What to Expect
Each breast cancer patient's needs are unique. Your first appointment will consist of a comprehensive evaluation that will begin with a detailed medical history. Assessment of shoulder mobility, upper extremity limb volumes and scar mobility will enable us to design a rehabilitation program to fit your individual needs. Lymphedema prevention education will also be included in the first evaluation session. At the end of your evaluation, you and your therapist will agree on a plan of care for future visits if they are needed.
Our private treatment rooms are located in the Women's Center on the third floor of Martha Jefferson's beautiful Outpatient Care Center. Our treatment setting is quiet and esthetically pleasing, while allowing for easy access to the second floor Physical and Occupational Therapy gym.
How We Can Help
Whether it's making your next course treatment easier, or helping you get back to full health after your treatment, we can help. Through balance training, teaching stretching techniques and helping you stay active, we can help you with the following conditions:
Pre and Post-Operative Assessment of Shoulder Function
Following surgery for breast cancer, some patients have difficulty regaining their full shoulder range of motion and cannot raise their arm over their head. This can be especially challenging after having an axillary lymph node dissection or reconstruction as both surgeries directly affect the muscles around the shoulder.
Your Physical or Occupational therapists can provide a pre-operative assessment which consists of establishing your baseline mobility and can show you exercises to perform after surgery. The therapists can also evaluate you post-operatively to loosen tight muscles and further increase your range of motion to prepare you for radiation and/or to help you return to your previous level of activity.
Swelling can occur after breast surgery in the chest wall, trunk and upper arm. This swelling usually temporary and resolves with short-term manual lymph drainage massage and a mildly compressive body shaper camisole.
Axillary Web Syndrome (Cording)
Following surgical removal of lymph nodes in the axilla (armpit), some patients may develop fibrotic bands or "cords". The cords may be located solely in the axilla or may extend down the arm as far as the palm. Shoulder range of motion may be limited by cording, but usually improves or resolves with consistent stretching and manual techniques performed by your physical or occupational therapist.
Chemotherapy-induced Peripheral Neuropathy
Chemotherapy-induced peripheral neuropathy is often called CIPN for short. It involves damage to the peripheral nerves that are responsible for sensation (feeling) in your hands and/or feet. Certain chemotherapy drugs can adversely affect the peripheral nerves. CIPN can be a short lived, long term or permanent condition.
Some symptoms of CIPN that can occur are the following:
- Muscle weakness in the arms and legs
- Dropping of objects held in the hands
- Balance problems
- Tripping while walking
- Altered sensation (increased or decreased) in hands and feet
Our physical and occupational therapists can assist you with balance training, safety precautions, strengthening and ergonomic evaluation to help reduce the effects of CIPN.
Cancer-related fatigue is very different from normal fatigue. Some patients describe it as feeling "bone tired" or "overwhelmed physically, mentally and emotionally". This type of fatigue does not resolve with proper rest or sleep. Although cancer-related fatigue is not fully understood, factors such as abnormal blood counts, sleep difficulties, stress, nutritional deficiencies and lack of exercise can be contributing factors.
As part of your Breast Cancer Rehabilitation plan of care, we will monitor you for signs of cancer-related fatigue. Good communication with your oncology physician will help identify any medical causes for your fatigue. We can assist you in maintaining a healthy level of activity to combat fatigue. It has been found that exercise helps women better tolerate the effects of chemotherapy and radiation.
After you have completed your active phase of medical treatment (surgery, chemotherapy and radiation), we will progress your strength and conditioning program so that you will be able to return to your previous level of activity.
We often refer patients to Union Yoga for a free, specially adapted class for breast cancer patients and survivors called "Yoga for Life" (www.unionyogaloft.com).
Another option for general conditioning is Martha Jefferson's "Movin' On" class specifically tailored to cancer patients and survivors. Contact Tracey Hill at 434-654-4501.
Lymphedema Prevention Education and Treatment
Lymphedema is a serious condition that results in abnormal swelling of the limbs. Lymphedema can be caused by cancer, radiation therapy, trauma, surgery, chronic skin infections, chronic venous insufficiency and congenital abnormalities.
Certified Lymphedema Therapists at Martha Jefferson provide treatment to reduce and manage this condition. Treatment consists of manual lymphatic drainage, application of compression bandages, massage, good skin care, wound care, patient education and exercise.
Martha Jefferson has had a lymphedema program for many years and provides the most cutting edge treatment. Our therapists have a combined 17 years of experience and have all received advanced training.
The primary treatment goals are edema and pain management and maximizing functional abilities.
- Manual lymphatic drainage massage
- Multi-layered bandaging
- Compression pumps
- Compression garments
- Skin care
- Specialized exercises
The program involves a brief but intense hands-on therapy regimen with a strong emphasis on a home program and training to maintain the goals and success of the treatment regime.
Once surgical scars are closed, they go through a phase of maturation that can last up to a year. Initially, the scar may be dark red or purple in color because of increased blood flow to the area. As time goes on, it will fade to pink and ultimately something close to the color of the surrounding skin. During the early stage when the scar is darker, it may feel tight or raised or lumpy. It may also be hypersensitive to touch, making it painful to wear clothes or shower. Tight scars can limit (shoulder) range of motion. The therapists in the Lymphedema Clinic at Martha Jefferson Hospital can help through the use of desensitization techniques, scar massage and scar compression. Our goal is to optimize mobility, comfort and cosmesis.
Return to work after breast cancer surgery/treatment may be difficult if the operated arm has limited range of motion or swelling/heaviness.
The therapists in the Lymphedema Clinic at Martha Jefferson Hospital can assess each individual and make recommendations for positioning at the computer to optimize comfort. The operated arm needs to be well supported to prevent aggravation to any swelling. Arranging the desk surface differently may improve efficiency with decreased stress on the affected arm.