Andréa Leiserowitz

At the time, I doubted he’d return for a second physical therapy appointment. John was in his 70’s and had been diagnosed with prostate cancer. He became my favorite and most inspiring patient.

His prostate and many lymph nodes had been removed, followed by radiation and anti-testosterone drugs. He wasn’t told he had a lifetime lymphedema risk.

Unfortunately, cancer had spread throughout his bones. After both legs swelled, he was referred to me. He was tired, weak and embarrassed about his huge legs, which occasionally leaked lymphatic fluid.John was also overweight and feisty. I teased him and we began the evaluation. He needed education and encouragement to improve several treatment-related problems.

John’s cancer-related swelling had progressed up both legs, into his groin and abdomen, worsened by his disease, weight, and weekly chemotherapy and steroids. Initially, he didn’t love exercise or compression socks, but as his lymphedema improved, he became convinced. We enjoyed working together, joking around while he and his wife learned lymphatic massage and exercise.

The lymphatic system is a critical part of our immune system. Lymph nodes drain lymph fluid from the body back up to the heart. White blood cells in lymph nodes fight infection and cancer. Obesity, radiation and infection increase lymphedema risk. Newer research demonstrates a likely inflammatory trigger (like diabetes) along with lymph node removal. Once lymphedema occurs, there’s no cure. It’s imperative to diagnose and treat promptly.

Unfortunately, many physicians lack sufficient training in lymphedema, leading to late diagnosis.Beginning swelling is often missed; instead, “large” swelling prompts specialist referral. It’s critical to identify early “small” arm or leg swelling and begin treatment before it worsens.

Lymphedema is dreaded by breast cancer survivors. But it’s not just their risk. It’s swelling that occurs in thousands of patients with cancer, such as those with head and neck cancer; prostate cancer; uterine cancer; colon cancer; lymphoma; sarcoma and melanoma. Lymphedema isn’t inevitable; many lifestyle changes reduce risk. Lymphedema treatments include skin care, bandaging, garments, massage and exercise. We should educate patients by adding a cancer-lymphedema certified physical therapist to every oncology team.

Months later, John dropped in. He was attending a local Livestrong exercise program three times a week, wearing compression garments and admitted, “exercise is more fun than I thought it’d be.” John proudly exclaimed, “I’ve lost 30 pounds, look at my legs,” and then quietly said, “You know, I’ve never felt better in my whole life.”

We both teared up. His cancer was worse, and he needed ongoing aggressive chemotherapy — he had every reason to feel terrible. Yet, losing 30 pounds and building strength improved his life. He hadn’t given up, instead he learned how to be healthy despite his terrible disease.

John died two years later from his prostate cancer. He lived longer and better by managing his lymphedema and increasing his strength and endurance. It takes a team to improve the lives of cancer survivors, including physical therapists trained in cancer and lymphedema.

Andréa Leiserowitz is a board-certified oncologic physical therapist in Oregon. Her expertise is in cancer, exercise and end-of-life issues.

For more news on cancer updates, research and education, don’t forget to 

Articles

A physical therapist recalls how one of her patient’s with prostate cancer hated exercise when he first came to visit her, but then his mindset changed once he realized his lymphedema started to get under control.

Although Many of Us Don’t Love the Idea of It, Exercise Can Help Reduce the Effects of Lymphedema

Winter is upon us, which makes me think about the seasons of life. As a physical therapist, memories return of patient deaths, including my own father, who should’ve, but like thousands of others, didn’t get the full benefit of hospice. Convincing my father he was dying and it was time to start hospice care, was harder than anticipated. These conversations are difficult, but we can and should do more to address the end of life before the dying process begins.

Forty years ago, my mother read an article about 

 who started hospice in England. My mother helped found 

, in Michigan. As the hospice movement grew across the nation, it transformed the death experience for many by preparing patients and families and managing problems like pain.

 shows that the benefits of hospice are greatest when on hospice for at least 30 days, yet unfortunately, many aren’t. Cultural beliefs about death, the patient or family’s inability to acknowledge the dying process, and clinician discomfort can keep some patients from having the discussion or 

After months, it became clear that my father’s worsening shortness of breath and oxygen dependence indicated heart and lung failure – he’d entered the early phase of dying. He and I talked about what would happen if he ended up in intensive care and after discussion, he decided to sign a Do Not Resuscitate form. He was reluctant to start hospice; he didn’t feel ready, didn’t feel like he was dying.I hadn’t expected this and only after promising him he could stop anytime he wanted, did he finally agree to start.

The hospice nurse came and assessed that he probably had less than a week left. Suddenly, time was short and heavy and we rushed to prepare the house, acquire equipment and learn how to draw up oral morphine in small syringes, while he quickly became more symptomatic and bed-bound.

Despite years of training and teaching, I’d never realized the true impact of family responsibility for all of the day and nighttime care. As he became frailer, it became difficult and even scary to turn and care for him, even for our medically trained family. I was tired, anxious, intensely “watching and waiting”, and needed nursing reassurance.

My father transitioned into a coma within a few days, with my son’s little blue stuffed elephant by his side. We waited for him to open his eyes or talk once more, but, neither happened. Looking back, our last conversation wasn’t the deeper connection I so needed. I sat waiting…watching his facial expressions change as if he was re-living life in reverse until finally, his heart just suddenly stopped. Later that night, I felt his presence stretched out, hovering overhead near the ceiling, and then he was gone.

The lessons from my father’s death are with me, influencing my teaching and work with cancer patients. His hospice nurse told me that for him, adding morphine earlier could’ve improved his breathing and extended his life, possibly by months. Starting hospice earlier could’ve provided more time and space to say goodbye.

Patients should have these conversations and make decisions with their family and doctor while still healthy. This enables earlier hospice initiation when the time comes, increasing the likelihood of a more comfortable death. My father, fortunately, had a simple death, but if he had had more hospice care, we might have celebrated his 90th birthday instead of attending his funeral.

And yet, how beautiful was the gift of his death with the kindness and assistance of the hospice team, that was started by his own wife 40 years earlier. For my father, the gentle hands of family and hospice guided his peaceful death and helped bring his life to a close.

This Share Your Story was submitted by Dr. Andréa Leiserowitz, board-certified oncologic physical therapist, double lymphedema certified, adjunct clinical professor and national speaker with expertise in cancer, exercise and end-of-life issues.

With winter upon us, a caregiver discusses how the end of life is akin to the cycle of seasons and how hospice does not have to be a challenging hurdle. 

Andréa Leiserowitz

Although Many of Us Don’t Love the Idea of It, Exercise Can Help Reduce the Effects of Lymphedema

Winter And Entering Hospice

Latest News