OT for Breast Cancer

New service line provides rehabilitative care to breast cancer patients

by Michele Berhorst  •  March 6, 2020

NEED PHOTO CAPTION.

Chrisanna Jung, 54, lives an active life with many occupations: wife, mother, grandmother, long-time employee at a local Ford dealership to a name a few. When she was diagnosed with breast cancer on May 28, 2019, she was determined to get control of her life— and her body—back as soon as possible.

“The support I had from my family, friends and at work was tremendous. My husband, Eric, was my world—I could not have gone through this process without him. He cried with me, laughed with me and held me up when up was the last place I wanted to be. When I told my boss, he broke down in tears and told me, ‘You first—whatever you need to do, you do it,’” Jung shares. “I started chemotherapy on July 1. I did four rounds of Adriamycin/Cytoxan, which they call the ‘red devil,’ and it was miserable. Then, I did 12 weeks of Taxol through Nov. 11.”

Jung had her first consultation with Marissa Tenenbaum, MD, to discuss the reconstruction surgeries that would follow her double mastectomy in mid-October. Therapist specialist Ellen King, BSOT, OTR/L, CHT, also attended the consult. King is one of several therapists at Washington University Occupational Therapy’s Milliken Hand Rehabilitation Center who provide specialized rehabilitative care for breast cancer patients like Jung. The new service line was developed when King and colleague Katie McQueen, OTD, OTR/L, CHT, treated a patient with a broken wrist.

“During her evaluation, we asked her to move her shoulder and she couldn’t. Then, she told us about her breast cancer journey and reconstruction surgeries. She didn’t know who to talk to about her frozen shoulder—she was just happy to be alive and cancer-free, so her shoulder wasn’t a priority,” McQueen explains. “With the right pre- and post-operative care, breast cancer patients can avoid these types of injuries or mobility restrictions, which could be permanent.”

After seeing more patients with similar issues, King and McQueen started working with Tenenbaum and other physicians in the Division of Plastic and Reconstructive Surgery at Washington University to develop the Occupational Therapy for Breast Cancer Program. Jung was one of the first patients referred to the program. Milliken colleague Sarah Mecadon, MOT, OTR/L, conducted the pre-operative evaluation and plan to prepare Jung for surgery and recovery.

“Sarah took my baseline measurements and gave me exercises and stretches to loosen up my shoulders, back and chest,” Jung recalls. “My husband, who went to all of my appointments, helped me with some of the exercises. Up to this point, I felt like I was at the mercy of my oncologist, the nurses and even the chemo treatments themselves. But doing these exercises before surgery—it empowers you. I would tell myself, ‘I’m going to prepare my body as best as I can and let the doctors do everything else.’”

On Dec. 18, Jung had the double mastectomy, and tissue expanders were inserted to prepare her for implants. As soon as she was able, Jung started doing the exercises and stretches again. “Everything felt so heavy and tight, and stretches gave me such relief—especially one that’s done against a wall to open up the chest. I would roll out of bed, and that stretch was the first thing I did. It felt so wonderful, and I think it made a big difference in my recovery,” says Jung, who did not need to take opioids following surgery. “I have a high tolerance for pain, but just Advil and muscle relaxers were enough for me.”

On Dec. 25, one week after surgery, Jung celebrated the holiday with her family at her son’s house. She recalls Colby, her 10-month-old grandson, reaching out for her to pick him up. “It just broke my heart that I couldn’t because everything was so tender, and I didn’t want to pull a suture. My husband picked him up instead, but he still reached out to me. This little guy didn’t understand why I couldn’t hold him. I can’t imagine what it feels like for young mothers to go through this and not be able to hold their babies.”

Four weeks later, Jung saw King to begin post-operative care that included more exercises and stretches, wound care, scar tissue massage and other treatments. One of Jung’s goals was returning to the gym. “My big question for Dr. Tenenbaum and Ellen was, ‘When can I lift weights again?’ Prior to surgery, I was doing three days of heavy lifting and two days of cardio. I wanted to get back to it as soon as possible,” says Jung, who has since resumed cardio and light hand weights. “I’m ready to feel healthy and strong again.”

Seeing patients getting back to their normal routines is one of the reasons that King enjoys working with this population: “You see a quick progression of patients getting better and regaining their con-fidence. They are motivated to get back to their lives, and they are so thankful for every gain they make along the way. As a therapist, you feel good about being able to help someone through a journey like that.”

On average, King and McQueen see patients four times following exchange surgery, which Jung is scheduled for on March 10 to replace the expanders with implants. While her journey is not over just yet, Jung is embracing the therapy services she receives and encourages other patients to do the same.

“Just do it to the best of your ability. It makes a world of difference to have someone like Ellen working with you to get your range of motion back. It might be painful, but stick with it. Embrace it. I can’t imagine going through all of this and ending up with restricted movement. This is something you can take back from the cancer and control,” Jung says. “You have that power.”