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.