters when she was diagnosed with breast cancer at the age of 36. It was, she says, a “massive pause” in her life. “I went from everything to nothing in zero seconds,” Siobhan says. Her own experience of breast cancer and her subsequent recovery led Siobhan down a path where she is now part of a global initiative promoting tele-rehabilitation to improve the lives of women recovering from breast cancer.
While her personal journey to recovery was a catalyst for change in her life, it was her mum Myra’s diagnosis with breast cancer two years ago that brought Siobhan back home, first to Dublin and then to Donegal, where she grew up and where her mother lives.
“It was a bit like coming full circle coming back to Donegal and then lockdown happened. The phone started to ring from patients asking ‘can you help me?’” says Siobhan.
At the time, the country’s Local Enterprise Offices were trying to help fund digital services and Siobhan applied for a business continuity voucher and began working on a website and designing her own telehealth service.
She also changed one of her bedrooms into a studio where she could have Zoom calls with patients wherever they were. What she found was the need for physiotherapy services was massive.
As she worked to design her telehealth course she sent it on to a physiotherapy colleague and one of the world’s leading experts on breast cancer recovery, Jill Binkley, to review it. As founder of US-based TurningPoint Breast Cancer Rehabilitation, an organisation that treats people regardless of their ability to pay, Binkley has helped some 5,000 patients move through the various stages of treatment and recovery.
She’s also lived that journey herself — twice. Binkley’s advice to her was to get her service up and running as soon as she possibly could. Binkley also asked Siobhan to join a research group looking at the feasibility of telehealth in reaching breast cancer survivors in 10 hard-to-reach locations around the world.
Siobhan feels that she’s not just talking the talk, that as a breast cancer survivor herself she knows the journey to recovery can be a long and arduous one. “People are terrified of cancer but there’s so much we can do. That’s why I flaunt my running on the beach. Because cancer treatment is systemic — it’s total body — the chemotherapy affects every part of you. You need to know how to manage that,” says Siobhan.
“A lot of women are very stoic, they just go about their business. But there’s no need to be under-informed and there’s every need to be completely educated about your situation”.
Exercise plays a vital role in recovery and in helping women reconnect with their joie-de-vivre. “I ask people what do they love? I tell my patients that they’re going to get back to doing whatever makes them feel alive,” she says.
Starting slowly and building up to a 35-minute walk every day is part of her prescription for a return to health. “That helps every single organ come back. You tell patients what the steps are to getting there. It might only take two or three sessions on the phone to get them going. Nobody told me any of this at the time and I had no idea how to start back. But you have to start so slowly and gradually rebuild. You really pace yourself,” says Siobhan. “If you ask your body, it will give it to you. The problem is people take off like rockets, but I say start slowly. You’re allowing your body to regulate your mental health, your bone health and your heart health — all these systems affected by treatment begin to come back,” she says.
Another issue breast cancer survivors may have to contend with is lymphedema. This is most commonly caused by the removal of or damage to lymph nodes as a part of cancer treatment. It results from a blockage in your lymphatic system, which is part of the immune system. The blockage prevents lymph fluid from draining well and the fluid build-up leads to swelling.
However, Siobhan says that the sooner patients have access to physiotherapy, the sooner recovery from will be. She explains that the body always has a plan B so the job of a physio is to allow the flow to stop fluids from building up. By teaching patients hands-on techniques they can mobilise the skin themselves to help this drainage process.
While telehealth is slowly being rolled out, Siobhan says it needs to be learned and it needs to be safe. “Practitioners in Australia and Canada are masters of this. They have been talking to people like this for a long time and we are learning from them,” she adds.
After being diagnosed with breast cancer in the third trimester of her pregnancy, 34 year-old Erica Tierney who lives in Sallins, Co Kildare, describes her recovery as a bit like trying to put Humpty Dumpty back together.
Erica Tierney, from Sallins Co. Kildare.
With her daughter Róise now a year old, Erica was 33 weeks pregnant when she underwent a mastectomy. She also had lymph nodes removed which affected her mobility in her arm and shoulder. Erica wondered how she would be able to hold her baby.
She started chemotherapy when Róise was just three-weeks-old, completing her treatment in March of this year. She also underwent radiation therapy, which ended in April. She found herself utterly exhausted after all she’d been through.
“The weird thing is when I finished treatment I was shuffling around the house and I had so many side effects. I said to myself ‘how do I get myself back to close to where I was?’ All the medical appointments fall away and I wondered what I could do to make myself feel better,” says Erica.
She explains that she first heard Siobhan’s name on the chemo ward and went about trying to find her. She had her first appointment over the phone with Siobhan in April in the early days of the pandemic. Through regular phone calls and Zoom calls, Erica began her recovery. “It helps that Siobhan has walked this path as well. “With all the drugs, it was taking a toll on my knees and hips and I couldn’t even walk to the shop.
“Siobhan went through everything with me and checked my mobility. From there she built a programme for me,” says Erica. “I’d always been quite active and that’s what I found hard. I was doing high intensity training and weight training and loving it. It was weird going from all that to pregnant to not being able to go for a walk”. “I started off doing a two-minute walk every day and now I’m doing a 10km walk. I learned strength-building exercises and how to loosen up my joints,” she says.
Guided by Siobhan, Erica also learned self-massage techniques for manual lymph drainage. “She showed me how to manage that myself and now I do self-massage every day. I’ve built it into my day and it’s like my daily habit now,” she says. While Erica was able to have an in-person appointment with Siobhan in July, she believes she wouldn’t be where she is now without the telehealth service.
“I can see going forward how amazing this could be for people. “For me, I didn’t know how to make myself better. The fatigue was relentless. I don’t know what I would’ve done without it,” says Erica.
To find a physiotherapist who does telehealth visit the Irish Society of Chartered Physiotherapists website www.iscp.ie
By Siobhan O’Reilly Bracken, MISCP MPA MSc CLT updated 28/09/20
Meticulous skin care is a cornerstone practice in your lymphedema self-care practices (LSCP). By proactively caring for your skin, you’re protecting it so it can protect you. You are also caring for your lymphatic system, because the superficial lymphatic system is situated in your skin!
Who benefits from practicing meticulous skin care?
If you are already living with lymphedema or if you are at risk for developing lymphedema, this article is for you. If you’ve had cancer treatment that involved your lymphatic system, you may be at risk of developing lymphedema. Fortunately, lymph vessels cut during surgery can regenerate; however, lymph nodes do not grow back, so the risk for developing secondary lymphedema is life-long. The risk is low when only the sentinel lymph nodes are sampled and higher (but not imminent) with a total lymph node dissection (TLND).
Life-long self-care practices
Lymphedema self-care practices, such as meticulous skin care, are life-long practices that will bear fruit now and for many years down the road. Clearly, the earlier you become skilled in your own skin care practices, the better for you and your quality of life.
How does your skin protect itself in order to protect you?
The outermost layer of skin is covered by a veil or film known as the “acid mantle.” This protective veil is maintained when sweat and sebum are secreted up onto the skin from sweat and the sebaceous glands just below. These secretions mix together to form a low pH acid mantle. Bacteria prefer an alkaline or higher pH environment. This acid mantle is the body’s own natural way of keeping your skin healthy. Healthy skin feels soft and supple and acts as a protective barrier, preventing bacteria and fungi on your skin from getting through the outermost layers and into the body
First-aid kit for skin breaks
Reduce your risk of skin breaks by using insect repellent, sun screen and wearing protective clothing, such as a high collared shirt, long pants, boots, gardening gloves and oven gloves. Make sure you have a first-aid kit at home, in the glove compartment of your car and in your suitcase when on holidays where insect bites are common. Useful kit items include antiseptic cream, anti-itch cream and over-the-counter pain medications to keep your fever low until you can see your doctor or an ER team.
FIRST AID KIT
What is the connection between breast cancer-related lymphedema (BCRL) and cellulitis?
Many people living with lymphedema are familiar with cellulitis. If the skin is broken, either because it is dry and cracked, by an insect bite, or by an cut, streptococcus and staphylococcus bacteria can enter and infect your skin causing cellulitis. The infected area becomes red, painful and swollen, and you may also develop flu-like symptoms. A mild cellulitis can go away on its own, but it can also spread quickly. Call your doctor without delay and explain your symptoms so that you can start oral antibiotics. Advanced cases will need intravenous antibiotics and possibly a hospital admission. Sepsis is a serious complication of poorly treated cellulitis, when the bacterial infection spreads into the bloodstream.
BCRL AND CELLULITIS
Back to the acid mantle
Without this emulsion of fats and sweat, skin becomes dry, feels tight and rougher, and becomes more susceptible to cracking.
THE ACID MANTLE
The acid mantle emulsion is made up of three naturally moisturizing factors:
Lactic acid and various amino acids from sweat secreted by the sweat glands.
Free fatty acids from sebum secreted by the sebaceous glands attached to hair follicles.
Amino acids, pyrrolidine carboxylic acid and other natural moisturizing factors.
Combined, these secretions maintain a low and slightly acidic pH on the skin, between 4.5 and 5.5. Therefore, it is the sweat and sebaceous glands that we are thinking about as we select our skin care program. If we select products and practices that are compatible with the body’s own highly evolved mechanisms, we can boost our skin’s ability to defend itself from fungal and bacterial infections, including cellulitis.
If you have lymphedema and a specific skin condition, such as psoriasis or eczema, please discuss it with your doctor and dermatologist, who may prescribe specific treatments.
Check the labels on the back of the skin care products you use. Read the percentages of perfumes, parabens and fragrances to get an idea of its pH. Consider the potential affect it will have on the skin glands and acid mantle.
Try products that state they have a low pH, e.g.:
Eucerin pH5 Body Wash
Eucerin Urea-Repair with 5% Urea, Replenishing Body Wash
LOW pH SKIN CARE PRODUCTS
Follow these principles of meticulous skin care, and your skin will serve you well!