Nurse Navigators for Cancer Patients: Do They Help?

When I was diagnosed with breast cancer in 2008, I felt like I was stepping down an indifferently-lit staircase into the Vast Unknown. At the time, the notion of nurse navigators was relatively new in my locale, and there were as yet none available. I could have used one. There was a dedicated breast health center, where clinicians from all the area hospitals who treated breast cancer could see their patients, along with a multi-hospital weekly tumor board where they could discuss treatment plans. Thus, my breast cancer surgeon, my radiation oncologist and my medical oncologist each worked for different hospitals, but I could see them in the same area and coordinate communication with them through the breast health center. Theoretically, that is. In practice, things didn’t work out that way. Instead, as I struggled to make treatment decisions, I also struggled with poor access, poor communication, poor coordination, and incomplete information. If I’d had a nurse navigator, she might have smoothed some of the bumps.

Now, as a homecare physical therapist with a specialty in oncology rehab, I deal with oncology nurses and nurse navigators regularly, from various cancer treatment centers. And they do help, especially when I or my patient just doesn’t know who the heck to call about a particular issue. But the road to coordinated cancer care is still bumpy for many patients.

When I began doing some research for this post, I was surprised to learn that the concept of cancer patient navigators was first conceived in 1990 by Dr. Harold Freeman and his colleagues at New York’s Harlem Hospital [Efficacy of Oncology Nurse Navigators]. And in practice, oncology nurse navigators have been around since the late 1990’s [Report on a Study on the Role of the Oncology Nurse Navigator]. Since then, defining their role has been a complex, ongoing issue, as well as defining the knowledge they need to perform their jobs. To add to the challenge, not all cancer patient navigators are specially-trained nurses, and some are not nurses or even clinicians. Some navigators are social workers, and some are lay people. As such, they may fulfill somewhat different roles in cancer care. In a study published in February, 2012 in the Journal of Health Care for the Poor and Underserved [Cancer Patient Navigators & Their Role in Cancer Care], the role of a navigator is defined as “an individual trained to help identify and resolve real and perceived barriers to care, enabling patients to adhere to care recommendations and thus improve their cancer outcomes.” These barriers may be economic, as well as lack of access to basic information about symptoms and preventative care. Thus, navigators may play a role across the spectrum, from screening to acute cancer treatment, to palliative care and survivorship care.

Recognizing this need to improve cancer care and to reduce cancer incidence and treatment disparities in the U.S. healthcare system, in 2007, the National Cancer Institute launched a pilot program [NCI Community Cancer Centers Program] in community hospital-based cancer centers to “support cancer research and enhance the quality of cancer care at the nation’s community hospitals.” Part of this program was to require cancer patient navigators. The hospitals that have taken part in this program have been studying ways to:

•Reduce cancer healthcare disparities
•Increase patient participation in clinical trials
•Improve quality of cancer care
•Enhance cancer survivorship and palliative care services
•Expand use of electronic health records and connect to cancer research data networks
•Promote collection of high-quality biospecimens to support genomically-informed research (also known as personalized medicine) [quoted from the previous link]

In 2014, this program was replaced with the NCI Community Oncology Research Program in order to “conduct multi-site cancer clinical trials and studies in diverse populations in community-based healthcare systems across the United States and Puerto Rico” in order to allow “access to a larger and more diverse patient population in a variety of ‘real world’ healthcare locations.” Meanwhile, cancer patient navigation continues, as well as efforts to refine the definition of the navigator’s role and the knowledge base needed by oncology nurse navigators in order to perform their jobs.

So, what do they do? Here’s a summary from Cancer Patient Navigators & Their Role in Cancer Care:

In my clinical experience with navigators, particularly nurse navigators, what they generally do when one of my patients has been diagnosed with cancer is to accompany them to each doctor visit, to help fill in the blanks about their treatment options and the potential risk vs. benefit of each option, to provide emotional support and facilitate practical support, to help coordinate care, and to serve as a go-to person when problems arise. In particular, I think one of most meaningful roles they can play is to help ensure that patients understand their treatment options and understands their efficacy and potential harms. I say this because I find that it is still too often the case that cancer physicians themselves either do not have the time to explain everything and answer all questions, or that they present only one treatment recommendation and do not inform the patient that there may be others. Patients are usually and understandably so overwhelmed and shocked by the reality of their diagnosis, they don’t even realize sometimes that they have a right to ask questions. Many patients are intimidated by questioning their doctors at all and may not feel brave enough to disagree with them or insist that their doctors address quality of life issues. A nurse navigator can really make a difference in such situations, so that the patient can arrive at treatment decisions that are truly informed.

Not all oncologists are alike, nor are navigators. Recently, I came across an article [You Have Nothing to Lose] by Lee Newcomer, who runs a cancer care center, about how an oncologist recommended treatment to a friend’s wife that did not reflect complete and current evidence-based information about this woman’s particular breast cancer. It underscored how important it is to have a thorough and honest discussion about risks versus benefits of treatment, and of the need to get a second opinion. We all want to be able to trust our doctors, but we also want the best treatment for us as individuals, with a full consideration of the impact of treatment on our lives. I could write another post entirely about recommended best practices for oncologists.

Also recently, I discovered that two of the navigators I deal with, who work in the same cancer center, see their roles differently. One of them tends to stick to the party line, as it were, explaining the side effects and efficacy of the particular treatment an oncologist recommends, but not offering information about other options that the oncologist may not have mentioned. The other is much more likely to encourage a patient to get a second opinion, to outline other options, and to emphasize that the patient has the right to disagree, question and be fully informed before making any decisions. It can be uncomfortable for nurse navigators to know that a certain oncologist, with whom they must regularly interact, may not be disclosing all the information a given patient needs for informed consent. It’s important for all navigators to have a consistent understanding of their role, as well as the support and education they themselves need to fulfill that role.

Another incident occurred recently when a patient attended her first chemo infusion. Her chemo nurse found that this patient had only a rudimentary understanding of the potential side effects of each of the drugs in her chemo cocktail, and immediately called a pharmacist to the scene to help her explain them to this patient and to the family member who accompanied her. This patient had a navigator, but somehow did not understand what she needed to deal with the treatment she was about to undergo. There can be a lot of reasons for this. As many of you know, it’s extraordinarily difficult to obtain and understand all the information you might need to make treatment decisions, and to understand all the ramifications of those decisions. It often feels like we are required to take, in effect, a crash course in clinical oncology in order to understand what is going on. Not every patient is equal to such a task, nor are her family members. Many patients still prefer to just leave all the decisions up to their doctors and endure the consequences.

In the meantime, researchers continue to study the efficacy of oncology nurse navigators, sometimes struggling to come up with parameters that truly reflect the value of the role they may play in cancer care. One such study reviewed the current research on this subject [Efficacy of Oncology Nurse Navigators]. Looking at 18 studies, it organized data by “rationale for implementation of nurse as navigator, study patient populations, navigator educational preparation, and measurable patient outcomes such as the time to diagnosis and treatment, effect on mood states, satisfaction, support, continuity of care, and cost.” Among other things, it outlined the difficulty of measuring navigator effectiveness in terms of cost of care, but also found that “nurse interaction with patients and families to mutually identify unmet needs; inform, teach, and support; and coordinate and promote the continuity of care” represent a valuable service that can improve patients’ experience of treatment and its outcomes.

I hope those of you who have had a patient navigator will comment and share your experience, and that those of you who did not have one will share how a navigator might have improved your experience. Personally, I think we need all the help we can get.


All the links mentioned in this article, plus some resources, are listed below.

Academy of Oncology Nurse & Patient Navigators

Cancer Patient Navigators & Their Role in Cancer Care

Delineating the role of the Oncology Nurse Navigator

Efficacy of Oncology Nurse Navigators

NCI Community Cancer Centers Program

NCI Community Oncology Research Program

National Comprehensive Cancer Network Patient Guidelines by Cancer Type

Report on a Study on the Role of the Oncology Nurse Navigator

You Have Nothing to Lose


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Nineteen Seventy-Three: A Memory

It’s Memorial Day weekend, and I was thinking about all the veterans I’ve known over the years, starting with my dad, who was probably the first veteran I knew personally. Eventually, I came to remember one named Kevin. And started writing this. Wherever you are now, Kev, all these decades later, I hope you’re okay.
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1973

Make love, not war
was what everyone said
back then, becoming, when we met,
our private joke, our secret portent,
you, in fact, a big man on campus,
six foot five in sneakers,
me, six foot two in platform shoes,
dancing.
Was it only that
it was easy for us
to see each other
above the crowd?
I used to joke
that I was drawn to you
because you were ‘an older man,’
not by much, but still,
twenty-four was ‘old’
for a sophomore.
Hah, you’d say,
only decent thing they did
since they signed you up
for the Marines,
sent you to ‘Nam,
scrambled your brains,
and discharged you, honorably,
least they could do
was pay for college
so you could try
to fill your head
with something else.

And so we made
love not war,
time and again,
you like a blanket
over me, muscle, sinew, skin,
listening
to Pink Floyd’s latest album,
over and over,
those apt lyrics,
those soaring vocals
matching our urgent
heartbeats, our quickened breath
wave for wave, until we crashed
into climax, your body melting
onto mine, when suddenly,
your psyche —
triggered perhaps by heat,
sweat,
adrenaline,
our tropical explosion —
would steal away,
your head,
filled again
with dark forebodings,
and I would be alone
with your body, now empty
as a spent mortar shell,
while the music played
‘I’ll see you on the dark side
of the moon.’

We didn’t have
a name for it then.
Shell shock
was the old name from
the war to end all wars.
You never told me
where you went
but I guessed
the general locale if not
the wretched details. I didn’t want
to think too much
about why
it was our coupling
that sent you off,
too frightened
to wonder why
making love
reminded you
of making war. I just
hung onto you
as if your life depended on it,
waiting for the moment
you’d return, relieved
that you did
return, wordlessly,
your mouth against my neck,
refusing to whisper,
silent as the smoke
rising from a field of ashes.



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Missing At Birth

When I was seven years old, my mother decided to impart some previously undisclosed details about my birth. I’d already heard, many times, along with several relatives, how much I’d weighed, that I was a happy baby, that I’d slept well, that I was the first grandchild on my father’s side of the family. Birth itself was still something of a mystery to me. I knew that babies grew in their mothers’ bellies, but I wasn’t sure how they emerged from them. My friend Suzie’s big sister had recently informed us that giving birth was sort of like peeing, except it hurt more and took a lot longer. I didn’t think any further information was necessary.

I also already knew that my parents had been married for three years when I arrived. By the time I was seven, they’d been married for ten years. My mother once told me that she’d had a number of miscarriages before I was born. She didn’t say if she’d had any after. She never told me what a miscarriage was, but I figured out it was some kind of unexpected, physical cancellation of pregnancy. She’d also told me several times that she’d always wanted to have more children after me. “It’s your father’s fault I haven’t had them,” she’d said. “He hasn’t been — romantic enough.” Once, when she was in one of her states, she told me it was my fault she hadn’t had them. But that happened later, when I was a little older.

Whatever the cause, the consequence of all this was that my parents had no other children. This did not seem advantageous to me. Being an ‘only’ put me under too much pressure. It was, however, nice to have a spring birthday. Easter was always near my birthday. For my seventh birthday, I’d gotten a very large Easter basket and an orange kitten. I’d named him Sweetpea. He liked sleeping on the paper grass in my Easter basket. He was also not averse to letting me wheel him around in my doll carriage.

Since my birthday, my mother had been fond of pointing out that, at seven years old, I had attained the Age of Reason. Whatever that meant. Just an excuse, I thought, for telling me more things I really didn’t want to know. I believed that there were just some things that mothers should not tell their children, whatever their age. It was okay for Suzie’s big sister to tell us a few home truths. She was one of us, after all. But mothers, I thought, should just keep some things to themselves. Normal mothers did, I was certain. But my mother was not a normal mother.

Sweetpea was asleep in my doll carriage when my mother announced, in mythic tones, that she had A Few Things to tell me. Sometime in the hours after I was born, she said, her doctor had told her that he believed I’d had a twin who didn’t make it. Something about the afterbirth, he said. It had not been, he thought, an identical twin.

I was stunned. I wondered how the doctor might have figured that out. In those days, they didn’t have ultrasound machines to determine prenatal womb occupancy. What was the something about the afterbirth, I wondered. Was there a tiny dead body in it? My mother didn’t say, and I didn’t ask. She also didn’t say what an afterbirth was exactly. She did tell me now that, missing twin aside, after all those previous miscarriages, she was just relieved I’d made it with all my working parts intact. I wondered if all those miscarriages had involved tiny dead bodies. Still, I felt somewhat reassured. I was afraid she might have been disappointed that she’d only ended up with me, and not with both of us. It seemed a little cruel to me to end up, say, with chocolate ice cream, only to find out you were meant to have both chocolate and strawberry, but that the strawberry had been cancelled at the last minute.

She admitted that she was unconscious during the crucial part of the proceedings. “Knocked out,” was how she put it. Once again, she mentioned that I’d weighed nine pounds, seven ounces. Before, I’d thought my higher-than-average birth weight was a point of pride, like an athletic achievement. Now, I wondered if I should feel guilty about it. Then she said that, despite my birth weight, she hadn’t had to have a C-section, which, I gathered, was some kind of surgical procedure conducted to remove extra-large babies. The reason she hadn’t needed one was amusing, she explained. When the nurse first placed me in her arms, she thought perhaps they’d made a mistake and given her someone else’s baby — not her newborn girl, but some one or two-month-old who was visiting the maternity ward. I weighed a lot, she said, but I was also twenty-three-and-a-half inches long. She sat back, grinned at me, and folded her hands. I stared at her, not grinning, and hoped there was a punchline.”Don’t you see?” she said. “You were so long and skinny, you just slid right out!” Sometime after I was considerate enough to just slide right out, that ominously suggestive afterbirth followed me.

Certainly, I was relieved that I hadn’t forced my mother to have a C-section. But why she was telling me all this? What was the point? How was I supposed to react to such information? I couldn’t tell. I also knew that my reaction was not uppermost in her mind. It never was. She just had to get this off her chest. Again, I wondered why she chose to unburden herself to me, and not to some grownup. Was there a subtext? Perhaps it was because I had evidently continued to be a rather considerate child. I was a good listener. I didn’t ask a lot of difficult questions. Perhaps it was because I was just there. Whatever her reasons, for now, her story was done, and, as usual, I was left to ponder it unaided.

I wheeled Sweetpea into my room and shut the door. I began to wonder about my missing twin. I imagined it was a brother. It could have been a girl, a non-identical sister. But I was sure it was a brother. I wanted it to be a brother. How was I supposed to feel about the fact that he hadn’t survived? Did that make me a murderer? Had I committed infanticide in my mother’s womb? Had I somehow robbed him of nutrition, elbowed him out of the way, and gobbled it all up for myself? Is that why I weighed so much at birth? Why didn’t he defend himself? Was it just the size difference? Was my zygotic self always bigger than his? Did I accidentally or deliberately kick him to death with my long, skinny legs? Did we get tangled in a sibling embrace that choked the breath out of him? Or, due to my overwhelming volume, did I just smother him to death?

Or was it even my fault at all? Was it possible for a woman like my mother to have a sort of partial miscarriage? Did my mother’s body decide, by some mysterious process, that it could only handle bringing one baby at a time into the world? Was I the product of some Darwinian, survival-of-the-fittest contest over which I had no control? Wow.

My options appeared to be that (a) I was a murderer, (b) I was a clumsy, unwittingly dangerous oaf, (c) I was too competitive, and (d) I won some contest I didn’t know I was participating in. Ultimately, I couldn’t decide which one applied. And it almost didn’t matter. Whatever happened to him, I felt bereft.

I wondered what life would have been like with a twin brother. Would my mother have divulged so much unsavory information to both of us, or to just one of us? Or to each of us one at a time? We could have at least compared notes afterward. It would have been helpful to have someone with whom to discuss the states my mother sometimes got herself into. Like the times she was convinced that the neighbors, or my father’s fellow ushers at church, or the women of the neighborhood coffee klatch, were all conspiring against her.

I wondered what my brother would have looked like. Would he have dark blond hair and blue eyes like me? Or brown hair like my mother? Or hazel eyes like my dad? Would our parents have liked one of us more than the other? Would my dad have recruited my brother, and not me, to help him develop photos in his darkroom? Or would he have put us both to work, hanging negatives and uncurling prints off the photo dryer? Would I have been spared the boredom of having to hand my father various tools while he tinkered with the car? Would I have gotten a kitten for my birthday? Would we both have gotten kittens?

Would we have the same friends? Would the boy next door, who’d kissed me on the cheek one day in his back yard and then run away, have been my brother’s friend instead of my first romantic interest? Would my brother have slugged him for kissing his sister? Would my brother and I be on the same side in our epic neighborhood snowball fights? Would we even like each other?

Of course we would, I decided. We were twins, after all. Maybe he would play with trucks while I played with dolls, but we could still play games and build forts and do puzzles together. We could push each other on the swings. We could still be allies when our parents had one of their screaming matches over dinner, ducking our heads together when they threw dishes at each other. I wouldn’t have to run, alone, to my room to cry afterward. I wouldn’t be an ‘only.’ All the pressure wouldn’t be on me.

It was really too bad that he didn’t make it. I missed him. A lot.


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Exercise After Cancer When You Don’t Feel Like It

There are a lot of folks out there who manage to get back to their pre-cancer fitness after treatment. Some of them even exceed their pre-cancer fitness. They run marathons, practice yoga regularly, take up kick-boxing, do spin classes or zumba, or walk three miles a day. I admire these folks unreservedly, but I am not one of them. This post is not for them. This post is for the rest of us, for whom just getting out of bed in the morning is often a struggle.

Personally, my greatest athletic feat after cancer was going back to work. I used to work full-time. I’m not up to that anymore. First, I worked half-time, then eventually I crawled my way back to working four days a week instead of five. I had bills to pay, after all. I work as a homecare physical therapist. For a long time, I had to take neuro-stimulant drugs to combat fatigue and brain fog so I could get through my work day. Now, I manage on caffeine. I once got myself a pedometer to see how much running around I really did. The results were somewhat ambiguous. So, I got an accelerometer, but it burned through batteries too quickly. Basically, a pedometer measures movement in 2D, while an accelerometer measures it in 3D. My advice to the average person about getting such a device? Save your money. Here’s my own advice to patients about exercise: don’t fuss about how far you walk or how many exercise reps you do. Just do something, and keep track of how long you spend doing it. Time is the most pertinent measurement anyway when you’re just trying to mitigate the effects of all those hours that you can’t pry yourself off the couch.

As far as doing something goes, I will admit that my job has its advantages. I see six patients on an average day. I schlepp a heavy bag loaded with a laptop and medical accoutrements. When I visit someone at an apartment complex, I usually have to park far from the door and hoof it to the entrance. I take the stairs between floors when I can. I’m not one of those physical therapists who sits and watches her patients laboring away. I always do the stuff with them. One demo is worth a thousand words of instruction. Conservatively, I’d say that I spend at least a quarter of my average work day engaged in significant movement. That’s about two hours out of eight. And it’s probably more than that. No wonder I’m exhausted when I get home. Exercise after work? I don’t think so.

It’s what I do or don’t do on my three days off a week that’s the problem. All these years later, I still catch myself comparing my current energy level and activity tolerance with my pre-cancer self. Big mistake. I was a ball of fire before cancer. Now, when I’m not jacked up on coffee while slogging through work, I’m more of a limp noodle. I’ve tried all kinds of things to entice myself into getting more exercise on my days off. I get paid to invent exercise programs, after all. A few years ago, I even bought myself a rowing ergometer, which used to be my favorite cardio machine at the gym. I still enjoy it now and then, but there are a lot of days when I just don’t have the wherewithal to unfold it and turn on the monitor.

I also know I’m not alone. Not only am I not alone in the Cancer Club, but I spend every day figuring out how to teach recently-hospitalized people who don’t feel like getting out of bed how to get up and move. Finally, it occurred to me to take some of my own advice to them. And to pass it on to you. Hence this post. I should also say at this point that, if you’re at all unsure about what you can or should do, especially if you have pain or lymphedema, ask one of your doctors to send you to a physical therapist first. Or get one sent to you at home.

When You Don’t Feel Like Getting Out of Bed, Don’t.

You can do a lot of exercise while lying down. Really. Even without throwing the covers off. If you’re reluctant to get up, just lie on your back (which is supine, as we PTs call it), stretch your arms out sideways and inhale deeply. Then hug yourself while you exhale. Repeat a few times. Then, pump your ankles up and down, slowly and methodically, several times. Next, tighten your butt muscles, hold for a few seconds, relax, and repeat. Then do likewise with your knees, straightening them as much as you can. If you feel friskier by now, you can try sliding your legs apart and back together a few times. Next, you can try to bend one knee and slide your heel up. Then slide it down. Repeat with your other leg. You might think all this is no big deal, but this is basically what we PTs teach all our patients who have just had joint replacement surgery. And it works. If you feel capable of throwing off the covers, you can try the supine exercises diagrammed on these two PDF’s: (1) simple back/leg exercises and (2) slightly less simple back/leg exercises. I put them together for people with sore backs, but you don’t have to have a sore back to do them. If you do have a sore back, I’ve put the links to the original posts at the end of this one.

Upright and Taking Nourishment

If you’ve managed to get up, crawl to the kitchen, eat some breakfast, and sit in a chair, there are lots of other things you can do. One of them is to stand up and sit down again several times in a row. This is essentially a squat, but easier and safer than a full squat sans chair. It’s a great, effective strengthening exercise, and there are several versions. If you need to use your arms to push off, no problem. Just try to stand up as straight as possible for a few seconds before you sit down again. If you can do it without pushing off, you can brace your hands on your thighs to help you stand. You can also try standing up from your chair with your arms folded across your chest. Or with your arms raised straight out in front of you. The main thing is standing up straight once you’re on your feet, making sure you feel your back, butt, knees and lower legs doing their thing. The magic is in repeating it two or three or ten times in a row. Honest. Simply amazing.

Another thing you can try in a chair is to lean over your own lap, let your arms hang down, and try to touch the floor. Don’t worry if your belly gets in the way or your shoulders are too tight to reach that far. It works better if you sit with your knees and feet apart. It’s a great way to stretch out your back. Just hang there for ten or twenty seconds, and when you get over the headrush, suck in your belly muscles and roll yourself upright again. And, of course, try repeating a few times, reaching further each time, if possible. You can mix things up by stretching your arms over your head as you sit up. Sort of like doing the Wayne’s World ‘We’re not worthy’ wave, but without the rock stars.

Say you’ve been sitting up for a while, checking your email, your Facebook page, your Twitter feed, and uploading a few pix to Instagram. Probably an hour or two has gone by. Time to move again. Don’t be afraid: you can still stay in that chair. Just push that laptop away, let your arms hang down by your side, and shrug your shoulders up and down. Shrug them ALL the way up and ALL the way down, slowly and thoroughly. Five times or ten times. Then squeeze your shoulderblades together, hard, several times. Hang your head forward and let your neck stretch out for several seconds. Then look straight ahead and slowly, gently, turn your head to one side and stretch it, and then turn to the other side. Slide your feet forward so your heels are resting on the floor, and pump your ankles up and down methodically. No ‘flapping.’ You want to feel your calf muscles working. Maybe try standing up a few times. Maybe even try standing up, moving your laptop to the kitchen counter, and checking your social media while standing. Just for a few minutes anyway.

Taking A Stand

Don’t worry. I’m not going to go off on you and load you up with a lot of fancy standing exercises. Really, I’m just going to encourage you to stand. There have been a lot of articles published about the benefits of simply standing, so I’ll let you do your own search for them. In one article I found, a physician claimed that, over a year, standing for a cumulative total of three hours a day had the same health benefits as running 10 marathons. I’m not sure if I could pull off standing three hours a day myself, but the point is that being a couch potato is detrimental to our health. In an excellent post by Carolyn Thomas, who blogs about women and cardiac disease, she quotes a leading cardiologist who shares some astonishing info. Even if you manage to perform that much-touted 30 minutes of exercise a day, if you spend most of your day sitting and not moving, as many people do, you’re still in much worse shape overall than people who get off their butts periodically. The point is NOT to slump motionless on the couch all day, but to move around now and then.

I’m also not talking about standing rigidly in one position. In fact, I don’t recommend that, especially for people with back problems. I’m talking more about doing a little something when you stand, something you’d normally do while sitting, like sorting your snail mail. One of my tricks is to turn on the radio and see if I can stand for the duration of the average song or news story. You could just stand there and listen while texting your friends. If you feel ambitious, you can add some further movement by loading the dishwasher or unloading that carton of canned cat food you ordered for your favorite fur baby. In fact, any attempt at those much-dreaded household tasks while standing is helpful. Like sorting or folding laundry. Or polishing the silver. Whatever. I worked on some of this blog post while standing. You get the idea.

The Bottom Line

The point of this post is not to flog you into doing something you really can’t do. I’ll save the complicated stuff for a subsequent post. The point is that, whether you’re vertical or horizontal, using your muscles some of the time, even just a little, is better than not using them at all. Pretty much any and all movement of any joint larger than your thumb will work. Or just using most of your major muscles to fight gravity by standing will work. It all counts. It doesn’t have to take longer than a few minutes. In fact, the other point here is that lots of benefits accrue by doing a little at a time, but doing it several times a day. Do keep track of it, too, and add it all up at the end of the day. You might be surprised. Two minutes here, five minutes there, it adds up. Recently, I visited a patient just home from having a few stents placed to make it easier for her heart to pump blood through her body. She felt like she’d been run over by a truck. I got her to agree to take a five-minute walk around her house each day. By our next visit, she said she’d spent the last few days taking two five-minute walks around her house each day. It wasn’t exciting — it was a small house. But, she felt enormously better. In fact, we ended up taking a walk outside that day. It really doesn’t take much. Just move your bottom.


A few old posts:
Arm and Shoulder Pain After Breast Cancer
Sore Back 101
Sore Back 201


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