Regaining Independence through Rehabilitation

 

Patient Philip Montagno works on the parallel bars with Sam Perez, a physical therapy technician, while members of his rehabilitation medicine team cheer his progress; from left are nurse Linda Sandles, Dr. Edward Lord, Dr. Theresa Gillis and Dr. Rebecca Clearman.

 

 

Destroying a patient's cancer is always the aim of any treatment team at M. D. Anderson, but it is only part of the challenge for caregivers.

 

The goal also focuses on returning patients to the normal functions they performed before cancer disrupted their lives.

 

Although an increasing number of patients can be cured today, the aggressive therapies usually administered may produce some loss of strength, sensation, mobility and cognitive abilities. No matter if the prognosis is positive or pessimistic, many patients experience such problems as difficulty with walking or self care, fatigue, pain, temporary or permanent impairment of bladder or bowel functions, anxiety, depression and lack of appetite.

 

"We want to help all patients regain their independence so they can have a good quality of life for as long as possible, whether for many years or only a few months. Even when the outlook for long-term survival is uncertain, it is very important that patients are in control and comfortable," says Dr. Theresa A. Gillis, assistant professor of physical medicine and rehabilitation in the Department of Neuro-Oncology and medical director of M. D. Anderson's Rehabilitation Unit.

 

The Rehabilitation Unit was established by Dr. Gillis as a pilot project about three years ago. Today, the 11-bed unit on the hospital's third floor provides a center where coordinated supportive therapies can be offered by rehabilitation team members - all of whom work closely with patients' multidisciplinary cancer specialists to assure maximum benefits prior to patients going home.

 

 

"We want to help all patients regain their independence so they can have a good quality of life for as long as possible."

- Dr. Theresa A. Gillis

 

 

Having the dedicated unit means some patients can be transferred soon after surgery or after they have completed other treatments to start physical, occupational, speech and/or cognitive therapies, self-care training and other programs geared to getting them as fully functional as possible.

 

"Typically, patients remain on the Rehabilitation Unit from five days up to four weeks, depending on what their needs are. We are often at full capacity, but we are in the process of expanding to other beds on the same floor," Dr. Gillis says.

 

Every month, the unit sees many kinds of patients with varying rehabilitation needs. In a recent visit, for instance, several patients on the unit had undergone surgery to have brain tumors and other tumors removed. Three patients had completed chemotherapy for tumors that had spread to the brain and/or bone. One patient had had an above-knee amputation, while a bone marrow transplant recipient was weak due to complications from steroid therapy.

 

In addition to the special unit, there is a Rehabilitation Consultation Service directed by Dr. Rebecca Clearman, assistant professor of physical medicine and rehabilitation. She coordinates screening patients for admission to the inpatient unit and also assists patients on other medical and surgical services with their rehabilitation needs.

 

"Our team helps with the management of weakness, fatigue, cognition deficits, communication difficulties, altered bowel or bladder functions, impaired nutrition, skin care needs and activities of daily living, such as dressing, bathing, grooming and eating normally," Dr. Clearman explains.

 

Rehabilitation therapies are provided in patients' rooms or in one of the therapy gyms. The majority of patients have a spouse or designated family member who can continue helping the patients at home. Even with care partners, though, some patients will require home health care services, which can be arranged by the rehabilitation staff.

 

Both Drs. Gillis and Clearman are physiatrists or specialists in physical medicine and rehabilitation. Besides inpatient services, they assess and follow outpatients in the Neuro and Supportive Care Center.

 

Philip Montagno, a 50-year-old businessman from St. Louis, Missouri, was initially evaluated by the Rehabilitation Consultation Service after having a brain tumor removed and received some therapies in his room. Three days after surgery, he was transferred to the Rehabilitation Unit for intensive physical therapy to regain his balance and strength and to allow him to fly home as soon as possible.

 

"I'm eager to get back to normal," he told Dr. Clearman in their first interview.

 

Montagno says he has "always been in great health and really active, including riding a bike for long distances. One day after a vigorous bike ride, I felt some tingling in my face ... and within a few days I was stunned to learn I had a brain tumor. We saw two surgeons in St. Louis but all of our homework pointed to M. D. Anderson as the place to go."

 

His wife, Mary Jo Montagno, picks up the story. "We were praying about what to do when I remembered that a cousin had been on the staff at M. D. Anderson for many years. I called him for advice. Then I met someone who had been treated there, and the next day one of my colleagues at the school where I work brought in an article about a patient. Dr. Raymond Sawaya was the doctor my relative recommended and also the surgeon who had removed the two patients' brain tumors," she relates.

 

The next step was calling the cancer center to see about an appointment with Dr. Sawaya, chairman of the Department of Neurosurgery. "Right from the first woman who answered the phone, I felt at ease. Within a few minutes, we knew which records to send ahead, what information to take with us and what to expect when we arrived. We didn't have much time to worry because the appointment was later that same week," Mrs. Montagno remembers.

 

Montagno spent nine days on the Rehabilitation Unit, where he learned "lots of little tricks" to compensate for the weakness he experienced after surgery. Twice-daily physical and occupational therapy sessions plus other services to restore his functions helped him feel stronger each day. One of the most important lessons was learning how to pace his activities.

 

"I'm grateful for the wonderful team of doctors, nurses, therapists, the social worker and everyone else who has rallied around us and been so supportive. I'll take six weeks of radiation treatments back in St. Louis . . . and I feel confident about the future," Montagno says.

 

A smiling Dr. Clearman reminds that she had predicted Montagno would do well quickly while on the unit. "He is highly motivated to return to work and to his normal family life . . . I suspect he'll be back on a bike before too long," she says.

 

Before they leave, Dr. Gillis makes sure the Montagnos have his personalized rehabilitation folder with telephone numbers of each team member, including their social worker and case manager. "Call any of us if you have any questions or concerns," she tells them.

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