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Prehabilitation is the process of raising physical, functional, and mental reserves/capacity to prepare for a significant stressor. Research has shown that engaging in regular exercise before cancer treatment can improve treatment tolerance, coping ability, reduce emotional distress and treatment related side effects.

You will be provided tools, strategies and resources to help you engage in a personalized exercise program that is safe and easy to comply to prior to and throughout your cancer treatment. If you are someone who is already quite physically active, you will be provided education on how to maintain and/or modify your current routine based on your treatment plan and schedule.

One of the biggest side effects of chemotherapy is chemotherapy related fatigue. Exercise is one of the best ways to manage this. When you are exercising at a moderate intensity, your body releases chemicals called endorphins that give you more energy and improve your mood. Exercising during the day allows your body to get better quality, restorative sleep at night, setting you up for success the following day.

Exercise throughout chemotherapy treatment can help with the management of peripheral neuropathies (commonly experienced as weakness, numbness and pain usually in the hands and feet), and improves tolerance of higher dose, more effective forms of chemotherapy.

Joanna is experienced in working post-operatively with cancer patients from all disease sites including head and neck, breast, abdominal surgeries involving the organs, and blood cancers that require a bone marrow transplant.

For the breast cancer population, pre and post operative care is provided for patients who undergo sentinel lymph node biopsies, axillary lymph node dissections, lumpectomies, mastectomies, both immediate and delayed breast reconstruction involving immediate implants, tissue expander insertions and exchanges, latissimus dorsi, DIEP and TRAM flaps.

Each of these surgeries have specific post-operative activity restrictions and exercises to help with recovery. Education regarding post-operative drain care, managing activities of daily living (dressing, clothing, bathing, diet, sleeping and driving) and identifying potential post-op complications (axillary web syndrome/cording, seromas) is also provided. It is recommended to book an appointment prior to surgery to review this information and your exercise program, which is safe and encouraged to start on post-operative day one in most cases.

For individuals whose cancer surgery requires reconstruction with skin flaps on their legs, you may have post-operative weight bearing restrictions. It is recommended to make an appointment prior to surgery in order to discuss these post-operative activity restrictions and strategies. This could include transfers, gait and stairs assessments, recommendations for gait aids or assistive equipment/devices to help with your functional independence and managing activities of daily living. Post-operative exercises will also be provided to help accelerate recovery and minimize risk for certain post-operative complications.

This appointment is dedicated to the breast cancer population who will be undergoing radiation treatment the following day (or as close as possible to the start of radiation treatment.)

During this appointment, Joanna will apply Mepitel film (MF) to the radiation field as outlined by the plan from your radiation oncologist and tattoos applied during planning. Education will be provided on how to best maintain the integrity of the MF throughout radiation in order to significantly reduce the impact of radiation dermatitis. A home stretching program will also be provided and reviewed. The goal of the program is to maintain functional shoulder mobility and range of motion in order to minimize postural changes and pain that can result from radiation induced fibrosis (RIF).

The goal is for the Mepital film to last the duration of your radiation, with only patch repairs as needed throughout your treatment course. Studies recommend Mepital film use for two weeks upon completing radiation in order to support tissue health as it recovers from the treatment.

A follow up appointment is required to have the MF reapplied following the completion of radiation treatment. Throughout radiation treatment, you can book follow up radiation prep appointments which can include patch repairs, reassessment of shoulder mobility, exercise prescription, or lymphatic massage if appointment time allows for it.

In preparation for your pre- and post-radiation appointments, please arrive recently showered with no deodorant, lotions, oils or creams used on your skin within the radiation field, both on the front and back side of your body.

In most cases, covering the entire radiation field requires the use of 6 sheets of Mepitel film, which are available for purchase at the clinic at $5+GST per sheet. You will also be sent home with extra sheets in case you need to do patch repairs on your own of any areas where the film may come off during the duration of your radiation treatment. If you would prefer to supply your own Mepitel film for this appointment, you are welcome to do so.

PLEASE NOTE:You must receive medical clearance from your radiation oncologist to proceed with Mepitel film use during and after your radiation treatment.

If your cancer treatment involves the surgical removal of lymph nodes or radiation to remaining lymph nodes, you are at an increased risk of developing secondary lymphedema. Lymphedema is a chronic condition, but is fortunately manageable with appropriate and early intervention from a combined decongestive therapist (CDT). You will be provided education, manual lymphatic drainage massage, exercises as well as compression therapy to help with the reduction and management of your lymphedema.

As an ADP authorizer, you will have your compression needs assessed. This includes reviewing program eligibility and completing application forms for garments such as reduction kits, compression sleeves as well as other devices. You will also be provided with a list of registered vendors who can appropriately fit and order your ready made or custom garments and/or devices.