Category Archives: Breast Health Navigator Training

Being a Product of the Product: Pilates and Breast Health Navigators

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Used with permission from Balanced Body

“Be a product of  the product.” That’s the mantra of EduCare founder and registered nurse Judy Kneece. And it’s solid advice for those who believe they should practice what they preach. But it takes on a different meaning when you discover what business EduCare is in.

EduCare founder Judy Kneece on a Reformer at the company’s headquarters

 “We train breast health navigators,” says Judy. “These are nurses who meet with patients as soon as they hear the understandably scary words ‘You have breast cancer.’” EduCare’s navigators coach the patient for the entire continuum of breast cancer care, from pre-surgery through surgery, chemotherapy and beyond.

EduCare has trained over 2,300 navigators who work in hospitals and breast centers all over the world since it opened its doors in 1994.

Three keys to recovery

Judy says it is crucial for a navigator’s patients to understand that there are some things in recovery that no one can do except themselves. After that steely mindset has been established, a breast cancer patient must understand three principles for recovery:

1.       Positive thought

“Every thought we have causes a cascade of chemicals that washes through our body. They can have a positive impact when we think of joyful, peaceful, helpful thoughts. But when we think of negative things like anger, fear and worry, these thoughts actually have a paralyzing effect on the immune system. It impairs recovery. The patient has to realize that they alone can determine what and how they think.”

2.       Nutrition

“Patients are responsible for everything they put into their mouths. Chemotherapy and radiation therapy “kill” cancer cells but “damage” healthy cells that have to be repaired. Only nutrients can do this and only the patient can really dictate what she eats. Every spoonful has to count.”

3.       Movement

“Exercise is a necessary component of healing. The body’s cellular waste sits in the lymphatic system until we move it out. Unlike the vascular system, the lymphatic system does not have a pump. Without exercise to help move fluid through the lymphatics, we actually become a toxic waste dump – particularly for patients in chemotherapy. It is the muscular contractions around the lymphatic that cleans our body and greatly facilitates recovery. Exercise also reduces fatigue, helps alleviate pain and elevates the mood of patients.”

Being a product of the product

For Judy, it’s not just the patients who have to comply with these principles; it’s the navigator’s responsibility as well. “You can’t teach what you don’t do yourself. It comes off as insincere,” she says. “During my training sessions I create a positive environment where the navigators experience exactly what we want them to teach their patients.”

At the four days of intensive training, the navigators eat nutritious meals, learn to think with a positive thought foundation, and are introduced to gentle movement. All of this helps them switch from the clinical focus ingrained in most nurses to actually building a healthy, healing environment in their own bodies.

Pilates is a big part of that.

“I have done Pilates for ten years,” Judy says. “I know what it has done for my body and I have seen magnificent results in other people as well. It is my first recommendation to patients as a method of exercise. Pilates empowers the breast cancer population because it is extremely effective yet gentle on the body. A breast cancer survivor has to move in order to heal, but many types of post-surgery exercise can hurt them. Pilates is the exception.”

Throughout the EduCare training session, Judy employs a trainer (also a Pilates instructor) to introduce Pilates and yoga to the navigators. They learn mat exercises and are encouraged to find a mind-body exercise program near their home or work. Judy also uses a DVD with specific exercises for breast cancer patients to restore range of motion to the surgical arm. “The video is key, because the navigators can buy it and loan it to patients for home use,” she says. “Or – if approved by the patient’s doctor and physical therapist – they can actually design a home exercise program for their patients.”

Pilates has become such a big part of EduCare’s program that Judy recently bought two Reformers for the EduCare office. “We have them in our “energy break” room and we are thrilled to be able to use them,” she says. “It is so good for both the body and the mind and really refreshes us so that we are at the peak of our game.

“And we really are playing a life-changing game.”

Breast Health Navigator Challenge: Overseeing Patient’s Surgical Arm Range of Motion Restoration

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One of the major roles of a Breast Health Navigator is to see that each post-operative patient, after undergoing a lumpectomy or mastectomy, has her physical range of motion restored to her surgical arm.  Most often, the patient is given written instructions and instructed to perform a set of recommended range of motion exercises at home until their physical range of motion is restored.  She is then expected to perform the recommended exercises at home under her own initiative.

Some women accept the challenge and perform the exercises as instructed, while some find it difficult to read the instructions and perform the exercises.  Having a coach, either a support partner or a healthcare professional, increases the likelihood the patient will be consistent and achieve full range of motion before they discontinue the program either from boredom or frustration.

Failure to perform the exercises and restore range of motion can result in future limited use of the arm.  This can cause difficulties with everyday tasks, such as zipping a back zipper or combing hair using the surgical arm. Occasionally, failure to exercise can result in a frozen shoulder which extremely limits normal movement and causes stiffness and pain.  Frozen shoulder occurs from scarring, thickening and shrinkage of the capsule that surrounds the normal shoulder joint.

Treatment of a frozen shoulder usually requires an aggressive combination of anti-inflammatory medication, cortisone injections into the shoulder and physical therapy. Without aggressive treatment, a frozen shoulder can be permanent. Physical therapy is often essential for recovery and can include ultrasound, electric stimulation, range of motion exercise maneuvers, stretching, ice packs and eventually strengthening exercises. Physical therapy can take weeks to months for full recovery, depending on the severity of the scarring of the tissues around the shoulder.

It is essential that patients are encouraged to comply with the stretching and range of motion exercises to avoid either limited movement or having a frozen shoulder.

Some large breast centers address the problem of compliance by referring patients to a Physical Therapist or to a post-surgical group exercise program for patients.  Patient compliance increases with increased encouragement from the personal interaction when attending a group or from the personal coaching provided by the Physical Therapist.  But what about the woman who has time and travel constraints and this is not a viable option?  For these women, achieving maximum rehabilitation can be a challenge.

A good solution is a new DVD, the Breast Cancer Survivor’s Guide to Physical Restoration, written and directed by a Dr. Suzanne Martin a Physical Therapist.  It is now available for breast cancer patients for at-home coaching. Dr. Martin’s video provides instruction for a complete physical rehabilitation program through a 30-minute daily workout program. The DVD includes nutritional guidelines along with a daily Pilates workout to increase core stability and strength. The video is designed for post-op rehab from breast cancer related surgeries including lumpectomy, mastectomy and reconstruction. Dr. Martin includes a self-test to measure surgical arm range of motion, a chest wall lymphatic massage demonstration and the foundation for restoring core strength and posture. The video is 108 minutes in length.  The cost is $19.95, making it affordable for most patients.

For Breast Health Navigators, this is an excellent answer to the challenge of surgical arm physical rehab and an excellent tool to recommend to patients. For women who cannot afford to purchase the video, it could be purchased by the facility and loaned out to patients during their arm rehab period after surgery and then returned to the facility. The DVD can be ordered here. Or, you may contact Balanced Body by phone at 1-800-745-2837.

Have any of you used this video yourself or with your patients. What are your thoughts on it?

 

How to Conquer the Fear of Cancer Recurrence

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Fear of recurrence is the number one reported fear of cancer survivors. A cancer patient laments, “I thought that once I completed cancer treatment I could go on with my life. Instead, I have found myself hypersensitive to every ache and pain and dreading my follow-up visits to the oncologist.”

This cancer survivor’s confession is all too common. Having escaped a death sentence, many survivors are now serving a new life sentence in a prison of fear. The fear of cancer recurring has robbed them of their joy and energy. To heal completely, survivors often find that they have to relearn how to live. This should be a major goal of a Navigator—helping patients gain a new perspective on life after cancer.

Having cancer is similar in some ways to other traumatic experiences such as the death of a family member or being in a car wreck. Facing the suddenness and severity of life and death issues changes something deep within. One thing that changes is one’s outlook on life. One survivor said it was like “repricing everything around her with new price stickers.”  Surviving cancer makes one conscious of what was almost lost and what can never be regained. This awareness makes some afraid that they may again face the trauma of cancer. Some survivors develop Post Traumatic Stress Disorder (PTSD), a state in which life is significantly altered by these fears.

In the same way, someone does not stop driving after a car wreck or having friends after someone they love dies, a person cannot stop living and working towards a positive life after cancer. A survivor must find ways to overcome their fears and return to a sense of “normalcy.”  However, what one decides is normal will have to be redefined because cancer has changed the way they see things.

Cancer interrupted a life already in progress. Old dreams and goals may have died along the way. It’s important that survivors grieve for those very real losses. Those with a heightened sense of fear may not have sufficiently dealt with the trauma that cancer caused in their lives. Since they are dealing with both present fears and issues from the past, their coping measures may not be sufficient. Identifying their losses and making peace with them will help them live a fear-less life.

Navigator Tips for Helping Patients Overcome Their Recurrence Fears

Challenge Survivors To:

  1. Identify exactly what you fear and do all that you can reasonably do to prevent it. Make a plan to improve your health. Write your planned changes down so you can review them and work your plan.
  2. Schedule and keep regular check-up appointments to monitor your body.
  3. Write a letter to fear. This may sound silly, but it works. Write it with a “revengeful attitude” and tell FEAR that you will no longer listen to its constant taunting. Tell fear how you chose to think, believe and live instead. Without an “instead” plan you will rubber-band right back into fear.
  4. Try an experiment. Write down every little thing you enjoy and are grateful for. See how you feel after five full minutes of writing. Schedule time to be reflective and grateful every day. Develop your attitude of gratitude. Plan to start writing short notes to people who touched your life for the better. Tell them now grateful you are for what they did and for what they mean to you.
  5. Develop an emergency kit. This kit can be a letter to yourself reorienting you on how you want to live and what you will think and believe. Ask a friend to be your emergency kit. Teach them to let you vent and then remind you of your chosen beliefs.
  6. Make a plan for what you will do if cancer does recur and how you will live if it happens. This sounds hard, but when you face this mentally and make plans there is a sense of power knowing you have plans, no matter what happens.
  7. Determine to live a positive, faith-filled life. It is has a positive effect on your immune system. Build, buy or make something that reminds you of your choice to live positively in the present.

Fear paralyzes a person. Conquering the fear of recurrence is essential for a cancer patient to reenter life as a triumphant cancer survivor. Many survivors are living life free of disease, but prisoners of their fears of recurrence. Navigators can be the catalyst to help change her perspective of recurrence into a manageable fear. Navigators can coach the patient on how she can transform her fear into knowledge and empower her to live life as successfully after cancer as she did before cancer.

These are some of our suggestions that our Nurse Navigators and patients alike have found helpful. What other steps have worked for you?

 

 

Dr. Ruth O’Regan: Featured Speaker at Educare Training this September

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For those of you visiting our Blog for the first time, we want to let you know that we have an exclusive, annual Breast Health Navigator Training at Emory University Conference Center in Atlanta. This year’s training takes place September 17- 20.  EduCare has been training Navigators for 18 years and over 2,200 nurses have attended the training.

This year’s training promises to be our best yet.  We say this because we are very excited to have, Dr. Ruth O’Regan, practicing Oncologist at the prestigious Emory Breast Center, who will teach the oncology treatment modules. Dr. O’Regan currently serves as an Associate Professor of Hematology and Oncology at the Emory Winship Cancer Institute and is the Director of Winship’s Translational Breast Cancer Research Program.

One of the most challenging roles of a Breast Health Navigator is understanding and discussing cancer treatments with a patient after surgery.  Drugs for chemotherapy are constantly changing, as is the delivery of radiation therapy.  New gene testing and targeted drugs are now a mainstay of oncology treatment.  The body of breast cancer treatment information is large, often complicated, and changes rapidly.  For nurses without an oncology background, cancer treatment navigation may be intimidating. Determining what is important to understand among the vast array of options is essential for effective patient navigation.  Because patients look to their Nurse Navigator to help interpret a physician’s treatment decision, a Navigator needs to feel competent to answer basic patient questions about chemotherapy, hormonal therapy, radiation therapy and the management of their side effects.

Dr. O’Regan brings her front-line, hands-on experience, to prepare Breast Health Nurse Navigators for the role of educating, supporting and navigating breast cancer patients through treatment.  She will condense the vast body of breast cancer information into the basic essentials that you, as a Navigator, must know to educate and empower your patients.

Starting with how treatment decisions are determined for a patient, Dr. O’Regan will:

  • Explain the most recent guidelines and treatment essentials a Navigator needs to understand to support a patient throughout chemotherapy, hormonal, and radiation therapy treatment.
  • Discuss the emotionally charged issues of fertility preservation for young women and treating a woman who is pregnant.
  • Teach Navigators the signs and symptoms of recurrence and the latest practice standards for the treatment of recurrent breast cancer.

We know you will benefit greatly from Dr. O’Regan’s expertise on these topics, and we can’t wait to have you join us in Atlanta. You can register for our conference here. We’ll also be glad to answer your questions in our comment section, or if you prefer, call us at (843) 760-6064 or reach out to us online here.