Most people think of physical therapy as exercises to regain mobility after surgery and recover from orthopedic and sports injuries. However, physical therapists can also help patients find relief from cancer related issues and other health concerns in the pelvic area.
Joining the show to tell us more about the role physical therapy can play in cancer care and pelvic health is Christy Wilson. She is a physical therapist with Hendricks Regional Health.
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The Many Benefits of Physical Therapy in Cancer Care and Beyond
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Learn more about Christy Wilson, DPT, CLT
Christy Wilson, DPT, CLT
Christy Wilson, DPT, CLT is a physical therapist with Hendricks Regional Health.Learn more about Christy Wilson, DPT, CLT
Transcription:
The Many Benefits of Physical Therapy in Cancer Care and Beyond
Melanie Cole (Host): Many people think of physical therapy as treatment and exercises that you usually do to regain your mobility after surgery or to recover from an orthopedic or sports injury. However, physical therapists can also help patients find relief from cancer-related issues and other concerns in the pelvic area. Joining the show today to tell us more about the role that a physical therapist can play in cancer care is Christy Wilson. She’s a physical therapist with Hendricks Regional Health. Welcome to the show, Christy. So, people do think of physical therapists as being orthopedic in nature, but you can also play a role in cancer care. Explain that a little bit for us.
Christy Wilson, DPT, CLT (Guest): Hi. Thank you for having me. Yes, just like orthopedic injuries, cancer, you can definitely do “prehabilitation,” which means getting ready for a surgery, getting ready for chemo/radiation. Getting people at their best and helping them get into better range of motion, in better endurance, and so forth ahead of time. We also have preventative rehabilitation, and then there’s restorative, supportive, and palliative rehabilitation. There’s like four different phases that as an oncology physical therapist that we look at and can help people during any phase of their cancer treatment.
Melanie: Then, let’s start with prehab. You mentioned that. What does that entail? If someone has been recently diagnosed with cancer, physical therapy’s probably one of the last things on their mind, and yet it should be something they think about at the start to help them. Explain prehab and how it can help.
Christy: So, depending on where we’re starting at, if we’re already starting at a level where you are having trouble getting out of bed, or we’re already starting at a level where you have been not eating well, and you are deconditioned, having trouble completing tasks at home or getting through the workday, then slowly getting you back to a good walking program, or if teaching you how to get out of bed with less pain. So, if we can get physicians to write us prescriptions ahead of time and patients being proactive at wanting to get stronger before they start having chemotherapy or that all the research shows also that people who exercise during chemotherapy or during even radiation, they have less effects during those treatments that they can withstand and actually get through their cycles of treatment better than other people who aren’t exercising.
Melanie: You brought up a good point about getting their doctors to write that script because anybody can go hire a personal trainer, but again, that’s not going to be something if you’re concerned about money and finances, but getting your doctor to write a prescription. So, if the doctor doesn’t suggest it, Christy, do you advise people to say to their physicians, please write me a prescription for prehab with a physical therapist so I can get going and get conditioned before I start treatment?
Christy: Definitely. A lot of times physicians are more worried about, okay, what drugs are going to be the best or how can we mitigate side effects. In Indiana, you can come to a physical therapist without a prescription; however, I always make sure I get back with your physicians, your surgeons, your oncologists, your radiation oncologist, to make sure that your blood levels are okay, that you can participate in exercise and that we are staying away from any contraindications. Whereas, someone with a personal training degree or just someone to help you with exercise may not take that extra step and actually make sure that you are safe to do exercise and what exercise you are safe to do.
Melanie: When we think of cancer and all of the side effects that go along with treatment as well as deconditioning and fatigue there’s also pain and sometimes neuropathy, and you know, there’s genitourinary conditions and complications. So, speak about how a physical therapist can help with all of those things and what you actually do with people.
Christy: So, we are very lucky here at Hendricks Regional Health, and we do have such a comprehensive team. We meet together twice a month, and we are able to help patients who do need a dietary consult, who do need a speech swallowing consult if we’re talking about a head and neck patient, but if it’s someone who we are questioning whether they are safe to drive; we have driving eval instructors with our occupational therapists. We have different folks who also make orthotics. So, let’s say if someone’s having really bad neuropathy pain in their feet, we can work on different exercises, stretches. Also, doing custom orthotics for them, getting them in the right tennis shoes. We also have dry needling, which is another new technique that we can use for that. We also do lymphedema care because sometimes it’s an over amount of lymphatic fluid, which is swelling. So, we can help get you into the right type of compression hose or a compression pump to make sure we’re letting the fluid move appropriately through your body to mitigate maybe that neuropathy pain as well.
When it comes to any bowel and bladder issues, just like we have specialist physicians, we have specialist therapists as well, and we can use different techniques such as with biofeedback to help retrain the bladder to learn to hold better. Whether that is learning how to do Kegels appropriately, which is pelvic floor muscle contractions. If someone’s having any urinary incontinence or bowel incontinence, teaching people how to eat the right amount of fiber, get the right amount of water. Also, the proper positioning on the toilet, possibly to empty, that way you don’t have as much pain, and a lot of people don’t think about that, but the Squatty Potty® actually does work in helping people with constipation, and constipation is such a common side effect due to any pain medication and then chemo and so forth that PT is really here to help people get through this time in their life to help with pain, as you said. I also like to use TENS Units which are trans-electrical nerve stimulators to put on any tight muscles or any painful areas so that we can keep the person moving because we know people who keep moving, they’re better off, and they’re going to be able to keep moving after treatment as well.
Melanie: And there’s really a psychosocial and emotional benefit to PT before, during, and even after treatment as well, Christy. So, speak a little bit about that emotional well-being and the anxiety and depression because when you say things like constipation, that alone can make or break somebody’s day, and so you have a role as a psychosocial, emotional helper for them. True?
Christy: Exactly. And what’s great is on our team here at Hendricks, I have a social worker. I have many social workers. I also have the nurse navigators to assist with this. Our whole goal is that we have more people in your corner to be able to be a consult for you so that we are giving you the education ahead of time, but then we’re also there for you to let you know that you aren’t the only one, and this is common with your, you know, with your type of diagnosis and that we can help be a listening ear to make sure that we are meeting your needs and actually sometimes being preemptive. Instead of let’s wait for the constipation, let’s go ahead and get you on some Miralax. Let’s go ahead and get you eating some more fiber cereal, and you’re right—these things all cause anxiety and stress and this is such a huge, stressful time. The more people you have in your corner and the more people you have as resources, the better people feel prepared for anything that does come up, and they have more avenues to reach out to and just basically people in their corner.
Melanie: Do you feel that people are hesitant or a little bit afraid to start seeing a physical therapist in regards to say, lymphedema or something, because they’ve heard throughout the years that anytime you move that joint or muscle around, it’s going to create more swelling. Have you run into that at all?
Christy: Yes and physical therapists are kind of known to be, you know, nicknamed “Pain and Torturists” or you know “Physical Terrorists” [laughs] and when it comes to joints, you know, yeah, we do have to get that total knee going after surgery. However, with cancer, it’s totally different, and in pelvic health, which is my other specialty and pregnancy care, it’s totally different in that we are trying to increase quality of life. So, there are certain areas, you know. You think of an orthopedic surgeon, yeah, they’re hammering in an artificial joint into your bone [laughs], but you don’t think of that when you think of a gynecologist or an obstetrician, you know. They’re definitely different and same thing with PT, you know. But we also know that moving, even when it comes to back pain, people who lay in bed with back pain end up having back pain for longer than people who get up and keep moving during back pain. So, pretty much the immobility and being people put on bed rest has been thrown out the window. We know that keeping people moving is our best bet in mitigating pain and making sure they don’t have a significant loss of function to where they’re having to start over and go to a rehab and a nursing home or start out from a walker and then progress. But if we can keep them moving, is their best bet.
And swelling. Swelling is one of those crazy things. We can get swelling due to lots of different things, but it comes down to what helps with swelling, compression. And compression making sure you’re in the right type of compression, whether that is compression hose, whether that is a compression pump. That’s where you need a physical therapist or a certified lymphedema therapist to help you get through that to be like, do I need something during the day, at night? What type of shoes or socks are best for me because there is a lot of options out there, but we’ve got to be sure that it fits your life and that it’s something that is beneficial for you.
Melanie: Christy, wrap it up for us with your best advice, and, also, I’d like to you to speak a little bit about what are the best and most rewarding parts of your job as an oncological physical therapist.
Christy: So, my best advice for someone who comes in that has a new diagnosis of cancer is number one, always get as many opinions as you need to feel comfortable, and unless you’re feeling comfortable with where you’re at, and who is working with you, then you’re always going to have that kind of nagging in the back of your mind. My other suggestion always is to reach out to the support staff, you know. Get with the nurse navigator; you know, understand what other resources a facility has for you. Like with us we have dietary, physical therapy, speech therapy. We have the nurse navigators, social worker. We have a financial assistance person who that’s all she does as well. So, having a whole team to work with which is very unique. Along with that is that we have a Live Strong Program. So, we don’t care just about you during your cancer treatment. It’s that after your cancer treatment or even during, whenever you feel like you’re ready for it, we offer three free months at the YMCA as a part of our Live Strong Program. They meet twice a week, and I help coordinate the program, and it’s only for cancer survivors that they get to work out at the YMCA with guidance so that we can make sure we’re getting you to your max potential and getting you on your way to a healthier life because there’s only about five things you can do as a cancer survivor, and that is watching your weight, no smoking, very limited drinking, managing your stress level, and exercising.
Melanie: Such great advice. Thank you so much for being with us today, Christy. This is Health Talks with HRH, Hendricks Regional Health, and for more information please visit Hendricks.org. That’s hendricks.org. I’m Melanie Cole. Thanks so much for listening.
The Many Benefits of Physical Therapy in Cancer Care and Beyond
Melanie Cole (Host): Many people think of physical therapy as treatment and exercises that you usually do to regain your mobility after surgery or to recover from an orthopedic or sports injury. However, physical therapists can also help patients find relief from cancer-related issues and other concerns in the pelvic area. Joining the show today to tell us more about the role that a physical therapist can play in cancer care is Christy Wilson. She’s a physical therapist with Hendricks Regional Health. Welcome to the show, Christy. So, people do think of physical therapists as being orthopedic in nature, but you can also play a role in cancer care. Explain that a little bit for us.
Christy Wilson, DPT, CLT (Guest): Hi. Thank you for having me. Yes, just like orthopedic injuries, cancer, you can definitely do “prehabilitation,” which means getting ready for a surgery, getting ready for chemo/radiation. Getting people at their best and helping them get into better range of motion, in better endurance, and so forth ahead of time. We also have preventative rehabilitation, and then there’s restorative, supportive, and palliative rehabilitation. There’s like four different phases that as an oncology physical therapist that we look at and can help people during any phase of their cancer treatment.
Melanie: Then, let’s start with prehab. You mentioned that. What does that entail? If someone has been recently diagnosed with cancer, physical therapy’s probably one of the last things on their mind, and yet it should be something they think about at the start to help them. Explain prehab and how it can help.
Christy: So, depending on where we’re starting at, if we’re already starting at a level where you are having trouble getting out of bed, or we’re already starting at a level where you have been not eating well, and you are deconditioned, having trouble completing tasks at home or getting through the workday, then slowly getting you back to a good walking program, or if teaching you how to get out of bed with less pain. So, if we can get physicians to write us prescriptions ahead of time and patients being proactive at wanting to get stronger before they start having chemotherapy or that all the research shows also that people who exercise during chemotherapy or during even radiation, they have less effects during those treatments that they can withstand and actually get through their cycles of treatment better than other people who aren’t exercising.
Melanie: You brought up a good point about getting their doctors to write that script because anybody can go hire a personal trainer, but again, that’s not going to be something if you’re concerned about money and finances, but getting your doctor to write a prescription. So, if the doctor doesn’t suggest it, Christy, do you advise people to say to their physicians, please write me a prescription for prehab with a physical therapist so I can get going and get conditioned before I start treatment?
Christy: Definitely. A lot of times physicians are more worried about, okay, what drugs are going to be the best or how can we mitigate side effects. In Indiana, you can come to a physical therapist without a prescription; however, I always make sure I get back with your physicians, your surgeons, your oncologists, your radiation oncologist, to make sure that your blood levels are okay, that you can participate in exercise and that we are staying away from any contraindications. Whereas, someone with a personal training degree or just someone to help you with exercise may not take that extra step and actually make sure that you are safe to do exercise and what exercise you are safe to do.
Melanie: When we think of cancer and all of the side effects that go along with treatment as well as deconditioning and fatigue there’s also pain and sometimes neuropathy, and you know, there’s genitourinary conditions and complications. So, speak about how a physical therapist can help with all of those things and what you actually do with people.
Christy: So, we are very lucky here at Hendricks Regional Health, and we do have such a comprehensive team. We meet together twice a month, and we are able to help patients who do need a dietary consult, who do need a speech swallowing consult if we’re talking about a head and neck patient, but if it’s someone who we are questioning whether they are safe to drive; we have driving eval instructors with our occupational therapists. We have different folks who also make orthotics. So, let’s say if someone’s having really bad neuropathy pain in their feet, we can work on different exercises, stretches. Also, doing custom orthotics for them, getting them in the right tennis shoes. We also have dry needling, which is another new technique that we can use for that. We also do lymphedema care because sometimes it’s an over amount of lymphatic fluid, which is swelling. So, we can help get you into the right type of compression hose or a compression pump to make sure we’re letting the fluid move appropriately through your body to mitigate maybe that neuropathy pain as well.
When it comes to any bowel and bladder issues, just like we have specialist physicians, we have specialist therapists as well, and we can use different techniques such as with biofeedback to help retrain the bladder to learn to hold better. Whether that is learning how to do Kegels appropriately, which is pelvic floor muscle contractions. If someone’s having any urinary incontinence or bowel incontinence, teaching people how to eat the right amount of fiber, get the right amount of water. Also, the proper positioning on the toilet, possibly to empty, that way you don’t have as much pain, and a lot of people don’t think about that, but the Squatty Potty® actually does work in helping people with constipation, and constipation is such a common side effect due to any pain medication and then chemo and so forth that PT is really here to help people get through this time in their life to help with pain, as you said. I also like to use TENS Units which are trans-electrical nerve stimulators to put on any tight muscles or any painful areas so that we can keep the person moving because we know people who keep moving, they’re better off, and they’re going to be able to keep moving after treatment as well.
Melanie: And there’s really a psychosocial and emotional benefit to PT before, during, and even after treatment as well, Christy. So, speak a little bit about that emotional well-being and the anxiety and depression because when you say things like constipation, that alone can make or break somebody’s day, and so you have a role as a psychosocial, emotional helper for them. True?
Christy: Exactly. And what’s great is on our team here at Hendricks, I have a social worker. I have many social workers. I also have the nurse navigators to assist with this. Our whole goal is that we have more people in your corner to be able to be a consult for you so that we are giving you the education ahead of time, but then we’re also there for you to let you know that you aren’t the only one, and this is common with your, you know, with your type of diagnosis and that we can help be a listening ear to make sure that we are meeting your needs and actually sometimes being preemptive. Instead of let’s wait for the constipation, let’s go ahead and get you on some Miralax. Let’s go ahead and get you eating some more fiber cereal, and you’re right—these things all cause anxiety and stress and this is such a huge, stressful time. The more people you have in your corner and the more people you have as resources, the better people feel prepared for anything that does come up, and they have more avenues to reach out to and just basically people in their corner.
Melanie: Do you feel that people are hesitant or a little bit afraid to start seeing a physical therapist in regards to say, lymphedema or something, because they’ve heard throughout the years that anytime you move that joint or muscle around, it’s going to create more swelling. Have you run into that at all?
Christy: Yes and physical therapists are kind of known to be, you know, nicknamed “Pain and Torturists” or you know “Physical Terrorists” [laughs] and when it comes to joints, you know, yeah, we do have to get that total knee going after surgery. However, with cancer, it’s totally different, and in pelvic health, which is my other specialty and pregnancy care, it’s totally different in that we are trying to increase quality of life. So, there are certain areas, you know. You think of an orthopedic surgeon, yeah, they’re hammering in an artificial joint into your bone [laughs], but you don’t think of that when you think of a gynecologist or an obstetrician, you know. They’re definitely different and same thing with PT, you know. But we also know that moving, even when it comes to back pain, people who lay in bed with back pain end up having back pain for longer than people who get up and keep moving during back pain. So, pretty much the immobility and being people put on bed rest has been thrown out the window. We know that keeping people moving is our best bet in mitigating pain and making sure they don’t have a significant loss of function to where they’re having to start over and go to a rehab and a nursing home or start out from a walker and then progress. But if we can keep them moving, is their best bet.
And swelling. Swelling is one of those crazy things. We can get swelling due to lots of different things, but it comes down to what helps with swelling, compression. And compression making sure you’re in the right type of compression, whether that is compression hose, whether that is a compression pump. That’s where you need a physical therapist or a certified lymphedema therapist to help you get through that to be like, do I need something during the day, at night? What type of shoes or socks are best for me because there is a lot of options out there, but we’ve got to be sure that it fits your life and that it’s something that is beneficial for you.
Melanie: Christy, wrap it up for us with your best advice, and, also, I’d like to you to speak a little bit about what are the best and most rewarding parts of your job as an oncological physical therapist.
Christy: So, my best advice for someone who comes in that has a new diagnosis of cancer is number one, always get as many opinions as you need to feel comfortable, and unless you’re feeling comfortable with where you’re at, and who is working with you, then you’re always going to have that kind of nagging in the back of your mind. My other suggestion always is to reach out to the support staff, you know. Get with the nurse navigator; you know, understand what other resources a facility has for you. Like with us we have dietary, physical therapy, speech therapy. We have the nurse navigators, social worker. We have a financial assistance person who that’s all she does as well. So, having a whole team to work with which is very unique. Along with that is that we have a Live Strong Program. So, we don’t care just about you during your cancer treatment. It’s that after your cancer treatment or even during, whenever you feel like you’re ready for it, we offer three free months at the YMCA as a part of our Live Strong Program. They meet twice a week, and I help coordinate the program, and it’s only for cancer survivors that they get to work out at the YMCA with guidance so that we can make sure we’re getting you to your max potential and getting you on your way to a healthier life because there’s only about five things you can do as a cancer survivor, and that is watching your weight, no smoking, very limited drinking, managing your stress level, and exercising.
Melanie: Such great advice. Thank you so much for being with us today, Christy. This is Health Talks with HRH, Hendricks Regional Health, and for more information please visit Hendricks.org. That’s hendricks.org. I’m Melanie Cole. Thanks so much for listening.