Physical Therapy can Help with Common Upper Extremity Problems following Breast Cancer Surgery

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Upper extremity pain and stiffness is common following surgery for breast cancer. According to McCredie et al, 7 out of 8 who have surgery for breast cancer experience some type of ongoing problem with shoulder/arm function, with most women presenting with more than one symptom. The prevalance of stiffness 6 months following surgery is greater than 40%; 60% have pain in the axilla or chest wall, and 25 to 50% experience weakness. (Kilbreath et al) These problems may not be resolved up to 2 years after surgery.

As a result of these postoperative problems, women may experience a reduced quality of life. Women may experience long term difficulties with everyday activities including: driving, dressing, washing their hair, and sleeping on the involved side. (Maunsell et al, Collins et al) For many women, the 'cure' produces other problems.

Physical therapists with specialized training in breast cancer rehabilitation are the ideal health care providers to address these musculoskeletal problems and help you achieve a pain free and fully functional lifestyle. Physical therapy intervention may address musculoskeletal problems regardless of how long ago your surgery may have been.

Physical therapy interventions aiming to decrease pain and improve function for those who have had breast cancer surgery may include:

• Exercises including an individualized stretching and strengthening program


• Manual therapy to improve the extensibility of tissue affected from surgery


• Scar mobilization to decrease pain, improve mobility and range of motion


• Aerobic exercise program to combat fatique and improve endurance


• Patient education


• Home program
  

At Fauquier Health Outpatient Rehabilitation Services, our cancer rehabilitation team, currently consisting of two physical therapists with specialized training, can provide these physical therapy interventions to patients with breast cancer.

If you have any questions for our cancer rehabilitation team, please call us at 540-316-2680 or click on the button below to submit an email inquiry.

References:

Collins LG, Nash R, Round T, Newman B. Perceptions of upper-body problems during recovery from breast cancer treatment. Support Care Cancer: 2004: 12: 106-13.

Kilbreath S, Refshauge K, Beith J, MiJoung L. Resistance and stretching shoulder exercises early following axillary surgery for breast cancer. Rehabilitation Oncology: 2006: 24:9-13.

Maunsell E, Birsson J, Deschenes L. Arm problems and psychological distress after surgery for breast cancer. Can J Surg. 1993:36:315-320.

McCredie MRE, Dite GS, Porter L, et al. Prevalence of self-reported arm morbidity following treatment for breast cancer in the Australian Breast Cancer Family Study. Breast. 2001:50:292-311.

Specialized Physical Therapists can help with Post-Prostatectomy Incontinence

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According to Moul et al, the prevalence of stress urinary incontinence at 3 months after radical prostatectomy is 17 to 54 % and 5 to 38% at 6 months post surgery. A study by McCallum et al reported that gains in continence will occur up to 2 years, but major gains occur in the first 3 months. Physical therapists who specialize in pelvic floor physical therapy can help men accelerate improvement with continence post prostatectomy by providing individualized treatment plans and strengthening the pelvic floor muscles.

The pelvic floor muscles attach to the bottom of the pelvis forming a sling or hammock of muscle which support the internal organs. These muscles contract to help stop the flow of urine and gas and assist with normal sexual function.

Physical therapy can help you learn how to properly contract the pelvic floor muscles in order to increase their strength so they function normally. During your therapy, an individualized progressive exercise program for pelvic floor and core strengthening will be given. Education regarding healthy toilet habits, urinary urge control, and fluid intake will also be provided. Biofeedback training and electrical stimulation may be used to achieve better control of continence.

At Fauquier Health Outpatient Physical Medicine and Rehabilitation, our pelvic physical therapy team has completed extensive training in pelvic physical therapy through the American Physical Therapy Association’s section on Women’s Health. Our therapists utilize a variety of techniques as well as education to ensure each patient’s needs are addressed. All pelvic floor treatments are conducted one-on–one in a private setting.
If you feel you may benefit from this service or would like to hear more, please call us at 540-316-2680. Or click on the button below to ask a question.

Patient Accolades

Our outpatient rehabilitation department prides itself on the many positive comments and outstanding scores we receive on our Press Ganey patient surveys. Some of our patients are kind enough to take the time to write a letter about their experience with us. The following is one of those letters. Kudos to Joan Wolf for providing exemplary care, and a big thank you to Mr. McCarthy for allowing us to share his thoughts here...

It was my great good fortune to be assigned Mrs. Wolf as my therapist during extensive therapy periods following surgeries for knee replacements in January and October of 2009.

That Mrs. Wolf proved to exceed my expectations in the professional performance of her duties as a therapist should perhaps be no surprise. However, it was as a concerned caregiver that she did surprise me. I came to Mrs. Wolf following my first surgery very depressed at ever achieving my recovery goals. She recognized the symptoms immediately and began a process of rebuilding my self-confidence so that in a short period she had us both working towards the goal of complete success in regaining mobility in that leg. Mrs. Wolf's careful attention to this aspect of recovery significantly reduced the therapy time needed when I had my second knee replacement in October.

In my experience, no other individual caregiver, in a long life rich with surgical experiences, has so embodied the very best in applied techniques as well as concern for the patient.

Thank you, and I am,
Very truly yours,

John W. McCarthy

Thank you, Mr. McCarthy, for your very kind words!

We welcome you to a discussion on "Other" Women's Health Issues

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Fauquier Health LIFE Center is pleased to offer you the first in a series of free health discussions, focusing on gynecological/urological conditions contributing to pelvic floor dysfunction including, but not limited to, incontinence and pelvic pain. This group will help you learn about and cope with symptoms that you may be too embarrassed to discuss with your doctors or friends.

At our first session, our guest speaker is a Doctor of Physical Therapy who specializes in women’s health issues at the Fauquier Health Outpatient Rehabilitation. She will be discussing how you may benefit from pelvic physical therapy to treat your symptoms. Also, a trained exercise physiologist will provide information on how an individualized exercise/stretching program, compatible with instructions from your doctor or physical therapist, can help reduce your pain or other symptoms. Both a morning and evening session will be offered to accommodate your needs.

Guest Speakers:
Kristen Pierce, PT, DPT, cert. MDT
LeAnn McCusker, director of the LIFE Center

Location:
The Fauquier Health LIFE Center
419 Holiday Court (Suite 200)
Warrenton, Virginia 20186

Dates:
Wednesday, February 3 , 10:00 am
Wednesday, February 24, 6:00 pm

To register for one of the sessions, please call the Life Center at 540-316-2640.

If you need any further information or have any questions, please contact Marilyn Caine at 540-349-9325 or click on the button below to send her an email:

Does your baby tilt and hold his head to one side?

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Your baby may have a condition that is known as torticollis. Torticollis is a term that describes an abnormal neck posture. Typically, the parents or physician observe that the baby prefers to tilt or turn his/her head and neck to one side. Evidence in the literature suggests that there may be over 80 differential diagnoses that may cause a torticollis posture. The first step to determine if your baby has torticollis is to bring up your concerns to your pediatrician so he can examine your baby and perform tests as indicated. Neck x-rays are sometimes advised to rule out any abnormality of the vertebrae.

How will I know if my baby has torticollis?

You will notice that your baby prefers to hold his/her head to one side and may have limited neck movement. Torticollis is usually diagnosed within the first 2-3 months of life by the pediatrician. Torticollis is also often associated with an asymmetrical head shape (positional plagiocephaly). This often occurs when babies sleep with their head always turned to one side.

How is torticollis treated?

Conservative treatment of torticollis typically includes passive muscle stretching exercises, active range of motion activities/strengthening exercises, positioning and handling techniques for postural correction, lateral head righting/postural control and developmental exercises. Evidence based outcome measures support manual stretching with good success rates reported from 61-85%.

Should my baby be examined by a physical therapist?

If your baby has been diagnosed with torticollis, you should seek an examination by a pediatric physical therapist as soon as possible. Torticollis limits the ability for a child to move their head freely to see, hear, and interact with his/her environment. Torticollis may also lead to delayed body awareness, weakness and difficulties with balance, and asymmetrical use of their arms and legs during their developmental stages resulting in favoring one side of the body. Physical therapists will perform a thorough neuromusculoskeletal examination of your baby and develop an appropriate program for your child that specifically fits his/her needs. They will check for other conditions that can occur with children who present with torticollis including plagiocephaly, hip dysplasia, and spine problems. They will discuss the results of the examination with you and provide education for a home activity program that includes not only stretching/range of motion exercises, but also information on massage techniques, positioning ideas, and strengthening exercises to prevent any asymmetry that may be occurring. The physical therapist will also observe the patient’s gross motor skills to assure that they are meeting their motor milestones.

How do I get started?
Most cases of torticollis respond very well to physical therapy intervention. Discuss your concerns with your pediatrician and obtain a prescription for physical therapy.

At Fauquier Health Outpatient Physical Medicine and Rehabilitation, our pediatric physical therapy team has special training to treat not only torticollis, but all other congenital, orthopedic, and developmental disorders. We provide a child friendly environment with hours to accommodate school and parent work schedules.

If you feel your child may benefit from this service and would like to hear more, please call us at 540-316-2680. Or click on the button below to ask a question.

McKenzie Spine Program at Fauquier Health Outpatient Rehabilitation Services

Karrie Giger, PT, DPT, cert. MDT explains rationale

of the McKenzie method to Kevin Turney.

Back and neck pain are very common in the general population. The annual incidence of low back pain in the general adult population is 18.6%, and the total cost of low back pain exceeds $100 billion per year in the United States according to studies. Another study reports that about 1/3 of the population will experience neck pain during a six or twelve month period, and the lifetime prevalence of neck pain is 66.7%.

The McKenize Method, also known as Mechanical Diagnosis and Therapy® (MDT) is a unique method used all over the world for examining patients with back, neck, and extremity problems and pain. It is an approach that uses a philosophy of active patient involvement and education. The McKenzie method uses a unique examination that provides the patient with a mechanical diagnosis which drives an appropriate individualized treatment plan. The McKenzie method is not merely extension exercises. It is a comprehensive, well researched approach to the spine that when followed appropriately has been found to have very successful outcomes.

This method has been found to be cost and time effective because it does not rely on expensive tests and it promotes the body’s potential to heal itself through appropriate directional movements prescribed by your physical therapist. The emphasis on active patient involvement limits the number of visits needed to the clinic. Research studies have shown that the initial McKenzie assessment procedures to be as reliable as costly diagnostic imaging (ex. X-rays, MRI) to determine the source of the problem and quickly identify those who will respond to conservative mechanical therapy. The McKenzie method is a safe, reliable, and valid method when performed by appropriately trained physical therapists.

Fauquier Health Outpatient Rehabilitation Services is the only facility in the Piedmont area to have three certified MDT physical therapists. Karrie Giger, PT, DPT, cert. MDT, Bruce Edwards III, PT, cert. MDT, and Kristen Pierce, PT, DPT, cert, MDT were credentialed by the McKenzie Institute International in August 2007 and specialize in spine physical therapy. Certification includes extensive postgraduate courses on spine assessment and treatment with successful completion of an international credentialing examination. Our outpatient department also has 5 other physical therapists currently in the process of becoming MDT certified and have received extensive training in this method. More information regarding the McKenzie method can be found at http://www.mckenziemdt.org

If you feel you may benefit from our spine service, and would like to hear more, please call us at 540-316-2680. Or click on the button below to ask your therapist a question.

May 11-17th is National Women's Health Week

What is a Women's Health PT?

Women's Health PTs are physical therapists who have advanced training and experience in assessing and treating specialized conditions including pelvic pain, pain and dysfunctions in pregnancy, incontinence and others. This training is obtained as post-graduate continuing education in specific areas.

Regina Davis, PT, Karrie Giger DPT, and Kristen Pierce, DPT, of Fauquier Health Outpatient Rehabilitation Services, are the most extensively trained physical therapists in Women's Health in the Warrenton, Virginia area. They are currently pursuing certification in Pelvic Physical Therapy through the Women's Health Section of the American Physical Therapy Association.

If you feel you may benefit from Women's Health physical therapy and would like to learn more, please call 540-316-2680 and ask to speak to Regina, Karrie or Kristen.

We understand it may be difficult or uncomfortable to discuss some Women's Health issues initially. If you would prefer to ask a question anonymously, please click on the button below. You will receive an email response within 24 business hours.

Specialized Care for Pediatric Patients

Adults aren't the only ones who need rehabilitation therapy to maximize their physical, mental and social abilities. Some children and adolescents also need specialized services to build strength, achieve their functional potential and develop the skills they need at thome, at school and within their communities. Children may benefit from rehabilitation services if they have or are recovering from:

• Birth defects or birth injuries


• Neurological, musculoskeletal or rheumatological conditions


• Developmental delays


• Feeding problems


• Acute traumas


• Bone fractures and other orthopedic problems


• Accidents


• Injuries


• Burns


• Cancer


• Surgery


• Chronic diseases (such as sickle cell, heart or kidney diseases)
  

A Team Approach

Kids who need rehabilitation services receive care from a mulitdisciplinary team of specialists who are trained to handle the unique needs of pediatric patients. The team includes physical, occupational and speech therapists who evaluate and assess the child's functional limitations.

Rehabilitation specialists design individual treatment plans to help mazimize patients' independence and the quality of their lives. Team members use a variety of techniques and technologies that can help:

• Support patients' growth and development


• Prevent future complications and impairments


• Relieve pain


• Improve kids' cognitive abilities


• Improve strength, coordination, range of motion and fine motor skills


• Relax muscles


• Develop kids' self-care skills


• Enhance speech and language skills


• Teach kids' how to use wheelchairs, braces and other assistive devices
  

Short and Long Term Care

Some pediatric patients may need only short-term rehabilitation therapy to address certain acute injuries or issues. Rehabilitation, however, can play a major role in health care for kids with complex, lifelong conditions.

While children and adolescents undergoing therapy may be tackling difficult issues, rehabilitation professionals provide services in an age-appropriate way that keeps pediatric patients engaged. For example, therapists may use fun activities to help kids develop key coordination, motor and hand-eye skills that may improve their walking, feeding or handwriting skills. The gains children make during rehabilitation therapy often help boost their self-confidence and self-esteem, giving them a sense of accomplishment.

Developments in Pediatric Therapy

>>Kristine Trimble, Alicia Lutman and Heather Smith comprise the pediatric rehabilitation team at Fauquier Health. The pediatric office is located at 493 Blackwell Road in the Warrenton Professional Center in Warrenton, Virginia. Over the past few months, the rooms have been renovated and updated. New therapeutic tools have also been added, which the children see as "new toys".

Kristine Trimble, PT, DPT is the pediatric physical therapist who provides therapy for children with torticollis, gross motor delays, traumatic brain injuries, acquired brain injuries, cerebral palsy and dyspraxia. She also implements aquatic therapy.

Alicia Lutman, MOTR/L, ATC is the pediatric occupational therapist who works with children with fine motor delays, visual processing deficits, autism, developmental delays, traumatic brain injuries and handwriting difficulties.

Heather Smith, MS, CFY-SLP is the pediatric speech lauguage pathologist who works with children with receptive and expressive language delays, apraxia, feeding delays, autism, developmental delays, articulation/phonological processing disorders, and acquired and traumatic brain injuries.

Fauquier Health is the only local facility to offer physical, occupational and speech therapies all at one convenient, child-friendly location. If you need further information please call 540-316-2680. Or click on the button below to ask a question or request additional information. Your email will be answered within 24 business hours.

A great day for Margaret Blue!

Friday, April 10, 2009

March 12, 2009 was a proud day for Margaret Blue. She became a member of Marriott's "Quarter Century Club", marking 25 years of service as a chef. Margaret thoroughly enjoyed everyone she came in contact with during her years with Marriott. Despite a debilitating neurogenic problem that causes her to have decreased balance and weakness, this amazing woman has only missed one day of work in 25 years--because of a snowstorm!After a recent injury, Margaret came to our clinic for strengthening and to improve her walking. She has worked closely with her physical therapist, Bruce Edwards & our student from Shennandoah, Brooks Brady. Margaret credits them for helping her become strong enough to walk up to receive her 25 year service award, something she was not sure she would be able to do after her injury.Margaret has a beaming smile for everyone she meets. Her positive attitude is contagious, and the reason she has come so far. Congratulations Margaret, on your achievements!

If you would like to know more about our services, or have a general question regarding rehabilitation services, please call us at 540-316-2680, or click on the button below to submit an email inquiry.

Physical Therapists offer help for Incontinence

Urinary incontinence, or the complaint of involuntary leakage of urine, is not just something that happens to older people. This condition can affect men and women of all ages. The National Association for Incontinence estimates that 25 million Americans experience urinary incontinence.

Stress Incontinence is a sudden involuntary loss of urine on effort or exertion. This may occur with activities such as exercising, sneezing, coughing or laughing. Stress incontinence usually results from weakness and lack of support in the muscles of the pelvic floor. Women with stress incontinence often have “under active” pelvic floor muscles. Causes may be pregnancy or childbirth, injury or trauma, surgery in the vagina or rectum, episiotomy (during childbirth), or lack of exercise or use.

Urge Incontinence is the loss of urine that occurs as soon as you get the urge to urinate. Women with urge incontinence often have weak and “over active” pelvic floor muscles.

Mixed Incontinence is involuntary loss of urine associated with urgency and also with exertion, effort, sneezing or coughing. Mixed incontinence can include any combination of the causes of stress and urge incontinence.

Many symptoms of urinary incontinence are caused by pelvic floor muscle weakness and dysfunction. Our specially trained pelvic floor physical therapists are the ideal healthcare providers to help you gain control over your symptoms. Our therapists use their specialized medical training to evaluate your problem and design an individualized treatment program to meet your specific needs.

Physical therapy can:

• Give you control over your bladder and your life


• Save money and embarrassment by allowing less use of pads and undergarments


• Reduce use of medications for incontinence


• Possibly prevent the need for surgery

Physical therapy treatment may include:

• Education on diet and nutrition to avoid food and beverages that may irritate the bladder


• Advice on how to change behaviors that make symptoms worse


• Techniques to increase awareness of the correct use of muscles that control urinary flow


• Exercises to strengthen the muscles of the pelvic floor


• Exercises to stretch and strengthen other important muscles to help you gain control


• Techniques to decrease urinary urge and frequency


• Biofeedback to help you re-train your muscles


• Electrical stimulation to improve awareness and strengthen muscles

You should be referred to a pelvic physical therapist if:

• You leak urine during normal daily activities


• You leak urine with sneezing, coughing, or laughing


• You have difficulty starting a urine stream


• You have trouble holding urine when you feel a strong urge to go


• You urinate frequently (more than every 3-4 hours during the day, up more than once to urinate at night)


• You have difficulty getting to the bathroom because of other problems such as pain or balance.
  
  At Fauquier Health Outpatient Physical Medicine and Rehabilitation, our pelvic physical therapy team has completed extensive training in pelvic physical therapy through the American Physical Therapy Association. Our therapists use a variety of techniques as well as provide you with education to ensure your needs are addressed. All pelvic floor treatments are conducted confidentially with your therapist in a comfortable, private setting.
  
  If you feel you may benefit from this service and would like to hear more, please call us at 540-316-2680. Or click on the button below to ask a question.
  

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Do you suffer from dizziness?

You are not alone. Did you know that symptoms of dizziness are the third most frequent reason people over the age of 65 seek medical attention? Dizziness is the number one reason people over the age of 70 seek medical attention.

Fifty percent of individuals over the age of 65 who suffer from dizziness will develop a particular form of vertigo that can be alleviated with one simple physical therapy treatment. The most common form of vertigo is Benign Paroxsymal Positioning Vertigo (BPPV).

Symptoms include:

• Sudden onset
• Brief episodes of dizziness, typically lasting less than one minute
• A sense of imbalance or motion sensitivity brought on by changes in head position relative to gravity by activities such as:
  o Lying down
  o Rolling over in bed
  o Bending over
  o Looking up

BPPV is caused by tiny crystals being dislodged in the inner ear causing changes in the movement of lymph fluid, giving you the sensation you are losing your balance.

Fortunately, this problem is easily detected and can be treated with a few different repositioning techniques to move the crystals through the ear canal and “dump” them into an area that no longer causes vertigo. This treatment is usually very successful, with resolution of all symptoms within 1 or 2 therapy sessions.

A Vestibular Rehabilitation course was recently held at Fauquier Hospital and was attended by some of our therapists. They received training in these vestibular techniques and are ready to help alleviate your dizziness. If you feel you may benefit from this service and would like to hear more, please call us at 540-316-2680. Or click on the button below to ask a question.

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Congratulations Andrew!

Outpatient Rehabilitation Services is proud to announce that Andrew Mazur, physical therapist, has received certification from the Aquatic & Rehabilitation Institute. Andrew provides outpatient aquatic physical therapy for adults at our pool in the Fauquier Health Rehabilitation & Nursing Center. Andrew’s patients enjoy the skilled, individualized care he provides that helps them maximize their range of motion, strength & function after an injury, illness or surgery.

We are the only clinic in the area to offer aquatic physical therapy. Our pool is kept at an inviting 92 degrees, optimal for therapeutic exercise.

We also offer aquatic physical therapy for our pediatric patients, provided by Kristine Trimble, our pediatric physical therapist.
If you or someone you know may benefit from aquatic physical therapy, please call us at (540) 316-2680 for further information. We look forward to hearing from you!

Have questions?

Right this way...

We've installed a new directional sign to help clients find their way to our outpatient clinic on the Fauquier Hospital campus. We are located in the Medical Office Building at 253 Veteran's Drive in Warreton, Virginia. Our clinic is on the first floor of the building, to the right of the elevator in the main lobby.

Health Insurance Co-Payments Studied

A story From United Press International Health insurance co-payments studied stated

"The message is simple and it's startling -- a small co-payment for a mammogram can lead to a sharp decrease in breast cancer screening rates," said Dr. Amal Trivedi, lead author of the study. "Co-payments as low as $12 deter women from getting mammograms. Because mammograms are critical in the fight against breast cancer, the most common cancer among American women, our findings have important health policy implications."

Kind of flies in the face of co-pays as a control mechanism for over-utilization rather than a control mechanism for utilization. I wonder what those $50 co-payments mean for those who may need a Physical Therapist?

Also makes one wonder what "Coverage" means these days.