LEADING THE WAY: AFTER BREAST CANCER

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.

SUPER GIRLS

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.

GOD MADE GIRLS

I live in a house full of men. I have three amazing sons, a great husband and a wonderful father-in-law, so when the country singer from The Voice named RayLynn sings about why God made girls, I sing along. I mean how can you not when you are surrounded by testosterone at every turn, and you look around and think, “Wow, women and men are like night and day, like oil and water, no wonder people say one is from Venus and the other is from Mars.” I mean it takes a heart full of forgiveness for men and women to live together, right?

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.

YOU ARE NOT ALONE

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.

BREAST RECONSTRUCTION — YES OR NO?

There was no way to explain it — other than the sheer joy of finally being whole — as a woman named Margaret raced into my office and promptly showed my staff her finished reconstruction.

She was laughing and talking a mile a minute, and we stood in awe as she explained how exciting it was to finally be done with cancer.

Her cancer surgery was over a year ago, but her breast reconstruction and the resulting other interventions to make this complete had taken the rest of the year.

She was ecstatic and rightfully so.

She had done it, and we were the lucky ones who got to celebrate that day with her.

Women with breast cancer now have so many options when it comes to breast reconstruction after having a mastectomy.

Reconstruction is now available in all different forms and types.

Twenty years ago when I started caring for women after breast cancer surgery, there were not as many choices. Now there are so many choices and decisions to make it can often be difficult to know what to do.

Do you reconstruct and use your own tissue, like a tram flap or DIEP flap or lat flap; or do you do implants, saline or silicone?

So often the answer lies in understanding a woman’s unique needs and the stage of life she is in.

Only the women in need can actually decide what is best for her. They must ask themselves, do they want to have another surgery or possibly multiple procedures?

Do they have a support system that is willing to assist them in this process?

Do they need to have chemo and radiation?

Will the irradiated tissue be a problem if they choose to do a certain type of reconstruction?

Some of the different types of reconstruction procedures are the tram flap, SIEA flap, TUG flap, DIEP flap, lat flap, hip flap, nipple sparing mastectomy and implant procedures where they stabilize the implant inferiorly with a small latissimus dorsi flap.

As you can see, the techniques are numerous and sometimes overwhelming.

There is a great app that can help you choose what is best for you.

Go online and pull up the Breast Cancer App, it is free. In this app they have a section called the “Procedure Wizard.” Click on this toolbar and follow the steps to answer questions that will help you to choose what surgical procedure is best for you. They don’t list all of them, but it is a good free tool to use for education. It takes into an account your height, weight, cup size previous to surgery and then asks you other questions regarding your history to help you make the best choice.

Then click on the toolbar for reconstructive options and read and see the pictures of the different procedures. There is also a “What to Ask” toolbar where numerous questions are answered about reconstruction. I think this section is particularly beneficial because you need to educate yourself on what is the best direction of care for you.

Of course, your surgeons and family doctors are also very knowledgeable, so feel free to ask them as many things as you can before you move forward with your procedures. Your breast cancer physical therapists can also be of great assistance in this matter. They work with people after surgery with all of the different procedures and can help you understand the rehabilitative stages.

Bilateral mastectomies and reconstruction have had a lot of press from famous celebrities like Angelina Jolie, Christina Applegate, Sharon Osbourne and Kathy Bates, but don’t just assume it is what you should do. There are lumpectomy procedures that are just as effective as mastectomies in regards to long-term outcomes according to current research. This is where you and your doctor must be able to talk through what is best for you. Do the research to investigate what you need to know and if you are not sure, just ask. You need to be informed and educated, because the success of your outcomes after reconstruction depends on it.

TOGETHER IS BETTER

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.

FLY FISHING AND BREAST CANCER

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.

LYMPHEDEMA: WHAT IS A BREAST CANCER PATIENT’S REAL RISK?

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.

BREAST CANCER RECOVERY AND THE GIFT OF COMMUNITY

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!

Race For the Cure Coeur d’Alene

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.