Sunday 6 December 2015

FG-MLD - A patient perspective.

Since the end of July I have been using the technique of Fluoroscopy Guided Manual Lymphatic Drainage (FG-MLD) in practice.  I wrote a post about it when I had finished the training.  At that time, I hadn't used it on real people with real lymphoedema.  Now, after seeing the amazing results I get with it I really believe it is the BEST method of MLD available.  The old technique worked well, so I am not taking away from the traditional forms of MLD, but having used FG-MLD clinically, I really cannot go back to the old way. My clients are feeling and seeing the difference too and recently I asked one of them if they would write me a wee testimonial.  So here it is, completely unabridged and unedited.

I got swelling in my leg 12 years ago, fairly soon after I had extensive surgery to treat cancer.  I had glands taken from my groin and my leg blew up within a few months of the surgery.  Since that time I have had some treatment for my lymphoedema.  I’ve attended a number of MLD therapists and had the bandaging done – they all told me they had got a good result, but I really didn’t think so.  My leg was massive, I’d say at least twice as big as my good one, and even after treatment, it was still huge.  I wear a stocking everyday, my leg was heavy and I felt it was getting worse, so in August I rung Joanne Brennan on the recommendation of a friend who had been raving about how good she was.  I am a complete sceptic, I really didn’t think that anything could be done for me that hadn’t already been tried.  I was probably just going to have to put up with this leg for the rest of my life.
I met Joanne and she assessed me – asked me all the same questions I had answered a million times before, and I thought to myself here we go again.  But then she explained that the technique of MLD she used was brand new.  She explained the science behind it and I thought to myself that really makes a lot of sense, I just hope it works for me.  Well, I have to say that I think it is an amazing technique.  It feels a lot stronger than the treatments I've had before, but that makes it feel like it’s actually working.  I would describe the other treatments I’ve had more like a tickle in comparison.  At the end of the first session I could see a thinner ankle and my leg felt lighter.  After 5 sessions my leg feels and looks brilliant.  It still swells as the day goes on, but when I wake up in the morning and I compare it to the other side there’s very little difference.  I haven’t seen my leg looking as good as it does now since before the surgery.  I can walk much further without getting tired, my energy is increased and I am sleeping much better.  I’ve told Joanne she has magic hands and I would be extremely happy to recommend her treatment to anyone else who suffers with lymphoedema like I do. 

I have been told that I have 'magic hands', I'm performing miracles and even sorcery!! But it is none of those, it is just the use of a brilliant technique which is based on the knowledge that we now have of how the lymphatic system works thanks to the work of Professor Jean-Paul Belgrado and his team.  

Saturday 29 August 2015

Scary Neuro-Surgeons!

For as long as I can remember I've been obsessed with the workings of the human body (hence my career choice) and my favourite bit of anatomy has to be the brain! When I was training as a physio I loved anything to do with the brain and nervous system, and when I got the chance to do my final year elective placement with one of the UK's leading neuro-physio's I jumped at it.  My first job was at Salford Royal Hospitals NHS Trust - AKA Hope Hospital, the Neuro-surgical Centre of excellence for the North West of England and I purposefully selected my junior rotation posts so as to make the most of being in the presence of neuro experts so I could learn from them.  From the very beginning Neuro-rehab was a big part of what I did.  When I started working at the Christie Cancer Treatment Centre, I was able to tie my two passions together when I took up the post of Senior Neuro-oncology physio, a job that I loved every single second of.
Despite my love of everything 'brain-ey', I did find the neuro-surgical wards a scary place to be.  Of all the patients in the hospital, these were some of the most critically ill I would ever come across.  I learnt very quickly that the line between life and death is a very fine one. I also learnt that the phrase 'a fate worse than death' has real truth in it, when I think of some of the patients I have treated who have had massive brain injuries and have been left severely disabled and debilitated but alive.  I can remember the tangible fear of the junior doctors on the wards at rounds time as they waited for the Consultant Neuro-surgeon to arrive.  As a junior physio I remember being made to feel completely inadequate when discussing patients with neuro-surgical nurses who had years of experience in the field and probably could treat the chest of an acutely ill patient far better than I could.  If it was my night to be 'on call', I would actually pray that neuro-surgery wouldn't call me,  and if in the middle of the night the pager would bleep (before mobile phones!) and I'd see their extension number I'd almost get sick to my stomach.  I felt that neuro-surgeons where scary, egocentric genius's with a very definite God complex, but I've always been intrigued by them and I suppose in awe of them,and in 2007, when a neuro-surgeon saved my mothers life, that particular surgeon got elevated to 'Legend' status!  So when I recently came across Consultant Neuro-surgeon Mr Henry Marsh's book 'Do No Harm', I had to read it.  And I am so glad I did. It gives a fascinating insight not just into the world of neuro-surgery, it also reveals the humanity behind that 'scary' façade  - a humanity which enables them to perform what must arguably be the most difficult and risky surgical procedures for the good of their patients.  They have to have the God complex, they have to believe that they are the best because if they make a mistake someone dies or worse can suffer a 'fate worse than death'.  Please God, I never have to go under the knife of a neuro-surgeon, but if I did I want him or her to be the scariest, most egoncentric genius I have ever met.  I'd highly recommend the book!

Wednesday 19 August 2015

Lipoedema Case Study

I have recently been treating a client with intensive decongestive lymphatic therapy (DLT) who has lipoedema.  The lady is 37 years of age.  Her history and examination reveals that she ticks a lot of lipoedema boxes:

  • bilateral symmetrical 'big' legs, disproportionate for waist/trunk size
  • history of bruising easily
  • endless attempts to lose weight and when she has lost weight it hasn't gone from the legs
  • 'orange peel' effect on the legs
  • feet are not affected and look 'skinny' in comparison to her ankles
  • non-specific achy feelings and heaviness in the legs
  • strong family history of thyroid disorders
  • other female relatives have similar big legs
  • her legs were overly tender to light pressure
  • her symptoms were exacerbated during pregnancy
The photo below shows her pre and post Delfin Moisture Metre readings along with her limb volumes. 


This is an ongoing case, I am still seeing this lady, the above post measurements are taken on day 5 of treatment. 
Subjectively the lady is feeling immense benefits from the treatment.  She says that her legs feel so much lighter than they have ever done, she doesn't have the aches and soreness that she was so used to and she is loving the fact that she herself can see her "ankle bones" and has shape in her calves.  
I sincerely hope that we can maintain these improvements as we continue to work together.  
I am plagued by questions as to what was/is going on in her legs based on the objective findings and putting that together with the knowledge I have gained during my recent Fluoroscopy Guided Manual Lymphatic Drainage (FG-MLD) training.  And I am specifically looking at area 'A' in the diagram.  On initial assessment there was definitely higher Moisture Metre readings in that are in her left leg. The left:right ratio difference in area A is averaging 1.3.  Her left leg did have a slightly higher volume and after 5 days had a reduction of 1370mls when compared to 805mls on the right.  But what interested me more is that the Moisture Meter readings were very much reduced on the left and more equal to those on the right - leading me to conclude that we had gotten rid of the excess fluid in that area.  But I then ask why was there more fluid just in that specific area?????? On assessing women with very early stage lipoedema, this area typically is where we can palpate the rubbery fat nodules, and is commonly an area that ladies identify as where they can see the abnormal fat in their legs.
So, when I think about what I learnt in my FG-MLD training recently - commonly there is an area just below the knee - roughly around area 'A' where we find our 'fill' spots.......I don't know where this is going but I am sure there is a research question in there somewhere, I just don't know what it is.  
I would love to get other therapists views on this - any thoughts?????

Wednesday 5 August 2015

Lipoedema

Recently I gave a talk on Lipoedema explaining what it is, how it is diagnosed and how it is treated and managed.  Here is the slide show, a lot of it is self explanatory but I'm happy to answer any questions if you comment below.

Monday 27 July 2015

FG-MLD....challenging and changing what we know about lymphoedema!

I've just spent the weekend in Cork doing some training with Jane Wigg of The Lymphoedema Training Academy, learning all about the new Fluoroscopy Guided Manual Lymphatic Drainage (FG-MLD) technique. I first did my MLD training with Jane in 2009 and ever since have been using it to great effect with clients who present with lymphoedema and chronic swelling. There is no doubt in my mind that MLD works – we know that, we see limbs shrink in volume, we feel fibrosis soften and we hear what difference that is making to patients. There are different schools of MLD, all using slightly different techniques but with broadly similar treatment aims – to re-educate the lymphatic system to take fluid away from where it is collecting to an area where it can be drained effectively. A problem that we have though in the field of MLD is that up until very recently, we didn't know for sure exactly how it works and the 'it just does' view has little value in the inquisitive and evidence based medical world. There is very little published research evidence available to prove that MLD works. We can set our hypotheses but actually testing them at the most vigorous level is difficult. So my mind has been well and truly blown over the last few days when I have learnt about some of the most recent work being done in lymphology to strengthen the evidence base and to finally answer with conviction the 'how it works' question. Professor Jean Paul Belgrado's work using an infrared camera to view the lymphatic system in living people is further building on Professor Leduc's anatomical work on cadavers from the 1970's. The evidence is compelling. Now we can see lymphatic flow in action in real life, we can see the impact that a compromised lymphatic system is having on that flow and we can see exactly how our hand placements, stroke movements and pressures applied can be adapted to maximise the effectiveness of the MLD technique, and that is what Jane Wigg, Professor Belgrado and his team have done with the creation of FG-MLD. I actually think that this new knowledge will have a massive impact on how we manage lymphoedema now and in the future and in my mind it is a significant medical breakthrough that will have life-changing consequences. Think about how Watson and Crick impacted on our knowledge of genetics or Fleming contributed to fighting infection – I think FG-MLD is the double helix or the penicillin of today!
So, what does this mean to MLD Therapists who are currently effectively treating people with lymphoedema using MLD techniques that have been tried and tested over decades, what does FG-MLD offer us? Well, it means we can have a fuller more informed understanding of what we are doing and why, and have the conviction to be able to say 'This works and we have the evidence to prove it'. It means that we can achieve more, we can have even better outcomes we can be even more effective at moving fluid and softening fibrosis. For patients with lymphoedema it means we can provide you with a researched and evidenced based technique which will reduce your swelling and it will improve your quality of life.
As a therapist I find this incredibly exciting and as I said 'mind-blowing', although at the same time I find myself really challenged. Challenged to change what I am doing, challenged to think differently, challenged to accept a fundamental change in the approach and underlying assumptions to that which we heretofore held about lymphoedema and MLD, challenged to trust this paradigm shift. How comfortable am I with such a high level of challenge? To answer that I have to bring my focus back to why I do what I do. I am a clinician, I want to achieve the best for my clients, I want to make them better, yes the techniques that I am currently using are doing that, but if I can use something that promises to be even better........I can't erase the images in my mind of the fluorescent lymphatic fluid being pushed out of a limb that are there since I saw the video evidence over the weekend. For me its a no-brainer! It's FG-MLD all the way from now on!

So, I actually can't wait to bring this knowledge to my clients. I can't wait to tell them all the new stuff I've learnt (and tell them to forget some of the stuff that I would have told them previously) and I CAN NOT wait to try out the new technique and see the results for myself . The world is revolving and evolving at a fast pace and similarly we have to evolve in our clinical practice. I for one am delighted to be part of this exciting new world of lymphoedema management!

Friday 17 July 2015

Lymphoedema........is it OK to get a massage?

I'm often asked about getting a massage by people who have lymphoedema or may be at risk of developing it due to treatment over a lymph node area.  The answer to this is not a simple 'Yes' or 'No'.....more of a 'well, you can and you can't' (typical Irish way of answering a question I know!).  So here's my guide to the things to think about...
Most important  - is the person offering the massage qualified to do so, and what are their qualifications.  If you are paying for a massage (as opposed to a family member, partner or friend providing it) then you do need to check out what training they have done.  Gold standard would be they are trained in the lymphatic system by one of the recognised schools of Manual Lymphatic Drainage (Leduc, Foeldi, Vodder, Casley-Smith and the Lymphoedema Training Academy - this is the one I do my training with!).  Any therapist with this training should have a full appreciation of the lymphatic system and what can cause lymphoedema or make it worse and therefore you should be in safe enough hands getting massage from them (it'll probably very likely be an MLD type treatment anyway - which is the best thing for the lymphatics).
There are however many massage therapists available that do not have the above training, and I think I am right in saying that the majority of therapists who work in Spa's, beauty clinics, hotels and sports facilities etc would fall in to this category. So similarly ask them what training they have done in the lymphatic system.  I would tell them that I either have or am at risk of developing lymphoedema and ask them how that would impact on the massage.  I'd then judge by their response would I go ahead with the massage - so I would be looking for them to explain to me how in this situation massage needs to be gentle and that all deep heavy strokes need to be avoided.  I would also be looking for them to ask me for more information in order for them to make a full assessment of me and then to be able to deliver the most appropriate massage for me.  I would have to be assured that I knew that they knew about lymphoedema - if I feel that then grand, if there was any doubts in my mind I wouldn't go ahead.
Strong deep strokes around the part of the body where the lymph nodes are compromised is not recommended. So if it's your armpit that is affected, avoid deep massage in the associated arm, breast, chest and back area.   Massage in that area should be light and gentle and strokes should always go towards the centre of the trunk.  I would strongly advise against getting a 'cupping' massage - where heated glass cups are placed on the body and as they cool they create suction which apparently 'stimulates circulation and healing', think 'lovebite' - cos that's what you end up with -  a series of big dark bruises wherever the suction was applied.  Physiologically a bruise is a sign that tissue damage has occurred, whether it be from getting a bang off a piece of furniture or from a 'healing treatment'.  If your impaired lymphatic system cannot cope with the demand that the increased circulatory and inflammatory response to this 'therapy' will place on it then you could run into trouble.
After having cancer treatment you may find your skin a little more sensitive than it was before.  You might need to avoid the use of perfumed creams and lotions.  If getting an aromatherapy massage, be sure to tell the therapist that you have had/having treatment and they can select the most appropriate oil for you.
Ask around - word of mouth is often the best way of finding the best people.  There are some very good massage therapists around who I would happily refer any of my clients to and if anyone wants their details then let me know.
There are immense benefits of receiving massage therapy by a trained competent therapist who can work with you tissues to bring about relaxation and release of tension throughout the whole body, and this can be very healing in itself, both physically and psychologically.  It is so important if you have/are at risk of getting lymphoedema to make sure you take all precautions that you need to take.  It is YOUR body, and you have to give permission to someone to place their hands on your body - only do that if you are completely happy they know what they are doing because at the end of the day, if something does go wrong, it is you that has to then deal with it.  You need to do your own risk assessment.  Unfortunately I have seen many clients who have received 'massage' and then end up coming to me because lymphoedema symptoms have been exacerbated. On questioning all these clients have said that they didn't feel totally convinced or comfortable that the therapist knew about lymphoedema, despite the fact that they might have said they did.
In the Autumn I will be running a course aimed specifically at body work in clients that have had breast cancer.  This will be open to any touch therapist (massage, physio etc) who might encounter breast cancer survivors in their work. We will be exploding some of the myths and exploring the many possibilities and benefits available from working on the body tissues through therapeutic touch.  More details will be posted soon, or contact me for more info.

Saturday 11 July 2015

My top tips for new Physiotherapists

There's a busy conversation on the Twitter machine at the moment #toptipsfornewphysios - quite timely as now is the time of year that new grads are starting out in the big bad world of work.  So, I decided that 18 years after I was in that very same exciting but daunting situation, here are some of the pearls of wisdom I have collected over the years:



  1. It is important to make a personal connection with the patient/client.  Always introduce yourself #hellomynameis and never assume that the name you see on the referral letter or medical chart is the name the person likes to be called.  Always ask the person how they would like to be addressed - 'Is it OK for me to call you......?' or 'what would you like me to call you?'  
  2. Make the most of non-verbal communication - 3/4 of the stuff we communicate is done through non-verbal communication - how we appear to the patient.  Be very aware of this! How you stand, hold your arms, even how you are dressed will send out very powerful messages - you want to make sure you are sending out the right ones.  Be wholly attentive to the patient, get yourself at eye level, use open arm gestures and relaxed postures to encourage an environment that is conducive to the sharing of information (so important in your history taking!)
  3. Always remember that we treat PEOPLE not tissues or conditions or injuries.  OK, so we do do a fair bit with tissues and injuries - that's physio, but behind every injury is a person - you'll be a better physio if you never lose sight of this. 
  4. Use your own internal quality gauge when going about your work - some simple questions to ask yourself - 'Would I be happy if roles were reversed here and I was the patient and 'they' where the physio?', 'Would I be happy if my Dad/Mam/Sister/Brother/Grandma/Grandad received physio treatment like that?', 'What would I want?'........If you're happy with the service you are providing then great, if not then do something about it! 
  5. If you're going to work in the NHS/HSE you will undoubtedly encounter the political stresses and strains of the system that will impact on your work.  Get yourself some advanced communication/conflict management/industrial relations training - the type of thing that comes with training as a Union Rep - when I trained as a CSP Rep years ago, my eyes were opened to exactly how the healthcare system works, and more importantly it enabled me to appreciate the complexities of the healthcare hierarchy and the personnel relationships within it - Hopefully you will have a long career in the health service, and having this knowledge will make it easier for you to contribute to strategic planning and the improvement of services and it might just prevent yourself from banging your head against a wall!!
  6. If you can, get some experience working in a specialist oncology setting  with specialist oncology physios.  #cancerrehab is such an exciting area to be working in right now (it had me hooked 16 years ago!).  There is a massive amount of research coming out about the effects and impact of exercise and physical activity for preventing cancer, reducing recurrence, making treatments more effective and improving patient outcomes.........We are definitely on the crest of a very big wave and once it hits, then patients, doctors etc are going to be looking more to the exercise specialists to intervene in cancer treatment.....and that's us!!!!!
  7. Do some Manual Lymphatic Drainage training.  I'm not sure if physio course itineraries have changed much since the early 90's, but I remember very little, almost non-existent teaching on the lymphatic system (apart from it being something to do with the immune system - killer T-cells, remember them!).  BUT, the lymphatic system is one of the most important systems in the body and and appreciation of how it interacts with all of the other systems and how it is involved with injury, healing, repair and nourishment of tissues will add vital information to your clinical evaluation, reasoning and treatments.  I wish I had done my MLD training years earlier than I did, I use it all the time, not just with lymphoedema and swelling. 
  8. If you make a mistake or do something wrong then apologise  and learn from it - simple! 
  9. The day that you think you don't need to learn anymore, or even worse, the day when you think you don't care anymore - GIVE IT UP AND GO ON GARDENING LEAVE!!!!!!!!!!
  10. ENJOY every second, learn from every experience, keep an open mind, smile and laugh, be creative and have fun, reflect often, mind yourself, grow personally and professionally.  Always appreciate that you are in a great profession - you have the skills to massively impact on other peoples health and wellbeing, you meet amazing people daily, and no 2 days are the same .......... and before you know it you will be an 'old' physio (but in your mind you're still a fresh faced new grad with the whole world to learn) and you'll wonder to yourself 'How the hell did that happen?!?!?!?'  





Tuesday 7 July 2015

Don't miss YOUR chance to shape the future of cancer services in Ireland!!

I posted on Facebook recently about how the Department of Health here in Ireland have appointed a steering group to work on a National Cancer Strategy for 2016-2025.  The work hasn't yet started - there is a period of public consultation whereby the public (we and us) are able to make comments to the Department of Health and steering group (them) regarding our own views/opinions/experiences of cancer care in the country and how we think things should proceed. Now, this is a really important opportunity for 'us' to impact on what goes into that strategy document, we shouldn't waste this chance.  Having worked on a similar level of national document in the NHS (NICE Improving Outcomes for Brain and Spinal Tumours) in the past, I can tell you that each and every comment that comes in through the public consultation period is read, recorded and acknowledged. So lets imagine that we wanted an improvement in access to specialist cancer rehabilitation services - you know to help people get their life back on track once medical treatment has done its stuff. If only one member of the public mentions this in their feedback form, you could see how it would be easy for 'them' to assume that access to rehab services isn't really an issue, as only one person has brought it up......but if a hundred people mention that they are very concerned about lack of access to specialist cancer rehab, then it would be a little harder for the Steering Group to ignore this!!  I'm not trying to tell you what to include when you give your comments - there are many areas of cancer care that could be improved upon, but naturally as a physio working in this area this is one of my major concerns, along with the nearly non-existent provision for lymphoedema services. And just to put this into a bit of context - The National Cancer Strategy Document that was published in 2006 contains the words 'lymphoedema', 'lymphedema' (American spelling), 'physiotherapy' and 'rehabilitation' a grand total of ZERO times........can you imagine that - a strategy for cancer care that doesn't even contain those words which are so vital to the complete package of care offered to anyone having cancer treatment.
This is now 2015.  We have shed loads of research which support physiotherapy and rehabilitation as a key aspect of cancer care not to mention the countless models of comprehensive care around the globe where these things are already part and parcel of what is on offer.  Lymphoedema occurs in upto half of all patients who have some form of treatment to their lymph nodes - it is a BIG part of cancer care and it does need to be mentioned.   If 'they' get lots of comments via the public consultation process asking what they are planning to do to make sure that everyone who needs lymphoedema services is able to access them, or everyone that needs physio is able to access it as part of their total cancer management then they will have to address this and come up with a really good reason if these things are not contained in the document.    So please when you see the link is taking you to the DoH website, don't groan and think to yourself 'what's the point'......CLICK the link. It's here again for you (and you do have to click on the blue word 'here' on that page to access the document) and fill out the form.  Collectively our voice can be very LOUD!

Friday 12 June 2015

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!

Monday 1 June 2015

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!

Wednesday 27 May 2015

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!

Sunday 19 April 2015

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! ;-)

Saturday 4 April 2015

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!!

Tuesday 31 March 2015

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!

Monday 30 March 2015

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

Sunday 29 March 2015

Butterflys flutter by!

I love butterflies! I find myself gravitating towards anything I find in a shop that has a picture of a butterfly on it.  I even have my mother on the case, and she's bought me some lovely stuff for my treatment room in keeping with the butterfly theme.  But, my obsession is so much more than a cosmetic/aesthetic one.  I love the whole 'you are one thing, something happens, then you are something else' symbolism.   I have always thought that it very much mirrors the journey that a lot of my clients have been on, and I really can't find any better way of saying this than in this picture.....isn't that what cancer survivorship is all about! 

I'm so crap at this!!

So, I've decided again to try and pick up on my blog and made my 'resolution' to write with a bit more regularity, we'll see what happens! But anyway, as I was going back through my old posts I came across the last one where I make excuses for not writing for so long.....this one.....and guess what, I have the very same excuse now.  Baby Gerard came into the world in January and if there is anything that this wee man has taught me it is the value of sleep, something that I have taken for granted, for most of my life.  Even when Elaine was a small baby, we never had any sleepless nights as she was the perfect little sleeper, but my son, oh no - a very different story! He didn't sleep for at least 6 weeks, neither did I, or his Dad!  It made me realise that it is no wonder that sleep deprivation is used as a form of torture!  Anyway am glad to say that now, nearly 12 weeks down the line we are now managing to get longer and longer sleeps and normality seems to be resuming! The thought of getting back to work with only an hour or 2's sleep was scary, but thankfully I think I'm now in a much happier place and I'm looking forward to getting stuck back into work, and I will try my very best to keep regular updates on here, even if it is only me that ever reads them!! :-)