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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 Physical Therapy, Uncategorized

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 Physical Therapy

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 Physical Therapy

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.