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!

Living with Cancer - supplement in The Times today

"1 in 20 of us are living with cancer" so says Todays Times newspaper, which includes a 20 page supplement - Living with Cancer, full of really useful information and inspiring stories.  It can be viewed online here.
I'm looking forward to reading the hard copy - that's if my Dad managed to get me one!

Wrong things, right reasons?

I can remember the very first time I treated a person with cancer and the lasting impact it had on me.  I was a student physio on an orthopaedic placement.  I was in the second year of training, so by this stage would have my own patient caseload which I took responsibility for under the supervision of my clinical mentor.  Orthopaedic rehab then, I’m not really sure what happens now as haven’t worked in the area for so long, was vey protocol led – Day 1 post Total Hip Replacement = check the patient’s chest, teach the patient circulatory exercises to be performed on the bed and get them up for a walk.  The lady I was seeing had broken her hip as a result of metastatic bone disease in her femur.  The morning after her surgery, as I approached her bed, I could see the lady was asleep and her husband was sat beside her holding her hand with his head resting close to hers, and he appeared to me to be whispering into her ear.  I went over to the bed, said hello and explained who I was and asked how the lady had been through the night.  The husband ushered me away from the bed and told me that the family had received some very bad news and they would appreciate if I would leave them alone.  This seemed an entirely appropriate request, so after explaining to the husband that I would check back in with them tomorrow, to which he agreed, I went about my business with my other patients.  Later that morning on discussing my patient caseload with my supervisor I relayed the story – I felt like I was intruding on the families space, so I didn’t treat the lady, I would go back tomorrow.  It was then pointed out to me that this lady was under my care, and I hadn’t done my job correctly and should she get a chest infection or a pneumonia then she probably would never leave the hospital, plus the new hip needs the stimulation from weight-bearing activity to help healing, so I was to go back and treat the lady TODAY, not leave it until tomorrow.  I can remember spending the whole of my morning break time crying in the toilets, then when it was time to go back to work, cleaning the smudged mascara from around my eyes taking a deep breath and attempting to flush my humanity away with the crumpled, damp, mascara stained tissues.

 Writing about it still evokes strong emotions within me.  But to this day, I maintain that I did the right thing that morning..….or maybe I did the ‘wrong thing’ but for the right reasons.  And this is just an example of where medicine, healthcare, rehabilitation etc is never just black and white –  there are many policies, procedures, protocols, checklists etc to guide us in our practice, and these are vitally important in ensuring a consistent quality service is provided for all, but within all of this and at the centre of all of this is a person and their family and the humanity needed to appreciate and understand this is something that cannot be measured or accounted for by the ticking of a box.