Oncology survivorship researcher, speaker, author. Optimizing cancer care delivery for survivors. I'm just a nerd all dressed up⛳️🧘♀️👠 Views=mine
#impsci
It has taken me a week to gather thoughts & put together a thread on what happened to my husband and I last week.
The message is important, it is one of awareness and practical vigilance. The choices we made at the time were logical based on our current vaccinated status…BUT 1/
If you’re around someone sniffling/coughing put on a mask & don’t by shy to ask them to do the same.
WE are out of the woods, but my recovery is VERY slow and not progressive. I’m not sure yet that our society is out of the woods.
Use caution and as I always say
WASH YOUR HANDS!
Yes, its likely a ‘variant’ we don’t have that info just yet.
But I think there is an important and balanced message to send as we start shedding masks and resuming ‘normal’, and that is to be vigilant. Sensible and vigilant.
If you’re sick stay home, wear a mask if you can’t.
…maybe that was true in the world of social distancing. mask wear & limited groups in public. Protections in place may have lulled us into a false sense of security regarding that extremely rare post vaccine + case.
2 of us, in the same house, w/2 different vaccines???
I am somewhat concerned that this would not have been investigated without my own professional contacts.
I’m frustrated by getting sick, of course, but more so intrigued by the repeated mantra of “it is extremely rare for people who are vaccinated to get COVID”…well…
This entire time, no one asked either of us for our vaccine proof, date, or vial numbers. I had Moderna and he had Pfizer.
No one knew how to test us or how to report a test for vaccinated COVID + people. Everyone said it was “extremely rare for vaccinated people to get COVID”.
CDC, state health dept, PCPs, there was no information to be found re: vaccinated people.
Do we shed viral material the same? Quarantine for the same time? Can we re-infect one another?
I used best judgement & most-restrictive practice (and a lot of bleach)
Not shocking it was + in 24 hrs, during which time I developed tinnitus, lost taste & smell, and was down with fevers through Wed night.
Through my contacts at the state health dept and my university, I was able to have Jay’s and my samples pulled and sent for sequencing.
So, I packed up my fevery self into the cold rainy morning and drove to the health dept where they looked at me like I had 2 heads when i asked for the ‘special’ COVID test since, I’M VACCINATED. No, go back to PCP we don’t have any special test.
PCP eventually agreed to test me
Jay develops worsening congestion, chest congestion, eventually fevers (Thursday) and learns that evening that work guy tested positive for COVID on a PCR that came back that day.
BUT I”M VACCINATED…my husband said as he was fevery at 102 and coughing/congested all night. 3/
He tested Friday w/ + COVID PCR returned on Sat. yes, he was vaccinated in March/April w/Pfizer.
What should I do…quarantine in the house? Not worry? I”M VACCINATED TOO.
A pubmed search & hrs later all I’ve got is “it is EXTREMELY rare for vaccinated people to contract COVID”
@Heart10Looks3
@CTrevorNelson
This is my concern too, the vaccinated breakthroughs are not being correctly accounted for in the population and it’s going to present even bigger concerns as we move away from our mask and social distancing mandates.
He moved to quarantine in the house and I was nervous. Jay slept most of Friday/Saturday/Sunday and only on Monday broke fevers. Lost taste and smell on Friday afternoon. O2 sats in the low 90s all weekend. Sunday night I was extremely fatigued, but I”M VACCINATED…5/
Two weeks ago, today, Jay started to exhibit symptoms of a head cold. He had been in meeting on Monday w/another guy who had a head cold at work…or so they thought.
Work guy said he’d had a rapid test done and it was negative for COVID. no further questions…for now 2/
Monday escalated with symptoms for me, Monday night I was fevery at 101.5, went to see PCP on Tuesday for test(Same PCP as husband).
the PCP however said ‘we can’t test you’ you’ve been vaccinated and need a special test and have to go to the county health dept. 6/
@caroljsroth
Nothing is a ‘big thing’ anymore. By the time kids gets to high school they’ve had 3 generations of phones, graduated 3 times, & have been limo-driven to at least 3 events.
Bending over backwards to give kids every experience robs them of future nostalgia of ‘big things’ IMO
How about just 1 fact:
Tuesday I start a new research position at West Virginia University Cancer Institute. Focusing on cancer survivorship research.
Excited for this appointment and opportunity to impact cancer survivors!
#survonc
#cancerrehab
#ruralhealth
I have been awarded a Lucy Blair Service Award by
@APTAtweets
Grateful to my colleague of over 2 decades, my partner in crime, the yin to my yang, Dr. Cindy Pfalzer for leading the nom. None of this is possible w/out
@APTAOncologyPT
& w/special thx to
#APTABOD
🙏🙏🙏🙏
My suggestion is to refer to the exercise specialist: physical therapists, exercise physiologists.
My GP doesn’t practice cardiology; she refers to the specialist.
#exerciseismedicine
and we should rely on providers with this expertise to prescribe and manage it.
"In medical school we get taught nothing about exercise ..." Dr Michael Mosley says. Do GP's need more training when it comes to prescribing exercise?
#InsightSBS
Just out!! Cancer Exercise app!!
Provides a tailored exercise prescription for individuals going through or after cancer treatment.
#cancerexercise
#cancerrehab
@theoncopt
@iscel
@DrEricDing
Thanks, tinnitus is gone, thank goodness! It was so annoying. Smell is back, taste is about 85% back. I’m still struggling with chest congestion and need to take it waaaay easy or I’m a bundle of fatigue.
@jedderm
This is a legit concern. Apparently, even vaccinated people carry enough viral load to infect others. I was around NO one except my husband, so he infected me.
Proud to announce that I was awarded the John HP Maley Lecture for PT NEXT 2020. Beyond excited and so very honored to receive this award.
Thanks to Steve Morris
@APTAOncologyPT
president for coordinating my nomination.
👏🏻 please 👏🏻 enable 👏🏻 your 👏🏻 patients 👏🏻 to 👏🏻 move 👏🏻 after 👏🏻
#breastcancer
surgery
Start overhead ex in the first 2 weeks! NO need to wait a month!
#cancerrehab
Early Upper Limb Ex After MRM & Immediate Implant-Based Reconstruct Are Safe & Beneficial
IMO, treating cancer means more than disease treatment. People need to live & function during and after treatment...for a long time in many cases.
Let's look at some very important information from recently published studies of great importance for the
#oncology
#CancerResearch
An exercise oncology clinical pathway: Screening and referral for personalized interventions.
Get viewer/reader access NOW through this link.
#exerciseoncology
#cancerrehab
On
#WorldCancerDay
I WILL keep pushing HARD for
#exerciseoncology
and
#cancerrehab
to be standard care for EVERY patient from diagnosis through treatment.
These interventions mitigate or PREVENT functional decline. Why are we not proactively providing these services?
#IAmAndIWill
@MikeMakher
We need to continually remind ourselves that there are indeed 3 pillars to Evidence-based medicine and that patient preference/experience is one of them.
One of the saddest things happened tonight. Actually it happens w/some frequency.
My phone rings ~6 pm from a VA number unknown to me.
I answer.
Person on the line:“ Is this Dr. Nicole Stout the cancer specialist?”
It is.
Caller: “I need your help...well it’s my sister”
1/
@sebastian_byron
@Warped_Horizon
@RadioFreeTom
My husbands business cant get enough welders, machinists, Heavy machine operators, drivers, fast enough. They are getting premium $$, per diem and over time + vehicle allowance and boot/unis. The college degree as the holy grail of opportunity is a fallacy.
#wildandwonderfulwv
It’s not good enough to publish guidelines. Let’s talk about implementing them.
If we stand alone as the
#exerciseoncology
community seeking referrals, we won’t get there!
Let’s leverage
#survivorship
frameworks to integrate
#cancerrehab
and exercise professionals in cancer care
(how to integrate the Advise, Assess part into oncology practices, and then encourage Referral)
(think about rehab and exercise using this framework)
(using EMRs to enable exercise assessment and referrals)
@wildingpaulaa
@lululemon
WOW!! I have PT colleagues who have gotten the discount…Maybe share some PUBLIC guidance
@lululemon
rather than all of this ‘DM us for clarity’ business.
If it’s no, it’s no, but dont hold out this discount like you’re doing something for all ‘healthcare providers’
***Super hot off of the press***
@JAMAOnc
@MayoClinic
@APTAOncologyPT
#PT
directed telerehab interventions improving function for patients with advanced
#cancer
Effect of Collaborative Telerehab on Functional Impairment & Pain Among Pts w/advanced cancer
SO many oncology guidelines recommend exercise & rehab interventions.
Why the disconnect?
MDs don’t know ex physiology. Exercise prescription is not in their repertoire of interventions.
Good news: there is an entire professional workforce waiting to collaborate to fill the gap
A large systematic review identified that exercise is the most effective intervention for
#cancerfatigue
superior to pharma and psych interventions.
Ref- Mustian et al 2017 JAMA Oncology 3(7) 961-69.
#medonc
#radonc
#surgonc
#survonc
If you’re looking at your patient and thinking ‘they don’t look like they need an exercise referral’ it’s sort of like saying ‘they don’t look sick.’
Everyone going through cancer tx needs some type of exercise prescription.
#exerciseoncology
This amazing gift showed up from an amazing colleague! Thank you
@JulieSilverMD
If ever there was a pub worthy of its own mug...this is it!!
I love our work together and look forward to many more collaborations in 2021 and beyond!!
#cancerrehab
@CAonline
⭐️Tips for clinicians⭐️
When you can not access a research study on line, email the corresponding author. Their email is almost always listed on the online abstract.
Most are happy to directly send you a full text copy!
#AcademicTwitter
#MedTwitter
It's not good enough to use pamphlet therapy in
#exerciseoncology
YES--> Most people w/cancer CAN exercise independently, but a tailored ex prescription, frequent 1:1 sessions, reassessment & prescription adaptation is needed. Ideally by a trained
#exerciseoncology
professional
Learning from
@NicoleStoutPT
of the importance of providing supervision for cancer specific exercise. Need to provide more than just advice.
@acpopc
#ExOnc2021
Roses are red
Cancer treatment-related neuropathy makes patients frown
Patients need
#cancerrehab
To help keep them from falling down
#cancerrehabvalentines
@fly_crimson
And on and off planes, and on and off bed stand.
Wouldn’t it be great if there was peer-review on audio? Not w/all the podcast type BS opinions but just someone reading the paper!?!?
I could listen while making dinner, while in the car, gardening.
This needs to happen!!
Incredible session!
Preview of new Bone Mets Exercise Recommendations
FANTASTIC work! More people living longer w/
#metastaticcancer
= need to keep them moving & healthy via exercise! New perspectives on how to safely load w/bone mets.
#ACSM21
@KLCampbellPhD
@DrNicolasHart
& team
In a retrospective study of 214 patients with
#COVID19
, neurological symptoms were seen in 36.4%, and more common in severe cases (45.5%), which included acute cerebrovascular events (5.7%), impaired consciousness (14.8%) and muscle injury (19.3%)
Another way to improve integration into cancer care is to have our
#patients
advocate for
#exerciseoncology
and
#exerciseprescription
If you are going through cancer treatment, you should be asking: WHERE IS MY EXERCISE PRESCRIPTION? &
WHO can I work with to keep active?
Achieving exercise as standard in oncology will require us to think differently about integrating exercise &
#cancerrehab
professionals into cancer care.
New standards on survivorship care from
@ACS
-COC an enabler for the cancer care team.
@NicoleStoutPT
#ExOnc_askmeanything
If you’re thinking:
‘I really don’t see cancer pts in my practice’
Think again...THEY SEE YOU EVERY DAY!
✅ understanding cancer tx side effects will make you think differently abt every pt!
✅ there are 17M ppl living w/& beyond cancer. This number will DOUBLE in the next 15 yrs
Do you want to learn more about the role of rehabs professions in cancer survivorship care?
This episode w/
@NicoleStoutPT
is a must listen!
Listen here:
“Never be afraid to recruit people brighter than you and...different than you. That is...incredibly powerful if you want to create a team that is really effective.”
How it started…how it’s going.
When you spend a few days w/grandma and she’s a PT, everything is about practicing for the next milestone.
Step-daughter/mom text today: “She did this all by her self…you’ve created a monster 🤗”
Finished
#exerciseoncology
#cancerrehab
talk yesterday @
#UTCforum
& a faculty member approached:
“I used to think exercise was not so important for pts w/cancer. You’ve completely changed my perspective! Every pt needs something...and all of that evidence!!” 🙌🏻
PATIENTS NEED NAVIGATORS!!
Dedicated navigators, whose primary role is to coordinate care.
Not an oncology nurse who 'does some care coordination' in addition to the 1000 other nursing tasks...
We are working through a huge systematic review w/a 20+ member interdisciplinary team right now to inform a cancer rehabilitation guideline.
This lecture will provide status update on the findings & the project.
#cancerrehab
#ACRM2019
Imagine how
#oncologists
would be RUNNING to this if it were a drug agent w/such outcomes?
There are >600 controlled trials supporting the benefit of exercise interventions for pts w/cancer. Continuing to ignore this evidence is essentially negligence.
@OncoAlert
#oncology
...and in this case maybe more important.
We have to do better as an
#oncology
community, as health care professionals.
I wish I could say this was a one-off but it’s not. Ive had calls abt lymphedema, pain Mgmt, people just looking for help.
#survonc
#cancerrehab
6/6
THIS MATTERS. A LOT.
#cancerrehab
⬇️ health care utilization
⬇️ cost of additional services outside of cancer care
@fitaftercancer
WOOT
Cost-Savings Analysis of an Individualized
#ExerciseOncology
Program in Early-Stage BrCa Survivors: A Clinical RCT
Reminder for the 15K+ convening on Denver next week
⭐️ If you’re sick, stay home
⭐️ Hi 5’s & elbow bumps
⭐️ Carry hand sanitizer/wipes/Lysol/Clorox/Thieves & use liberally
⭐️ Sneeze into your elbow
⭐️ WASH YOUR HANDS ⭐️
Spread the love, not the germs
#APTACSM2020
🔥 HOT OFF THE PRESS 🔥
Incorporating guideline recommendations for rehabilitation enhances guideline-concordant care for cancer centers and clinics.
#cancercaredelivery
@NCCN
@AmCollSurgeons
Patients with better baseline fitness had higher chemotherapy completion rates.
STOP writing off chemo or dose reducing b/c your patient isn't fit.
Fitness & function are modifiable w/exercise &
#cancerrehab
interventions.
Pretreatment exercise should be a standard of care.
New! From Prof Kerry Courneya, Ki-Yong An, et al.
START & CARE trial results for predictors of chemo completion rates.
✴Higher starting VO2peak appears helpful
Clinical application: use pre-chemo window (& during) to ⬆️ fitness
#exerciseoncology
@AdamMGrant
Which is why I don’t consider
#metoo
and some of the other movements de jour to be feminism. Seeking equality in rights and opportunities is not about tearing men down. We’ve lost that part of the equation.
#feminismmeansmentoo
Long-Term Survivorship Care After Cancer Treatment: A New Emphasis on The Role of Rehab Svcs
@APTAOncologyPT
@ACRMCancerRehab
@acapt2
@CoHSTAR_PT
Please share widely because we must improve rehab integration in cancer care
More good stuff!! Hot off the press! Check out the full book. Huge props to
@fitaftercancer
for leading this effort!
Prehabilitation: An Emerging Standard in Exercise Oncology
The earlier we begin strengthening and targeted balance exercises the more likely we are to prevent functional decline and mitigate fall risk.
#fallsprevention
Falls are No. 1 cause of injury and death in adults 65 and older, per
@CDCgov
Dr. JoAnn Manson, Chief of Preventive Medicine at
#BWH
, tells
@AARP
that prevention starts with exercise rather than supplements.
Here is my take, “Likes” are nice for your ego, retweets are critical to disseminate & amplify great info
If I see a tweet that you’ve published something, given a talk, are being recognized, are sharing research I am going to RETWEET it.
Can I encourage this in others?
Advance PTJ
#COVID19
content!
@joshkj_dpt
and colleagues found that patients with
#COVID19
who received more in-hospital physical therapy had improved functional outcomes and were more likely to discharge home!
Read more here: