Life After Cancer: It’s More Than Just Survival

In 2015, it was estimated that 98,280 women would be diagnosed with a gynecologic cancer and some 30,440 will die from the disease.  For men, prostate cancer is the second most common cancer in America after skin cancer.  About 1 out of 7 men will be diagnosed with prostate cancer during his lifetime.  Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.  Also, the number of people living beyond a cancer diagnosis reached nearly 14.5 million in 2014 and is expected to rise to almost 19 million in 2024.  This is due, in large part, to advances in medical technology and research.  Most people think that when you are a cancer survivor, survival is all you need to think about. But, there are many side-effects and issues that can arise from cancer treatments and the disease itself.  Cancer can have a negative impact on your pelvic and sexual health, causing issues, such as incontinence, constipation, pelvic pain, and sexual dysfunction.

levitt-sara-dsc_6-9-1-16-bhphotoSarah Levitt, MPT, PRPC is our pelvic floor rehabilitation practitioner, and she has seen, first hand, the issues these patients are dealing with.  She recently attended a continuing education course in the treatment of oncology-related issues through the Herman & Wallace Pelvic Rehabilitation Institute.  This course was designed to give practitioners, like Sarah, an understanding of the impact of pelvic and gynecological cancers have on the health and quality of life in our male and female patients.  It also gives an insight into the important role we play as members of the oncology multidisciplinary healthcare team.

As a pelvic rehabilitation practitioner, Sarah, has expert skills in the evaluation and treatment of pelvic dysfunctions, but oncology-related dysfunctions create unique challenges.  Some of these challenges may be injury to the lymphatic system, anatomical excisions, tissue injury from radiation, and systemic issues from chemotherapy.

Through this course, Sarah has gained an understanding of the diagnosis and treatment of pelvic and gynecological cancers and the long term implications of these treatments; especially in relation to pelvic floor and lymphatic function, cancer related fatigue, and bone density issues. The course covered common female gynecologic cancers including ovarian, uterine, cervical, vaginal, and vulvar cancer; as well as common male pelvic cancers, such as prostate, testicular, penile, bladder, and colorectal cancer.  The course provided instruction on specific interventions for the lymphatic system including, but not limited to, genital lymphedema and evidence-based approaches for treating cancer-related fatigue and osteopenia/osteoporosis.  Sarah is also able to provide strategies for clinical and home-based programs that will address conditions, such as sexual dysfunction and pelvic pain.

It is also important to understand the psychological effects of cancer on sexual function and health.  Because of the training she received in this course, Sarah is able to address those issues and keep an eye out for when a patient should seek additional support and guidance from a mental health provider.

Here is an informative article on how pelvic radiation can affect a woman’s sexual health. 

Sarah is eager to help patients like these as it is much needed.  If you would like to contact Sarah or schedule an appointment with her, please contact our Clarkston office at (248) 620-4260.

Resources:
https://hermanwallace.com/continuing-education-courses/oncology-and-the-female-pelvic-floor
https://hermanwallace.com/continuing-education-courses/oncology-and-the-male-pelvic-floor
http://www.foundationforwomenscancer.org/about-gynecologic-cancers/
https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

Don’t Dread That First Step Out of Bed in the Morning

Plantar Fasciitis

Have you ever woke up feeling good, fully rested, but as soon as you place your foot down to step on the floor, you have a aching or stabbing pain in the bottom of your foot? You know you didn’t injure it, but then as the mornings go by, it seems to happen every morning.  This condition is called plantar fasciitis.  It affects 1 out of 10 people in their lifetime.  A person is more likely to get it if they are a woman, overweight or has a job that requires a lot of walking or standing on hard surfaces.  It can be seen quite often in walkers and runners, especially if they have tight calf muscles.

foot-painPlantar fasciitis is a condition that occurs when the long fibrous plantar fascia ligament that travels along the bottom of the foot develops tears in the tissue.  This results in pain and inflammation.  People usually complain of pain close to where the fascia attaches to the calcaneous or heel bone.   They also may describe it as a burning, stabbing or aching pain in the bottom or heel of the foot.  Most people feel that it is worse in the mornings.  This is due to the ligaments tightening up in the middle of the night.  Once they climb out of bed and place pressure on the ligament, it becomes taut and painful.  The pain usually decreases as the tissue warms up.

There are many treatment options available, such as NSAIDs and orthotics.  Physical therapy is a great alternative due to the fact that it not only has shown to reduce pain significantly, but also helps the pain from recurring.

At Advanced Physical Therapy Center, we teach proper body mechanics to help improve gait and teach the patient exercises that stretch the surrounding muscle tissue.  We offer laser light therapy and cold therapy to reduce inflammation.  Massage is another piece of the therapy component that helps to relieve tension in the plantar fascia.  We use the Graston Technique to break up adhesions and release restrictions. Lastly, we will tape the foot to allow the foot to rest and increase healing.

About 90 percent of people with plantar fasciitis improve significantly after two months of the initial treatment of physical therapy.  We treat plantar fasciitis at all our locations. To schedule an appointment or free consultation to see if we can help you, give us a call. Click here to see all our locations.  

Exercises for Plantar Fasciitis Patients

Intrinsic Foot Stretch

Intrinsic Stretch:

  • In a sitting position and keeping the leg steady, pull the foot toward you so that the bottom of the foot is stretched
  • Hold this for 30 to 60 seconds and release, repeat five times
  • Do this exercise three times per day, especially in the morning before first step

Soleus StretchSoleus Stretch:

  • Place hands on a wall for support
  • Stand with one leg in front of the other, feet pointed forward and your back straight
  • Bend knees, drop your buttocks toward floor
  • Gently lean into the wall until you feel the stretch in your lower calf
  • Hold and repeat several times

 

 

What a Pain in the Neck!

How many times a day do you look down to check your phone?  How many times are you leaning closer to your computer at work to get a closer glance of the screen?  You are probably doing it multiple times, if not all the time, throughout the day.  Those little movements can add up to a big pain in the neck.  Neck pain can occur in any part of the neck – muscles, bones, joints, tendons, ligaments, or nerves.

Mature woman with neck painMuscle strain or tension is the most common cause of neck pain.  The problem is usually over-use, such as sitting at a computer for too long as mentioned above.  Sometimes you strain your neck muscles from sleeping in an awkward position or overdoing it during exercise.  There are other causes of neck pain that you may or may not have heard of:

Radiculopathy – A pinched nerve, often from a herniated, or slipped disc.  This causes pain down the arm that’s often described as an electrical feeling.

Myofascial Pain – Generally an aching pain in muscles that tends to be associated with poor posture.  Patients can become sore in different parts of the body like the neck and arms, and often patients report they have difficulty sleeping or feeling restored from sleep.

Spinal Stenosis – A narrowing of the nerve openings either around the spinal cord or nerve roots that can cause symptoms similar to a pinched nerve.  The pain is described either as an aching or an electrical feeling down the arms or legs.  It can cause weakness as well.

Tendon, Ligament and Soft Tissue Pain – Localized pain or tenderness when an area is stretched or its muscles are overused.

Spinal Instability – Increased motion between the vertebra, usually resulting from an injury in the neck ligaments and muscles.  The pain can cause tingling in the neck or arms.

Non-Spinal Causes of Neck Pain Pain imitating a neck injury, but from another cause.  Shoulder and elbow injuries and gall bladder disease are examples of problems that can refer pain to the neck area.

Repetitive Strain Injury – An injury that occurs from a chronically used part of the body, either in a normal or abnormal way.

If you are experiencing any of these symptoms, you definitely want to talk to your doctor about physical therapy.  The use of physical therapy and exercise is integral to almost all forms of neck pain treatment.  Sometimes physical therapy and exercise are the first lines of treatment, other times it may help manage chronic pain, or provide rehabilitation after surgery.  Physical therapy and exercise are perhaps the most mainstream of all non-surgical treatments for neck pain.  And unlike other conservative treatments, physical therapy can also help prevent and or lessen future occurrences.

What can you do to keep neck pain away?

Take frequent breaks.  Don’t sit in one place for a long time.  Get up and move!  Instead of emailing someone, walk to his or her desk to relay the message.   Arrange items at your desk so they are less convenient to reach.

Maintain good posture.  Adjust the seat of your computer or desk chair so your hipsergonomics are slightly higher than your knees; your head and neck will naturally follow in the correct position.  Traveling in a car, airplane or train?–Place a small pillow or rolled towel between your neck and a headrest to keep the normal curve in your neck.

How are you sleeping?  Avoid sleeping with too many pillows or falling asleep on the couch with your head on the armrest.

On the phone a lot?  Use a speakerphone or headsets.  Do not cradle the phone in your neck.

Exercise.  Treat your body to a consistent regimen of stretching and strengthening to balance your muscle groups.  This protects your neck as well as helping your whole body.  Walking at any pace is excellent exercise for your neck.  The rotation of the spine provides a great natural workout for the neck muscles.

 

 

Get to Know Dellisa Wynn, MPT

Dellisa Wynn, MPT has been a practicing physical therapist for nearly twenty years. She began her career as a staff physical therapist for Hurley Medical Center in 1997. During her fifteen years at Hurley, she worked in industrial rehabilitation, impatient rehabilitation and in their acute care setting. She has been a wonderful addition to the Flint clinic ever since she joined Advanced Physical Therapy Center team in 2013.

Dellisa has had a long-time desire to help those who suffer from illness. She chose physical therapy, because it is one of the few healthcare careers that offers a diverse work environment where you can work with various types of patient populations. Dellisa received both a Bachelor of Health Science degree and a Master of Physical Therapy degree from the University of Michigan-Flint.

Dellisa has many interests when it comes to treating patients ; geriatrics and sports BH2_5298 retouch wynn 4x5rehabilitation are two of her favorites. Lately, her interest has been focused on physical therapy in relation to autoimmune disorders. This interest is very personal to her, because she was diagnosed with Lupus in 1999. Before her diagnosis, Dellisa was a long
distance runner and was very active. Her condition has kept her from participating in those activities she loved. Because of this, she feels she is able to sympathize and find a connection with her patients who have lost their mobility and independence. “I think when you are trying to deal with the changes and challenges of learning to live with an auto-immune disorder or any type of illness that takes away your mobility, you can develop a lack of confidence. My goal is to help patients gain back their confidence and get them back to living independently,” says Dellisa. Dellisa is a Flint native, and when she is not working with patients, she serves as a mentor and parliamentarian for her college sorority, Alpha Kappa Alpha. She is a board member of the sorority’s non-profit, Ivy House, which provides clothing and food for those in need. They also provide financial, need-based scholarships for Genessee County high school seniors entering college. When she is not volunteering with her sorority, she enjoys attending church services at New Jerusalem Full Gospel Baptist Church.

Providing Gentle Care for the Littlest of Patients

As a parent of a newborn, you try to prepare yourself as much as possible for the day torticollisyour little one will arrive.–You get the nursery ready, buy all the necessary items and install the infant carrier into the car. The big day arrives, and you’re ready to take your perfect little one home with you.  Then on the first visit with your pediatrician, they mention to you that your baby has torticollis, and you’re freaked.  It sounds pretty serious, doesn’t it? There is no need to worry too much.  Torticollis is fairly common and treatable.

Torticollis means “twisted neck,” and it’s also sometimes called wryneck. If a child is born with this condition it is called congenital torticollis. When a baby has congenital torticollis, their head will be tilted to one side, while the chin is turned to the other side. Congenital torticollis is most often due to tightness in the muscle that connects the breastbone and the collarbone to the skull. Many times, this tightness developed because of the way the baby was positioned in the uterus. If you have seen a baby with torticollis, you may notice that the baby holds their head to one side and has limited neck movement. Another telltale sign is small bump on the side of their neck. While it may look painful, it usually isn’t. Congenital torticollis is usually diagnosed within the first two months of a baby’s life. Even if parents don’t spot it, a pediatrician will.  In most cases, the pediatrician will recommend physical therapy.

At Advanced Physical Therapy Center, our therapists are caring and patient.  They will thoroughly evaluate your child before starting treatment. They will also teach you, as a parent, how to do the stretching and positioning exercises with your child. The moves are not complicated,Smiling Mother and Toddler and they are very gentle. It is essential that your child sees a licensed therapist, so they can teach you the proper technique to continue these exercises at home. Once your baby starts treatment, you will probably see an improvement within weeks, and the condition should be fully corrected by age one. Just remember to practice these moves as much as possible and give your child plenty of “tummy time” to strengthen their neck muscles.

We have several clinicians on staff that can effectively help your child with congenital torticollis:

Luci Harris, PT, DPT, OMPT – Clarkston Location (248) 620-4260

Ashley Herrick, PT, DPT – Davison Location (810) 412-5100

Jill Ivy, PTA – Davison Location (810) 412-5100

Kortney Smith, PT, DPT – Davison Location (810) 412-5100

 

Gardening Tips for Those with Arthritis

Each spring, we eagerly or not so eagerly clean up our yards by removing brush, trimming overgrown areas and plant in our gardens.  As we age, these activities aren’t as easy as they used to be, especially if you suffer from arthritis.  As physical and occupational therapists, it is our job to keep you doing the things you want and need to do.  We have provided a list of tips that you can use to make gardening with arthritis easier.  Feel free to print out these tips and give them to your friends and family.

Gardening TIPS for Arthritis_Page_1

Gardening TIPS for Arthritis_Page_2

Why am I so dizzy, and why does it seem to happen more and more as I get older?

An estimated 90-million Americans will experience dizziness at least once in their lifetime.   By age seventy-five, dizziness and balance disorders are one of the most common reasons for seeking help from a physician.  U.S. physicians report a total of more than 5-million dizziness/vertigo visits per year, which is a cost of $1-billion according to the Vestibular Disorders Association.

WHAT IS BALANCE, AND HOW DO WE MAINTAIN IT?

Normal balance is dependent on many factors, including multiple systems of the body, as well as external and environmental factors. The body has three primary sensory systems that work together to create postural stability. With normal brain function, the vestibular system of the inner ear coordinates with the visual system and proprioceptors that sense the position and movement of your body in space. These three systems work together while we perform simple tasks, such as standing and walking, or more complex and dynamic activities, such as yoga or hitting a golf ball accurately.headache pic 1

WHAT HAPPENS TO THE VESTIBULAR SYSTEM (INNER EAR) AS WE AGE?

The inner ear is a complex structure of fluid filled tubes and chambers. Specialized nerve endings inside these structures sense the position and movement of the head and detect the direction of gravity. Signals sent from the nerves of the vestibular system are critically important to the brain’s ability to control balance in standing and walking. They also control movements of the eyes that make it possible to see clearly while moving.

Anatomical studies have shown that the number of nerve cells in the vestibular system decreases after about age 55. Blood flow to the inner ear also decreases with age. When the vestibular system is damaged, an individual may experience dizziness and balance problems. However, the gradual, age-related loss of vestibular nerve endings can result in balance problems without any associated dizziness. This type of slow loss of vestibular function may be first noticed as difficulty walking or standing, especially in the dark while on soft or uneven surfaces (such as thick carpet or a forest path). A decline in inner ear function may be caused by a number of conditions, including normal aging, benign paroxysmal positional vertigo (BPPV), infection, Meniere’s disease, or diminished blood flow to specialized nerve cells. Additionally, certain medications such as some antibiotics for severe infections and chemotherapy may damage the inner ear, resulting in temporary or permanent hearing loss, impaired balance, and trouble seeing clearly while in motion. Feelings of dizziness, vertigo, imbalance, and disequilibrium may indicate that the inner ear is not functioning correctly.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder in older adults and causes a sense of true spinning vertigo triggered by a change of position of the head or body. With this condition, the spinning can be triggered by things like tipping your head up or down, quickly rotating your head, bending over, rolling over in bed, or getting in and out of bed. BPPV is a mechanical disorder that occurs when debris, called otoconia, loosen and tumble into the semicircular canals of the inner ear. This event causes false signals to the brain triggering a brief sense of vertigo. The spinning lasts less than a minute and can provoke nausea, vomiting and imbalance.

OTHER DISORDERS OF THE INNER EAR

Labyrinthitis is an infection or inflammation of the inner ear that causes severe vertigo lasting 1-2 days, hearing loss, and severe imbalance that can affect walking. Neuronitis is a similar disorder causing vertigo, but it does not affect hearing. Both can be triggered by an upper respiratory infection, virus or flu, or can occur with no obvious cause.

Meniere’s Disease causes similar symptoms, including periodic episodes of vertigo, dizziness, and hearing loss. It is thought to be a result of an excess amount of fluid, called endolymph, collecting in the inner ear.

HOW CAN I GET RELIEF?

Advanced Physical Therapy Center (APTC) provides a non-invasive program that entails a systematic, individually designed regimen of exercises and activities such as re-positioning maneuvers and gait/balance retraining.

The goal of Vestibular Rehabilitation is to:

  • Improve balance and stability during locomotion
  • Minimize falls and improve neuromuscular coordination
  • Decrease sensations of dizziness

Therapy can be curative, completely relieving the symptoms, or compensatory, assisting the patient to use other systems more effectively to make up for permanent losses of vestibular function.  Most of all, it can decrease the anxiety the patient is experiencing due to his or her disorientation.

The goal of VRT is to use a problem-oriented approach to promote compensation. This is achieved by customizing exercises to address each person’s specific problem(s). Therefore, before an exercise program can be designed, a comprehensive clinical examination is needed to identify problems related to the vestibular disorder. The examination includes administering different tests to more objectively evaluate the patient’s problems. The therapist will screen the visual and vestibular systems to observe how well eye movements are being controlled. Testing assesses sensation (which includes gathering information about pain), muscle strength, extremity and spine range of motion, coordination, posture, balance, and walking ability.  Depending on the vestibular-related problem(s) identified, three principal methods of exercise can be prescribed: 1) Habituation, 2) Gaze Stabilization, and/or 3) Balance Training.

Habituation exercises are used to treat symptoms of dizziness that are produced because of self-motion and/or produced because of visual stimuli. Habituation exercise is indicated for patients who report increased dizziness when they move around, especially when they make quick head movements, or when they change positions like when they bend over or look up to reach above their heads. Also, habituation exercise is appropriate for patients who report increased dizziness in visually stimulating environments, like shopping malls and grocery stores, when watching action movies or T.V., and/or when walking over patterned surfaces or shiny floors.

Habituation exercise is not suited for dizziness symptoms that are spontaneous in nature and do not worsen because of head motion or visual stimuli. The goal of habituation exercise is to reduce the dizziness through repeated exposure to specific movements or visual stimuli that provoke patients’ dizziness. These exercises are designed to mildly, or at the most moderately, provoke the patients’ symptoms of dizziness. The increase in symptoms should only be temporary, and before continuing onto other exercises or tasks the symptoms should return completely to the baseline level. Over time and with good compliance and perseverance, the intensity of the patient’s dizziness will decrease as the brain learns to ignore the abnormal signals it is receiving from the inner ear.

Gaze Stabilization exercises are used to improve control of eye movements so vision can be clear during head movement. These exercises are appropriate for patients who report problems seeing clearly because their visual world appears to bounce or jump around, such as when reading or when trying to identify objects in the environment, especially when moving about.

There are two types of eye and head exercises used to promote gaze stability. The choice of which exercise(s) to use depends on the type of vestibular disorder and extent of the disorder. One type of gaze stability exercise incorporates fixating on an object while patients repeatedly move their heads back and forth or up and down for up to a couple of minutes.  The other type of gaze stability exercise is designed to use vision and somatosensation (body sense) as substitutes for the damaged vestibular system. Gaze shifting and remembered target exercises use sensory substitution to promote gaze stability. These exercised are particularly helpful for patients with poor to no vestibular function, such as patients with bilateral (both sides) inner ear damage.

Balance Training exercises are used to improve steadiness so that daily activities for self-care, work, and leisure can be performed successfully. Exercises used to improve balance should be designed to address each patient’s specific underlying balance problem(s). Also, the exercises need to be moderately challenging  but safe enough so patients do not fall while doing them. Features of the balance exercises that are manipulated to make them challenging, include:

  • Visual and/or somatosensory cues
  • Stationary positions and dynamic movements
  • Coordinated movement strategies (movements from ankles, hips, or a combination of both)
  • Dual tasks (performing a task while balancing)

Additionally, balance exercises should be designed to reduce environmental barriers and fall risk. For example, the exercises should help improve patients’ ability to walk outside on uneven ground or walk in the dark. Ultimately, balance training exercises are designed to help improve standing, bending, reaching, turning, walking, and if required, other more demanding activities like running, so that patients can safely and confidently return to their daily activities.

Clio Patient Stephanie

Stephani Pobocik, PT, DPT performing re-positioning maneuvers on a patient with Benign Paroxysmal Positional Vertigo in our Clio clinic.

For patients with Benign Paroxysmal Positional Vertigo (BPPV) the exercise methods described above are not appropriate. First a clinician needs to identify the type of BPPV the patient is suffering from, and then different re-positioning exercises can be performed.

After BPPV has been successfully treated and spinning symptoms have resolved, some patients will continue to report non-specific dizziness (symptoms other than spinning) and/or imbalance. In these cases, treatment using habituation exercise and/or balance training may be indicated.

An important part of the VRT is to establish an exercise program that can be performed regularly at home. Compliance with the home exercise program is essential to help achieve rehabilitation and patient goals.

Along with exercise, patient and caregiver education is an integral part of VRT. Many patients find it useful to understand the science behind their vestibular problems, as well as how it relates to the difficulties they may have with functioning in everyday life. A therapist can also provide information about how to deal with these difficulties and discuss what can be expected from VRT. Education is important for patients because it takes away much of the mystery of what they are experiencing, which can help reduce anxiety that may occur as a result of their vestibular disorder.

If you are experiencing any of these symptoms,  contact your nearest Advanced Physical Therapy Center ask for one of our vestibular rehabilitation specialists.

Resources:
http://vestibular.org/understanding-vestibular-disorder/treatment/treatment-detail-page
http://vestibular.org/sites/default/files/page_files/Documents/Balance%20and%20Aging_Vestibular%20Function%20in%20the%20Older%20Adult.pdf