Exercise and Strength for Cancer Survivors | June 8, 2021

June 09, 2021

Information

Presentations by: Dr. Tara Sanft, Dr. Janet Freedman, Scott Capozza, PT, MSPT, Kelly Herzog, and Stacey LaRosa, APRN

ID6702

To CiteDCA Citation Guide

00:00Everyone to the first of four smilow
00:04shares events with a focus on National
00:07Cancer Survivors Day or here at Smilow,
00:11we're going to celebrate the entire month.
00:15My name is Doctor Tara Samt I am
00:18the director of the survivorship
00:20clinic at Yale, New Haven.
00:22So the chair of the NCC N survivorship
00:25guidelines this is near and dear
00:28to my heart and it's my pleasure
00:31to be facilitating this panel
00:33tonight on strength and exercise.
00:36Just a few things to mention
00:39before we get started.
00:40This is supposed to be fun and an
00:43casual and hopefully interactive
00:45in our brainstorming sessions,
00:47we decided we would come up with some
00:50mythbusting ways to talk about some
00:53of these topics because there is
00:55certainly a lot of myths as it relates
00:58to exercise and strength after cancer.
01:02We have a lot of people tuning in tonight,
01:05so welcome if you have questions,
01:07we encourage you to use the question
01:10and answer section or for the chat you
01:12can chat to the panelists if you'd
01:14like to put in your questions that way,
01:17and I know that some of my dear friends
01:20and patients are on the call tonight too.
01:24So before we get started,
01:26we'll just go around and we can
01:28briefly introduce each of our
01:30speakers and panelists tonight.
01:31Why don't we start with Kellyanne?
01:33Then?
01:34We'll scoot around and then we'll have
01:36Stacy kick us off with some words.
01:41Hi, my name is Kelly Herzog.
01:44I'm an exercise physiologist
01:46at Greenwich Hospital.
01:47I've been there for 15 years
01:50and I work with cardiac rehab,
01:53pulmonary rehab and our next
01:55steps Breast cancer program.
01:58Thank you Scott.
02:01I am Scott composer under the
02:02physical therapist for the Smilow
02:04Multidisciplinary survivorship clinic.
02:06That Doctor Santa is the medical
02:08director of up in up in New Haven,
02:11and I'm also the first physical therapist.
02:14Flat Yellow Haven Hospital who's
02:16dedicated to doing oncology rehab.
02:18So it's an honor and a
02:20pleasure to be here tonight.
02:24And doctor Janet Friedman
02:28I'm Janet Friedman and I'm a
02:30physciatrist at Greenwich Hospital in
02:32the physical medicine department and
02:34I treat a wide range of patients with
02:37physical medicine and rehabilitation,
02:39but also see all of our breast
02:42cancer patients and.
02:44Staff our new survivorship clinic.
02:48And Stacy larosa. My name
02:51is Stacy La Rosa.
02:52I am a nurse practitioner working
02:54in the Smile Office in Waterbury.
02:55So for any of you listening in a
02:58little bit north of New Haven but
02:59not quite as far West as Greenwich,
03:01we are a small office that's great
03:03easy on off from 84. So anyone.
03:05We treat every type of cancer there.
03:09Great, thank you so much.
03:11I think what we'll do is we'll start
03:13with a few words from Stacy and Stacy.
03:15Tell us what you were thinking about
03:17when coming on to this panel tonight.
03:19So when I was coming on to
03:21this panel, I would say one of the most
03:24common myths that I hear from patients
03:26about exercise is related to fatigue.
03:28So fatigue is obviously one of the most
03:30common symptoms that patients experience when
03:31they were going through cancer treatment.
03:33And unfortunately, even for survivors,
03:35it's one of the most common symptoms
03:37experienced even after being cured of cancer.
03:39So oftentimes we're talking
03:40about how to manage fatigue,
03:42and one of the most common things
03:44that I recommend is exercise,
03:45and the first response I get
03:47is how can I possibly exercise?
03:49I'm exhausted enough already.
03:50That's going to make me even more exhausted.
03:52You must be crazy.
03:54So I get it.
03:55It seems totally counterintuitive
03:57that exerting yourself would
03:58actually lead to more energy,
04:00but there's actually strong
04:01evidence that it's true,
04:02so the typical dose,
04:04so to speak,
04:05for activity that's been proven to
04:06help fatigue is 30 minutes of moderate
04:09aerobic exercise three times per week,
04:11plus twice per week of strength exercise.
04:13You will note that this is
04:15technically different than the
04:17recommendations for exercise for
04:18general health and physical fitness,
04:19which would be about five times per week
04:22of moderate activity for 3030 minutes each.
04:25But it can absolutely help fatigue.
04:29The few things that I tell my patients
04:31is first of all set an achievable goal.
04:33So for many patients going through
04:35chemotherapy, radiation, or surgery,
04:36you may have not been very physically
04:38active during that treatment.
04:39It might have been hard to get off
04:41the couch to even go to the bathroom,
04:43so setting an achievable goal of 1st,
04:45I'm going to go from the couch
04:46to the front door.
04:48Then I'm going to go to the
04:49couch to the mailbox, you know,
04:51setting, and the goal is,
04:52of course, 30 minutes,
04:53three times a week,
04:54but you don't want to feel like you
04:56failed or that you haven't reached
04:58your goal by not meeting that.
05:00So keep track of that and
05:02give yourself credit.
05:03And the second thing I would say
05:05is telling patients to choose
05:06an activity that you enjoy.
05:08So moderate aerobic activity
05:09would be brisk walking, tennis,
05:10biking or dancing.
05:11So find one of those that you really enjoy
05:14and can actually see yourself doing so.
05:16For me I hate dancing,
05:17so if anyone told me that Zumba
05:19was my only form of exercise,
05:21I would avoid it at all costs,
05:23but I love biking and said something I'm
05:26actually more excited about doing any
05:28of you doing closer to free ride also.
05:30And finally,
05:31find someone that you enjoy doing
05:33exercise with so that they can actually
05:34keep you accountable and you'll enjoy it.
05:36Whether it's a spouse or another cancer
05:39survivor or a friend or family member.
05:42Important thing to remember is safety first,
05:44so always talk to your oncology
05:45provider about what the safest
05:47way you need to ask if you can
05:48have clearance to exercise.
05:50If there's any restrictions
05:51that you need to follow or
05:52anything like that, and then in terms
05:54of what kind of program I would,
05:56I'm going to turn the floor over to Scott
05:58in terms of exactly how to start a program,
06:01what that might look like and what
06:03options are available for you locally.
06:06Thank you Stacy.
06:07Those are some great myths to start with.
06:10How could I possibly exercise if
06:12I'm so fatigued? But you're right,
06:14the evidence shows that that
06:16is some of the best medicine.
06:19Janet, let's move to you.
06:21I know that you have some a few slides
06:23to show to take us through an you're
06:26going to bust some myths as well.
06:31And you are muted, so you might need
06:34to unmute yourself. Before speaking.
06:44OK so I wanted to talk about the myth
06:46that exercise will cause lymphoedema
06:48and I started treating lymphoedema in
06:51the night late 1980s and we had very
06:53different ideas about it at that time.
06:56So Lymphoedema just to catch up on what
06:59it is is a swelling of a part of the
07:02body and it could occur after any type
07:04of surgery that involves the lymph nodes.
07:08So it can cause swelling in the arm,
07:11the leg, the head and neck in the breast,
07:14and it's an accumulation of fluid in
07:16the area that is having trouble with the
07:18normal drainage it would have because
07:21lymph nodes drain this fluid called lymph,
07:23which is about 10% of our circulating.
07:33Just me or body
07:35so many different types of surgery
07:38and cancer treatment can affect that.
07:41And just to give you an idea of the rate
07:44of lymphoedema and now if you had Sentinel
07:47lymph node biopsy with breast cancer,
07:50your risk is about 2 to 5%.
07:52When I first started treating Lymphoedema
07:55almost everyone had axillary lymph
07:57node dissection which took out many
07:59more lymph nodes and had a much higher
08:01rate prostate cancer, uterine cancer,
08:03ovarian cancer, skin cancer.
08:05All these types of treatments can give.
08:07You can give you risk of lymphoedema.
08:10Oh and now I'm not. Go away OK,
08:13just a picture of arm lymphoedema.
08:15So we did a lot of fear mongering about
08:18lymphoedema in the 1980s and into the 1990s.
08:21You know we didn't really know why.
08:23Why do 40% of people get it?
08:25Why isn't it 100%?
08:27Why is it 1%?
08:28What are the risk factors?
08:30So we came up with huge lists of
08:32things not to do because that might
08:35cause lymphoedema and I always tell
08:37patients when you see this longer list,
08:39it means we really don't know
08:41what the cause is.
08:43We're just throwing everything here.
08:45So patients have told me
08:46they were told don't retire.
08:48Clothing don't wear any elastic
08:50wrists on your blouses.
08:51Don't carry a shoulder bag.
08:53Don't lift over £5 and just think
08:55a gallon of milk weighs 8 pounds.
08:57Don't fly in an airplane.
08:59Don't have a blood test.
09:00Don't have blood pressure.
09:02Don't ever have surgery on
09:03that limb for anything else,
09:05and I've had patients who were told
09:07not to lift their grandchildren,
09:09so we did.
09:10We really terrified people about
09:12lymphoedema thinking that these
09:14common things in life could cause it.
09:16So oops, I want to go back from it so.
09:20There was a big prohibition
09:22about exercise with lymphoedema,
09:23especially lifting weights on
09:24the idea that you were going to
09:26increase blood flow to your muscles.
09:28That would make more lymph fluid and
09:30that part of your body would just
09:32get bigger and bigger and bigger.
09:34So I was never really happy about
09:36this because as a physciatrist,
09:37working with a lot of physical problems,
09:40I knew that if you are now not
09:42going to use this arm for anything,
09:44it's going to get weaker and
09:46weaker and weaker.
09:47And then you know one day you're going
09:49to tear your rotator cuff because you.
09:51Pick something up so I came home
09:53from work one day and there was the
09:56New England Journal of Medicine in
09:58my mailbox and this was the days
10:00when it was always in paper and this
10:02is like the premier Medical journal
10:04in the country and they would have
10:07their top articles on the front
10:09cover so you could look at it and go.
10:11And here was an article and the title
10:13was weight lifting and women with
10:16breast cancer related lymphoedema
10:17and I was like Oh no.
10:19I've sort of been telling people they
10:21can exercise and. And what's going on?
10:24So this
10:24was a really great big study.
10:26295 women have been treated for breast
10:29cancer, half had lymphoedema, half did not,
10:32and they did arm and leg resistance exercise.
10:34So they were weight lifting twice a
10:37week for 52 weeks, 60 to 90 minute
10:40sessions like this was serious stuff.
10:42They wore their compression garment
10:44of the head lymphoedema and lo.
10:46And behold, after year of weightlifting
10:48they had no volume change,
10:50so this like freed us.
10:52Now go out in the world and try to erase
10:55a lot of the fear we had put into people.
10:58Other studies came out.
10:59I'll just run through these quickly.
11:01This is a study on hatha yoga.
11:03Same thing, no yoga, no yoga.
11:05You can't do downward dog and
11:06put your arm in that dependent
11:08position and lean your body on it.
11:10That's dangerous.
11:11So again three times a week, eight weeks.
11:14And in this study,
11:16lymphoedema actually improved another study.
11:18Again, half the patients have lymphoedema.
11:20This was arm and leg exercise.
11:23In this study, wearing a garment was
11:26optional and no change in limb volume,
11:29and I think this is my last one.
11:33Here again, 32 patients,
11:34all with lymphoedema.
11:36This was a mixed exercise.
11:38Aerobics, Aquatics, an resistance again,
11:40no change in arm volume.
11:42So you know why.
11:44Why were we worried we shouldn't be worried?
11:47'cause exercise adapts muscles,
11:48it adapts the circulation system.
11:50We grow more Kappel Aries when we
11:52exercise so blood can go in and out and it
11:56doesn't really change your limp structure.
11:58What happened to your
11:59lymph system from surgery?
12:01Radiation is still there and exercise
12:03also increases what we call the
12:05muscle pumping that directs blood
12:07out of the limb into the trunk.
12:09And as I said,
12:10we protect the limb from developing
12:12weakness an possible injury so.
12:14Can you lift weights?
12:16Yes,
12:16weight training is safe for people
12:18who've had lymph nodes removed.
12:20People with Lymphoedema probably
12:21should wear their garments
12:22during exercise.
12:23That's what I still tell
12:25people in general to do,
12:26but there's also no limit.
12:28You can gradually increase and
12:30your body will adapt to it.
12:32So that was what I wanted to say.
12:37Thank you Janet.
12:38What a great myth to bust and I'm
12:40sure that there is more to talk about
12:42there everyone if you have questions,
12:44you can put them in the chat or the Q&A.
12:48And that leads us to Scott.
12:51Talk to us a little bit about
12:52what your what your thoughts
12:54are on this topic tonight.
12:56Well, first of all, yeah,
12:57you know both both Stacy and Doctor
12:59Freeman you you set the stage
13:01perfectly because yeah, these are.
13:03These are some of the business
13:05that we see in survivorship.
13:07These are some of the big myths
13:08that we that I see in outpatient
13:11physical therapy and doctor Freeman.
13:13You're right that that study from
13:14from Katie Smith and her team.
13:16You're right, it did kind of free us,
13:19you know, to say that yes, we can do this.
13:22I you know.
13:23One thing I want to make sure that we.
13:26Make sure we let everybody know is that
13:28you know that those those exercises,
13:30those were all supervised, right?
13:32They were all supervised
13:33by by physical therapist.
13:34They were supervised by my train
13:36exercise physiologist who had experience
13:38working with cancer survivors.
13:39And so I think that's one of the
13:41things that we should always,
13:43you know,
13:44keep in the back of our mind if you're,
13:47especially if you're starting
13:48an exercise program in your
13:49you've never exercised before,
13:51but it's probably good to seek
13:53out professional assistance when
13:55you're when you're doing that.
13:56But yeah, when when, when, again,
13:58when it comes to these these these myths
14:00of exercise and and coming up with,
14:02I don't know how to exercise.
14:04I don't know like they were
14:06kind of exercises.
14:07You know, Stacy you you.
14:08You mean.
14:09I think we get along perfectly well.
14:11I I don't like Zumba either.
14:12I'm not coordinated enough
14:14to to do Zumba Iama,
14:15a cyclist as well, and you know,
14:17we were going to be riding closer free.
14:19Again, you know this year as well, you know,
14:22so that's always a great place to start.
14:25So you know one of the things that
14:28that I also wanted to touch my quickly.
14:30You know, Stacy you were talking about this,
14:32but you know,
14:33with the guidelines, right?
14:35You know what's what's the right
14:36amount of exercise for for you
14:38know what I should be doing,
14:40you know,
14:40see what you were alluding to.
14:42Is these these these updated
14:43guidelines that came from the
14:45American College of Sports Medicine.
14:46It is interesting again to look
14:48back and see how far we've come.
14:50You know,
14:51in just a short amount of time
14:52when the American College of
14:54Sports Medicine came out with.
14:56There exercise guidelines
14:57for cancer survivors in 2010.
15:00There wasn't a whole lot of
15:02research at that point to back
15:04up exercise for cancer survivors,
15:06and so those recommendations and 20% were
15:09really based upon the general population.
15:12When they updated those guidelines in 2019,
15:14there was now this huge plethora
15:16of research studies that showed
15:18the benefits of exercise,
15:19so they were able to really,
15:21and it's really exciting for for
15:23individuals like Kelly and I,
15:25who are the ones that are working with
15:27with cancer survivors one on one.
15:30To say we can actually kind of dose
15:31our our exercise interventions based
15:33on people how people representing you know.
15:36So he says he was saying,
15:38you know, for somebody who's got
15:40who presents with cancer related.
15:42City with high levels of fatigue.
15:44You know if we want to do cardiovascular
15:47exercise three times a week,
15:4830 minutes with strength
15:50training twice a week.
15:52Interestingly,
15:52now that we have more research out there,
15:55if if somebody comes to us and one of
15:58their concerns is fear of recurrence
16:01and they are presenting with higher
16:04levels of anxiety and depression.
16:07These new guidelines actually
16:08have a different dose of exercise.
16:10For that they actually recommend 30 to
16:1260 minutes of cardiovascular exercise
16:14for somebody whose primary concern more
16:16is in that anxiety and depression.
16:19So if it's really,
16:20it gives us a lot of tools in our toolbox,
16:23so to speak. And so again, how do you?
16:26How do you start an exercise
16:28program again says he was talking
16:31about this a little bit,
16:32finding you know finding what's what?
16:34Do you like to do?
16:37An finding somebody that can do that.
16:40You can exercise with whether
16:41that's in person or is virtually,
16:43or you know,
16:44you know,
16:45you're texting your friend back and forth.
16:47You're keeping tabs on each other.
16:49Over were various apps you know
16:51to kind of motivate each other.
16:53I tell people all the time that
16:55you know it's always fun to have
16:57these little competitions to
16:59see who can get the most number
17:01of steps in over the month.
17:03Or you know who can write,
17:05cried the most miles and.
17:07You know whoever you know,
17:08then you know then you gotta meet
17:10up afterwards and whoever didn't
17:12get that number of of walks or steps
17:14that has to buy the other person
17:16ice cream or something like that,
17:18right?
17:20I think when we think about
17:22strength training and I already saw
17:25the question pop up in the chat,
17:27you know how many minutes of strength
17:29training should are cancer survivors do?
17:31It's not really strange.
17:33Thing is not really about minutes.
17:35Strength training is more about targeting
17:38the muscle groups that you know they
17:40can help you with your function and
17:43how to get you where you want to be.
17:45And I'll give you the perfect example.
17:48I'm working with the individual now.
17:51Who has gone through head and
17:53neck cancer treatment?
17:54He said surgery and radiation therapy.
17:57And he he's lost a lot of ways lost
18:00a lot of muscle mass and he he was
18:03telling me that he's become so weak
18:06that he can't start his chainsaw.
18:09And his goal.
18:10The most important thing to him right
18:13now is to be able to clear off land,
18:15apply to land that that they
18:17have up on Massachusetts coast,
18:18because he wants to build his
18:21retirement home and and have that
18:23be a place for his grandkids to go.
18:25So that becomes a functional
18:27goal for us to say, OK,
18:29what muscle groups do we need
18:31to be approaching to to address
18:33that this person's concern?
18:34So we're working on core strengthening.
18:36We're working on shoulder stability.
18:38We're working on our leg strength
18:40and that sort of thing to make
18:43sure that we're able to do that.
18:45So when it comes to strength and it's
18:47not really necessary about minutes as
18:49much as it is about making sure that,
18:52again that we're targeting those those
18:55muscle groups that are really important.
18:58Again,
18:58when it comes to exercise and really
19:00being able to see your your progress,
19:03I may be a little old school when I say,
19:06you know to to write it down to
19:09keep a journal you know to kind
19:11of show your progress, you know.
19:13But again,
19:14there are.
19:15You know if you have wearable
19:17technology or you have it on your phone,
19:20you can monitor this all on different
19:22apps and it is.
19:23It's really empowering to you right to say.
19:26OK,
19:27I'm starting a walking program
19:28and 1st week of June I'm going
19:31to go out and I'm going to walk
19:3310 minutes three times a week.
19:35Great, that's your starting point.
19:37And then the next week you make
19:39that small achievable goal,
19:41like Stacey was saying.
19:42Now you want to walk 15 minutes
19:44three times a week,
19:45and then the next week you wanna
19:47walk 20 minutes three times a week.
19:49So by the end of the month you can
19:51look back and you can say look,
19:53look where I am now compared to where I
19:56was at the at the beginning of the month.
19:58And and that's that,
19:59again,
20:00that's very empowering and I
20:01think that that's what we need to
20:04make sure that you know we want
20:05to be able to help set you all
20:07up for success so that.
20:09That really exercise becomes
20:11a lifestyle change and
20:12I think you're going to hear that
20:15theme throughout this month,
20:16but with the different survivorship series
20:18that we're we're doing through smile.
20:21Oh, this month is that you know
20:23so much of what we are discussing
20:26here through survivorship,
20:27you know whether it's exercise or
20:30whether it's nutrition or whether
20:31it's mindfulness to really try
20:33to set up these these patterns.
20:36This lifestyle patterns to
20:37make these slashed out changes.
20:40To keep you healthy physically and
20:41emotionally for the balance of your life.
20:46Thank you so much Scott.
20:48And for those of you tuning
20:50in after the introductions,
20:52I just I want to welcome you.
20:55This is the Smilow shares event talking
20:57about strength and exercise and we have
21:00our panelists and we will go into the
21:03question and answer portion of tonight.
21:05For those of you tuning in late,
21:08we have doctor Janet Friedman,
21:10physical medicine and Rehab Doctor Greenwich,
21:12Stacy Larosa nurse practitioner.
21:14Out of the Smilow Waterbury Care Center,
21:16Kelly Herzog.
21:17Exercise physiologists an one,
21:19someone who runs a cardiac
21:21pulmonary rehab program,
21:23as well as a breast cancer exercise
21:26program for survivors at the
21:28Greenwich Care Center ANDSCOTT.
21:30Compose a physical therapist.
21:33The multidisciplinary survivorship
21:34clinic in the greater New Haven area
21:38and also on rehab specialist at Yale.
21:40New Haven hospital.
21:42I'm Tara same time your facilitator tonight,
21:45so maybe I'll just start by saying.
21:48Tekeli you know I think one of the myths is.
21:52That in order to be in like a rehab program,
21:56you have to like look really
21:58weak or you have to be really,
22:00you know, debilitated.
22:01And I find even that's a myth that
22:03I held because I met survivors
22:05who had lobectomies for their
22:07lung cancer and they look great.
22:09But they said you know what I
22:11used to be able to walk from
22:13the train station to clinic.
22:15And this time I had to
22:18stop five times on the way.
22:20What do you like?
22:21Tell me a little bit about what you
22:23think about that myth and what you
22:25see in your patient population.
22:27So
22:28we primarily see breast cancer patients
22:30at this point with our program,
22:32which I can talk about a little bit later.
22:37But I find that we've had the whole
22:41range of people we've had triathletes.
22:44All the way through people who have
22:47never exercised and we offer them
22:49cardiovascular exercise where we do,
22:52actually a submaximal stress
22:53test on their very first visit,
22:56so we can kind of see where
22:59their fitness level is.
23:01In the beginning and then at the end of
23:04our program will do it again and it's
23:06really exciting to see the changes.
23:09I have about five of them coming
23:11up in the next two weeks.
23:13Thanks to Doctor Friedman,
23:15and I'm actually really excited
23:16to do all of them,
23:18'cause these women have have
23:19really come a long way,
23:21so we just try to encourage them
23:23to get like Stacy and Scott both
23:25mention at least the three days a
23:28week of that cardiovascular exercise,
23:30and most of them are.
23:32Only are getting about the three days,
23:34not not the recommendation of
23:36the 150 minutes a week and then
23:39the strength training.
23:40We offer personal training
23:41sessions for them to learn what
23:44strength training exercises to do.
23:46Some have done strength training and passed.
23:48Others have never ever done it.
23:51So we design a program for them.
23:53We meet with them four times.
23:56I write it down, they take it home.
23:59Then we review in a couple of weeks.
24:02And we always,
24:03you know,
24:03come up with a program based on
24:05do they have equipment at home?
24:08Are they going to the gym or
24:10they gonna use our equipment
24:11that we have at our facility?
24:14So with some people I start with
24:16just very light band exercises
24:17and progress up to weights.
24:19I did that with someone actually
24:21just a few hours ago and she said,
24:24oh,
24:24I think I can do this because
24:27I've already been doing it with
24:29the band and that has helped
24:31me so much to know the motion.
24:33Now I can do it with weights,
24:36so we've progressed over these
24:38three months from a light band
24:41to weights that she has at home.
24:44So we just try to encourage to try
24:46to get as much movement as they can.
24:49And like Stacy said in the beginning,
24:52with fatigue that really the
24:54exercise is going to help.
24:56The fatigue more than more than heard it.
25:00Thank you so much. Doctor Friedman,
25:02I think this is a good time to start
25:05to address some of these questions
25:08coming through about lymphoedema.
25:10A couple about blood draws.
25:12Maybe we could start with that one.
25:14It's a little off our topic.
25:17Let me just say right now that a lot
25:20of their recommendations for people
25:22with lymphoedema are really changing.
25:24They're really in flux.
25:26The European and Asia Asian countries
25:28have a much more developed and
25:31sophisticated approach to lymphoedema
25:33than we do here in North America,
25:35and similar to that long list
25:37of don't do don't do, don't do.
25:40They look at us and go.
25:42What are you talking about?
25:44There's no evidence for any of this,
25:46so there's a lot of recent,
25:48very good research from all over
25:50the world that it will also.
25:52Just like now,
25:53we can lift weights with lymphoedema.
25:55We can draw blood from the arm.
25:57With Lymphoedema we can have blood
25:59pressure taken from the arm with lymphoedema,
26:01because these things are
26:02not changing your anatomy.
26:03They're not a risk for developing
26:05in Fatima and we do have a lot
26:08of really good studies now,
26:09right before the pandemic,
26:11I was at an international meeting.
26:13And the US people said, OK,
26:15we're going to have to sit down and
26:17rewrite all our guidelines because
26:19there's so much research out there.
26:21And then,
26:21of course,
26:22the pandemic hit and that has not happened.
26:24But I never tell my patients you
26:26can have blood drawn from that arm.
26:29You can take blood pressure from that arm.
26:31If you have are having surgery on
26:34the other arm and you need an Ivy,
26:36you can put that in your arm
26:38at risk for lymphoedema.
26:39Much better than putting it
26:41in your leg at risk for.
26:43Deep vein thrombosis.
26:45So a lot of these restrictions are
26:48really really being lifted so that
26:51that will all be evolving soon.
26:54These
26:55are major myths to bust,
26:56so thank you so much Stacy,
26:58maybe this is something you
27:00could speak to a little bit.
27:02What do you think?
27:03A patient right?
27:04What is it that causes fatigue
27:06years after treatment has ended?
27:09How would you approach
27:10that topic in your clinic?
27:11And I can also chime in too if you
27:14if you wanted me to write so good.
27:17It's a good question.
27:18Unfortunately,
27:19the answer is not always 100% clear.
27:21Oftentimes it's multifactorial.
27:22So for instance, for some patients,
27:24so it depends what you
27:25consider treatment ending.
27:26So some of our patients have chronic
27:29loop lymphoma prints for instance,
27:30and they might be on treatment
27:32and then off treatment.
27:34But maybe they are anemic chronically,
27:36so they might chronically have a low
27:38level of fatigue related to that.
27:40Certainly emotionally depression
27:41and anxiety like Scott talked about
27:43can contribute to fatigue as well.
27:45That's a huge,
27:46huge reason people complain of fatigue.
27:48You know immediately after treatment,
27:49certainly there's some cell repair
27:51that's going on that can make you
27:53feel a little bit more fatigued.
27:55Some people have trouble sleeping with,
27:57whether that's just regular run of the mill,
27:59insomnia,
28:00or if it's related to anxiety
28:02about disease recurrence.
28:03Any of those things can cause insomnia also,
28:05cause you to feel fatigued,
28:07so there's there's a lot of different
28:09reasons that can cause you to feel fatigued,
28:11even years after you're done with treatment.
28:14And unfortunately, it's not.
28:15Easy to pin down.
28:17I think that's exactly right, and you know,
28:20sometimes you can have other medical
28:22issues that come up that can can mask
28:24as fatigue or be signal fatigue can
28:26be a signal that something's wrong,
28:28so there is often a bunch of labs
28:31that people might do just to rule
28:33out any other issues going on.
28:35In addition to all the.
28:37The things that Stacey mentioned.
28:40OK Scott, let's hear from you.
28:43There is a couple of questions.
28:45One is about the updated guidelines,
28:48so maybe you could speak that.
28:50I see you put something in the chat
28:54and then there's also a question.
28:57For women with metastatic breast
28:59cancer to the bones, is it OK to
29:02do weight bearing exercises?
29:04Yeah, I. I just tried to pop
29:06the the American College Sports
29:08Medicine guidelines into the chat.
29:10If it didn't go through somebody,
29:13let me know and I'll try to repost it there.
29:17So to the to the question about
29:19anybody with metastatic disease.
29:21Anybody who may have bone metastases,
29:24the answer is yes,
29:25that you can exercise again.
29:27For anybody who has metastatic disease,
29:30you know we would highly recommend
29:32that you would work with a physical
29:34therapist or work you know with with
29:36a certified exercise physiologist.
29:38It's just start a safe program.
29:41My approach to this is to work
29:43is to do a lot of what we call
29:46kind of closed chain exercises,
29:48at least starting there and what
29:50I mean by closed chain exercises
29:53that to make sure that that the
29:55hand is anchored or that the.
29:58Foot is anchored,
29:58so I might start with like
30:00wall pushups for example.
30:02It's something like like even like squats.
30:04For example, is a safe exercise and
30:06we can even like you're.
30:08You know, if you're in our gym,
30:11you know you we can set the height
30:13of the map table for example.
30:15So instead of going from a very low height,
30:18we can raise that height so that it's
30:21just a very small distance that you
30:23have to do that that this is standard.
30:26Do that squat, so to speak.
30:29And so we would.
30:30We would start there and then we would
30:33progress you through slowly and safely.
30:35But yes, we would be able to
30:37progress you through that,
30:39and it's interesting.
30:41The actually again the American
30:43College sports medicine.
30:44They just had their big
30:46annual conference last week,
30:48all virtually,
30:48and there was a great talk about exercising
30:52an so supposedly by the end of this year,
30:55by the end of 2021,
30:56they're going to update their clinical
30:59practice guidelines for exercising for
31:01individuals who have Bony metastases,
31:02and so will definitely have
31:04a much clearer picture.
31:06And so for all of us as the clinicians,
31:09we're going to take that.
31:11And bring that to you,
31:13but I I am currently working with
31:15people who have vomit ***** now and
31:18again that's that's my approach.
31:19Yes,
31:20I want you doing cardiovascular
31:21exercise safely.
31:22I want you doing weight bearing exercises.
31:25Like I said,
31:26typically starting with closed
31:27chain exercises and then we
31:29can progress from there.
31:30I did see somewhere in there too.
31:33Maybe this also kind of corresponds.
31:35I saw a question about crunches
31:37and so this would be another
31:39opportunity for again for it.
31:41Trail for education.
31:42You know that Kelly or I could do to say,
31:46OK,
31:46maybe we don't want to necessarily
31:48do crunches,
31:49but there are other core exercises
31:51that you can be doing that can
31:53engage your abdominal exercises
31:54and work on that core.
31:56Strengthening but protecting your
31:58back at the at the same time.
32:02OK, thank you alright, so here I'm going
32:05to read this Chattan see maybe Kelly
32:08this might be appropriate for you,
32:10but anyone can chime in.
32:12What would be considered too much exercise?
32:15For example, is there a maximum heart rate?
32:18I'm 42 that we need to stay under.
32:22When I first got diagnosed,
32:23I was only walking about 2 miles per week.
32:26I couldn't keep my heart
32:28under 130 beats per minute.
32:29Now I can walk four to five
32:31miles five times a week.
32:33Great without going over 120.
32:35I recently had my power port removed and
32:37I have started with weight exercises,
32:39but my heart rate often goes up to 150 range.
32:42Energy hasn't been a problem,
32:44but I'm concerned about injuries
32:46and setbacks. Thank you.
32:48Thanks for that question.
32:51Can
32:51you just read one more time when it goes up
32:55to the 150 range? Sounds like with
32:57a new straight weight exercises,
32:59so I think that's strength training.
33:02OK. So I'm wondering so, first of all,
33:07that sounds like great fitness progression
33:09from the beginning part of that question,
33:12and we tend to see when I first do that
33:15submaximal stress test with people
33:17I tend to see heart rates skyrocket.
33:21In people that you would see if
33:24they walked through the door at
33:26look very healthy and fit to you.
33:28I see them going from a resting heart
33:31rate of. 80 to 140 within the 1st
33:333 minutes of that Submax stressed,
33:36so I see that a lot.
33:39I think the deconditioning from
33:41the treatment really does a lot,
33:43but that progression sounds good with
33:46the strength training getting that
33:48heart rate up to 150, I'm wondering if.
33:51Maybe there's some breath holding
33:53going on there or the exercise.
33:56Maybe is a little too hard.
33:59At 42 years old you should be able
34:02to get your heart rate up to 1:50 if
34:05you're not on any cardiac medications.
34:08I would say we typically do a
34:10Karvonen calculation,
34:12which once I'm done talking,
34:14I can even figure that out,
34:16but I don't know this person that
34:19well and any other meds because we
34:22also use that submaximal stress test.
34:24Went because it's so very individual
34:27to see what what heart rate that
34:30they got to what's there 85% if
34:32they even reached it.
34:34Some people aren't even
34:35physically fit enough,
34:37but The Walking in this
34:39question sounds sounds great,
34:40but I'm wondering maybe the weight
34:42is a bit too heavy to start out
34:46with and maybe the breathing.
34:48You know X hailing on the exertion,
34:50paying close attention to the breathing,
34:53not holding breath and breathing properly.
34:55And also possibly maybe they're doing
34:57is she doing well or he or she doing
35:00multi muscle strength training is
35:02when you're doing both upper body
35:04and lower body at the same time?
35:06You might be hitting.
35:08Higher heart rates,
35:09so that would be kind of my
35:11thoughts for that question.
35:13I hope it helped.
35:16If you want me to figure out a Karvonen,
35:18I can,
35:19but again,
35:20not knowing this person.
35:21I
35:22guess those are
35:23some great great thoughts
35:24to start with for sure.
35:26OK, here is another one
35:27that maybe piggybacks on to
35:29this with strength training.
35:30How can I do strength training
35:32without bulking up my muscles?
35:36That's a, that's a good question.
35:38I can start with that and then kill
35:40if you wanna hop in on that one too.
35:43So yeah, so if you want to build
35:45strength without building a lot of bulk,
35:47typically what we do,
35:48what we would tell you is to do kind of a
35:52lower weight but higher repetitions you know.
35:54And so again you were talking
35:56about the bands, for example.
35:57Like all of these resistance bands
35:59that we use in the exercise classes
36:01and in therapy, they're all.
36:03They're actually all color coded
36:04by resistance, and so you can use.
36:07One of the bands that has a lower
36:10resistance but you rather than doing,
36:12you know three sets of 10 repetitions.
36:15You know, maybe you're doing two sets of 20,
36:18but it's a lower lower resistance.
36:24So you're saying you can strength
36:27train without getting huge
36:29big muscles? Yeah, absolutely.
36:32And I can just add if it's OK,
36:34I can just add a little bit to that.
36:37I also find that it's actually kind
36:39of hard to get huge big muscles.
36:42You have to be working in
36:45the gym very regularly,
36:47lifting very heavy weights,
36:48but also there's the nutrition side
36:51of things that people that get huge.
36:54Big muscles tend to be trying
36:56to eat a lot of protein.
36:59Maybe they're taking protein powder.
37:01They're eating a lot of calories.
37:04It takes work to get huge big muscles.
37:08Also, a lot of that is genetic.
37:12Some people can get bigger
37:14muscles easier than other people,
37:16even if those people are trying.
37:18So like Scott mentioned,
37:20the lighter weight we tend to do two to
37:23three sets of like 12 to 15 repetitions,
37:26but I don't really have people doing
37:29heavier weights with the lower
37:31repetitions to build the muscles,
37:33so I find I think it's difficult
37:36to grow big muscles.
37:39A lot of women don't want big muscles,
37:41so they won't be reassuring,
37:43but it's hard. It would be
37:45hard to get big muscles.
37:48Well, Stacy and Janet, I know.
37:50So Kelly mentioned a little bit
37:52about people who are bulking up
37:54and eating different things.
37:56What do you guys talk to your patients
37:58about in regards to diet and exercise?
38:01So someone wrote if I exercise,
38:03should I change anything that I eat?
38:06Should I be eating more protein?
38:10Any thoughts on that? I think it
38:13depends. If like Kelly said,
38:14if you're trying to build muscle,
38:16certainly protein is important,
38:17but I think speaking with a
38:19nutritionist can help in terms of
38:21determining exactly how much protein
38:22you need and if you really you
38:24don't necessarily need to bulk up.
38:26I think talking to them about that,
38:28and I always tell patients it's
38:29not really about a diet per say,
38:31it's just about a well balanced eating
38:33and lifestyle lifestyle in terms of diet,
38:35diet sets you up for failure in terms of
38:38doing it for a short period of time and
38:40then falling off the wagon versus that.
38:42Making lifestyle choices both before and
38:44during your cancer treatment and after.
38:47Like that? How about the pattern? Right?
38:50And Dan, we are going to have a session
38:53in two Tuesdays on supplements and
38:55nutrition after cancer, so stay tuned
38:58if you have more questions about that.
39:02OK, let's see here.
39:04There have been some really
39:06interesting questions coming in.
39:09Janet or Kelly. I am six years post.
39:13Left Pneumonectomy I still need oxygen
39:16drain exertion, walking, stair climbing, etc.
39:19Otherwise I desat rapidly.
39:21Should I be concerned?
39:24He thoughts on that.
39:29You guys have much. I know,
39:31Kelly, I had heard you had done
39:32pulmonary rehab in the past,
39:34but maybe I'm putting you on the spot.
39:37For this question. No, that's
39:39OK. Most of the patients I do
39:42pulmonary rehab with our steel, PG or.
39:46Interstitial lung disease.
39:48Not as many lung cancer.
39:52But, you know, is this person exercising
39:55regularly in order to condition the
39:59heart and the lungs and the muscles?
40:02Have they had pulmonary function test to
40:05see if there's something else going on,
40:08requiring them to need oxygen while
40:11doing these activities would be my.
40:14Thoughts on that one? Yeah,
40:17I would agree with that. I think that.
40:22If the person has not had any formal
40:24exercise type of instruction or therapy,
40:27that would be helpful.
40:28I think a lot of people feel if they're
40:31getting short of breath with exertion,
40:34the solution is not to exert themselves
40:37as opposed to the understanding that.
40:40Endurance exercise will increase
40:41their tolerance to activity
40:43both by working on their heart,
40:45their long, but also helping their
40:48muscles be more efficient with
40:49the oxygen that they're getting.
40:54Thank you, and here's a good one.
40:57I bet Scott you could
40:58probably talk about this.
40:59I'm almost five years cancer free.
41:01I have a great deal of radiation
41:03damage after stage three breast
41:05and a double radical mastectomy.
41:07There's a hardening and
41:08stiffening which is quite painful.
41:10Do I work through the pain or possibly
41:13look towards an additional surgery to help?
41:15Anything upper body at the gym
41:17or even lifting to put dishes
41:20away hurts everything, pulls.
41:22Yeah, I hear this all the time in my clinic.
41:25Yeah, and I sent to you yes,
41:27yes you
41:28do Doctor Stanton and I'm grateful for that.
41:30Yeah, for this first person who wrote
41:32this question and first and foremost,
41:34I want to let you know that you're not alone.
41:38We're experiencing sounds like something
41:40that we call radiation fibrosis syndrome,
41:42which is kind of this long term side
41:45effects that we see is that it's this
41:48kind of gradual binding down of the
41:51connective tissue and just show the skin.
41:53But like that layer,
41:55connective tissue that's just
41:57below the level of the skin,
41:59and everything that you described is.
42:01You're right.
42:02Everything just feels tight and
42:04you just feel like you can't
42:06move that arm over your head an.
42:09What I would say to you is that
42:11we don't necessarily want you
42:13to push through the pain,
42:15'cause obviously it's it's not comfortable.
42:17You would want to get a referral from
42:19your from your college team to either a
42:22physical therapist or occupational therapist,
42:24because we can do a lot of manual therapy
42:26and actually get our hands on you.
42:29Just try to work some of that that
42:31scar tissue out of there and to try
42:34to loosen that connective tissue.
42:361st, and that's a lot of what I see.
42:39In my outpatient clinic,
42:41I have to address the the the most,
42:43those muscular skeletal impairments first
42:45before we can address strength training.
42:47You can't go through a really good
42:50strength training program if your range
42:52of motion is limited in its painful,
42:54so will address that part first.
42:56You know the other thing.
42:58Everything again,
42:59Doctor Sam's team and you know
43:01you see this doctor Freeman.
43:03I know you see this.
43:04You know, you know if somebody develops
43:07the condition cord called cording we.
43:09Sometimes you get that that that tight
43:12band kind of rate here and so same thing.
43:15It's it's.
43:15It's hard to raise your arm and it's painful,
43:19and so we as a trained physician
43:22occupational therapist we can
43:23go in there and use our hands.
43:25To help loosen that up and there are
43:28some modalities that we can use to
43:29assist us with that and then once
43:31that gets loosened up and you get
43:33this range of motion OK, great,
43:34now that that's kind of been freed up.
43:36Now we can move ahead and we can
43:38do the next phase of things,
43:40which is the strength training.
43:48Yes, thank you so much Scott.
43:50There are so many good questions here and
43:52I know we're coming up on the hour soon.
43:55Maybe what we could do is talk a
43:57little bit about these issues that
43:59affect the hands and the feet.
44:01So I'll read the neuropathy one and then
44:04I'm also going to piggyback that into
44:07the hand Foot syndrome one and then.
44:09So any any of you who feel like you
44:12can come in on this please happen here,
44:15but here is what one listener wrote
44:17neuropathy in my feet impairs my
44:19ability to balance and walk safely.
44:21I'm 74 and have severe Bursitis and
44:24tendonitis which developed after COVID
44:26ended aquatic therapy prescribed at SMILOW.
44:28I have had PT for this since last August.
44:32It developed when I tried to do normal
44:34gardening and landscaping work.
44:36Everyone PT,
44:37an orthopedic doctor says pool only.
44:39How does that square with recommendations
44:42for cardio and resistance recommendations?
44:45And then the piggy back to that is
44:47suggestions for exercise with hand
44:48and foot syndrome. Dude is aloda.
44:50I know there are two different things,
44:52but we have a lot of questions so
44:55hopefully just trying to get as
44:57many people's questions answered.
45:01Well, I'll I'll start and then
45:02I don't know Doctor Freeman.
45:03If you want to jump in on that,
45:05you know from the.
45:07You're right, you know I we did
45:09send allowed people to aquatic
45:11therapy when that was an option,
45:13and I know that that is not an
45:15option for a lot of people.
45:17Now as far as as far as the neuropathy goes,
45:20you know my my approach has been,
45:22you know, kind of a multi pronged
45:24approach to to the neuropathy.
45:26You have to address this the
45:28sensory aspect of things.
45:29You have to work on the strengthening
45:31aspect of things and you have to
45:33work on the on the balance and
45:35So what a typical session with.
45:37With story that I'm working with,
45:39you has dropped the end and
45:41I probably had three or four
45:42individuals just today alone,
45:44but this is what we were working on.
45:46I have them take their shoes off
45:48and we get on an uneven surface
45:51and we're practicing sit to stands
45:53on that to work on leg strength.
45:55Usually we have a small vibra Tori
45:57device at our clinic that will
45:59use that vibra Tori device to try
46:02to help stimulate,
46:03give that deep pressure sensation
46:05to the to the toes inside the
46:07bottom of the feet to try to help
46:09with that sensation there.
46:11I know our occupational therapy
46:13colleagues have a lot of training when
46:15it comes to sensory reintegration
46:17and so I'll tap into them a lot for
46:20their mom for their thoughts as well.
46:22And again,
46:22a lot of a lot of hip strengthening.
46:25For strengthening your we want to
46:27make sure that we're preventing
46:28any any increased risk of falls
46:30when you can't steal your feet,
46:32and then as far as like the precise
46:34is go like those we can address.
46:36You know,
46:37kind of like our classic physical
46:39therapy interventions with you
46:40know with modalities with ice and
46:42heat and those kinds of things.
46:43But when it comes to rapidly,
46:45you know it's it's not just one
46:47not one treatment modality that
46:49we're going to have to use.
46:50We're going to have to use a lot
46:53of different tools in our toolbox,
46:54so to speak, to be able to address that.
47:00Thank you. OK. Let's see here.
47:04There's one specific this
47:06question is for Kelly.
47:08If we are interested in beginning
47:10an exercise program after treatment,
47:11how can we get an appointment
47:13with you if we weren't initially
47:14treated in Greenwich?
47:16Thank you.
47:16This is really interesting.
47:18You have a fan.
47:21So Doctor Freeman can probably
47:23help me with this a little.
47:26So originally the program started out.
47:28I've been at Greenwich 15 years
47:30and there was a grant provided
47:33for breast cancer patients for our
47:36three month free program to breast
47:39cancer patients who have had their
47:41treatment at Greenwich Hospital and it
47:44encompasses the cardiovascular exercise,
47:46the personal training sessions as
47:48well as nutrition counseling. So.
47:51It there is no more grant but the
47:54hospital administration has wanted
47:56to keep it going because it's
47:58such a great program.
48:00So what normally happens is the
48:03patient sees Doctor Friedman usually
48:05and sometimes our other physciatrist
48:07Dr Grant prior to coming in in order
48:10to rule out any of those issues that
48:13Scott was talking about earlier.
48:15With, you know the courting or the.
48:18I forget the name of it was that
48:21the radiation fibrosis?
48:22Yes, anything like that.
48:24Any musculoskeletal issue that needs PT
48:26or OT first Doctor Friedman will see them,
48:29and then she'll refer them on to me.
48:32You know,
48:32this person is going to be ready after
48:35PT on May 29th or whatever it may be,
48:38so that's typically how it works.
48:41It's a free, it's a gift.
48:43It's a free three month gift now as far
48:46as not being treated at Greenwich Hospital,
48:48that would be something that I think
48:51we at the hospital could talk to.
48:55Our director of the program about how.
48:58You know he wants to go about it,
49:00whether they're treated somewhere
49:01in the Yale system.
49:02If that's OK, because at this point.
49:05That program is breast cancer only,
49:07and it's a three month gift,
49:09but we can see a patient who has cancer.
49:13We have a medical fitness program and
49:16the person just does have to pay out
49:19of pocket of a fee and then we can
49:22still do all of the tests and work
49:24you through a program for exercise.
49:27And we have people you know that have
49:30come undone that not quite as many as
49:32in the breast cancer program, but we do get.
49:37Some.
49:38Does that help at
49:39all? Yes, thank you Ann. You know Stacy.
49:42Maybe you can chime in here too because
49:45there had been a question in the chat
49:48about exercise places that are free
49:50or low cost and so I'm hearing that
49:52there are some resources at Greenwich.
49:54Of course, anyone needing physical
49:56therapy or occupational therapy should
49:58ask for referral from your oncologist.
50:00We also have a multidisciplinary
50:03clinic where you could get.
50:05Medical type visit with some
50:07exercise information embedded in
50:08there with Scott Capozza but Stacy,
50:10what tell us a little bit about
50:12what you're what you tell your
50:14patients out in Waterbury when
50:15they ask about low cost programs.
50:19So most often we refer to
50:20the LIVESTRONG program.
50:21I think you
50:22can actually find those across
50:23the state in most YMCA's,
50:25a lot of them shut down
50:26during kovid unfortunately,
50:27but I think the one in Waterbury
50:29I'd heard recently was starting
50:30to open back up here to patient
50:32about that mentioned that recently,
50:33so that's exciting for people to be
50:35able to get back in there and work
50:37with someone who actually knows
50:39what they're talking about and can
50:40teach you how to safely exercise
50:42and kind of get back into things.
50:44Obviously taking into mind safety first,
50:45so asking your medical provider who
50:47knows your medical history first,
50:48whether or not that's safe or recommended.
50:51Scott had also recently introduced
50:52me to a program run by the Quinnipiac
50:55University students, which is virtual,
50:56and he can definitely speak more about that.
50:59It sounded really interesting so.
51:02Want to say something about that? Scott,
51:04yeah, there's a.
51:05There's a group of physical therapy
51:07students at Quinnipiac University if I can.
51:10If I can find the flyer, I will try again.
51:13Try again to try to post it
51:16into the chat here.
51:17They are offering a virtual exercise
51:19class for any cancer survivor that
51:21will be starting later this summer and
51:24so it will be run by the students but
51:27supervised by me in their professors.
51:29So we're pretty excited to to offer that to.
51:32Danny survivor in the state.
51:36A great program. And we should just
51:38clarify that we define any survivor
51:40as having had a history of cancer
51:43starting from diagnosis through the
51:45balance of your life, and that had
51:47been a question in the chat before.
51:52Here's a one last we have about 2 minutes
51:54left before will start closing here,
51:57but I am a 71 year old into my fifth
51:59year of prostate cancer survival.
52:01My testosterone level has been
52:03below normal and I had a compression
52:05fracture at the T5 or seven level
52:07of my spine this past January.
52:09I have no pain emanating from the fracture.
52:11Should I forget about strength training?
52:15I swim or walk six or seven days per week.
52:18Sounds great.
52:20Anybody have any thoughts on on
52:23this gentleman with a history
52:25of a compression fracture? I'm,
52:27I think it's Scott's got said earlier.
52:30These people, people with any type
52:32of bone Mets, certainly can exercise.
52:34They just need to be doing it to begin with
52:38under supervision and gradually increase.
52:40And certainly there's not.
52:42I don't believe a reason not
52:44to resume other exercise.
52:46Aquatic exercise is great.
52:47It does not give you any gravity really.
52:51So you're not strengthening bones.
52:52But you certainly can do a lot.
52:55You can do a lot of
52:58strengthening in the water with.
53:00The Styrofoam noodles and things like
53:02that to give you some resistance,
53:04but then you can also begin a supervised
53:07strengthening program on land.
53:10Great, thank you.
53:13OK, and then let me go up 'cause there
53:15had been a kind of an initial one,
53:17an maybe Kelly. You can comment on this.
53:21I'm 59 now, but was diagnosed with
53:24mantle cell lymphoma in late 2018.
53:27After localized radiation in 2019
53:29and then six months of chemotherapy
53:31in 2020 with good results.
53:33Unfortunately,
53:34I sadly contracted COVID-19 and
53:36symptoms lingered for six months and
53:39lead to interstitial lung disease.
53:41Sorry to read this.
53:43Putting aside the covered component
53:45for a moment for those of us still
53:47competing in an aerobic sport.
53:49Running, cycling, rowing.
53:50Is it reasonable to expect the
53:51body to recover back to the same
53:53level as prior to treatments?
53:55If So what is the reasonable time frame
53:57to set on those expectations so this?
53:59Writer had.
54:02Not only lymphoma, radiation,
54:04chemotherapy,
54:04also then COVID and some long
54:08consequences from that so.
54:11Kelly, with your vast experience.
54:15There's a lot there.
54:16How do you unpack some of this?
54:18What should this person expect?
54:21You know?
54:24For me to say at this point we still have.
54:28We have a couple of people right
54:30now post COVID that were both in
54:33the hospital a long, long time.
54:36One of them does wear oxygen,
54:38the other one does not,
54:40but she was desaturating in the
54:43beginning and now she's doing better.
54:46We've had them.
54:48We've had them for several months now.
54:52And they're still working themselves back up.
54:55I think it's going to take a lot of time.
54:59Unfortunately, I I don't know how
55:02much time I'll be honest with you,
55:05especially given unfortunately,
55:06the diagnosis, the cancer diagnosis and
55:08treatment prior to the COVID diagnosis, but.
55:11I think you said the age was 59, right?
55:15So I think that you have age on your side.
55:20That you're able to and you
55:23were an exerciser prior.
55:24And that's also very helpful.
55:26'cause your body doesn't forget
55:28that you have exercised before.
55:30So I think if you just continually
55:33are doing moderate exercise an in a
55:35monitored setting or a supervised
55:37setting where you're watching your
55:39heart rate in your oxygen saturation's,
55:42that would be beneficial for you.
55:44'cause then you know and just continually
55:47just as regular as you can make the exercise.
55:50If you can get there.
55:52The three days a week or even.
55:55If you're able to do four to
55:57five days a week,
55:59I think you will be able to get back to it,
56:02but timeline unfortunately I don't know.
56:03I don't know if Scott or
56:05anyone else can speak to that.
56:09That's a really hard case and
56:11I think someone like that.
56:13You know, I hope you can.
56:14You know, seek out some some supervised
56:17help and and try to get back to the goals
56:20that you that you have for yourself.
56:22And thank you so much for taking
56:25the time to write that.
56:27OK, we have two minutes left.
56:31Some questions about how
56:32people can reach you.
56:34Those those of you who are actively
56:37prescribing exercise programs.
56:38Maybe what we could do is just say
56:41how you guys stay healthy in the
56:43midst of a pandemic and also seeing
56:46patients if you exercise at all.
56:49If you care to share and then we'll
56:53close out the last minute here.
56:56How about Janet?
57:00Well, I had the benefit of
57:02working in the hospital in the
57:05pandemic as a pharmacy runner,
57:06and I walked about 5 to 6 miles
57:09a day in Greenwich Hospital.
57:11So that really helped.
57:13But like many of my patients,
57:15I started to develop foot and
57:17knee pain from suddenly having
57:19walking as my only exercise.
57:20My gym was closed.
57:22I don't really have much at home so
57:25so I learned a lesson from that and
57:27actually have seen a lot of people who said.
57:31I was walking six miles a day
57:33and my feet are killing me right?
57:36But I've gradually returned.
57:38Back to the gym,
57:39as I've been brave enough to go there,
57:42so that's what I'm in the
57:43gym with the mask on.
57:46Thank you Stacy.
57:50So I love to bike. Like
57:52I said, I actually joined
57:54the cult following of Peleton
57:55during the during the pandemic.
57:57So I have to say that that's
57:59that's my ideal way of working out,
58:01particularly with a four month
58:03old and a 2 1/2 year old at home.
58:05So that's my
58:06that's my go to love that. Thank you, Kelly.
58:12During the pandemic I was also
58:14redeployed to the hospital.
58:16But unlike Doctor Friedman,
58:18I was redeployed to a completely
58:20sedentary job in front of the computer
58:23all day which gave me migraines
58:25and made me cry when I went home.
58:27So but my hours were eight to four.
58:31At 8:30 event, which are much
58:33later than my normal work hours,
58:35so I was able to get up in the morning
58:38and walk the neighborhood or do yoga or
58:41something prior to that sedentary day.
58:44Also, almost every hour I would
58:46just go down to the bottom level
58:48of branch hospital and up to the
58:50third floor on the stairs before
58:53returning back to the computer to
58:55try to do some sort of movement.
58:57And now I'm kind of back to my normal,
59:00you know, walking.
59:01And I've gone to the gym as well,
59:04like Doctor Freedman.
59:05Tom and I have three young kids,
59:08two or so you know,
59:09playing Wiffle ball and whatever
59:11we can do to stay active.
59:15Oh, thank you Kelly and Scott.
59:17Uh, yeah. So interesting Kelly.
59:19I was the opposite when I
59:21was redeployed last spring.
59:22I was doing inpatient care and so
59:25my hours shifted to 7:00 to 3:30
59:27and so I was getting home at 4:00.
59:29And so I you know.
59:31So instead of getting home later,
59:33you know I was home early and so
59:35the kids and I would actually go
59:37biking around the neighborhood.
59:39And so that's how that's how we
59:41got our closer to free training
59:43in last year was, you know,
59:45taking the kids around the neighborhood?
59:47You know, after after being inside all
59:49day and now and they have been on and
59:51they were inside all day on their screens,
59:54you know doing the virtual learning
59:55so they need to get out and exercise
59:58as well you know and so you're hearing
60:00a common theme here with, you know,
01:00:02trying to exercise with little kids.
01:00:03You know a lot of it is, you know,
01:00:06kind of picking your spots.
01:00:07I mean I will.
01:00:08I will drop my daughter off for soccer
01:00:10practice and then I will go for a run
01:00:13and then I will pick her up when she's done.
01:00:15'cause that's the only time that I've got.
01:00:18And so you learn how to.
01:00:19Mine is little holes in your schedule.
01:00:21You learn to get creative
01:00:23or the other thing you know.
01:00:24You know,
01:00:25Doctor Stanton.
01:00:25I know you and I we.
01:00:27We need to start getting on
01:00:28the bike and start raining.
01:00:30So again use the buddy system and you
01:00:32motivate each other and you say alright,
01:00:34I will.
01:00:35I will be at your house at 7:00
01:00:37AM on Sunday morning.
01:00:38Let's go.
01:00:39That's
01:00:40right, well, it's 3 minutes past
01:00:42the hour for contact information.
01:00:45Further questions, please call.
01:00:46Feel free to email us at
01:00:49cancer answers at yale.edu.
01:00:51Otherwise, I will see you back here next
01:00:54week where we're talking about sexuality,
01:00:57intimacy and menopause symptoms after cancer.
01:01:00And thank you for our panelists
01:01:02an your time tonight.
01:01:03I think this is really successful and we
01:01:06couldn't have done it without all of you.
01:01:08So thank you very much.
01:01:10Good night everyone.
01:01:12Tonight.