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Getting ahead of the curve: Cancer rehab in DL helps patients get back into life

Marna Crow, right, shares a laugh with Physical Therapist Assistant Tory Anderson as she uses a Rainbow Arch to improve her hand strength and dexterity at Essentia Health-St. Mary's Physical Therapy Center in Detroit Lakes on Tuesday. Crow is partaking in a cancer rehabilitation program after recently finishing six rounds of chemotherapy. Marie Johnson / Tribune1 / 4
One of the hand exercises Marna Crow works on in physical therapy involves finding and removing small objects hidden in a bowl of rice. One of the side effects from her chemo treatments is a loss of sensation in her fingers. Marie Johnson / Tribune2 / 4
Marna Crow practices her balance and improves her leg and foot strength by stepping up and down on a wood block without using her hands. When she first started therapy, she would not have been able to do this exercise without holding on to the railings at her sides. Marie Johnson / Tribune3 / 4
Marna Crow has seen improvements in her strength, endurance, energy levels and more since starting a twice-weekly cancer rehab program in March. She finished her last round of chemo in February. Marie Johnson / Tribune4 / 4

She made it through chemo and doctors declared her "cured," but Marna Crow knew her battle with cancer wasn't really over yet.

Her body had beaten the odds and survived more than six months' worth of needle pokes, CT and PET scans, chemotherapy and abdominal surgery — all in an attempt to diagnose, and then treat, her lymphoma.

She was grateful to be alive at the end of it, of course, but the treatments — especially the six grueling rounds of chemotherapy — left her drained and almost immobile. Tired and weak, she couldn't stand for more than a minute, or walk for more than two. She had lost some sensation in her fingertips and feet, and her balance was off.

"At home, I'd have to have a stool in front of the stove just to cook dinner," she said. "I'd stand up and stir something and then sit back down."

Crow finished her last round of chemo in February, and then had a choice about what to do next — she could go home and tackle her recovery process on her own, or she could take part in a cancer rehabilitation program to help move things along. She chose the latter. Somewhat surprisingly, she's in the minority for that.

Jennifer Frank, a physical therapist at Essentia Health-St. Mary's Therapy Center in Detroit Lakes, said the vast majority of cancer patients who have rehabilitation needs never enter into a cancer rehab program. Studies have shown that anywhere from 65 to 90 percent of current or former cancer patients have one or more needs for rehabilitative therapy, she said, but only 6-10 percent actually get referred for it.

The reasons behind that are varied, but Frank suspects it's most likely due to a lack of awareness that such rehab programs exist (and of how much they can actually help), along with a general feeling among cancer survivors that once chemo or radiation is done, the war is over, so to speak, and they can go home.

"A lot of times I just think it's patients feeling like, 'I'm alive, I'm doing well,' when really they could be doing so much better," Frank said. "But when you've battled cancer and you've won... they're just happy to be alive and feel like they can deal with fatigue or some lingering pain."

Crow, who's been in healthcare for a long time — she's been a nurse midwife at Essentia Health-St. Mary's for the past 20 years — was familiar with the concept of cancer rehab and recognized her own desire and need for it. She consulted with her doctors about it, and started a program in March. She's been going about twice a week ever since.

At the Essentia Health Physical Therapy center on Tuesday, Crow said she was 16 visits in to her therapy sessions, and she planned to keep going until she felt more like her old self again — a process her oncologist told her would take roughly six months.

Less than two months in, Crow was already feeling significantly better. She could stand and walk for extended periods, and go up and down steps without holding onto a railing. She's seen her strength and endurance improve. She and the Physical Therapist Assistant she worked with on Tuesday, Tory Anderson, were just starting to work on getting the sensation back into her hands and feet.

"I've gained a lot since I've started," Crow said. "I can tell it's helping. I wouldn't be where I am today without this."

She was even able to return to her job this week, doing some light office work on a part-time basis. Before too long, she should be able to start delivering babies again.

The kinds of improvements Crow is seeing are common among cancer rehabilitation patients. The average patient is seen for about three months, usually a couple of times a week (though individual programs vary in length and frequency depending on the needs of the patient). Some cancer patients start a rehab program while still undergoing chemo or radiation treatments; others don't start until long after their cancer has been in remission. The timing is completely up to the patient.

Frank said the cancer rehab sessions "look similar to someone who just had a knee replaced, or is having hip pain, but it's more fine-tuned to meet specific needs and issues of a patient, particularly patients who are still going through their treatments."

All cancer patients at Essentia Health are screened as potential candidates for the rehabilitation program, Frank said. Anyone found to be having issues like Crow — fatigue, balance problems, weakness and peripheral neuropathy, among others — are referred to the program. Once they're there, the goal is to get them back to where they were before they were diagnosed with cancer, or as close to that as possible. And most of the time, that goal is met.

"We see people feeling better," said Frank. "They have more energy and can get back to their daily routines. I would say almost everyone is making gains toward a better quality of life."

There are some patients, however, "who aren't going to win the battle," Frank added. "Not everyone is walking out to a happy ending — that's part of the reality of cancer. We do work with end of life with some people, working with the families on easier mobility of the patient, and helping the patient transition easier or be more comfortable in their mobility."

The cancer rehabilitation program is relatively new at Essentia Health in Detroit Lakes, becoming available in 2013. Frank said the services are covered by insurance.

After a patient completes his or her therapies, they're most often transitioned into a home program that includes regular exercise so they can maintain or continue to improve their endurance, strength and energy levels.

Crow's not quite there yet, but she believes she will be before too long.

"I feel okay," she said. "I'm glad my chemo's done, and I'm glad to be moving forward again."

Crow was diagnosed with a common type of non-Hodgkin lymphoma, called diffuse large B cell lymphoma, in early September.

She had woken up one morning with "moderately intense" abdominal pain, she said, and she ended up visiting an ER to find out what was going on. A CT scan revealed a mass in her abdomen, just below her diaphragm.

After a failed biopsy, her surgeon in Fargo decided to try and remove the mass, but it was too entangled and ended up being inoperable. Doctors did get a conclusive result from a biopsy taken during that surgery, however, and Crow finally got a definitive diagnosis. She learned that the cure rate for her kind of cancer is 60 percent.

"I felt like, 'Whoa,' when they told me about the cancer," she said. "You have that initial shock, but you get over that and then it's like, 'OK, you can do this.'"

As soon as she healed from the surgery, Crow started chemotherapy. Beginning in early October, she went through one chemo treatment every 21 days, six treatments total. Each treatment took about five hours. The first round was completed in Fargo, in case of any bad reactions to the drugs; the rest were done in Detroit Lakes.

Crow started noticing the effects of the chemo early on, losing her hair, including her eyebrows and eyelashes, and feeling fatigued and nauseous. She would lose her voice for awhile after every treatment, and get sores in her mouth. After awhile, all the symptoms that eventually led her to the cancer rehabilitation program — the weakness, balance issues, etc. — were apparent.

Because she was immunocompromised, Crow couldn't be around sick people or crowds, so she was unable to work and spent most of the winter cooped up at home.

Halfway through her chemo treatments, Crow got some great news: it was working. A PET scan showed that her lymphoma had resolved. The mass was going away. She still had to finish three more rounds of chemo, but things were looking really good.

With the help and support of her friends, family and chemo nurses, she said, she made it through her remaining treatments. People brought her food so she didn't have to cook. They gave her rides to her appointments. They prayed for her.

And she survived.

"Throughout the process, I had my doubts and depressions sometimes," she said. "I thought, 'I can't do this,' but then I thought about all the kids out there who've gone through this, and I told myself if they could do it, I could, too."

She has a long road to recovery still ahead of her, but today, she said, "I'm considered cured."

The experience has changed her in some profound ways.

"I've never faced any life-threatening situations like that before," she said. "I think once you do that, you learn what's really important—not to sweat the small stuff, to be grateful for what you've got and live every day. To do what you want and be happy."

Marie Johnson

Marie Johnson joined the Detroit Lakes Tribune as a reporter and magazine editor in November 2017 after several years of writing and editing at the Perham Focus. She lives in Detroit Lakes with her husband, Dan, their 4-year-old son and toddler daughter, and their yellow Lab.

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