Thank you for your thoughtful response.
Cheryl Canaday, PT, DPT, CLT-LANA
Physical Therapist, Certified Lymphedema Therapist
Baptist Health South Campus ǀ Rehabilitation Services
Phone: 904-271-6575 ǀ Fax: 904-271-6678 ǀ
Cheryl.canaday@xxxxxxxxxx<mailto:Cheryl.canaday@xxxxxxxxxx>
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From: aptaoncology-bounce@xxxxxxxxxxxxx
[mailto:aptaoncology-bounce@xxxxxxxxxxxxx] On Behalf Of Steve Wechsler
Sent: Thursday, March 3, 2022 2:33 PM
To: aptaoncology@xxxxxxxxxxxxx
Subject: [aptaoncology] Re: Radiation and STM
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Claudia, I think your strategy is justified. I would suggest that it's our
responsibility to promote tissue healing while optimizing function... This
feels like one of those oncology rehab-specific clinical decision making
moments where we understand that things are going to get worse before they get
better due to treatment effects. While a patient is actively undergoing XRT, I
usually limit manual interventions within the radiation field (as you describe)
and transition to AROM (to patient's tolerance) and think about what I can do
in adjacent regions (deep breathing to facilitate rib cage expansion, pec
lengthening if skin is less/not irritated there, scap stabilization
strengthening)... I may set a goal with the patient about maintaining a certain
ROM rather than pushing to get more during this phase.
I think it's also a great opportunity to educate the patient about what they
can expect including signs/symptoms of worsening skin irritation that they can
look for (so when they're stretching at home and inevitably pushing themselves
further than you might, they know when they're going too far)... Educating them
about how taking a step back in our therapy intensity may be necessary to
prevent 2 steps back if we cause worse skin breakdown with aggressive
STM/movement... we may be the first provider to educate them on what's to come
- not an easy conversation but important!
To Cheryl's question - I do tend to have a heavy hand but I would say my rule
of thumb is still to think about promoting tissue healing even in the chronic
stage. So if things get "hot" and stay hot after STM... maybe that was too
much. If you're getting results (greater soft tissue mobility, ROM, less pain)
without s/s of increased inflammation... maybe that's the sweet spot! Different
for each patient.
Steve
On Thu, Mar 3, 2022 at 2:08 PM Perry Ashley
<dmarc-noreply@xxxxxxxxxxxxx<mailto:dmarc-noreply@xxxxxxxxxxxxx>> wrote:
That's a good question. I have done a lot of research to try and find the
answer to this. I even sat down with a Rad Onc to have a discussion of tissue
properties, combed through his text books to see how the cellular matrix is
effected but didn't find a lot of concrete advice. I would be interested to
hear if anyone has a clear answer.
That being said, what I did find is the cellular matrix is essentially dried
out with high levels of cytokines for at least 3 months. I asked the Physicist
how long these elevated cytokine levels last and his exact words " no one
really knows. "
I usually err on the side of caution as to not cause more inflammation
furthering scar tissue in the long run, but it does kill me not to be able to
get in aggressively right away.
-----Original Message-----
From:
aptaoncology-bounce@xxxxxxxxxxxxx<mailto:aptaoncology-bounce@xxxxxxxxxxxxx>
[mailto:aptaoncology-bounce@xxxxxxxxxxxxx<mailto:aptaoncology-bounce@xxxxxxxxxxxxx>]
On Behalf Of Canaday, Cheryl A
Sent: Thursday, March 03, 2022 1:10 PM
To: APTAOncology@xxxxxxxxxxxxx<mailto:APTAOncology@xxxxxxxxxxxxx>
Subject: [aptaoncology] Re: Radiation and STM
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To add to that question, I would also like to know what is the best practice
for STM over radiated field after many years where there is significant
radiation fibrosis
Cheryl Canaday, PT, DPT, CLT-LANA
Physical Therapist, Certified Lymphedema Therapist
Baptist Health South Campus ǀ Rehabilitation Services
Phone: 904-271-6575 ǀ Fax: 904-271-6678 ǀ
Cheryl.canaday@xxxxxxxxxx<mailto:Cheryl.canaday@xxxxxxxxxx>
This message is confidential, intended for the name recipient(s) and may
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-----Original Message-----
From:
aptaoncology-bounce@xxxxxxxxxxxxx<mailto:aptaoncology-bounce@xxxxxxxxxxxxx>
[mailto:aptaoncology-bounce@xxxxxxxxxxxxx<mailto:aptaoncology-bounce@xxxxxxxxxxxxx>]
On Behalf Of claudia wiser
Sent: Thursday, March 3, 2022 1:04 PM
To: APTAOncology@xxxxxxxxxxxxx<mailto:APTAOncology@xxxxxxxxxxxxx>
Subject: [aptaoncology] Radiation and STM
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I received a call from a physiatrist yesterday who specializes in onc rehab and
he advised me that I should be doing more aggressive STM in a patient’s axilla
where he is currently receiving radiation. I typically go hands off when skin
starts to get pink, sooner if there are other factors that concern me.
What is the current best practice for STM in the radiated field?
Thank you!
Claudia Wiser
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