You’ve probably heard that oncology specialization is the best way to catapult your cancer rehab career – but what does this actually look like for a practicing clinician?
Sheree King, a physical therapist specializing in oncology, shares her journey of opening a private practice and becoming a board-certified specialist in oncology. Despite the challenges of starting a practice during COVID-19, Sheree has successfully expanded to multiple locations and is a go-to cancer rehab pro in her area.
Sheree shares her specialization journey, why she started, how she navigated specialization while running her private practice, & how it impacted her patient care along the way. gained recognition from oncology providers in her community.
If you’ve ever wondered if it’s possible to do & have it all in cancer rehab, listen NOW to this amazing interview with Sheree King!
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About Sheree King, PT
Sheree graduated from University of Tennessee College of Health Sciences with a BS in Physical Therapy in 1988. She has worked in various settings including acute care and out patient setting since that time. She lives in Johnson City, TN with her husband and is the proud mother of 2 adult mathematician daughters. She is owner of Ribbons Physical Therapy, LLC with 2 locations: Johnson City and Kingsport, TN which serves the oncology/lymphedema community with OT and PT services. Sheree has worked in oncology since 2007. Received Certified Lymphedema Therapist in 2007 and became LANA certified in 2008. Developed breast cancer surveillance program for Sullivan Center Rehab Center. Serves on the Ballad Health Cancer Committee and the Survivorship Subcommittee for Ballad Health. Sheree Completed Board Certification in Oncology in 2023.
Transcript
Elise – @TheOncoPT (00:04.258)
Hey, Onco PT and welcome to this episode of TheOncoPT podcast. Now I briefly mentioned this story off camera, but I’m going to share it one more time because I think this next guest is really, really cool and helped me set a goal that I never thought that I could actually accomplish.
So Sheree King is our guest today on the Onco PT podcast. And Sheree was one of the first like quote, strangers or like not a friend that I met in person who then followed me on social media. And I set a goal for myself. I was like, one day, I don’t know who this ribbons PT person is on Instagram, but I’m going to meet this person someday because I think they are really, really cool. And I have since setting that goal, had the immeasurable honor.
and privileged to meet Sheree but also to get to coach her along some really cool milestones in her career that we’re going to talk about today on the Onco PT podcast. So without further ado, Sheree, welcome to the Onco PT podcast.
Sheree (01:12.614)
Thanks so much for having me, Elise.
Elise – @TheOncoPT (01:15.69)
So Sheree, I know a little bit about you, but would you mind sharing with our audience today who you are, where you practice, and then we’ll go from there.
Sheree (01:28.002)
So I’m a physical therapist and I practice in Johnson City and Kingsport, Tennessee. And I had a really strong background in acute care and some outpatient. And then when we relocated to this area, I took a job in outpatient PT and then I opened a private practice in the middle of
COVID in 20. So, I saw our first patient in May of 20 when everybody else was staying at home, yes.
Elise – @TheOncoPT (02:05.683)
Oh my God.
Elise – @TheOncoPT (02:09.37)
Okay, so I knew it was during COVID, but I didn’t know how fresh during COVID. So let’s take a step back. So you came from acute care, some outpatient, and then you decided, A, I’m going to start a private practice. Was it in oncology from the get go? Like you knew you wanted to do oncology in your private practice?
Sheree (02:31.342)
Yes, when we relocated to this area, I took a job at a big hospital based outpatient center. And the person that was doing lymphedema therapy there was transferring back inside the hospital. So they needed somebody to do lymphedema, which they sent me and paid for my training. So that’s how I got interested in all that. And you know, when you tip the iceberg in lymphedema, you can’t
Elise – @TheOncoPT (02:38.058)
Mm-hmm.
Elise – @TheOncoPT (02:52.204)
Nice.
Sheree (03:01.366)
just get lymphedema without getting all the rest of the taste in your mouth for the cancer rehab. So, and my boss was very sports orthopedic minded and they put him on the cancer committee for that health system and he didn’t wanna do it. So he came to me and he goes, I need you to go do this. And so I got stuck on the cancer committee. I guess not stuck, it was kind of a blessing in disguise.
Elise – @TheOncoPT (03:26.498)
Hehehehe, yeah.
Sheree (03:29.654)
Because we had a very, went through some vice presidents, but we had one vice president over oncology that really picked up on my passion for oncology. And she actually created me a job inside the cancer centers. So, I worked from 16 to 20 inside 3 cancer centers. I commuted between 3 cancer centers.
Elise – @TheOncoPT (03:53.986)
Oh my God. Holy cow.
Sheree (03:55.322)
And then our system went through a huge merger and I was already like maxed out with business because it was you know me, myself, and I. And when we went through the merger there were way too many balls in the air for them to develop programs and do all that. And I’m gonna spring chicken so I knew if I was going to
develop programs and do more in cancer rehab, it was not gonna be on their umbrella because they had too many balls in the air, do other things. And I actually, and this was my husband’s idea, we went to some higher ups in our health system and said, y’all just went through this merger, you got a lot of things going on, but we have this unmet need in the community and we wanna do it. And they said, go do it.
Elise – @TheOncoPT (04:28.244)
Yum.
Sheree (04:50.53)
Of course, they did not financially support us, but they said, go do it. We will support you with our referrals. So. That’s how we opened, but that and that we met with them in the fall of 19. And as you want to start in product practice, you’ve got to find a location. We started out taking insurance from the get go. So we were trying to do credentialing and all that.
Elise – @TheOncoPT (04:58.734)
Holy cow.
Sheree (05:19.31)
and like signed a lease in on January 1st or 2nd or and then started credentialing then and of course then everybody shut down in 20 when we’re trying to open her hired our first employee in March an office person and then we had a presidential stay at home order so
Elise – @TheOncoPT (05:38.978)
My God.
Elise – @TheOncoPT (05:45.111)
Hmm.
Sheree (05:46.61)
But we do focus only on oncology and lymphedema. We don’t see orthopedics. We’ll see you with an orthopedic injury if you’ve had a history of cancer, but not straight orthopedics or neuro or any of that. So my husband always says once you’re in the club, you can come back here, but you gotta have cancer or lymphedema to be in the club.
Elise – @TheOncoPT (05:47.586)
Oh my God.
Elise – @TheOncoPT (05:58.465)
Mm-hmm.
Elise – @TheOncoPT (06:14.41)
I’m the same, I’m 100% the same. So fast forward to todaysheree. Ribbons, which is the name of your private practice, is not just doing well in the one location, but y’all also have multiple locations now, right?
Sheree (06:32.446)
Yes, we open the second location was up in a year in this January. So, and all of our staff can meet back and forth between locations. We just had a, we were getting a lot of referrals from that.
Elise – @TheOncoPT (06:44.566)
Mm-hmm.
Sheree (06:51.154)
Our area where there’s three smaller cities and like you can easily drive between them and if you’re from a big city you don’t think twice about that but the people here think that they can’t leave their city limits. So a 20 minute 25 minute drive is like oh no I can’t drive all the way there.
Elise – @TheOncoPT (06:57.794)
Mm-hmm.
Elise – @TheOncoPT (07:06.082)
Totally.
Sheree (07:12.994)
So we had a lot of referrals coming from a couple of physicians in Johnson City. And I actually live in Johnson City. I’ve just worked in Kingsport most of my career in this area. So that’s why I opened in Kingsport first. But so we opened in Johnson City.
Elise – @TheOncoPT (07:31.042)
Oh my God. Okay, cool. So take me back. Deciding to open a private practice is already so huge, especially when you’re leaving. You know, there is some sense of security when you’re working with a larger institution. Now, yours was in flux because like you mentioned, they went through that merger. There were a lot of balls in the air. And then on top of that, we had COVID hit,
beginning part of 2020. And this is coinciding right when you are starting, like you are laying the foundation to hit the ground running whenever I’m sure like, the insurance credentialing process came back. What was that like in the early months of, oh my God, we’re opening a private practice and also we have the mandatory stay at home situation.
Sheree (08:19.474)
Yes. And so credentialing took, I think, longer because like people, they weren’t credentialing, like Medicare, it took forever and I finally called them one day and they go, is this COVID related? I go, no, but I filled out my application January 2nd and it’s like, you know, March or whatever. So everybody was just way overwhelmed. Everything was done differently. It was
Elise – @TheOncoPT (08:26.636)
did it.
Oh.
Elise – @TheOncoPT (08:39.21)
Jeez, yeah.
Sheree (08:49.03)
it was like we were, and of course I didn’t know any different, but looking back on it now, I can like, I can say, oh my, like that wasn’t normal because, you know, it was just done so differently. You know, everybody that credentialed with the insurance companies was working from home and there was a couple of contracts that we sent back and forth and they’re like, oh I can’t make those changes at this computer at my house and…
You’re just going to have to trust it’s going to be that way. I’m like, I’m not signing it like that. No. Yeah. So.
Sheree (09:22.386)
Um, so it was, it was a lot of different, different things and they kind of, it really worked to our advantage a couple of times because there was no wording to support something. And, um, we came back and said, you said you’re going to do this and you didn’t. And I had an email stream and they were like, oh, yeah, well, we really, really mean it.
Elise – @TheOncoPT (09:22.414)
Oh my god!
Sheree (09:48.386)
for all of those people, just for certain people. But I was like, but that’s not what’s not related to me.
Elise – @TheOncoPT (09:53.986)
that, right? Like, ooh, way to have that in writing, Sheree. Oh my God.
Sheree (09:56.911)
Yes.
Elise – @TheOncoPT (10:01.726)
Very smart, very smart. So when you said that you had your first patient in May of 2020, is that right? How was that process? Because so from my perspective, so I’m in Texas and I was previously employed by a corporate like hospital-based outpatient system and we actually stayed working for better.
Sheree (10:02.007)
Yes.
Sheree (10:10.366)
Yes, yes, yes.
Elise – @TheOncoPT (10:30.458)
for worse, mainly full time during that first month or so. And it was in April and May when our hours started getting cut, even though we still had patients because I was inside the cancer center, et cetera. So your stuff was kind of taking off as mine was very much being shut down. What was that like? Because I imagine that kind of mirrors what was happening elsewhere in the country as well.
Sheree (10:53.311)
Right.
And I think that if I was in a normal private practice, like I wouldn’t have survived, but cancer patients, they had to get their chemo, they had to get a radiation, they were getting out anyway. So they came to PT. Some of them were very, a little standoffish, but when I told them, I said, you know, we only see cancer patients and also you’re gonna be the only, cause I saw patients one-on-one.
I said, you’re going to be the only person in the clinic. You might pass somebody come in, you know, you know, leaving or going. But and they were like, oh, okay. Well, then I’ll come. And I also because I’d worked for this health system for a long time. I had a huge supply of PTO hours piled up. So what I did is as I took as I got credentialed with certain insurances, I just flip them to my private practice and see them here. And then I saw everybody else.
Elise – @TheOncoPT (11:33.442)
Cool.
Elise – @TheOncoPT (11:41.607)
Nice.
Sheree (11:52.046)
still in my old job. So I just took PTO hours when I was working here and until I got all credentials and then I completely cut the cord.
Elise – @TheOncoPT (11:54.846)
Wow.
Elise – @TheOncoPT (12:03.986)
Oh my God. How was that transition? If you’re comfortable talking about that, going from working for somebody to working for yourself, for the patients.
Sheree (12:14.002)
Um, it, I mean, it was, it was good. And you know, some patients saw me both places, like with, I remember one person I saw, um, with an insurance that I’d already been credentialed with and I scheduled for an evaluation. I was like, why? Cause I had tried to train the people that are doing my scheduling. I was like, why’d you schedule this person here? They go, she wouldn’t come to the other place. And I was like, okay. So after I saw it was like.
I was like, why won’t you come to the other place? She said, well, I just didn’t know if I would see you or not. And I was like, yes, we’re going to see me. So yeah. But it went smooth. I mean, the staff and everything was very supportive. You’d think it would have been mass confusion. It really wasn’t. And, you know, I would just have the patients fill out requests for records and then they would fax over like my previous.
So, yeah, it was smoother than you would think it would be.
Elise – @TheOncoPT (13:14.454)
That is amazing.
Elise – @TheOncoPT (13:20.17)
That is incredible. I’m first of all, so happy for you, but also selfishly I’m very jealous because that sounds amazing and so much smoother than, so right now I’m going through the insurance credentialing process and I mean like, I don’t know if it’s day or night sometimes with those applications. So.
Sheree (13:27.115)
Ha ha!
Sheree (13:32.877)
Yes.
Sheree (13:38.538)
Yes, it’s a nightmare. I think I saw you post like tackling Medicare again and you had a big cup of, I think it was hot tea, but I almost replied to that. Is that tea or wine? Ha ha ha.
Elise – @TheOncoPT (13:40.575)
Holy cow.
Elise – @TheOncoPT (13:54.13)
You should have asked. It was tea that time, but I think maybe in the future I’ll have a little something extra.
Sheree (14:00.851)
Yeah!
Because yes, I don’t want to do that paperwork ever again. Yes.
Elise – @TheOncoPT (14:11.591)
So today in your practice, Sheree, what kind of patients are you seeing? What kind of diagnoses? What kind of impairments are you seeing in your practice?
Sheree (14:22.402)
We see, well, we see non-cancer related lymphedema. We do have a big vascular surgeon that sends a lot of non-cancer related lymphedema. And, but we see any other cancer diagnosis. Breast cancer is probably our biggest population just because we have a lot of surgeons onboard for breast cancer surveillance.
Elise – @TheOncoPT (14:31.03)
Very cool.
Very cool.
Elise – @TheOncoPT (14:45.897)
Mm-hmm.
Sheree (14:50.722)
that send them before surgery and then we see them after surgery for up to a year. So breast cancers are big, but we do, we’ve had a lot of colon cancers lately with peripheral neuropathy, balance issues. I’ve made our OT our kind of head and neck specialist because Medicare lumps PT into speech.
and those head neck people need a lot of speech therapy too. So we let OT have their own bucket of money and she’s done mainly our head neck cancers but she is doing a lot of monitoring them for lymphedema, doing range of motion, all of those kinds of things. And those are usually referred by our RADOX because the RADOX kind of really gotten on board with that.
Elise – @TheOncoPT (15:44.425)
Mm-hmm.
Sheree (15:49.162)
We’ve seen, I’ve seen a few multiple myeloma going for stem cells. Mainly they were referred for neuropathy before they go for their stem cell. We don’t do stem cells here. They’re going to a bigger cancer center in Charlotte, North Carolina, Nashville, or even at Duke University. So they, a lot of times they don’t make it back in the clinic.
Elise – @TheOncoPT (15:57.794)
Mm-hmm.
Elise – @TheOncoPT (16:11.92)
Wow.
Oh him.
Sheree (16:18.558)
afterwards to be from back up after that but we’ve seen some before they go for their shin cell.
Elise – @TheOncoPT (16:21.07)
Mm-hmm.
Elise – @TheOncoPT (16:28.99)
Very, very cool. And you mentioned you’ve got OT in house. So it seems like you’ve got a multidisciplinary presence at Ribbons.
Sheree (16:35.846)
Yes, we have another PTA, a PTA, and then we just had our second OT and she just got back from CLT training. Yes.
Elise – @TheOncoPT (16:46.762)
That is so exciting. Oh my God. Okay, I think I’m gonna have to talk to you more, maybe in like a second interview, about some of the kind of tricks and tips of the trade, because I had completely forgotten about the whole, there’s OT and then because of the dang, not Oxford comma, that is not, the Oxford comma is not there.
Sheree (17:10.554)
Yes.
Elise – @TheOncoPT (17:12.686)
in the language. So PT and speech therapy are lumped together, which like, okay. So anyways, I’ll have you back on Sharita to talk about the tips and tricks of the trade. Because there’s some of these strategies that we don’t really think about because we’re so into the patient care of like, yeah, we’re going to help this patient get better. And then there’s this admin silliness kind of on the other side. It’s like, oh yeah, you have to pay attention to that. I’m sure you have quite the experience in.
Sheree (17:22.114)
Okay.
Sheree (17:41.332)
Yes.
Elise – @TheOncoPT (17:41.658)
do’s and do nots of all of that. Oh my god. So you’ve been practicing in oncology for several years at this point, even before you opened your private practice. At what point did you say, I think I want to go deeper. I want to specialize in oncology physical therapy.
Sheree (17:43.746)
Yes.
Sheree (18:05.534)
Yeah, so I had a little bit of taste of that when I was working in the cancer centers and I had mentioned it to our current vice president at that time and she was like, yeah, we’ll pay for that if you want to do that. And of course, I looked at all the specials that, you know, all holiday I had to do and I was like, yeah, can’t do that. Can’t do that. Can’t do that. But then when I went into private practice, I was like, you know, I need to, if I’m going to go head to head with why you need to send patients.
to us. You know, I need to have the credentials behind my name to show why you need to send it to us. So I wanted to be able to present myself better and show that I had the knowledge base to treat cancer survivors, just to assure our referring providers that why do they need to send them to us instead of, you know, because we still have patients. There’s
Elise – @TheOncoPT (18:42.718)
Yes.
Elise – @TheOncoPT (18:52.139)
Mm-hmm.
Sheree (19:03.894)
Southwest Virginia borders us and that’s a very rural area and we still have patients drive out of that. We’ve had patients drive from Kentucky, yeah southeast Kentucky down to CS so I need I felt like I needed to just be able to prove myself that it was worth the drive and the referral so to have more credibility.
Elise – @TheOncoPT (19:07.148)
Mm-hmm.
Elise – @TheOncoPT (19:30.046)
And that’s a really good point. Yeah, that’s something that Scott Capoza talks a lot about for his kind of justification of, when I walk into a room and I have these, this title behind my name, people kind of pay attention a little more. What’s been your experience with, since you’re now board certified, how do you feel like that’s kind of helped you show up in your community as a go-to expert?
where people know that they can get high quality cancer rehab.
Sheree (20:02.174)
Yes, and I think it also, I think it gives you, I feel like now I have a platform to stand on, to voice my voice in the community. And, you know, I’ve done a couple of lectures at a PT school in Nashville, you know, to, I did that before I had.
that, um, sort of special certification, but also since having certification, I feel like I really have a platform to use to, you know, go more into the community and speak in the community and, um, do those kinds of things. Um, just because I’ve got the credentials now rather than saying, yeah, I know a lot about breast cancer. Yeah. Um, so I do have the credentials to do that with.
Elise – @TheOncoPT (20:53.236)
YAH
Sheree (20:56.818)
And I think we have also been able to, we had an insurance company contact us. I think it was going to go in force in September of last year, and they were trying to cut our reimbursement 30%. And so we had to contact them and said, we’re not the big box PT clinic. We’re not seeing.
three and four patients at a time. We’re seeing patients one-on-one. All of our therapists are certified lymphedema therapists and we have one of three board certified oncology PTs in the state. So they actually, not only did we go back to our original rate, but we bumped it up 30%.
Elise – @TheOncoPT (21:25.366)
Mm-hmm.
Elise – @TheOncoPT (21:29.184)
Yeah.
Elise – @TheOncoPT (21:48.034)
Okay, Sheree needs to be teaching this now. Like my teaching is done. Sheree is teaching the master class now. Oh my God, are you serious?
Sheree (21:50.594)
Ha ha
Sheree (21:57.874)
Yes, and I’ll have to, my husband, you know, does our operations and I’ll have to give him credit for that one. Yeah. He went to that really hard for that. Yeah.
Elise – @TheOncoPT (22:14.546)
I did get to meet Mr. Sheree King at CSM this past February, and he was an absolute delight. I’m so glad that he’s on your team doing all of this stuff for you and your patients, because that is just so amazing. Oh my God, and like, this is not, that absolutely is not one of the like perks.
or benefits that we tend to talk about when it comes to specialization, but what an incredible opportunity to turn that around and show that to that third party payer and say, actually, we’re doing really, really good and important work here that is not happening elsewhere in our area, but one of three in the entire state of Tennessee, Sheri? Like, oh my God.
Sheree (22:51.245)
Right.
Sheree (23:06.434)
Right, yes, yes. And I think patients too, they’ll say, they’ll say, you know, the oncologist really wanted me to come here. You know, they really wanted me to come here. And I would say, yeah, you know, I am a board certified specialist and oncologist. And they’d be, oh, okay, oh.
Elise – @TheOncoPT (23:18.86)
Mm-hmm.
Elise – @TheOncoPT (23:27.17)
That makes sense. Oh my gosh. Wow. Do you feel like that’s something that the oncologists and the oncology providers in your region recognize as being important and you need to see Sheree because she’s a board certified specialist?
Sheree (23:46.227)
Yes, I do think they see that.
Sheree (23:53.442)
So I do it, I take a yoga class and there’s a lot of people from the Cancer Center in there here in Kingsport. And so they like, I was like, I’m gonna go to my board. You know, they heard me like, I gotta go study, I gotta take my board, I gotta, so they know how hard I worked for that. So they’ve been very supportive, yeah.
Elise – @TheOncoPT (24:02.151)
Mm-hmm. Yeah.
Elise – @TheOncoPT (24:10.55)
Oh my god, that’s awesome!
Elise – @TheOncoPT (24:15.878)
And again, like, what a great way to educate the community on A, cancer rehab, period, but also that you’re not just practicing, you know, baseline cancer rehab, but you’re actively seeking out this really great opportunity to deepen, to further your knowledge so that you can better show up for their patients. And I don’t know about you, Sheree, but the oncology, you know, physicians, NPs, PAs, the nurses are fiercely…
protective of their patients. And they wanna know that they’re getting good care. And I feel like that is such a great way to show like, I am doing exactly that for our patient.
Sheree (24:48.162)
Yes.
Sheree (24:58.186)
Yes, yes. And there’s one oncologist and she’ll introduce me. She goes, this is our PT. And I looked at her one day and I said, it’s so nice to have you say I’m still your PT even though I don’t even work here anymore. She’s like, but you are, you’re still our PT. Yeah.
Elise – @TheOncoPT (25:15.842)
Oh my God, well, game recognize game. I mean, I love that so much. So rewind a little bit for the listener who maybe is just starting to dip their toe into the specialization process. They may not know that the first part of actually getting to sit for the oncology specialty certification exam is the application. And the application is not just a paper form that you fill out and say, my name is Elise and I am a PT and I want to.
do the oncology thing. You also have to submit a case report as part of this initial application. And it’s not just, here’s a case report I wrote, it’s your case report has to be good enough for it to be accepted. So when you were first starting the specialization journey, what did you know about the application and the case report before you started on that process?
Sheree (26:14.03)
probably nothing except just the, like how many hours you had to have of, you know, working in oncology and that kind of thing. And I think the thing that I got so frustrated with over the application process was, I mean, I knew I had to write a case report, but I could have gone in and put all that other stuff in there and then just gone back and put my case report in there. But you can’t go any further until you put your case report in there.
Elise – @TheOncoPT (26:16.786)
Same.
Elise – @TheOncoPT (26:44.235)
Yeah.
Sheree (26:47.396)
I think I even emailed them. I was like, I can’t get this to go. Do I have to do my case report first? They’re like, yes.
Elise – @TheOncoPT (26:54.419)
Yeah.
And I’m curious if you felt this way. I knew that there was a case report because my clinical instructor in PT school actually was one of the first class to take the exam. And she told me, like on the last day I had my clinical rotation, she was like, you need to take this exam. I was like, okay, yeah, okay. Someday I’m gonna take this exam. And I had no idea what I was getting myself into.
And so when you get into the application, or at least this is how it was, right, you know, a couple of years ago and I did this, you get to the application and then the case report. It’s not just like you submit a PDF of your case report. Like you have to literally copy and paste your case report into different sections.
Sheree (27:39.35)
Paste it. Each section, yes.
Yes.
Elise – @TheOncoPT (27:47.706)
Oh my God. Cause I genuinely wrote my entire case report, like, you know, in a Google doc. And I was like, man, this is a great case report. And then I kept, I got to the very end of my application on the day of the deadline, no doubt. So like this is on me. And then I was like, Oh my God, I may not make it because I am literally copying and basting individual chunks of my case into this application portal. I was like, I may not make it. And that’s, I’ll just have to wait till next year.
Sheree (27:53.911)
Yes.
Sheree (28:00.897)
Oh dear.
Sheree (28:19.382)
Yes, because that was very odd, I thought, too. Seems like you could just put your whole document in there, but no.
Elise – @TheOncoPT (28:28.078)
Who’s to say? Obviously, Sheree and I don’t work for ABPTS, so we don’t have any insight into why things are the way that they are, just that they are what they are. So application woes aside and like the navigating the portal problems aside, let’s dive in a little more to the case report. So before you started writing your case report, how did you feel about having to write a case report?
Sheree (28:33.729)
Right.
Sheree (28:55.262)
Extremely overwhelmed. I’d never written a case report and I am, I’m so old that I’m a, I have a bachelor’s. So we didn’t write a case report when I was in school. I think a lot of schools now you have to write a case report and I was like yeah never done this, I don’t know how to do this. So very overwhelming.
Elise – @TheOncoPT (29:09.226)
Gah!
Elise – @TheOncoPT (29:16.16)
Mm-hmm.
Elise – @TheOncoPT (29:20.898)
I’m gonna ask you a question I know the answer to, but I know the audience is wondering this. Sheree, are you a researcher?
Sheree (29:28.486)
No, absolutely not. No.
Elise – @TheOncoPT (29:29.642)
Like, do you publish articles and literature reviews and all that on the regular? This is what, and Sheree, first of all, like spoiler alert, Sheree submitted a bomb case report, all the good things, it’s clearly, you know, got accepted, board certified specialist. Now, Sheree is a clinician like me and like so many of us listening to the podcast right now. And this is a really common barrier or obstacle that a lot of…
Sheree (29:34.338)
No, no, no.
Elise – @TheOncoPT (29:59.362)
PTs have Sheree as far as they think, I’m not a researcher, I’m not an academic, I don’t write papers, so I can’t possibly write a case report. Is that something you also experienced or felt?
Sheree (30:15.518)
Yes, yes, I had no idea how to do that and could not.
Yeah, I don’t do research. Honestly, before becoming board certified, didn’t read a lot of research even. I think I read more research now because I guess maybe I got the nerd bug and started wanting to read more, but didn’t do any of that then. But I will say, I had a friend that worked in our medical library.
Elise – @TheOncoPT (30:33.078)
Same.
Sheree (30:52.278)
Locally and so she was like just email me when you need one of those articles just emailing. I’ll send it to you So that was a huge blessing. Yes
Elise – @TheOncoPT (30:52.938)
Wow.
Elise – @TheOncoPT (31:02.922)
That is amazing. So you get down to write your case report, like you mentioned previously, you were overwhelmed, didn’t really know how to get started, and then at some point you decided, I’m going to enroll in Elise’s case report writing workshop. What made you decide to enroll in that course?
Sheree (31:23.506)
Oh yeah, because I need somebody to hold my hand. Well, I wrote back. Case report, yes. Talk me through it. Break it down into little steps so that it would be easier. One step at a time.
Elise – @TheOncoPT (31:40.798)
Mm-hmm. Yeah. And, you know, everything that’s in the case report writing workshop is because I goofed it up so badly on my own. I was like, no one needs to go through this.
Nonsense. Okay, so Sheree, I applied to take the exam. So I sent in my application in 2020, which as we already talked about was COVID year. And I actually missed the first deadline. Like it came down to it and I was like, there’s no way I’m going to get my case report done. I’m just going to wait until 2021 to submit for my application. And they actually…
Sheree (32:07.982)
COVID, yes.
Elise – @TheOncoPT (32:22.694)
AB PTS actually ended up extending the deadline. They made like a second deadline at the end of September because I think so few people had submitted to take the exam because of COVID, obviously understandable. And even then I was literally like the deadline in September. I was typing in my case report into the application portal. Like it was so bad. And I said, no one else is gonna do this again. Like.
Sheree (32:34.286)
COVID, right.
Elise – @TheOncoPT (32:51.474)
It doesn’t need to be this hard. That’s why we made Case Report Writing Workshop. What would you say you found to be most helpful or just really helpful in general about Case Report Writing Workshop for your case report?
Sheree (33:09.967)
So I think I chose a patient that had breast cancer, metastatic breast cancer, 3-lin lymphedema. And just to like maybe focus in and have a direction to go as well as, and you know, part of case report writing is
not that you did everything correctly, but to look back and see what you did wrong. And so I evaluated her, she was referred to lymphedema. And then like, have you ever seen a patient so long and then like something suddenly hit you in the head? Like, why haven’t we working on this other stuff? So I saw her lymphedema a long time and then.
Elise – @TheOncoPT (33:42.987)
Yes.
Sheree (34:03.458)
when we were putting on her daytime garments, I realized that she had, I mean, I knew she had pain because she had bony metastasis everywhere, but she was very limited functionally, like to reach her legs and do that, getting in and out of a chair was difficult. So it’s kind of like I had two case reports balled into that one patient because it wasn’t until we finished with the lymphedema that it was like,
Elise – @TheOncoPT (34:14.229)
Bye!
Elise – @TheOncoPT (34:30.027)
Yeah!
Sheree (34:32.722)
Oh yeah, we should be doing some functional things and some strengthening things. So we didn’t do that until the end of the lymphedema. And I think I really had a hard time bundling that all into one case report. So you were helpful with that. And also that whole, you know, that whole care.
Elise – @TheOncoPT (34:38.56)
Yeah!
Elise – @TheOncoPT (34:49.755)
Mm-hmm.
Sheree (35:01.99)
care statement the care statement Yeah, I still don’t understand that but I just know how to have it in there. So I Was just like I don’t understand why this has to be in there but it has to be in there So I would never have ever I know it spells out that it has to be in there But I probably would have like skipped right over that I would have been like why what is this care statement?
Elise – @TheOncoPT (35:04.261)
Yeah.
Elise – @TheOncoPT (35:15.95)
Yeah.
Elise – @TheOncoPT (35:27.546)
Yeah, I think the only reason that I saw it to put it into my own case report is because someone else pointed that out to me. So what Sheree and I are referring to is as part of your case report, you have to include some explicit reference to a care article. So long story short, it’s basically like
Sheree (35:29.346)
Thanks for watching!
Elise – @TheOncoPT (35:50.534)
some scientists and researchers got together and said, this is how human case reports need to be done so that they’re ethical and they’re true, they’re not false. Gosh, I didn’t know that was a problem in research, but I guess it is. And so it’s basically just my case report adheres to those guidelines set by the care. And that, Sheree, is the number one reason that I have heard of people’s case reports getting denied.
Sheree (36:04.173)
Thanks for watching!
Elise – @TheOncoPT (36:18.826)
when they first submit them is because they just don’t submit, they don’t include a care statement. And that is so, so common. And it’s like a bullet point or two in the instructions. And if you could totally look over that so easily and just not think about it and not include it and write a really great case report, but because it doesn’t have that one thing, it’s an automatic, like, nope, you got to fix it before you can submit it again.
Sheree (36:29.794)
Right.
Sheree (36:43.19)
Nope.
Sheree (36:47.09)
Yes, totally. And I still am like, okay, it’s gotta be in there.
Elise – @TheOncoPT (36:48.074)
Very common, very, very common. What is a right, right? So you kind of answered my next question. I’m curious if you have any other thoughts on this. You mentioned that you wouldn’t have included the CARE statement without taking case report writing workshop. Is there anything else that you learned or wouldn’t have known to include in your case report had you not taken case report writing workshop?
Sheree (37:15.618)
Um, I, and I probably went overboard.
references you could have, but I have the maximum. But yes, and I even had to take one out. Like I was like, oh, this article mentions both of these things, so we’ll ditch this one. But I think I went overboard with why you did what you did. You know, what research shows to support why you did what you did. And then overboard maybe with
Elise – @TheOncoPT (37:25.336)
Did you really?
Elise – @TheOncoPT (37:45.62)
Okay.
Sheree (37:50.034)
I think my patient was on Ibrance and I did a reference about side effects of Ibrance and those kinds of things because my patient swore that the Ibrant caused her legs to swell and there’s no, I couldn’t find any documentation on that but she said when she ran out of the medication and had trouble with her pharmacy getting it that her leg swelling decreased while she was off of it.
Elise – @TheOncoPT (38:04.783)
Oh… Yeah.
Sheree (38:17.442)
Yeah, so I mean I like did a I think I’ve over killed it on references and probably a little bit too much as to
Elise – @TheOncoPT (38:25.482)
Yeah.
Sheree (38:29.011)
So, I kind of took that literally.
Elise – @TheOncoPT (38:30.902)
I guess it’s better to have too many than too few. So.
Sheree (38:34.398)
Right, right, right.
Elise – @TheOncoPT (38:39.718)
Okay, so you and I have kind of alluded to this previously, but you submitted your case report and then what happened?
Sheree (38:46.518)
You wait.
Elise – @TheOncoPT (38:50.254)
You’re right, you’re right.
Sheree (38:50.342)
And you wait. And you wait some more.
Sheree (38:57.314)
I don’t know, a long time. I mean, even so much so, I think I, I don’t remember if I emailed her right when I was thinking about emailing, they emailed and said, oh yeah, we’re taking a little longer with these case reports. Just gonna take a little while. So wait, but then mine was accepted without any corrections. I didn’t have to do anything to it. It was, I won’t say it was perfect, but it was perfect in their eyes. So, you know.
Elise – @TheOncoPT (39:09.011)
Mm-hmm.
Elise – @TheOncoPT (39:24.13)
Oh my god, that’s amazing.
Sheree (39:27.33)
That’s all that matters.
Elise – @TheOncoPT (39:30.178)
Yay. And then fast forward, obviously, I did kind of give away the ending at the top of the episode, but Sheree is a board certified oncologic clinical specialist, which means that her case report was obviously perfect in our eyes. Good enough to be accepted by the board. They said yes. And it obviously went through like multiple reviewers, I think during the process. So they were like, this is a great case report. You took your exam.
Sheree (39:30.669)
Yeah.
Sheree (39:37.75)
Right, yes.
Sheree (39:53.614)
Correct, yeah.
Elise – @TheOncoPT (39:55.838)
And then you had to wait some more to find out you passed and you obviously passed, which is why we’re here today.
Sheree (39:58.142)
Oh yes, wait, wait and wait some more, yes.
Elise – @TheOncoPT (40:03.692)
What advice would you give to somebody who is considering specializing in oncology physical therapy?
Sheree (40:14.066)
One, not to be overwhelmed. You know, break it down into small steps. And then when you’re tackling the case report, just start writing. You can go back and fix it later, just start writing just as it comes to you, just write. Like if you’re writing a short story, you would just start writing that and you’d go back and tweak it. So just start writing and it will all fall into place. So.
Elise – @TheOncoPT (40:35.037)
Mm-hmm.
Elise – @TheOncoPT (40:42.802)
And then what would you tell somebody who is considering taking Case Report Writing Workshop?
Sheree (40:50.826)
It is well worth your money. I think it’s a day, one full day, but it is well worth your money to get your, help you get your thoughts organized and be able to take those thoughts and just kind of run with them and finish your case report.
Elise – @TheOncoPT (40:56.706)
Mm-hmm.
Elise – @TheOncoPT (41:11.638)
How did you feel about writing and finishing your case report after you took case report writing workshop?
Sheree (41:22.046)
Um, yeah, I don’t think I could have done it without the workshop because I just had no direction. Like I knew I had to ride and I, I honestly wasn’t really sure that the patient I had chosen I was going to keep, but I did end up keeping that patient because I put that whole day into that patient. So I just figured out how to make that work. But um, I
Elise – @TheOncoPT (41:40.224)
Mm-hmm.
Sheree (41:48.978)
you know, maybe some other people are a little more driven than me. I don’t know, but I don’t think I could have done it without the workshop just because it helped you sit down and get your thoughts written down. And, um, I actually looked back through the workbook before this so that I could familiarize myself with it. And, um, you know, you had to, um, list like all the, the patient deficits or patient problems and
Elise – @TheOncoPT (42:01.186)
Mm-hmm.
Elise – @TheOncoPT (42:09.545)
Yeah.
Sheree (42:17.89)
Like just linking that all together to what you did for that and your treatment plan was very helpful.
Elise – @TheOncoPT (42:26.922)
Yay. Oh my gosh, that makes me very happy to hear obviously that it like worked and did what it was intended to do. Ha ha ha.
Sheree (42:32.333)
This is to do, yes, yes.
Elise – @TheOncoPT (42:37.558)
I feel like, you know, I know the process of specialization is what really for me solidified that I really know what I’m talking about in cancer rehab. I know how to help patients who have XYZ, but I don’t feel like we talk about the case report as much and how it directly ties to what we do as physical therapists in the clinic, in the hospital and not.
just researching writing these like for our daily lives. How do you feel like what you did in your case report has affected your patient care now?
Sheree (43:20.619)
Um.
Sheree (43:25.534)
everywhere pretty much a lot of places and even when I worked in the cancer center I would be like this patient’s got bony metastasis and I would like talk to the oncologist and say yeah what’s that to do with this person but through having to find resources and yeah I don’t know that
Elise – @TheOncoPT (43:26.099)
Mm-hmm. Yep.
Sheree (43:52.934)
Grumeretz it’s article that came out that has specific dos and don’ts in there. And I think that came out about the time I was writing my case report or just before my case report. So I had through doing that, I gained the knowledge of, you know, these are safe to do with bone metastasis patients and, you know, it’s safe to exercise them and I’m not like
Elise – @TheOncoPT (43:57.511)
Mm-hmm.
Elise – @TheOncoPT (44:03.466)
Yeah!
Sheree (44:20.854)
I have put the fear of death into my staff. Like, you know, you can do this, but you got to follow these guidelines here in this article, because if something happens and you’re following these guidelines, we’ve got this article in the back itself. So, um.
Elise – @TheOncoPT (44:29.99)
You got to be safe with it, right?
Elise – @TheOncoPT (44:36.672)
Mm-hmm.
Sheree (44:38.522)
I think to make me, it made me feel safe, safe to exercise with a patient with bone metastasis, whereas before I was always like kind of, you know, crossing my fingers behind my back. Oh, maybe they’re not going to crack anything today, but gained that knowledge.
Elise – @TheOncoPT (44:56.29)
Totally. Yeah.
Elise – @TheOncoPT (45:02.842)
Oh my God. What advice would you give to somebody who is starting to write their own case report? Like right now they’re listening to this, you’re giving them the motivation to actually get started typing or writing. What would you tell them?
Sheree (45:23.214)
Just write it. And first of all, I guess, be pretty confident in the patient that you chose because I was kind of iffy. But just be confident with that choice of the patient you chose and dig in and go with it and do a second guess. And like I said, there was mistakes I made with this patient. Another mistake I made with her was
Elise – @TheOncoPT (45:35.316)
Mm-hmm.
Sheree (45:50.67)
She mentioned to me, I don’t know, like way out into when we were working on our mobility and stuff and she was like, she quilted and she said, you know how I looked down there and I had a pin stuck in my finger and she didn’t realize it because she had taxon based chemo years ago. And I never tested her sensation, which is probably something I should have done when I was putting compression garments on her. So.
Elise – @TheOncoPT (46:08.08)
Oh…
Elise – @TheOncoPT (46:16.47)
But again, and Sheree, thank you so much for sharing that too, because I think there’s a lot of pressure we put on ourselves that it has to be a case that we did everything right and everything turned out well. And that is not at all the case. I’ve gotten to read some of my students’ case reports over the past couple of years that I’ve done this course. And I mean, even like my patient had a DVT.
Sheree (46:26.571)
Right.
Elise – @TheOncoPT (46:42.294)
during our episode of care and then also ended up with another pathological fracture in the lumbar spine. So those were very adverse events that happened that it’s like, ah, and I still wrote a really great case report. This is the perfect opportunity to reflect on, now I know better and I’m going to do better and that’s what Sheree has taken with her into her practice today with patients is now I know something that I didn’t think to do.
Sheree (46:42.818)
during the course, yeah.
Sheree (46:53.35)
Right, exactly.
Sheree (47:02.058)
I think we lost you. Oh, it’s.
Elise – @TheOncoPT (47:11.094)
do previously, and that’s perfect.
Sheree (47:14.002)
Exactly. So you don’t have to do everything right, but you there is a place in there where you talk about maybe what you didn’t do Right and what you should have done differently. So it’s okay to be critical of yourself. It doesn’t mean that it’s not a good case report
Elise – @TheOncoPT (47:30.946)
All right, I have one last question for you on case report stuff, and I did not cue you for this. So like, I do know I’m blindsiding you a little bit. What are you most proud of about when it comes to writing your case report?
Sheree (47:35.302)
Okay.
Sheree (47:47.886)
Well, I’m glad it got finished.
Elise – @TheOncoPT (47:52.214)
Thank you.
Sheree (47:54.172)
But I think…
Sheree (47:59.566)
to I think the knowledge that I gained through writing that case report and
Sheree (48:13.046)
just the whole learning process itself.
Sheree (48:23.102)
And my, actually my case report, patient, I still see. So.
because she’s metastatic and like we’ve, you know, she’s not come for a little while and come back. And so she’s currently coming like once every two weeks we’re not as intensive as we were, but.
Sheree (48:47.15)
Also, she was referred from an outside area. She drives a little distance, see the oncologist. So I had to request records from down there really to do her as my case report. So I think that made me pull everything together more because the patients that…
Elise – @TheOncoPT (48:54.066)
Mm-hmm.
Sheree (49:11.194)
I have come from that from outline area. Sometimes I don’t request all their records and I probably should so.
Elise – @TheOncoPT (49:17.674)
Yeah, honestly, that’s probably a good lesson for all of us. I have a patient right now that I’m like, the records are coming week by week as I see the patient. I feel like I’m learning something new each time of like, oh. Ha ha ha.
Sheree (49:21.777)
Yes.
Sheree (49:29.634)
Something new every day. Ha ha
Elise – @TheOncoPT (49:36.378)
Oh man. Sheree, thank you so much for coming on the podcast today and talking about all of this. It’s been so fun to watch you at first from afar. We definitely connected over Instagram first, which is my favorite place to hang online. So to see you there at first and then to get to meet you in person and just see all these really cool things that you’re doing has been really, really cool to watch. It was so lovely to get to meet your biggest cheerleader at CSM.
Sheree (49:48.206)
Okay.
Sheree (50:05.407)
Yeah.
Elise – @TheOncoPT (50:06.074)
in February. He said, your husband said something to me that was just so sweet. He was like, I heard your voice all the time.
Sheree (50:14.376)
What?
I have you on my phone, he walks through the living room. Is that Onco girl?
Elise – @TheOncoPT (50:24.458)
Yes!
Sheree (50:25.362)
Yes, yes.
Elise – @TheOncoPT (50:30.018)
where can people follow you and connect with you online, Sheree?
Sheree (50:40.81)
Okay, I lost you a little bit there.
Elise – @TheOncoPT (50:43.218)
Oh, that’s okay. The only thing I asked was, where can people find you and connect with you online?
Sheree (50:49.378)
Oh, okay. I’m on Instagram, ribbonspt, and that’s pretty much it. We don’t have a Facebook. You can email me anytime, sheree, S-H-E-R-E-E, at ribbonspt.com.
Elise – @TheOncoPT (51:09.662)
And I will of course link to all of this in the show notes today. Sheree, thank you so much for coming on. It’s been such a pleasure getting to see you just grow and blossom into this amazing clinician and private practice owner that I need to learn a lot from during this journey. So I will definitely be having you back because I have some questions for you, friend.
Sheree (51:10.754)
to do this in the contact zone.
Sheree (51:22.903)
Oh.
Sheree (51:29.018)
Okay, okay. And I encourage everybody, you know, that’s even thinking about specialization, do it, because you’ll learn so much to the process that benefit your patients, which ultimately is the reason why we should do it.
Elise – @TheOncoPT (51:46.602)
Mic drop, I have nothing to add, that was it. Oh my God, Sheree, thank you. Ha ha ha.
Sheree (51:48.866)
Thanks.
Thank you, Elise.