Tag Archive for: physical therapy

The Lymphedema Superheroes among us

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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.

 

Lymphedema & Physical Therapy

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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

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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

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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

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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

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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

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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

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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.

Exercise During Pregnancy

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Amelia Iams, DPT

aquatic exercise during pregnancy

Exercise is important to include in everyone’s daily life, but it becomes even more important when you are pregnant. Pregnancy causes many changes in a woman’s body.  Hormone changes in the body cause softening of the ligaments, joint laxity, and instability in the ankles.  Hormones and anxiety can be the reason for increased mood swings.  Changes in the center of gravity due to a growing belly can cause increased occurrence of back pain.  Increased retention of fluid in the body causes swelling in both the hands and feet and can amplify complaints of constipation.

Exercise during pregnancy provides similar benefits to your body as it does during other times in your life, but it also can prevent and minimize changes in the body and pain or discomfort that occurs when you are pregnant. Some of the proven benefits that exercise during pregnancy includes are:

  • Avoidance of excessive weight gain
  • Maintenance or improvement in endurance, muscle strength, and flexibility
  • Reduction of the likelihood of gestational diabetes
  • Decrease or reduction in symptoms of low back pain or pelvic girdle pain
  • Reduction in occurrence of preeclampsia
  • Decrease in the risk of cesarean delivery
  • Reduction in psychological stress

The American College of Obstetricians and Gynecologists (ACOG) states “for healthy pregnant and postpartum women, the guidelines recommend at least 150 minutes per week of moderate-intensity aerobic activity (ie, equivalent to brisk walking). This activity should be spread throughout the week and adjusted as medically indicated.”  That is equal to about 30 minutes 5 times a week of moderate exercise.  Research also indicates that including both strengthening and aerobic exercise to your routine is important to help support the changes that occur in your body with pregnancy.

Despite all the benefits to exercising while pregnant, most women do not begin an exercise program and those who were exercising prior to pregnancy actually decrease their activity during pregnancy.   Through several studies and surveys, women have stated various reasons for decreasing their activity during pregnancy.  The two most common reasons are: not enough time and pain with movement associated with the pregnancy.

Choosing an exercise program that is safe, can be maintained during the entire 40 weeks of pregnancy, and can fit into a busy work and family schedule is a difficult task.   It is recommended that pregnant women avoid high contact sports and activities that have an increased risk for falls or impact, such as soccer, basketball, hockey, snow skiing, water skiing, and off road cycling.  Exercises that require jumping and quick changes in directions, such as Zumba, Cross fit, and trail running, are not recommended due to joint instability brought on by hormones.  Also high impact aerobics can be difficult to and uncomfortable to perform later in pregnancy.

An underutilized exercise avenue is aquatic exercise programs. Several research studies have advocated the use of pool exercises for women who are pregnant.  The natural properties of water help alleviate many of the adverse changes associated with pregnancy.  The buoyancy of the water will help to eliminate the stresses on the joints and to support the abdomen.  Women have reported feeling more comfortable moving in the water and able to assume better postures as a result of the additional support.  Hydrostatic pressure is an additional benefit when exercising in the water.  The pressure that the water exerts on the body helps to decrease the swelling in the limbs brought on by pregnancy.

Aquatic exercise is non-weight bearing and low impact, so stress on the joints is minimized. Water provides natural resistance to movement which helps to strengthen muscles and thereby incorporating both strengthening and aerobic exercise into one session.  This can help you meet both suggestions for a healthy body during pregnancy without increasing the time you spend at the gym.  Many women stop exercising as their pregnancy progresses because of decreased balance, increased swelling in their feet, or pain and discomfort in their back.  The water helps to support the body, and it is not likely that you will be injured falling in the water. Several studies have proven that exercising in the water during pregnancy helps to decrease low back pain and reduce time off from work due to pain and discomfort.  There are many benefits to exercising in the pool that cannot be achieved with land based exercise, therefore making it an excellent option for women during pregnancy.

There are many fitness centers as well as physical therapy centers that offer aerobic exercise classes in a pool and individualized pool exercise sessions. Choosing the right one for you should be based on several factors, such as cost, location, available time, and expertise of the instructor.  In some cases aquatic therapy can be covered through your health insurance when provided by a physical therapist.  A physical therapist can help design an exercise program that is individualized to you.  Other options to consider when choosing a pool are temperature of the water, depth of the water, and air temperature of the pool area.  Exercising in the water decreases your ability to sweat but there is increased loss of heat through skin contact with both the water in the pool and the air temperature difference in the pool room.  It is recommended that pools utilized for aerobic exercise for pregnant individuals be at about 80-86 degrees Fahrenheit.  Most pools at a gym are cooler to allow for longer time and more intense exercise while therapeutic pools at rehabilitation clinics will be warmer and offer increased comfort for those suffering from back pain.

Safety and monitoring your exercise regimen in the pool is important. The properties of water will naturally decrease the heart rate by increasing the volume the heart pumps out.  If you use your heart rate to gauge your exercise, it is suggested that you decrease your heart rate guidelines by 15 beats per minute.  When exercising in a pool is better to gauge your exercise intensity by using a scale called Borg Rating of Perceived Exertion.  A physical therapist can provide you with the scale and educate you on how to use it.  Dehydration with exercise can occur in the pool as easily as it can on land.  Having access to water during exercise can be important to avoiding any complications with exercise.

All exercise programs are most effective when you can choose an activity they enjoy and a program that is individualized to your needs and goals. We highly recommend water aerobics or any aquatic exercise for women during pregnancy. Aquatic exercise is an exercise program that women would be able to follow throughout the entire 40 weeks of pregnancy.

 

Amelia Iams, DPT is a Physical Therapist at FMH Rehabilitation Aspen Ridge in the treatment and management of sports related and orthopedic injuries.

Does your Bladder Dictate your Life? Let’s talk.

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May 8th through the 13th is Women’s Health Week and the goal is to empower women to make their health a top priority and educate on the steps women can take to improve their health.  During the week, you can get the answers to top questions that are asked about Women’s Health. 

~Lynne Schill, Physical Therapist, Guest Author
Lynne Schill is a Women’s Health Physical Therapist at FMH Rehabilitation Women’s Center Crestwood. She has experience in treating women’s health diagnoses and has found this work to be extremely rewarding because of how significantly it can improve quality of life. Her compassionate nature coupled with an incredibly warm bedside manner inspires confidence, determination and empowers the individual to become proactive in their own recovery.

Does your bladder dictate your life? Do you have to plan your day around where the next bathroom is?  restroom signAre you afraid to leave your home for fear of not making it to the next bathroom or leaking? Do you feel something bulging in your vagina or have you been diagnosed with pelvic prolapse? Do you suffer from pelvic pain which affects your lifestyle and intimacy? Do you skip the jumping jacks or walk instead of run during your exercise routine?

May 8th through the 13th is National Women’s Health Week with the goal to empower women to make their health a top priority and to educate women on the steps to take to improve their health.   Women’s issues are important and most women suffer needlessly because they are not aware of the rehabilitation programming designed especially for women.

So, did you answer yes to any of the questions above? If so, you may be a candidate for women’s health physical therapy!  Physical therapy (PT) is a great alternative for women who don’t want to take medication and want to avoid surgery for incontinence, pelvic pain, and pelvic prolapse. Don’t let your bladder dictate your life or continue to suffer from pelvic pain, which can affect your lifestyle and intimacy.

Women often suffer in silence, not mentioning these problems to their healthcare provider and think they just have to “live with it”. However, there is hope—and help available, with physical therapists who have been specially trained to treat these conditions.

According to the National Association for Continence (NAFC), 26% of women between the ages of 18-59 have involuntary leakage, 20% of women over 40 also have overactive bladder, and 66% of women and men ages 30-70 have never discussed their bladder health with a healthcare provider.

It’s time to start the conversation!

My incontinence…

There are three types of incontinence: urge, stress, and mixed (which is combination of the first two).

Urge incontinence is when there are strong urges to urinate even though the bladder may not be full and there is an increased frequency of urination. Physical therapy treatment approaches include filling out a detailed three-day bladder log. Information gathered in this log includes the number of voids per day and night, how much is voided, what the patient was doing at the time, determining if the patient is drinking enough water, and identifying any dietary triggers.  Often, eliminating bladder irritants from the diet including caffeine, alcohol, citrus, carbonated beverages, and artificial sweeteners can help decrease or stop the problem.  Smoking can also be a factor, as can constipation.

Running to the bathroom and frequent emptying ‘just in case’ can actually make the problem worse. Teaching patients urge control techniques including standing or sitting quietly, doing a few quick Kegel contractions, and deep breathing can help decrease the urge. Another mistake women make is restricting their fluid intake.  This can not only lead to dehydration, but it can also cause the urine to be more concentrated, which can be irritating to the bladder lining and lead to further urgency.

Urge incontinence and overactive bladder sufferers can benefit from physical therapy relaxation techniques including deep breathing and nervous system quieting in order to help calm the bladder.

Stress incontinence happens with coughing, sneezing, laughing, exercising, or lifting. The increased pressure in the lower abdominal and pelvic region can cause leakage because of weakened pelvic floor muscles.  Pelvic floor muscles provide support to the pelvis and pelvic organs.  One exercise many women know that can help strengthen the pelvic floor is Kegels. However, it might be surprising to know that more than 50% of women perform Kegels incorrectly! A physical therapist can educate you further on pelvic floor anatomy to help identify which muscles you need to be contracting, how to isolate the contraction in order to do a correct Kegel, and then advise you on a home exercise program.   Strengthening the pelvic floor and lower abdominal muscles is especially important for this type of incontinence.  Also, modifying activities and exercise by avoiding a lot of heavy lifting, jumping and running can decrease symptoms.

My pelvic prolapse diagnosis…

Pelvic Prolapse is when a pelvic organ—such as your bladder, rectum or cervix—drops from its normal position. If you suffer from pelvic prolapse, you may benefit from postural education, strengthening of the pelvic floor muscles, activity modification, and positioning techniques to help reduce prolapse symptoms. Eliminating constipation is also important; a physical therapist can teach strategies to achieve regularity in order to avoid bearing down hard, which can potentially increase prolapse.

My pelvic pain…

Pelvic pain can be another life-changing problem for women—causing problems with simple daily activities and affecting intimacy. Pelvic pain and pelvic discomfort can be associated with menopause, post hysterectomy and other surgeries, trauma/injury, pregnancy/child birth, and pelvic malalignment. A physical therapist performs a thorough assessment and develops a program to meet individual needs.  Treatment may include hands on soft tissue techniques, biofeedback, and/or relaxation techniques.

Biofeedback is a valuable tool that is used to assess the muscle activity of the pelvic floor muscles and helps patients recognize when their pelvic floor is relaxed versus in a contracted state. While being coached by a physical therapist, the patient can become more aware of the pelvic floor muscles and how to use them via visual feedback.

Ask yourself, “Would I like to improve my pelvic health and quality of life without surgery or medication?” It’s time to do something about it and Women’s Health Week is the perfect time to start!

A Physical Therapist trained in treating pelvic floor dysfunction is available for your specific needs and diagnosis. Your bladder doesn’t have to dictate your daily routine; you don’t have to live with pelvic pain in silence. You deserve your life back!

Tx:Team Women’s Health Physical Therapy programs can be found at FMH Rehabilitation in Frederick, MD, St. Vincent Frankfort Hospital in Frankfort, IN, and St. Vincent Jennings Hospital in North Vernon, IN. Ladies, it’s time to take the steps to improve your health and Women’s Health Week is the perfect time to start!

 

 

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