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The O’Reilly Centre Online Learning Academy Launch

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We are delighted to launch our Online Learning Academy, making our courses much more accessible for physiotherapists and clinicians interested in cancer rehab and lymphoedema.

Click on the link below to visit our NEW Online Learning Academy and register for a course to further your expertise

Online Peer Support for people living with Long Covid

Online Support for Living with Long Covid
Online Support for Living with Long Covid

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

Long COVID in Academia

Independent Newspaper Feature

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Top of Form  

https://www.independent.ie Thurs 17th December 2020 

“People are terrified of cancer, but there is so much we can do — exercise can reconnect people with their joie-de-vivre” 

Physiotherapist Siobhan O’Reilly draws on her personal experience of breast cancer to help others as part of a global initiative promoting the provision of rehabilitation through technology 

Siobhan O’Reilly and her cockapoo Bo at Killahoey Strand, Dunfanaghy, Co. Donegal. PHOTO LORCAN DOHERTY

Siobhan O’Reilly and her cockapoo Bo at Killahoey Strand, Dunfanaghy, Co. Donegal. PHOTO LORCAN DOHERTY  

https://www.independent.ie/incoming/c4d5b/39056886.ece/AUTOCROP/w50square/Kathy-Donaghy.jpg

Kathy Donaghy December 10 2020 02:30 AM 

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. 

Siobhan O’Reilly

Siobhan O’Reilly 

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

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 

Lymphedema Self-Care Practices Tips for Soft Supple Skin

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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

Image: Use repellent to prevent insect bites and
anti-histamine or antiseptic creams to treat them.

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

Image: Cellulitis with right arm
breast cancer-related lymphedema

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

Image: The acid mantle (see the blue striped layer) becomes weakened when
you use alkaline soaps or skin products with perfumes, parabens or fragrances.

The acid mantle emulsion is made up of three naturally moisturizing factors:

  1. Lactic acid and various amino acids from sweat secreted by the sweat glands.
  2. Free fatty acids from sebum secreted by the sebaceous glands attached to hair follicles.
  3. 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.

Practical suggestions

  1. 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.
  2. 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.
  3. 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!

Report from June 2019 Course

Report from “The Strong Pink Women Program”, breast cancer rehabilitation for Physiotherapists course on June 13th and 14th 2019.

Physiotherapy teacher: Siobhan O’ Reilly Bracken

Exercise classes teacher: Hayley Killen

This course was held in UCD School of Physiotherapy rooms, over 2 days with 11 participants, one administrative assistant, one time-keeper/teaching assistant. Coffee breaks and light lunches were provided

We started day 1 with lectures on: (1) Breast cancer treatment, (2) Surgery and reconstructions and (3) The healing lymphatic system and cording. After lunch we focused on learning manual therapy techniques for scar tissue release, cording and fibrosis. Hayley Killen brought us through a thoughtful and balanced breast cancer exercise class.

We started day 2 with lectures on; (4) Radiation, the side-effects and implications for manual therapy, (5) Chemotherapy side effects and implications for exercise. (6) A walking program to meet Physical Activity guidelines. (7) Early lymphedema and early compression therapy. (8) Essential self-care skills. In the afternoon we focused on learning the manual therapy techniques for scars, cords and fibrosis. Hayley then brought us through a Yoga class designed for breast cancer rehabilitation. We closed out the course with an inspiring guest speaker who is herself a Physiotherapist and breast cancer survivor and she described her experience with DIEP breast reconstruction and how she progressed her exercises to return to running. Certificates of completion were awarded and course evaluations completed.  Read more.

June 13th and 14th 2019 course evaluation comments;

‘Wonderful presentations, all referenced and the pre-reading was so useful’. OG

‘Good practical skills, smaller numbers excellent’. MB

‘Time management good!’ MB

‘I feel a lot more confident in assessing and treating patients, but also in being able to answer questions they may have and offer advice’. Anonymous

‘Fantastic course and loved all the hands-on practical work’. Anonymous

‘I feel the work you put into this course is fantastic, I would love to follow up with another course with you’. AOD

‘Thanks so much Siobhan. Your mannerisms and humour made this course so much more enjoyable’. Anonymous

Siobhan, thank you so much for a wonder physio-promoting, evidence based enjoyable course! You are such an engaging, facilitative educator. Hope your dreams for world-class breast care in Ireland is realised! With our help! AC

Prospective Surveillance Model of Care

The CSSM Model in Ireland Oct 17th 2017

Implementing Standards of Care in Cancer Rehabilitation In Ireland’s Health Services

Proposal for Cancer Survivorship Surveillance Model (CSSM).

Original Article by:

Jill Binkley, PT, MSc(PT), CLT, FAAOMPT.

Siobhan O’Reilly Bracken, MISCP, MPA, CLT. MSc(Sports)

Tuesday, October 17, 2017

Background

Treatment for cancer typically includes surgery, chemotherapy, radiation therapy and endocrine therapies, which introduce a variety of physiological effects known to adversely impact body structure and function.1-8  Treatment side effects have been most well documented in breast cancer patients, where effects may lead to physical impairments including lymphedema, pain, fatigue, weakness, restricted range of motion, joint arthralgia, neuropathy, and osteoporosis. Treatment is also known to adversely affect physical function, body weight, and cardiovascular health. These impairments may adversely affect patients’ participation in activities of daily living and employment, and negatively affect healthy lifestyle behaviors such as regular exercise.9 While there may be a clinical impression that these issues are uncommon, emerging evidence indicates that a majority of patients experience at least one or more of these physical impairments and suffer from the aggregate burden of impairments, co-morbidities and disease treatment.4,7-9

Lymphedema is a common, much-feared and deeply impactful side effect of cancer treatment.3,7,8,10,11 The risk factors for lymphedema in cancer patients include lymph node removal, radiation, primary involvement of the lymph system. Risk can be decreased through exercise and weight management. In the case of breast cancer, virtually all survivors are at risk for lymphedema and approximately 30% of patients will experience this much-feared side effect in their lifetime. The condition is progressive, chronic and costly to manage when it becomes moderate to severe. Research has demonstrated that patient education regarding risk reduction and provision of early detection and treatment is successful in preventing the impact and progression of lymphedema through less costly intervention.12-15

The Prospective Surveillance Model of Breast Cancer Rehabilitation

The Prospective Surveillance Model of Breast Cancer Rehabilitation (PSM) was developed by the American Cancer Society in collaboration with a team of experts in the field of cancer survivorship.14 The model aims to identify physical side effects early in order to reduce impact on patients and reduce costs in the healthcare system. In the model, baseline assessment that includes arm volume, shoulder range of motion, pain and strength are taken prior to surgery, which is typically the initial phase of breast cancer treatment. Measures are repeated at follow-up visits post-operatively in an effort to identify early signs of physical impairment. If impairments are detected, rehabilitation may be initiated. This proactive approach promotes early intervention to optimize recovery and return to pre-morbid levels of function.9,16-1

Lymphedema risk is reduced through the model through educating patients regarding risk factors, providing early detection as well as treatment of related impairments such as cording and limitation of motion that increase lymphedema risk. Education and reinforcement of health promoting behaviors such as exercise, weight control and physical activity is continued is woven throughout the model of care.

Perspectives of Cancer Patients  

In Ireland and internationally, cancer patients’ unmet needs for education and support for cancer treatment side effects are widely documented. In general, cancer patients are seeking access to care that promotes understanding, prevention and treatment of cancer side effects through evidence-based education, lifestyle change, exercise and, when needed, rehabilitation for cancer treatment side effects.19,20 A prospective surveillance model of survivorship care meets patients’ needs.

The PSM as a Model of Survivorship Care in Other Cancers

The PSM serves as a template for a more general Cancer Survivorship Surveillance Model (CSSM) proposed here that will address survivorship issues commonly seen in other cancers. The focus of this proposal is on cancers where chronic side effects of treatment, such as lymphedema result in the need for ongoing care and cost to the health care system. As such, the focus initially is on breast cancer, head and neck cancers, skin cancer with either axillary or inguinal lymph node dissection and radiotherapy and abdominal and gynecological cancers, where lymphedema is a common side effect of treatment.

Implementation of a Cancer Survivorship Surveillance Model (CSSM) for Lymphedema Risk Reduction and Early Management in Ireland

The CSSM could be implemented for all cancer patients, or at different levels of intensity based on risk for chronic impairments such as lymphedema. It includes a pre-operative assessment by a physiotherapist or occupational therapist, including relevant range of motion, strength, limb volume assessment, education and exercise instruction, as applicable. This would be carried out in one of the Cancer Centers. These records and post-operative discharge notes will be sent to the patients’ family practitioners and community based physiotherapist for continuity of care and as a reference point for ongoing care and surveillance frequency, based on risk factors and co-morbidity. Post-operative follow-up assessments and management of survivorship issues, including lymphedema, would be carried out by community-based physiotherapists and occupational therapists trained in the model.

Calculating FTE/WTE

Three tracks of care have been identified to broadly demonstrate trajectories of care within the CSSM. Research suggests that implementation of a prospective model that facilitates early detection of issues, including lymphedema and that includes education and exercise may reduce patients in need of Track 3 care, which is more burdensome to the patient and significantly more expensive to provide.

Figure: Cancer Survivorship Surveillance Model

Current and Future Health Care Provider Capacity

Most aspects of the proposed CSSM relies on community physiotherapists already in place, with basic undergraduate education in oncology, including assessment of range of motion, pain, function and lymphedema risk factors, risk reduction and intervention for mild lymphedema. However, there will need to be clinically skilled leadership in each province to facilitate implementation of the model and train community-based physiotherapists. These trainers will be physiotherapists or occupational therapists who understand cancer rehabilitation, lymphedema risk and management and the proposed model of surveillance. We propose two trainers per province.

The CSSM trainers would be provided with advanced training related to the proposed model of surveillance through the HSE. The proposed training would be three 2-day workshops, taught by Siobhan O’Reilly Bracken, MISCP, PT, MPA, CLT. MSc-Sports and Jill Binkley, PT, MSc(PT), CLT, FAAOMPT.

Workshop One: Identify and train 2 nominated Chartered Physiotherapists and or Occupational Therapists as trainers and facilitators to pilot the program in each province. Once trained, the liaison would pilot the program in each of the provinces for 6 months.

Workshop Two: Follow-up training for 2 days at 6 months to identify successes, challenges and barriers, provide further training and develop report for the NCCP.

Workshop Three: In the third workshop, liaisons take what the executives agree to roll out and we do an advanced workshop and train the same trainers in the agreed approach.

Health Care Cost Reduction

When impairments and functional limitations are detected early, education and treatment measures can reduce the burden to cancer survivors as well as to the health-care system from a cost perspective. For example, studies have demonstrated that early detection, management and education regarding lymphedema can prevent progression of the condition and in fact, reduce the cost-burden of treating more advanced lymphedema.15 The reinforcement of health promoting behaviors such as exercise, weight control and physical activity is woven throughout the model of care not only decreases lymphedema risk, but also the risk of cancer recurrence, which may have an impact on recurrence, mortality and future costs to the health care system.15,21,22

 

References

(Complete Bibliography Available On Request)

  1. Levangie PK, Drouin J. Magnitude of late effects of breast cancer treatments on shoulder function: a systematic review. Breast Cancer Res Treat. 2009;116(1):1-15.
  2. Ewertz M, Jensen AB. Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol. 2011;50(2):187-193.
  3. Hayes SC, Rye S, Battistutta D, Newman B. Prevalence of upper-body symptoms following breast cancer and its relationship with upper-body function and lymphedema. Lymphology. 2010;43(4):178-187.
  4. Schmitz KH, Speck RM, Rye SA, Disipio T, Hayes SC. Prevalence of breast cancer treatment sequelae over 6 years of follow-up: The Pulling Through Study. Cancer. 2012;118(8 Suppl):2217-2225.
  5. Leidenius M, Leppänen E, Krogerus L, von Smitten K. Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg. 2003;185(2):127-130.
  6. Nesvold IL, Fossa SD, Holm I, Naume B, Dahl AA. Arm/shoulder problems in breast cancer survivors are associated with reduced health and poorer physical quality of life. Acta Oncol. 2010;49(3):347-353.
  7. Deura I, Shimada M, Hirashita K, et al. Incidence and risk factors for lower limb lymphedema after gynecologic cancer surgery with initiation of periodic complex decongestive physiotherapy. Int J Clin Oncol. 2015;20(3):556-560.
  8. Smith BG, Hutcheson KA, Little LG, et al. Lymphedema outcomes in patients with head and neck cancer. Otolaryngol Head Neck Surg. 2015;152(2):284-291.
  9. Campbell KL, Pusic AL, Zucker DS, et al. A prospective model of care for breast cancer rehabilitation: function. Cancer. 2012;118(8 Suppl):2300-2311.
  10. Hayes SC, Janda M, Cornish B, Battistutta D, Newman B. Lymphedema after breast cancer: incidence, risk factors, and effect on upper body function. J Clin Oncol. 2008;26(21):3536-3542.
  11. Hayes SC, Johansson K, Stout NL, et al. Upper-body morbidity after breast cancer: Incidence and evidence for evaluation, prevention, and management within a prospective surveillance model of care. Cancer. 2012;118(8 Suppl):2237-2249.
  12. Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P. Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer. 2008;112(12):2809-2819.
  13. Stout NL, Pfalzer LA, Levy E, et al. Segmental limb volume change as a predictor of the onset of lymphedema in women with early breast cancer. PM R. 2011;3(12):1098-1105.
  14. Stout NL, Binkley JM, Schmitz KH, et al. A prospective surveillance model for rehabilitation for women with breast cancer. Cancer. 2012;118(8 Suppl):2191-2200.
  15. Stout NL, Pfalzer LA, Springer B, et al. Breast cancer-related lymphedema: comparing direct costs of a prospective surveillance model and a traditional model of care. Phys Ther. 2012;92(1):152-163.
  16. Springer BA, Levy E, McGarvey C, et al. Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer. Breast Cancer Res Treat. 2010;120(1):135-147.
  17. Gerber LH, Stout NL, Schmitz KH, Stricker CT. Integrating a prospective surveillance model for rehabilitation into breast cancer survivorship care. Cancer. 2012;118(8 Suppl):2201-2206.
  18. Harris SR, Schmitz KH, Campbell KL, McNeely ML. Clinical practice guidelines for breast cancer rehabilitation: Syntheses of guideline recommendations and qualitative appraisals. Cancer. 2012;118(8 Suppl):2312-2324.
  19. Meade E, McIlfatrick S, Groarke AM, Butler E, Dowling M. Survivorship care for postmenopausal breast cancer patients in Ireland: What do women want? Eur J Oncol Nurs. 2017;28:69-76.
  20. Binkley JM, Harris SR, Levangie PK, et al. Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer. Cancer. 2012;118(8 Suppl):2207-2216.
  21. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005;293(20):2479-2486.
  22. Mehra K, Berkowitz A, Sanft T. Diet, Physical Activity, and Body Weight in Cancer Survivorship. Med Clin North Am. 2017;101(6):1151-1165.

VHI Women’s Marathon 2019

Siobhan and colleagues from the Irish Society of Chartered Physiotherapy volunteering at The VHI Women’s mini-marathon. Once finished runners enter the Wellness Arena to cool down and recover. Using mats, foam rollers and tennis balls, tight muscles and sore feet are gently massaged and stretched to ease any soreness and help recovery. It’s an emotional day with people running after serious illnesses, to raise money for charities and in memory of lost loved ones. The weather was beautifully warm and windy, families and friends relaxed and chatted afterwards in the beautiful Merrion Square Park. “A special event good for the soul”, said Siobhan 

Pink Ribbon Program

Pink Ribbon

The Pink Ribbon Program

Once breast cancer patients has recovered free and painless mobility of the chest and arm of the affected side they can start strengthening to safely:

  1. Restore shoulder strength and movement
  2. Restore ability to do activities of daily living (ADLs).
  3. Return to recreational activities and high-level sports.

There are many approaches to strengthening after breast cancer including The Pink Ribbon Program which is popular with women all over the world.

What is the Pink Ribbon Program?

This Pink Ribbon Program was designed by breast cancer survivor and exercise Physiologist Doreen Puglisi MSc in 2004. Siobhan has studied with Doreen and is also a Certified Pink Ribbon Instructor.

Pink Ribbon Program General Guidelines

  1. Talk to your doctor and your Physiotherapist before you start this or any exercise program after breast cancer treatment even if treatment was several years ago
  2. Notify your doctor and your Physiotherapist if you experience unusual swelling or tenderness.
  3. Progress slowly and try to avoid missing classes so you build strength steadily.
  4. Wear comfortable, loose clothing when doing exercises.

The Pink Ribbon Program is 22 exercises listed below in 4 phases.

The warm up

Starting position: Sitting on edge of a stool on a Yoga mat.

  • Breathing
  • Shoulder rolls
  • Neck stretch tension release

Phase 1

Starting position: Sitting on edge of a stool on a Yoga mat.

  1. Seated shoulder slides
  2. Open elbows

Staring position: Lying face up on Yoga mat, folded towel behind head, knees bent.

  1. Overhead stretch
  2. Reach for the sky
  3. Arm scissors
  4. Supine puppet

Phase 2.

Starting position: Sitting on the edge of a stool on a Yoga mat.

  1. C-Curve.
  2. Lateral flexion.

Starting position: Sitting on right hip with both legs folded to the left.

  1. Mermaid stretches.

Starting position: Lying face up on Yoga mat, folded towel behind head, knees bent.

  1. Arm circles supine.

Starting position: Seated on Yoga mat, legs crossed, hands together in prayer.

  1. Inner peace stretch.

Phase 3.

Starting position: Seated on edge of a stool on a Yoga mat.

  1. Seated puppet

Starting position: Lying face up on Yoga mat, folded towel behind head, knees bent.

14a. Toe taps

14b. Modified Toe Taps for TRAM – one-foot stays on the floor, still in imprint, engage core, hinge at the hip.

  1. Hip lift.
  2. Hip swivel and Knee Drop.

17a. Half Roll back

17b. Modified half Roll Back – in seated position, place hands on balance ball in front and stretch forward.

Starting position: Kneeling on Yoga mat with hands on balance ball

  1. Modified Sliding Child’s Pose.

Phase 4

Starting position: Standing on a Yoga mat, with the band secured under one foot, the ends of the TheraBand in each hand.

  1. Lat Pull.
  2. Back Row
  3. Shoulder Side Raise
  4. Side Stretch and Pull.

Cool down

Starting position: Lying face up on Yoga mat, folded towel behind head, knees bent.

Find a Certified Pink Ribbon Instructor in your Area.

To find an instructor in your area go to http://www.pinkribbonprogram.com/?page_id=12 and select the country listed or select Other International

The program is comprised of 22 exercises in 4 phases and is available on Amazon for $12.99 Pink Ribbon Program: Post-Operative Workout Enhancing Recovery

by Doreen Puglisi M.S. | Jul 21, 2010

The TheraBand beginners set is available on Amazon for $13.99

TheraBand Resistance Bands Set, Professional Non-Latex Elastic Band for Upper & Lower Body Exercise

*****

Manual Lymph Drainage (MLD)

Final Manual Lymph Drainage (MLD)

Manual Lymph Drainage (MLD)

MLD is a massage technique developed by Dr Emil Vodder to stimulate and drain the body’s lymphatic system and reduce swelling. Siobhan is a Certified Lymphedema Therapist (CLT) since 1996. She uses these specialised MLD techniques and sequences to stimulate lymphatic nodes and vessels and move lymph fluid along to the deeper system for processing. In breast cancer rehab for example, MLD is used in combination with manual therapy, decongestive exercises and compression sleeves to drain the treatment area.

Long term lymphoedema care.

When patients need long term care, Siobhan with refer the patient to lymphoedema services and MLD therapists in their area. MLD therapists in Ireland are listed by location on http://www.mldireland.com

Conditions we treat with MLD include:

  • Cancer treatment.
  • Post-surgical swelling.
  • Lipoedema in the legs.
  • Pregnancy related swelling.
  • In sports.
  • Sinusitis sufferers.

Therapies

Pink Ribbon

Therapies

Treatment in provided in a warm and comfortable atmosphere.

We specialise in the aftercare of:

Breast cancer surgery

And

  • Gynaecological cancer surgery.
  • Skin cancer surgery.
  • Head and neck cancer surgery.
  • Sarcoma surgery.

Symptoms such as.

  • Shoulder pain and stiffness
  • Muscle tension
  • Fibrosis
  • Cording
  • Adhered scars
  • Swelling and lymphoedema
  • Neck stiffness and pain
  • Back complaints
  • Hip complaints
  • Knee stiffness and swelling

Therapies

  • Soft Tissue Mobilisations
  • Scar therapy
  • Cording and axillary web therapy
  • Myofascial release therapy
  • Massage
  • Trigger Point Massage
  • Relaxation therapies
  • Breathing exercises
  • Therapeutic exercises.
  • Manual Lymph Drainage. (MLD)
  • Compression therapy (i.e. measuring and fitting compression garments).

Breast Cancer Rehab.

In many cases patients recover full and pain-free mobility after instruction on home exercising by the hospital based Physiotherapists. In some cases, however, significant symptoms occur and it is these symptoms that benefit from specialised treatment.

Siobhan specializes in the treatment of these acute problems. She offers evidenced based treatments that quickly lead to the improvement of these symptoms. Her approach is based on the most recent published studies.

Survivorship.

An emerging standard of care in breast-cancer-surgery-after-care, includes screening for changes in limb volume and detecting early stage lymphoedema during the survivorship years.

Screening for early lymphoedema and other sequelae helps avoid serious impairments from developing and includes taking standardised circumferential measures of the treatment-side arm either before treatment starts or soon there-after.

Therapists can use these measures to compare and identify changes in arm girth during scheduled follow-up visits. For example, the arm’s girth may be decreased possibly due to guarding and disuse or it may be increased possibly due to accumulating lymphoedema. In either case these objective measures show changes over months and years during the survivorship years and guide rehab as needed.

Siobhan takes these measures as a standard part of her initial assessment and at subsequent reviews and can recommend therapies as needed.

If you have further questions, please contact us by phone or by sending us an email to siobhan@theoreillycentre.ie