Healing is a process, a journey that has its ups and downs. Your journey back to wellness after your breast cancer treatment program is likely to have its own ups and downs: Two steps forward and one step back. With your consent and your commitment, we can work as partners to combat Axillary Web Syndrome and Lymphedema.
As a PTA at Pratt Physical Therapy, I am often asked, “How much longer?” Or “Why does my wrist now hurt?” “You’ve fixed me in one place and now I’m aching in another spot. Why?” Best yet: “When will I be done with all this?”
“Are we there yet?” Well my answer is: “Are you ready to commit?”
The healing process relating to lymphedema and Axillary Web Syndrome (AWS) is gradual. Getting technical here now….Once we introduce new physical therapy interventions, your body will respond rapidly to the disruption of the inflammatory responses that currently contribute to your pain and soft tissue congestion. The physiological changes that are achieved are maintained; however, day to day cellular processes continue to strain your (already overwhelmed) lymphatic system. As a result, lymphedema and/or AWS often require prolonged treatment interventions to reduce the risk for flare-ups and to achieve a stable situation.
To identify quantifiable change (for the better we hope!), we rely on a series of functional outcome measures. These measurements include:
upper extremity and chest girth measurements
strength and range of motion testing
pain measurements.
Pain? Yes! Pain is considered the 5th vital sign!
CMS guidelines typically denote the model for measuring functional outcomes to determine whether or not a treatment is covered) describes pain “as a complex and dynamic interaction among physiological, psychological, and social factors that can perpetuate or worsen the clinical presentation. The CMS persists, stating “pain must be taken into consideration in determining the effects on a patient’s quality of life and functional status.”
As a physical therapy provider, we not only consider your pain severity, but also your pain location, descriptors, and alleviating/aggravating factors, which will allow us to plan and modify our treatment strategies to target the involved areas with a range of treatments. This treatment plan may include, but may also extend beyond, the use of manual treatment interventions, modalities, and exercise as part of your complete decongestive therapy treatment goals.
We gather information, including feedback on your pain threshold in your daily treatment notes. We do this because it allows us to determine the areas we need to continue to focus on and the areas of improvement needed; it also strengthens your relationship with us as we work collaboratively to achieve your wellness goals.
We Need Your Buy-In To Make this Healing Journey Work!
The American Medical Association defines the ideal patient - provider relationship as the collaborative effort between patient and provider with both parties working together in a mutually respectful alliance to achieve optimal treatment outcomes. As a provider, we are privileged to be participating in your care plan with our principal duty to provide education regarding your diagnosis, prognosis, and recommended treatment options. I can’t emphasize enough that this is an alliance. We want to enable you to make an informed decision as we first seek your consent to allow us to embark on your healing journey.
Often as individual patients we undermine our ability to consent to treatment. By attending the appointment, or meeting with a doctor, you are agreeing to do something. But ask yourself…do you know what… or why…. you are agreeing to do what is being tasked of you? For most, especially for our persons undergoing treatment for lymphedema and axillary web syndrome, the answer is no; your consent has become transactional, you just fought the greatest fight of your life. Know that consent becomes your means of moving forward to the next step, the next phase, the next part of the journey that persists as a result of receiving a diagnosis of breast cancer. This is the point where we - as physical therapy providers - hope to change things for the better. Recall: the ideal patient provider construct is based on collaborative effort. Our role, when done well, is to empower you with the knowledge and understanding of lymphedema and axillary web syndrome, to recognize, validate, and assess your concerns regarding the physiological changes that do occur as a result of medical/surgical interventions for breast cancer. Our goal is to provide you with the most up-to-date evidence-based care practices so that you may begin to heal. Your collaboration is necessary. We are committed to providing you with the best functional outcomes we can achieve but you MUST be an active participant in your healing process.
Without your commitment we are unable to fully achieve your functional goals to move better, to feel better, and to return to the very best version of you. Let’s do this together!
Jaclynn Robey, PTA