Why I Relay.....

I am currently involved in helping to organise Kilkenny’s first ever Relay for Life event, which is happening on 20^th and 21^st July 2013.  ‘Why we Relay’ is a very important question, so here is my go at answering it…….

When I trained as a physiotherapist I never in a million years would have expected that I would end up working in cancer care, but here I am nearly 20 years on and I often get asked what brought me to oncology in the first place.  Well, it certainly wasn’t planned!   In the hazy Summer of 1999 (that was the year Manchester United won the treble…YAY!!) I found myself working as a locum physio in a hospital that I really didn’t like, I won’t name it or say why I hated it, but I really didn’t enjoy going to work in the mornings.  It got so bad that one day I rung the locum agency and told them I wanted out….there had to be something better than this, to which I was told ‘we only have one other placement at the moment and that is at The Christie’.  The Christie is a very well know cancer treatment hospital in Manchester and up until that point, I had, Thank God, never had any reason to visit it, so knew very little about it apart from the fact that everyone in there had cancer.  I think my thoughts at the time went something like ‘What would a cancer hospital need a physio for?’ or more to the point ‘what sort of physio would I be doing in there’ and I suppose my next thought would have been ‘don’t they all die?’.  But, me being me and I’ll try anything once decided that it couldn’t be any worse than the job I was doing and hating presently, so the very next week off I went to my new placement in the Christie Cancer Hospital. 

From the very first moment I entered the Christie I was just amazed.  It didn’t feel like a hospital, it felt warm and friendly, homely and cosy.  There was a really positive vibe around the place and it had a brightness that shone even on the dullest, dreariest of days, and Manchester certainly has a lot of them!  – it’s difficult to describe, but anyone who has been there will know exactly what I mean.   

I felt that I had been completely welcomed with open arms.  The physio’s that were working there were just brilliant and it took me no time at all to feel like I was part of the Christie family.  My work placement was on the surgical wards so it involved lots of pre-op assessments and then lots of post-op ‘getting going again’ – clearing chests, sitting patients out of bed, getting them walking and then getting them home– for many of them, this was just the beginning of an incredibly tough journey, a  journey that would impact on every aspect of their lives and for some would last for years to come.   They needed lots of help and support, and I quickly came to the realisation that these patients were so deserving and needing of physiotherapy input – and that THIS was why I became a physio in the first place – this was my ‘physio home’.  I fully expected the work to be stressful, upsetting and emotionally draining, and although there have been occasions where I have gotten very upset and cried about certain patients and their situation, I have to say that generally working in oncology has been a very positive, inspiring and life changing experience.  It has made me realise the important things in life and has completely changed my outlook and perspective on things.

Within the hospital there was an incredible openness about cancer – the word itself wasn’t said in hushed tones or avoided like I had experienced in other hospital wards in other hospitals.  All the patients  knew that all the other patients in there had cancer somewhere and that they were in the hospital for treatment of the disease or it’s symptoms.  This openness allowed a great sense of camaraderie and solidarity amongst fellow patients and amongst the staff – we were all united in the fight against this awful disease.  It is often said that ‘laughter is the best medicine’ I certainly believe that it enhances the effectiveness of anticancer treatments after all that I have experienced and observed over the years. 

So ‘Why do I Relay?’ Well I Relay to say ‘Thank You’.  Thank You to each and every single person that I have had the privilege to work with and help along their cancer journey for allowing me to join them on their journey and learn so much, experience so much and become not just a better physio, but a better person too!

Ta Ra for now! 

Exercise can help Cancer Related Fatigue – Official!!

“You know when you’ve had a really hard day at work, and you flop down on the settee in front of the telly at the end of the day……if the phone rings across the other side of the room, you might feel so tired that you choose to ignore it.  But, if you smelt burning from the kitchen and saw black smoke you would be able to jump up and go and find out what’s going on…….well, the way I am feeling at the moment, if that was me, I think I would have to take my chances with the fire, as I have absolutely no energy reserves left, I have nothing!” 

Cancer Related fatigue (CRF) as describe above by a patient of mine a few years ago is a very common side effect of cancer or cancer treatment.  It is suggested that most people undergoing treatment for cancer will at some stage experience a degree of CRF.  In my experience I would have to say I think everyone who has cancer or is having treatment will suffer with CRF at some stage throughout their treatment journey.  It can happen during or after treatment and can persist for weeks, months even years for some people.   It can affect every single aspect of a person’s life – every day activities, hobbies, work and social life, and can have a detrimental effect on their wellbeing and state of mind.   CRF can be quite debilitating, but the good news is that help is available, and it can be alleviated.   A physio is typically the last person on earth that a patient feeling fatigued would want to see, but actually, we are probably one of the most important members of the cancer rehabilitation team when it comes to treating CRF.  We are able to assess a person’s individual level of fitness and activity and prescribe an appropriate activity or exercise programme to help that person break the vicious cycle of CRF.  It’s all about finding a balance between having the right amount of rest (which is important to enable the body to repair and recover from the treatments) and the right amount of activity, which will maintain and improve muscle strength and  cardiovascular fitness.  As these improve so too do energy levels meaning that fatigue is reduced. 

A research review (here) paper was published last week, which confirms everything  that us physio’s have always known…..that if you have CRF then rest is most definitely not best!    

Physiotherapy in Cancer Care

The term Cancer describes a multitude of complex diseases each with its own distinct nature and course. Traditionally the focus of cancer treatments have been primarily medical, with the strive to increase survival from the disease being the main driver. Whilst survival and longevity are no doubt the focus for everyone who has a diagnosis of cancer, survivorship and rehabilitation are also very important. These 2 words encompassing what it means to live with the consequences of the disease or its treatment and for life to return to a semblance of normality. People who have been diagnosed with cancer often present with a myriad of complex problems which occur as a direct result of the disease itself or of the treatments which they have undergone. Physiotherapy has a key role to play in the management of people with cancer throughout all stages of the disease, from diagnosis, through medical treatment, into remission and even in the later stages of the disease.
Within the context of cancer care, the primary goal of physiotherapy is to assist the cancer survivor to be able to live their life as fully as possible, by assisting them to achieve their goals whatever they are and to enable them to have a degree of control over their lives and a greater quality of life.
Research Studies have shown that Exercise and activity is effective in alleviating many of the longer term side effects of cancer treatment, such as fatigue, reduced function, depression and anxiety, decreased fitness and strength etc.  Also, those cancer survivors who are physically active can reduced their risk of the cancer recurring, and hence the risk of dying from the cancer by up to 50%.
People who have cancer may present with some of the following common problems as a result of their disease or as a consequence of the treatment they have undergone:

• Reduced mobility, for example difficulty climbing stairs or getting out of a chair
• Reduced exercise tolerance and general fitness, maybe not able to walk to the local shop anymore
• Joint stiffness and pain
• Weakness, for example struggling to lift a kettle or to pick something from the floor
• Shoulder or neck problems following treatment for breast cancer or head and neck cancer
• Lymphoedema and swelling
• Problems with breathing control
• Neurological dysfunction, for example altered balance, problems with feeling or touch or difficulty getting a body part to work properly for you
• General fatigue and lethargy
• Reduced independence or a greater dependence on others for everyday activities
• Reduced confidence
• Increased fear and anxiety
• A worry about finding the balance between how much to push themselves and how much to rest

All of the above can be helped by undergoing an assessment and treatment from a physiotherapist who is experienced and knowledgeable in cancer care.   See my website www.homephysio.ie for more info!

Pilates for Breast Cancer Recovery

I came across this article recently.  Pilates is a great way of exercising for women who are going through or have completed treatment for breast cancer.  Pilates can help to:

• Improve range of movement at the shoulder joint
• Improve the stability of the shoulder complex
• Increase strength and endurance
• Reduce cancer related fatigue
• Improve flexibility 
• Improve posture and body alignment
• Improve balance and coordination
• Improve the circulation
• Stimulate the lymphatic system, which aids drainage of fluid and is important in the prevention of lymphoedema
• Increase bone density, which is important to prevent osteoporosis
• Aid relaxation and reduce anxiety
• Provide an enhanced sense of wellbeing.

My 'Pink Pilates' classes are now available in Kilkenny! 

Back in Action!!

Well, after a very long break from writing my blog, I feel I must try and get myself back in the habit!  First of all the reason for my inactivity over the past year or so......a little girl called Elaine, my first baby who was born in January and who is now 9 and half months old.  I really don't know where the last year has gone, and the time since Elaine entered the world has gone by in a flash!!  Becoming a mother has been a major life changing event for me.  I am loving my new role, but there have been, and I am sure will continue to be times that I find really difficult and challenging, not least of all adjusting to a very different new reality and altered priorities, but on the plus side, I have had a good long rest from work, at times I think the physio bit of my mind got completely switched off, but it is switched back on and ready to go now.....so watch this space.

Susie Long

Living in Kilkenny I have always been very aware of the plight of Susie Long.  Susie died of advanced cancer in 2007.  Her story is a tough one to hear.  Having presented to her GP with worrying symptoms, Susie then had to wait for 7 months before a colonoscopy examination took place.  By this time, the cancer, which had been growing all the while was at an advanced stage, meaning that Susie’s life expectancy was dramatically reduced by the time she received a diagnosis. Susie spoke out publicly about the unfairness and the inequality that she had experienced in the Irish health service.  It was unfair and inequitable because Susie did not have health insurance, if she had, she would have gotten the colonoscopy done within a few days, her cancer would have been detected at a much earlier stage, and who knows maybe she would still be here today to lead the campaign against injustice herself.  

It is really heart-breaking to hear similar stories – endless visits to the GP, endless waiting on scans and investigations, endless worrying.  When I began my career in cancer care in the UK in 1999 these stories were fairly commonplace then.  Having left the UK in 2005, I am not able to comment on how effective the introduction of the ‘2 week wait’ standard has been – that anyone who presents to their GP with suspected cancer will have been seen by a specialist within 2 weeks, but I can remember being on the wards just before I left and hearing the stories about how quickly tests and treatments were organised, so I was optimistic that the tide was beginning to turn.  Here in Ireland, I can’t help thinking that we have a  long way to go yet.  The 2 tier system, which so badly let Susie Long down is still very much in place. After many years of wasted overspending and now in the days of cuts and restrictions it is quite possible that the gap between the 2 tiers is now even wider.  And it’s not just the cancer services that I worry about, it’s the system as whole.  There is rarely a week goes by without some kind of scandal or horror story related to our health services. 

The new government have pledged to reform the health service in Ireland.  Their plan aims to have a Universal Health Insurance scheme in place by 2016 – which effectively will mean equal better healthcare for everyone.  Hopefully by then our health statistics will reflect this, but remember that behind and within every statistic, there is a person, a family and their unique story.  Susie Long was such a person, her family were such a family, and their story cannot be ignored.  

The Susie Long Hospice Fund  aims to  “To provide the highest possible quality of end-of-life care for patients and their families through the establishment of a 12-bed hospice in Kilkenny”.

Lymphoedema - reducing the risk.

For anyone who has had a node clearance as part of their cancer treatment, the risk of developing lymphoedema can be a major cause of concern.  Typically lymph nodes are surgically removed from the armpit or the groin in an attempt to fully remove any cancer cells from the body.   To be extra sure, sometimes radiotherapy is also used, and this can further impact on the already depleted lymphatic system.   The lymphatic system is the body’s own ‘waste disposal’ system.  It transports fluid and molecules from the tissues to the venous circulation whereby waste products can then be eliminated.  Lymphoedema is an abnormal collection of fluid, proteins and fat within the tissues as a result of a dysfunctional lymphatic system.   The lymph nodes are a vital component of this system, and in order to fully understand the importance of reducing the risk of developing lymphoedema we need to have an understanding of how the body would normally utilise the lymphatic system.  Imagine getting a bee sting on the back of your hand.  You would probably feel pain, see redness developing around the area, and then see swelling occur around the site of the sting.  This redness and swelling is an indication that the body has recognised that the protective barrier of the skin has been breached and that its own defence system has been deployed to the area to breakdown and remove any infection or foreign particles that should’nt be there.  The local swelling, which includes the nasty bits of the sting, will then be transported to the lymph nodes in the armpit where they will then be emptied into the central lymphatic system, which will ultimately remove them to the circulatory system where they can be disposed of.  In a person who has had their axillary (armpit) nodes removed, the body will respond in exactly the same way to a bee sting on the hand, but it is  the removal of the local swelling that is now going to be much reduced, resulting in the fluid staying in the hand, which can be the onset of lymphoedema.  It is therefore vitally important for anyone who has had lymph node removal to take precautions every day for the rest of their life to try and minimise the risk of getting lymphoedema in the first place.  Avoiding any kind of breaks to the skin on the affected limb is really important, and a break to the skin that is intentional, for example the introduction of a hypodermic needle for the taking of blood of the giving of drugs can be every bit as dangerous as a bee sting, cut, scratch, or burn.  It is also important to avoid any kind of compressive forces which may produce a tourniquet effect, for example, tight fitting clothing and jewellery or the pressure cuff used when taking blood pressure.   Looking after the affected limb by keeping the skin well moisturised and exercising regularly are hugely beneficial.  It is also important to be vigilant of any changes in the limb, including changes in shape and volume, feelings of tightness or heaviness, pain and reduced range of movement and discuss these with a lymphoedema practitioner at the earliest opportunity.  Lymphoedema can be an extremely debilitating condition, but if it is recognised and treated in its very early stages, it will be a lot easier to manage it in the long term.