I had the opportunity to speak this last weekend to an amazing group of women (and a few Kevin’s) at Casting for Recovery North Idaho and Eastern Washington chapter during Cabela’s Spring Days. What an incredible experience I had, being able to interact with so many women about something so important to me, breast cancer.

I have been a physical therapist for over 32 years, and about 20 years ago, a physician who was very dear to me sent me a woman with lymphedema and asked for my help in caring for her. At that time, little was being done in the United States (especially in rural communities) with lymphedema, an often-difficult side effect of breast cancer. Because of that woman and my desire to have all woman with breast cancer cared for, I started my specialty in breast cancer care here in Coeur d’Alene. I had no idea that this woman would expand the scope of my practice and then introduce me to such a tenacious group of people. In my practices we now treat not only breast cancer patients, but any oncology patients such as prostate, uterine, abdominal, skin, and more.

Our goal is always the same in physical therapy: to restore our patients back to the life they desire with their new set of circumstances. Surgery, chemotherapy and radiation takes its toll on people. They are fatigued, run down, not sleeping and often get depression and anxiety as a result of the physical loss. This is where physical therapy steps in. We create a baseline for them and we walk through their physical loss with them and ask them their goals for the future. This allows them to think through their life, process the loss and move forward with their physical challenges. Knowing they are not alone and isolated helps them keep moving forward, and they often forge friendships with all my staff during this difficult time in their life. I think that is why I was so excited to hear about Casting for Recovery. I felt like it was right up my alley.

Casting for Recovery is a national organization that has an incredible program for women who have had breast cancer. Their mission “is to enhance the quality of life of women with breast cancer through a unique program that combines breast cancer education and peer support with the therapeutic sport of fly fishing.” Each woman applies online at castingforrecovery.org, and 14 of them are picked each year to go on a two-and-a-half day retreat. The retreats can be held in different places, but last year it was held at the majestic 5,000-acre Flying B Ranch in Kamiah, Idaho. I am excited to introduce you to this organization and I hope you will take a moment to go online and learn about them. Every year, they are making a big difference in the lives of 14 ladies in our community who are possibly your neighbors or someone you work with. I am thankful for their commitment to our breast cancer ladies, and I saw the difference this program has made here over the last five years. I hope we can partner with them to support our ladies in their healing process, because it’s alway better when we are together.

Who knew that the best place to start when learning how to fly fish is with paint brushes and cups of water, swimming pool noodles, and rods and reels with no hooks or flies in sight? These are just a few of the learning techniques the Casting for Recovery Breast Cancer group experienced this weekend at the five star Flying B Ranch in Kamiah, Idaho.

I was asked to come on staff as a medical facilitator this year for the retreat this past weekend. I take care of breast cancer patients everyday in my practice, so I felt what Casting for Recovery was doing was a great idea. I soon discovered that the participants and I would learn more about fly fishing, friendship, and healing than I thought possible in just a few days.

Casting for Recovery is a national organization that was established as a support and educational program for breast cancer survivors. It is ranked among some of the top charitable organizations and it started as a simple idea: Give women a place to learn a therapeutic technique to speed their recovery by exercising the soft tissue damaged by radiation and or surgery. Combine this with counseling and education in a retreat-like setting for two and a half days away from the stress of work, home and community demands. Provide the fun of learning the new skill of fly fishing with the infusion of interactive group activities by clinical psychologists, and then add in pertinent medical discussions by the health care team, and then watch this program become a powerful personal boast to women who have had breast cancer.

The Eastern Washington and Northern Idaho chapter is run by an amazing group of volunteers. Not only do they have great leadership skills, but they have a way of making every person feel unique and special all while taking people out of their element to learn a new skill, like fly fishing.

There was lots of laughter heard while learning the skills of fly fishing were being taught. The paint brush technique taught you how to hold your rod from the 10 o’clock to the 12 o’clock position with a bent elbow and no wrist action, thumb up. The water on your brush helped you to remember to flick of the brush at the end of the motion that sets the line. Then they picked up the swimming noodles to pretend with them. They called it answering the phone. You held the noodle at the ten o’clock position with a bent elbow, and then with rapid acceleration, you lifted the noodle to the twelve o’clock position like you were answering a phone quickly to your ear. The noodle shook at the top end, simulating what happens with the rod and then the fly line. Then out came the real thing: rods and reels with line and a little piece of red yarn at the end. This helped a lot with seeing if you were casting in a straight time down the hill, and the incredible fly fisher instructors were coaching the participants all the way.

Then on Sunday, the river helpers showed up in their trucks in a grand processional with much fanfare, as these are the guides that will get paired with each lady. A great deal of thought goes into this, as each lady gets their own river helper for three to four hours of one-on-one instruction at the lake, and they want to make sure each lady has the right river guide for them. At the lake, I heard sequels of joy and laughter as fish were landed and new skills were put to the test, all while the ladies cheered for each other’s accomplishments and the staff beamed with pleasure.

There were 12 amazing ladies that learned the art of fly fishing together this past weekend, but more importantly, this group of talented, beautiful ladies got a chance to share their fears, hopes and dreams for the future in a safe and playful place. Each of them seemed to find peace, laughter and friendship in the hearts of each other along the way. I also think they realized they are not alone on this journey, now they have a whole group of new friends and staff members cheering them on as they make their way forward in their life after breast cancer.

To apply to go to a Casting for Recovery retreat as a participant, breast cancer survivors can apply online for next year’s retreat in the spring. To volunteer or donate, please visit www.castingforrecovery.org and sight our local chapter to help take care of our community of ladies who are breast cancer survivors. We need your help to ensure everyone has a chance to be a participant and experience the joy of friendship with other breast cancer survivors.

A few years ago at Stanford University, I had the opportunity to study with Jean-Paul Belgrado, PT, a leading researcher in the field of lymphedema from the Universite Libre de Bruxelles in Belgium. He presented at the Breast Cancer Conference the possible reasons why lymphedema occurs after surgery.

Lymphedema is the accumulation of protein-rich fluid, which normally can be transported out of the lymph system easily, but for some reason, the transport system is damaged. This causes a backlog of this fluid that fills up in the outer layer of the tissue.

For years, it was commonly believed that you would only be at risk if you had more than five lymph nodes removed and had gone through radiation, but now we know this is not the case. Patients who have had an axillary lymph node dissection have between a 15 to 25 percent risk of occurrence over their lifetime. Even if the patient only had the sentinel node removed (which is considered anything under four lymph nodes) and no radiation, there is still a 6 percent chance of occurrence.

A physical therapy evaluation by a trained breast cancer specialist is the key. It will provide you with education and teach you about precautions and prevention techniques that will allow you to return to your active lifestyle, with no worries about whether or not you are at risk.

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 re-section 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: There is evidence that certain drug interventions produce an inflammatory response, increasing the possibility of lymphedema. A physician in the EU has recently documented a list of meds that have been noted to increase this level of edema.

• Radiotherapy: It has been seen that with radiation of the breast tissue and the axillary region you can compromise the fluid movement patterns. 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 to determine lymph flow health 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: It has been evidenced that there is a genetic tendency towards edema in certain groups and populations.

• 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 (and 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 their BMI is 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 baseline examination with a physical therapist specifically trained in breast cancer management — either as soon as their drains are removed or 12-14 days after surgery — to establish a plan of care for their musculoskeletal management, and to see if they are at risk for lymphedema and venous issues. These issues can be prevented and cared for early on if patients are at risk and their quality of life can be ensured.

What makes America great is the people in our community. There is power in the people when they are dedicated to making the lives of other people, better. So on Saturday night at the Best Western Inn, the Casting for Recovery, North Idaho and Eastern Washington chapter, lead by Renee Bylthe, held an amazing celebration to honor the ladies in our community that are breast cancer warriors and they raised money to insure their recovery is complete through the art of fly-fishing.

Last Spring I had the incredible opportunity of being asked to join their organization, as a medical facilitator, due to my specialty in cancer care and lymphedema. My staff and I have been caring for oncology patients for over 20 years now in our community and we feel lucky and blessed everyday that we get to help our patients on their journey. And believe me it’s no easy road they are on. They are hit on every side with physical loss, pain, emotional and mental fatigue and lots of worries. But Saturday night you would have never known any of it. They were full of life, laughter and the joy of friendship. You see one of the amazing things that happens at the Casting for Recovery retreats is they meet and become connected with women who have been on their same road and a bond forms that is beyond words. I have done cancer recovery work for a long time and in my office we see these friendships happen, but I had never seen anything like it elsewhere.

So I watched in amazement as the Casting for Recovery volunteers threw a party, so more women in our community have the opportunity for healing in the great outdoors. This I believe allows our retreat participants to live richer, fuller lives, all due to a group of people who our willing to believe that we are better together, than alone when it comes to healing and recovery.

One of the great events of the night was when the Casting for Recovery Executive Director Whitney Milhoan and her sister Hilary Hutcheson, of the famed Trout TV, interviewed each other about their love of family, fly-fishing and the wonder of the great outdoors. Since 2012, these loves lead Whitney to her current position of leadership in our Casting for Recovery national organization. Their inspirational banter about the power of healing in a safe outdoor community, with fly-fishing as a tool to help these ladies step outside their comfort zone in order to reach their recovery, was remarkable. Their passion and dedication, that all women be empowered to live life to its fullest was moving and their smiles and laughter were contagious. Everyone was clear that Casting for Recovery makes a difference in the lives of 14 women every year in our community and in 45 states across the country.

Yet there are women who apply each year and don’t get a spot due to there being not enough funding for them. So as a result, we are determined to raise enough money so everyone gets a chance to be a part of the sisterhood. So this year as the Holidays are approaching and you are wondering what charity to give to, please consider the women of our community and the healing that can happen when we care for one another through Casting for Recovery.

If you are a breast cancer survivor please go online to castingforrecovery.org and apply to go to our 2017 retreat on Coeur d’Alene lake in the late Spring. We hope to see you there!

Early morning is always peaceful to me in North Idaho, and no one was out Sunday morning on my way driving to the Coeur d’Alene Race for the Cure. I had my car loaded with items for our booth, and I don’t know what happened or what started it, but a wave of emotion poured over me and I started to tear up.

I guess it just hit me how so many of our lives have been touched by cancer. We’ve lost loved ones to the disease and had to stand alongside our dearest family and friends as they have battled for their life. I guess my heart was overwhelmed by the thought of it and I cried, because I wanted it to go away and never again knock on anyone else’s door. I just didn’t want anyone to have to suffer anymore.

I never knew 31 years ago when I became a physical therapist that I would care for oncology patients as part of my everyday professional life. I had no idea these patients would creep in my heart and make a home in the lives of my staff and mine forever. I didn’t know that I would learn so much from them as I cared for them and their families as they walked into the darkness and then back out into the light.

This past Sunday at the Race for the Cure, I saw so many people and their families that I knew and that I had cared for this past 23 years in North Idaho. I felt honored to know them and to be allowed to help them in their personal journey. I felt a sense of awe as the Survivors and the Fighters took their seat for their picture in front of all of us. These people are incredible to me. They have chosen to live, to participate and to thrive. They were there reminding me that it doesn’t matter what life throws at us, we have a choice to make. Will we choose life?

This is what the human spirit is all about I think. It is about the digging down deep when the going gets rough and making hard choices. A person’s real character shows up with cancer. At the Race, I had the pleasure of seeing a couple that are very dear to everyone in my office and we listened as they talked of their journey. We stood in amazement at their commitment to one another and their choice to live, one fighting for her life and the other as her faithful caregiver. It wasn’t perfect, and maybe it wasn’t what they thought It was going to be when they first fell in love, but they are making it despite this glitch in their plan.

So I guess all the tears were because of all of these incredible people I know, and because their stories move my heart to believe their is something greater going on during race day in Coeur d’Alene than people running and walking. That somehow to have all these people in one place together is a feat in itself and then to know they have struggled, defied death and lived to tell about it must mean that we would all be on hallowed ground on race day. And I was right, we were on hallowed ground, you could feel it and it was definitely time to celebrate. And celebrate we did. We celebrated life and all its abundance, and we won.

Thanks Race for the Cure for another year to celebrate with our community the race for life.

Sheree DIBiase, PT, is the owner of Lake City Physical Therapy and she and her incredible staff can be reached in her Coeur d’Alene office at (208) 667-1988 and in her Spokane Valley office at (509) 891-2623. Her office specializes in breast cancer care and in all post-oncology rehabilitation care.

What makes America great is the people in our community. There is power in the people when they are dedicated to making the lives of other people, better.

The Casting for Recovery, North Idaho and Eastern Washington chapter, lead by Renee Bylthe, holds amazing celebration to honor the ladies in our community that are breast cancer warriors – they raise money to insure their recovery is complete through the art of fly-fishing.

In 2016 I had the incredible opportunity of being asked to join their organization, as a medical facilitator, due to my specialty in cancer care and lymphedema. My staff and I have been caring for oncology patients for over 20 years now in our community and we feel lucky and blessed everyday that we get to help our patients on their journey. And believe me it’s no easy road they are on.

They are hit on every side with physical loss, pain, emotional and mental fatigue and lots of worries. But Saturday night you would have never known any of it. They were full of life, laughter and the joy of friendship. You see one of the amazing things that happens at the Casting for Recovery retreats is they meet and become connected with women who have been on their same road and a bond forms that is beyond words. I have done cancer recovery work for a long time and in my office we see these friendships happen, but I had never seen anything like it elsewhere.

So I watched in amazement as the Casting for Recovery volunteers threw a party, so more women in our community have the opportunity for healing in the great outdoors. This I believe allows our retreat participants to live richer, fuller lives, all due to a group of people who our willing to believe that we are better together, than alone when it comes to healing and recovery.

One of the great events of the night was when the Casting for Recovery Executive Director Whitney Milhoan and her sister Hilary Hutcheson, of the famed Trout TV, interviewed each other about their love of family, fly-fishing and the wonder of the great outdoors.

Since 2012, these loves lead Whitney to her current position of leadership in our Casting for Recovery national organization. Their inspirational banter about the power of healing in a safe outdoor community, with fly-fishing as a tool to help these ladies step outside their comfort zone in order to reach their recovery, was remarkable.

Their passion and dedication, that all women be empowered to live life to its fullest was moving and their smiles and laughter were contagious. Everyone was clear that Casting for Recovery makes a difference in the lives of 14 women every year in our community and in 45 states across the country.

Yet there are women who apply each year and don’t get a spot due to there being not enough funding for them. So as a result, we are determined to raise enough money so everyone gets a chance to be a part of the sisterhood. So this year as the Holidays are approaching and you are wondering what charity to give to, please consider the women of our community and the healing that can happen when we care for one another through Casting for Recovery.

If you are a breast cancer survivor please go online to castingforrecovery.org and apply to go to our 2017 retreat on Coeur d’Alene lake in the late Spring. We hope to see you there!

•••

Sheree DiBiase, PT, is the founder of Lake City PT. She and her staff believe that family, community and quality medical care, along with a spirit of hope, are what make the difference in your cancer care recovery. Please come see us so we can help be part of your healing process. Coeur d’Alene (208) 667-1988, Spokane Valley (509) 891-2623, Hayden (208) 762-2100 and Post Falls.

Perineal spray is traditionally a herbal solution used to help ease prenatal and postpartum discomfort. It can be used during pregnancy and after childbirth Formulated with natural herbal ingredients, including astringent witch hazel, antibacterial lavender, and cooling peppermint pure essential oil.

The perineum is the area between the vagina (birth canal) and the anus (rear end opening). In the first few weeks after childbirth, you will probably have soreness or pain in your perineum. You will also have discharge coming out of your vagina.

What is perineal spray used for?

Cooling perineal mist with herbs traditionally used to helps ease prenatal and postpartum discomfort during pregnancy and after childbirth. Formulated with natural herbal ingredients, including astringent witch hazel, antibacterial lavender, and cooling peppermint pure essential oil.

What is Peri spray?

How do you make perineum spray?

How do I clean my perineum after giving birth?

How do you make postpartum spray?

The challenges of pregnancy on a women are unique to her and often come with minimal understanding. In a recent study of 569 women, it was estimated that 42% of women will have low back pain and 34% will have some type health d pelvic girdle pain.

That alone points to the need for physical therapy interventions at an early time frame. Evidence also suggested however that these physical changes will most likely begin to occur by week 15 during pregnancy.

Knowing the signs to look for and understanding that early intervention is highly successful is key to a women’s long-term health. Prevention is paramount to attaining and maintaining your physical health during and after baby.

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These are some of the most common physical signs and changes that need your attention and intervention before and after baby. It doesn’t matter how long it’s been since your baby, check to see if you have any of them.

1. Low back pain

It is the most common pain women describe during pregnancy and after her baby is born. The increased structural load to the system disrupts normal upright posture and this strains the back. Also due to so many hormonal changes a women becomes exhausted and fatigued as she is often not sleeping well at night either, especially if she is breast feeding.

A Coccyx strain with resulting pain can often occur as well during pregnancy due to the heavy load in the floor, but it is esp common during labor and delivery when prolonged pushing occurs, especially with bigger babies and can occur also with fast childbirth experiences where the transition happens quickly. Often when this occurs, women are unable to sit very well, go from a sit to stand position without pain or they are unable to do prolonged standing due to pain there. This can occur acutely after delivery or can last for years if the coccyx had a severe trauma to it.

2. Pelvic girdle or pelvic floor pain

This is the second most common complaint. The pubic symphysis is at the front of the pelvic girdle snd it separates due to the hormone relaxin to make room for the growing baby and to prepare for delivery.

The Sacro-iliac joint in the back of the pelvis has large ligaments that will often soften as well due to increased hormones and the sacrum and ilium will often become unstable esp during walking, rolling over in bed and with sit to stand. Often during pregnancy a pelvic girdle belt is needed if the instability is interrupting your normal lifestyle at home and work. Tight hip muscles can also be the culprit as well so these need to be addressed as well.

3. Abdominal weakness

The abdominal muscles are one of the 4 pillars of the “core” muscles ans without them functioning well we are unselect I love well. It is possible that a diastasis Rectus can occur due to the hormone changes as these hormones create laxity of the abdominal tissue.

There is also the possibility of an abdominal hernia due to weakening of the tissue. This can look like a vine shaped structure or a pooching of tissue that occurs with movement.
A C-section scar line can disrupt abdominal function as well, creating a downward pull on abdominal muscles, instead of upward lift. Scar tissue needs to be addressed and mobilized after labor and delivery to restore normal movement patterns in the core trunk especially.

4. Diaphragmatic breathing issues

As the baby is growing the ability to do deep breathing due is limited due to the abdominal and pelvic cavity space constraints. We need our ability to breath deeply even during pregnancy as the the diaphragm and the pelvic floor work together in the core. If the diaphragm dies not work properly neither will the pelvic floor.

They are directly related if one is strong they both are strong if one is weak they both are weak.
Often as baby grows we tend to breath up high only in the chest and neck region. This tends to create tightness in our neck and chest wall. Learn to breath down into your lower lateral ribs and use your hand over this area of your ribs to feel the air expanding your ribs there with your breath.

5. Pelvic Floor Trauma during pregnancy and or during labor and delivery

If you have had to have an episiotomy, forcep and/or vacuum assisted labor and delivery it is evidenced that this alone can disrupt the floors neural and muscular integrity. Please have your pelvic floor checked to ensure that it’s muscles are functioning properly.

Large babies, excessive hormones that cause decreased peristalsis and straining during bowel movements along with excessive pushing during labor and delivery can cause external and internal hemorrhoids and bowel constipation. During pregnancy drink more water and eat more soluble fiber to help. Exercise increases blood flow and decreases constipation.

Pudendal nerve irritation or damage can occur as well during pregnancy or following baby due to pressure and compression on the nerve directly, tightening of muscles and/or fascial tissue in the region due to body changes, decreased blood flow to region due to baby size and sustained pressure or trauma during labor and delivery on the nerve itself. Numbness and tingling or poor sensation in the pelvic floor itself can occur. This needs to be addressed quickly to avoid long term damage.

6. Urinary incontinence

This happens often as the baby is growing during pregnancy because the pressure is increasing in the abdominal cavity. Leaking is the most common with activities where there in a quick change of position. This means the front part of the floor is weak and not communicating with the abdominal and other “core” muscles correctly. This should be addressed quickly during pregnancy and afterwards to mitigate long-term health issues.

7. Hip and knee pain

Due to the increased structural load to the hips and knees during pregnancy, along with the increase in hormones, the ligaments and cartilage of the hips and knees soften and are more lax overall. This causes pain with squatting, stooping, descending stairs, kneeling and athletic activities. Often the hip flexors and piriformis are too tight along with the IT band and the antagonist muscles are too weak and need to be strengthened.

8. Pelvic Organ Prolapse

This occurs when the pelvic floor muscles and the surrounding fascial and connective tissue become weakened during pregnancy and then can become damaged during labor and delivery if there is sustained pushing that occurs. The Pelvic organs will fall down inferiorly and begin to push into the vaginal canal. The bladder and the rectum due this most commonly, but there can be vaginal or urethral tube dropping as well. Your OB/ GYN most often will use Grades 1-4 to describe these changes and physical therapy intervention is needed immediately if you are a Grade 1 and 2. Often if you are a three or higher surgical intervention is necessary.

9. Emotional changes

The flood of hormones for a women can cause many feelings during pregnancy and particularly afterwards. The brains system is being rewired and this is the time to ask for help from your loved ones. Please do not do this time alone. Enlist family, friends and care givers such as doulas etc to be part of your tribe. Depression, anxiety and the “baby blues” are real things and need to be addressed, quickly. Please ask for help! We are here for you as a Support in motherhood.

10. Neck, upper back and shoulder pain along with carpal tunnel

During pregnancy the physical changes in the abdomen and pelvic region directly affect the rest of the spine. Due to the instability that often occurs in the low back and pelvic girdle, the upper back, neck and shoulders often become stiff and the muscles tighten in response. The neck, upper back and shoulders muscles will need daily stretching. Cat and cow, neck rotation with chin nods and child pose with side bending and rotation reach can help.
Excess fluid retention can cause swelling around the carpal nerve and compress it in the tunnel thereby increasing numbness and tingling. Often this occurs at night while sleeping, but some women will have it t/o the day as well. Stretching these areas is important t/o these time frames, as well as strengthening the core postural muscles.

11. Abdominal bloating, swelling in the legs and arms and varicose veins

Changes in the vascular system is immense during pregnancy and the system then has to adapt after baby as well. Make sure to exercise daily, walking is esp beneficial to keep the system working correctly and to minimize the likelihood of excess swelling t/o the body. Also daily strengthening exercises activates the muscle pump around the blood vessels and this facilitates vascular health.

12. Breast Mastitis

This can occur whether you breast feed or not. It’s most common during breast feeding when a milk duct becomes clogged. Infection can then set in in the breast and it will become red, hot and swollen and lumps will often occur. See your MD immediately as you will need antibiotics if you have a fever.

Please come see us during pregnancy and afterwards as we specialize in women’s health.

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Sheree DiBiase, PT is the owner of Lake City Physical Therapy and she and her incredible staff look forward to taking care of you during and after baby. It’s never to late to make a change. Please come see us at our Hayden (208)762-2100, Cda (208)667-1988, Post Falls (208) 457-3435, Spokane Valley (509)891-2623.