1 00:00:09,280 --> 00:00:12,920 Hello, everybody, and welcome to the Doctors of Running podcast, 2 00:00:12,920 --> 00:00:16,440 where we, a group of doctors of physical therapy, discuss the 3 00:00:16,480 --> 00:00:19,040 art and the science of the stuff that we're putting on our feet. 4 00:00:19,560 --> 00:00:22,960 I'm Andrea Myers, and we have a very special guest with us here 5 00:00:22,960 --> 00:00:27,160 today, Scott Capoza, who's a physical therapist at the Smilo 6 00:00:27,160 --> 00:00:29,400 Cancer Hospital Survivorship Clinic. 7 00:00:29,880 --> 00:00:34,640 Scott is one of the leaders in the field in oncology rehab, and 8 00:00:34,640 --> 00:00:39,240 he's here today to talk with us about runners returning to 9 00:00:39,360 --> 00:00:42,640 training either during cancer treatment or after. 10 00:00:43,120 --> 00:00:47,400 He's also here to share his own survivorship story and his path 11 00:00:47,400 --> 00:00:50,640 in getting back to running after he was diagnosed with cancer in 12 00:00:50,640 --> 00:00:53,920 his 20s. So Scott, thank you so much for 13 00:00:53,920 --> 00:00:55,960 joining us. It's a real treat to have you 14 00:00:55,960 --> 00:00:57,640 here. Welcome to the show. 15 00:00:58,400 --> 00:00:59,400 Yeah. Thanks Andrea. 16 00:00:59,400 --> 00:01:02,280 And you know we've known each other for a while and I'm, I'm 17 00:01:02,280 --> 00:01:04,920 so excited that you've that you've got this podcast that 18 00:01:04,920 --> 00:01:07,480 you've you've got this platform, you're doing incredible things 19 00:01:07,480 --> 00:01:10,360 and it's it's a incredible honor to to be with you today. 20 00:01:10,960 --> 00:01:12,480 Yeah. And well, it's an honor to have 21 00:01:12,480 --> 00:01:13,760 you here. So thanks so much. 22 00:01:14,160 --> 00:01:16,920 So to give you a little more information about Scott's 23 00:01:16,920 --> 00:01:21,400 background, he has been at the Smilo Survivorship Clinic since 24 00:01:21,400 --> 00:01:25,280 its inception in 2006 and it's a really unique setting. 25 00:01:25,280 --> 00:01:29,440 He works with a dietitian, a social worker and a physician 26 00:01:29,440 --> 00:01:32,960 assistant to address the late and long term side effects of 27 00:01:32,960 --> 00:01:35,320 cancer treatment. Through this unique 28 00:01:35,320 --> 00:01:39,400 collaborative team approach, common survivorship themes such 29 00:01:39,400 --> 00:01:42,480 as cancer related fatigue and fear of recurrence are 30 00:01:42,480 --> 00:01:45,400 addressed. Scott and his team actually 31 00:01:45,400 --> 00:01:50,680 presented their clinic model at the 2020 APTA combined sections 32 00:01:50,680 --> 00:01:53,160 meeting, which is a really big deal in the PT world. 33 00:01:53,480 --> 00:01:56,200 So congratulations to you for that Scott. 34 00:01:57,360 --> 00:02:01,840 Scott is also Yale New Haven Hospital's first dedicated 35 00:02:01,840 --> 00:02:06,120 outpatient physical therapist in oncology rehab, which is huge. 36 00:02:06,120 --> 00:02:09,800 And I know that you just touched so many people's lives with your 37 00:02:09,800 --> 00:02:13,560 help for them during, during and after their treatment process. 38 00:02:14,560 --> 00:02:16,560 So Yale is really lucky to have him. 39 00:02:17,400 --> 00:02:21,640 Additionally, Scott is among the first class of board certified 40 00:02:21,640 --> 00:02:24,920 clinical specialists in oncologic physical therapy in 41 00:02:24,920 --> 00:02:29,160 the country and he serves as an item writer for the Oncology 42 00:02:29,160 --> 00:02:32,600 certification exam through the ABPTS. 43 00:02:33,160 --> 00:02:36,640 He is currently the Membership Chairperson for the APT as 44 00:02:36,680 --> 00:02:40,840 Academy of Oncologic Physical Therapy as well as the APTA 45 00:02:40,920 --> 00:02:44,720 Connecticut CHAPTERS Oncology Special Interest Group Co 46 00:02:44,720 --> 00:02:47,840 Chairperson really in the world of oncology rehab. 47 00:02:47,840 --> 00:02:52,080 Scott is a good person to know and like I said, I can't imagine 48 00:02:52,080 --> 00:02:54,880 a better person to have on the show to talk about this topic. 49 00:02:54,880 --> 00:02:56,680 So thanks again for joining us, Scott. 50 00:02:57,520 --> 00:03:00,320 Well, thank you again. And yeah, it's a, it's it's 51 00:03:00,320 --> 00:03:03,560 obviously it's a, it's a subject in an area that's near and dear 52 00:03:03,560 --> 00:03:06,240 to my heart. And but I'll be honest with you, 53 00:03:06,240 --> 00:03:09,640 you know just to start off our conversation Andrea that you 54 00:03:09,640 --> 00:03:12,920 know, you know I don't know about you, but when I went 55 00:03:12,920 --> 00:03:16,680 through PT school, we didn't talk about oncology PT because 56 00:03:16,680 --> 00:03:20,040 there was no such thing as oncology physical therapy. 57 00:03:20,600 --> 00:03:25,160 You know 25 years ago you know anybody who who had a diagnosis 58 00:03:25,160 --> 00:03:27,280 of cancer and had and was going through treatment, they were 59 00:03:27,280 --> 00:03:34,160 told not to move, movement was actually contraindicated for 60 00:03:34,480 --> 00:03:37,480 any, any patients undergoing chemotherapy or go undergoing 61 00:03:37,480 --> 00:03:42,000 radiation therapy. So I like to start there as a as 62 00:03:42,000 --> 00:03:46,640 kind of a backdrop as to to show where we were and where we are 63 00:03:46,640 --> 00:03:49,200 now. But also, you know, we still 64 00:03:49,200 --> 00:03:54,040 have some some distance to go as far as making sure that, you 65 00:03:54,040 --> 00:03:56,760 know, we try to touch as many patients who have a history of 66 00:03:56,760 --> 00:03:59,280 cancer as possible. We do, yeah. 67 00:03:59,280 --> 00:04:00,800 And I think that's a really good point. 68 00:04:01,080 --> 00:04:03,800 You know, you were in PT school 25 years ago. 69 00:04:03,800 --> 00:04:08,640 I was in PT school 20 years ago. And looking back, I think the 70 00:04:08,640 --> 00:04:12,480 most we talked about cancer rehab was lymphedema therapy. 71 00:04:12,680 --> 00:04:16,399 But it certainly wasn't about, well, what do you do to support 72 00:04:16,399 --> 00:04:18,760 somebody who's going through cancer treatment? 73 00:04:19,079 --> 00:04:21,240 What are the exercise recommendations? 74 00:04:21,240 --> 00:04:23,960 What should people do? What shouldn't they do? 75 00:04:24,120 --> 00:04:30,600 So I think it's huge that the APTA has made oncology rehab a 76 00:04:30,600 --> 00:04:36,560 specialty and that there is increasingly a greater focus on 77 00:04:36,560 --> 00:04:40,160 the importance of it during the whole process, both during 78 00:04:40,160 --> 00:04:43,600 treatment and afterwards. Yeah, and that. 79 00:04:43,800 --> 00:04:45,720 And you're right. I mean you when you and I were 80 00:04:45,720 --> 00:04:50,760 in PT school, we didn't have any guidelines as far as you know, 81 00:04:51,360 --> 00:04:54,000 how our our patients with with cancer is supposed to be 82 00:04:54,000 --> 00:04:56,960 exercising. And so when the first consensus 83 00:04:56,960 --> 00:04:59,360 statement came out ironically enough from the American College 84 00:04:59,360 --> 00:05:03,960 of Sports Medicine in 2010, you know that was kind of a landmark 85 00:05:05,080 --> 00:05:08,560 journal article that came out. However, they still didn't have 86 00:05:08,560 --> 00:05:11,240 a whole lot of research at that time to base it on. 87 00:05:11,680 --> 00:05:14,400 And so those exercise recommendations were really just 88 00:05:14,400 --> 00:05:18,080 extrapolated from what the general population should be 89 00:05:18,080 --> 00:05:20,520 doing. And then you Fast forward to 90 00:05:20,520 --> 00:05:26,800 2019 where we did have more in a way of of research specific to 91 00:05:26,800 --> 00:05:30,080 to exercise and and rehab for patients with cancer. 92 00:05:30,480 --> 00:05:33,840 And so they were able to update those guidelines in 2019 and 93 00:05:33,840 --> 00:05:37,480 it's much more specific now. They're much more definitive 94 00:05:37,480 --> 00:05:40,920 about not just recommending cardiovascular exercise to 95 00:05:40,920 --> 00:05:46,440 combat cancer related fatigue and the anxiety that can go 96 00:05:46,440 --> 00:05:50,160 along with a cancer diagnosis, but much more definitive about 97 00:05:50,160 --> 00:05:52,800 recommending strength training as well. 98 00:05:52,800 --> 00:05:57,160 Again to specifically address some of the the adverse effects 99 00:05:57,160 --> 00:05:59,560 that we see from cancer treatment such as cancer related 100 00:05:59,560 --> 00:06:00,960 fatigue. Right. 101 00:06:00,960 --> 00:06:04,320 Muscle loss. All of the things that we have 102 00:06:04,320 --> 00:06:08,120 known for a long time occur in relation to cancer treatment, 103 00:06:08,120 --> 00:06:10,200 but we weren't necessarily addressing. 104 00:06:10,640 --> 00:06:13,840 Right, exactly. We have a lot of PTS and other 105 00:06:13,840 --> 00:06:17,000 healthcare providers who listen to this podcast and I think that 106 00:06:17,000 --> 00:06:19,840 we're going to provide a lot of great resources for people. 107 00:06:19,840 --> 00:06:24,000 But where can people find those guidelines, Scott the updated 108 00:06:24,000 --> 00:06:27,880 2019 guidelines? Are they on the APTA website or 109 00:06:27,880 --> 00:06:32,040 somewhere else? If you did any kind of Google 110 00:06:32,040 --> 00:06:36,000 Scholar search, they are free access. 111 00:06:36,800 --> 00:06:41,560 So again the the 2019 consensus statement from the American 112 00:06:41,560 --> 00:06:45,400 College of Sports Medicine was released in 2019. 113 00:06:46,440 --> 00:06:50,640 So that is that is an option right there to start to start 114 00:06:50,640 --> 00:06:53,240 there. As far as finding out what the 115 00:06:53,240 --> 00:06:57,640 current guidelines are for exercise recommendations for any 116 00:06:57,640 --> 00:07:01,200 PTS who who are listening if they do are interested in 117 00:07:01,200 --> 00:07:03,600 learning more about oncology rehab. 118 00:07:04,520 --> 00:07:08,840 Again Andrea as you alluded to there is a A section or an 119 00:07:08,840 --> 00:07:12,960 Academy in oncology within the American Physical Therapy 120 00:07:12,960 --> 00:07:16,600 Association. So you know you can join that 121 00:07:16,600 --> 00:07:20,200 and get access to all of the resources including the rehab 122 00:07:20,280 --> 00:07:25,520 oncology journal as part of that that the oncology Academy. 123 00:07:26,720 --> 00:07:30,360 I will say for any if you have any PT students who are 124 00:07:30,360 --> 00:07:34,080 listening and it's always good to to support our our PT 125 00:07:34,080 --> 00:07:35,800 students who are out there listening. 126 00:07:36,640 --> 00:07:39,200 The Academy of Oncologic Physical Therapy, the the 127 00:07:39,200 --> 00:07:45,120 section of of APTA has free membership because we want new 128 00:07:45,120 --> 00:07:49,640 grads and students to to get more involved because again 129 00:07:49,640 --> 00:07:52,240 looking at the most current research of where we're at now, 130 00:07:52,240 --> 00:07:58,000 the the American Cancer Society releases their updated stats 131 00:07:58,080 --> 00:08:02,480 every year in January. And so they their article, their 132 00:08:02,480 --> 00:08:07,080 journal just came out in January about the number of incidents 133 00:08:07,320 --> 00:08:09,200 for a cancer in the United States. 134 00:08:09,800 --> 00:08:12,640 And this is the first year, Andrea, that we're going to see 135 00:08:12,920 --> 00:08:17,400 the overall incidence of cancer diagnosis cross the two 136 00:08:17,400 --> 00:08:22,240 millionth threshold. Yeah, so that's a lot of people 137 00:08:22,240 --> 00:08:27,240 and we already have based on, again American Cancer Society 138 00:08:28,200 --> 00:08:32,480 estimates 18 million people living in the United States with 139 00:08:32,480 --> 00:08:35,280 a history of cancer. Obviously not all of them are 140 00:08:35,520 --> 00:08:42,000 currently in treatment but 18,000,000 and so there's that's 141 00:08:42,000 --> 00:08:45,120 a lot of people that that's that's a bigger part of the 142 00:08:45,120 --> 00:08:50,040 population you know that that we need that we as PTS need to try 143 00:08:50,040 --> 00:08:52,640 to try to see. Right. 144 00:08:52,800 --> 00:08:56,480 That's a lot of survivors. And I think, and you wrote about 145 00:08:56,480 --> 00:09:02,920 this in a journal article about your survivorship journey, those 146 00:09:02,920 --> 00:09:05,520 survivors have a history of cancer. 147 00:09:05,520 --> 00:09:09,400 And it's important for PTS, doctors, other healthcare 148 00:09:09,400 --> 00:09:13,640 providers to remember that when evaluating somebody who has a 149 00:09:13,640 --> 00:09:17,840 new complaint and to keep in mind that, hey, this history of 150 00:09:17,840 --> 00:09:21,080 cancer 20 years ago might actually be relevant to the 151 00:09:21,080 --> 00:09:24,800 problem that they're having now. And I hope you'll talk a little 152 00:09:24,800 --> 00:09:28,560 bit more about that in a minute, because I think it's a really 153 00:09:28,560 --> 00:09:32,840 good way to illustrate the importance of us as healthcare 154 00:09:32,840 --> 00:09:36,000 providers, remembering that. Yeah. 155 00:09:36,440 --> 00:09:39,360 And and again you know specifically you know for for a 156 00:09:39,360 --> 00:09:43,040 lot of your listeners who who are PTS, who probably work with 157 00:09:43,120 --> 00:09:47,320 with runners or or runners themselves, I do always say that 158 00:09:47,320 --> 00:09:51,200 you know, somebody may be coming into your clinic, you know, as a 159 00:09:51,200 --> 00:09:54,440 as a runner and you know they may have what may look like a 160 00:09:54,440 --> 00:09:58,760 traditional orthopedic injury. You know, they may have, you 161 00:09:58,760 --> 00:10:02,080 know an MCL strain or they may you know have something else, 162 00:10:02,080 --> 00:10:05,440 you know from from running. And but that's why it's so 163 00:10:05,440 --> 00:10:08,640 important to do a really thorough chart review and to 164 00:10:08,640 --> 00:10:12,200 really ask that patient, you know what's what is your 165 00:10:12,200 --> 00:10:17,040 previous history Because if there's something you know in 166 00:10:17,040 --> 00:10:21,040 their history of where they had cancer, then you do want to know 167 00:10:21,040 --> 00:10:22,480 what were your treatments that were on. 168 00:10:22,480 --> 00:10:27,080 Because some of these late effects that we see from from 169 00:10:27,080 --> 00:10:31,400 cancer treatments can include cardiotoxicity, can include 170 00:10:31,680 --> 00:10:34,600 pulmonary fibrosis. So this is all going to affect 171 00:10:35,040 --> 00:10:40,040 how we dose our exercise and how we dose our interventions for 172 00:10:40,040 --> 00:10:43,680 these patients. So, so yes, you know, for, for 173 00:10:43,680 --> 00:10:46,560 all of, you know, for all of your listeners who who work with 174 00:10:46,560 --> 00:10:50,520 runners or are runners themselves, you need to 175 00:10:50,520 --> 00:10:53,720 sometimes take a a step back and take a look at the the whole 176 00:10:53,720 --> 00:10:56,000 person, right. We're not just looking at an 177 00:10:56,000 --> 00:10:57,760 ankle or we're not just looking at a knee. 178 00:10:57,760 --> 00:11:01,880 Like we have to look at the whole person and truly be 179 00:11:01,880 --> 00:11:04,360 cognizant of of that patient's history. 180 00:11:05,000 --> 00:11:08,000 Absolutely. And it's so common for cancer 181 00:11:08,000 --> 00:11:12,440 survivors to not know what those potential late effects of their 182 00:11:12,440 --> 00:11:14,640 treatments would be. So it's really on us as 183 00:11:14,640 --> 00:11:18,520 healthcare providers to be aware and not. 184 00:11:18,960 --> 00:11:22,120 That's not to say that every physical therapist should be an 185 00:11:22,120 --> 00:11:25,480 expert in every chemotherapy drug, but to at least have the 186 00:11:25,480 --> 00:11:28,240 understanding that if you have a patient who went through 187 00:11:28,240 --> 00:11:33,440 chemotherapy or radiation in their past, that those drugs may 188 00:11:33,440 --> 00:11:35,960 have an effect on how their bodies are working now. 189 00:11:36,640 --> 00:11:38,560 Right. Yeah, that you're absolutely 190 00:11:38,560 --> 00:11:41,040 right. And and again, it could just be, 191 00:11:41,240 --> 00:11:46,200 again could be something as mundane as you know again a knee 192 00:11:46,200 --> 00:11:48,880 injury or an ankle injury that that comes into your to your 193 00:11:48,880 --> 00:11:52,160 clinic. But it's important to ask those 194 00:11:52,160 --> 00:11:56,080 questions and even if you don't have all the answers, that's OK 195 00:11:56,080 --> 00:11:58,560 We're like we're not expected to know all the answers. 196 00:11:58,560 --> 00:12:02,080 Like there's no way for me to know all the all the latest 197 00:12:02,320 --> 00:12:05,760 sports medicine techniques that you're probably practicing, you 198 00:12:05,760 --> 00:12:09,040 know, with with your patients. But that's why, you know, the PT 199 00:12:09,040 --> 00:12:11,800 world is a small world and so we need to be able to collaborate 200 00:12:11,880 --> 00:12:15,920 with each other. So if you don't have the answer, 201 00:12:15,920 --> 00:12:18,360 then you can text me. And if I don't have the answer, 202 00:12:18,360 --> 00:12:22,680 then I text you Andrea to be like, hey, you know, can we work 203 00:12:22,680 --> 00:12:25,640 together or can you give me some ideas moving forward working 204 00:12:25,640 --> 00:12:27,600 with this patient? Absolutely. 205 00:12:27,680 --> 00:12:32,560 And we also have lots of great resources online and textbooks. 206 00:12:32,840 --> 00:12:36,080 You know, if it's a lot of times healthcare providers don't know, 207 00:12:36,080 --> 00:12:39,160 have the answer in their brains. But a good healthcare provider 208 00:12:39,160 --> 00:12:40,560 knows where to go to look for it. 209 00:12:41,000 --> 00:12:44,320 Yeah, I would agree with that. So Scott, could you tell our 210 00:12:44,320 --> 00:12:49,320 listeners about your diagnosis, the treatment that you went 211 00:12:49,320 --> 00:12:51,880 through? But then also that article that 212 00:12:51,880 --> 00:12:55,440 you wrote I think was really compelling, both as a healthcare 213 00:12:55,440 --> 00:13:00,320 provider but also just as a person understanding what a 214 00:13:00,320 --> 00:13:03,920 survivor might experience long term after treatment. 215 00:13:04,640 --> 00:13:07,840 Sure. So maybe I'll take, I'll go even 216 00:13:07,840 --> 00:13:11,520 further back in time and say that, you know, I I I was a 217 00:13:11,520 --> 00:13:17,360 competitive runner. I ran cross country and track at 218 00:13:17,360 --> 00:13:21,800 Ithaca College for all four years and was actually in the 219 00:13:21,800 --> 00:13:24,120 process of training for my first ever marathon. 220 00:13:24,120 --> 00:13:27,520 I was trying to qualify for the Boston Marathon when I was 221 00:13:27,520 --> 00:13:31,720 diagnosed at the age of 22 with stage two testicular cancer. 222 00:13:32,720 --> 00:13:36,520 Ironically enough I was in my last year of PT school when that 223 00:13:36,520 --> 00:13:39,200 happened and again you would think that somebody who's 224 00:13:39,200 --> 00:13:45,080 running 5060 miles a week and did not drink and did not smoke 225 00:13:45,160 --> 00:13:52,160 and also did not have a family history of cancer would ever be 226 00:13:52,160 --> 00:14:00,840 at risk for developing cancer. But I did and so so that's 227 00:14:00,920 --> 00:14:04,520 that's my back story in the sense of that yeah I was AI know 228 00:14:04,520 --> 00:14:05,800 I wasn't just a runner like I was. 229 00:14:05,800 --> 00:14:12,040 I was considering myself pretty competitive and and so I when I 230 00:14:12,040 --> 00:14:17,160 was going through treatment, I I missed running when I wasn't 231 00:14:17,160 --> 00:14:21,080 able to run. When I was in the hospital for a 232 00:14:21,080 --> 00:14:24,520 month after my cancer surgery. And I had all these 233 00:14:24,720 --> 00:14:27,880 complications and I had tubes coming in and out of me. 234 00:14:28,760 --> 00:14:32,080 You know, I I walked out of the hospital 20 lbs later than I had 235 00:14:32,080 --> 00:14:35,120 walked in. And I was so deconditioned that 236 00:14:35,480 --> 00:14:39,960 again I went from, you know, running 60 miles a week and and 237 00:14:39,960 --> 00:14:43,480 I did actually run that marathon and then a month later I was 238 00:14:43,480 --> 00:14:47,040 diagnosed with cancer. So to go from that level of 239 00:14:47,480 --> 00:14:51,240 fitness to then when I walked out of the hospital and I could 240 00:14:51,240 --> 00:14:55,560 barely walk up the seven steps to get into my apartment, that's 241 00:14:55,560 --> 00:15:00,000 how much muscle mass I lost. And so I had to basically 242 00:15:00,000 --> 00:15:04,560 rebuild myself. And and Andrea, I, I tell this 243 00:15:04,560 --> 00:15:08,320 story all the time because again I I, I hope that it gives a 244 00:15:08,320 --> 00:15:13,760 little context as to where we were 25 years ago and that, you 245 00:15:13,760 --> 00:15:17,200 know, we now have the evidence that exercise and rehab is 246 00:15:17,200 --> 00:15:19,240 beneficial for patients who are in treatment. 247 00:15:19,920 --> 00:15:24,800 But I distinctly remember after I'd had my surgeries and I came 248 00:15:24,800 --> 00:15:28,400 back to Connecticut so that I can get my chemotherapy and that 249 00:15:28,400 --> 00:15:31,240 was fine. I met with my medical oncologist 250 00:15:31,240 --> 00:15:34,320 and he said, OK, well, these are the three different chemotherapy 251 00:15:34,320 --> 00:15:39,920 drugs that you're going to get and you will lose your hair, you 252 00:15:39,920 --> 00:15:45,360 will be nauseous, your white blood cells might drop, your red 253 00:15:45,360 --> 00:15:48,520 blood cells might drop. And so the this whole litany of 254 00:15:48,520 --> 00:15:50,640 things right? And it says, do you have any 255 00:15:50,640 --> 00:15:54,120 questions? And I said, yeah, can I run 256 00:15:54,120 --> 00:15:58,360 while I'm on chemo? A perfectly reasonable question, 257 00:15:58,360 --> 00:16:00,800 really. Right, a perfectly reasonable 258 00:16:00,800 --> 00:16:04,440 answer from a 23 year old at this point who is a runner who 259 00:16:04,440 --> 00:16:06,360 identifies himself as a runner. Right. 260 00:16:06,960 --> 00:16:09,000 And you know what his answer was? 261 00:16:10,240 --> 00:16:11,520 I don't know. Oh my gosh. 262 00:16:12,080 --> 00:16:14,560 He didn't know because nobody else ever asked him that 263 00:16:14,560 --> 00:16:18,680 question before because again, exercise was contraindicated 25 264 00:16:18,680 --> 00:16:21,200 years ago for anybody going through treatment. 265 00:16:21,600 --> 00:16:25,960 And so I was like, well, that's how I identify myself is as a 266 00:16:25,960 --> 00:16:29,080 runner. I need it physically and I also 267 00:16:29,080 --> 00:16:34,360 needed it mentally, right? Like, why don't we run, right? 268 00:16:34,360 --> 00:16:38,000 Yes, we we do it to stay in shape and to be healthy and to 269 00:16:38,000 --> 00:16:40,640 compete against ourselves. But we also need it As for our 270 00:16:40,640 --> 00:16:42,520 mental health, right? Absolutely. 271 00:16:42,680 --> 00:16:44,640 Yep. Running is the best meditation I 272 00:16:44,640 --> 00:16:46,480 have. Yeah, exactly. 273 00:16:46,480 --> 00:16:50,440 And you know for you know you're if you have a bad day at work or 274 00:16:50,440 --> 00:16:53,680 you just, you have a dispute with your significant other like 275 00:16:53,680 --> 00:16:56,000 to be able to go for a run and to be able to blow off some 276 00:16:56,000 --> 00:16:58,400 steam, right. Like that's so important, right, 277 00:16:58,400 --> 00:17:01,560 that we have that that that's our outlet right as runners. 278 00:17:01,640 --> 00:17:04,920 Absolutely. So I needed it mentally. 279 00:17:04,920 --> 00:17:08,040 I needed to run so that I knew that I wasn't losing to the 280 00:17:08,040 --> 00:17:12,920 cancer. So I remember, Andrea, I 281 00:17:12,920 --> 00:17:17,160 remember distinctly I went for a run, went for just a simple 282 00:17:17,160 --> 00:17:21,000 three mile run for the day, like the evening after I got my first 283 00:17:21,000 --> 00:17:25,680 chemotherapy dose. And I actually felt OK and I was 284 00:17:25,680 --> 00:17:27,800 like, all right, this isn't so bad. 285 00:17:28,400 --> 00:17:32,960 And then I got chemo the next day and went for a run, a little 286 00:17:32,960 --> 00:17:35,760 three mile run and it said, hey, I still feel pretty good. 287 00:17:36,920 --> 00:17:39,640 And again, I'm blissfully ignorant as to what's about to 288 00:17:39,640 --> 00:17:42,560 happen. And as with with most 289 00:17:42,560 --> 00:17:46,200 chemotherapies, you feel OK when you're actually getting the 290 00:17:46,200 --> 00:17:49,320 chemo because they're also kind of you're given steroids to 291 00:17:49,320 --> 00:17:54,520 support you at that point. But then we have a condition 292 00:17:54,640 --> 00:17:57,440 called nadir when your blood counts all bottom out. 293 00:17:57,920 --> 00:18:02,040 And so that hit me over the weekend and that's when I could 294 00:18:02,040 --> 00:18:05,240 barely get from my bedroom to the living room. 295 00:18:06,600 --> 00:18:10,640 And so that was a bit of a shock where again, I was trying to 296 00:18:10,640 --> 00:18:16,080 rebuild myself and I was just exhausted. 297 00:18:16,080 --> 00:18:19,960 Just never felt that exhausted before, not even after finishing 298 00:18:19,960 --> 00:18:21,480 a 20 mile run. Like, not. 299 00:18:21,840 --> 00:18:24,840 Like you take that level of exhaustion and you multiply it. 300 00:18:26,440 --> 00:18:29,920 So I figured out as I went through my chemo cycles, like 301 00:18:29,920 --> 00:18:32,520 which days I was going to feel good and which days I was not 302 00:18:32,520 --> 00:18:34,560 going to feel good. And so I could at least kind of 303 00:18:35,160 --> 00:18:40,360 plan when I could go for a run and then, you know, be OK with, 304 00:18:40,440 --> 00:18:43,120 OK, you're not necessarily going to go for a run on these two or 305 00:18:43,120 --> 00:18:46,520 three days because your counts are going to bottom out and 306 00:18:46,520 --> 00:18:50,000 you've got nothing. So. 307 00:18:50,680 --> 00:18:57,640 So I kept running to whatever level I could during chemo and 308 00:18:57,840 --> 00:19:00,240 then I started training again like I finished chemo. 309 00:19:00,240 --> 00:19:03,640 They took my port out and they said there's no evidence of 310 00:19:03,640 --> 00:19:06,720 disease, you're free to go so to speak. 311 00:19:07,160 --> 00:19:10,760 And so I started training again and I was leaner and I was 312 00:19:10,760 --> 00:19:15,520 definitely more focused on this second go around. 313 00:19:15,520 --> 00:19:23,000 And so I ended up qualifying for Boston and and ran Boston twice. 314 00:19:23,720 --> 00:19:26,920 Congratulations. So yeah, I was able to run the 315 00:19:26,920 --> 00:19:30,000 granddaddy of them all. Twice good. 316 00:19:31,080 --> 00:19:34,520 So, so, yeah. So, you know, so in those 317 00:19:34,520 --> 00:19:39,360 initial few years when I finished treatment, I was in the 318 00:19:39,360 --> 00:19:42,400 best shape of my life, right? So ran Boston twice. 319 00:19:42,880 --> 00:19:47,240 I ran New York once, was running a bunch of half marathons. 320 00:19:47,240 --> 00:19:50,560 Like, you know, I was. I felt like I was in better 321 00:19:50,560 --> 00:19:53,320 shape. Like I didn't have the the short 322 00:19:53,320 --> 00:19:55,560 distance speed like I had when I was in college. 323 00:19:55,560 --> 00:19:58,240 Like I, you know, I couldn't go under 5 minutes for a mile 324 00:19:58,240 --> 00:20:01,320 anymore, but I could like I had the endurance so that I could 325 00:20:01,320 --> 00:20:05,040 run a half, you know, or a ten mile run and wouldn't be an 326 00:20:05,040 --> 00:20:09,160 issue. And I felt great for about 10 327 00:20:09,160 --> 00:20:13,320 years. And then right about the 10 year 328 00:20:13,320 --> 00:20:19,840 mark was when the late effects from my treatment started to 329 00:20:19,840 --> 00:20:25,440 catch up with me. And you know, you again, you you 330 00:20:25,440 --> 00:20:30,600 don't know what you don't know. Like I remember reading when I 331 00:20:30,600 --> 00:20:33,440 was about to start treatment that one of the chemotherapy 332 00:20:33,440 --> 00:20:37,480 drugs that I had called bleomycin has the potential to 333 00:20:37,800 --> 00:20:41,280 damage the lungs. But I didn't think anything of 334 00:20:41,280 --> 00:20:42,520 it. And then I was went back to 335 00:20:42,520 --> 00:20:46,120 running and I felt fine. So I said, OK, maybe, you know, 336 00:20:46,160 --> 00:20:51,360 maybe it didn't affect me, but I think that's the difference 337 00:20:51,360 --> 00:20:53,880 between, you know, what we see for patients who are in the 338 00:20:53,880 --> 00:20:56,360 middle of treatment versus the patients that we see five years 339 00:20:56,360 --> 00:20:58,200 later, 10 years later, 20 years later. 340 00:20:59,800 --> 00:21:06,440 So my exercise tolerance started going downhill and so my my pace 341 00:21:06,440 --> 00:21:11,080 got slower, my ability to finish long runs started to diminish, 342 00:21:11,760 --> 00:21:14,240 you know, and nothing really, nothing really changed about, 343 00:21:14,280 --> 00:21:16,920 you know, what I was doing. It was still, you know, getting 344 00:21:17,520 --> 00:21:20,320 fair, you know, decent amount of sleep and, you know, eating 345 00:21:20,520 --> 00:21:22,880 decently like my weight stayed the same. 346 00:21:22,880 --> 00:21:29,400 So nothing really major changed. And so I really couldn't put my 347 00:21:29,400 --> 00:21:31,960 finger on it And then I said no, I bet you it's probably those 348 00:21:31,960 --> 00:21:37,240 late effects catching up to me. And so the the article that 349 00:21:37,240 --> 00:21:41,680 you're referring to was about five years ago. 350 00:21:41,680 --> 00:21:47,440 I went to my my PCP and I said, you know, I'm not feeling great. 351 00:21:47,800 --> 00:21:52,040 I'm not who I was. I know what I was, what I'm 352 00:21:52,040 --> 00:21:54,600 capable of doing, and I'm not doing that anymore. 353 00:21:55,720 --> 00:22:00,560 Thankfully he took me seriously based on my history, and he sent 354 00:22:00,560 --> 00:22:04,320 me for a bunch of cardio, cardiac and pulmonary workups. 355 00:22:05,560 --> 00:22:08,800 And thankfully the cardiac workups were all normal, but the 356 00:22:08,800 --> 00:22:13,600 pulmonary was not. My lungs look like I had COPD. 357 00:22:16,840 --> 00:22:20,320 And so the the driving point of that article is that the 358 00:22:20,320 --> 00:22:23,600 pulmonologist looks at me and he says you don't fit the profile 359 00:22:23,600 --> 00:22:27,320 like you're, you know, you've got a normal weight, you're more 360 00:22:27,320 --> 00:22:31,360 exposed to any environmental toxins and all the things. 361 00:22:31,360 --> 00:22:33,520 And I said, yeah, I had glutomycin and he goes, oh, 362 00:22:33,760 --> 00:22:36,280 right. Then he started taking me 363 00:22:36,280 --> 00:22:39,040 seriously. I think that's a really good, 364 00:22:40,680 --> 00:22:43,000 I'm glad that you talked about this because I think that this 365 00:22:43,000 --> 00:22:46,760 story will really sit in healthcare providers minds like 366 00:22:46,760 --> 00:22:49,000 right. I need to remember that this 367 00:22:49,000 --> 00:22:53,520 patient had cancer 20 years ago and they while they appear very 368 00:22:53,520 --> 00:22:57,000 healthy and they don't have any of the normal risk factors. 369 00:22:57,520 --> 00:23:01,600 I forgot about an important one because we've got to help our 370 00:23:01,600 --> 00:23:04,880 patients as best we can, and that includes really considering 371 00:23:04,880 --> 00:23:08,440 their whole medical history, not just the person who's sitting in 372 00:23:08,440 --> 00:23:10,920 front of us at this moment. Yeah. 373 00:23:10,920 --> 00:23:13,440 And I think and there's more and more research that has come out 374 00:23:13,440 --> 00:23:17,320 now again about how especially for the, for our patients who 375 00:23:17,320 --> 00:23:22,840 are younger, you know, our, our pediatric oncology survivors and 376 00:23:23,080 --> 00:23:27,440 you know, As for me as an adolescent young adult, you know 377 00:23:27,440 --> 00:23:30,040 who are going to potentially hopefully have decades of life 378 00:23:30,040 --> 00:23:33,840 ahead of them, that just means there's a longer runway, but 379 00:23:33,840 --> 00:23:35,280 they can experience these late effects. 380 00:23:35,600 --> 00:23:39,080 And so, yeah, so on the outside, yeah, my hair grew back and you 381 00:23:39,080 --> 00:23:41,920 know, everything looks OK on the outside. 382 00:23:41,920 --> 00:23:46,520 But inside our body systems deteriorate faster than somebody 383 00:23:46,520 --> 00:23:49,440 who is not exposed to those treatments. 384 00:23:50,000 --> 00:23:54,360 So now you know in modern times, like if this happen, if you were 385 00:23:54,360 --> 00:24:01,440 diagnosed now, how do you think your care from diagnosis to then 386 00:24:01,440 --> 00:24:04,840 the follow up ten years later would have been different. 387 00:24:05,160 --> 00:24:08,880 Like what one, You definitely wouldn't have been in a hospital 388 00:24:08,880 --> 00:24:11,440 bed for a month. Even if you needed to be in the 389 00:24:11,440 --> 00:24:14,040 hospital for a month, you definitely would have received 390 00:24:14,040 --> 00:24:16,600 some physical therapy in the hospital, right? 391 00:24:17,320 --> 00:24:21,960 So how do you like, in an ideal situation, the way that you 392 00:24:21,960 --> 00:24:25,720 teach your students, the way that Smilo does things. 393 00:24:26,080 --> 00:24:29,360 If you were, if you were in PT school now and got that 394 00:24:29,360 --> 00:24:31,680 diagnosis, how do you think things would have been 395 00:24:31,680 --> 00:24:34,560 different? Well, right off the bat, I can 396 00:24:34,560 --> 00:24:37,320 tell you that they don't use bleomyosin as much as they used 397 00:24:37,320 --> 00:24:41,760 to because of the late effects, because of that pulmonary 398 00:24:41,760 --> 00:24:45,440 fibrosis. And so I was, that was stage 399 00:24:45,440 --> 00:24:48,320 two. So the cancer had spread from my 400 00:24:48,320 --> 00:24:52,840 testicle to my lymph nodes, but it did not get in my bones. 401 00:24:52,920 --> 00:24:56,000 And thankfully. And so they usually preserve 402 00:24:56,000 --> 00:25:00,840 bleomyosin for, you know, anybody who's like a Stage 3 or 403 00:25:00,840 --> 00:25:05,520 a Stage 4. And if I had the complications 404 00:25:05,520 --> 00:25:08,960 that I had back then and I was hospitalized for a month, yes, 405 00:25:08,960 --> 00:25:12,200 PT would have hopefully gotten to me to Get Me Out of bed, to 406 00:25:12,200 --> 00:25:14,240 get me moving around. I think that's the other thing 407 00:25:14,240 --> 00:25:18,600 too, that I forgot to mention, Andrea, is that, and this always 408 00:25:18,600 --> 00:25:22,640 blows, at least definitely my students minds at this point, 409 00:25:22,640 --> 00:25:24,720 right? You know, they'll ask me, 410 00:25:24,720 --> 00:25:26,520 they'll say. Well, didn't you get PT? 411 00:25:27,400 --> 00:25:30,440 No. I did not get, I did not get PT 412 00:25:30,440 --> 00:25:34,640 when I was in the hospital. I did not get PT at any point 413 00:25:35,160 --> 00:25:39,840 during treatment and I have I have never to this day received 414 00:25:39,840 --> 00:25:45,720 APT referral be based on my cancer or my treatments. 415 00:25:46,680 --> 00:25:49,840 Wow. So hopefully now that's changing 416 00:25:51,560 --> 00:25:55,800 and I think that medical oncologists and and surgeons are 417 00:25:55,800 --> 00:25:59,880 much more cognizant of that and they and radiation oncologists 418 00:25:59,880 --> 00:26:01,560 are much more cognizant of that And they're getting their 419 00:26:01,560 --> 00:26:04,120 patients to rehab. They're getting them to you in 420 00:26:04,120 --> 00:26:06,800 May to say make sure this patient does not get 421 00:26:06,800 --> 00:26:09,520 deconditioned. I'm even working with, with a 422 00:26:09,520 --> 00:26:13,400 doctor now who specializes with in patients with colorectal 423 00:26:13,400 --> 00:26:16,880 cancer who may have metastasized. 424 00:26:17,240 --> 00:26:23,680 And he's all about prehab, like he wants patients before they 425 00:26:23,680 --> 00:26:27,960 have surgery to get PT, to get them conditioned, to get them in 426 00:26:27,960 --> 00:26:30,960 the best shape possible going into surgery. 427 00:26:31,400 --> 00:26:34,560 Because we we have that evidence now that's because we have that 428 00:26:34,560 --> 00:26:36,520 evidence from an orthopedic perspective, right. 429 00:26:36,520 --> 00:26:40,560 But you know this as an orthopedic specialist, you know, 430 00:26:40,840 --> 00:26:44,480 if I was going to have my knee replaced or my hip replaced, you 431 00:26:44,480 --> 00:26:47,120 know, the orthopedic doctor would evaluate me and then they 432 00:26:47,120 --> 00:26:50,920 would send me to you and they say, all right, Andrea, get this 433 00:26:50,920 --> 00:26:54,440 guy in shape prior to his hip replacement. 434 00:26:54,920 --> 00:26:58,840 Yeah, we know that any type of surgery is going to knock your 435 00:26:58,840 --> 00:27:03,160 fitness down a peg or several pegs, depending on your the type 436 00:27:03,160 --> 00:27:06,800 of surgery. So if you get as fit and strong 437 00:27:06,800 --> 00:27:10,160 as possible before the surgery, yeah, you're still going to get 438 00:27:10,160 --> 00:27:14,480 knocked down those pegs, but the level you get to isn't going to 439 00:27:14,480 --> 00:27:18,520 be as low. And hopefully in prehab you can 440 00:27:18,520 --> 00:27:22,760 address any small issues that could become bigger issues 441 00:27:22,760 --> 00:27:27,040 during the recovery process. So for example, someone who 442 00:27:27,040 --> 00:27:31,440 might be going to have a mastectomy or a lumpectomy who 443 00:27:31,440 --> 00:27:35,440 has shoulder range motion issues, you might work on that 444 00:27:35,440 --> 00:27:41,160 prior to that surgery to help with their recovery at post op. 445 00:27:41,600 --> 00:27:44,160 Yeah, absolutely. We can address range of motion 446 00:27:44,160 --> 00:27:47,000 concerns. We can address anybody who has 447 00:27:47,000 --> 00:27:51,600 any kind of balance concerns, you know overall conditioning 448 00:27:51,600 --> 00:27:54,120 ahead of time. And again I think it's really 449 00:27:54,120 --> 00:27:58,480 important for us as PTS to have that baseline data so that we 450 00:27:58,480 --> 00:28:00,000 know where they're starting from. 451 00:28:00,520 --> 00:28:03,760 So your to your point like when they come out of the hospital, 452 00:28:03,760 --> 00:28:06,680 we know where to get them back to, right? 453 00:28:06,680 --> 00:28:10,800 Like if we don't see them prior to any major surgery, whether 454 00:28:10,800 --> 00:28:14,040 it's a hip replacement or it's a mastectomy, we don't know what 455 00:28:14,040 --> 00:28:15,680 their prior level of function was. 456 00:28:15,680 --> 00:28:18,120 We don't, we only have their their report, but we don't have 457 00:28:18,120 --> 00:28:21,200 any objective data, right, to compare that to. 458 00:28:21,680 --> 00:28:24,960 So if we can get to those patients ahead of time and then 459 00:28:24,960 --> 00:28:28,920 we can say, oh, right, like let's, let's see where you're at 460 00:28:28,920 --> 00:28:30,480 now. And if we do have a little bit 461 00:28:30,480 --> 00:28:33,080 of a window, great, and maybe get you even a little bit more, 462 00:28:33,560 --> 00:28:37,320 little bit stronger and then when you come out of the 463 00:28:37,320 --> 00:28:40,480 hospital, we can get you back up to where you need to be. 464 00:28:41,280 --> 00:28:43,800 Right, and I think that's important for a few reasons. 465 00:28:43,800 --> 00:28:48,440 One, in today's insurance driven world, if you have documentation 466 00:28:48,440 --> 00:28:52,280 as to a person's prior level of function, then you have better 467 00:28:52,280 --> 00:28:56,120 justification for why they might need to stay in treatment longer 468 00:28:56,120 --> 00:28:58,720 post OP. The other thing is, you know, 469 00:28:58,720 --> 00:29:03,600 this is a podcast for runners. Runners tend to be on the high 470 00:29:03,600 --> 00:29:06,520 end of the spectrum when they go in to see a doctor or a physical 471 00:29:06,520 --> 00:29:12,280 therapist, and too often athletes do not get help to 472 00:29:12,280 --> 00:29:15,160 return to their prior level of function. 473 00:29:15,520 --> 00:29:19,520 They get help to basically be able to walk and to go up and 474 00:29:19,520 --> 00:29:23,000 down stairs, and then their insurance often cuts them off. 475 00:29:23,560 --> 00:29:29,640 But their lifestyle, their identities, Their primary mode 476 00:29:29,640 --> 00:29:32,480 of physical activity, they need to be able to get back to a 477 00:29:32,480 --> 00:29:36,000 higher level. So even if their insurance isn't 478 00:29:36,000 --> 00:29:40,360 going to pay for it, often runners are willing to continue 479 00:29:40,360 --> 00:29:43,280 with treatment to help them get back to the level that they were 480 00:29:43,280 --> 00:29:46,640 previously at, so that they can get back to their life. 481 00:29:47,240 --> 00:29:50,240 And if we don't have documentation as to what that 482 00:29:50,240 --> 00:29:55,240 level was, it's hard to, one, estimate how long it's going to 483 00:29:55,240 --> 00:29:57,040 take to get them back to that point. 484 00:29:57,440 --> 00:30:01,320 But two, just to have a have objective goals for that person. 485 00:30:02,000 --> 00:30:03,560 Yeah. And I think what you're, what 486 00:30:03,560 --> 00:30:06,080 you're referring to there, Andrea, is again patient 487 00:30:06,080 --> 00:30:09,480 centered care, right. And really being able to 488 00:30:09,720 --> 00:30:13,160 identify what that patient's goals are, right. 489 00:30:13,200 --> 00:30:18,000 And if that patient's goals are to get back running again, then 490 00:30:18,520 --> 00:30:21,040 their goals become our goals as PTS. 491 00:30:21,040 --> 00:30:25,000 Right. And so yeah, it's not, you know, 492 00:30:25,040 --> 00:30:27,760 for that person. It's not enough to just say, OK, 493 00:30:27,760 --> 00:30:30,200 well, you can, you know, you can walk, you know, from the bedroom 494 00:30:30,200 --> 00:30:31,840 to the bathroom and and that sort of thing. 495 00:30:31,840 --> 00:30:34,320 Like we're again, we're talking about quality of life. 496 00:30:35,280 --> 00:30:38,080 Right. And that's how I frame it so 497 00:30:38,080 --> 00:30:41,400 often when I write my notes, you know, my justification is, you 498 00:30:41,400 --> 00:30:44,400 know, this is we're trying to enhance their quality of life. 499 00:30:44,400 --> 00:30:47,360 And you know, if they're still here, then they're not at their, 500 00:30:47,560 --> 00:30:50,440 their optimal quality of life. They have not returned to that 501 00:30:50,440 --> 00:30:53,280 prior level of function. Right. 502 00:30:53,520 --> 00:30:57,640 And so I've worked with plenty of patients who were runners, 503 00:30:57,880 --> 00:30:59,560 you know, prior to their diagnosis. 504 00:31:00,840 --> 00:31:04,560 And and that's what they said. They said, OK, great, my arm. 505 00:31:04,840 --> 00:31:08,240 I can raise my arm over my head now that's great. 506 00:31:08,600 --> 00:31:11,240 But I need to get back on the treadmill, right? 507 00:31:11,240 --> 00:31:15,760 Like I, you know, I really want to run a 5K, you know, at the 508 00:31:15,760 --> 00:31:19,360 end of the summer. OK, Well, let me also make sure 509 00:31:19,360 --> 00:31:24,120 that I'm screening for neuropathy in your feet because 510 00:31:24,120 --> 00:31:26,320 of your chemotherapy. Let's make sure you're safe 511 00:31:26,320 --> 00:31:29,200 first and foremost, let's work on that. 512 00:31:29,480 --> 00:31:34,160 Once we can address that, then we can build on that and we can 513 00:31:34,320 --> 00:31:37,560 up the ante so to speak. And then we can work on, you 514 00:31:37,560 --> 00:31:40,960 know, working on endurance and working on on speed and and that 515 00:31:40,960 --> 00:31:43,120 sort of thing. And they may, you know, injury, 516 00:31:43,120 --> 00:31:47,560 they may get to a point where you know, I work with them and 517 00:31:48,040 --> 00:31:51,440 again they may have the neuropathy in their, their feet 518 00:31:51,440 --> 00:31:53,680 like they have this, this numbness and tingling in their 519 00:31:53,760 --> 00:31:58,320 in their toes induced by their chemotherapy. 520 00:31:58,600 --> 00:32:02,120 And so I'll give them exercises to work and I'll give them 521 00:32:02,120 --> 00:32:05,520 sensory activities to work on and try to diminish that. 522 00:32:06,080 --> 00:32:08,720 And then I might say, listen, you're, you know, you're doing 523 00:32:08,720 --> 00:32:10,920 well from an oncology perspective, from a cancer 524 00:32:10,920 --> 00:32:13,840 perspective, you're doing good. I'm going to send you over to my 525 00:32:13,840 --> 00:32:17,160 friend Andrea now and she is a specialist, she's an orthopaedic 526 00:32:17,160 --> 00:32:19,600 specialist. And so she can take you that 527 00:32:19,600 --> 00:32:22,640 next level. You know, if I can't do it, then 528 00:32:22,640 --> 00:32:26,640 I got somebody who can to be able to advance you to get you, 529 00:32:26,800 --> 00:32:28,280 get you back to where you need to be. 530 00:32:28,560 --> 00:32:32,200 Again, we have to be able to work together, you know, to to 531 00:32:32,200 --> 00:32:34,000 meet the needs of these of these patients. 532 00:32:34,520 --> 00:32:35,480 Absolutely. Yep. 533 00:32:35,520 --> 00:32:38,240 Healthcare is always a team approach and I really love the 534 00:32:38,240 --> 00:32:41,640 collaborative nature of the team that you have at Smilo. 535 00:32:41,920 --> 00:32:44,640 So can you talk just briefly about how that works? 536 00:32:44,640 --> 00:32:48,600 So you work with a dietitian and a social worker and APA, so 537 00:32:48,680 --> 00:32:51,560 you're really covering a lot of bases in terms of what someone 538 00:32:51,560 --> 00:32:55,840 might need. So if somebody is, you know, 539 00:32:56,320 --> 00:33:01,440 recently diagnosed, they've been referred to your clinic, what is 540 00:33:01,440 --> 00:33:04,880 that intake like? What what does each member of 541 00:33:04,880 --> 00:33:08,040 the team look at and how does their treatment? 542 00:33:08,040 --> 00:33:10,640 I'm of course it's different for everybody, but how might 543 00:33:10,640 --> 00:33:13,320 treatment typically progress? Yeah. 544 00:33:13,440 --> 00:33:19,440 So that particular clinic that you're referring to is we we see 545 00:33:19,640 --> 00:33:24,920 folks who are done with active treatment for maybe for a a 546 00:33:24,920 --> 00:33:28,160 patient who's had breast cancer, they may still be on on hormone 547 00:33:28,160 --> 00:33:33,880 therapy, but the chemo, the radiation surgery that that 548 00:33:33,880 --> 00:33:39,840 that's all done at that point. And so we all work together 549 00:33:39,840 --> 00:33:44,400 collaboratively to identify what the needs of that person are. 550 00:33:45,040 --> 00:33:49,640 And so for example we'll talk about cancer related fatigue 551 00:33:49,640 --> 00:33:52,240 which again is a very real phenomenon. 552 00:33:53,160 --> 00:33:56,720 It's the most common physical side effect that we see as a 553 00:33:56,720 --> 00:34:02,800 result of cancer treatment. And so, you know, you and me as 554 00:34:02,800 --> 00:34:08,960 PTS, you know, we may be talking to this patient about OK, how 555 00:34:08,960 --> 00:34:12,360 can you start an exercise program or how can you resume an 556 00:34:12,360 --> 00:34:15,400 exercise program And we can talk again about the dosing of the 557 00:34:15,400 --> 00:34:20,840 exercise and and how to progress somebody again because now we 558 00:34:20,840 --> 00:34:25,960 have the evidence that says to be able to exercise helps to 559 00:34:26,400 --> 00:34:31,480 reduce cancer related fatigue. But fatigue is a multifactorial 560 00:34:31,480 --> 00:34:33,960 thing. It's not just one thing and 561 00:34:33,960 --> 00:34:35,600 there's not just one way to address it. 562 00:34:36,280 --> 00:34:39,040 So the dietitian is going to see that person next. 563 00:34:39,520 --> 00:34:44,199 The dietitian is going to say, OK, how are you eating? 564 00:34:44,400 --> 00:34:47,639 When are you eating? Are you hydrating well enough? 565 00:34:48,000 --> 00:34:51,320 You know, and and I think one of the one of the great things that 566 00:34:51,400 --> 00:34:55,040 all the dietitians that I that I work with and I have worked with 567 00:34:55,040 --> 00:34:58,480 over the past is that none of them talk about a diet. 568 00:34:59,560 --> 00:35:03,520 It's not a diet, it's a modification. 569 00:35:03,520 --> 00:35:07,440 It's swapping one thing for something else and it's not 570 00:35:07,440 --> 00:35:12,360 starving yourself and it's not doing crazy that, you know, fad 571 00:35:12,360 --> 00:35:15,840 diets that you see on Instagram, It's all same thing. 572 00:35:16,240 --> 00:35:19,480 It's based on their evidence, on their research that their 573 00:35:19,480 --> 00:35:27,080 profession has done to be able to help fuel patients properly 574 00:35:27,080 --> 00:35:31,840 and safely so that it helps them give them more energy so that 575 00:35:31,840 --> 00:35:35,920 way they can run and get back to exercising. 576 00:35:36,760 --> 00:35:41,040 So that's the the dietitian contribution to fatigue. 577 00:35:43,440 --> 00:35:51,320 Fatigue can also be emotional and the the stress of the cancer 578 00:35:51,320 --> 00:35:55,800 diagnosis and the stress of having to put different aspects 579 00:35:55,800 --> 00:35:58,200 of your life on hold while you go through treatment and how 580 00:35:58,200 --> 00:36:02,920 that affects you and how that affects your immediate nucleus 581 00:36:02,920 --> 00:36:07,160 of a family and and work. And all of that just contributes 582 00:36:07,160 --> 00:36:10,320 to an enormous amount of of stress and anxiety. 583 00:36:12,080 --> 00:36:16,800 And so for a social worker to be able to address that and to be 584 00:36:16,800 --> 00:36:24,080 able to validate it and then give that person tools, you 585 00:36:24,080 --> 00:36:27,280 know, whether it's meditation apps or if it's a support group 586 00:36:27,280 --> 00:36:30,680 or something like that to help them from an emotional 587 00:36:30,680 --> 00:36:34,840 standpoint address the fatigue is really important. 588 00:36:35,920 --> 00:36:38,440 And then the last part, the medical component again whether 589 00:36:38,440 --> 00:36:43,160 it's a physician's assistant or an APRN, you know, they're going 590 00:36:43,160 --> 00:36:46,400 to look at that person's, you know, do a really deep dive into 591 00:36:46,400 --> 00:36:50,880 the that person's medical records and and again look at at 592 00:36:51,560 --> 00:36:54,880 you know blood values and and hormone levels and everything 593 00:36:54,880 --> 00:36:57,520 and you know, potentially make any suggestions or 594 00:36:57,520 --> 00:37:01,120 recommendations to say Oh yeah your your B12 is really low. 595 00:37:02,120 --> 00:37:06,520 So maybe you do need to, you know, take a, you know, take a 596 00:37:06,520 --> 00:37:09,680 bite AB vitamin, B complex vitamin or something like that. 597 00:37:10,560 --> 00:37:14,920 You know, so based on, you know, on lab work, we can see, Oh 598 00:37:14,920 --> 00:37:16,920 yeah, you're deficient here. You're deficient there. 599 00:37:16,920 --> 00:37:20,360 So we can come up with that even just something like sleep 600 00:37:20,360 --> 00:37:26,040 hygiene, you know, like if you're if you're on screens all 601 00:37:26,040 --> 00:37:29,840 night long and you know you're only getting 3 hours of sleep, 602 00:37:29,840 --> 00:37:34,400 like that's a conversation that the the PA or the APRN can have. 603 00:37:34,640 --> 00:37:40,360 And so you put all of that together and that's how we have 604 00:37:40,360 --> 00:37:44,840 this multidisciplinary approach to addressing cancer related 605 00:37:44,840 --> 00:37:47,280 fatigue. That just sounds like a dream 606 00:37:47,280 --> 00:37:51,360 team and how lucky your patients are to have that center 607 00:37:51,360 --> 00:37:54,880 available to them is I know SMILO was the first. 608 00:37:54,880 --> 00:37:59,920 Do you know if there are any other similar centers in the US 609 00:38:00,400 --> 00:38:04,160 just for our listeners, in case they're in need of a place like 610 00:38:04,160 --> 00:38:07,120 that? Yeah, a lot of the, a lot of the 611 00:38:07,120 --> 00:38:10,880 major cancer hospitals around the country have some form of a 612 00:38:10,880 --> 00:38:16,280 survivorship program. There is no true blueprint as to 613 00:38:16,400 --> 00:38:20,240 what that looks like. So there is there may be some 614 00:38:20,240 --> 00:38:24,360 variability between you know what we you know you and me here 615 00:38:24,360 --> 00:38:27,760 in the Northeast versus somebody who's you know in the in the 616 00:38:27,760 --> 00:38:30,400 Midwest or somebody who's who's on the West Coast. 617 00:38:31,600 --> 00:38:36,280 I do know, you know I think that is one of the things that we are 618 00:38:36,360 --> 00:38:41,240 that when I say we the more of the you know the oncology world 619 00:38:41,240 --> 00:38:44,240 is trying to figure out is how to disseminate you know 620 00:38:44,240 --> 00:38:47,760 survivorship care, you know comprehensive holistic 621 00:38:47,760 --> 00:38:52,320 survivorship care from the major academic centers down to more of 622 00:38:52,320 --> 00:38:57,240 the community based hospitals and even further out you know 623 00:38:57,240 --> 00:39:01,400 into rural areas. And so I know that the 624 00:39:01,400 --> 00:39:05,960 oncologists recognize that that is an area that needs further 625 00:39:05,960 --> 00:39:09,440 development. But yes anybody around the 626 00:39:09,440 --> 00:39:13,520 country you know if you live semi close to or if you had your 627 00:39:13,520 --> 00:39:17,880 treatments at you know at A at an academic center of some kind, 628 00:39:17,880 --> 00:39:20,960 they have some form of partnership program there. 629 00:39:21,880 --> 00:39:25,440 So you know to be able to to talk with your, with your 630 00:39:25,440 --> 00:39:30,040 doctors and see if you can get that referral, I think that 631 00:39:30,040 --> 00:39:31,480 would be really beneficial. Yeah. 632 00:39:31,480 --> 00:39:33,880 I was going to ask how does somebody get referred and just 633 00:39:33,880 --> 00:39:36,960 ask their primary care doctor or does it need to come from their 634 00:39:36,960 --> 00:39:39,320 oncologist? They might not be seeing their 635 00:39:39,320 --> 00:39:41,720 oncologist anymore. Yeah. 636 00:39:41,720 --> 00:39:46,640 I mean it's that that's a great question because you know 637 00:39:46,720 --> 00:39:49,440 there's that, there's also that discussion about whose job is it 638 00:39:49,440 --> 00:39:53,640 anyway, is it the medical oncologist, is it the PCP or are 639 00:39:53,640 --> 00:39:57,880 PCPS you know, cognizant enough. I mean again I was very 640 00:39:57,880 --> 00:40:02,400 fortunate that my PCP, you know, he is not necessarily an expert 641 00:40:02,400 --> 00:40:06,840 in in in cancer care, but he was at least you know, willing to 642 00:40:06,840 --> 00:40:10,800 listen to me and take me seriously to get me to the, the 643 00:40:10,800 --> 00:40:15,800 referrals that I needed. Not all PCPS you know, have the 644 00:40:15,800 --> 00:40:20,760 ability to do that. So they may, you may have to 645 00:40:20,760 --> 00:40:24,680 actually, you know. Go and and search and see what 646 00:40:24,680 --> 00:40:29,200 is in your area. If you go to the National Cancer 647 00:40:29,200 --> 00:40:36,040 Institute's website socancer.gov or if you go to the National 648 00:40:36,040 --> 00:40:41,520 Comprehensive Cancer Network, so nccn.org, they should have a 649 00:40:41,520 --> 00:40:44,080 pretty good listing. Like if you put your zip code 650 00:40:44,080 --> 00:40:48,600 in, they can probably help you as far as being able to find a 651 00:40:48,600 --> 00:40:50,400 survivorship program close to you. 652 00:40:50,960 --> 00:40:52,720 Great. And we'll throw those websites 653 00:40:52,720 --> 00:40:55,000 in the show notes so our listeners can get those. 654 00:40:55,840 --> 00:41:02,680 So I think you know getting back to our runner listeners, so if a 655 00:41:02,680 --> 00:41:07,480 runner has been newly diagnosed with cancer, how do they know if 656 00:41:07,480 --> 00:41:11,200 it's safe to continue running? Who should tell them that? 657 00:41:11,720 --> 00:41:16,880 And who is the best person to guide them in that initial 658 00:41:16,880 --> 00:41:21,440 treatment phase of their cancer diagnosis? 659 00:41:22,040 --> 00:41:24,520 Yeah, I think that would you know that would that should come 660 00:41:24,520 --> 00:41:29,200 from us as PTS you know to be able to screen them for, you 661 00:41:29,200 --> 00:41:33,000 know any short term adverse effects again whether it's 662 00:41:33,000 --> 00:41:38,240 neuropathy, whether it's range of motion limitations, anything 663 00:41:38,240 --> 00:41:42,920 like that to be able to to be able to screen them and be able 664 00:41:42,920 --> 00:41:46,120 to say, yeah, you're you're ready to return to running. 665 00:41:47,120 --> 00:41:49,640 You know a lot of times if somebody's coming off of a major 666 00:41:49,640 --> 00:41:54,040 surgery like a mastectomy or if they are coming off of 667 00:41:54,040 --> 00:41:57,840 colorectal cancer surgery, they may have some restrictions which 668 00:41:58,400 --> 00:42:02,360 you know, their surgeon may say, you know, don't do any exercise 669 00:42:02,360 --> 00:42:05,520 or don't do any heavy lifting, you know for X amount of time. 670 00:42:05,520 --> 00:42:10,360 But then once that X amount of time has gone past then they 671 00:42:10,360 --> 00:42:13,680 don't know right what's how do they make that transition from 672 00:42:13,760 --> 00:42:15,560 not necessarily lifting more than 10 lbs. 673 00:42:15,560 --> 00:42:19,400 So then how do we then start going back to working out and 674 00:42:19,400 --> 00:42:20,760 exercising and that sort of thing. 675 00:42:20,760 --> 00:42:24,360 And so that's where you know that's where we as PTS come into 676 00:42:24,360 --> 00:42:28,200 the to the equation here is to say OK let's do this 677 00:42:28,200 --> 00:42:31,800 progressively, let's do this responsibly to be able to get 678 00:42:31,800 --> 00:42:36,240 you exercising again. You know and I I do tell my 679 00:42:36,240 --> 00:42:38,040 patients that it is a process, right. 680 00:42:38,040 --> 00:42:40,560 Like again your goals are my goals. 681 00:42:40,560 --> 00:42:42,960 You want to get back to running great. 682 00:42:43,520 --> 00:42:47,720 We're going to start with you know probably working on range 683 00:42:47,720 --> 00:42:50,440 of motion and just working on balance and strength. 684 00:42:50,840 --> 00:42:53,280 Then we can start to add in some low level cardio. 685 00:42:53,760 --> 00:42:57,040 Then I will start adding in some high intensity interval 686 00:42:57,040 --> 00:43:00,640 training, probably in a safer environment, maybe on like a 687 00:43:00,640 --> 00:43:02,440 like a new step or something like that. 688 00:43:04,040 --> 00:43:08,720 But I will, I will push you and I will progress you based on how 689 00:43:08,720 --> 00:43:10,360 you're doing, how you're presenting to me, what you're, 690 00:43:10,640 --> 00:43:15,280 what you're verbalizing to me. So they, and of course in most 691 00:43:15,280 --> 00:43:18,320 states we have direct access. But someone undergoing cancer 692 00:43:18,320 --> 00:43:22,120 treatment would definitely need a referral for therapy specific 693 00:43:22,120 --> 00:43:24,680 to their treatment. So should they ask their 694 00:43:24,680 --> 00:43:26,960 oncologist? Should they ask their PCP? 695 00:43:26,960 --> 00:43:29,520 Who is the right person to get that referral from? 696 00:43:29,800 --> 00:43:32,320 Yeah. Usually I would say the from the 697 00:43:32,320 --> 00:43:35,240 oncology team whether it's the the surgeon, whether it's the 698 00:43:35,240 --> 00:43:39,520 medical oncologist or again you know a lot of times it is the 699 00:43:39,800 --> 00:43:43,640 the the PA that works in the breast center or it's the APRN 700 00:43:43,640 --> 00:43:48,240 who works in the the colorectal cancer clinic will be the ones 701 00:43:48,240 --> 00:43:50,800 who will physically put those referrals in. 702 00:43:52,000 --> 00:43:55,400 And so you know or even then you know you can talk even with your 703 00:43:55,400 --> 00:43:58,680 nurses like if somebody is in the middle of chemo, you know 704 00:43:58,680 --> 00:44:02,360 and they're sitting in the chemo chair for 5-6 hours, they can 705 00:44:02,360 --> 00:44:05,200 have that conversation with their nurse and their nurse can 706 00:44:05,200 --> 00:44:09,600 run that conversation up to say OK, you know so and so once a 707 00:44:09,600 --> 00:44:14,480 referral for PT they elevate that to whoever the APP is, the 708 00:44:14,480 --> 00:44:17,800 advanced practice practitioner is and they put that in. 709 00:44:17,800 --> 00:44:22,640 So yeah, you can definitely ask any member of of your oncology 710 00:44:22,640 --> 00:44:27,040 team for that referral. And they might have to ask more 711 00:44:27,040 --> 00:44:30,880 than one person to get the referral, unfortunately. 712 00:44:31,360 --> 00:44:33,560 Yeah, they might have to and then you need to. 713 00:44:33,720 --> 00:44:36,440 You know, again depending on where you are, if you're in a a 714 00:44:36,440 --> 00:44:41,440 smaller community based Cancer Center, you know, hopefully you 715 00:44:41,440 --> 00:44:43,160 get that referral through quicker. 716 00:44:43,160 --> 00:44:45,920 If it's a larger academic institution, you may have to 717 00:44:45,920 --> 00:44:48,200 double check to make sure that that referral did get further. 718 00:44:48,760 --> 00:44:51,600 Right. So I'm sure even the most 719 00:44:51,600 --> 00:44:56,320 dedicated of runners, if they got a cancer diagnosis, might 720 00:44:56,320 --> 00:45:01,240 hesitate to continue to exercise either during treatment or after 721 00:45:01,240 --> 00:45:03,560 treatment for fear that it's going to interfere with their 722 00:45:03,560 --> 00:45:07,240 recovery. So what is the research about 723 00:45:07,400 --> 00:45:09,800 the benefits of exercise during cancer treatment? 724 00:45:10,160 --> 00:45:13,840 And what are some guidelines that you use to help determine 725 00:45:14,680 --> 00:45:16,960 what a person should be doing and when? 726 00:45:17,640 --> 00:45:23,200 Yeah, you know, it's interesting if you actually look at our, you 727 00:45:23,200 --> 00:45:29,280 know, our, our cell biology and the the cancer cells themselves 728 00:45:29,280 --> 00:45:37,920 are very, a very acidic hypoxic environment, which makes it hard 729 00:45:37,920 --> 00:45:42,280 for our natural immune system. That's why our immune system has 730 00:45:42,280 --> 00:45:46,200 a tough time identifying and getting into those cancer cells 731 00:45:46,200 --> 00:45:49,480 to kill them, because the cancer cells themselves mutate and 732 00:45:49,480 --> 00:45:53,400 create this really nasty hypoxic environment. 733 00:45:54,800 --> 00:45:58,160 But we can turn on our immune system, we can turn on what's 734 00:45:58,160 --> 00:46:02,040 called natural killer cells, and those are stimulated by 735 00:46:02,040 --> 00:46:06,360 exercise. And so again, if I can get to 736 00:46:06,360 --> 00:46:08,680 these patients while they're in the middle of chemo, the way 737 00:46:08,680 --> 00:46:13,120 that I tell them, the way that I'd say that exercising during 738 00:46:13,120 --> 00:46:18,400 chemo is so important is that you're helping your body fight 739 00:46:18,400 --> 00:46:19,520 the cancer. You're helping with that 740 00:46:19,520 --> 00:46:22,480 delivery of that chemotherapy to get to where it's got to go 741 00:46:22,800 --> 00:46:26,800 specifically and you're stimulating your own immune 742 00:46:26,800 --> 00:46:34,520 system to fight the cancer. And so when I frame it that way, 743 00:46:34,560 --> 00:46:36,880 it really helps patients understand. 744 00:46:36,880 --> 00:46:40,160 Oh, right. Like I can actually do something 745 00:46:40,160 --> 00:46:43,840 about this like in a moment when you feel absolutely powerless 746 00:46:43,840 --> 00:46:46,800 and you feel like you're, you don't have any control right 747 00:46:46,800 --> 00:46:49,360 after that, that cancer diagnosis and you're going 748 00:46:49,360 --> 00:46:52,720 through everything. That's what we can do as PET, 749 00:46:52,720 --> 00:46:54,160 right? We can empower our patients 750 00:46:54,160 --> 00:46:58,560 through movement. So again I will try to support 751 00:46:58,560 --> 00:47:01,840 patients in the prehab phase if I can get to them at that point 752 00:47:02,400 --> 00:47:07,040 I want to see them during chemotherapy during radiation to 753 00:47:07,040 --> 00:47:11,960 help again prevent that loss of function so that they don't lose 754 00:47:11,960 --> 00:47:16,680 that function. And then into survivorship into, 755 00:47:16,680 --> 00:47:20,600 you know that their post treatment phase, whatever that 756 00:47:20,600 --> 00:47:24,240 might look like and forever how long that might look like to 757 00:47:24,880 --> 00:47:29,360 help them get back to the prior level of function, help them 758 00:47:29,360 --> 00:47:32,920 reach their goals. And for so many of our patients 759 00:47:32,920 --> 00:47:38,320 is creating these lifestyle changes because again we have 760 00:47:38,320 --> 00:47:42,400 the evidence now that for people who have a history of breast 761 00:47:42,400 --> 00:47:46,800 cancer, prostate cancer or colorectal cancer, exercise 762 00:47:46,800 --> 00:47:50,000 helps reduce your risk of recurrence by 50%. 763 00:47:50,720 --> 00:47:53,760 Wow. So yeah, it's a pretty powerful 764 00:47:53,760 --> 00:47:57,120 medicine, being able to get our bodies to move. 765 00:47:57,480 --> 00:48:02,120 So even for someone who maybe wasn't a runner or exerciser pre 766 00:48:02,120 --> 00:48:06,360 diagnosis, becoming one afterwards is one of the best 767 00:48:06,360 --> 00:48:08,040 things they can do for themselves. 768 00:48:08,520 --> 00:48:12,040 Yeah, absolutely. So can you maybe walk our 769 00:48:12,040 --> 00:48:15,800 listeners through, if they're coming in for an evaluation with 770 00:48:15,800 --> 00:48:19,600 you and your outpatient clinic? So they've finished treatment, 771 00:48:20,240 --> 00:48:23,680 they're very deconditioned. They're basically like you were 772 00:48:23,680 --> 00:48:25,360 when you were out of the hospital. 773 00:48:26,040 --> 00:48:29,800 What is that process like? When you evaluate them, what are 774 00:48:29,800 --> 00:48:32,720 you looking at? How do you progress them? 775 00:48:32,720 --> 00:48:36,480 What measures do you use to figure out when they're ready to 776 00:48:36,840 --> 00:48:38,680 get on a bike or get on the new step? 777 00:48:38,680 --> 00:48:41,240 When they're ready to start walking outside? 778 00:48:41,240 --> 00:48:42,720 When they're ready to start running? 779 00:48:43,120 --> 00:48:46,880 So again I want to see, I need to measure where they're at. 780 00:48:46,880 --> 00:48:50,480 So I will usually measure their their strength with their upper 781 00:48:50,480 --> 00:48:52,200 body strength and their lower body strength. 782 00:48:53,520 --> 00:48:57,800 I tend to, I like numbers and I was never a math person, but I 783 00:48:57,800 --> 00:49:01,320 definitely like numbers especially if that patient may 784 00:49:01,400 --> 00:49:06,480 transition to you at some point. So I like to do kind of the, 785 00:49:06,680 --> 00:49:10,240 the, you know, kind of the simpler ways of assessing 786 00:49:10,240 --> 00:49:13,320 strength by using a hand gripped entomometer and a 32nd set to 787 00:49:13,320 --> 00:49:16,800 stand, you know, because those are much more objective than you 788 00:49:16,800 --> 00:49:19,080 know what you and I were taught in PT school to do like the 789 00:49:19,080 --> 00:49:26,160 manual muscle testing. So and and then from there, 790 00:49:26,200 --> 00:49:27,640 we're going to come up with a plan. 791 00:49:28,040 --> 00:49:32,120 And I think one of the things that I need to think about 792 00:49:32,440 --> 00:49:36,640 again, if that patient is in the middle of actually in the middle 793 00:49:36,640 --> 00:49:39,800 of treatment is their chemo cycle. 794 00:49:40,400 --> 00:49:46,280 So are they, are they getting chemotherapy every two weeks, 795 00:49:46,360 --> 00:49:49,160 Are they getting chemotherapy every three weeks? 796 00:49:50,360 --> 00:49:54,320 So because I need to know when they're going to have that down 797 00:49:54,320 --> 00:49:59,440 point that Nader so to speak. And so I need to be able to work 798 00:49:59,440 --> 00:50:03,560 around that and so and it drives my scheduling team nuts because 799 00:50:03,560 --> 00:50:06,160 you know I don't do the traditional twice a week for six 800 00:50:06,160 --> 00:50:14,880 weeks thing that I I might say once a week for an on chemo week 801 00:50:14,880 --> 00:50:16,600 and twice a week for an off chemo week. 802 00:50:18,960 --> 00:50:21,960 So, but I tell my patients, I roll with you, right. 803 00:50:23,920 --> 00:50:27,080 So that's I think a big part of that again if I'm if I'm seeing 804 00:50:27,080 --> 00:50:28,920 them when they're in the middle of treatment whether it's that 805 00:50:28,920 --> 00:50:32,320 it's it's chemo or if it's again if it's radiation. 806 00:50:32,800 --> 00:50:34,600 All right. Maybe I need to see you before 807 00:50:34,600 --> 00:50:38,800 you go down to radiation so that I can stretch you out, right. 808 00:50:38,800 --> 00:50:42,280 And and help you get that range of motion to help you get that 809 00:50:42,280 --> 00:50:46,600 arm up over your head so that you can receive the radiation 810 00:50:46,600 --> 00:50:51,720 for that day. And then I will have, you know 811 00:50:51,920 --> 00:50:55,160 for an initial eval, the doctor has to sign off on it. 812 00:50:55,240 --> 00:51:00,080 And again 99% of the time it's coming from one of the oncology 813 00:51:00,080 --> 00:51:02,760 providers. So they know that I'm seeing 814 00:51:02,760 --> 00:51:07,280 their patient and and that I'm working with them and and I can 815 00:51:07,280 --> 00:51:10,760 see again through their chart like who who their doctors are. 816 00:51:10,760 --> 00:51:13,240 So if I have any questions, I can always send them a message 817 00:51:14,400 --> 00:51:18,320 to say, hey, you know, I saw this today with this with your 818 00:51:18,320 --> 00:51:20,680 patient. It looked a little suspicious, 819 00:51:22,160 --> 00:51:25,280 you know, Do you think maybe we need to, you know, investigate 820 00:51:25,280 --> 00:51:29,360 this a little bit more? And so then you know that they 821 00:51:29,360 --> 00:51:31,600 need to order imaging or anything like that. 822 00:51:32,120 --> 00:51:35,200 They will do that. So I'll give you a quick example 823 00:51:35,440 --> 00:51:41,040 about that, Andrea, if I can. Working with a young woman with 824 00:51:41,080 --> 00:51:45,640 breast cancer after radiation therapy, and she was reporting 825 00:51:45,640 --> 00:51:52,600 to me very localized pain on her chest wall in the area where she 826 00:51:52,600 --> 00:51:58,200 had her radiation. And it was very tender to 827 00:51:58,200 --> 00:52:01,680 palpation in two very distinct spots. 828 00:52:02,760 --> 00:52:07,840 And it didn't quite fit the MO of traditional radiation 829 00:52:07,840 --> 00:52:10,480 tightness. So I messed with the doctor and 830 00:52:10,480 --> 00:52:14,200 I said this doesn't quite add up to what I would think I would 831 00:52:14,200 --> 00:52:17,680 see after somebody who's had radiation, you know? 832 00:52:18,240 --> 00:52:19,760 Would you mind taking a look at it? 833 00:52:20,200 --> 00:52:21,880 They look at. They took a look at the patient 834 00:52:22,080 --> 00:52:26,040 they sent her for imaging. She had two rib fractures. 835 00:52:26,320 --> 00:52:28,160 Oh my gosh. Wow. 836 00:52:28,520 --> 00:52:31,480 From the radiation. The radiation weakened her bones 837 00:52:32,880 --> 00:52:36,000 and so that's what we can do with PT, right? 838 00:52:36,000 --> 00:52:41,360 Like we can screen for that in real time and we might need to 839 00:52:41,360 --> 00:52:45,480 be the one who caused the alarm and says this doesn't quite add 840 00:52:45,480 --> 00:52:48,200 up. I think this needs a little bit 841 00:52:48,200 --> 00:52:50,760 more of a work up. Absolutely. 842 00:52:50,760 --> 00:52:54,160 One of the great benefits of being APT is we get to spend 843 00:52:54,160 --> 00:52:57,640 more time with our patients than almost any other healthcare 844 00:52:57,640 --> 00:53:01,440 provider outside of nurses. So we have time to really 845 00:53:01,440 --> 00:53:05,840 explore people's new complaints or worsening complaints. 846 00:53:06,280 --> 00:53:10,360 And then, because PT is like all members of the healthcare team 847 00:53:10,640 --> 00:53:14,800 are good at communication, we can tell that person's doctor, 848 00:53:14,800 --> 00:53:18,320 nurse, or whoever the right person is to get that person 849 00:53:18,320 --> 00:53:20,600 looked at as soon as possible. Yeah. 850 00:53:20,880 --> 00:53:23,880 But to go back to you know kind of finish the, the answer to 851 00:53:23,880 --> 00:53:27,680 your question about you know if somebody is a is a runner and 852 00:53:27,680 --> 00:53:30,040 they're diagnosed with cancer, you know and what that would 853 00:53:30,040 --> 00:53:32,440 look like. Again you need to tell your PT 854 00:53:32,440 --> 00:53:37,000 that and and again tell them that that's important to you. 855 00:53:37,000 --> 00:53:40,800 So that way we, you know, you and me as the PTS, we know that 856 00:53:40,800 --> 00:53:44,320 that is something that is important for you so that we can 857 00:53:44,320 --> 00:53:47,600 help set those goals. I think it's important that we 858 00:53:47,600 --> 00:53:50,880 set realistic expectations to say, OK, well, if you're in the 859 00:53:50,880 --> 00:53:53,440 middle of chemo, you're in the middle of radiation, I don't 860 00:53:53,440 --> 00:53:57,560 necessarily want you going out and running a marathon, but I 861 00:53:57,560 --> 00:54:00,960 still need you to move, right. And so this is how we're going 862 00:54:00,960 --> 00:54:02,000 to do it. This is how we're going to 863 00:54:02,000 --> 00:54:06,200 decide the program. And then as they transition out 864 00:54:06,200 --> 00:54:10,600 of active treatment, then again, that's when we can say, OK, now 865 00:54:10,600 --> 00:54:14,240 after treatment is over, we can advance this a little bit more. 866 00:54:14,400 --> 00:54:18,160 We can start to introduce some of you know, some high, you know 867 00:54:18,160 --> 00:54:21,760 some HIIT training potentially we can do some higher level 868 00:54:21,760 --> 00:54:26,560 balance things and get you back to where you were, you know as 869 00:54:26,560 --> 00:54:30,480 close to back to where you were, you know prior to your 870 00:54:30,480 --> 00:54:32,720 diagnosis. So, but you need to be able to 871 00:54:32,720 --> 00:54:35,960 share that with your, with your, with your provider, you know 872 00:54:35,960 --> 00:54:40,520 share that with your PTS so that we know what's important to you. 873 00:54:41,600 --> 00:54:43,240 Right. And several years ago, 874 00:54:43,240 --> 00:54:46,440 definitely before the pandemic, I went to a great presentation 875 00:54:46,440 --> 00:54:50,160 by Beth Aronson, who's a physiatrist at Danbury Hospital 876 00:54:50,520 --> 00:54:54,560 and it was on cancer rehab. And she gave this incredible 877 00:54:54,560 --> 00:54:59,320 statistic that I feel like it was like 98% of cancer patients 878 00:54:59,320 --> 00:55:01,320 are never referred to physical therapy. 879 00:55:01,640 --> 00:55:04,280 I don't know if that's correct, if I'm remembering correct or 880 00:55:04,280 --> 00:55:08,040 not, but which is shocking and horrible. 881 00:55:08,600 --> 00:55:13,240 But another thing, the kind of theme in her presentation was so 882 00:55:13,240 --> 00:55:18,680 often the focus is just on saving that person's life, that 883 00:55:19,480 --> 00:55:23,000 the doctors are paying attention to that very important thing. 884 00:55:23,000 --> 00:55:26,600 But I think also it's common for the patients to not want to 885 00:55:26,600 --> 00:55:30,640 bring up anything extra like you want. 886 00:55:30,880 --> 00:55:34,160 They almost feel like they have to be just glad that they 887 00:55:34,160 --> 00:55:37,040 survived and like not ask for anything else. 888 00:55:37,040 --> 00:55:39,400 But that's that's not really it, right? 889 00:55:39,400 --> 00:55:43,480 Like the point of this healthcare system is to not only 890 00:55:43,840 --> 00:55:47,480 save your life, but save the quality of your life, which 891 00:55:47,480 --> 00:55:51,760 you've mentioned many times. And I think it's just important 892 00:55:51,760 --> 00:55:56,320 for patients to know that it's OK to ask about those sort of 893 00:55:56,320 --> 00:55:59,440 things. It's not, you're not being a 894 00:55:59,440 --> 00:56:02,280 pain, You're not, you know, asking for too much. 895 00:56:02,280 --> 00:56:04,520 It's your life, it's a big part of your life. 896 00:56:04,520 --> 00:56:08,160 So don't don't hesitate to bring it up when you're talking to 897 00:56:08,160 --> 00:56:10,120 your providers. Yeah. 898 00:56:10,120 --> 00:56:13,160 And I think that that might be a really good, this might be a 899 00:56:13,160 --> 00:56:14,920 good time to to bring this up too. 900 00:56:14,920 --> 00:56:17,800 Again, you know, what you're talking about is, is, is patient 901 00:56:17,800 --> 00:56:23,160 advocacy And you know, I I tell my patients all the time, it is 902 00:56:23,160 --> 00:56:25,240 your right to go get a second opinion. 903 00:56:26,280 --> 00:56:31,120 It is your right as the patient to bring somebody with you as a 904 00:56:31,120 --> 00:56:34,720 second set of eyes and a second set of ears and preferably that 905 00:56:34,720 --> 00:56:37,360 that person's got either their laptop with them or they got a 906 00:56:37,360 --> 00:56:42,080 pen and paper to be able to have pre prepared questions and to be 907 00:56:42,080 --> 00:56:46,760 able to write down things. Because you know most of the 908 00:56:46,760 --> 00:56:50,400 time for the patient themselves like they're so overwhelmed that 909 00:56:50,400 --> 00:56:54,720 they probably hear only you know 20% of what the doctor is 910 00:56:54,720 --> 00:57:01,720 saying. So, yeah, I think that quality 911 00:57:01,720 --> 00:57:06,280 of life, not just living but having you know a good quality 912 00:57:06,280 --> 00:57:11,120 of life is I think the new forefront of oncology care in 913 00:57:11,120 --> 00:57:15,200 general. I do feel like I am seeing, I've 914 00:57:15,200 --> 00:57:18,760 done this long enough that I am starting to see a shift with 915 00:57:19,720 --> 00:57:21,640 with oncology care. You know what? 916 00:57:21,880 --> 00:57:24,680 Globally, where, you know, they're being cognizant of 917 00:57:24,680 --> 00:57:28,040 saying, OK, well, again, this patient is young. 918 00:57:28,040 --> 00:57:31,480 This patient is, you know, 30 years old with a diagnosis of 919 00:57:31,480 --> 00:57:36,080 breast cancer. Maybe we don't use Adriamycin, 920 00:57:36,080 --> 00:57:39,160 which is cardiotoxic. Maybe we come up with a 921 00:57:39,160 --> 00:57:44,240 different protocol for this patient because we hope that 922 00:57:44,240 --> 00:57:47,400 she's going to live for another 50 years after this, Right? 923 00:57:48,840 --> 00:57:53,160 But not every, not every institution says that, and not 924 00:57:53,160 --> 00:57:55,960 every doctor says that. So I do think that that is, you 925 00:57:55,960 --> 00:58:01,240 know, a legit question to ask. But again, you know, when it 926 00:58:01,240 --> 00:58:05,680 comes to to quality of life, you know that's where you and I and 927 00:58:05,680 --> 00:58:09,520 and all of our PT colleagues come into play here just to make 928 00:58:09,520 --> 00:58:12,880 sure that, you know, it's one thing to be living, but it's 929 00:58:12,880 --> 00:58:15,320 another thing to be living well. Right. 930 00:58:15,720 --> 00:58:18,240 Yeah. And and you know, I think I want 931 00:58:18,240 --> 00:58:21,560 to talk a little bit about us as physical therapists too, because 932 00:58:21,560 --> 00:58:26,160 I think many PTS don't have the experience or education in 933 00:58:26,160 --> 00:58:29,120 oncology rehab. Certainly you and I didn't get 934 00:58:29,120 --> 00:58:32,360 that from our schools. Newer grads are hopefully 935 00:58:32,360 --> 00:58:37,240 getting some of that. But many of our patients no 936 00:58:37,240 --> 00:58:40,720 matter what type of setting we work in outpatient, ortho, 937 00:58:40,720 --> 00:58:43,920 neuro, Pediatrics, we've got patients who are cancer 938 00:58:43,920 --> 00:58:47,400 survivors and those patients would be better served to have 939 00:58:47,400 --> 00:58:49,640 PTS who are educated on this topic. 940 00:58:50,080 --> 00:58:54,760 So, and I hopefully this whole episode has provided PTS and 941 00:58:54,760 --> 00:58:57,760 other healthcare providers many good reasons to get educated. 942 00:58:58,240 --> 00:59:01,400 But why should PTS who don't work in an oncology setting 943 00:59:01,440 --> 00:59:05,200 learn more about oncology rehab? And if they want to, do you have 944 00:59:05,200 --> 00:59:07,080 any suggestions where they can do that? 945 00:59:07,760 --> 00:59:10,440 Yeah, well, again the, you know, just the the stats that we 946 00:59:10,440 --> 00:59:13,920 talked about earlier, you know in this podcast of you know of 947 00:59:13,920 --> 00:59:18,240 18,000,000 cancer survivors currently living in the United 948 00:59:18,240 --> 00:59:20,720 States. You know, and in 2024 there will 949 00:59:20,720 --> 00:59:24,600 be 2 million new diagnosis of cancer. 950 00:59:24,600 --> 00:59:27,640 So you know, I've been saying this for a long time and my 951 00:59:27,640 --> 00:59:31,160 colleagues in Gahorian Oncology say that again, it's not a 952 00:59:31,240 --> 00:59:33,440 question of if you will see somebody with a history of 953 00:59:33,440 --> 00:59:37,880 cancer, but when. And again, they may not be 954 00:59:37,880 --> 00:59:42,720 walking in your door with a specific concern related to 955 00:59:42,720 --> 00:59:48,800 their cancer treatment, but it's important to screen for any of 956 00:59:48,800 --> 00:59:52,120 those lead effects depending on where that person is. 957 00:59:53,520 --> 00:59:59,240 Again, you know, we want to make sure that we're cognizant of any 958 00:59:59,720 --> 01:00:05,080 side effects whether it's again, is it neuropathy, is it range of 959 01:00:05,080 --> 01:00:11,280 motion deficits that were caused or shoulder deficits that are 960 01:00:11,280 --> 01:00:15,200 caused because of. A mastectomy surgery plus 961 01:00:15,200 --> 01:00:20,400 radiation therapy or any or anything like that. 962 01:00:21,840 --> 01:00:25,440 I think that if PTS specifically would want to get more 963 01:00:25,440 --> 01:00:30,040 information about oncology rehab, there are some great 964 01:00:30,040 --> 01:00:31,800 resources that are out there now. 965 01:00:32,200 --> 01:00:40,120 I know in late 2022 there was a a great textbook that just came 966 01:00:40,120 --> 01:00:44,120 out called Oncology Rehabilitation by Dougherty 967 01:00:44,120 --> 01:00:49,720 Wilson and Bow Wright that was written by PTS or PTS in 968 01:00:49,720 --> 01:00:56,160 oncology rehab. If as APET, if your institution 969 01:00:56,160 --> 01:01:00,680 does have a a subscription to to the Medbridge platform, 970 01:01:01,200 --> 01:01:04,640 Medbridge is great because it's got the patient facing aspect of 971 01:01:04,640 --> 01:01:07,840 it, which is great for us to put together our home exercise 972 01:01:07,840 --> 01:01:10,920 programs for our patients. But it also has a professional 973 01:01:10,920 --> 01:01:17,760 track for us for us to get our CUS and in addition to great 974 01:01:17,760 --> 01:01:23,320 content in ortho and neuro and IMPEDES, there is content on 975 01:01:23,320 --> 01:01:28,200 there and there is actually a track now in oncology care, 976 01:01:28,240 --> 01:01:33,120 oncology PT with some of the the greats in in the oncology PT 977 01:01:33,120 --> 01:01:35,600 space who've done presentations there. 978 01:01:35,600 --> 01:01:39,800 So you know so there's those are some great options to to kind of 979 01:01:39,800 --> 01:01:42,960 get started. You know, hopefully you'll put 980 01:01:42,960 --> 01:01:46,240 my contact information in the show notes as well that people 981 01:01:46,240 --> 01:01:48,320 are always welcome to reach out to me. 982 01:01:50,520 --> 01:01:55,560 And but yeah, it's there. There is more and more evidence 983 01:01:55,560 --> 01:01:57,560 that's out there now. There's more research that's out 984 01:01:57,560 --> 01:02:00,480 there now. So you know, don't feel that you 985 01:02:00,480 --> 01:02:03,840 can, you know that, oh, I can't, I can't do this because I, you 986 01:02:03,840 --> 01:02:06,120 know, I can't work with this patient because they've had 987 01:02:06,120 --> 01:02:08,440 cancer. No, they they, those patients 988 01:02:08,440 --> 01:02:10,640 need you again. If they're trying to get back to 989 01:02:10,640 --> 01:02:14,600 running or if they're trying to get back to lifting their 990 01:02:14,600 --> 01:02:18,560 three-year old grandchild, whatever their goals are, that's 991 01:02:18,560 --> 01:02:21,480 what our goals are. Yeah, we are the movement 992 01:02:21,480 --> 01:02:23,560 specialists. We just need to make sure that 993 01:02:23,560 --> 01:02:27,560 we're educated enough to help our patients who have cancer as 994 01:02:27,560 --> 01:02:31,040 a either current or past medical history definitely. 995 01:02:31,920 --> 01:02:36,000 And just one last question. So of course you are one of the 996 01:02:36,000 --> 01:02:40,160 founding members of the oncology section of the APTA. 997 01:02:40,520 --> 01:02:46,320 So how can patients find PTS who are also certified in oncology 998 01:02:46,320 --> 01:02:50,240 rehab? So if through our national 999 01:02:50,240 --> 01:02:54,000 organization, the American Physical Therapy Association, if 1000 01:02:54,000 --> 01:02:59,360 they go to the website choosept.com, that's all one 1001 01:02:59,360 --> 01:03:03,000 word. Choose pt.com, you can put in 1002 01:03:03,000 --> 01:03:09,880 your zip code and then you can put in based on specialties. 1003 01:03:09,880 --> 01:03:12,640 So if they were looking for an orthopaedic specialist, they can 1004 01:03:13,000 --> 01:03:15,200 put, you know they can put Connecticut, they can put 1005 01:03:15,200 --> 01:03:18,040 orthopedic specialists and and then your name would pop up. 1006 01:03:19,600 --> 01:03:24,080 Then if they, if you're looking for an oncology specialist in PT 1007 01:03:24,520 --> 01:03:27,920 then you could, you know if you lived in Connecticut then my 1008 01:03:27,920 --> 01:03:31,800 name would pop up. So that is a great starting 1009 01:03:31,800 --> 01:03:36,640 point for that. Yeah, I would probably say that 1010 01:03:36,640 --> 01:03:40,240 that choose pt.com website is probably a great place to start. 1011 01:03:40,680 --> 01:03:42,280 Great. And we'll throw that link in the 1012 01:03:42,280 --> 01:03:46,080 show notes too. So any closing thoughts for our 1013 01:03:46,080 --> 01:03:51,160 listeners, Scott, firm runners who are at any point in their 1014 01:03:51,640 --> 01:03:54,760 either cancer diagnosis or treatment or survivorship 1015 01:03:54,760 --> 01:03:59,560 journey, anything else that you think they should know from your 1016 01:03:59,560 --> 01:04:02,120 both your personal and professional experience? 1017 01:04:02,600 --> 01:04:04,320 Yeah. For you know, for the runner 1018 01:04:04,320 --> 01:04:10,880 specifically that you know again most of us run for a variety of 1019 01:04:10,880 --> 01:04:16,240 reasons and even if that has to be put on hold for a short 1020 01:04:16,240 --> 01:04:20,960 amount of time, that's obviously a very important part of of who 1021 01:04:20,960 --> 01:04:24,160 we are. It's how we identify ourselves. 1022 01:04:24,560 --> 01:04:28,400 And so you need to start that conversation with your providers 1023 01:04:28,400 --> 01:04:32,080 early and often so that they are cognizant of that. 1024 01:04:33,040 --> 01:04:37,880 And again I think that just helps generate that referral to 1025 01:04:37,880 --> 01:04:44,160 us as PTS to be able to help you be able to maintain your fitness 1026 01:04:45,080 --> 01:04:47,200 as best as possible through treatment. 1027 01:04:47,200 --> 01:04:50,600 And then we can continue to advance that you know as 1028 01:04:50,600 --> 01:04:56,800 treatment is is ending. And and have that conversation 1029 01:04:56,800 --> 01:04:59,760 with your providers as well to say like this and this is really 1030 01:04:59,760 --> 01:05:02,360 important to me, being a runner is really important to me. 1031 01:05:02,920 --> 01:05:10,640 How are these treatments going to affect me as a runner and you 1032 01:05:10,640 --> 01:05:14,040 know, is there, is there a discussion to be had there as 1033 01:05:14,040 --> 01:05:20,840 far as you know, dosage or or anything like that as far as 1034 01:05:20,840 --> 01:05:23,320 your care goes? Yeah, that's great advice, 1035 01:05:23,320 --> 01:05:25,680 Scott. Well, thank you so much for 1036 01:05:25,680 --> 01:05:28,040 coming on the podcast. I really think this is going to 1037 01:05:28,040 --> 01:05:32,320 be a really helpful episode for a lot of people, both our 1038 01:05:32,720 --> 01:05:36,360 everyday listeners and PTS and other healthcare providers. 1039 01:05:37,160 --> 01:05:40,920 We'll certainly throw Scott's information in the show notes so 1040 01:05:40,920 --> 01:05:43,480 you can find him if you have questions for him. 1041 01:05:44,520 --> 01:05:47,560 As always, thank you everyone for listening to the Doctors of 1042 01:05:47,560 --> 01:05:51,320 Running podcast. We love to hear your questions. 1043 01:05:51,800 --> 01:05:54,840 Please leave us a review. You can leave us a review 1044 01:05:54,840 --> 01:05:57,280 anywhere you get your podcasts on YouTube. 1045 01:05:57,880 --> 01:06:01,320 Send us an e-mail at doctorsofrunning@gmail.com. 1046 01:06:02,040 --> 01:06:02,800 Thanks everyone.