Evidence Update: TurningPoint-Avon Breast Center at Grady Partnership Continues at the American Society of Breast Surgeons
The results of a 2-year research joint project between TurningPoint, the Avon Breast Center at Grady Hospital, Emory University and Morehouse School of Medicine were presented by Dr. Lisa Lai at a recent meeting of the American Society of Breast Surgeons, held in Dallas, Texas. Dr. Lai is a surgeon doing Fellowship Training with Dr. Sheryl Gabram at the Avon Breast Center. Dr. Gabram is a TurningPoint Medical Advisory Board member. The goal of the research project was to examine the feasibility and impact of a prospective surveillance approach to breast cancer rehabilitation. Subjects were 110 patients with Stage 0 – III breast cancer. Most were inner-city and minority women. Shoulder range of motion, arm volume and function was measured before surgery, early post-operatively (2-4 weeks), 6 weeks and then at 3 month intervals for up to a year post-op. We found that approximately 1/3 of patients had early stage lymphedema and other upper extremity limitations that warranted rehabilitation intervention. Patients with higher breast cancer stage, greater numbers of lymph nodes removed and who received chemotherapy were found to have more treatment side effects that required more rehabilitation intervention. Patients with lower levels of function and higher pain levels at their early post-operative visit were more likely to need rehabilitation intervention. Our research team concluded that early identification and management of breast cancer treatment side effects (such as decreased function, limited range of motion and lymphedema) may decrease the impact of these issues and potentially improve quality of life. ASBS Poster April 2016 Photo above: Dr. Lisa Lai (left), Breast Cancer Surgical Fellow at Avon Breast Center at Grady and Emory University with members of TurningPoint’s physical therapy staff, l to r: Grayson Webb, Carrie Kozel and Lauren Bober. Dr. Lai visited TurningPoint recently to further increase her understanding of the role of rehabilitation for breast cancer patients.
Caretaker Perspective: Kaitlyn Kosten
Caretaker Perspective: Kaitlyn Kosten In honor of Mother’s Day, we would like to feature a caretaker perspective, written by the 15 year-old daughter of a patient, Tricia Kosten. Kaitlyn Kosten is a freshman at North Forsyth High School, enjoys the drumline in the marching band and hopes to pursue a career in engineering. We hope you enjoy this amazing piece as much as we have. There is a moment in everyone’s life when the impossible happens. There is a moment in everyone’s life when the option of turning back is no longer available, when the world pauses and suddenly everything is unreal, yet the pain of reality is nearly unbearable. For me, this moment was while I gathered with my sisters and brother to discover the horrific news: my own mom was diagnosed with cancer. When you hear “cancer story,” it might convey bittersweet images of survivors or unlock the gates to countless stories told again and again from those who have been crowned a victor of this wearisome battle. This story, however, is different. It is not told from a survivor, or even written about a survivor, but from the perspective of a young girl who was witness from the sidelines of the battle. It will not center around the heart wrenching tragedies that come as a side effect of cancer. No, this story focuses on what I like to call “caretaker perks.” When a family member is diagnosed, it feels as if the world has stopped. The painful realization that the cancer has only shattered the world of those who know your family is soon dumped on you like a chilly bucket of ice when the grocery cashier greets you like she does every week, and everybody seems to step forward while you step back, again and again. Soon enough, you learn that to feel “normal” once more, you have to immerse yourself in what you love. For me, this took the form of music and running. As odd as the two may sound, they became a sort of therapy for me, and grew to be a constant reminder that, as Beau Taplin said, “She was unstoppable. Not because she did not have failures or doubts, but because she continued on despite them.” If a family member has the misfortune of being diagnosed, the family itself is convinced that they alone are the main support system, and while this may be true, the family needs a support system itself. They need a place to draw their strength from, someone to listen and provide guidance, https://livingwellnessmedicalcenter.com/klonopin-clonazepam/. I relied heavily on friends, as most people in this situation do. Our bonds were strengthened, and I felt a renewed trust and loyalty that was displayed by my closest friends. Such a miserable situation fortified my second family, the family who chose to stay close by my side. Life itself is not a gift, as some like to insist, for we do not get to keep it. It is not rightfully ours, for what have we done to deserve it? No, life is simply a loan, and one day, it will be taken back from us. What we accomplish in the few years allotted is our decision, a decision we must make every day, every hour, every second we awake to this demanding yet hopeful world. This experience showed me that at any second, everything we hold near and dear can be snapped away, before we have time to say goodbye. I must not take for granted the time I am permitted; instead, I must live instead of simply existing. I must learn and watch and grow, so that one day, when it comes time to recall my life, I will know that I have given it everything I have, every talent, every smile, and every laugh. These “caretaker perks” are only a few bonuses among many, simple lessons that, when applied, hold the power to change everything. When someone in a family is diagnosed, the family is on the sidelines cheering them on, but they are fighting their own battle with the same enemy. Cancer affects the whole family, and everyone must fight. In the end, the survivors stand with pride, but their caretakers are never far behind them, for we, too, are victorious.
Evidence Update: Water Exercise and Lymphedema
A recent study examined the effect of water versus land exercise in improving lymphedema. Eighty-eight eligible patients with secondary lymphedema after breast or gynecological cancer participated in this controlled clinical intervention study. Patients participated in either a water-based or land-based exercise program. Researchers measured subject’s arm volume, as well as BMI, function, well-being and body image. In patients who participated in water exercises, more women had reduced arm limb volume and there were also significant improvements for these women in lower BMI and decreased self-reported frequency of swelling. Women with arm lymphedema in the land exercise group showed more improvement in upper extremity function and range of motion. Researchers conclude that water exercise may be offered to patients when the goal is to reduced lymphedema while to improve daily shoulder function, land exercises are preferred. Your TurningPoint physical therapist can help you develop an exercise plan that is designed specifically to help meet your unique goals. Lindquist H et al. Water exercise compared to land exercise or standard care in female cancer survivors with secondary lymphedema. Lymphology. 2015 Jun;48(2):64-79.
Patient Perspective: Alana Ramirez
Patient Perspective: Alana Ramirez My cancer journey started in October of 2015 when I heard the words no one wants or expects to hear. After my yearly mammogram, I was called back for a second set of pictures followed by a Core Biopsy confirming DCIS in my right breast. The Radiology Doctor reviewed the pathology report with us explaining DCIS, procedure options for removal and provided a surgeon referral. I was beyond stunned at the diagnosis, but my husband remained strong and supportive saying we will get you better! Over the following weeks we spent time researching/learning about DCIS, interviewing surgeons for options, having an MRI and genetic testing. We prepared to the best of our ability to make the right decisions for my treatment and were thankful for the early detection. The surgery on December 22, 2015 was incredibly successful. I was released from the hospital 48 hours later on Christmas Eve cancer free, truly the best gift I had ever received. At the surgeon post op appointment six days after my surgery, the pathology report confirmed DCIS and no other invasive cancer. Both lymph nodes were clear which meant no need for chemotherapy or radiation. The relief and joy from the positive results cannot be expressed in words. My surgeon felt it was prudent to take two proactive measures for risk mitigation in my treatment plan. First was to schedule a consultant with the Oncologist, and second was to contact TurningPoint for Physical Therapy. He said “Patients love TurningPoint so much they never want to leave.” He was spot on! January 6th, 2016, fifteen days after my surgery I had my first appointment at TurningPoint. In mid-January my Plastic Surgeon was impressed with my ability to use my core and arms with ease. The TurningPoint experience was WOW and continues to be WOW months later. I consider the TurningPoint staff an integral and long term part of my medical team. TurningPoint provides me support and inspiration to take back my active life. Thank you TurningPoint!
