Staying fit, feeling good

Do daily exercises

After a mastectomy or if you have surgery to your armpit, your surgeon and physiotherapist will ask you to do regular exercises to help you recover. Your arm may feel stiff on the side where your breast was removed. Simple arm exercises can help to

  • give you back your full range of movement (also important for radiotherapy treatment)
  • relieve pain and stiffness
  • reduce swelling

After surgery, do the exercises until you have full movement back in your arm and shoulder. Ideally, you should do these twice a day.

To start with, the exercises are quite gentle. The aim is to get your arm and shoulder moving as it was before the surgery. You can begin each session by circling your shoulders, to get the muscles moving. Other early exercises are brushing or combing your hair, putting your arms behind your back and touching your shoulder with your hand. As you get stronger and more confident, you can do more of the exercises and gradually increase the range of movements.

Have a look at this excellent video:

https://www.youtube.com/watch?v=vo1S-K2MetM

Talk to your surgeon or physiotherapist if you have ongoing problems with arm or shoulder pain, stiffness or swelling.

If you have had breast reconstruction surgery the exercises you do are different and depend upon the type of reconstruction you have had. Check with your surgeon and physiotherapist!

Stay physically active

Tiredness and weakness is finally being recognised as one of the most common side effects from cancer treatment. It’s called: Cancer Related Fatigue. The reasons for it are multifold: the cancer itself drains your energy, the treatment is intense and often toxic, but also the lack of normal physical activity during treatment leads to loss of fitness.

It is encouraging that taking regular exercise can help to combat it. More and more research is showing that exercise during and after treatment is safe and helps recovery after cancer. Regular exercise can reduce stress and give you more energy.

 

But how much, and how often, and what exercise is suitable for me?

To be beneficial, exercise should be 30 minutes a day, 5 days a week, of moderate intense activity such as walking, cycling or dancing. You should get warm and increase your heartbeat without getting out of breath. This level of activity is helpful for people even during treatment.

30mins

Everyone is different and exercise needs to be tailored to individual people, taking into account your diagnosis and treatment (weightlifting shortly after breast surgery), other problems (diabetes, cancer in the bones) and not least: what you love to do and feel is possible in terms of time, travel and costs! A physiotherapist or biokineticist can help you on your way.

Have a look at the pyramid and see what daily exercise you can easily incorporate in your life.

pyramid

Exercise can also be helpful in a number of cancer related side effects:

  • neuropathy (pins and needles, problems with balance): aerobic exercise helps with the recovery of the damaged nerve ends by increasing blood flow.
  • osteoporosis (thinning of the bones): weight bearing exercise means running or rowing or anything where your bones are doing some work. This type of exercise may protect you against osteoporosis (thinning of the bones). Osteoporosis is a concern for many post menopausal women who have had hormone dependent cancers and so cannot take hormone replacement therapy.
  • depression/anxiety: many women with breast cancer battle with depression; regular exercise, possibly in a group, leads to less anxiety and need for medication.

Keep your pace

A very important advise to women fighting cancer is to listen to your body. But how can you do that, juggling a family, doctor’s appointments, medication, work obligations and loosing a breast at the same time?

This great advice was shared with us by the fabulous physiotherapist Liesbeth Raymakers

 

Staying active and healthy

We’re on a mission to help you to live an active and healthy life during cancer treatment, to empower you actively to cope with the cancer journey.

The recipies we are sharing are part of that, and here is a great list of things to do (and not to do) to make your journey easier.

Do’s:

    • talk with your loved ones about your feelings of loss, speak to other breast cancer survivors, find support online
    • get adequate pain medication
    • contact your doctor or nurse when you develop problems
    • massage the scars daily, dry or gently with a non-irritating skin oil. There’s a good video here to help you.

Don’ts:

  • push yourself: be mild and accept the pace your body is healing at
  • lift or carry anything heavy for the first few weeks after surgery. This includes vacuuming, shopping and lifting a full kettle or a child.

Watch out for:

Wound infection

If your operation site becomes red, inflamed, or painful, or there is a fluid (discharge) leaking from your wound site, you may have an infection. Contact your surgeon or breast care nurse immediately. If you have an infection, you will need antibiotics to clear it up.

Fluid collecting around the operation site (seroma)

Sometimes fluid continues to collect near the wound after your wound drains have been taken out. This is called a seroma. It causes swelling and pain and can increase the risk of infection. The fluid usually goes away on its own. Sometimes a nurse needs to drain the fluid off with a needle and syringe. They may need to do this a few times.

For some women, the fluid takes a long time to go. It can take up to a few months after your surgery.

Nerve pain

You may have numbness or tingling in your upper arm, particularly if you had your lymph nodes removed. This is normal and happens because some nerves are cut during the operation and need to repair themselves. It can take a few weeks or months to go. If it continues, get in touch with your breast care nurse or surgeon.

Swelling of your arm or hand

You may have some swelling in your arm or hand after your operation. This is normal. But it should start to go away as you do the exercises (see below) to get back the movement of your shoulder and arm.

If you continue to get a lot of swelling, heaviness, pain or tenderness in your arm or hand, let your breast care nurse or surgeon know as soon as possible. After surgery or radiotherapy to the armpit, there is a risk of developing permanent swelling called lymphoedema. Once you have lymphoedema it can’t be cured but early treatment can effectively control it. Look at the information about lymphoedema page for ways of preventing lymphoedema.

Scar tissue in the armpit (cording)

Some women develop scar tissue in the armpit (axilla), which forms a tight band. This can happen 6 to 8 weeks after the operation. The scar tissue is called cording or banding and can feel something like a guitar string. Cording is harmless but can be uncomfortable. It can get better after some time if you massage the area of the scar tissue. Your specialist nurse or a physiotherapist can teach you how to do this.

This great advice was shared with us by the fabulous physiotherapist Liesbeth Raymakers

 

 

Keeping the balance

Over the next couple of weeks, we will be posting a series of recipies that will help you as you go through treatment. The Cancer Lifeline recipies are divided into three phases:

  • Tough Times, for use when you are very ill, during treatment, while the appetite is poor and the weight low.
  • Clean Machine, for detoxification of the body, post cancer treatment, or to kickstart a holistic health creation programme.
  • Eat Right, to set the right style of eating for the rest of your life to generate optimum health.

The recipies have been created by celebrity chef and nutrition consultant, Jane Sen, for the nourishment and healing of people with cancer. The recipies are part of the Cancer Lifeline Kit by Dr Rosy Daniel, which she has generously shared with us.

balance

Making an impact

The Breast Course for Nurses: who we are and what we have done over the last 12 months     

We have run several courses over the last 12 months:

Cape Town, South Africa – 15 nurses trained
Lilongwe, Malawi – 26 nurses trained
Windhoek, Namibia – 30 nurses trained
Ongwediva, Namibia – 30 nurses trained
Harare, Zimbabwe – 257 health care providers trained
Johannesburg, South Africa – 42 nurses trained

An account of each course can be found on the blog: http://www.jennyedge.co.za and Facebook page: www.facebook.com/breastcourse4nurses

blog 2The course is constantly evolving and I want to highlight some of the new changes we have made this year.

The major challenge we have addressed is allowing the course to run independently.

I have learnt a lot about teaching through the whole process.  The course was set up along the principles of the flipped class technique.

blog 2.1Unlike teaching at school, the participants on the courses are very varied and most are experts in their own areas.  We were constantly faced with the challenge of having large numbers of health care workers with vastly differing levels of knowledge about breast cancer and differing needs from the course.  In Zimbabwe, we were asked to extend the training to include doctors.  We met the challenge by dividing the 2 day course into 3 day long modules:
Module 1 was capped at 80 students and aimed at primary health care workers, breast cancer advocates and registered nurses.
Module 2 was capped at 50 participants and was aimed at registered nurses from the clinics, oncology sisters and doctors.
Module 3 was capped at 30 participants and was aimed at oncology sisters and doctors.  It allowed us to teach biopsy techniques.

blog 2.2We were also asked to have a “train the trainers” day. In many ways, the request ran against our aim to equip nurses to be self sufficient in their learning.  (The principle behind PEP is that health care workers should educate themselves with the material provided.)  Nevertheless, we blended the 2 approaches and Prof Woods and I ran a day in which we looked at different teaching modalities and tried to apply them to the course.  We defined “teaching” as the “sharing of understanding”
The result was that Module 1 of the Breast Course for Nurses was entirely taught by the nurses who attended the train the trainer’s day and studied the book (Breast Care).  I was immensely proud!

In Johannesburg, we took a different approach to deal with the challenge.  The course was run at Charlotte Maxeke Hospital by Dr Sarah Nietz and her team.  I wasn’t there at all.  I understand that 45 nurses completed the course.  The faculty were entirely local.

blog 2.3

Many thanks to everyone who has been involved with the Breast Course for Nurses.  If you wish to become involved, run a course or know more, please contact us.

Dr Jenny Edge, Founder and director of Breast Course for Nurses (PBO No.: 930050375)

Facebook: http://www.facebook.com/breastcourse4nurses

Blog: www.jennyedge.co.za

Email: lieskewegelin@gmail.com

 

 

The Breast Course for Nurses: who we are and what we do

Regular readers of this blog will know that the Cancer Alliance is a collective initiative by South Africa’s main breast cancer organisations. We will be introducing each of our partners over the next few months. Today, meet Breast Course for Nurses. This blog was written by Dr Jenny Edge, Founder and director of Breast Course for Nurses.

     

It is an indisputable fact that women who are diagnosed with breast cancer at an earlier stage have a much better outcome than those diagnosed at a later stage.  Breast cancer screening programmes are well established in high income countries.

The modality of screening used is generally mammographic screening.

There has been a lot of debate about why women are diagnosed late in low income settings.  Do they present late because they are scared or cannot afford to access the health facility?  Do they present with symptoms that are not recognized as cancer by the health care worker (generally a nurse in a primary clinic)?  Do they get lost in the journey of diagnostic tests?

We don’t have the answer to these questions.  The Breast Course for Nurses aims to educate nurses working in primary clinics and equip them with the skills to recognise normal changes to the breast and differentiate them from changes associated with breast cancer.  We teach clinical breast examination with an aim to identifying breast cancers at an earlier stage.

Does clinical breast examination work as a means of breast screening?

Clinical breast examination, as a screening modality, has been studied with mixed results.   A recent study carried out in Sudan showed that clinical examination does pick up breast cancer at an earlier stage than in the control population.1    In Canada, where clinical breast examination was compared to mammographic examination, the mortality from breast cancer, 20 years later, was similar in both groups although more cancers were diagnosed in the mammographically screened population2.

The Breast Course for Nurses is a combination of a self-learning program (PEP educations series) and a residential program that contextualizes the theory in the book, encourages networking amongst the participants and stimulates debate as to how to improve access to care.  The courses are taught by local faculty and no course is the same.

Does our method of transferring understanding work?  We will be doing various projects to look at the impact of running our course.

In the next blog, we will give details of the courses we have run over the last 12 months.

References

  1. Abuidris DO1, Elsheikh A, Ali M, Musa H, Elgaili E, Ahmed AO, Sulieman I, Mohammed SI. Breast-cancer screening with trained volunteers in a rural area of Sudan: a pilot study. Lancet Oncol. 2013 Apr;14(4):363-70. doi: 10.1016/S1470-2045(12)70583-1. Epub 2013 Jan 31.
  1. Anthony B Miller, Claus Wall, Cornelia J Baines, Ping Sun, Teresa To, Steven A Narod.. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast. Screening Study: randomised screening trial. BMJ: g366 doi:10.1136/bmj g 366

Facebook: http://www.facebook.com/breastcourse4nurses

Blog: www.jennyedge.co.za

Email: lieskewegelin@gmail.com

ABC - Advocates for Breast Cancer - Breast Course 4 Nurses

#TouchYourselfTonight

In a series of witty PSA videos, the masked superhero Deadpool is using his new popularity to extend the benefits of self-examining your breasts to check for breast cancer. So, #TouchYourselfTonight.

“Did you know that one in eight women will be diagnosed with breast cancer at some point in their life? So it looks like you’ve got some fumbling to do yourself.” #TouchYourselfTonight

Source: www.faircare.io

World Cancer Day highlights urgent need for a breast health policy in South Africa

 

8_WeCanShapePolicyChange_WCD2016_512x1024
It has been 16 years since World Cancer Day (WCD) was declared as part of the Paris Charter adopted at the World Summit Against Cancer for the New on 4 February 2000, but for most cancer patients in South Africa little has changed.

“Cancer is still not regarded as a priority in South Africa,” says Salomé Meyer, spokesperson for the Advocates for Breast Cancer (ABC), a coalition of interested breast cancer organisations in South Africa.

ABC was formed in 2014 to campaign for a national breast health policy for South Africa and to prioritise the management of this disease. Eight breast cancer organisations – The Breast Health Foundation, Reach for Recovery, CANSA, Pink Drive, Project Flamingo, Breast Course for Nurses, People Living with Cancer and Wings of Hope – are working together to lobby government to create and implement an equitable breast health policy for all South Africans.

“We know that breast cancer is still the leading cause of cancer related deaths for women in our country,” Meyer said. “But we still do not have a cancer registry which would provide the vital real-time data that is needed to plan or budget appropriately.

“This World Cancer Day we are calling on the Minister of Health, Dr Aaron Motsoaledi, to urgently develop a breast health policy for our country.”

As part of its advocacy campaign, ABC provides information about breast cancer on its blog at www.blogforbreastcancer.wordpress.com and through its Facebook page at https://www.facebook.com/AdvocatesForBreastCancer/.