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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.”

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. 

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