Treating breast cancer related pain

An article appeared in the New York Times this week entitled 'When pain persists after breast cancer surgery' It mentioned that upto 50% of women post mastectomy might be affected with ongoing pain for a long time after their surgery and for many this pain might never go away. Further down the article it mentions that a study had been done looking at giving women a pain killing injection to combat this pain and that in the majority of women this was looking like it worked.....although the long term effects are unknown at the moment. The doctor who has pioneered this work was quoted as saying “Even if you had to do the injection every six months, that’s so much better than having that pain.” And here's where I have the problem with the article. Yes, anything has to be better than living in constant pain, but there are alternatives to injections (and those injections look horrendous, if you're a bit sqeamish don't watch the video). It is amazing what a bit of hands on therapy can do!! This 'hands on stuff' is what I do day in day out, and I have to say that the vast majority of clients respond well to it, After breast cancer surgery there are many reasons for ongoing persistent pain, many of them directly related to the surgery - scarring, myofascial tightness and nerve damage. However, there are lots of other factors which impact on the woman's experience of pain and among these we have to look outside the area of the breast and chest wall. We need to be looking at the whole integrated mind - body system and consider carefully the emotional and physical impact that the breast cancer treatment rollercoaster has had on the woman. In my experience, breast cancer treatment related pain seldom occurs in isolation, it is often associated with other symptoms such as movement restriction, swelling, altered/ineffective movement patterns, cancer related fatigue, Axillary Web Syndrome (cording), lymphoedema. Add into that mix sleep disturbance, low mood, body image issues, and a whole load of other psychosocial problems.......would a six monthly injection help all of these??? The evidence for the effectiveness of the injections is looking good, but I would just hope that women who might be considering this line of treatment would see a physio who is skilled and knowledgeable in breast cancer recovery BEFORE they get the needle!! We've a lot to offer, we can fully analyse movements and tissues and have the skills to do something about the problems we detect and physio works! Physio V needle.....I know what I'd go for!

Pinterest positivity!

I love Pinterest! I could spend hours looking at the huge range of stuff that's on there and I find myself going off on tangents then forgetting what I was looking for in the first place.  (I also love Pinterest Fails, but that's my evil alter ego talking!) I've been adding to my own boards and yesterday started up a board called 'The Bucket List' and then proceeded to search the interweb for pictures of things/places that I could add to my board - stuff that I want to achieve before I get too old or am taken by the man above to a higher place. I realised that once I'd added my trip to NYC and a few other places I want to visit, then I was trawling the web for trawlings sake - so my bucket list board wouldn't look empty!

I'm not saying I don't have any dreams or aspirations, cos I do, but how do you capture 'I want a long happy healthy life enjoyed with my loved ones' in a picture?  I am actually very content with my lot! (and lets face it, I'd need a good lottery win to enable me to have the time and the dosh to do a lot of bucket list things).  So I decided I needed another board - 'the stuff that I can tick off on my bucket list' - that's going to be so much easier to fill I think and I wont get depressed on this dreary, cold June Bank Holiday Monday finding pins for it! Now, off I go on a self directed tangent!
Here are my boards!

Activity Tracking.......

How technology has moved on!!! I recently got one of those new fangled activity trackers and have to say I love it!! I got the Withings Activite Pop watch - you wear it as normal like a watch and download the app to your phone, then go about your business and like magic it tracks how many steps you do, converts that to how many miles you've walked and how many calories you've burned and it also tells you how much sleep you get and the quality of that sleep. I spend lots of time in the swimming pool and eventually there will be a software update that will enable the Activite Pop to know I am in the pool and then track how much swimming I do! It's a great little motivational tool, you'll see in the picture the smaller disc on the clock face - that tells me what percentage of my daily activity I've completed today, or it tells me how much more I need to do to get to my 100% (which I have set at 10,000 steps per day).  So today I've done roughly 80% (8000 steps) and if I go out and do a brisk walk, it's a light dry evening so I've no excuse not to go out and get those extra 2000 steps I'll be done for the day!!  How it works I do not know, it blows my mind even beginning to try and work it out. (Maybe there's a leprechaun inside it who pops his head out every now and again and reports back), but whatever the mechanism is, I've tested it against my phone GPS tracker and it seems to be fairly spot on in its accuracy.  

I think this new technology can have a role to play in the fight against cancer and other diseases.  We know that a half of all cancers can be prevented by diet and lifestyle choices.  Being physically active is proven to bring health benefits that can reduce the risk of developing cancer.  The international recommendations regarding the level of activity we need to do to get those health benefits is 30 minutes of moderate intensity exercise on most days of the week.  As a physio working in cancer care I feel it is my responsibility to spread this message and inform my clients that they can reduce their risk of cancer recurrence by increasing their activity levels and to help them to achieve this as it is not always the easiest thing to do though for people who have been through treatment and might be suffering with Cancer Related Fatigue (CRF).  CRF is a common side effect of cancer treatment, affecting almost everyone who has had treatment at some stage in their journey to recovery.  It is complex and multi-factorial and the management of it is far from simply 'getting yourself more active'.  I've done lots of work with clients who have CRF and I'd always advocate that folk use whatever works for them to pace themselves, monitor their activity levels and ultimately try and ensure they get their recommended level of daily exercise.  So, over the years the tools I use have changed with the times, starting off in the early days with a simple paper diary sheet, we then progressed on to pedometers and then the GPS phone apps, but I really think that the new wave of activity trackers could be a game changer in the management of cancer related fatigue which to put it in its most simplified form is very much about finding a balance between rest and activity and working out an individual programme to increase activity levels without causing fatigue levels to rise. My tracker is so simple to use and it must be foolproof! It gives me great feedback and motivation. Plus they don't have to break the bank, with lots of different models being available on the market for all budgets.  Here's my analysis for my activity for Monday -  a day when I spent all day working with clients, who would have thought that I'd clock up so many miles just moving around the treatment room!

and the second picture gives me my sleep breakdown for last night - with a 4month old baby it is certainly encouraging to see that I am actually managing to get into a good deep sleep.  I didn't need the tracker though to tell me it only took me 4 minutes to get to sleep cos I know as soon as my head hits the pillow I'm out like a light! And now, I've spent a little longer writing this than I thought I would so it's now dark outside, I'm not going to get to my target steps for the day and it's time for me to start clocking up the zzzzzzzzzzzzzzz's!! Night, night!

Lymphoedema Information and Resources

I'm presenting at a Lymphoedema Awareness Information Day in Enniscorthy on 25th April organised by the Hope Cancer Support Centre.

 I will be talking about what lymphoedema is, who is at risk and why and what a person can do to reduce their risk of developing it.  I will also be talking about what we do to manage lymphoedema.  In order to make it easier for folk who attend the talk to find the information resources I will be referring to, I have them all here:

The international consensus document

Best Practice for the Management of Lymphoedema

The Lymphoedema Support Network (LSN)

Lymphoedema Ireland

MLD Ireland

The British Lymphology Society

Macmillan online community

Lymphoedema Network Northern Ireland (LNNI)

Joachim Zuther’s Blog

Activa Healthcare E-Learning zone

BMJ online learning module

Hope this helps! ;-)

When is a physio not a physio?

I am often asked what the difference is between a 'Physiotherapist' and a 'Physical Therapist' and it annoys me so much that here in Ireland it takes me a while to answer, whereas in the UK, where our professional title is protected I can simply say 'they mean the same thing!' And what that is is that over there anyone using the title 'physiotherapist' and hence 'physio' or 'physical therapist' has gained an internationally recognised degree level qualification in physiotherapy (physical therapy), which covers anatomy and physiology, disease processes and the effect on the body, pharmacology, psychology, sociology and the application of clinical skills and a whole lot more.  Student placements are undertaken in all areas of healthcare including musculoskeletal, neuro, cardi-respiratory, paediatrics, womens heath, rheumatology, oncology etc and they are expected to be committed to their ongoing continual professional development as part of their 'licence to practice'. In Ireland 'yer man' off the street can come at you with a wet sponge, crack your back and dish out some well meant advice and call himself a physio! I find this both frustrating and concerning! I'm not going to enter into an arrogant dialogue about 'them and us'......there's plenty of that out there, just google (second thoughts I wouldn't bother), but the message I'd rather convey is just make sure that the therapist you are seeing is legitimately what they say they are, and the safest way by far of being guaranteed that they have received a standard level of training is to always make sure your physiotherapist is 'Chartered'.  All Chartered Physiotherapists are registered with the Irish Society of Chartered Physiotherapists we have to submit details of our ongoing professional development to register and we have to be fully insured - it's for your own protection! Now, where's me wet sponge!!

Is kinesiology taping as effective as a parachute??

I recently saw this article  in The New York Times and have to say it got me a little riled!! Basically it is asking whether Kinesiology Taping (KT) works, and more importantly where is the proof if it does.  It obviously doesn't work because there is no existing research evidence to support the claims made by I'd say thousands of professionals like myself and their clients that it does!! I say that with my tongue firmly lodged in my cheek!!  And here is my beef with 'evidenced based practice'.......we deal with people not statistics, cases or cohorts even the most evidently sound treatments are commonly never 100% effective for everyone.  You see there is a point at which the statistics become significant, meaning we can say something works.....and that's ok for those people that fall into the majority 'significant' group, but what about the ones that lie outside of it?? Or more importantly, what about listening to the INDIVIDUAL PERSON and when they say something works, and as a therapist we see something that works, and use this as our evidence?? I use KT tape loads, I've been using it for years, if I didn't think it worked, and if my clients told me it was a waste of time I wouldn't bother, simple as! I'll just share 2 examples - personally when I was pregnant I had all the usual aches and pains associated with a growing bump, didn't want to be taking painkillers so got myself taped, it made pregnancy much more comfortable, nothing adverse happened, I had full term healthy happy babies.  A client of mine who was in the palliative stages of pelvic disease had ascites (huge swelling of the abdomen) meaning that it was extremely uncomfortable and painful trying to move around her house.  I used KT to help lift the weight of her belly and give her lower back some support.  She was able to get out of bed easier, able to walk with less pain.  Nothing adverse happened, sure, she passed away within a few weeks, but I don't believe the KT caused her death, it actually helped her make the most of what time she had left as she was able to do more of the stuff she wanted to do.  But, if I had looked for the evidence to back up such applications I wouldn't find it.....so should I be doing it??   Hopefully this work  being done in Leeds will enable therapists like me to back up my many anecdotal success stories. While I'm on this topic, please do read one of my favourite ever research abstracts (if it's even possible to have a favourite piece of research) from the BMJ entitled Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.  There's absolutely no proof that they work, but I know I'd rather have one strapped to my back if I ever find myself gravitationally challenged!

The value of your £€'s

Friday saw Ireland's annual Daffodil Day, which is the Irish Cancer Society's main national fundraising day throughout the year.  Over the next few months Relay for Life will be held in a number of Irish counties, and again, the ask will be there - please dig deep and give a few bob (or more!). I recently had a conversation with a friend, who had had a dear friend die of advanced cancer.  Understandably she was very upset at the loss of her friend, but also very angry that her friend hadn't been one of the lucky ones, and what was the point in donating millions to cancer research when as far as she could see it wasn't making the slightest bit of difference. Does that sound familiar? I'm sure it will to many.  I think it it is totally understandable, I'd be fairly pissed off too losing a friend at such a young age, it is a tragedy! But, I have to say that in the 17 years I've been working in cancer care that I have seen exactly how our money and consequently research is making a difference.  When I started working at the Christie nearly every other patient had a horror story to tell.....how they'd had a delayed diagnosis resulting in their disease being beyond curative, or that they'd had all the treatment they could and now, well, now it was very much in the hands of the Gods (if that's what you believe).  I'm not working in an acute hospital ward anymore, but I see clients daily who have had a cancer diagnosis, who have had their treatment and are now CANCER FREE! People who are living beyond cancer, and have every reasonable expectation that they will continue to be cancer free! And even those who may have some residual disease, or 'hotspots' that need a close eye keeping on them, medically their management is very much a long term arrangement, with continued reassuring surveillance and a confidence that 'we'll deal with whatever happens' is very much the case.  Recently a very dear friend of mine had what was believed to be a recurrence of her cancer - I worried for her and felt sick all the time she was waiting on results.  She on the other hand was very calm, her medical team giving her the confidence to know that if it was back, then they have the ways and means to combat it again.  Years ago I fear that her options would have been very restricted! And that is all down to research, and every pound or euro that goes into a collection pot is in some way helping to ensure that more people will live beyond cancer, so please support Daffodil Day, support Relay for Life, YOU will be helping to save lives! #wewontgiveupuntilcancerdoes