Category Archives: Health Tips

Smartphones Are Really Stressing Out Americans

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This article originally appeared on Time.com. 

It’s easier than ever to stay in touch on multiple platforms throughout the day, but that 24/7 availability is stressing Americans out. Four out of five adults say they constantly check their email, texts and social media, according to a new report by the American Psychological Association (APA).

The APA polled about 3,500 adults in an online questionnaire during August 2016 and found that people who are always looking at their digital devices—called “constant checkers”—reported higher levels of stress compared to people who spend less time interacting with their gadgets.

The amount of time people spend on social media also appears to be stressing people out. 42% of constant checkers report that social media conversations about politics and culture cause them stress, compared to 33% of people who check less often. Constant checkers also worry about how social media is affecting their wellbeing; 42% say they worry about how social media can impact their mental and physical health, yet only 27% of people who check less often say the same.

This digital obsession also appears to take a toll on families. Almost half of parents say they feel less connected to their family when technology is present, even when they are spending time together. Close to 60% say they worry about the impact of social media on their children’s mental and physical health.

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Yet people are finding ways to cut back on the stressful effects of technology. The vast majority of parents, 94%, say they do something to limit their children’s use, like not allowing cell phones at the dinner table or limiting phone use before bed. That’s not always easy, though. Close to 60% of parents say they feel like their child is attached to their phone.

Overall, Americans want to unplug more often. Nearly two-thirds of people surveyed say they agree that taking an occasional digital detox is good for their mental health. However, less than 30% say they actually do so.

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An Update on Echinacea: How to Use It Like a Pro During Sneezy Season

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Echinacea is consistently among the top-selling supplements, with U.S. consumers typically spending more than $100 million on it every year. But a study published recently in The New England Journal of Medicine (NEJM) panned the herb, saying it doesnt prevent colds or make symptoms less annoying. The lead researcher—Ronald B. Turner, MD, a pediatrics professor at the University of Virginia—thinks most of the evidence in favor of echinacea is far too weak to make it a reasonable remedy. Naturally, echinacea supporters disagree. And they recently panned Turners findings, saying the amount of echinacea used in his study was roughly three times less than what veteran herbalists recommend.

Recently, I visited an echinacea farm run by one of Europes most respected makers of natural products, Bioforce AG. Instead of allowing the plant to dry out first, Bioforce transforms it into a cold remedy within hours of harvesting. Company scientists say drying seems to snuff out the unstable immune boosters in echinaceas purple flowers, leaves, stems, and roots—a theory endorsed by leading U.S. herb experts who have studied and used the plant for years.

Now I understand why my hot cup of echinacea tea isnt working. That form, like the drying process, basically defangs echinaceas active ingredients, according to botanist James A. Duke, PhD, a member of Health magazine's Advisory Board and author of the Green Pharmacy Herbal Handbook. Those pills you can buy in any drugstore are also of little use, because chances are theyre made from dried plants. Plus, a typical pill dosage is hopelessly short on enough immune-boosting power to tame a cold. (I should note that some herbalists claim the pills work well, but most dont believe that.)

Most herb pros seem to agree that youll have good luck with a tincture, or alcohol-based extract, made from fresh herbs. Unfortunately, few supplement companies make tinctures with fresh echinacea. Try calling the manufacturer to ask before you buy—and see An Update on Echinacea: Dos and Donts for a list of brands recommended by professional herbalists.

Whatever brand you choose, youre likely to keep on sniffling if youre stingy with the bottle. When you dont take enough, “its like sprinkling fairy dust on your cereal,” warns Steven Foster, who has studied echinacea and other herbs for a quarter-century. Foster, author of Echinacea: Natures Immune Enhancer and co-author of the just-published National Geographics Desk Reference to Natures Medicine, says he takes 1 to 2 teaspoons of a tincture (mixed with a little water) every 2 to 4 hours when hes coming down with a cold. Thats at least three times the amount used in the NEJM study.

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Health24.com | 7 warning signs that you’ve got a bladder infection

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A urinary tract infection (UTI) is, quite literally, a pain. It’s typically caused by E. coli bacteria, which normally lives in the colon and around the anus. Women tend to get UTIs more often because the urethra is shorter and closer to the anus than it is in men.

Because of improper wiping or sexual intercourse, this bacteria enters the urinary tract through the urethra and multiplies in the bladder, its most common target.

This can result in cystitis, an infection which brings about an inflammation of the bladder. If left untreated, it can spread to any part of your urinary system from your urethra to your kidneys and cause excessive discomfort.

So how can you find out if you have a bladder infection before it becomes more severe? If you display any of these seven symptoms, you’ve got a strong chance of having an infection.

It’s also important that you consult your doctor for a medical history and physical exam – after that, your doctor may request lab tests to help diagnose the cause of your symptoms before you can begin targeted treatment.

1. Dysuria (painful urination)

Experiencing stinging pain, discomfort or a sharp, burning sensation whilst you’re urinating? You’re suffering from dysuria. According to Dr Thomas Michels, dysuria is present at least occasionally in approximately 3% of adults older than 40 years, and it’s especially common in women. It’s a classic tell-tale sign that you may have a UTI such as cystitis or urethritis (an infection of the urethra).

Read more: The illness you can get from having too much sex

2. Frequent urination

When you’ve gotta go, you gotta go. But if you find yourself going to the bathroom more than eight times a day or waking up during the night to urinate, you may need to go to a doctor. 

Frequent urination can be indicative of interstitial cystitis, a UTI that causes inflammation of the bladder muscle layers and pain in the pelvic region. With this condition (which, unlike common cystitis, isn’t caused by bacteria), you’ll feel the frequent need to urinate, even if you only produce a small amount of urine.

3. Urinary urgency

This is when you feel an overwhelming need to urinate immediately – as in now. Going hand in hand with frequent urination, you might find yourself needing to rush to the restroom and the urge to do so very suddenly. Urinary urgency can also be a sign of interstitial cystitis, as it may be accompanied by pain or discomfort in your bladder or urinary tract.

Read more: “How often should I REALLY be peeing?” 

4. Lower abdominal tenderness and lower back pain 

If you’re feeling sensitive around your abdominal region, chances are you could be suffering from cystitis. Pressure on your pelvis, particularly around the pubic bone, can cause some serious discomfort, especially when coupled with frequent, painful urination. 

Likewise with lower back pain: when a bladder infection remains untreated for a long time, it can spread from your bladder to your kidneys, causing you to experience a dull pain in your lower back and sides. That’s an indicator of pyelonephritis, or kidney infection, which is more serious than cystitis. Other signs of pyelonephritis to look out for include shaking, high fever, nausea and vomiting.

5. Blood in urine

From light-pink to dark-red or cola-coloured with clots, haematuria – or blood in the urine – is a huge tip-off that you have a bladder infection. But how does the blood get into your urine in the first place? It’s due to a leakage of red-blood cells from your kidneys or other parts of your urinary tract. UTIs and pyelonephritis are the likely culprits behind the leaks. In the case of UTIs, however, haematuria can be microscopic (meaning the blood cells are only visible through a microscope).

Read more: This explains why you get clots in your period blood

6. Strong-smelling urine

Pee-ew, indeed! When there’s an infection in the urinary tract, says Dr Melissa Stöppler, the urine may take on a foul-smelling odour. If your urine has a strong ammonia smell, gives off a slightly sweet scent or the stench is outright unpleasant, it’s your body’s unsubtle way of alerting you to a possible UTI.

7. Cloudy urine

Under normal circumstances, urine is clear and has a light-yellow colour. But when you have an infection anywhere in the urinary tract, it can cause pus (containing dead skin cells, bacteria and white blood cells) to appear in your urine, giving it a cloudy or murky appearance. So if your urine’s yellow, you can mellow. But if it’s cloudy… not so much.

This article was originally published on www.womenshealthsa.co.za

Image credit: iStock

Nereesha Patel

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Health24.com | Can you overuse your nasal spray?

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Here’s the scenario: A few seasons ago you suffered from congestion. You’ve been well for a long time, but can’t seem to get rid of that stuffy nose.

Some nights you wake up in a panic as you try to find your bottle of nasal spray on your bedside table – and you don’t understand why you still need it.

Could it be that you’ve developed an addiction, and is it serious?

A dependence on nasal spray is pretty real. Why else would there be a warning on the label that you shouldn’t use it for more than three to five days?

It’s an official condition

Nasal spray dependence is such a well-known problem that there’s even a name for the term: rhinitis medicamentosa. This describes the adverse nasal congestion that develops after using nasal decongestants longer than the recommended period of time.

How does a nasal spray work?

Not all nasal sprays are the same. There are several nasal sprays available on the market that contain steroids, saline or antihistamine.

Some nasal sprays contain a drug group called vasoconstrictors, which include norepinephrine and pseudoephedrine. These ones get rid of a stuffy nose by shrinking the congested blood vessels in the area, thereby opening up your nasal passages.

Other nasal sprays may contain anti-inflammatory steroids to reduce swelling and mucus in the nose.

Steroid nasal sprays usually do not offer immediate relief and can take a couple of days to be fully effective.

The blood vessels only respond to the chemicals in nasal sprays for a few days. After that, the nasal spray no longer has any effect.

Call your doctor when:

  • You only suffer from nasal congestion with no other symptoms.
  • You get withdrawal symptoms such as headaches when you don’t use your nasal decongestant.
  • You need to use more decongestant to get relief.

How to break the dependence

  • Switch to a saline spray or use something like Vicks Vaporub or natural herbal remedies.
  • Go completely “cold turkey”.
  • Discuss the matter with your doctor.
  • Try oral antihistamines to clear up nasal congestion.

Image credit: iStock 

Marelize Wilke

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Health24.com | Postpartum depression likely in subsequent pregnancies

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Between 10 and 30% of all mothers suffer from postpartum depression. It can happen any time after the baby is born, not only in the first few weeks after the birth. It can be mild or severe.

A new Danish study shows that women who have suffered from postpartum depression are more likely to go through it again after subsequent pregnancies.

Cushioning the blow

Postpartum depression occurs 27 to 46 times more frequently during subsequent pregnancies for mothers who experienced it after their first birth, researchers report.

These results show that women who have had postpartum depression in the past should prepare themselves if they get pregnant again, said lead researcher Marie-Louise Rasmussen, an epidemiologist with Statens Serum Institut in Copenhagen.

Antidepressants or psychotherapy could help cushion the blow or even head off postpartum depression, Rasmussen said.

“In theory, psychotherapy is preferred but not always sufficient and not always available. Often, the general practitioner has to add antidepressant medication,” Rasmussen said. “Social support from the spouse and surroundings is also very important.”

Resolved within a year

In most cases, women can expect to shake off their postpartum depression within a year, the researchers found.

“Based on this data, we would think for most women who receive treatment, their depression should be treated and resolved in six months or less,” said Dr James Murrough. He’s director of the mood and anxiety disorders program at the Icahn School of Medicine at Mount Sinai in New York City.

Postpartum depression generally takes hold of a new mother within days of delivery, although sometimes depression develops during pregnancy, according to the US National Institute of Mental Health.

Why does it occur?

Brain chemistry changes caused by post-delivery hormone fluctuations are a contributing cause of postpartum depression, along with the sleep deprivation experienced by most new parents, NIMH says.

Signs of postpartum depression can include feelings of sadness and hopelessness, frequent crying, anxiety or moodiness, changes in sleeping or eating patterns, difficulty with concentration, anger or rage, and loss of interest in activities that are usually enjoyable, according to the mental health institute.

A new mother with postpartum depression also might withdraw from friends or family and have difficulty forming an emotional attachment to her baby.

A bolt out of the blue

Rasmussen and her colleagues undertook this study to provide women facing pregnancy with better estimates of their overall risk of postpartum depression.

“Postpartum depression is a disease depriving families of a time period that should be filled with affinity, love and bonding,” Rasmussen said. “Especially for women with no prior experience with psychiatric disease, this must come as a bolt out of the blue.”

The researchers analysed data from Danish national registries on more than 457 000 women who delivered their first child between 1996 and 2013 and had no prior medical history of depression.

They reviewed medical records for signs of postpartum depression – specifically whether these women filled an antidepressant prescription or sought treatment for depression within six months after giving birth.

About 1 in every 200 women experienced postpartum depression, the researchers found.

But within a year of seeking care, only 28% of these women were still being treated for depression, the results showed. And four years later, that number was 5%. This new study was published in the journal PLOS Medicine.

Why treatment is important

The risk of postpartum depression in subsequent births was 15% for women who took antidepressants following their first birth and 21% for women who sought depression treatment at a hospital. That amounts to a 27 and 46 times higher risk than for women who didn’t experience depression during their first pregnancy, the researchers said.

“The episodes were characterised by a relatively short treatment duration, yet a notably higher rate of later depression and recurrent episodes of postpartum depression,” Rasmussen said.

The higher risk for women who’ve already experienced postpartum depression “suggests that there’s some underlying vulnerability to develop depression in these particular individuals,” Murrough said. “Basically, it’s not random. If you had it before, you could have it again.”

Murrough and Rasmussen urged pregnant women to discuss the risk of postpartum depression with their doctor, particularly if they suffered it before.

Tips on coping

The South African Depression and Anxiety Group (SADAG) gives the following tips on how to manage postpartum depression:

  • Don’t hesitate to ask for help.
  • Be realistic about your expectations for you and the baby.
  • Follow a healthy diet and get some exercise.
  • Make time for your partner and family members.

Image credit: iStock

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Health24.com | 9 ways to boost your kidney health

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Our kidneys work extremely hard to dispose of all the excess salt and water we consume.

During this process, they also eliminate toxins that would otherwise accumulate and negatively affect our bodies.

In addition, our kidneys control blood acidity and blood pressure levels.

“When kidneys fail, the body is literally overwhelmed by excess water, salt and toxins, which defeat every other organ and body system,” says Association for Dietetics in South Africa (ADSA) spokesperson and dietitian Abby Courtenay.

“The job of the kidneys may not be glamorous or poetic, like the heart, but it is every bit as important.”

kidney health, pullout quote

Here nine ways to boost your kidney health:

1. Eat more antioxidants

Cecile Verseput, dietitian and ADSA spokesperson, says that researchers are discovering more links between chronic diseases, including chronic kidney disease (CKD) and the role foods play by forming free radicals or protecting against chronic inflammation through antioxidants.

“Chronic inflammation results in permanent damage, for instance in blood vessels in the heart and kidneys, that causes damage,” she explains. “Antioxidants found in fresh fruit and vegetables can be seen as the ‘firemen putting out the harmful flames’ of inflammation caused by these free radicals.”

All fresh fruits and vegetables contain antioxidants.

2. Cut back on fatty red meat and dairy

Do you regularly eat plenty of fatty red meat and full-cream dairy? Unfortunately, you’re putting your kidneys at risk – they have to work so much harder to get rid of the excessive waste generated from digesting these animal proteins, explains Verseput.

Swap fatty meats and full cream dairy firstly for legumes, tofu and nuts, or alternatively for fresh/unprocessed fish or poultry.

3. Lose the weight

When you carry a bit of extra weight, your kidneys have to work so much harder – they need to filter more blood than normal to avoid the risk of developing CKD in the long term.

In fact, people who are overweight or obese are seven times more likely to develop end-stage renal disease compared to those with normal weight.

If you have a family history of CKD or renal failure, this should raise a red flag that you need to focus on the health of your kidneys. If you are overweight, you need to find ways to lose it and cut back on the stress you’re placing on your kidneys says Courtenay. 

Woman weighing herself on a scale

4. Manage hypertension

The prime culprit in 64% of CKD cases in South Africa is undetected or uncontrolled hypertension.

Protect your kidney healthy by having your blood pressure tested regularly, following your treatment plan (if you’re on one) and making lifestyle changes to keep your blood pressure in check, Courtenay advises.

5. Eat more green

“Go green!” says Verseput. “Give preference to a plant-based eating pattern including lots of fresh, whole foods, fruits and vegetables. You can also swap red meat for plant-based proteins like legumes, nuts and tofu.”

Green fruits and vegetables

6. Get real

“Drop the high-salt, trans-fat takeaways and convenience foods like hot cakes,” says Courtenay. She suggests developing an interest and enjoyment in cooking from scratch with fresh, healthy ingredients – it also means you’ll know exactly what you’re eating, so you won’t be at risk for hidden salt and sugar.   

“It’s so much more delicious, and good for your kidneys.”

7. Be choosy about fats

Fats are not created equal and you need to be careful about the ones you choose to eat.  

“Go for extra-virgin olive oil and avocado oil rather than hard fats to protect the blood vessels in your kidneys,” says Courtenay.

8. Forget the convenient fads

Although convenient, sugar-sweetened drinks and treats, fast foods, processed and red meat are bad news for your kidneys.

“If your diet consists of processed, junk food, it could cause similar damage to type 2 diabetes,” says Verseput.

A study, published the Experimental Physiology journal, showed that regularly eating junk food, such as fizzy drinks, burgers, cakes, biscuits and fast food, causes similar blood sugar levels as type 2 diabetes.

“This causes an accumulation of sugar, or glucose, in the blood, which can have severe long-term consequences for organs, including the kidneys, where it can lead to diabetic kidney disease.”

Woman saying no to junk food

9. Go nuts

Nuts are a great way to provide healthy fats and fibre to your diet. Courtenay says you should boost your intake of both nuts and legumes. 

Image credits: iStock

Compiled by Mandy Freeman

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Words Of Wisdom For Doctors Interested In Trying Locum Tenens Work

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June 5th, 2017 by in Health Tips, Opinion

I receive a significant amount of email in response to my blog posts about locum tenens work. Curious colleagues (from surgeons to internists and emergency medicine physicians) ask for insider insight into this “mysterious business” of being a part-time or traveling physician. I am always happy to respond individually, but suddenly realized that I should probably post these conversations on my blog so that all can benefit.

The most common question I receive is: How do the agencies compare with one another? Followed closely by: Where should I start? There is no online rating system for this industry, and so grade-focused physicians (taught to value performance ratings) feel at a loss as to where to begin. One day I hope we’ll have a locum tenens quality website, but for now  I can offer you my N=1, “case study” experience.

I’ve been doing hospital-based, locum tenens work for 6 years in the field of inpatient rehabilitation medicine. I have accepted 14 assignments through the following agencies:

CompHealth, Weatherby Healthcare, Jackson & Coker, Medical Doctor Associates, LocumTenens.com, and All Star Recruiting

I have had extensive conversations with recruiters at the following agencies, but have not ended up taking an assignment through them:

Staff Care, Delta, Onyx, Barton Associates, and Farr Health

I have summarized my experiences in this table:

Agency Name Number of Assignments Quality of Client (Hospital or Employer) Quality of Recruiter(s) Salary Provided (percent of what I would consider standard)
Comp Health 4 B,B,C,C A 80-100%
Weatherby Healthcare 3 A,B,C A 85-100%
Jackson & Coker 3 A,C,D C 85%
Medical Doctor Associates* 1 A+ A 100%
LocumTenens.com* 2 A,D B 50-100%
All Star Recruiting* 1 B- A 150%
Self-Negotiated 3 A,B,D N/A 175%

*These agencies use VMS systems.

These “data” are highly subjective, of course, but there are a few important points to be gleaned:

  1. Bad clients are hard to avoid. When I give a client a “D” rating, that means a hospital or employer that is so bad, you have concerns for your medical license or don’t feel ethically comfortable with what they are asking you to do. These are nightmare assignments and must be carefully avoided. I describe my experience with one of the “D’s” here. Big name agencies (and even I on my own) can be duped into accepting bad apple clients. Since it’s hard to know which ones are truly bad (even after a phone interview), I now only commit to a short (about 2 week) initial assignment and then extend once I feel comfortable with the match.
  2. There are good recruiters everywhere. Although the larger agencies pride themselves in outstanding customer service, the truth is that I have had great relationships with most recruiters at most agencies. From a physician perspective, the “customer experience” is fairly uniform.
  3. Vendor Management Systems (VMS) don’t create the race to the bottom I expected. The largest agencies are strongly against automated physician-client matching software (which is essentially what VMS does) and argue that they destroy the customer service experience for both hospitals and physicians. Although I am philosophically opposed to being listed on a hospital purchase order along with IV tubing and non-latex gloves, the truth is that such matching has brought me higher-paying assignments at good quality hospitals that do not hire locum tenens physicians outside of a VMS system. I see no reason to exclude agencies who use VMS, though there is a risk of being in a larger competitive pool for each individual assignment. This means that you may waste some time before being placed, but in the end if the pay is $150% of base, then its probably worth it.
  4. Boutique is not better in the locum tenens world. Unless you are in a specialty that is so small you require recruiters who can perform highly customized job matches, boutique agencies can be home to some of the most depressing assignments in America. Desperate clients who have not had success in filling positions through the (highly motivated) big agencies will turn to boutique ones, hoping that their sheer force of personality will cover for the flaws that make their hospital’s hiring difficult. I have learned to steer clear of the boutique charm offensive.
  5. You can make a higher salary if you find your own job. Agencies provide significant value to physicians. They do the hard work of locating and updating job assignments, assisting with credentialing and licensing paperwork, negotiating salary and overtime, providing professional liability insurance, and handling logistics (travel/lodging booking and re-booking).  That being said, if you’re willing to do all that yourself, you can negotiate a much higher salary if you work directly with hospital HR.
  6. Will “gig economics” eventually bypass the current agency model? Online job-matching sites will probably take a big chunk of market share, but won’t “own” the space because they don’t provide the logistical, legal, and credentialing services that physicians enjoy from agencies.  However, given that agency fees add about 40% costs to physician hiring, there is strong motivation to find alternative hiring strategies, and I suspect that Millennial physicians won’t mind doing extra work for higher pay. Websites like Nomad Health are suffering from limited user sign up (both on the client and worker side), but will likely reach a tipping point when a VC firm provides the marketing capital to raise sufficient awareness of the new hiring marketplace that bypasses recruiters and saves hospitals money. Until then, dipping your toes into the healthcare gig economy is easiest to do through an agency – and the big ones (CompHealth and their subsidiary Weatherby Healthcare have about 50% of the market share, followed by Jackson & Coker as the next largest) provide the largest number of options.

The bottom line is that part-time and short term physician assignments can prevent physician burnout and overwork. The pay is generally very good, and agencies can make the experience as painless as possible. Those who desire higher hourly rates can achieve them if they’re willing to take on more responsibility for paperwork and logistics.  Whether this “do it yourself” movement is enhanced by online marketplaces, or good old fashioned cold-calling to find work – physicians hold the cards in this high demand sector. I suspect that more of us will be ready to play our cards in the locum tenens space in the upcoming years, because full time medical work (at the current pace) is, quite ironically, simply not healthy.

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Cancer Patients May Not Get The Rehab They Need: A Missed Opportunity To Consider

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April 5th, 2017 by in Health Tips, Opinion

This blog post first appeared at: Curious Dr. George 

Rehabilitation medicine is one of the best-kept secrets in healthcare. Although the specialty is as old as America’s Civil War, few people are familiar with its history and purpose. Born out of compassion for wounded soldiers in desperate need of societal re-entry and meaningful employment, “physical reconstruction” programs were developed to provide everything from adaptive equipment to family training, labor alternatives and psychological support for veterans.

Physical medicine and rehabilitation (PM&R) then expanded to meet the needs of those injured in World Wars I & II, followed closely by children disabled by the polio epidemic. In time, people recognized that a broad swath of diseases and traumatic injuries required focused medical and physical therapy to achieve optimal long term function. Today, cancer patients frequently benefit from comprehensive rehabilitation as they recover from the effects of chemo (neuropathy, weakness, and cognitive impairments), radiation (scarring and range of motion limitations), surgery (flaps, plastics procedures, tumor resection, amputations), and brain injuries (edema, debulking, gamma knife and neurosurgery).

Rehabilitation is a phase of recovery occurring after any major life-changing medical or surgical event. Our bodies are designed to regenerate and repair, though optimizing this process takes skilled guidance. PM&R physicians (also known as physiatrists) are trained to use physical modalities (stretching, strengthening, heat, cold, etc.) to mechanically enhance healing. They prescribe medications to manage pain, spasticity, nerve injury, and cognitive impairments, while also leveraging the power of physical therapy to increase cardiopulmonary fitness, muscle strength and flexibility. PM&R physicians are also experts in neurologic injury, and can adapt exercises to coax spinal cord, brain and peripheral nerve injuries to construct new pathways for movement and repair.

Inpatient rehab’s prime directive is to get patients back home. To succeed at home, patients need to be able to function as independently as possible, using trained assistants for managing the activities that cannot be performed without help. Admission to a rehab hospital or unit offers the patient home practice opportunities – with simulated challenges that can include everything from terrain parks, test kitchens, medication management trials, driving simulators, balance tests, electric wheelchairs and even exoskeletons that allow paralyzed patients to walk again. It is like a robotic Disney World, with endless aquatic and equipment possibilities for restoring movement and independence.

When I discuss admission to inpatient rehab with my cancer patients, I ask them about their goals, motivation, and energy levels. Timing of rehab is important, because it must dovetail with treatment, so that the physical exertion strengthens, not saps, the patient. Often times when a person is newly diagnosed with cancer, they want “everything done” – intensive chemo/radiation/surgery as well as rehab/exercise. But staggering these interventions can be more effective.

In other cases when care is palliative, learning new skills and being fitted with battery or electric-powered equipment can mean the difference between living at home or in an assisted environment. Some successful cancer patients come to inpatient rehab to practice managing their activities of daily living with varied amounts of assistance, preparing for increased needs as time goes on so they can enjoy being at home for as long as possible.

For the physiatrist, cancer is a cause of impairments that can be overcome with creativity and practice, no matter the long-term prognosis. Adaptive equipment, physical exercise, and cognitive retraining may be applied intensively (3 hours a day in the inpatient setting), or at a slower outpatient pace, depending on individual need. Rehab physicians desire to support and sustain patient function at the highest level, and “add life to years.” As such, rehabilitation should be considered an integral part of successful cancer care and management.

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