Volume 26
Number 18
September 4, 2015
Hospital of the University of Pennsylvania
Restoring
FUNCTION...and Quality of Life
`` Mously Le Blanc, MD, examines cancer patient Sarah Happy using an ultrasound machine to visualize the tendons, ligaments and nerves and bones that make up the shoulder joint. This will give her real time information about any structural abnormalities causing the patient’s pain.
Mously Le Blanc, MD, is a detective of sorts. As a cancer rehabilitation specialist — one of only a few in the country — she uses her knowledge of nerves, muscles, and bones to connect the dots between patients’ mysterious symptoms and cancer treatments, often from years before.
INSIDE Cancer Support Services..........2 Spreading the Good Word of Science...................................3 Christmas Comes Early............3 2015 Quality and Patient Safety Awards...........................4
Take, for example, the 35-year-old patient with a right shoulder weakness who came to see her two months after receiving a Botox injection. “He couldn’t raise his arm more than 90 degrees and thought it was connected to the injection,” she said. “But the location of the injection site and where he had weakness didn’t add up.” When he removed his shirt for examination, Le Blanc immediately knew the problem. “I asked him if he had been treated for cancer and he told me he had both surgery and radiation for bilateral tonsilar cancer 13 years earlier.” How did she know? The muscle tissue in that area had shrunk and looked contracted, tight from the radiation. And the shoulder
blade was winging out, as opposed to lying flat as it normally does. “During head and neck surgery or radiation treatment, the spinal accessory nerve — a small nerve that lies near the surface —can be injured,” she explained. “This nerve stimulates the trapezoid muscle, which is a major shoulder stabilizer. Without the working nerve, the shoulder blade doesn’t move correctly and prevents the arm from moving the full range of motion.” Le Blanc prescribed a rehab program aimed at restoring muscular balance. “We worked on strengthening the compensatory muscles, like the rhomboids and levator scapular, and also stretching out the pectoral muscles,” (continued on page 2)
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Restoring
FUNCTION...and Quality of Life
(continued from page 1)
she said. “After eight weeks, the patient had a full range of motion back on that side.” Women who undergo treatment for breast cancer can experience similar problems from radiation, which changes the musculature structure. “The muscles are no longer soft and tensile. They’re still and fibrotic,” she said. “These women can become hunched over due to overactive pectoral muscles from the radiation. They’re scared to move their arm and avoid using that side, losing much of their range of motion.”
discomfort. Le Blanc started her on a medication that specifically addressed the nerve pain. “After three weeks, the patient identified her pain as ‘level 2‘ and was able to wear a bra and shirt,” she said. But, more important, she was able to hold her baby close. “Patients often have symptoms for years and have undergone physical therapy for pain management,” she said, “but, without an accurate diagnosis, treatment results are limited.”
ncologists save lives. I help facilitate a return O to a better quality of life.
Six months after one patient had a mastectomy, she couldn’t dress herself and was in significant pain. Anti-inflammatories didn’t work and neither did physical therapy using just heat and massage. Le Blanc gave her a steroid joint injection and then put her on an aggressive physical therapy plan. “The woman regained her full range of motion and is pain free,” she said.
Aramatase inhibitors (AIs), which are estrogen blockers given to women with hormone responsive cancer to reduce the risk of recurrence, can also cause problems. At least one-third — and possibly more — of these patients develop symptoms very similar to fibromyalgia, including pain, fatigue and “a foggy brain.”
“Radiation can affect all the muscles, bones, nerves and lymphatics in the irradiated area but the effects can occur years later,” she said. “That’s the problem. When they do present, it’s so far out from the cancer that primary care physicians aren’t even considering that the problem has to do with the cancer treatment.”
Daily activities, like walking, going down stairs, cooking and cleaning, are now impossible without significant pain. “These women are often in their 30s or 40s but feel like they aged 20 to 30 years overnight. I hear that all the time,” she said. “They go through physical therapy, acupuncture, and pain medication but nothing helps.”
To relieve these symptoms, Le Blanc prescribes a neuropathic pain medication and an anti-inflammatory as needed, in combination with a specific PT/OT program. Often, by the time they return for a follow-up visit three weeks later, “the difference is amazing.”
atients often have symptoms for years and have P undergone physical therapy for pain management but, without an accurate diagnosis, treatment results are limited.
Post-mastectomy pain syndrome is another complication that is frequently misdiagnosed and, as a result, mistreated. This chronic pain can occur after breast cancer surgeries — most prevalent after a lumpectomy — and auxiliary lymph node dissection. Both radiation and direct injury to the sensory nerves in the underarm can cause the symptoms. “It’s like a stabbing, burning, squeezing that shoots across the chest in a band-like distribution,” Le Blanc said. One of her patients was on high-dose narcotics but still was in pain and unable to have anything touch her chest area without severe
Staying on the AI is essential to decrease the risk of recurrence, she stressed. “Creating a plan to help them manage potential side effects can be life saving.” Le Blanc can also help patients before treatment, through a “prehabilitation program to help minimize the risk of developing some of these complications,” as well as during treatment. “If a patient is not tolerating treatment, it may need to be stopped,” she said. “If it’s better managed, the patient will stay on.” Cancer patients have a lot of rehab needs, including musculoskeletal disorders, pain, lymphedema, and fatigue, she said. Early intervention is key. “Oncologists save lives. I help facilitate a return to a better quality of life.”
Cancer Support Services The Abramson Cancer Center offers multiple programs to help patients, both while undergoing treatment and after, including: •O nline support, including a tool for navigating a new diagnosis and a Survivorship Care Plan Program. Learn more at www.oncolink.org. •M assage and Reiki
•A cupuncture •Y oga • Penn Program for Mindfulness •S ocial Work and Counseling •N urse Navigation
To learn more about these support programs and more, contact Laura Galindez MSW, LSW, integrative patient navigator at 215-360-0580 or laura.galindez@uphs.upenn.edu.
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`` From left: Carolyn Vachani, OncoLink nurse editor; Karen Arnold-Korzeniowski, oncology content specialist, and Christina Bach, education specialist, handed out information during Cancer Survivors Day.
Spreading the Good Word of Science As the realities of science move closer and closer to science fiction, the laymen among us are lucky to have people like Marion Leary, MPH, MSN, RN, assistant director of Clinical Research in the Center for Resuscitation Science, around. Leary volunteers with the group Start Talking Science, whose goal is to spark an interest in STEM (Science, Technology, Engineering, and Math) among Philadelphians of all ages and backgrounds. Leary began volunteering for the group after attending their inaugural presentation last year and recently won a Penn Medicine CAREs grant to help the cause. “I’ve been a science geek from a young age. I was looking for groups to get involved with to spread the good word of science and it’s exactly what I was looking for,” Leary said. “They help make STEM research accessible to the general public.”
Scientists who want to present at the Start Talking Science event submit poster ideas to a panel for approval. Then, draft posters are submitted and looked over by specialists to ensure they make sense to the average Joe. At the event, the experts make themselves available to show off their posters, explain their subjects, and answer questions that may arise. Start Talking Science gives the general public a rare chance to have casual conversations about high-level scientific concepts with some of the best and brightest that Philadelphia has to offer. “We want to get students and the general public engaged in the STEM work being done in Philadelphia, and, more important, present it in a way that is engaging,” Leary said. The CAREs grant will go towards materials needed to put on the event and refreshments for guests. Leary, who also writes about science and health for The Huffington Post, said Philadelphia is a growing hotbed for those
in the STEM industry and that STS event gives professionals from across the city a chance to collaborate. Last year, presenters came from many different institutions, including the University of Pennsylvania, Drexel University, Temple University and more. By Leary’s count, the `` Marion Leary, MPH, MSN, RN number of applications to present tripled this year over last, showing a booming interest coming from the city’s scientific community. To learn more about Start Talking Science and this year’s presentation on Tuesday, September 29, go to http://starttalkingscience.com/
Chr istmas comes early Several members of the Perelman Endoscopy Center were instrumental in putting together a “Christmas in July” collection and donation for the residents of Horizon House, a homeless shelter in the West Philadelphia area. Holly Sharpe, BSN, and Omar Arenas, BSN, who led the effort, were inspired by the plight of the under-privileged in and around the West Philadelphia area. “Horizon House is a shelter I drive by every day on my way home from work,” Sharpe said. “One day it just clicked — We’ll do a Christmas in July.”
Greg Ginsberg, MD, director of Endoscopic Services, praised the efforts of everyone involved. “It’s inspiring because we have staff who are consummate professionals. In addition to performing with excellence at the workplace, they have their eyes open to what’s going on in the rest of the world and they are interested in impacting on that in an equally positive manner.”
Sharpe said the director and counselors who accepted the donations were “immensely appreciative.” Among all the donations was a single pair of socks. “We were told that people there really need socks,” Sharpe said, “so that will be our next campaign: a sock/winter clothing drive.”
`` Holly Sharpe and Omar Arenas with some of the many contributions to residents of the Horizon House.
“It’s a way of giving back to the community surrounding the Endoscopy Center, because we cater to a lot of West Philadelphia area patients,” Arenas added. Sharpe coordinated with the director of the shelter there to see what its needs were. They requested hygiene items and under clothes for the residents. Thanks to some generous contributions, the collection raised $200 and 60 grab bags containing a washcloth, soap, toothbrush and toothpaste. “We also collected a large amount of miscellaneous toiletry supplies,” Sharpe said.
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Papal Visit Preparations As Philadelphia prepares for the Pope’s visit later this month, Papal planning teams at each entity have been meeting to assess site-specific issues that may arise, including necessary staffing levels and adequate supply delivery. Each entity will provide more detailed guidance to staff as required. As a reminder, all elective procedures and outpatient appointments in any downtown facility on Friday, September 25, and Monday, September 28, have been rescheduled. General information as well as useful external web links and the ability to submit questions can be found on the UPHS Intranet home page. In addition, the Papal Visit Playbook, an in-depth guide about what to expect, is now available at http://www.worldmeeting2015.org/papal-visit-playbookhomepage. It provides a comprehensive list of do’s and don’ts for visitors and a transportation plan overview. Keep checking the site for soon-to-come pedestrian maps and walking routes to special dining and event offerings.
2015 Quality and Patient Safety Awards Have a great project that you want to share with others? Submit it to the UPHS Quality and Patient Safety Awards. This award has been a longstanding opportunity for teams to formally document their achievements in quality and patient safety over the last 12 months. It acknowledges Penn Medicine departments or teams that have exhibited leadership and innovation in activities that ensure high quality clinical outcomes, patient satisfaction, patient safety, and/or operational improvement. Click on the 2015 Quality & Patient Safety Award Submission link on the UPHS homepage to learn more and submit your project. All applications and projects must be submitted electronically by September 24.
Still Time to JOIN! Help support Alzheimer’s and aging-related research and care at Penn’s Institute on Aging by participating in the Fourth Annual 5K for the IOA & The Memory Mile Walk on Sunday, September 20. The race starts at the Shoemaker Green entrance to Penn Park (between Walnut and South Streets) at 8 am. New this year: Dogs on leashes are welcomed for the Memory Mile Walk (not the 5K). Online registration at www.pennmedicine.org/5kioa is available through Thursday, September 17. Walk-up registration will also be available on race day. For more information, contact Elizabeth Yannes at 215-573-4961 or elyannes@upenn.edu.
HUPdate EDITORIAL STAFF Sally Sapega Editor and Photographer Abby Ernst Graphic Designer
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Susan E. Phillips Senior Vice President, Public Affairs Holly Auer Director of Communications CONTACT HUPDATE AT: 3535 Market Street, Mezzanine Philadelphia, PA 19104 phone: 215.662.4488 fax: 215.349.8312 email: sally.sapega@uphs.upenn.edu HUPdate is published biweekly for HUP employees. Access HUPdate online at http://news.pennmedicine.org/inside/hupdate.
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