Forté’s Specialty Care Oncology Clinic provides therapy for musculoskeletal disorders, neurological problems, fatigue & lymphedema for cancer survivors.

Many survivors have difficulty enjoying the activities they did before their diagnosis and the therapists at Forté are committed to helping them return to work, leisure, and sports. Our therapists have special skills in treating problems unique to cancer patients such as post mastectomy shoulder and back pain, chemotherapy induced neuropathy, cancer related fatigue, axillary web syndrome, ORIF, difficulty moving due to CNS tumors, or lymphedema.

Physical Therapy begins with a complete review of the cancer diagnosis and a thorough examination of their problems. Therapy sessions usually involve “hands on” techniques such as soft tissue or joint mobilizations to decrease spasms or increase movement, and specific activities designed to increase strength, motion, or coordination. We understand the unique problems that go along with a diagnosis of cancer and know how to work within a patient’s limitations while going through cancer treatment. Our patients are guided through each therapy session with sensitivity, skill, knowledge, and compassion.

Forté Rehabilitation and Wellness Center is a primary sponsor of San Antonio’s DIVA Program, exclusively for breast cancer survivors, and all DIVA exercise classes are held here at our facility. Click here for more information on San Antonio’s DIVA program.

Musculoskeletal Dysfunction:

What is musculoskeletal dysfunction?

Musculoskeletal dysfunction, a condition in which muscles or bones are not functioning properly, can stem from an acute injury, long-term disease, muscle weakness, or immobilization. The resulting reduction in motion or strength often causes pain and decreased use of the affected area.

The condition is common to cancer patients who have undergone radiation or a surgical procedure, such as mastectomy, lymph node excision, or tumor resection. Radiation and surgery may lead to scarring of the skin and underlying tissue. This scarring often results in adherence of the soft tissues to other structures, causing pain and significant limits in motion. In addition, many people "guard" the area affected by treatment and discontinue using the limb. This immobilization and disuse leads to shortening of the muscles and weakness.

Surgery and radiation do not necessarily have to lead to pain and loss of motion; but if it does, Forté Physical Therapy has experienced physical therapists that can help patients to alleviate the pain and restore joint structure and function.

How is musculoskeletal dysfunction treated?

Musculoskeletal dysfunction is treated in a variety of ways, depending on the specific characteristics of the disorder. The therapists at Forté Physical Therapy will perform a thorough musculoskeletal examination, identify the nature of the problem, and develop a plan of care. Treatment usually involves hands-on techniques to release adhesions or muscle spasms or loosen tight joints. This is usually followed with specific exercises aimed at increasing strength and range of motion. As the motion is restored and the soft tissue is released, the pain is typically reduced. The treatment usually requires two to three visits per week, about one hour per visit, with duration depending on the severity of the problem.

How can musculoskeletal dysfunction be avoided?

• Follow your physician's advise for exercise following surgery
• When cleared by your physician, use the affected area as normally as possible.
• Minimize scar tissue formation by gently massaging the area. Ask your physician or physical therapist how to do this safely and effectively.
• Report any pain or loss of motion to your physician as soon as possible. The sooner you receive treatment, the better your chances are for recovery.

Who can benefit from treatment?

Anyone who experiences pain or loss of function in a joint or limb would benefit from a thorough evaluation to determine the underlying cause of the problem. The appropriateness of therapy will be determined and discussed with each patient on an individual basis.

Cancer-related fatigue:

What is cancer-related fatigue?

Cancer-related fatigue (CRF), the most frequent and distressing problem related to cancer and its treatment, is defined as an unusual, persistent, and subjective sense of tiredness that interferes with normal functioning. Typically, CRF is not related to activity level or rest patterns and may continue to be a problem long after an individual completes cancer treatment.

CRF is very a complex problem with many contributing factors that can stem from the disease process as well as its treatment. Current medical research shows a correlation between high fatigue levels in cancer patients and a high level of cytokins, a group of naturally occurring products in the body released in response to the existence of a tumor. Patients may also be dealing with other metabolic disorders, sleep disturbances, poor nutrition, emotional stress or depression. All of these problems may contribute to significant muscle wasting, which in turn leads to increased effort to complete normal tasks, resulting in fatigue.

How is CRF treated?

The treatment for CRF first requires a thorough examination by a physician to determine the
to determine the underlying cause. Managing the problem calls for a multidimensional approach that may involve prescription drugs, patient/ family education and counseling, and other interventions such as exercise and recreation.

At Forté Physical Therapy, the therapists perform a thorough physical therapy evaluation, set goals for treatment, and develop care plans for patients, while educating patients and their medical team about the importance of conserving energy and exercising. The exercise program begins when the patient starts cancer therapy and may last throughout the entire treatment phase. The exercise program is performed three to five days per week at a low to moderate intensity and lasts anywhere from 15 to 60 minutes, depending on the patient's tolerance.

After discharge from therapy, patients have the opportunity to maintain their newly achieved fitness level by joining our Wellness Program.

How can CRF be controlled?

• Talk to your physician about your fatigue. Your medical team can help.
• Participate in light exercise on a regular basis.
• Eat a well balanced diet and drink plenty of fluids.
• Continue to participate in enjoyable activities as possible. You may need to
  modify these activities to you tolerance.
• Plan your day to allow for frequent rest periods.
• Ask for help from family and friends for difficult and tiring tasks.
• Keep a " fatigue journal" to help identify patterns of fatigue.
  

Who can benefit from CRF treatment?
Anyone undergoing treatment for cancer who feels a persistent fatigue that does not resolve with prescription drug therapy alone.

Lymphedema:

What is Lymphedema?

Lymphedema, a chronic disorder affecting approximately 2.5 million people in the United States, is characterized by swelling in the limbs, which can lead to severe disfigurement, pain, loss of function, chronic infection, and even hospitalization.It is caused by the decreased ability of the lymphatic system to carry excess fluid away from an area of the body.

Lymphedema is divided into two types: primary and secondary. Primary lymphedema is thought to be congenital in origin and can begin in infancy, adolescence, or adulthood. It most commonly affects women and is usually seen in the foot and leg. Secondary lymphedema is most commonly seen in the United States as a result of surgery or radiation for treatment of breast cancer. It can also be caused by tumors, circulation disorders, parasites, and other incidents that lead to damage of the lymphatic system.

How is lymphedema treated?

Forté Physical Therapy provides a specialized therapeutic service effective in decreasing the swelling and restoring function. This treatment for lymphedema is known as complete decongestive therapy (CDT), which consists of wound and skin care, gentle massage, compression, therapeutic exercise, and patient education.

The therapy requires an average one-hour visit, three to five times a week, with the duration depending on the severity of the problem. When administered by a licensed physical therapist, the treatment is paid by Medicare and commercial insurance companies.

How can Lymphedema be prevented?

• Avoid taking blood pressure on the limb at risk.
• Avoid blood draws or injections on the limb at risk.
• Avoid insect bites, pet scratches, manicures or pedicures, and any other type of trauma that results in breakage of the skin.
• Keep the skin clean and use a good, pH-balanced moisturizer.
• Avoid extreme temperature changes including hot tubs, saunas, and the hot sun.
• Wear gloves when gardening.
• Avoid lifting heavy objects with the limb at risk.
• Perform light to moderate exercise as recommended. Seek guidance from your physician or physical therapist prior to beginning an exercise program.
• Wear a compression garment whenever you travel by plane.
• Call your physician at the first sign of infection.

Who can benefit from lymphedema treatment?

Many patients with:

• Breast cancer, especially after surgery
• Swelling and/or wounds due to circulatory problems
• Swelling in arms or legs after surgery
• Swelling of an unknown origin
• Patients deemed appropriate by their referring physician or therapist