Cancer rehab may not always be the first step on your PT journey – but that doesn’t mean you’re behind or you can’t become an expert oncology clinician.
Today’s guest is the PERFECT example of this: Melissa White began her PT career nowhere near oncology. But after she transitioned into pelvic floor therapy, she found herself treating more & more cancer survivors. And soon, she was HOOKED.
Fast forward, she’s now building cancer rehab programs in her area & specializes in onco-pelvic PT. Melissa shares her experience of starting the specialization journey, writing her case report, going through our signature program Case Report Writing Workshop, & how it’s helping her become the best PT possible for her patients.
Want to crush your case report like Melissa?
Then you need to watch my brand new masterclass, The 3 Step Framework to a Finished Case Report. Watch the masterclass today!
Want to watch the episode instead?
Watch this week’s episode of TheOncoPT Podcast on our YouTube channel!
Transcript
Elise – @TheOncoPT (00:00)
Hey Onco PT and welcome to this episode of the Onco PT podcast. I have a first time guest here on the podcast and I’m so excited because my guest today, Melissa White & I are going to dive into some of the behind the scenes stuff of what it takes to write and submit your case report. And so without further ado, Melissa, welcome to the Onco PT podcast. I’m so excited you’re here.
Melissa White (00:20)
Thank you. I listen to you a lot.
Elise – @TheOncoPT (00:24)
Oh my God, thank you so much. It’s so nice to have you. Oh my God. I was telling Melissa, you know, before we hit record, it’s so nice to get to actually connect in this like virtual face -to -face format because I get to see so many like names on email and social media, but I don’t always get to connect like face -to -face wise. So this is super, super exciting. So Melissa, can you tell us a little bit about you, your practice, and then we’ll go from there, okay?
Melissa White (00:28)
So it’s funny to actually be here. Yeah.
Okay, so I have been a physical therapist. Let’s see, I graduated in 2004. In 2012, I switched jobs basically right after I had my I had twins and I was like, okay, let’s just change course here and just change everything all at once. And I had a friend who was like, we need a full time pelvic floor therapist at our clinic.
and I was like, oh, I don’t know, because at that time I had just started dabbling in pelvic floor. And so I wasn’t sure that that was something I wanted to do full time. But with this being a hospital based clinic, that meant that I didn’t have to work 40 hours. So I was like, ooh, that was enticing. And just also, you know,
pay increase and just there was the benefits package. So my husband was like, you really need to kind of look into this. And so I made the jump. They had a really good established pelvic floor team. So that’s really when I, my skills as a pelvic floor therapist really skyrocketed just because of, of the team and because I had a full caseload of pelvic floor patients. So it was, it was a nice jump for me. And so,
have been there ever since. And again, the pelvic floor has really been my entire caseload. However, cancer rehab has just been kind of creeping its way into my, it’s always been there with prostate cancer patients. But that’s how I first, I guess got introduced to cancer patients. And then just as,
Elise – @TheOncoPT (02:29)
Yeah, yeah.
Melissa White (02:37)
you know, as word got out and we started talking to more doctors and just trying to increase our caseload, just more and more things started happening and making more and more connections. And so my caseload of cancer patients has really, really increased. And I don’t know if it was about five years ago, I started working in what we called cancer services. And,
Like I was telling you earlier, I was there four days a week until COVID hit. And then when COVID hit, we still kept working, but it was like a skeleton crew. And so I went to this different clinic and, you know, just really kind of saw whatever came through the door. And then as we started getting our other therapists back and.
Elise – @TheOncoPT (03:16)
Yeah.
Melissa White (03:29)
caseload started increasing, I went back to my cancer clinic one day a week. And so that’s kind of where it’s kind of stayed. And we just built here in central Illinois in Peoria, the new OSF Cancer Institute. And so we have a proton beam therapy, we have like everything in house. And so that’s super exciting. And so I’m just, I’m really hoping to build some of these programs that we had,
Elise – @TheOncoPT (03:35)
Okay.
Wow.
Melissa White (03:58)
and start some new programs. So I’m just so excited for where that could lead us and I’m hoping for that to be a majority of my caseload moving forward. So we’ll see what happens with that, but super exciting.
Elise – @TheOncoPT (04:01)
Mm -hmm.
That’s so exciting too. So I last last year, so it’s been a hot minute. I interviewed a local physician who heads up the proton therapy center in Dallas. Um, and we talked a lot about prostate both in the interview and off the interview. And so now I’m thinking like, that could be so huge for you. Cause I think prostate again, I’m very new to the, the proton therapy side of things, but I’ve based on what I understand and know about it. Prostate is such a like,
It lends itself really well to being treated very effectively with proton therapy, especially in light of everything that happens pelvic floor -wise with external beam and even brachytherapy. Wow, that is really cool. That is really, really exciting.
Melissa White (04:53)
Yeah, oh.
Oh gosh, I know. So it’ll be interesting to see, you know, as people start being treated, like what diagnosis, diagnoses are being treated with the proton therapy. And then, you know, my question too is, is, you know, how is, how is insurance going to be with that as well? So yes, all good things to come. So, so yeah, it was so interesting. So we’ll see.
Elise – @TheOncoPT (05:04)
Mm -hmm.
Mm -hmm.
That is really exciting. I’m gonna plant this seed now. I would love to talk to you more about proton therapy and kind of just that’s from the therapy side of things. Cause like I said, I was introduced but I haven’t seen any patients yet from that. So anyways, we’ll chat more about that.
Melissa White (05:25)
Okay.
Yeah, yeah, absolutely. And that’s the thing, honestly, you know, maybe that’s a conversation for down the road because I haven’t seen any either. So, again, we’ll see what happens with more time because I mean, literally, I mean, we just opened the doors like I haven’t even been there a whole month yet. So but yes, yeah. So maybe in the future as I start getting those patients. So yes, absolutely.
Elise – @TheOncoPT (06:04)
I can see it happen right now. This is really exciting. So we mentioned prostate as part of pelvic floor and whatnot. What other kind of oncologic diagnoses are you seeing with your 100 % pelvic floor patient load?
Melissa White (06:21)
Okay, so like I said, it all started with prostate cancer. And then I then developed kind of my own protocol program with the colorectal cancer patients where I was seeing them at diagnosis just to kind of like, hey, I’m the pelvic floor therapist.
Elise – @TheOncoPT (06:24)
Mm -hmm.
Melissa White (06:44)
you know, you, these are possible side effects. This is the reason why you’re seeing me, blah, blah, blah, blah, blah. This is kind of what to expect. Just kind of like a little, cause they’re so overwhelmed. But you know, but I’m going to be part of your team. And then, um, then I would see them right before their ostomy surgery where they were going to remove the mass give them the ostomy. Cause I was like, okay, now remember those exercises I gave you? I hope you’re still doing them. Here’s a reminder of them. And now here’s what to expect.
Elise – @TheOncoPT (06:55)
Yeah, absolutely.
Hehehehehe. Mmhmm.
Melissa White (07:14)
If you have any questions or any urinary issues, because again, they’re doing a huge surgery right next to their bladder. So if you have any urinary issues, hello, I’m your gal, get a hold of me. And I did have a few men that had to come back and we had to just get some things going. They were having incontinence. And then I would see them, oh, before the ostomy reversal, like, okay, here’s what’s going to happen. You know, your bowels are now going to go from zero to 60 in 2 .2 seconds.
Elise – @TheOncoPT (07:32)
Yeah.
Wow, yeah.
Melissa White (07:43)
Yes. And so and then the big show, as I like to call it, was after that surgery because now it’s getting control of their bowels. So actually the the dietitian and I worked well together because she saw them with, okay, here are the foods, here’s the supplements, here are all the things, and then I’m just talking about, you know, the pelvic floor. So we kind of saw them incrementally. And then like I said, when COVID hit that all
And so, and then when when COVID was, you know, I don’t know that it’s ever over. But like when it was things were starting to get back on track again, I just really wasn’t getting those referrals. And I was told that they are, they had kind of switched protocols to a lot of watching and waiting instead of doing surgery on everyone. But, you know, so I don’t know, we’ll see because I
Elise – @TheOncoPT (08:22)
Right.
Mm -hmm.
Really?
Melissa White (08:40)
At one time, the surgeon had talked about how they were doing that over in Europe, but that the reoccurrence rates were still so high that he wasn’t willing to take that chance. So I don’t know what our research is, but that’s what I was told why I wasn’t getting a lot of referrals. So that’s a program that I would like to see kind of get going again. Just, you know, I don’t see them a lot. I’m just like, okay, here, you know, here, here. And then, like I said, if they’re having issues,
Elise – @TheOncoPT (08:48)
Oh, yeah.
Mm -hmm.
Mm -hmm. Mm -hmm.
Melissa White (09:10)
on the back side of things getting their bowels under control again because because my big thing is you have to go through these things with cancer you have to go through these treatments and then the doctors are like okay great you know we cured your cancer you know but yes but what life did we did we leave you you know so i’m i’m concerned with their urinary function their intimacy and their bowel function and any pain that they’re having so which then leads me to
Elise – @TheOncoPT (09:30)
Yeah.
Absolutely.
Melissa White (09:39)
I am currently seeing a lot of gynecological cancer patients. So I’m doing a lot of dilator training. So these women have had to have brachytherapy and these poor women, I just, I feel so bad for them because they’ve been diagnosed with cancer. And then, then they had to have brachytherapy, which is very invasive. And then, and then now because they’ve had this brachytherapy,
Elise – @TheOncoPT (09:43)
Mm -hmm.
Mm -hmm.
Melissa White (10:08)
Their vaginal tissue is now going to shorten and become atrophied. And again, not to mention all of the women that are probably going through menopause at the same time. So they’ve got vaginal dryness. And so now they’re told, oh, well, now we need you to use this dilator three times a week to keep your vagina open so that we can do these vaginal assessments. And it’s like, okay, you just think that it’s over and now you’re told what?
Elise – @TheOncoPT (10:22)
Oh my God.
Oh my God, for real.
Melissa White (10:39)
you know like oh my gosh so what i really pride myself on is i really i love educating these women because i want to i want to make it easier for them i want them to understand that they’re not the only one that feels like this is the end of the world like and it’s not the end of the world but that’s how they kind of feel you know and and we’re telling them to use this tool that a lot of them
then think of as like a sexual thing and I have to tell them no. That is you have to change your mindset because that is not accurate. What is accurate is that you have had these cancer treatments that could possibly decrease the mobility of your vagina. You are then possibly going to have difficulty with vaginal exams as well as intercourse if that’s even a goal for you. So this is a health condition that you
Elise – @TheOncoPT (11:12)
Mm -hmm.
Mm -hmm.
Mm -hmm.
Melissa White (11:35)
need to do this so that you can maintain a good vaginal opening so they can monitor you for reoccurrence. And those are the things that you have to have to tell yourself. So I really try to break down lots of barriers with, well, I just couldn’t find time to do it. Okay, well, let’s make a schedule. Let’s do Monday, Wednesday, Friday at this certain time or one patient, her in -laws lived with her. And I was like, okay, well, could you…
Elise – @TheOncoPT (11:55)
Yeah.
Melissa White (12:04)
have your husband then take them out for lunch or you know, don’t they have doctor’s appointments? You know, I just try to make up things like, okay, how can I make this easier for you? How could I break this down and crash these barriers for you to make this more successful? And so I really pride myself and I feel like I do a really good job of that. And so that’s another program that I really hope to get up and going where the radiation oncologist says, okay,
you’re ready for the dilator, now you’re gonna see Melissa and she’s gonna teach you how to use it. Oh, and another thing, nobody is talking to these women about vaginal moisturizers. I mean, everybody’s talking about lubricant, but nobody’s talking about moisturizers. And I’m like, I think that’s part of these women’s, I mean, the first problem in their pain is just that, again, if they’ve gone through menopause and now they’ve done radiation, they’ve just dried things out. So there’s like, no wonder they’re having pain.
Elise – @TheOncoPT (12:43)
Oh my God. Oh my God. Right? Yes.
Melissa White (13:02)
So anyways, I could go down a rabbit hole on this, but you know, just, I love educating and I love teaching these women. And so I hope to get that going as well where I’m reaching more patients. Cause again, a lot of patients are not in our area. They come from surrounding areas, so they don’t want to come back again for another appointment. So that’s where I’m hoping to catch them.
Elise – @TheOncoPT (13:23)
Mm -hmm.
right.
Melissa White (13:28)
with the radiation oncologist where I’m like, oh, you’re here. You don’t have a chance to say, no, I’m just going to see you. And yeah, so I’m hoping that we get these programs up and going. So.
Elise – @TheOncoPT (13:40)
Okay, so are you in house, in where these patients are seeing their radiation oncologist, their medical oncologist, et cetera?
Melissa White (13:52)
So yes, we just moved in pretty much what the beginning of March. Yes, the beginning of March. And like I said, I’m only there one day a week right now, but my schedule is filling up. And again, I’ve been told, you know, if my schedule fills up, then I can go more and more days. So trying right now, we’re just trying to get.
Elise – @TheOncoPT (14:04)
Mm -hmm.
Okay.
Melissa White (14:14)
meetings set up with providers and you know letting them know that we’re there and trying to go to tumor boards and make connections and so all the hard things right now to get these programs up and going so.
Elise – @TheOncoPT (14:26)
Yeah. Well, and I’m curious, you know, I’m this is just something that I’m picking up on because I also have my own lens that I’m kind of living this through as well. We in in my local area, I feel like we made some really, really good progress in 2018, 2019 and very, very early 2020. And then it’s like the clock reset.
with COVID and then having to kind of go back and reestablish like, hey, we still have to, like, we still gotta do these things because it’s best practice. Like, send your patients.
Melissa White (15:00)
Right. Yeah, because I just feel like it was like during COVID, they were like, okay, what can we get rid of? Okay, we can get rid of therapy. We don’t need that. It’s not something that’s essential, which again, in my opinion is what’s your definition of essential. But anyways, but yeah, we are because and I think physicians are just as guilty as us. They get stuck in these routines and they have tunnel vision and they’re like,
Elise – @TheOncoPT (15:13)
Right? Right, right?
Absolutely. Absolutely.
Melissa White (15:26)
Oh, therapy. Oh, oh yeah, that’s a good idea. But I feel like we have to keep being on their radar like every six months, like, hey, remember me, I’m still here. So that’s another thing we’re trying to work on is how do we make it so easy for the physician to order therapy. So we’re really trying to find and again, this is out of my area, but just a button just.
Elise – @TheOncoPT (15:29)
Mm -hmm.
Agreed. Agreed.
Melissa White (15:50)
to check the box and then PT is ordered. How can we make it simple and easy because doctors are not gonna wanna do something that is very difficult. Again, we know, I mean, everybody’s time is valuable, but how can we keep it in their face and easy for them to order? So working on that.
Elise – @TheOncoPT (15:51)
Right. Right.
Mm -hmm.
I agree. Yeah. Yeah. I really appreciate what you said about, you kind of have to be in their face every six months. We would do like regular appearances at, it was, it was more like the staff meeting is what we would usually show up to and be like, here we are therapy. Don’t forget about us. And then we would, we would see an uptick in those referrals. And then after a little while, they’d jump back off. So we’d have to go again. So, you know, maybe that is something we kind of have to like, as it is a larger therapy community, I think we have to be a little more aware of like.
Melissa White (16:26)
And then, yep, yep.
Elise – @TheOncoPT (16:38)
We don’t just sit in a picture frame on their desk of like, don’t forget about me.
Melissa White (16:43)
Right. I know. I know.
Elise – @TheOncoPT (16:47)
So at what point did you say, I really like this. I like working with this patient population. I’m a specialized, I’m gonna get really serious about this patient population.
Melissa White (16:58)
pelvic floor or oncology?
Elise – @TheOncoPT (17:00)
oncology specifically.
Melissa White (17:02)
So I think it was in a meeting that we had that is like with all of our leadership and they just kind of tell us, hey, this is what’s going on. This is what’s been happening. Here are our numbers, blah, blah, blah, blah. And one of our higher ups I think mentioned that there was now this oncology specialty through the APTA.
And I already had a pelvic floor one, not through the APTA. I have my, what is it? Pelvic rehab practitioner certification through Herman and Wallace. So I already kind of had that. So I had some experience with taking a test, not so much the writing the case report. That was one of the big reasons why I went with Herman and Wallace, because you didn’t have to do that. But yeah.
Elise – @TheOncoPT (17:45)
Mm -hmm.
I hate that.
oooo
Melissa White (18:01)
But she had said something about how, you know, there was this specialty and that, um, that I was going to be the pelvic floor therapist that was going to be in the cancer Institute or, or somebody. And I was like, or somebody like, no, no, me. Like I have worked my butt off. I have worked with these patients. Like I was like, no, no, no, no, no.
Elise – @TheOncoPT (18:17)
Mm -hmm.
Melissa White (18:30)
I was like, I want to learn more about this oncology specialist specialty because I’m like, I want to be that person. I want to be that go to, but like I have not worked this hard for you to take this away from me and give this to somebody else. And I’m very competitive. And so I’m like, I, I want you to need me, you know? So I’m like, I am going to do what I can to be like, to shine, to, to, um,
Elise – @TheOncoPT (18:38)
I love that.
Mm -hmm.
Absolutely.
Melissa White (19:00)
I don’t know what the right thing is to say here, but like just, I wanted to have the specialty. I want to be the person. I want to be the one that knows what is going on. So I think it was at that meeting where they were telling us about the cancer Institute and everything. I just lit a spark in me when she was just like, or somebody I’m like, no, no, no, no, no. Me, me, me, me. I don’t think she meant anything by it, but it was just like, no, like this is my baby.
Elise – @TheOncoPT (19:11)
Mm -hmm.
Melissa White (19:29)
So I will show you. And so I just started looking it up and I was just thinking about it. Shouldn’t I, should I? You know, I have two very active kids and I was just like, oh, I don’t know. And you know, everybody that I kept talking to was just like, you gotta do it. You gotta do it. You gotta try, you know? So I was like, all right, I’m gonna do it. So I did.
Elise – @TheOncoPT (19:45)
Yeah! Yeah!
And at what point did you discover that there was a case report as part of the application?
Melissa White (19:57)
I was starting to research, you know, just looking more into it and I was like, oh god. I was like, okay, all right. So and then that’s where I think as I was starting to research, I stumbled upon you and I don’t know where I found you at, but it was like a godsend because I was like, okay, I think you I think when I found you, you were studying for your own test because I was just like, where do I go?
Elise – @TheOncoPT (19:59)
Okay, cut it.
Yo.
Oh god, yeah, yeah.
Melissa White (20:26)
Like what do I do? Because this was so new. There was nothing out there on studying for this. And I’m like, I need a guide. I need help. I need. So I just kind of kept following you and listening to all of your podcasts. And you know, then I stumbled upon where you had this case report writing thing and I was like, Oh my God, thank you.
Elise – @TheOncoPT (20:32)
Totally.
Melissa White (20:51)
because I had no idea what I was doing. I had no idea where to go. So like I said, you just kind of, you led me through the whole entire process because I had no idea what I was doing. I was completely blind and because it was so new, you know, there weren’t a lot of people out there. So like I said, I don’t even know how I stumbled upon you, but I’m so grateful that I did because it was so worth everything that I did because like I said, I was on my own.
Elise – @TheOncoPT (21:02)
Mmm.
Melissa White (21:20)
and you just kind of laid it all out there. I was like, okay, I’m gonna sign up for that next thing, sign up for the next thing. Well, because you were just like, you were telling every step how to do it. And that was exactly what I needed, so.
Elise – @TheOncoPT (21:20)
Mm -hmm.
Yay!
I’m going to ask this next question and it’s not to be facetious in any way. Melissa, have you ever written a case report before? Before this. Were you a researcher before you wrote your case report?
Melissa White (21:42)
No. No.
only when I had to research, you know, like when I was looking something up, but no, like I hate research. Like, you, I don’t even know what I’m reading. You read it and you tell me what it, what it says, you know, so no, absolutely not. Like that’s why I am a continuing ed junkie. Like I love continuing ed because somebody else has read all this stuff. You, you are just telling me and I can just absorb it and I have the notebook, but no, I don’t like doing research. No, no, no. It’s not my.
Elise – @TheOncoPT (21:51)
Alright!
Mm -hmm.
I ask this because so many people, this is where a lot of people get hung up on, I don’t have my PhD, which I do not. And Melissa, I don’t think you have your PhD either, right?
Melissa White (22:29)
Well, I don’t even have my doctorate. So I went, right, I got my masters, like I was in that middle group. So I feel like having your doctorate, like you did more research where I was like, ah!
Elise – @TheOncoPT (22:32)
Oh, see, like, you don’t have to. Yeah. Yeah.
We did some, yeah. Right? Yeah. Yeah. And this is where so many people get stuck because I mean, and understandably so, like you can find case reports in peer reviewed journals and be like, oh wow, like, well, look at these amazing researchers and academics writing this. And then I think we have this very much this, this false narrative in our head of like, oh, I have to be that.
Melissa White (22:46)
So I was so lost.
Elise – @TheOncoPT (23:11)
in order to write this case report when in fact that is not the case. And you know, all of all of the people that I’ve had go through case report writing workshop so far have been clinicians. Like this is written for clinicians by clinician because we don’t have to be academics and researchers and have our PhD to make a really, really good case report, especially if this is something that you’re interested in. What? So let me back up. Before you started the writing process,
Melissa White (23:39)
Mm -hmm.
Elise – @TheOncoPT (23:40)
How did you feel about writing or the prospect of writing a case report?
Melissa White (23:48)
Scared to death. I’d rather go run a marathon than write this. I’m not a writer. Like I am not good at English. I’m not good with words. I am not… That is not my area. Hence why I’m a physical therapist. I am a math and science person. So it terrified me.
Elise – @TheOncoPT (24:13)
I appreciate the honesty because this is, I mean, that’s not something I feel like we have to, I feel like there’s such this, there’s such a feeling that we have to.
I know exactly what I’m doing. I don’t need your help. I know I have a plan, whatever. When in fact, I mean, writing my own case report, I was like, I don’t know what the heck I’m doing. And that like, that’s what most of us are out here doing is just trying to figure out like what the heck to do. So that makes me really, really excited that you’re like, oh, I would, that’s going to be the quote from this interview of I would rather run a marathon than write a case report.
Melissa White (24:48)
haha
I mean, and I’m not lying, I was just that even just worse than studying. Like I, I’d rather, you know, study for the dang thing versus write. I am just, like I said, I’m just not a writer. I’m not good with words. And so yeah, it was, I dreaded it.
Elise – @TheOncoPT (25:02)
Mm -hmm.
And again, like I said, I super appreciate your honesty because I think a lot of people out there are feeling that, but maybe you don’t want to say it because maybe they’re afraid to say that a little bit. What was the tipping point for you where you said, I’m going in, I’m enrolling in case report writing workshop so I can write my own dang case report?
Melissa White (25:32)
I don’t really think it took much thought just the fact that you had it and I saw it and was like, well, this is a no brainer. Because again, I didn’t know what I was doing. So, I mean, as soon as I saw that it was even offered, I was doing it. And the thing that I loved too was I couldn’t do it live. One of my kids had something. And so that was something that I so appreciated. Even just with all of the things that you offer is that you can do it on your own time.
Elise – @TheOncoPT (25:40)
Love that.
Mm -hmm.
Melissa White (26:01)
And so that was huge for me. I needed this help, but I also needed to do it on my own time. And so I think I ended up doing it like the next weekend or whatever. So yeah, so that, like I said, it was a no brainer. Once you offered it, I was like, yes. Like I said, I didn’t know what I was doing. I needed something. So it was, yes, it was a no brainer.
Elise – @TheOncoPT (26:21)
Mm -hmm.
What was most helpful about taking Case Report Writing Workshop as you were going through your own writing process?
Melissa White (26:33)
Well, I think there’s the fact that you had it all laid out. You know, like when you were done, you know, you pretty much had it all written. You know, so I mean, I think it was just, yes, how you had it all laid out and just how you broke it down and just basically you told me what to do, just put my patient in. Yeah, it was…
It was so much easier than having to figure it out on my own.
Elise – @TheOncoPT (27:07)
much. What is one thing or multiple things if you have them off the top of your brain that you would have forgotten or not included as part of your case report without case report writing workshop?
Melissa White (27:21)
Well, the one big thing is, and correct me if I’m wrong, but like the CARES statement. I’m like, what is this? So that, and I think like the timeline too, that ended up being a huge thing. But I would say the number one thing is the CARES statement. Cause I was like, I don’t even know what you’re talking about. So.
Elise – @TheOncoPT (27:24)
Mm -hmm. Yes. Yes. Yeah.
Ooh, mm -hmm.
Mm -hmm.
Yeah.
And again, not a facetious question. Did you know what that was before you started this process? Because I sure did not. Yeah. Yeah, that’s that is the number one answer I get to this question. And I think all of us genuinely, and this is not to be like, oh, I had no concept of that. And it’s mentioned in the instructions. But unless you really understand what they’re asking for, it’s very easy to gloss over.
Melissa White (27:55)
No. No. Had no idea.
Elise – @TheOncoPT (28:16)
And that’s based on other people that I’ve heard who have submitted their case reports and have gotten, hey, you need to make corrections and whatnot. That is probably one of the biggest things they have to make corrections on. So same, same girl, same.
Melissa White (28:29)
And I think another thing that was really helpful was just saying they’re gonna tell you that you’re gonna have to make corrections. Because otherwise I would have been like, oh my gosh, like, you know, I did a terrible job. And like, just expecting that I think was huge because I was like, okay, not a big deal. You know, like I didn’t take it as hard having to make all of those corrections. So.
Elise – @TheOncoPT (28:37)
Mm -hmm.
Mm -hmm. Good.
Mm -hmm.
Yeah, yeah. And corrections are very common. I had to do corrections on mine. So many people have to do corrections on theirs. And I appreciate that there is an opportunity to make corrections instead of outright rejection. Because again, especially as clinicians who are writing this, we don’t have necessarily like…
Melissa White (29:13)
Yes.
Elise – @TheOncoPT (29:20)
I mean, I don’t know what it’s like if I’m a full -blown professor writing case reports for peer -reviewed journals, but I feel like there’s multiple layers of checking things before they eventually get published, and we don’t necessarily have that as clinicians trying to submit our case report like this. So…
Melissa White (29:34)
no, during the day we’re treating patients coming home trying to put her, you know, make dinner for our families, put our kids to bed, and write this darn thing, so…
Elise – @TheOncoPT (29:40)
I do. Right? Oh my God. For real. What would you tell somebody who is considering taking case report writing workshop?
Melissa White (29:50)
Well, I would say if you are signing up for the oncology exam, like this is a must, unless you are a professor and you know what you’re doing, you know, unless if you already know what you’re doing, then fabulous. But like I said, this for me was so helpful. It was a guy, I mean, it explained everything to a T what I should do, what I should include. Because like I said, I was terrified to do this. I had no clue what I was doing.
And this was, like I said, the best thing I could have done because you laid it out for me. So I don’t even know where I would have been with… I probably would have not followed through because I didn’t know what I was doing. So…
Elise – @TheOncoPT (30:34)
Yeah. So I’m really glad you brought that up because I almost quit my own case report twice before I submitted it. Like, and not just, oh, I’m done with this. I’m going to quit for the night. I genuinely had two points during my process where I thought I’m just going to put it, I’m going to stop and I’m going to wait until next year. And it was the, it was the 11th hour when I finally said, ah, I’ll just, I’ll just finish it and hope for the best, whatever. And.
I think that’s something that not a lot of people like to talk about because for me, it felt shameful of, I can’t finish this. I can’t finish what I’ve started. And I felt like I was not only letting down myself, but also my patients. And like writing your case report is hard. How did you during those moments, because you know, maybe there were for you as same as me, where you were like,
Melissa White (31:13)
Mm -hmm.
Elise – @TheOncoPT (31:28)
I cannot do this. I don’t want to do this. What carried you through to actually finishing and submitting your case report?
Melissa White (31:36)
Um, I think just taking, taking breaks and like when I felt like that, just like, okay, I’ve got to put this down. Um, and kind of like I shared with you earlier, like this was also something I wanted to show my kids that like, okay, life gets hard and like you set goals for yourself and, um, we’re going to do this and we’re going to follow through. And I tell my kids all the time, we can do hard things. So I think just.
Elise – @TheOncoPT (31:42)
Mm -hmm.
Melissa White (32:05)
just that, like trying to show them, you know, cause again, they’re sixth graders in school and so yeah, just, I think just having them as motivation and like, I’m doing this, I’m gonna, you know, I said I was gonna do this and I’m gonna do it. So that helped, like I said, taking breaks. One thing that I have found is that I cannot study like I did when I was in college, like,
I was a power studier. I mean, I would just go to the library and just study, study, study, study. I have like an hour that my brain can handle and then it’s, it’s mush. So I have over the years discovered that like, I can’t just sit down and study. So I think that was helpful too, that, you know, just taking more brain breaks and, um, chunking it up. And so when I got frustrated, I just was like, I’m not quitting, quitting. I’m just, I’m quitting for today.
Elise – @TheOncoPT (32:33)
Yeah!
Definitely.
Mm -hmm.
Right. Right. You are taking that break to take care of your brain because you know your brain. That’s so good. Yes. I did not prompt you for this question. So I am throwing you a little bit of a curve ball here. So obviously, like we said, Melissa submitted her case report. Like we’ve, we’ve, we’ve spoiler alert if you didn’t pick up on that right now. How do you feel like writing your case report impacted your patient care?
Melissa White (33:04)
You know.
Yes. Yes.
Mmm.
I think it made me, this is a really good question, realize, because when I was doing my case report, I ended up diving deeper into my patient’s chart because I needed more like background. And so there were things that I was like, oh, I didn’t know that. Oh, I didn’t know that she had that. Oh, I didn’t know that.
And so that just kind of made me realize that I needed to do a deeper dive into just, oh shoot, I’m gonna loss for the word.
Reading my patient’s chart, what’s the word? Yes, thank you. Oh my gosh, I can’t. Case reviewing, you know, your patient’s chart, like, I find it very different from when I’m just doing a regular pelvic floor patient. I mean, granted, some people, yes, you find you’re like, oh, I need to go back, I need to go back further. But some of them are very plain Jane, like my little old ladies that have urinary incontinence that, you know, like, oh, okay, like there’s not much, much to that.
Elise – @TheOncoPT (34:21)
like chart review or, okay, okay, cool, yeah.
Melissa White (34:47)
But my cancer patients, I’m like, ooh, like if I have the time, like I want to go through their chart deeper. I always tell my supervisors, like, I want to pretend like I know what’s going on. You know, I want to go into this with information. I hate it when my patients are like, oh, I had this. And I was like, oh, I didn’t know that. You know, right.
So that really helps me with like, oh, maybe I need to do, like I said, a deeper dive into their chart before I see a lot of them. And actually my new supervisor and I were just kind of having this conversation because I’m changing my hours come this summer because when my kids are in junior high, I really just want to work while they’re in school. Like I don’t want to look back in life and…
feel like I missed out on a whole lot. Yes, I’m a full -time working mom, but that’s the joy of pelvic floor or not pelvic floor physical therapy is that we can kind of adjust our schedules a little bit with you know with leadership. And so anyways they have I’ve been very blessed that I’ve been allowed to do that. And so that with the way that my hours have to be laid out I’m starting on Thursdays when I’m at the Cancer Institute half an hour later and I’m like,
Elise – @TheOncoPT (35:40)
Yeah.
Mm -hmm. Yeah. Yeah.
Melissa White (36:08)
But then I started thinking, I’m like, you know what? That actually won’t be a bad idea because that’ll give me 30 more minutes. I’ll come at the same time I normally do and that’ll give me 30 more minutes to chart review onto my patients. Cause that would be the day that I would need it. So I’m like, okay, trying to make lemonade out of lemons. That’s my motto. So, but yes, that to answer your question, long answer the question just.
Elise – @TheOncoPT (36:20)
oooo
You, good for you.
Melissa White (36:33)
chart reviewing these patients. There’s a lot that’s going on, a lot that has happened. And so I think that’s what I had kind of discovered. There’s a lot about her that I wish I had known while I was treating her that I only found out writing my case report.
Elise – @TheOncoPT (36:35)
Yeah!
I think that’s part of the beauty of genuinely writing a case report though, is that’s part of this process as many of the listeners are learning if you haven’t already learned that. We don’t always get things right when we’re working with patients. Now, ideally we’re getting most of the things right, but when I was writing my case report, I wrote mine on a patient, Melissa knows because I talked about it in case report writing workshop. I wrote mine on a patient who had multiple myeloma and…
You know, not everything went right. This patient actually had a DVT while we were in the middle of our plan of care, also ended up with another pathological fracture. And so there were things that now looking back, I’m like, man, I wish I had did that a little differently, but now I know. And that’s also part of the reflection process. Again, if you haven’t gone into the instructions behind what you’re supposed to do with your case report, that reflection process is part of this because again,
This is supposed to be for clinicians who are going to take this experience and go back ultimately to your practice and say, I know better now and I’m going to do better. And that’s how we ultimately advance cancer rehab. Right? So if you’re, if you know, the listener is out there thinking, Oh gosh, I don’t have a perfect patient case. No friend. You do. Right. We’re humans. We’re not perfect, but what a great learning opportunity as Melissa has laid out of.
Now, Melissa, you know this is what I need to do to get that information so that I can show up and really understand what’s going on with my patients. Like, that’s amazing. Oh my God. So that makes me so excited. So what advice would you give to the listener who’s considering writing their case report?
Melissa White (38:33)
Yeah.
would just say you have you have to do this this class because it’s again it takes all the struggle out of it you know and again if you are like me you know you’re working full -time you have a family you know it’s
Why reinvent the wheel? You know, it’s just, this is what this is all laid out there for is to help us and make it easier. The other thing is too, is that Elise is there to ask questions too. You know, so again, that was the other thing is that I was writing this by myself. I didn’t have anybody else that was doing this with me. So it was so nice to just be like, Hey, what am I supposed to do with this? Should I include this? You know, what do you think about this?
Again, that was such a huge blessing to me. Just to have some guidance. So because again, otherwise, I don’t know where you’re going to get that. You’re just going to be guessing. So.
Elise – @TheOncoPT (39:47)
Right, absolutely. I would agree with you, because I was there. I was guessing. It was not pretty.
Anything else you would like to leave with the listeners today, Melissa, this has been such a fun interview.
Melissa White (40:02)
Uhhhh
I don’t know, I guess I will share too, we had kind of talked about this earlier that, yes, I studied my rear end off for this test and I unfortunately did not end up passing the test. And I was sharing with Elise that, I mean, I did everything that I could, I studied, I bought the books, but I am, as I kind of analyzed everything, I feel like it was just my practice wasn’t set up to,
Elise – @TheOncoPT (40:14)
Yeah.
Mm -hmm.
Melissa White (40:40)
I guess, promote using all the things that I had learned. I’m a full -time pelvic floor therapist. And so even the oncology population that I am immersed with, you know, I’m not constantly looking at lab values. I’m not working on strengthening and peripheral neuropathy and all of those things. So, and I am, I don’t treat lymphedema. I’m not a lymphedema therapist. So I think all of those things hindered me. It was an amazing.
Elise – @TheOncoPT (41:03)
Yeah.
Melissa White (41:09)
process. I learned so much. I have a ton of resources. But and like I said, I’m so glad that I went that I went through it again, just trying to teach my my kids lessons and you know, you work hard for things you do your best and and you don’t always come out on top. You don’t you don’t always win. You know, my I shared this with you at least that my son said to me, well, a lot of people wouldn’t have even tried.
Elise – @TheOncoPT (41:18)
Mm -hmm.
Melissa White (41:34)
You know, and so I feel like just in our household, that was a huge lesson for my kids to see that, hey, mommy did something really, really hard and, you know, I didn’t pass, but like I said, I still feel like I learned so much and it wasn’t all for nothing. Like I have the experience, I have the knowledge. Like I said, I have the resources that if I do need those things that I will go back in and look at them again. So.
So just for everyone out there, you know.
Elise – @TheOncoPT (42:11)
Thank you so much for sharing that too Melissa, because that’s, and this is something you had mentioned to me off air, and I want to make sure that we really touch on it here. This is not something that people talk about. Like, I don’t know that I’ve, I personally, because you and I have talked about it and I’ve talked with a couple others, like I know there are some people out there who have taken the exam and did not ultimately pass when they took it the first time. And that’s still a really valid,
Melissa White (42:23)
Right.
Elise – @TheOncoPT (42:41)
Valid’s not the right word I’m looking for. Obviously that’s your experience, but I think one of the things that gets lost sometimes in the oncology specialty, and even like I’m sure the others, right? But I’m not in a wound care, so I can’t comment on that. But the process of specialization, I believe the writing of the case report and the studying for the exam is what makes you.
the expert clinician where it really solidifies that expertise that you have. Because again, I’m going to put you on the spot. I’ve been asking you questions that I did not prep you for. How do you feel like your practice, your clinical care for oncology patients changed over the studying process? I know I asked you about the case report. What about kind of this end of things?
Melissa White (43:32)
Mm -hmm.
Well, just, and this is something I too, now that I’m back in the Cancer Institute, I wanna refresh up on again, but just, I think the huge thing was just the, not the cancers, the treatments that patients are on, like the side effects, like being able to prepare them and just being able to know, oh, when they’re on this drug, they’re going to experience this. When they’re on this, you know,
Elise – @TheOncoPT (43:50)
Mm -hmm.
Melissa White (44:03)
just helping them understand what it might lead to, what they might experience. Cause a lot of patients, they don’t know, you know, they’re just like, Oh, I have to take this drug. And whether they were told or not, you know, they only absorbed so much. So, you know, being able to help them with, okay, well let’s, let’s make sure that, you know, you watch, you watch your balance. And then if you’re starting to notice anything, you know, ask the doctor to come back.
Elise – @TheOncoPT (44:09)
Mm -hmm.
Mm -hmm.
Right.
Melissa White (44:33)
you know give you an order for for rehab. That’s one thing that I would I would love to do is like the perfect what is that the perspective surveillance model. I would love to incorporate that more with like with all of our rehab like okay you’re on this protocol this is going to cause you fatigue and peripheral neuropathy. Let’s start screening for that so that once you start experiencing that we can start treating it.
Elise – @TheOncoPT (44:42)
Yeah! Yeah!
Melissa White (44:59)
Like that’s something that I would love to do. And just knowing that that’s a thing and to help, like that’s the part that has really helped me is just the side effects of the treatments of the chemo’s specifically, because I didn’t know what they were before. I mean, I was reading them all the time, but I’m like, I don’t know. I don’t know what this is going to do, where it’s going to go, what’s going to happen. And so that was, that was huge for me.
Elise – @TheOncoPT (45:16)
Yeah. Yeah!
That’s amazing. And again, you know, I really like the W’s in the background of your house. You know, they’re around these like wonderful family photos, but like we could do hard things. It’s just, I feel like that’s been peeking at me from behind the screen of like, we can do hard things. And this is a really good example of like,
Melissa White (45:34)
Oh, my last name’s White, yeah.
Elise – @TheOncoPT (45:46)
you did a really, really hard thing. You did, first of all, let’s pause. You did two really hard things because you not only, you wrote and submitted a case report and then you studied your butt off for this exam, which is so amazing. And ultimately your patients are the ones who are benefiting the most out of this experience because you are showing up fully armored with this knowledge of like, I know what to expect. And that’s what I really love. We were talking about this a little more off air.
Melissa White (46:02)
Absolutely.
Elise – @TheOncoPT (46:14)
more than in the actual interview, but just how much education you’re doing on, hey patient, here’s what you can expect from this kinds of treatment. Because like you said, they are already trying to absorb so much information. I know we talk about in PT school, you know, trying to drink out of a fire hydrant. I feel like when you’re diagnosed with cancer, the fire hydrant is only part of it. It’s like trying to drink out of a hurricane.
Melissa White (46:41)
Mm -hmm.
Elise – @TheOncoPT (46:41)
Like just with the amount of load and force and insanity that’s happening around you. And if you’re one more voice who is just reinforcing and restating some of that information, they probably got somewhere, hopefully got somewhere, but you and I also know sometimes they don’t get that information. Just being that constant dependable source of where they can get that information. Man, man, that is amazing and so transformative in their experience.
Melissa White (46:58)
Absolutely.
Elise – @TheOncoPT (47:11)
to ultimately hopefully get some of that quality of life back. And I know we were talking about that a little more off air too of, yeah, treatment cured you, but what kind of a life are you left with? So.
Melissa White (47:22)
100%. That’s my thing. I want to help them get as functional as they can and always. So education is, I think, my favorite thing to do. I always tell patients I love to run my mouth because I just, I want them to get it. I mean, even in the pelvic floor, that is an area that patients have no idea what they’re there for, that they even have a pelvic floor, that there’s even treatment for these things. And so I always feel like on my first visit,
with them when I’m doing the eval that I’m buying them. Like I have to hook them. I have to give them the reason why they’re coming back, why they need to see me and that’s education that, oh my God, this girl knows what she’s talking about. Like, oh, she might actually be able to help me. You know, that’s, she makes sense. Yeah. So that’s, that’s what I, that’s what I go on is just trying to help the patient understand. So.
Elise – @TheOncoPT (47:57)
Absolutely.
Yes. Yes.
Mm -hmm.
Oh my gosh. Melissa, thank you so much for sharing all of that, first of all. And again, I really appreciate you being honest and vulnerable today talking about this, because this is not something that people talk about. I think we like to put on this gloss of like, everything’s fine and we have everything figured out. And sometimes we don’t, and sometimes we need help and it’s okay. And that’s why we’re here as a community to help each other out. So thank you so much for that. Anything else that you’d like to leave our listeners with today before we wrap up today’s interview.
Melissa White (48:25)
Yes!
I don’t think so. Like I said, I just feel like your whole program was a blessing to me. Like I said, I can’t remember how I stumbled upon it, but you know, just just learning from your podcasts and just, you know, the help and just the resources. And again, you’d be silly not to sign up for the program and then for your boot camp too. I will put a plug in for that too. That was amazing. So helpful. It was.
Elise – @TheOncoPT (48:57)
Thank you.
Thank you.
Melissa White (49:19)
I think you have what, one a week or something, a podcast where you’re educating and just you can do that at your own pace. I was trying to get information from all these different places and it was just so nice to be able to do it at home at my own pace. And so you did such a great job at just pouring in the education that we need. And so, yes, like I said, I’m just so grateful that I stumbled upon you.
Elise – @TheOncoPT (49:22)
Mm -hmm. Mm -hmm.
Well, thank you so much, Melissa, for those kinds of words. I really can’t wait to share this episode because I just feel like so glowy right now. I was like, oh, that makes me so happy. So I will, of course, link to the information regarding Case Report Writing Workshop in today’s show notes so that everybody can find that. But again, Melissa, thank you so much for coming on today. I so, so appreciate your time. And I know that my listeners really learned a lot from you. So thank you so, so much for that.
Melissa White (49:54)
Yeah!
Well, I’m glad.
My pleasure, thank you for having me