The Lymphedema Superheroes among us

Today, Tx:Team celebrates Lymphedema Day and the work of therapists to serve those living with Lymphedema. Physical Therapists and Occupational Therapists perform really incredible work so that their patients regain the strength and confidence to live a life they thought was out of reach. One of our own therapists, Amy Rutherford, pursued a specialty in Lymphedema therapy early in her career, and today, we highlight the care and compassion that she provides to the residents of Frankfort, Indiana.

Amy works at IU Health Frankfort Hospital, located about an hour northwest of the state’s capitol, Indianapolis, in its more rural Clinton County. In her area, she mostly sees Lymphedema patients coming in with swelling of the lower extremities from COPD and diabetes. For Amy, she appreciates how simple lifestyle changes can greatly affect her patients and reduce the burden of Lymphedema on their lives.

What’s Lymphedema?

Lymphedema is a diagnosis of body swelling that is caused from damage to the lymphatic system. Whereas healthy bodies can manage their fluids and dispose of waste properly, bodies with damaged lymph nodes can build up the fluid that would normally be filtered out. On the outside, we see that buildup of fluid looking like an arm or leg that’s been blown up like a balloon.

In early stages, Lymphedema is easily treatable and reversible. However, the signs of this stage are so subtle that they can be very difficult to detect. A patient might feel tight in clothing or they’ll need to loosen the notch of their wristwatch. By the time the body is noticeably swelling, Lymphedema has typically progressed into a lifelong chronic condition that can significantly interfere with someone’s quality of life.

How does Lymphedema affect a person’s life?

A swollen arm or leg can make it difficult for a person to get dressed in the morning because their body is heavier, and they might not fit in the clothes they usually wear. It can be more difficult to do some of life’s basic routines, like bathing, for example. Little things that we don’t think about in our everyday lives- like washing our feet- can suddenly become near impossible because it’s too straining to reach passed the swelling to the feet.

It’s not just a physical condition. You can imagine that not being able to fit in your normal clothes and going out in public with a large swollen arm could affect your self-confidence. And if you can no longer wash your feet, you probably feel less clean than you’d like to be. For these reasons, Lymphedema can take a toll on a person’s mental health. Feelings of embarrassment and depression can creep in and linger throughout the day.

Just about all superheroes don’t wear capes.

Day in and day out, Amy is committed to making her patients feel healthy and great about themselves. She provides not only her expertise, but also compassion for her patients’ lives. When a patient arrived unable to properly clean himself, she knelt down to wash his feet. Really wash his feet of likely weeks of grime. “Cleaning a patient,” she says, “is work that really creates a bond. It’s work that reminds you of the biblical act of washing feet to show your care for another.” Encouraging patients to use proper soap and lotions, like Dove and Eucerin, and getting them to be a little more active in their day has undoubtedly improved the lives of many. We remember how simple, yet genuine care can impactfully change lives.

So today, we thank Amy Rutherford for almost twenty years of work in her field. Lymphedema is a debilitating and frustrating condition that can bring a lot of pain into patients’ lives. Therapists like Amy, who have committed themselves to treating Lymphedema, offer support that restores independence and dignity to those they serve.

Amy is just one of our Certified Lymphedema Therapists. We are thankful for all our CLTs and the work they do.

 

Cabin Fever? Beat the Winter Doldrums

“I’m bored.”  In the middle of winter, this phrase can make any mom or dad break out in a sweat.  And a snowy winter day with children who cannot find anything to do may seem to last centuries.  A long day at home or a lengthy winter vacation is the perfect time for children to participate in fun activities that will build their skills, as well as put a stop to the classic complaints of boredom.  Coming up with creative ideas in a variety of skill areas, along with ideas for adaptations for children with special needs, can be a daunting task for parents as well.  Consider the child’s age and/or developmental level, safety, needs, and preferences to help you select appropriate activities to bust those cries of boredom!

 

Plan Ahead

To avoid being put on the spot in coming up with a fun activity when the famous “I’m bored…” complaint erupts, put together a “boredom box” with ideas from which the children can select.  Assist your child with coming up with his or her own ideas of what to include.  This can be a good strategy to use whenever your child has more ideas of things to do than time.  Include skill building activities that are developmentally appropriate and are “just the right challenge” with a fun twist so that the activity is not viewed as work.  To avoid having to scramble for materials for activities at the last minute, organize an additional “supply box” with basic craft supplies (e.g., construction paper, crayons or markers, cardboard tubes, paper plates and bags, glue, glitter or other decorations).   Consider including small craft sets with instructions, puzzles, and small travel games that are new or seldom-used.  Examine the skill categories below and adapt the following activities to your child’s skill level and safety needs.

 

Make Dressing and Self-Care Fun!

Winter break, snow days, and weekends afford plenty of opportunities for children to master the art of getting dressed, due to the extra time to get ready, and the extra seasonal clothing, such as snowsuits and boots.  If your child needs additional practice mastering fasteners, or resists getting dressed without assistance, incorporate fasteners and dressing into a game.  When multiple children are present, have a suitcase race where children don clothes (over their own clothing) as quickly as they can to win a prize—this can be done as a relay race for more than two children.  Institute a fashion show where the children can practice putting together their own outfits from old clothes (including parents’ clothing), or a doll or stuffed animal fashion show.

 

Visual and Fine Motor Skills

As visual and fine motor skills are an integral part of the school day from an early age, incorporating some of the fun activities below at home will help to boost skills

  • Make some homemade Valentines or birthday cards.
  • Write letters to family or friends on personalized letterhead.
  • Design scrapbook pages from a recent vacation or holiday to incorporate cutting, coloring, and handwriting.
  • Dust off the jigsaw puzzles, legos, lincoln logs, or travel editions of games (these have smaller parts).
  • Encourage building from a model made by a parent or older sibling, or if appropriate, building from instructions on the box. In addition to visual motor skills, word finds or crossword puzzles build vocabulary, and your child can design his or her own puzzle for someone else to solve.
  • For imaginary play, set up a pretend office with supplies such as paper clips, binder clips, old folders, or junk mail to practice manipulating common items. Get messy with squirt bottles (to spray a window or shower), hole punches, or clay tools and presses to strengthen fingers.
  • You can make handwriting fun by designing a secret code to write with fun squiggly pens, bathtub or window markers, or invisible ink markers.
  • Institute a “no-talking, only writing” time to communicate for fifteen minutes or so to encourage writing (this also might help to calm a noisy household).

 

Gross Motor Skills

After spending too much time indoors due to inclement weather, children will need to find a safe way to move around and expend some energy.

  • In a large, open area (basement, family room), provide your children with common household items, such as chairs, plastic juice bottles, a broom handle, hula hoops, or jump rope to design an obstacle course (with adult supervision for safety).
  • Hang up an over-the-door basketball hoop, or design one from a box with the top and bottom cut out to play rag basketball (from knotted up towels or t-shirts), or use a lightweight sponge ball.  Using these homemade toys or games can be more fun than purchased ones, and this will encourage their creative development.
  • If your child enjoys dance or aerobic exercise, consider renting or purchasing an inexpensive exercise or dance video for kids, use a dance pad video game, or have your own dance choreography contest.
  • Consider games from birthday parties or gym class, such as “Twister,” hopscotch (many toy stores offer foam mats), hula hoops, jump rope, “Simon Says,” or “charades” to encourage development of certain movement skills and physical activity.  By playing these games in a fun, friendly atmosphere, rather than being graded in gym class, or being concerned with winning a prize in sports, children who have difficulties with coordination may become more comfortable with motor planning.

 

Cognitive and Social Skills

We all continue to build our cognitive and social skills throughout life, establishing systems to do things and how we appear to other people; therefore, these are very important skills to practice.

  • If your child has difficulties interpreting emotions from facial expressions and body language, try body language charades (what is this person telling you?) or making an emotions collage of people from magazines with a designated facial expression or body language.
  • Practice teamwork by building something together or use an obstacle course as a relay race.
  • Work on sequencing via the oldie but goodie “follow directions game” by having children write down the directions to make a peanut butter and jelly sandwich, then have someone else make the sandwich following the directions exactly (use your *clean* hands if the directions don’t specify a knife)!

 

Sensory Skills

For children who have difficulties interpreting and processing sensory information, winter may be a difficult time to get used to seasonal changes in sensory input, and less access to outdoors (where many calming strategies might be located).

  • You can put clean snow in a dishpan or large plastic container for some table play inside to adjust to the sensation and temperature of snow prior to immersing the child in snow outside.
  • For a slightly easier to clean up sensory experience, place rice, beans, flax, or popcorn kernels into a bowl/bin/container with some of those summer sand toys!
  • Also, pull out the summer mini child’s pool, and fill with lightweight plastic balls (available at many toy stores) to create your own ball pit.
  • To create an indoor quiet area, your children may enjoy draping old sheets or blankets over two chairs to create a tent or use a large (appliance) box for a calming space with cushions or pillows for resting.
  • Children may enjoy spending a day inside making pretzels, kneading bread dough, rolling out cookie dough, or making “slime” as a tactile sensory experience.
  • Some household heavy work can be calming to children with “cabin fever,” such as pushing or pulling a vacuum, pushing a shopping cart, shoveling snow, pushing a wagon or wheelbarrow—all of these should be of appropriate size/weight (toy or regular), depending on the child’s size/abilities.

 

Seeking Expert Assistance

If your child has significant difficulties with dressing/fasteners, fine motor or handwriting skills, visual motor skills, motor planning, or sensitivity to tactile experiences, he or she may benefit from a physician’s referral for a pediatric therapy evaluation.  A pediatric therapist working in an outpatient center can determine if your child could benefit from skilled services and home exercise programs that build on these skills.

Lymphedema & Physical Therapy

Christina Kuzma, Manager of Business Development at Tx:Team, successfully battled breast cancer this year using physical therapy as an integral part of her treatment plan. She says that the one thing she would have done differently is to start physical therapy sooner. She began therapy the day after surgery with stretches and massages to target her lymphatic system. Despite her success, she thinks that her body would have been better prepared for the pain and stiffness if she had practiced therapy in the weeks leading up to her surgery. These pre-operation exercises are especially important when thinking about post-operation outcomes that can hinder a patient’s success. An example to consider, which often goes undetailed, is Lymphedema. Christina’s symptoms during radiation did not flare to become Lymphedema; however, reports show that having an extensive surgery, such as mastectomy, paired with radiation can increase the odds of facing Lymphedema six-fold.

WHAT’S LYMPHEDEMA?

Lymphedema can occur from any compromise to the lymphatic system; however, Lymphedema is especially common among breast cancer survivors because it can happen when lymph nodes are missing, impaired, or removed. Swelling will ensue if this system begins to have problems draining excess fluids, waste, or toxins from the body. Most commonly in breast cancer patients, the swelling shows in the arm or hand, and sometimes in the underarm, chest, trunk, or back. It can be a very serious, debilitating, and painful problem.

 

To identify Lymphedema, know that it develops gradually; however, early detection is important. Uncomfortable sensations, like tingling or numbness, in any of the listed common areas precedes visible swelling of those parts. Some patients will also report feeling full or heavy, and others report decreased flexibility and tightness. Including a Lymphedema assessment in a routine follow-up visit with a doctor at most, 6 months after surgery, could substantially decrease the physical, emotional, and financial burdens of Lymphedema on breast cancer survivors. Early detection treatment and even a pre-surgical rehab visit can vastly improve your outcome if diagnosed with Lymphedema.

MEET KIM BROWN

Kim Brown is a Tx:Team Physical Therapist at FMH Rehabilitation Crestwood, in Frederick, Maryland. While she did not treat Christina directly, Kim is all too familiar with the diagnosis and treatment for patients just like Christina.

Kim is trained and certified in Lymphedema treatment. Seventy-five percent of her clients are breast cancer patients. Due to the sensitivity of this condition, which balloons the body and causes intense, uncomfortable pain, Kim treats Lymphedema with private and personal care. According to Kim, “Success is defined by the empowerment of patients, with hopes of not only regaining their strength and living pain-free, but also regaining self-esteem and authority over their condition.”

For that reason, education about Lymphedema is a big part of Kim’s job.  “Most patients haven’t tried much besides medication to cope with their pain or persistent disability,” says Kim.  It’s likely that for that reason, many patients arrive thinking that there’s no real opportunity to improve. However, alongside the use of manual therapy and bandaging to heal tissue and reduce swelling, Kim and her team of therapists teach their patients how to exercise and manage their condition on their own.

There are few comprehensive studies conducted on Lymphedema in breast cancer patients, and as a result, Lymphedema can often be brushed over in conversation. Christina Kuzma reports that she only knew about Lymphedema thanks to a co-worker. Otherwise, Lymphedema was only mentioned to her quickly in a doctor’s visit as a potential outcome. Despite this serious lack of information and discussion, you are not an outlier if you experience this swelling and it deserves immediate attention. One study reports that in the first 18 months of recovery from breast cancer surgery, 1 in 10 patients experience Lymphedema. By 18 months, about 30% of patients have, or have had Lymphedema. Irrespective of these odds, it is most important to educate yourself on Lymphedema and keep tabs on the changes in your body as it undergoes intense and stressful circumstances.

LIVE YOUR LIFE, PAIN-FREE

It cannot be said enough how important it is to care for the health of your body and those you love. Circumstances can quickly change and you may feel out of control, but know that living comfortably is within reach. Especially to cancer patients, Kim Brown insists that there is always room for improvement. She says, “Beating cancer isn’t the end of your journey. Don’t accept weakness, fatigue, and pain as a part of your life post-cancer. Talk to your doctor and maintain that your goal is to return to the state that you were in before cancer came into your life.”

Treatment is Over, Her Journey Continues

In celebration of Christina Kuzma’s successful fight against breast cancer at the age of 33, Tx:Team brings you the final part of our series to share her experience with physical therapy during treatment.

Everything about cancer was out of Christina’s comfort zone. It turned her world upside down in a moment and put everything that she had lived for on the line: her family and friends, her ambition, her days spent on the lake. What would her life look like a year from now? Before her bilateral mastectomy, Christina couldn’t have imagined how many normal movements would be affected. When she began physical therapy, simply sitting up or lying down was difficult. Christina told herself, “Everyone has just one life, and faces adversity in many ways. So many days I want to curl up and be sick. But that’s a day wasted. I am breathing, and I have a heartbeat, so it’s time to take the energy I do have and do something remarkable with this day. Even if that means something small like smiling at a stranger.” After she was declared cancer-free post-op, she continued to fight – striving to regain the strength and degree of health she had before cancer entered her life.

Christina is all about taking the harder sprint to have an easy marathon. Physical therapy after a grueling 6-hour operation was not easy. She was in a lot of pain completing the simplest of stretches. It was at this time that Christina separated herself from convention. Every day, patients receive opioid medications for their pain. However, Christina is living proof that the positive long-term results of pursuing physical therapy and foregoing opioids outweigh the short-term pain.

When we left off at Christina’s second week of therapy after surgery, she was just becoming strong enough to lift her arms above her head and wash her hair. In her third week post-op, Christina’s physical therapist offered new exercises to up the ante and push her further.

CHRISTINA’S EXERCISES

Throughout the day, she concentrated on her posture, squeezing her shoulder blades to release the tension built up in her chest wall. When she was in the shower and her muscles were more flexible from the heat, she would stand and slide her open palm up the wall. During the “wand exercise” she was on the floor holding a yardstick. She raised her hands above her chest and held the stick in place for as long as she could. This specifically targeted the area from where her lymph nodes were removed. She also practiced putting her arms behind her head in the sit-up position to move her elbows up and down. This exercise would specifically prepare her for the position she would be in weeks later while receiving radiation treatments.

By the end of the fourth week, she regained full range of motion in her arms and resumed the responsibilities of daily life. She was also able to discontinue her Tylenol use. Reaching up for dishes or pantry items was still a struggle, but her pain had subsided. Now, she could get outside every day for a walk- a small win, but a huge improvement. She felt good enough to get back to work. To start, she practiced driving in her neighborhood. Again, she was shocked by how difficult some of those movements were. Looking over her shoulder to change lanes was a slow and careful motion. But by now you know she kept practicing despite the challenge. She even began to coach her three-year old daughter’s soccer team, comfortably bending down to pick up all the soccer balls- incredible.

WHERE IS SHE NOW?

Today, exactly 17 weeks since her surgery in August, Christina is wrapping up radiation therapy. With only one more appo

intment to complete, Christina reflects on her past year, saying: “The one thing I would have done differently is start physical therapy sooner.” Despite her success, she thinks that her body would have been better prepared for the pain and stiffness if she had participated in physical  therapy during the weeks leading up to her surgery. Supervised pre-surgical exercises are especially important to post-operation outcomes.

Although her treatment is over, her journey continues. 2018 was not just her year battling cancer, with months of stress, complete exhaustion, pain, and frustration. 2018 was also the year that Christina worked to become a stronger version of herself. One who is vocal about what she knows is good and right for her. One who appreciates the strength it takes to simply lift her arms over her head. One who is so thankful for her health and body providing the opportunity to be outside on a soccer field with her daughter.

2018 was the year that Christina became an advocate for physical therapy as an integral part of breast cancer recovery. Even now, months later, she’s keeping up with her PT appointments. To put it simply, she “Won’t Back Down”. Ultimately, she wants others to know that doctors are receptive to the way you want to heal; talk with them openly. Second, no matter your age or health status, all women need to check their breasts. Early detection saved her life. And she hopes that more people will consider her approach if faced with a similar challenge. Physical therapy is a safe and effective way to heal your body and treat your pain. Prioritize your body’s long-term health.

Our hope is that Christina’s story will impact others for years to come, serving not only as an inspiration for people diagnosed with breast cancer, but for people struggling with chronic pain in any form.

#ChoosePT

Choose Physical Therapy as Your Option

In celebration of Christina Kuzma’s successful fight against breast cancer at the age of 33, Tx:Team brings you Part Three of our weekly series to share her experience making decisions about her treatment.

The month of February was incredibly stressful for Christina. Uncertainty reigned as doctors ordered different scans to assess the lump that she found in her breast. She’ll tell you that the anxiety she experienced then was worse than any part of her treatment thereafter. When she was officially diagnosed with HER2-positive breast cancer, she was able to regain control of her path. She began studying, using research articles, blog posts about others’ experiences with breast cancer, and her coworkers’ expertise in health care to make sense of all the information available. Looking back, the information-gathering period of Christina’s first months with breast cancer was vital to the success that she’s currently experiencing as a survivor.

At this point, we’d like to pause Christina’s story to talk about the research behind Christina’s decision to forego opioids in her treatment plan. Opioids are medications that can help manage pain, such as that caused by cancer and its treatment, by blocking pain signals from injured nerves to the brain. They vary in strength and form. In the first blog post of this series, Christina revealed that the side effects of opioids were the primary reason for her decision to opt out of using them as part of her treatment plan. The temporary and limited pain relief that they could provide was not worth relying on them. This was about deciding to be cautious with the risks and committing to a plan that was reliable and effective.

HOW RISK-TAKING DEVELOPS INTO CRISIS

Christina believes strongly that “addiction doesn’t discriminate.” The composition of opioid analgesics is similar to that of morphine and heroin and they act on the same parts of our brain, so they intrinsically present an abuse and addiction risk. There has been awareness of this risk for decades, but opioids continued to be prescribed because it was believed that the drugs’ benefits outweighed the risks. Numbers now show that the rates of addiction and accidental death from opioid overdoses have turned that risk into a crisis.

The severity of the opioid crisis is underwritten by the drastic increase of written and dispensed prescriptions, the greater social acceptability of using medications, and aggressive marketing by pharmaceutical companies. Between 1991-2014, the number of opioid prescriptions has tripled. In 2016 alone, 214 million opioids were prescribed- that’s a prescription for every 2 out of 3 Americans. Of course, opioid prescriptions are often only one part of the pain management plan proposed by a provider. For breast cancer-related pain, opioids are not considered the first line of treatment. And yet, the number of opioid prescriptions among breast cancer patients has surged similarly, becoming a normalized method for pain relief.

While opioid medications will reduce pain for a short period of time, they are predictably dangerous as extended methods of pain relief. A 2016 survey by the Washington Post-Kaiser Foundation released its findings: 34% of survey respondents who had taken opioids for at least 2 months said they had become addicted or chemically dependent, while 54% of opioid users’ household members surveyed said they thought the opioid user would struggle to discontinue use. Furthermore, opioid overdoses currently account for 2/3 of drug overdoses, which are now the leading cause of accidental deaths in the United States. In 2016 alone, roughly 115 Americans died every day from opioid overdoses. These staggering statistics should cause providers to be extremely cautious when prescribing pain medication and focused on the long-term health of the patient.

TALK TO YOUR DOCTOR ABOUT A RELIABLE PLAN

Anxiety surrounding the pain management process can factor in to a patient’s decision-making. Pain, especially cancer-related pain, is very real. Fearing this pain, an opioid medication’s appeal for quick relief cannot be underestimated. Furthermore, especially in older breast cancer patients, there is a high correlation between the number of patients extending the use of opioid pain relievers and those who also use medication for anxiety or depression. This information indicates that opioids, when mishandled, will likely perpetuate the physical and mental pain for which they are prescribed. To avoid dependence on a medication that is unreliable, talk to your doctor about other options for pain relief. Be your own advocate and speak honestly about the concerns you have and the research you have done. Most importantly, consider the long-term health of your body and the quality of life that you desire.

A NATIONAL SOLUTION

The American Physical Therapy Association (APTA) developed a national campaign, #ChoosePT, to bring awareness to physical therapy as an effective and safe treatment for pain. This is about avoiding the risk of creating a bigger life problem while trying to care for your body. On the front page of the #ChoosePT site, APTA writes, “When it comes to your health, you have a choice. Choose more movement and better health.” While treating the pain of a current problem, physical therapy will strengthen the body and reduce the risk of developing other chronic conditions in the future.

The Centers for Disease Control and Prevention (CDC) has also recognized the epidemic of our current environment of opioid use. As the national health protection agency, the CDC released a set of guidelines in March 2016 for prescribing opioids in the United States. Within the guidelines, the CDC writes, “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.” There are multiple health treatment cases cited where opioids could have been significantly reduced or avoided altogether. Additionally, “there is high-quality evidence that exercise therapy (a prominent modality in physical therapy) improves function immediately after treatment and that the improvements are sustained for at least 2-6 months.”

When Christina Kuzma was diagnosed with breast cancer in February 2018, she was determined to save her life and preserve her health. She spent a lot of time that month researching the pros and cons of each known method for treatment. The best thing that you can do if you find yourself in a similar situation is to find a treatment plan that you are confident in and commit to that plan. To inform yourself on the topics we have covered, please include these sites and research articles in your own study:

America’s Addiction to Opioids: Heroin and Prescription Drug Abuse

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

Move Forward. ChoosePT

 

 

 

 

 

 

Preparing to Fight

In celebration of Christina Kuzma’s successful fight against breast cancer at the age of 33, Tx:Team brings you Part Two of our weekly series to share her experience making decisions about her treatment. 

These days, Christina Kuzma is at work like usual, hosting meetings, educating whomever she can about Tx:Team services, and plugging in a radiation treatment where they fit. She’s doing extremely well but it has been a long road to get to this point.  From her month of “scanxiety” in February after receiving her diagnosis to feeling like she’d been hit by a truck throughout her 4 months of chemotherapy, Christina faced incredible pains in her mind and in her body. But before she could tackle her cancer, she knew that she had to get her head right. Her motto was simple, which kept her focused: “I won’t back down.” And with that, she prepared herself to fight by placing her trust in the treatment plan and her physical therapy regime.

LIVING LIFE NORMALLY, BUT WITH A LITTLE EXTRA UMPH

If you’re already humming Tom Petty, you’re right there with Christina. Petty’s song, “I Won’t Back Down” strengthened her during the toughest weeks of chemotherapy. He’s a big deal in the Kuzma family. Just this past month, Christina’s daughter, at 3 years old, proudly declared that she was going as Tom Petty for Halloween.

Well, I know what’s right
I got just one life
In a world that keeps on pushin’ me around
But I’ll stand my ground
And I won’t back down

 

The Grateful Dead’s “Touch of Grey” was a second anthem. Some days, carrying on with normal activities during chemo was really hard. However, the sun was still shining and her heart was still beating, so Christina echoed Garcia: “I will get by, and I will survive this day!”

To keep things normal, Christina launched her favorite saying: “controlling the controllables.” Amongst the loss of control that is cancer, she took hold of what she could.

Most importantly, she continued working during chemo. She arranged Thursday infusions so that she could take Fridays off and rest over the weekends. Even so, Mondays were agonizing, and Tuesdays weren’t easy either- like “the worst hangover of your life.” To combat the soreness and fatigue, Christina picked up yoga. Yoga helped her stretch her aching joints. She also opted for cold cap therapy, a non-invasive scalp cooling technique. Keeping her hair was exactly the mind trick she needed. When she didn’t look sick, she didn’t feel as sick. She could look in the mirror and feel like herself. And that extra boost of energy during treatment made a world of difference.

CHRISTINA’S SURGERY

On August 10, 2018, Christina had a bilateral mastectomy and began reconstruction.  Her breast surgeon removed all of her breast tissue and 4 lymph nodes to test for any cancer remaining after chemotherapy. Next, the plastic surgeon inserted expanders, which are temporary implants that stretch the skin and optimize radiation treatment. Christina verifies, “Expanders are about as comfortable as they sound. They feel like two bowls just sitting in your chest.” Finally, a drainage tube was inserted on each side of the breast to collect the fluid that gathers after surgery. Altogether, the surgery lasted 6 hours and left her body exhausted and in pain.

In typical Kuzma fashion, Christina focused on the best part of her surgery. She and her family had a small win to celebrate big time- the biopsied tissue came back with zero traces of cancer. Christina’s body had a complete response to the chemotherapy. She paused to reflect on the past months, and at 33 years old, watching as her life flashed before her eyes, she felt aged and wiser. The small stuff is everything, and you’ve got to appreciate the simple things that saturate life in emotion and meaning.

SHE CHOSE PT

Christina’s recovery began full-force on Day 1 in the hospital. The overwhelming pain that follows a surgery like the one Christina had can lead a patient to consider stronger medications for relief.  Christina had concluded that stronger pain relievers would not serve her as well as physical therapy could in the long run. The day after surgery, Christina cut off her opioid pain medication, had her first meeting with a physical therapist, and began managing her pain with Tylenol. The therapist introduced exercises for her to practice 3 times a day and she progressed daily.

After all her body had been through in surgery, Christina started basic exercises to soothe her lymphatic system: stretching the neck, deep breathing, and massage. She also made a point to move her arms immediately.  Even simple things like eating, brushing her teeth, and combing her hair were taxing. While on a bed, she held her arm above her heart for 45+ minutes. A specially created pillow helped to keep her arm in place, which significantly decreased swelling. And of course, the trusted Tx:Team stress ball came in handy. Katie Guerdan, Manager of HR at Tx:Team, dropped it off in a get-well basket with the challenge to use it. Christina built up to 25 squeezes. By Day 3 post-operation, she was able to begin chest exercises.

In 2 weeks’ time, Christina regained about half of her full range of motion and she could finally wash her hair by herself! A small, but huge win for Christina, for which she was so grateful. That weekend, with drains still in place, she was eager to get busy living.  She went out with her family on their boat, content to watch the world around her, and appreciate getting back to living the normal life of Christina Kuzma.

Physical Therapy: A Better Solution for Pain

In celebration of Christina Kuzma’s successful fight against breast cancer at the age of 33, Tx:Team begins a weekly series to share her experience making decisions about her treatment.  Christina is the Manager of Business Development at Tx:Team, and more than that, she is the catalyst for making things happen  – an entrepreneur, easily connecting with others and quick to inspire them to be their best.  It’s no surprise then that when she was diagnosed with breast cancer, Christina explored all treatment strategies and committed to one that she believes in. She hopes that more people will consider her approach, especially if they find themselves in similar circumstances to hers in the beginning of 2018.  Being honest about her “crappy 2018” is a strong suit, so we’ll come to understand how the months since Christina’s diagnosis on February 5, 2018, have pained her body, given life to the small stuff, and ultimately transformed her into a different person. 

Read more

The Weekend Warrior and Olympian Champs All Rely on Physical Therapy

The Winter Olympics are starting! For an Olympic athlete, training is a year-round activity.  But many of us non-Olympians go to the gym, work hard, and participate in recreational activities we love.

Olympians put a lot of stress and strain on their bodies. And so do we as weekend warriors. Odds are when you incur an injury, much like the Olympians, you will start a rehabilitation program.  What are the differences?  Not many!  Your physical therapist is most times using the same treatment strategies that are used on Olympic athletes

Evaluation

Your therapist will evaluate your current status and work with you to develop a treatment plan based on your goals. They will ask you questions about your current lifestyle, routines, and history to customize an individualized plan unique to you.  At each visit, your progress and treatment plan are reviewed and your therapist may ask you additional questions and adjust your goals to help you reach maximum success.

Remember, no matter your level, all athletes set goals.

Treatment Plans

Your physical therapist will take in account your current limitations and devise a plan to slowly and methodically reach your short and long-term goals. They will be careful to push you just enough so that you see progress without overusing those areas that you are seeking treatment.  Just as Olympic trainers push their athletes to reach success.

Participation

When Olympians stop participating in the recovery plans, their chances of success diminish. Your active participation in your rehabilitation recovery is crucial.  Communicating with your Physical Therapist about your daily routine, exercise habits, work schedule, and other obligations can help ensure you accomplish as much as possible during your Physical Therapy session.  And they will always ask you about your Home Exercise Program so be sure you are keeping up with your plan.  Your Physical Therapist expects you to reach self-management – actively maintain the strength, range of motion, and flexibility you have achieved.

Whether you’re a professional athlete, weekend warrior, or recovering from a recent fall, a sprain, or surgery, you can benefit from the same rehab strategies that help Olympians climb on top of that podium and achieve gold!

Specialized Wound Care in Rural Indiana

In 1908, twenty-six Putnam County female citizens started what would be the founding of a hospital to serve their family and friends. The hospital would offer solutions to their ever-changing healthcare needs, and would bring technologies only previously offered in larger cities to their rural community.

The team at Putnam County Hospital (PCH) provides comprehensive inpatient and outpatient physical, occupational, and speech therapies to the residents in Putnam County. Today, over 100 years later, one program in particular is a continuation of its founding females’ goal of bringing the latest in technologies to the hospital:  Wound Care.

wound care

Wound care at PCH is a comprehensive team approach using the latest technology including treatment, nutrition, labs, radiology, surgical, and AOI services. With the newest technology and the vast experience of treating wounds, Putnam County Hospital Rehabilitation can treat the residents of the community locally without the need to travel to Indianapolis.

The PCH Team provides Wound Care Services that include but not limited to compression, specialty wound care treatments, swelling relief, education, debridement and modalities. The functional piece of the program is the continued monitoring and guidance with the specialty dressings used.

Wound Care services are so important to speed the healing of the wound and educate the patient from the wound returning in the future. The impact is better healing at a faster rate and return to prior function so they can return to a better life.

Terry Schaefer, PTA, WCC, CLT, CEAS, CCI, COF is no stranger to the current and innovative treatment with complex open wounds. Having spent 30 years treating wounds, he has learned the importance of using the most advanced equipment as Qoustic Ultrasound Machine. Terry is very passionate about the treatment of wounds and its possibilities for healing. He strives to help his patients to achieve their goals of healing and his varied background provides the perfect foundation for helping to achieve those treatment goals.

“Our goal is to speed healing in the best manner with the less impact on patient’s life.”

If one were to walk into the PCH gym, you would see a caring environment with lots of education about wound and wound healing and our team answering all patient questions. Treatment plans for wounds vary depending on the level of care needed. A typical plan would include treatment 2- 3 times per week for about 8 weeks.

Many patients do not understand the complexity of a wound, the way it affects their lifestyle, or the treatments that are available for them. As a clinician, the Wound Care Program has made Terry realize the varied degree of patient understanding and involvement with their wound care prior to treatment.

Our partner, Putnam County Hospital, knows for a fact that patients are getting the best wound care with the best equipment and technologies in Putnam county. It’s not uncommon for hospital employees to give referrals to patients.  “Go see Terry!”

Putnam County Hospital is a critical access hospital committed to providing affordable, high-quality healthcare close to home. For more information about Putnam County Hospital and the expanded services and specialties now being provided, please visit www.pchosp.org.

Avoiding Sports Specialization to Preserve our Young Athletes’ Health

Nicholas, Harbaugh, PTA

Sports Specialization has led to a trend over the past couple of years involving our young athletes: the increase in cases of injuries ranging from simple overuse to breaks and/or sprains. This increase in rate and number of injuries seen in young athletes, according to multiple studies, can be linked to the increase of sport specialization in children.  Sport specialization is defined as “year-round intensive training in a single sport at the exclusion of other sports.”

Sport specialization has been associated with high volume training that can result is psychological and physiological stress in an athlete. This stress has been linked to an increased rate of burnout in athletes, as well as recurring and overuse injuries in multiple studies. Overuse injuries otherwise known as cumulative trauma disorders, are described as tissue damage that is a result from repetitive demand over the course of time. The term refers to a vast array of diagnoses: occupational, recreational, and habitual activities. Along with these studies the American Academy of Pediatrics (AAP) have released statements on their position against sport specialization to prevent these problems from arising.

sports specialization

Children were not always encouraged to specialize in a sport. A factor that may have contributed to this cultural change may be in part due to the increased pressure that coaches and parents place on their children to perform at a higher level to attain a collegiate scholarship or professional contract. In 1993, Ericsson and colleagues proposed a statement that in order for a musician to achieve mastery/expertise in that area you must practice for 10,000 hours. Parents and coaches have adopted this rule and applied it to sports to justify year-round intensive training. Many have adopted and applied this rule to athletes without realizing this was made primarily for musicians. These are high, sometimes costly, expectations for an athlete who performs repetitive, rigorous, sometimes high velocity movements and techniques year round without adequate rest time.

Some people ask “But doesn’t focusing on a sport make our youth excel at that particular sport?” Studies have shown that is not necessarily the case. Some studies have even shown that most multisport athletes (participating in 2-3 sports) show more promise to excel in a sport than a specialized athlete due to an increased overall athleticism and better gross motor function. Many professional and collegiate athletes were multisport athletes.

Examine the Ohio State varsity recruitment habits of coach Urban Myers as they depict a preference for the

young athlete

There have been statements from multiple coaches, along with Urban Meyer’s graph, pertaining to their preference of multisport athletes for example

multisport athlete.  According to Pete Carroll former USC and current Seattle Seahawks coach: “The first questions I’ll ask kids are; “What other sports does he play? Does he play ball? All of those things are important to me. I hate that kids don’t play 3 sports in high school…. I really don’t favor kids having to specialize in one sport.” Dan Starsia University of Virginia men’s lacrosse coach and Tim Corbin of Vanderbilt Baseball both concur with Carroll.

 

If this is the thought process of elite coaches, why, as parents, is ours so different? If the athletes goal is to play in college or to try and make it to a professional level, they need to have an all-around athleticism as most elite athletes do.

Examples of multisport athletes are:

  • Michael Jordan- Basketball and Baseball
  • Abby Wambach- Soccer and Basketball
  • Terry Bradshaw- Football and Baseball
  • Amy Rodriguez- Soccer, Swim, Softball, and Track
  • Tom Brady- Football and Baseball
  • Lauren Holiday- Soccer, Track, and Basketball
  • Babe Zaharias- Track and Field, Golf, Basketball, Tennis, Swimming and Volleyball
  • Wilt Chamberlain- basketball, volleyball and track

With many elite athletes being multisport, we need to get away from the thought process that sport specialization will make our children elite. In fact, sport specialization may be the reason a child does not get to that elite level. With burnout and overuse, reoccurring, and surgery required injuries, specializing in one specific sport may actually do more harm.

Year round training through a child’s growth spurt period places an increased work load on lengthening muscles and developing joints. During a growth spurt, performing consistent intensive training throughout the year will increase the stress that is placed on muscle attachments and the coinciding joints. This increased work load causes an increased risk of joint and ligamentous damage and injury. The more repetitive the motion…the more risk for overuse injuries.

Common overuse injuries associated with sport specialization are as follows with patellofemoral (knee) pain being the most prominent:

  • Osgood-schlatter disease
  • Sever’s disease
  • Medial epicondyle apophysitis
  • Distal radial physeal stress syndrome
  • Proximal humeral physiolysis
  • Stress fracture (e.g. spondylolysis)

A common overuse injury seen in pitchers, for example, is ulnar collateral ligament damage which can lead to having Tommy John surgery. This is the reason why we have pitch counts to limit the amount of stress placed on the elbow joint and the associated ligaments.

To allow proper rest time for the young athlete in organized sports, the AAP recommends

  • that children play multiple sports (2-3)
  • play no more than 8 months a year
  • play no more hours per week than the child’s age (13 year old =13 hours) with a maximum of 16 hours per week total.

You may ask: “What do I if my child is specializing in a sport or gets injured in that sport?” The first thing to do if a child is injured is to get them examined by an orthopedist or physician. Depending on the findings, the next step would be starting a physical therapy plan to address the injury and to examine the mechanics of the athlete and their sport. The physical therapist will help evaluate each athlete’s situation on an individual basis and help to prevent any further injury or re-injury.

If an athlete does not suffer from an injury requiring immediate attention, it is recommended that he or she see a physical therapist to examine their movement patterns and form as well to prevent an injury from occurring and needing any further treatment. Before an athlete gets to that point though, the change must start at home with parents and coaches encouraging children to participate in multiple sports as well as decreasing the amount of pressure to play. After all, the main purpose of participating in sports is for overall physical activity and health and most importantly, fun, and enjoyment!

Talk to your children about their goals and encourage them to participate in more than one sport. Once you know their goals, you will know what they want to achieve! Encouraging diversity in sports can help to decrease the occurrence of overuse injuries.

Nicholas Harbaugh is a Physical Therapist Assistant at FMH Rehabilitation Aspen Ridge Outpatient Clinic.  Nick is experienced in treating orthopedic and sports-related injuries with  traditional land therapy techniques as well as aquatic therapy.