The definition of a survivor is to be able to carry on despite hardship or trauma, and to stay alive and thrive in the middle of it all. Surviving is not easy, and families and friends become the rock for so many survivors, along with their health care providers direction. That is why it is important for you to choose health care providers that you connect with because healing happens when you are surrounded by a positive support system at home and during your care programs.

For these reasons, Lake City Physical Therapy has devoted the last 17 years of its practice to caring for oncology patients, and especially for breast cancer patients. It is our specialty, and we are proud to provide our patients with the most advanced treatment options for the best possible outcomes. We are well aware of the challenges you face and we know that the best way to prevent future issues is to start early.

An evaluation with a physical therapist is the best way to start. We will quantify your arms’ flexibility, then measure the girth size of both of your arms to determine if there is any swelling. Next, we then test to see how strong you are, and we also look at your skin health and scar mobility. The scar should be pliable and there should be no “tugging and pulling” present on the scar to the chest wall or when you move your arm. This becomes your baseline for your program – whether you are in Chemo or radiation, you need to have an established program to make sure that you do not develop any disabilities.

Physical therapy programs consists of:

a) Exercise – Specific exercises to assist in mobility and healing

b) Massage – Gentle manual lymph massage, scar mobility, myofascial release

c) Compression Therapy – Garments such as camisoles, bras, sleeves, compression shorts, lower leg garments, etc. that prevent edema and Lymphedema

d) Skin care – promotes skin health, wound healing, 2x day Cetaphil or Eucerin

Sheree DiBase, PT, is the owner of Lake City Physical Therapy, PA, and she and her highly trained staff want to thank you for your support at the Race for the Cure. It was a great event. If you would like to learn more about breast cancer physical therapy or oncology care please come this Wednesday night, Sept. 25, at 6 p.m. to a free class at our Coeur d’Alene office at 2170 Ironwood Center Drive. Call for reservations at (208) 667-1988, seats are limited.

A couple of months ago, a beautiful woman came into my office, wondering why she had been referred to physical therapy after she started radiation therapy. She had a partial mastectomy with axillary lymph nodes removed three months before, and had already had chemotherapy. She felt pressure in her arm with a little bit of stiffness when she did her hair each morning, but that was it. She thought she had no pain, and wondered why physical therapy was necessary and what the purpose of it was.

According to Dr. Susan Love in her book ” Dr. Susan Love’s Breast Book,” she reports “that all mastectomy and axillary lymph node dissection patients get an automatic referral to physical therapy where at a minimum, they are taught basic exercises and also receive additional lymphedema education.” Side effects of surgery and radiation can occur three to six months after treatment; it is best to start early with physical therapy so prevention techniques can be started with the patients. Research has indicated that physical therapy should begin after drains are removed or on the 12th to 14th day after surgery.

Side effects following mastectomies and lumpectomies are numerous. This is the reason skilled intervention by a breast cancer physical therapist is needed. Some of the problems come from the surgical intervention due to removal of the axillary lymph nodes. This resection in the armpit is the reason for most of the shoulder stiffness and axillary web syndromes.

Loss of mobility in the tissue under your armpit is painful; shortening of the muscles and tendons occurs as a result, and you become weak. Often, you don’t even realize that your arm is stiff and weak until you are tested. Other changes will occur in the tissue due to radiation. Radiation produces inflammation in the muscle tissue and the surrounding tissue; it is cumulative in nature, so may not show up for months after treatment. The tissue becomes thick and hard in nature, and mobility is lost in the scar lines. Physical therapy intervention is crucial for anyone who has had axillary nodes removed or tissue radiated.

Physical therapy for breast cancer includes a first visit evaluation for an hour with a breast cancer specialist. Then, an assessment will be made and goals established for your individualized program. This process should begin two weeks after surgery. This insures that a baseline is created, and then prevention techniques can be started.

In our program, Step Forward 4 Oncology Care, we utilize a four-step approach. The four steps include skin care; specific shoulder and neck exercises; specialized massage to re-direct lymph fluid, assist in reabsorption, and soften tissue scar lines; and compression therapy, which includes compression garments for your arm and chest wall and bandaging with compression, if needed.

Please do not wait to begin physical therapy with your breast cancer specialist; your long-term outcomes depend on how early you start your plan of care.

Sheree DiBiase, PT, is a breast cancer specialist certified with the International Lymphology Association. She and her staff have trained with Stanford University as breast cancer and lymphedema specialists. They can be reached in their Coeur d’Alene office at (208) 667-1988, and in their Spokane Valley office at (509) 891-2623. Lake City Physical Therapy.

I always thought the old saying “a picture is worth a thousand words” was true, and now I really think that is the case. Two weeks ago at the Race for the Cure, we had the opportunity to test the antioxidant levels of a lot of our community that stopped by our booth. As you look at our sampling, you can see that the majority of those that we screened were in the 20,000 to 30,000 ranges, which is the orange color. Then came the yellow and the red color. These three colors are associated with low antioxidants levels. The blue and green colors, which are 40,000 and above, are associated with good antioxidants levels that will protect you from disease, such as heart disease, diabetes, depression, cancer prevention and re-occurrence, and auto-immune diseases. Dr. Oz scored 75,000 when he was tested on his show.

Antioxidants are available to us in the foods we eat and drink and the supplements we take. Your body absorbs these micronutrients, which are called carotenoids, from fruits and vegetables, and then uses them to protect you from the free radicals that we are associated with everyday. We are exposed to free radicals in the form of air pollution, smoking, X-rays, industrial chemicals, certain drugs and the ozone. These free radicals break down our line of defense and make us more susceptible to diseases. These diseases then take hold in our body and make us sick.

One simple solution to protect your self from the daily effects of free radicals is seven to nine serving sizes of fruits and vegetables a day. A serving size is about the size of your fist. One medium sized apple would be considered one serving size. You would like to utilize an array of these fruits and veggies and change them throughout the week. The more colorful the fruit and veggie, the higher the antioxidant level. Carotenoids are phytonutrients. More than 600 of them have been identified, and in the U.S. diet we presently have 40 of them that we have daily access to.

A recent research article released in the Journal of the National Cancer Institute analyzed eight prospective studies regarding circulating carotenoids, the micronutrients in fruits and veggies, and the risk of breast cancer. The study suggests that women with higher levels of circulating carotenoids may be at a reduced risk of breast cancer. Specifically, the carotenoids a-carotene, B-carotene, lutein, zeaxanthin and lycopene were the ones that stood out in the study to be the best for reducing the risk of tumors and preventing the re-occurrence of them as well.

A good source of a-carotene is carrots, B-carotene are sweet potatoes and green leafy vegetables, tomatoes for lycopene, citrus for B-cryptoxanthin, and leafy greens for lutein+zeaxanthin. It is important to have these in your diet daily, and as you can see by the tests we did at the Race for the Cure, our community did not score at the level we would have liked it to. We are far too low, and that means we are at great risk for disease processes. Our goal is to have a score above 50,000 and above.

Join us tonight, Oct. 8, from 6-7:30 p.m. for a wellness seminar in our Coeur d’Alene office on antioxidants. Come and get tested on how to protect yourself from disease, and see if what you are doing is working for you and if you are covered. Call our Coeur d’Alene office for reservations.

Sheree DiBiase, PT, is the owner of Lake City Physical Therapy. She and her staff can be reached in their Coeur d’Alene office at (208) 667-1988, and in their Spokane Valley office at (509) 891-2623.

Over 18 years ago, I started treating clients after breast cancer surgery and our goal is still the same. Early rehabilitation in physical therapy after surgery yields the best results for our ladies in every physical way. Just as early detection is key, so is early treatment in therapy for the best quality of life after surgery. In fact, our best results are with ladies who come in after their drains are removed, which is usually about two weeks or so after surgery. We can then start gentle active and assisted range of motion, and begin the re-direction of lymphatic flow patterns due to lymph nodes being removed. It doesn’t matter if only the sentinel node is removed or a dozen nodes are removed, the re-direction of the lymph system is needed and the body needs help in knowing where to go with that fluid, because it is no longer being picked up by the nodes that are gone.

The scar also needs to be mobilized; this starts in the next two weeks. The scar line should be able to move in every direction with no areas of “pulling or tagging.” Something called “axillary cording” can also begin in the armpit after surgery. It usually starts very slow and almost has the feel of guitar strings, then it becomes thicker, like a strand of rope. It especially needs to be released, otherwise it will slowly begin to limit your mobility, and you will not even notice it. To check yourself for it, lie on your back and put your arm on the pillow over your head. Then rub your fingers across your armpit. If you feel any rough or thick areas when you compare it to the other side where no nodes were removed, then you know that axillary cording is beginning to occur. This cording should not be there and can be reduced with the right stretching, massage and exercise.

The key before you have radiation is to make sure you have full shoulder flexibility, mobile scar lines without axillary cording, and to have no swelling in the chest wall or under the arm pit. Radiation is often the hardest on the system. It is because a lot of fibrosis can occur when you are having radiation. Fibrosis is when the tissue layers become thick and tough. There, natural elasticity decreases, and then swelling and fluid backs up in certain areas. The tissues that were flexible before will become stiff and hard to move again. If there was any axillary cording starting, it will often become worse after radiation also.

Physical therapy rehabilitation after breast cancer surgery is a four-step process. If you are doing the four steps you will have done everything you can to take the best care of you. Come to physical therapy and learn the four steps, Sally did, and so can you.

Sheree DiBiase, PT, and her staff can be reached at (208) 667-1988 for the full four-step rehabilitation plan for breast cancer. Lake City Physical Therapy.

Recently while visiting my oldest son in Boise, I had the opportunity to have an interesting interaction with a woman about the seven different chakras that make up our body. She asked me to smell the different smells that are associated with these chakras and see which one of the scents was the most soothing to me. You have to understand, I have never really delved into chakras or the idea that they need to be in balance, but as a physical therapist dealing with people’s lifestyle imbalances, I was intrigued. So I took the test. Interestingly enough the smells I gravitated to that day were the lavender, lemon and the fir balsam. I joked with her about it and then I proceeded to read what chakra number three was all about.

Chakra number three is located between the chest and the navel. Hmm, I thought this is interesting. You see currently I have been learning the techniques of breathing and warming, for physiological quieting of the Autonomic Nervous System (ANS), so I can teach my patients how to control their pain levels and turn off their ANS till they really need it. The number three chakra is called “The Chakra of Intention” and its color is yellow. This chakra relates to the idea of how to have our motivation, power and desire present to make good decisions each day for our body to stay in balance. Needless to say she suddenly had my attention.

According to doctors Upadhyay and Maharshi from the Clinic and Research Centre in India, they stated that, ” The chakra system is the symbolic representation of energies which exist in the body influenced by the subconscious mind. Yoga and meditation help you awaken those energies for the most balanced state of the body, mind and soul”. In my practice I see a lot of people that seem to be unable to understand mediation or lack the “time” to do Yoga because of their fast paced culture, so sometimes it feels easier to just forget the whole idea of slowing the system down. Being still, seemed impossible.

In our physical therapy office, we often focus on the Autonomic Nervous System (ANS) and the little almond-shaped set of neurons or grey matter set deep in the brain that is associated with our “Fright and Flight” mechanism called the amygdala. Dr. Paul Whalen describes this area of the brain as our attentional area. He has studied the emotion of fear for years. The amygdala helps us be more aware, more vigilant of our surroundings. The amygdala gives the signal to the other areas of the brain, like our sight or hearing to pay attention to whatever is going on. Often my patients who have been in motor vehicle accidents tell me that when they saw the car about to hit them in their rear-view mirror, they braced themselves for the hit, way before the hit even occurred, this is the response of the amygdala and the ANS.

We need the ANS and the amygdala to keep us safe, but we should not live with it “on” all the time. Many of my patients that have experienced a trauma, surgery or injury have an ANS system that is on “high alert.” How do we know if our ANS is on “high alert” too much of our life?

The first thing you do is check is your temperature. I don’t mean your oral temperature; I mean the temperature of your hands and feet. Check to see if your hands are the same temperature as each other and if your feet are the same temperature. If your ANS is on “alert,” your temperature will not be equal or it will be too low compared to your core temperature. Often our patients have too high a temperature in a limb that is swollen or a decrease in temperature in an area where the body has had a trauma. Often our breast cancer patients who have had radiation have an area that is cold and their skin is white instead of pink and this signals an area where the body is not sending blood-flow, as it should be. This is where the physiological warming technique comes into play. Imagine your hands, your feet or the part of your body that is not doing well, getting warmer. The key here is to imagine it mentally and then if you need to, do it physically by rubbing your hands together or running them under warm water. This imagining also turns off the analytical side of the brain and turns on the creative side and changes the body’s chemistry.

The next thing to do is check your breathing patterns. Put your hands on your ribs on the side of your belly. These ribs should be expanding out as you inhale deeply with your breath. Now put your hands on your ribs under your clavicle. Do you feel more movement there or at the side of your trunk when you breathe in deeply? You should feel more movement in the side ribs as you inhale then with your high ribs. You then should practice doing three to five deep breaths every 60-120 minutes. This keeps your ANS in check. Do this exercise by inhaling slowly with your breathe to a count of four and exhaling to a count of four as you breathe out. Research indicates this will re-set your internal systems and dissipate unwanted stress.

The last step is to “check in” with your body. This is easiest to do at nighttime before you go to bed. It will help you sleep like an angel and you will wake-up well rested. Close your eyes and get in a comfortable position. Then start at your face and jaw. Ask yourself if you feel any tension there. If you do, imagine that all of the tension in your jaw and face melting away like an ice cube left on the counter on a hot summer day. Then sense the back of your neck do you feel any tension there? If you do, imagine that it is heavy and loose and let it fall back into the pillow where it can rest. Then note your shoulders are they touching the bed evenly? Do you feel knots or stiffness there? If you do imagine them letting go like the water down the stream after a heavy rain. You will slowly work through your entire body like this, attending to each area. Amazingly enough after you begin training like this you will slowly be able to decrease your pain, settle down your ANS irritation and you will be able to attend to your problem areas much better and will begin to identify the areas where you hold most of your tension.

These easy steps can be done in the comfort of your own bed, room and house. You don’t have to pay anyone, go anywhere or take any medications to accomplish this quieting of your physical self. This quieting can add years to your life and give you a new outlook on life even if you have disabilities. As you practice these techniques you will get better and better at them and you will see how healthy you can be by spending a little bit of time each day taking care of yourself.

Sheree DiBiase, PT, is the owner of Lake City Physical Therapy, and she and her staff want you to be well. Please make an appt if you need assistance with learning these techniques. We are glad to help you take charge of your health. Coeur d’Alene office (208) 667-1988, Spokane Valley office (509) 891-2623.

This next week I will visit with Jean-Paul Belgrado, PT, a leading Belgian researcher from the Universite Libre de Bruxelles who has specialized in the field of lymphedema for over 30 years.

He has specialized in mapping the lymph system with the use of lymphoscintigraphy. In his lab, he uses a specialized colloidal protein with a radioactive dye and he injects this into the back of the hand and then watches as the lymph system does its job pumping the lymph fluid to the heart. He projects this on a screen overhead and then they determine where the possible obstructions are with the lymph system in patients with lymphedema. This then enables the physical therapists to reroute the lymphedema around the areas of compromise and have more successful outcomes for their patients.

I am excited to see his lab and their hands-on techniques. Currently this technology is not available in the US, but we know that approximately 20 percent of patients who have surgical interventions for breast cancer will get lymphedema. What we want to know is why do the other 80 percent have no side effects from their surgical interventions, because then this will help us determine how to prevent these side effects for the other 20 percent.

Here are some of the possible reasons why lymphedema can happen after breast cancer:

Surgical Intervention: What type of breast cancer surgery did they have? Was there an axillary resection with lymph nodes removed? Or was it only a sentinel lymph node? If there was an axillary dissection performed, was the sheath of the axillary vein compromised when the nodes were removed? Where are the scar lines located? Are there multiple scars lines blocking the fluid flow patterns?

Chemotherapy: It has been evidenced that certain drug interventions produce an inflammatory response and this increases the possibly of lymphedema. A physician in the EU has recently documented a list of meds that have been noted to increase this level of edema and we are awaiting his research data to be published.

Radiotherapy: Research indicates that with radiation of the breast tissue and the axillary region you can compromise the fluid movement patterns of the lymph system. All patients who have had radiation need to have an evaluation to determine skin integrity and scarring in the area of radiation and surrounding tissue because this can block the lymphatic flow watershed patterns.

Scar tissue: The scar lines are significant in how the pattern of fluid can move. If they are restricted, thick, hard and immobile then back flow of the fluid can occur around and behind the scar lines.

Genetic: There appears to be familial patterns due to genetics towards developing edema.

Physical Activity: What is your level of physical activity at work, home and in you community life? There must be a balance in your activity level, where you are activating the muscle pump, but not increasing the level so high, with such repetitive activities, that you create an inflammation.

Body Mass Index: The level of obesity present affects the amount of fluid that might occur. The higher the BMI the greater the likelihood of edema that can occur especially if over 30 percent.

The above list needs to be considered and looked at to determine if you are at risk for lymphedema. Because of this, all breast cancer patients should have a base line examination with a physical therapist trained in this type of care, as soon as their drains are removed or 12-14 days after surgery so that lymphedema issues can be prevented and cared for early on if they are at risk.

Sheree DiBiase, PT, and her staff can be reached at Lake City Physical Therapy (208) 667-1988 or in the Spokane Valley office at (509) 891-2623 for a baseline evaluation, prevention and a complete care program after breast cancer surgery. She has a specialization in breast cancer care, and has trained at Stanford University in lymphedema. Don’t wait, you are in charge of your own health care. Come and see us so we can help you stay well.

When I was growing up, no girls had super powers in the movies that I could relate to. I guess there was Catwoman with Batman and Robin, and Supergirl who was like Superman, but none of them made me stop and say, “She looks like a good hero for me.” I guess none of them felt real to me, so I started looking around and found real women that became my super heroes.

Real heroines to me were women like Florence Nightingale, Amelia Earhart, Mother Teresa and my mother, who started her own business in 1969. I remember thinking I needed women like these to look up to so I could learn from them how to make a difference in the world.

Who would have known that now in my physical therapy practice I would get to meet the most amazing women everyday that are superheroes. They are the women in our communities that are fighting cancer. These women are amazing. They fight for life. They battle the unseen enemy and they call on every source of strength they can get to win. And sometimes in the fight they struggle with who and what they have lost along the way.

Cancer is especially difficult on families, spouses and children. Often marriages crumble and misunderstandings occur. In Amy Robach’s new book “Better,” she shares how her battle with breast cancer nearly destroyed her and her husband’s relationship and how they fought to save their marriage. This theme is not uncommon with illness of this type. In fact, my patients often describe similar personal struggles as they work to redefine their life after cancer.

Because it takes courage and strength to fight cancer, you need to surround yourself with a group of people to support you, such as your family, friends and your medical team to get you through.

October is Breast Cancer Awareness month, and we salute all you ladies who are survivors. You are the superheroes in my eyes. Go Super Girls, you can do it!

Sheree DiBiase, PT, is the owner of Lake City Physical Therapy and she and her staff can be reached in their Coeur d’Alene office at (208) 667-1988 and in the Spokane Valley at (509) 891-2623. Super girls fight cancer and we can help.

This month we are celebrating all the Breast Cancer “girls” and we are calling on all the other “girls” we know to be proactive and get their annual mammogram screening. Just this week, I heard a story of a lady who missed her screening last year and two years went by till she had her next one, and then she had a small lump that showed up. Thank goodness it’s only a centimeter in size with no nodes involved, so she is very fortunate.

Often a small lump is hard to palpate on your own if you are not used to doing your own breast exams each month. According to the Susan G. Komen Foundation, the most common warning signs are “changes in the look or feel of the breast, or changes in the look and feel of the nipple and nipple discharge.”

There may be changes in the color of the breast, like redness or a darkening of the tissue. You may feel swelling or a warmth in the breast in a certain area. There may be changes in the size of the breast with a dimpling or puckering that occurs. Sometimes a pain starts that just won’t go away, and sometimes there is a pulling or a tugging sensation that you feel as well. If you get an itchy, scaly rash that develops on the nipple region, it is a sign of possible breast cancer.

Also nipple discharge that is clear or bloody needs to be checked too. Changes in the texture of the breast or armpit, such as a thickening, a lump or a hard type of knot need to be looked at by your healthcare provider. These lumps can be cysts or a fibroadenomas but it is best to see your MD to make that determination. You know your breast better than anyone else, don’t be afraid to do your self-exam. If you don’t know how to do it, please ask your healthcare provider.

We have found in our practice when “girls” learn to take care of their health and honor their bodies, it empowers them in all avenues of their lives. When your health becomes a priority, things change: your self-esteem, your drive and your opportunity.

Every “girl” I know has an innate beauty and it is our job to care for ourselves in a healthy way. So I personally challenge you to step forward this month and make a change. Do something new. Step out of your comfort zone for your health. Personally, I have been wanting to take a yoga class, but could never seem to find the time. This month I decided to make the time and I am taking the class from a sweet friend of mine once a week for six weeks. So far I am loving it. After my first class, I slept like a baby, and I felt the tensions that are so easy to carry around with me, melt away. I can tell already that yoga is a lifelong skill for me and it will be something that will help change my mind and body health for the better.

So “girls,” get ready to rock the world, you can do it. Take a stand for your health and never give up on your body. Start with one new choice, one new decision a day, and don’t look back. So what if you have a few extra rolls and things that hang lower than they used too. Accept the past and commit to the new you. I’m cheering for you, “girl!”

Sheree DiBiase, PT, is the owner of Lake City Physical Therapy, and she and her staff want you to put on your big girl pants and get moving on to better health. We look forward to helping you on your health quest at our Coeur d’Alene office (208) 667-1988 or our Spokane Valley office (509) 891-2623.

A couple of months ago I traveled to Portland and I had the pleasure of hearing Glennon Doyle Melton speak at a women’s conference. I had never heard her speak before, so I was particularly amazed at how her work has struck a chord with me. She has an online blog called Momastery.com and her message was quite clear that day at the conference: we are not alone in our “messy, beautiful life.” Her writing asks us “to believe in ourselves, be kind, brave and let go of perfectionism, and realize that motherhood,marriage and friendship is hard, so stop pretending they are not.”

Her ideas have stayed with me these past few months as I have weathered the return of cancer in a lot of my patients, friends and family members’ lives. It can be daunting to hear that your patient or family member have cancer or a reoccurrence of their cancer. It stops you in your tracks and reminds you of life’s precious gifts: friendship, laughter and time with the people you love.

Cancer patients — in particular in our practice — often face decisions that are life-altering. Breast cancer patients especially are confronted with a lot of options, as to whether to do a lumpectomy, partial mastectomy or bilateral mastectomy; and then whether to do reconstruction with implants, saline or silicone, or their own tissue through a free flap or pedicle flap. Suddenly words are coming at you that you have no idea what they mean, let alone what is best for you. You are not alone in this, it is common to feel overwhelmed and possibly confused. Often when treatment does begin, you feel isolated because you are exhausted, sleep deprived and painfully worried.

Breast reconstruction decisions can be especially challenging, as these options alter the body in completely unfamiliar ways. Suddenly, highly functional people are unclear how to express their fears and concerns. Some of the possible long-term effects after surgery and radiation include scarring, cellulitis, pain and the possibility of lymphedema (swelling), according to Dr. Susan Love, Clinical Professor of Surgery at UCLA and president of her own research foundation. Dr. Love states that patients should be treated “aggressively when we find a small amount of swelling-physical therapy, manual massage, compression-and try to reverse it. Physical therapy and exercise can help.”

This year, Lake City Physical Therapy will make a commitment to begin a Lymphedema Support Group in our community, to ensure that no woman or man ever feels alone in their journey with lymphedema. The physical and psychological effects of lymphedema have been greatly underestimated, according to Dr Love; and because of this, we want to assist our community to be educated and be able to live productive, fulfilling lives. Whether your lymphedema has occurred following your bout with cancer, or you were diagnosed with it due to other health issues, you should not have to face this alone. We are here for you, come join our Lymphedema Support Group.

Sheree DiBiase, PT is the owner of Lake City Physical Therapy and is a certified International Lymphedema Specialist.

She and her amazing staff are dedicated to your optimal health and they want you to be well.

Please come see in and see them in their CDA office (208) 667-1988, Hayden office (208) 762-2100 and in our Spokane Valley office (509) 891-2623. The first Lymphedema Support Group meeting is in their Coeur d’Alene office at 2170 Ironwood Center Drive on February 3 from 5:30 to 6:30 p.m. Please call to reserve your space.