Copyright © 2015 Laura Kupperman, All rights reserved

YOGA FOR CANCER: IPYT MENTORING

With Laura Kupperman, M.A., E-RYT 500 January 19, 2017

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CALL AGENDA

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• Review types of cancer

• Review types of treatment and side-effects

• Importance of exercise and movement during cancer treatment,

and how to safely integrate yoga

• Review breast surgery, reconstruction, and how yoga can help

• Ensuring a positive, safe environment for your students

• Building your network to better serve your students

TYPES OF CANCER• AIDS- related malignancies (certain lymphomas and Kaposi sarcoma)

• Bone and soft tissue sarcoma

• Bladder and kidney cancer

• Breast cancer

• Central nervous system cancers

• Colo-rectal cancer

• Endocrine malignancies (thyroid is most common)

• Esophageal, stomach, liver, gallbladder, and pancreatic cancers

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TYPES OF CANCER, CONT.• Gynecologic cancer

• Head and neck malignancies (mouth, nose, throat)

• Leukemia (white blood cells & bone marrow)

• Lung cancer

• Lymphomas (lymphatic system)

• Multiple myeloma (plasma)

• Prostate cancer

• Skin cancer

• Testicular cancer

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QUICK CHECK IN• What type of cancer do your clients have? • Any questions about types of cancer?

Let’s Discuss

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TYPES OF TREATMENT

• Chemotherapy

• Surgery

• Radiation

• Transplant (autologous, allogenic)

• Biotherapy (boosts the body’s immune response)

• Hormone therapy (suppress hormones)6

SIDE-EFFECTS OF CHEMOTHERAPY

• Bone Marrow Suppression: Infection,

bleeding, fatigue related to anemia

• Fatigue

• Gastrointestinal Tract: Nausea, vomiting,

diarrhea, constipation, loss of appetite,

mouth sores

• Heart: Congestive heart failure, blood

pressure changes, changes in heart rate

• Brain/nerves: “chemo brain,” peripheral

neuropathy, vision/hearing effects,

dizziness, emotional changes

• Lungs: shortness of breath, cough, pain

with breathing

• Appearance: jaundice, hair loss, weight loss/gain, skin changes

• Bone & muscle pain, bone fragility

• Hormonal: infertility, menopausal

symptoms, decreased muscle mass,decreased libido, problems with body temperature regulation, mood changes

• Secondary cancers

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SIDE-EFFECTS OF SURGERY

• Anesthesia related side-effects: digestive

system, constipation, dizziness, BP

changes, fatigue, allergic reaction

• Pain

• Loss of muscle mass and ROM, muscle

guarding

• Postural changes, imbalances

• Scar tissue

• Lymphedema**

• Sleep disorders

• Infection

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LYMPHEDEMA REVIEW

Lymphatic system has three primary functions:

1. Returns excess interstitial fluid to the blood. Of the fluid that leaves the

capillaries, about 90 percent is returned. The 10 percent that does not return becomes part of the interstitial fluid that surrounds the tissue cells. Lymph capillaries pick up the excess interstitial fluid and proteins and return them to the

venous blood. After the fluid enters the lymph capillaries, it is called lymph.

2. Absorption of fats and fat-soluble vitamins from the digestive system and the

subsequent transport of these substances to the venous circulation.

3. Defense against invading microorganisms and disease. Lymph nodes and other lymphatic organs filter the lymph to remove microorganisms and other foreign

particles. Lymphatic organs contain lymphocytes that destroy invading organisms.

LYMPHEDEMA REVIEW, CONT.

Lymphedema is an abnormal accumulation of protein-rich fluid in the interstitium which causes chronic inflammation and reactive fibrosis of the

affected tissues.

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In the earliest stages it may be reversible, but there is no “cure” for lymphedema.

Remember the car wash analogy: if there are five lanes, leading up to five car wash bays, and two of the bays shut down (like

lymph nodes that are removed), all the cars from those lanes will have nowhere

to go. The load has exceeded the capacity.

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DISCUSSION / QUESTIONS

• Who is at risk for lymphedema? • What precautions can we, as yoga therapists

take to minimize the risk of lymphedema?

Let’s Discuss

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SIDE-EFFECTS OF RADIATION

• Skin: redness, dryness, flakiness, fibrosis

• Hair loss

• Bone Marrow: possible decrease in

white blood cells and platelets

• Gastrointestinal: mucositis, dry mouth, nausea/vomiting, gastritis, diarrhea

• Early menopause, infertility

• Urinary tract infections

• Cardiovascular: clot formation, fatigue, pericarditis

• Bone pain and fracture

• Hoarseness, inflammation of lung tissue

• Lhermitte’s Syndrome (electrical sensations when when neck is flexed)

• Secondary cancers

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SIDE-EFFECTS OF AUTO TRANSPLANT

• Patient’s cells are collected then frozen

• Patient receives high dose chemotherapy

• Cells are transplanted about 48 hrs following the chemo

• The cells grow and “engraft” in about 2 weeks

• Most patients are discharged back to their oncologists after about a month

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Side-effects are similar to those from chemotherapy, with fatigue and weakness often being extremely pronounced.

SIDE-EFFECTS OF ALLO TRANSPLANT

• Patient is given their “conditioning” regimen (chemo or chemo with total body irradiation

- TBI)

• Donor is collected a day or two before the cells are to be given

• Donor can be the patient’s sibling, or on occasion, parent, an unknown donor from

the NMDP (National Marrow Donor Program), or cord blood

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Side-effects are: similar to those from auto transplant +nausea, vomiting, mouth sores, diarrhea, hair loss, fatigue from TBI + Graft vs. Host Disease

SIDE-EFFECTS OF BIOTHERAPY

• Short-term: typically not substantial, flu like

• Long-term: increased risk of infection

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SIDE-EFFECTS OF HORMONE THERAPY

• Menopause / andropause • Mood changes, depression • Loss of sex drive • Loss of muscle mass • Joint stiffness • Vaginal dryness • Sleep disruption • Hot flashes • Cognitive dysfunction,

memory issues

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DISCUSSION / QUESTIONS• What are the most common side-effects you are observing with

your clients (or would expect to observe)? On the level of all the koshas?

• Any questions about side-effects?

Let’s Discuss

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BENEFITS OF EXERCISE & MOVEMENT FOR CANCER PATIENTS

• Improved immune function

• Reduced fatigue, better sleep

• Improved memory and mood

• Decreased anxiety and depression

• Decreased risk of embolism

• Better digestive and eliminatory function

• Better posture = proper organ function and efficiency of skeleton

• Ability to breathe more fully

• Sense of stability and security -> cultivate more strength

• Functional ability -> independence

• Ability to complete cancer treatment

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CONTRAINDICATIONS WITH EXERCISE FOR CANCER PATIENTS• See page 186-188 in Life Over Cancer

• Keep heart rate in safe zone (how do we know what that is?)

• Build strength slowly and progressively

• Avoid big BP changes, quick positional changes

• Avoid anything that could make someone dizzy or fall

• No open wounds, make sure all incisions are healed

• Adhere to doctor ordered restrictions, have them ask if they/you aren’t certain what is safe

• Don’t overheat the body

• Avoid stressing bones where osteoporosis or bone mets might be present

• Stay within your zone of safety and knowledge AND have your students take responsibility for themselves

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DISCUSSION / QUESTIONS

• How can we bring the benefits of exercise into our yoga classes, but still “keep it yogic”?

Let’s Discuss

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BREAST SURGERY

• Lumpectomy or mastectomy

• Sentinel node biopsy or full axillary dissection (become outdated)

• Removal of lymph nodes creates risk of lymphedema

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LUMPECTOMY

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MASTECTOMY - MODIFIED RADICAL

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MASTECTOMY - SKIN SPARING

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RECONSTRUCTION - IMPLANT

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RECONSTRUCTION - EXPANDER

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RECONSTRUCTION - TRAM

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RECONSTRUCTION - LAT FLAP

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RECONSTRUCTION - DIEP

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RECONSTRUCTION - GAP

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IMPORTANT CONSIDERATIONS FOR CLIENTS WITH BREAST CANCER

• What type of surgery did they have, lumpectomy or mastectomy?

Uni-lateral or bi-lateral?

• Are they having reconstruction?

• How long ago was surgery? What phase of reconstruction are they in

currently?

• Any tenderness while lying on belly (especially after expander fills)?

• Any donor site issues - e.g., scar tissue, loss of sensation and proprioception - for autologous tissue reconstruction?

• Any loss of muscle use, for TRAM, LAT flaps?

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DISCUSSION / QUESTIONS• Any questions about breast surgery or reconstruction? • What are the most common side-effects of having breast surgery / radiation

1. Lymph node removal -> lymphedema risk 2. Mastectomy - > postural changes, forward rounding 3. Tightened pecs 4. Overstretched back muscles 5. Unstable shoulder girdle and scapulae 6. Scar tissue at donor site, weakness at donor site 7. Radiation caused skin changes, tightness, fibrosis

Let’s Discuss

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BREAKOUT GROUP #1• How can yoga help to increase lymphatic flow, stretch the pecs, and

strengthen the back muscles? • Design a short sequence for breast cancer survivors:

1. Breath focus 2. Warm up joints/muscles first 3. Something to stretch pecs & strengthen back and shoulder girdle

(you choose the order for these two) 4. Keep it simple, no more than 8 things in the sequence 5. Feel free to add mudra, mantra, affirmation, visualization

Let’s Discuss

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BREAKOUT GROUP #2In order to help clients safely build and maintain strength during treatment we will progress in this fashion:

1. Isometric toning 2. Partial weight bearing until joint integrity is established 3. Full weight bearing once joint integrity is present

Give examples of how to do this for upper and lower body • Isometric strengthening for arms, legs, hips • Partial weight bearing for the same • Full weight bearing for the same

Let’s Discuss

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BREAKOUT GROUP #3We’ve focused a lot today on the annamaya kosha and how to keep your students safe physically.

What can you do to support the emotional, mental, and spiritual well being of your students? 1. Through the language you use, or don’t use, in class 2. Your intake process 3. How you first interact with your student 4. The way your present yourself 5. Through what you teach (or not), and the choices you give (or not) in class 6. The way you instruct . . . whatever that means to you

Let’s Discuss

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THANK YOU FOR ALL YOU’RE DOING TO SUPPORT CANCER SURVIVORS!

www.laurakupperman.com39