February 13, 2017

Hours: 8-12:30

First patient: Post-op breast cancer patient that has finished radiation
as well. Last week she was doing great with range of motion and
sensitivity. Today, she was very touchy and did not do well with the
manual lymph drainage. She reported a catching sensation under
her left breast that felt like intense pressure and caused shortness of
breath when she did certain activities like bending down or reaching to
high. She was extremely sensitive to even stretching the skin. Mrs.
McGowan thinks that it is just a result of the breast going down in
swelling and causing the lymph system to get out of order. She also
had a thick ban of scar tissue from the left breast under the arm, and
into the back area. We gave her some modified exercises to help
prevent the catching sensation but to still keep the arms moving.

Second patient: post op lumpectomy patient that has finished

radiation. Range of motion seems to still be in tact with only small
amounts of residual swelling. Patient did not report any major pain. We
set her up to order a new compression sleeve and gave her some
exercises to keep the arms moving. Recommended a walking regiment
for the mostly sedentary patient for overall better circulation.

Third patient: Pre-op breast cancer patient that is having a

mastectomy. She has already gone through a couple rounds of
chemotherapy to reduce the size of the mass in her right breast. We
measured the patients arms for baseline measurements for after
surgery. We educated patient on possible complications from surgery
and what to expect post-surgery. We also recommended a walking
regiment to help reduce fatigue going into surgery and for overall
health, as the patient was slightly obese and therefore at more risk for
developing lymphedema.

Fourth patient: This was our melanoma patient that was reporting
swelling in the leg, thigh, and belly. Last week we bandaged her and
this week we measured her leg to see if there were results. After
measuring, we found the patient had reduced in lymph volume by over
9% in her right leg! This was a huge improvement, and because of the
success of the bandages, the patient can now be fit for a compression
sleeve for her leg. We also tested the compression pump on her leg to
see if she liked the feeling and if it was something she would be
interested in.

February 15, 2017

Hours: 8-11:00

First Patient: today we saw a patient who was having some

residual swelling in her right arm because of her breast cancer
treatments form two years ago. I learned that the window for
increased risk for lymphedema post surgery is 1-5 years, so even
though she was 2 years out form surgery, this was a normal
occurrence. She had seen Mrs. McGowan earlier in 2016 where
her volume difference from her right arm to left arm was up to
47%. Today, after management through wearing a compression
sleeve and doing her exercises, she was down to 11% volume
difference.
Second patient: this patient had a kidney surgery years ago and
as a result of his surgery, he had a couple lymph nodes removed.
The patient presented with some minor swelling in his left leg.
While the swelling was minor, he is still at risk for lymphedema
because of the lack lymph nodes. He has been wearing a
compression sock from walmart but it only goes to the knee and
Mrs. McGowan is concerned that it is dumping excess fluid into
his knee that he already has problems with.
The rest of the day I was working on a special data collection
project for Mrs. McGowan. She is collecting data on breast cancer
patients from the last year. We are recording whether they
started therapy pre-op or post-op, if they had a lumpectomy or
mastectomy, if the surgery was ALND or SLND, and if they
received chemotherapy and or radiation.

February 17, 2017

Hours: 8-12:30

First Patient: This was a pre-op breast cancer patient who will be
having a lumpectomy within the next month. We took baseline
measurements and educated her on the potential complications
following surgery. Patient also needs a total knee replacement and
so we are concerned that if she were to have complications like
cording or swelling and take away her mobility in the arms she will
really have a hard time moving around. We gave her exercises for
her to do after surgery and before she comes in for another
appointment.
Second Patient: This was a stage 4 lipidema patient that has server
swelling in the legs. The patient is probably over 300 pounds. She
has be wearing a farrow wrap around her right leg only because she
has seeping and her skin was broken down form cellulitis. At this
point, the patient can only manage her lipidema with the farrow
wrap and she was against using a compression pump. After
measuring her legs, she is not swelling any more and is content with
just using the wrap. Patient was discharged.
Third Patient: This patient had her lumpectomy in the left breast in
January and will be going to radiation in the next couple weeks. Her
scar from surgery is clean, and the skin around it is soft, both of
which are great indicators of a full recovery. She has full range of
motion in her left arm and no signs of swelling. She almost seemed
like a pre-op patient and not a post-op patient. While radiation will
increase her chance for infection and lymphedema, her progress so
far is excellent.
Fourth Patient: This was our patient with vein disease that has had
swelling in both his lower legs with a small open wound. He was
fitted for stockings and the stocking provider will be at his next
appointment to fit them and then we wont have to wear the
bandages. His wound is very close to closing and Mrs. McGowan is
hopeful that he will be fully healed in a week.

Reflection:

This week we saw some patients that were in need of a multitude

of medical services and not just physical therapy. This sparked
conversations about treating patients with an open mind and wide
perspective to decide on the best course of treatment. Medical
professionals need to have this perspective and work with each
other to make individualized treatment plans for each patient. In our
evolving world, with new technology and discoveries, I think the
emphasis of health care is more about the diagnosis than the
patient. Medical professionals are seeing more and more patients,
and therefore the one-on-one time with each patient is becoming
less, or being substituted with an online questionnaire. This limits
the ability to diagnose with that wide perspective and create a
personalized treatment plan and could limit the potential for
recovery for the patient. I think this is an important concept that
should be referenced when graduate school/medical school
programs are being created. Medical graduate programs, and the
medical professionals they produce, could benefit from a course or
lecture series on the multimodal method of addressing health care
and the individualized needs of the patient.