Fighting Cancer While Enjoying Life

Doylestown Health's Cancer Rehabilitation Program is a Physiological Oncology Rehabilitation Institute Center of Excellence (PORi), which means physical therapists have undergone specialized training to help cancer patients like Laurie Geissel manage their side effects.

Doylestown resident Laurie Geissel has always been healthy. She has never been hospitalized for an illness and says she rarely has to take medicine. So, when Laurie felt a lump near her right breast in August 2023, she initially brushed it off. However, she grew concerned when she noticed a rash in the same area.

"I went to my primary care physician, and they sent me for a mammogram. Within a day, doctors told me I had advanced breast cancer. I was completely shocked," she says.

Laurie was diagnosed with bilateral stage 3 breast cancer. She met with a Doylestown Health oncologist who recommended an aggressive treatment plan that included chemotherapy, a double mastectomy, and radiation. Laurie's doctor told her treatment would last months, possibly years.

"I'm pretty active. My family loves hiking and camping, so giving it all up was scary. I was determined to do whatever I could to remain in good condition so I could continue to do all the activities I enjoy," she said.

Preventing Lymphedema

True to her word, Laurie didn't let er chemotherapy treatments keep her down. "I was tired following treatment, but within two or three days, I was back on my feet," she says.

By January 2024, she was ready for the next phase of treatment – a double mastectomy. Donna Angotti, MD, Doylestown Health Breast Surgeon, suggested Laurie see a physical therapist before her surgery to develop a plan to prevent lymphedema, a common side effect of radiation and cancer surgeries like mastectomies.

"Lymphedema is swelling that occurs when excess fluid is in our body. It happens because the lymphatic system, our drainage system, isn't working. When a lymph node is removed during surgery, or blood vessels narrow due to radiation, it causes a roadblock where fluid builds up. It is most likely to occur in your chest, arms, and legs, but can occur anywhere in your body," says Doylestown Health physical Therapist Nickie Griesemer, PT, DPT, CLT-LANA.

During Laurie's initial evaluation, her physical therapist recorded her range of motion in both arms and measured her chest. Griesemer says this was used as a baseline so her therapists could easily see if she began to experience swelling or mobility issues in her shoulders and arms.

Managing Lymphedema

A few weeks after her surgery, Laurie returned to physical therapy to begin a lymphedema management program. "We like to start working with people as soon as possible to help prevent issues from happening before they even occur. Untreated lymphedema can lead to skin infections like cellulitis," says Griesemer.

Laurie's physical therapists used several approaches to help her prevent lymphedema. Those methods included:

• Fitting her for compression garments that encouraged fluids to move throughout her arms and chest.
• Manual lymphatic drainage, a hands-on approach to help move fluid throughout her arms.
• Developing a skincare regime to help prevent infection.
• Exercises to help move the fluid out of the arm.

Griesemer says Laurie responded well to lymphedema management. "She had minimal swelling, but she did have some scar tissue that could lead to lymphedema. We used a laser to get underneath the skin and break the scar tissue down," she says.

Reducing Side Effects from Cancer Treatment

Before releasing Laurie or any other of their patients in treatment for cancer from physical therapy, Griesemer says they review their medical records to see if there are different ways physical therapy could benefit them during cancer treatment. She says this is one of the benefits of Doylestown Health's Cancer Rehabilitation Program being a Physiological Oncology Rehabilitation Institute Center of Excellence (PORi).

"Our physical therapists have received specialized training to help people manage side effects related to cancer treatments. Cancer treatments can cause several health issues. Our goal is to help people reduce their side effects so they can continue to receive treatments they need and have a good quality of life," says Griesemer.

Some of the most common side effects related to cancer treatment that physical therapists at Doylestown Health's Cancer Rehabilitation Program can help manage include:

• Balance issues
• Fatigue
• Cardiotoxicity (heart damage due to chemotherapy or radiation)
• Lymphedema
• Pelvic floor issues
• Scar tissue build-up

While Griesemer says physical therapists at Doylestown Health's Cancer Rehabilitation Program work with people at any point during their cancer treatment, she says it's better to start at diagnosis. "We can look at the overall treatment plan upfront and develop a plan to help manage potential side effects. We can even reduce fatigue through exercise," she says.

Managing Heart Issues Related to Cancer Treatment

In reviewing Laurie's medical history, Griesemer noticed that she had been on a type of chemotherapy that can cause cardiotoxicity. Griesemer asked Laurie to record her heart rate on her watch to monitor it over time. "We noticed her resting heart rate was pretty high. It was in the 90s and should be in the 60s at rest. We also did a treadmill test and saw that it took a long time for her heart rate to decrease after exercise," says Griesemer.

Laurie told Griesemer that her heart issues were preventing her from enjoying activities she usually enjoyed. "I like to walk with my daughter, but I just couldn't keep up. My daughter was also getting married, and I wanted to enjoy the wedding without being short of breath and tired," she says.

Griesemer prescribed Laurie a 12-week exercise program that gradually increased her heart rate. "If we start slow, we force the heart rate to come down with activity, and the system starts to calm down a little bit, and then we can start to increase the heart rate on purpose," she says.

After several weeks, Griesemer says they began to see results. Laurie's heart rate gradually came down to rest, and she continues to work on building her endurance. She was also able to enjoy her daughter’s wedding without suffering from any fatigue or issues.

Laurie says physical therapy has become a big part of her life and was glad there were resources available to help her throughout her treatment. "It has been a great experience. I got to know all of the physical therapists. It is clear that they are very passionate about their job and care about each of their patients," she says.