In PT school, you may have heard that cancer is a disease of the old. But this is only half true.
Cancer affects people of all ages, including those in their childbearing years, even during pregnancy.
And you’re likely going to be seeing more of these patients in your own practice.
Dr. Rebeca Segraves, PT, & Dr. Alexandra Hill, PT, are back on the podcast to discuss this unique patient population, how cancer & cancer treatments affect a pregnant person, & how YOU can start treating this underserved patient population today.
Listen NOW!
The intersection between pregnancy & oncology PT
Without a doubt, there is a significant overlap between pregnancy & cancer. This can be due to people having children later in life, the significant hormonal changes during pregnancy, & rising rates of obesity.
Additionally, as a society, we are seeing an increase in adolescent/young adult (AYA) cancers, which are prime childbearing years. Thus, it’s likely you may see more of these patient cases in your practice over the next several years.
While relatively rare, this intersection is still something that YOU need to be aware of & know how to approach in your practice.
Cancer treatments & pregnancy
Cancer treatments depend on the person’s diagnosis, prognosis, available resources, geographic location, & many other factors. Pregnancy adds a whole new dimension to cancer treatment planning.
In general, there are certain time periods during pregnancy when certain cancer treatments affect fetal organ development more significantly.
However, there are some treatments, including chemotherapy, that can be safe to administer during pregnancy. Always check with the patient’s oncology team to understand their treatment protocol when establishing your plan of care.
The team approach is even more important for pregnant patients with cancer
A team approach is essential for pregnant patients undergoing cancer treatment. Fertility preservation is a crucial consideration, even though the patient might be currently pregnant &/or already have children. This proactive approach ensures patients have options for future family planning despite their diagnosis.
Psychosocial support and nutrition are also critical. Helping patients connect with psychologists, counselors, & registered dietitians is a key role OncoPTs can play to support the patient’s whole health. Same goes for financial support & social work services.
It’s also crucial to recognize the role of caregivers/partners & the risk of caregiver burnout. Providing support for caregivers, including respite care & counseling, ensures they can offer the best care without compromising their own health & wellness.
Addressing these multifaceted needs through a coordinated team approach enhances the quality of care and overall outcomes for your pregnant patient with cancer.
How to START treating your pregnant patient with cancer
Start by taking vitals. Vitals are especially important for the pregnant & postpartum patient because of how significantly their cardiovascular system is impacted by pregnancy (see Ep. 286 for more).
Dr. Hill recommends monitoring their lab signs, as well as constitutional signs & symptoms. Just because something might happen during pregnancy (genital or leg swelling, for example) doesn’t mean that it’s normal for this person, especially with a cancer diagnosis. Talk to the oncology team & keep communication open as you work with this patient.
Dr. Segraves also discussed the importance of establishing what support systems the patient has. Who is on their team, who needs to be on their team to navigate pregnancy & a cancer diagnosis?
More info on pregnancy & oncology
If you haven’t already, you MUST listen to Ep. 286 – How to Start Addressing Cardiovascular Health Disparities in Cancer Rehab. In this episode, I interviewed Drs. Rebeca Segrave, Jenna Segrave, Katherine Sylvester, & Allyson Sutkowi-Hemstreet about their 2024 APTA CSM session on this exact topic.
AND WHEN I TELL YOU this was the most mind-blowing CSM session I’ve ever attended, it’s no joke. Queue this episode up asap for some more info on pregnancy, peripartum, & oncology & ways to implement this into your own practice.
Want to watch the episode instead?
Watch this week’s episode of TheOncoPT Podcast on our YouTube channel!
About Dr. Rebeca Segraves, PT
After 3 major surgeries on my knee and years of physical therapy that is now part of my life routine, I was shocked to learn that women after c-section, a major open abdominal surgery, were routinely sent home with a diaper and not a rehab plan.
Early in my career, I recognized that the traditional standard of recovery for female-specific surgeries and childbirth did not offer access to rehab services to enhance function sooner.
To remedy this, I started Enhanced Recovery and Wellness to prioritize mental and physical function early in the hospital and home after major procedures that impacted women’s health.
We passionately train occupational and physical therapists to go beyond the standard of care in their hospitals and practices so that women’s health was a priority, and not an afterthought.
I am dedicated to helping you enhance your recovery and function sooner after surgery and birth. You’re worth it.
https://enhancedrecoverywellness.com
About Dr. Alexandra Hill, PT
Alex earned her Doctor of Physical Therapy (DPT) degree at the University of Florida and completed a Women’s Health Physical Therapy Residency at Duke University. Since becoming a physical therapist in 2014, she has specialized in working with all folks experiencing pelvic health, oncology, and lymphedema-related conditions. She is passionate about helping people understand and take charge of their symptoms to live confidently. In her free time, Alex loves hiking and traveling.
- Doctor of Physical Therapy
- Board-Certified Clinical Specialist in Oncologic Physical Therapy
- Board-Certified Clinical Specialist in Women’s Health Physical Therapy
- Lymphology Association of North America – Certified Lymphedema Therapist
Transcript
Elise – @TheOncoPT (00:19)
Hey, Onco PT and welcome back to this episode of the Onco PT podcast. When I say today’s episode is very timely, it’s no joke. And we’ll get into that just a little bit later. But I’m so pleased to welcome back some of my favorite podcast guests, starting with Dr. Alexandra Hill and Dr. Rebeca Segraves. Now we know them, we love them. They’ve been on the podcast previously, but I’m going to allow them a little time to introduce themselves. And then we’re going to get into today’s conversation.
Alex Hill (she/her) (00:41)
Thank you.
Elise – @TheOncoPT (00:47)
So I’m gonna start with Dr. Rebeca Seagraves. Will you introduce yourself again to my audience?
Dr. Rebeca Segraves, PT, DPT (00:51)
Absolutely. Hey everyone, I am Rebeca Segraves. I’m a physical therapist and owner of Enhanced Recovery and Wellness, where we train acute care, occupational and physical therapists in a program called Enhanced Recovery After Delivery to really expand their services in the hospital, in the home for individuals immediately after birth and even during high -risk pregnancy, like the topic we’re going to talk about today. So really happy to be here.
Alex Hill (she/her) (01:12)
you
Thank you.
.
Elise – @TheOncoPT (01:21)
And I have to say, Rebeca, your CSM session was one of the most impactful ones that I’ve ever attended. And that is not to give any discredit to our next speaker, Alexandra Hill, because her sessions were also my favorite ones at CSM. But man, Rebeca, you and that team just brought the house down. So I’m super excited to have you back. Alex, would you mind reintroducing yourself to our listeners today as well?
Alex Hill (she/her) (01:30)
you
Yes, absolutely. And I completely agree. The number of people that I heard talking about that session for weeks after, not like days where it’s still like hot on Twitter X whatever, like this was weeks after that people were talking about the session. So bravo to you and your team of panelists that had that amazing talk at CSM this year, like phenomenal. So after that lovely introduction, Dr. Rebeca.
I’m sorry.
My name is Alex. I’m a physical therapist. I’ve been a PT for 10 years. I practice an outpatient. I’m in Jacksonville, Florida. I specialize in oncology and pelvic health, and this is all I’ve done for 10 years. These are really my passions. I work in a hospital -based clinic, but I also own my small business Onco Pelvic PT, which has just been an amazing experience and journey over the last four years. I started it in
2020 during the pandemic. And it’s grown to be this amazing company. So yeah, that’s me in a nutshell and I’m really excited to be on again.
Elise – @TheOncoPT (02:56)
Okay, so Rebeca alluded to what we’re talking about today, but I want to make it abundantly clear for the listeners. So one of the things that I genuinely never thought could happen, like these worlds did not collide until they did. So I previously didn’t really consider that pregnancy and oncology ever overlapped. And it wasn’t until several years ago, I encountered a patient who was actually pregnant with twins.
Alex Hill (she/her) (03:02)
you
Elise – @TheOncoPT (03:25)
and was going to be undergoing treatment for breast cancer. And it was really interesting to just kind of talk to her about, you know, we have an idea of what a typical breast cancer treatment protocol looks like, but that has to change a lot of times when it comes to, you know, adding on pregnancy on top of this. And so I was so thrilled that Rebeca and Alex approached me about this topic because, and y ‘all don’t know this, I manifested having this interview back in September of 2023.
Alex Hill (she/her) (03:48)
The stars have aligned.
Elise – @TheOncoPT (03:54)
It has been a draft on my computer for all these months and I just like never pulled the plug on it. So when y ‘all reached out, I was like, it is time. So I’m so excited to do this. The stars have aligned. So let’s first of all, I kind of already like answered the question, but I want y ‘all’s answer on this. Do pregnancy and cancer overlap?
Dr. Rebeca Segraves, PT, DPT (04:04)
Amazing.
Alex Hill (she/her) (04:07)
.
Yes, resounding yes. And we’re seeing this especially, you know, people are having children later. We’re seeing that people are delaying the time that they’re having children. We’re seeing these rising rates of obesity. And at the same time, we’re also seeing that people are getting diagnosed with cancer younger. And so those, you know, childbearing years are
Dr. Rebeca Segraves, PT, DPT (04:21)
Yeah.
Elise – @TheOncoPT (04:33)
Mm -hmm.
Alex Hill (she/her) (04:45)
kind of unfortunately in those crosshairs of when people are getting diagnosed with cancer now, especially earlier. So unfortunately, I think that we are going to be seeing more of these cases just with these trends that we’re seeing unless as a population, we kind of change things very drastically.
Dr. Rebeca Segraves, PT, DPT (05:04)
Yeah, and also, I mean, if you think about the hormonal shift that occurs during early pregnancy, a lot of these hormonal driven, these hormone driven cancers, breast cancers, you know, uterine cancers, again, that’s really is a very dynamic period, right, especially during the first trimester. And unfortunately, a lot of women are finding out during the first trimester that
They also have a cancer diagnosis that they’re navigating. So it’s just important just to know the stage of life that you’re in, the stage of pregnancy, all the things that can be compounding that. And so Alex, you’re right in terms of like obesity and just general demographics, but it’s also just that state of pregnancy and where you are in terms of development.
Alex Hill (she/her) (05:56)
Mm -hmm.
Elise – @TheOncoPT (05:58)
So I’m gonna back up actually a little bit. So we’ve established, yes, there is definitely an intersection and overlap between oncology and pregnancy. Are y ‘all seeing a relationship between like the type of cancer that is seen when a person is pregnant or like, you know, cause sometimes maybe the cancer comes first, then the pregnancy or the pregnancy, then the cancer.
Are we seeing any kind of a correlation or trends in what kind of cancer diagnoses are we seeing concurrently when a person’s pregnant?
Alex Hill (she/her) (06:32)
I’m not sure of the most recent trends. if we look just purely by the prevalence of, of cancers, especially for, people assigned female at birth or people, foreign women, with breast cancer being kind of number one, we’re seeing that typically more frequently. I’m not sure Rebeca, if you’ve seen on the other newer trends.
Dr. Rebeca Segraves, PT, DPT (06:56)
Yeah, I feel the same way in terms of breast cancer. That’s personally, clinically what I’ve seen the most. Then also that could be due to referral. That could be honestly due to just the patients that have been referred to me in terms of like prevalence. So I don’t want to be skewed or biased. I don’t know research -wise what the trends are.
Alex Hill (she/her) (07:07)
Mm -hmm.
Elise – @TheOncoPT (07:20)
Mm -hmm.
Alex Hill (she/her) (07:20)
Yeah. The other tricky thing too is, especially for like gynecological cancers, there’s kind of a lot going on during pregnancy in the gynecological organ. And so a lot of times these cancers are getting missed or misdiagnosed or diagnosed later because some of these symptoms that people are experiencing during pregnancy seem like normal pregnancy symptoms versus
Elise – @TheOncoPT (07:33)
Mm -hmm.
Mm -hmm.
Alex Hill (she/her) (07:49)
cancer symptoms or signs and symptoms of cancer. And so even some of the changes at the cervix and within the uterus, like those changes may mask some of what might be a cancer as well. So I’d be curious even with, you know, research looking at those trends and prevalence, like how accurate are they?
Elise – @TheOncoPT (08:03)
Mm -hmm.
Alex Hill (she/her) (08:13)
So.
Elise – @TheOncoPT (08:15)
That’s a really good point. And this kind of leads into my next question. I know I did not prepare you for this, but I’ve had one experience so far and that patient wasn’t even someone I was treating. It was just someone that I had like cross paths with in my previous position. But I’m curious when a person is pregnant and is then diagnosed with cancer, again, typically a lot of my experience has been with
breast cancer survivors, there’s a very typical plan. Like we know generally what to expect as far as treatment goes. Maybe they’ll have some neoadjuvant chemotherapy. They’ll usually undergo some kind of mastectomy or maybe a lumpectomy of sorts. Then there’s usually some more chemotherapy and some radiation therapy, maybe some hormone therapy, et cetera. But I would imagine that this kind of changes once a person is pregnant. Can we talk a little bit about what maybe some of those changes might be?
Alex Hill (she/her) (09:07)
Okay.
Elise – @TheOncoPT (09:10)
B for the pregnant patient with cancer.
Dr. Rebeca Segraves, PT, DPT (09:15)
Yeah, so I mean, it really depends on that treatment plan that the specialist, the OB cancer specialist is going to outline in some of the cases. And what comes to mind is that some of those treatments will actually wait and be put on pause until a baby is delivered. There are some cases that we recently, I had the pleasure of
Alex Hill (she/her) (09:26)
Okay.
Dr. Rebeca Segraves, PT, DPT (09:45)
interviewing a person who went through this herself with Alex, who actually started chemotherapy during pregnancy. So it really depends on the treatment plan, on the specialty and practice, on the geographical location. I mean, all of those things in terms of what they’re looking at, in terms of the guidelines to make those decisions and those judgment calls. But I treated patients in both cases where immediately after
Elise – @TheOncoPT (10:04)
That’s a good point.
Alex Hill (she/her) (10:04)
Mm -hmm.
Dr. Rebeca Segraves, PT, DPT (10:14)
pregnancy, they were scheduled for either chemotherapy or surgery. So I’ve seen kind of a diverse mix.
Elise – @TheOncoPT (10:23)
Mm -hmm.
Alex Hill (she/her) (10:24)
Yeah, yeah, I definitely agree. It really depends on and that’s the other thing too is access to specialists who can kind of traverse this very unique population. People are having to travel pretty far to find specialists that do this. A lot of things to look at, like Rebeca said, is where are they at in gestation. So there’s certain time periods early on where the organs are starting to develop. Those would be times that we don’t necessarily maybe want.
chemotherapy or radiation, like things that could impact the organ’s development. Typically looking at chemotherapy, for example, a lot of people think like, chemotherapy, like absolutely never during pregnancy. Actually, there are some chemotherapies that are okay to take during chemotherapy. As Rebeca said, it’s gonna depend on the molecular weight on the type of chemotherapy that it is. Right now with immunotherapy, the most recent things that I’ve seen is it’s not recommended.
Elise – @TheOncoPT (11:00)
Mm -hmm.
Mm -hmm.
Alex Hill (she/her) (11:23)
during pregnancy at this time. There’s just not enough research to show the impact of it. If you think about the immune system of the mother and the immune system of the child starting to develop, they just don’t know what happens with that. Same thing with radiation therapy, depending on where it’s at in the body, that could have an impact. And with surgery, like Rebeca said, like a lot of times they’re scheduled for treatment right after.
Elise – @TheOncoPT (11:26)
Mm -hmm.
Alex Hill (she/her) (11:52)
they deliver and that’s, I’m sure a whole other question topic that we can discuss is like delivering a human child into this world and trying to navigate that and then immediately also having to get your cancer treated. And as Onco PT is like, we know how overwhelming just getting the cancer treated can be on top of maybe being a brand new parent. Maybe this is their first child.
Elise – @TheOncoPT (12:17)
Bye.
Alex Hill (she/her) (12:22)
or maybe they have multiple children that are younger and you’re having to take care of them. So it can be very daunting, but in general, yes, the treatments will depend on the type of cancer, how aggressive it is. They may need to do some treatments because the cancer is very aggressive. And then the gestation as well.
Elise – @TheOncoPT (12:22)
Mm -hmm.
Mm -hmm.
Yeah. And I don’t know what chemotherapy it was, but the patient I’ve talked about previously, she was actually going through some chemotherapy and it was very much like a, we’re trying to keep things at bay from the cancer side of things until after she delivers. And then, I mean, it was, I don’t know necessarily how it was in actuality once she delivered, but it felt very like.
Alex Hill (she/her) (12:48)
you
Elise – @TheOncoPT (13:10)
as soon as she has those babies. It was like, wham, bam, thank you ma ‘am. We have this plan, boom, boom, boom, boom, boom. Because it really is, you know, and I mean, wow, this is a whole other can of worms that we can choose to get into or not. But in a lot of these cases, like these patients are weighing so much on, again, like Alex just mentioned, there’s already a cancer diagnosis with life changing, which, I mean, just alters.
Alex Hill (she/her) (13:26)
Okay.
Elise – @TheOncoPT (13:35)
so much in that person’s existence, but not only them, but also their family and what that looks like for them, what they’ve envisioned for themselves. And so then having to make these choices on like, what are we going to do? What are we not going to do? And so I actually totally just lost my train of thought there to be perfectly honest. I had it and then it went like, woo.
Alex Hill (she/her) (13:59)
This is a big topic, a lot of roads to go down.
Elise – @TheOncoPT (14:02)
Yeah, yeah, I think that’s kind of where I’m at a crossroads of like there’s 17 different ways that we could take this right now.
Dr. Rebeca Segraves, PT, DPT (14:08)
Yeah, for sure.
I will say like, yeah, no, I mean, I…
Elise – @TheOncoPT (14:14)
This will be one of those parts that I take out. Yeah, go ahead, Rebeca.
Alex Hill (she/her) (14:17)
Leave it in. Leave it in.
Dr. Rebeca Segraves, PT, DPT (14:20)
I say yeah, because I mean, honestly, when you think about it, like just to give pause to just what you just said, there’s so much happening in such a short period of time for the person who may be starting their cancer treatment during pregnancy, but then you know it’s gonna go full throttle right after a baby is born, right? And so, I mean, the patients, and again, we’re talking about a rare occurrence. However,
as a profession, our rehab therapists, our OncoPTs really prepared for those cases that will come and we’ll see them, right? We’ll see them. And so when I think about that particular case I saw in the hospital, this individual was just after his cesarean section to deliver her baby, wasn’t gonna even go home, was gonna actually go right down the street to MD Cancer, MD Anderson, right?
So she delivered at Texas Children’s Hospital, which is a perinatal level four, the highest designated maternal care facility in Houston, and was gonna just go right over to MD Anderson to start her cancer treatment. So I mean, you think about the boom, boom, boom, but we’re also thinking, well, maybe they have time for rebonding with baby. Maybe they have time to just kind of adjust and recover. And so I was even thinking like, what’s the thinking behind this?
Alex Hill (she/her) (15:38)
Great.
Dr. Rebeca Segraves, PT, DPT (15:46)
of not allowing her to recover from a C -section and going right over, you know? And so that speaks to the aggressiveness of the disease, the treatment plan in place. And we don’t all always have the answers on the acute care therapy side because we have a mission. We have a goal. We have a very short period of time to see that person in.
Elise – @TheOncoPT (15:55)
Totally.
Alex Hill (she/her) (16:04)
Yeah.
Elise – @TheOncoPT (16:08)
I’m really glad that you said that Rebeca, because I think I kind of picked up some breadcrumbs is where I was trying to go with that. So thank you for that. I think where I was trying to go is that, you know, when these patients typically when a person is diagnosed with cancer, like they meet with the oncologist, they develop a treatment plan, you know, maybe there’s a second opinion in there. They usually meet with multiple people to try and, you know, like, okay, what do we need to take care of leading up to when we actually start treatment?
Alex Hill (she/her) (16:13)
Hahaha!
Elise – @TheOncoPT (16:33)
you know, this is a whole other layer and maybe like three or four different layers that we now have to consider with the pregnancy, you know, and I do think there’s a consideration that, and I think we have to be cognizant of this as the rehab therapist of there is always a consideration for mortality and you know, like, am I going to make it? Am I going to survive this cancer diagnosis? And so I think that’s, that’s a significant added burden to
You know, not only am I trying to live for whatever I have in my life right then and there, whether that’s a partner, I have other children, you know, and of course this child that I’m trying to bring into the world, but also how does my own life expectancy change with holding off on treatment? Because again, I’m trying to stay pregnant during this time period. So I think that’s something that we really need to be aware of as physical therapists. Again, mortality is something our patients are already thinking about, but this is a whole other
on top of that, that maybe we don’t think about right away, but when we really start to sit with and talk about the different alterations alterations modifications to a typical cancer treatment plan, that’s something that we have to think about. And again, that’s so interesting, that patient story that you just shared, Rebeca, Rebeca, how fast that turnaround was from…
Alex Hill (she/her) (17:32)
Okay.
Elise – @TheOncoPT (17:58)
delivering to then starting that next phase of cancer treatment and very aggressively too. So that’s, I never would have thought of that. Never would have thought that that quick of a turnaround would have happened in that way.
Alex Hill (she/her) (18:02)
Mm -hmm. Yeah.
Dr. Rebeca Segraves, PT, DPT (18:12)
Yeah, the mental health component of this is it just can’t be overlooked.
Alex Hill (she/her) (18:15)
Okay.
Elise – @TheOncoPT (18:19)
When you’re seeing a person who is pregnant who also has cancer, again, if we zoom back and we think of kind of our general oncology patient, we know. Let’s kind of focus in on young adult, because there’s layers to that. So one of the things that we want to be considering and as a team, right, not just rehab, but as a team, as an oncology team here, you know, of course we want to be treating the person’s cancer.
Alex Hill (she/her) (18:32)
Okay.
Elise – @TheOncoPT (18:44)
But we also have other considerations like fertility preservation. Maybe this person is not done having children. They want to have more children. They want to grow their family more. The psychological component that we were just talking about making sure that psych social support is on board. Nutrition, that’s already an important thing. But again, then we’re growing a human on top of this. There’s so many layers to this. What are some other team members or maybe…
Alex Hill (she/her) (19:04)
Bye.
Elise – @TheOncoPT (19:11)
you know, services that we really need to be making sure as a team that the pregnant oncology patient has access to.
Dr. Rebeca Segraves, PT, DPT (19:21)
Yeah, and you touched on this psychology, it often is an umbrella term for just addressing any of the mental health and psychological components. So under that, we also have to just think about our bereavement care team, because yes, that person is pregnant and we are obviously, the care team is hoping to get that pregnancy to a viable state, but that’s
Alex Hill (she/her) (19:27)
Mm -hmm. Mm -hmm.
Dr. Rebeca Segraves, PT, DPT (19:50)
Also just the consideration of is there a bereavement support, is there spiritual support in place for that person? Is our care culturally responsive to that person’s wishes to preserve their fertility or whatever that means for them? Are we really acting in a culturally responsive way to really envelop the support that that person wants and needs?
Alex Hill (she/her) (19:55)
.
Mm -hmm.
Mm hmm. Yeah, I completely agree with that. And then social work would be another one, especially in terms of you think about the financial toxicity that’s associated with cancer diagnosis, cancer treatment, missing work. And on top of that, now having to pay for everything that’s involved with having a newborn. I don’t have kids, but I have friends and family members that have kids and Jeepers creepers, the cost of having a child is
Elise – @TheOncoPT (20:25)
Mm -hmm.
Alex Hill (she/her) (20:47)
seemingly astronomical. So together, those two things with financial, the financial burden of that is insane, especially with our healthcare system and the cost of it as it is right now. And we’re so reactionary. But having a really good social worker team and having resources available, nonprofits that are available to provide support, support groups that may be
I’ve found sometimes support groups are helpful, but also it’s such a unique experience that these people go through. It’s not just cancer, it’s cancer and pregnancy and delivery. So like an online support group with people who have gone through something similar would be something to consider as well versus a support group that has a range of people all the way to their 70s, 80s, 90s that wouldn’t…
Elise – @TheOncoPT (21:26)
Right.
Alex Hill (she/her) (21:46)
necessarily relate to what you’re going through and you still feel isolated, you still feel alone, I think those would be some other considerations too.
Elise – @TheOncoPT (21:47)
Right.
Alex Hill (she/her) (21:55)
The other thing to consider too is the partner. If there’s a partner, what kind of support do they have? Because they were maybe expecting just to be a parent, but now they may be a parent and a caretaker. Or maybe the sole provider, you know, there’s typically if they’re pregnant, there’s planned for maternity leave if there’s working, but still, I mean, that’s, I find that that’s often overlooked as support for the caretaker. And you know, that caregiver
Elise – @TheOncoPT (22:08)
Yeah.
Mm -hmm.
Alex Hill (she/her) (22:23)
burnout and burden that people also experience. I think that that’s something, you know, in terms of social work and mental health services, that kind of thing to make sure that they have support as well.
Elise – @TheOncoPT (22:38)
Man, we haven’t even like, I don’t know why I didn’t even think about the caregiver. Like, of course, like, you know, and for some patients that may not be the case, but in a lot of cases, there is a partner that, you know, again, probably went into this thinking I’m going to be a new parent or I’m going to be a parent again. And now it’s caregiver for newborn caregiver for maybe other children. And then also for the patient and.
Alex Hill (she/her) (22:43)
laughs
Mm -hmm.
Elise – @TheOncoPT (23:05)
Woo, talk about layers, y ‘all. Like, we just keep finding more. my God.
Alex Hill (she/her) (23:06)
Right, yeah. Yeah, it really is.
Elise – @TheOncoPT (23:15)
Okay, so we’ve established like this is a big issue. It may not be common, but it is something that we’re seeing potentially an increase in over the years as we’re seeing trends in our population health. So where does OncoPT come in? Let’s start first. Is oncology physical therapy, is rehab appropriate for the pregnant oncology patient?
Alex Hill (she/her) (23:39)
All together now, yes. So I’ll let Rebeca tackle this first in terms of like acute care aside. I think like, and this was one of the the why I reached out to Rebeca, Rebeca, spoiler alert: presenting at CSM on this topic in 2025. But this was one of the reasons I reached out to her is to have that like continuum of care for these folks. So I’ll let Rebeca take it off
Elise – @TheOncoPT (23:40)
Hahaha!
Mm -hmm.
Dr. Rebeca Segraves, PT, DPT (24:07)
There’s so much change occurring during this time. And so it really strikes me that I personally, during pregnancy, have not treated a person who was diagnosed with cancer, but I’ve treated them immediately after birth, within the first 12 to 24 hours after a cesarean section, and then also within the first two weeks after giving birth, preparing for a mastectomy.
And I’ve always thought about Alex’s guidance on just looking at the whole person, looking at all of these things, how does it impact their activity? How does it impact their recovery, their function? And that just really stuck with me. So from the acute side of things, I say that rehab therapists, if we’re not involved, first of all, on the maternity unit, first let’s address that. Because you never know who’s gonna be in the hospital during a high risk pregnancy.
Alex Hill (she/her) (24:36)
Yeah.
That’s amazing. I never see that.
Dr. Rebeca Segraves, PT, DPT (25:06)
what’s going on physiologically with them, and then what their recovery is going to be like, especially if they have a diagnosis of cancer. Now that we’re talking about all the compounding factors, let’s not wait for that rare moment. Let’s actually be serving the population while they’re in the hospital, especially after an unexpected C -section or a delivery complication. And so that’s really my take on that, but I had to plug in Alex’s guidance from our residency.
Elise – @TheOncoPT (25:12)
That is so amazing. my God. my God.
Alex Hill (she/her) (25:19)
Well, Jeepers, I mean, that’s fine. Like I remember specific cases just for starting out and like taking those along with me. So I’m honored to be one of those cases for you to take along with you. So for me on the outpatient side, I’ve worked just with a couple people who’ve
Elise – @TheOncoPT (25:23)
you
Alex Hill (she/her) (25:47)
either had been diagnosed with cancer during pregnancy, or I’ve seen them fairly soon, like within a year after delivery and they were diagnosed with cancer. And really when we look at pregnancy associated cancer, it’s, I think, don’t quote me on this, I believe it’s three months prior to abortion within the first nine months before
delivery or within 12 months of any mode of delivery, whether it be C -section or vaginal delivery. So it’s kind of a big range if you think about it. When we look at pregnancy associated cancer, it’s not just during pregnancy. That whole postpartum first year, they’re postpartum, right? Postpartum is an end at six weeks. So when we look at as onco -PTs like
Elise – @TheOncoPT (26:39)
Mm -hmm.
Alex Hill (she/her) (26:43)
we need to, that’s needs to be a question that we’re asking them and that we know is when was your last delivery? Especially if they’re in childbearing years. But that would be one thing I would want out, especially outpatient onco -PTs. They just kind of be aware of is it’s cancer during pregnancy or cancer associated, sorry, pregnancy associated cancer is not just during pregnancy. So it’s being mindful of not just all of the
Elise – @TheOncoPT (27:08)
Mm -hmm.
Alex Hill (she/her) (27:13)
side effects and things to consider with cancer, but like working with a pelvic health therapist or women’s health therapist who knows what to expect and what to do and how to help people in that postpartum period, they may need to see two separate therapists. They may not have the dual training that me and Rebeca have, right? They may need to see dual therapists to really get the care that they need and you may need to advocate for them to get that.
Elise – @TheOncoPT (27:31)
Mm -hmm.
Okay, you queued up my next question really, really well. So what is the role of the OncoPT specifically when working with the pregnant oncology patient? Because yes, let’s assume that this is a situation where the therapist is not dual trained. We’re going to need to have both teams on board. So what should the OncoPT be doing with this person?
Alex Hill (she/her) (27:44)
Hahaha!
Vitals.
You
Dr. Rebeca Segraves, PT, DPT (28:32)
I’m right. Vital signs. Yeah, like as a rehab therapist, being intimately, intimately familiar with that person’s treatment plan, right? Because you may be catching signs that the oncologist, the OB -GYN specialist, whoever is taking lead on the case, the team, right? You may be catching signs that they’re not aware of or they’re missing.
Alex Hill (she/her) (28:37)
Mm -hmm.
Dr. Rebeca Segraves, PT, DPT (29:03)
And so in the case that Alex and I were gonna present on at CSM and the person that we interviewed and we were so excited that we have this story in this case example, they weren’t aware that there were issues of very severe anemia leading to help syndrome. And so if you’re an oncopity, you’re gonna be like help syndrome, you might not be familiar.
Alex Hill (she/her) (29:05)
.
Elise – @TheOncoPT (29:05)
That’s me. That’s me.
Alex Hill (she/her) (29:14)
.
Dr. Rebeca Segraves, PT, DPT (29:29)
You might not be familiar with those diagnoses that really affect platelet count, but you do know platelet count issues in oncology. And so just applying it to this patient population, you just have to really be intimately familiar with their vital signs, with lab values if you have access to that, with just day to day having this…
Alex Hill (she/her) (29:43)
you
Dr. Rebeca Segraves, PT, DPT (29:53)
really open and where you have so many tools to do that now, especially with AI, but having and using these tools to really have a system of monitoring. And a lot of what we do in our education, we’re using smart devices, right? Which I feel like I’m hearing a lot from the onco space as well, in terms of being able to monitor those physiological signs that you may be able to catch and say, hey.
Elise – @TheOncoPT (30:07)
Mm -hmm.
Dr. Rebeca Segraves, PT, DPT (30:21)
I’m noticing something in terms of like, you know, your day to day, your heart rate recovery, whatever it is, have you been more active or is there something else going on? And so that’s really in terms of just what you would use anyway with your patients, you really have to now expand your consideration for physiologically what’s going on during pregnancy and then how is that being impacted by either the disease or the treatment.
Alex Hill (she/her) (30:24)
Yep. The only thing I could have said it better, honestly, like the biggest thing is on copetes is just monitoring the vitals and then.
monitoring their lab values and being aware of what treatments they’re having and how could that impact their values? Because again, like I mentioned earlier, a lot of times, some of these symptoms can mimic each other. So for example, swelling in the legs and in the genitals is pretty common during pregnancy, but that could also be a sign of maybe malignancy or metastasis into the lymphatic system or a blockage from a tumor. So it’s
being mindful of things that don’t, you know, the little spidey sense that you get, like you need to dig into that a little bit more. Even if it’s something that ends up being benign, it’s totally fine. That should be something that you talk to their oncologist about or their oncology OBGYN.
Elise – @TheOncoPT (31:20)
Mm -hmm. What I know this is a very big question I’m asking, but what are some of those, because I personally have never been pregnant, I don’t have the experience of knowing what to expect in pregnancy and I haven’t worked with a lot of patients previously who are pregnant. So what are some of these, you know, signs or symptoms or, you know, experiences that patients are reporting on that would lead you to say, hmm.
something doesn’t feel quite right. Can you give me some examples of those?
Alex Hill (she/her) (32:01)
Okay.
Elise – @TheOncoPT (32:18)
Mm -hmm.
Dr. Rebeca Segraves, PT, DPT (32:19)
Definitely, like, so we were laughing about vital signs, but that’s one of your first indications, right? And higher than normal or even lower than normal resting or baseline blood pressure, which is different, right? Your baseline would be taken first thing in the morning, right? And then comparing with the rest of your day, resting, you’re taken at rest. And so just making sure that people are aware.
of their baseline blood pressures if possible before pregnancy, but that’s not always a luxury that we have people who are monitoring their vital signs before an actual issue would cause them to. And so having that done early in your plan of care with that individual is gonna help you determine what are their norms, what’s deviating from their norms. And so later on in pregnancy is not…
Alex Hill (she/her) (32:55)
Mm -hmm.
Elise – @TheOncoPT (32:57)
Mm -hmm.
Dr. Rebeca Segraves, PT, DPT (33:14)
to hear someone saying, you know, they’re getting more short of breath, but is that happening earlier in pregnancy where that would be uncommon? Is there an issue where there may be some reduced blood flow if they are on a chemotherapy that’s not supposed to affect their circulation, but it is, this reducing their red blood cell count? Is there signs and symptoms of anemia that you know is going to significantly impact the oxygen that the fetus is getting?
Alex Hill (she/her) (33:19)
Okay.
Yep. Again, she says things so perfectly. I think the only other addition I would say is just being mindful, just the typical constitutional signs and symptoms. Like a lot of times with these conditions that mimic a lot of times, again, the physicians and the other medical providers are missing them. So if you miss something as a rehab therapist, also don’t take that to heart because other people
Dr. Rebeca Segraves, PT, DPT (33:44)
And so those are the things that you really just want to be aware of is know your physiology of any patient really that we’re encountering, know their physiology of what’s normal during this time period as you enter their plan of care, but then also really be mindful that where things should be occurring during gestation, if they’re not occurring during that time period, that’s a flag that we need to pay more attention to.
Elise – @TheOncoPT (33:55)
Mm -hmm.
Alex Hill (she/her) (34:11)
who are trained to diagnose these are also missing them. I know that we, as therapists tend to take on a lot and like try to be a quarterback for our patient and advocate for them and like figure out, well, this could be this or this. Like that’s not necessarily our role also. It’s more so to screen and make sure is this time to refer to somebody else to make sure that they do get that proper diagnosis. But.
Elise – @TheOncoPT (34:26)
Mm -hmm. Mm -hmm.
Alex Hill (she/her) (34:35)
Just like Rebeca said, being mindful of what is normal physiology. And if it takes a little Google search, that’s okay. So you don’t understand it. Talking with a colleague, if they’re on a chemo regiment using chemocare .com, I think I first heard that resource from you, Elise, with knowing what is normal, right? Are these side effects typical or is this pregnancy or is this something else? So it just takes a little bit more…
Elise – @TheOncoPT (34:43)
Always a good thing. Always a good thing.
Alex Hill (she/her) (35:05)
thoughtfulness and being aware and talking to your patient about what’s feeling normal. Are there multiple symptoms that just seem like too, a little too much of a coincidence for it to be just pregnancy related, for example.
Elise – @TheOncoPT (35:19)
Mm -hmm. Mm -hmm.
Alex Hill (she/her) (35:24)
I feel like that sometimes and then sometimes I get sacked. I’m like, come on, someone got to help me out.
Elise – @TheOncoPT (35:31)
my receivers. Come on.
Alex Hill (she/her) (35:41)
We’re literally trying to do so many things.
Dr. Rebeca Segraves, PT, DPT (35:45)
I love that Alex used the quarterback like analogy.
Alex Hill (she/her) (35:46)
Yeah, we have to.
But the team also needs to show up. I’m just saying that. Like we need, right? Like I know this will get into a whole other discussion, but we’re so siloed. I like personally, I just, I need to see an ENT. I need to see him for my sinuses and my ears. I have to make two separate appointments. One for a physician who does just ears, one for physicians who does just sinuses. You’re an ENT. Obviously a very small issue compared to like everything we’ve been talking about, but like
Dr. Rebeca Segraves, PT, DPT (35:54)
For real though, I mean, I will find because you’re so close to this patient during their whole journey that you try to be the quarterback, but then you also try to run and catch. And it’s like, wait a second, you use your team, yeah.
Elise – @TheOncoPT (36:01)
Yeah.
Dr. Rebeca Segraves, PT, DPT (36:19)
Mystery. Yeah.
Alex Hill (she/her) (36:19)
It just showed like our healthcare system is so fractured. It shouldn’t be a rehab therapist who’s trying to be the quarterback for everything. One, that should be primary care. But two, like also this should be elevating as we are doctors of physical therapy. Again, this is getting on a total tangent. But again, like we have this training, we should be using it. We should, you know, be screening and that kind of thing, but also don’t feel bad if you miss something too. As long as you’re being diligent, you’re doing what you’re supposed to be doing.
Elise – @TheOncoPT (36:23)
Mm -hmm.
Alex Hill (she/her) (36:48)
vitals, paying attention to their labs, paying attention to what their treatment is, you’re doing your due diligence. You’re doing just fine.
Total tangent, so sorry.
Elise – @TheOncoPT (37:06)
Mm -hmm.
Dr. Rebeca Segraves, PT, DPT (37:19)
No, she’s totally right. I mean, especially, yeah, no, it’s not. But I think honestly, you’re right is that, especially with pregnancy, you will have an OB -GYN that’s not going to follow you through your cancer journey. I mean, talk about the six week visit, like that just goes out the window. That’s a blur in the midst of so many other visits that you now have for cancer. And so there is a disconnect. There will be siloed care. And it’s just, we do have to be mindful that it’s going to feel like
Alex Hill (she/her) (37:35)
Yeah.
Yep.
Elise – @TheOncoPT (37:46)
I’m gonna bring back something that Rebeca said earlier to what you just said right now, Rebeca. So again, Alex and I cannot say enough amazing things about Rebeca Seagraves and her team presenting at CSM on the cardiovascular and pulmonary peripartum experience. I mean, first of all, I will link to that in today’s show notes. So go back and listen to that episode because it was, I know it was just the preview of this session, but the nuggets of gold that were dropped in there.
Dr. Rebeca Segraves, PT, DPT (37:46)
We need to take that on in terms of connecting all of those players. But I think there’s also power in empowering our patients to figure out systems that really do help connect the dots. And I think that we’re just under utilizing the technology that allows us to do that as a system, as a healthcare profession, but then just also just what’s available to people.
Alex Hill (she/her) (38:02)
Okay.
Elise – @TheOncoPT (38:15)
Amazing. And one of the things I really appreciated and took away from that presentation at CSM Rebeca was the use of smartwatches and different things for tracking these things. And so it made me think right now, not pregnant, okay, like we’re a little bit of apples and oranges here, but I have a patient right now who has a really unique oncology diagnosis and experience. And she has been so diligent.
Alex Hill (she/her) (38:16)
.
Elise – @TheOncoPT (38:42)
about using her smartwatch and tracking different things on there. Is it completely perfect? No. Is it better than nothing? Absolutely. And are we getting some really good information that objectively can kind of fill in some of the gaps that maybe, you know, the patient doesn’t notice and because I’m not with her 24 hours a day, I don’t see? Yes. And so that has been a really fun thing to lean into over the past, you know,
with this patient like four months now. That could be something that we can really leverage, I think especially in oncology, but particularly this space, especially when it comes to those vitals, whoops, might watch things, I’m tucking into it. The cardiovascular implications of oncology and oncology treatments, but also the pregnancy side of things and the peripartum experience. What a great tool that many patients already have access to. We’re not asking them to go out and buy like a
a chest strap and all these crazy monitoring. I mean, like if they’ve got a smartwatch and it does not have to be the latest and greatest Apple watch, what a great way to get some information to help fill in some of those gaps. So, you know, even if maybe you’re in the session with the patient, like Alex said, and things just aren’t like making sense, that can help inform a little bit more of what are we seeing here? What do we kind of need to act on next?
Alex Hill (she/her) (39:48)
Mm -hmm.
.
you
Elise – @TheOncoPT (40:25)
Right, right.
Dr. Rebeca Segraves, PT, DPT (40:30)
Completely, right? I mean, I had a discussion at CSM with a therapist, really, and I respect this person, they’re a major force in the cardiopulmonary space, but they express concerns that these things are just not accurate enough. And I said, well, they’re not gonna be a physical therapist on the wrist. Like, they’re not going to replace us. They are really just tools. And it’s much better if I…
Elise – @TheOncoPT (40:54)
Yes.
Dr. Rebeca Segraves, PT, DPT (40:55)
receive maybe a mixed signal, a false negative or a false positive, you know, on the two -way communication system from my smartwatch to my patient, I’d rather have a false positive than have the story of my team completely missed, that my platelet count was dropping, that my, you know, that, you know, I was really essentially coding.
Alex Hill (she/her) (41:02)
Mm -hmm.
.
Dr. Rebeca Segraves, PT, DPT (41:25)
you know, from the conversation that Alex and I had with the person that we’ll be discussing at CSM. And it was just like, I would go for that story any day of the week, is that I was using a smart device, I was using technology to monitor my patient remotely, you know, to have that feedback that goes to our team, then to be on the side of we totally missed this. And now you really ran into an issue that…
Elise – @TheOncoPT (41:38)
Mm -hmm.
Alex Hill (she/her) (41:44)
Mm -hmm. Mm -hmm.
Dr. Rebeca Segraves, PT, DPT (41:53)
affected the outcomes of your pregnancy, ended up in a bereavement birth, all of the things that we do here occur that now are with that person long -term. And we’re trying to pick up the pieces on the back end. And so, yeah, if you have that accessible to you or if you don’t know information, I mean, I think that this is a huge area. I’m just gonna put a plug just for Alex’s line of courses.
Alex Hill (she/her) (42:11)
Mm -hmm.
Elise – @TheOncoPT (42:11)
Mm -hmm.
man, this gets me so fired up. It’s like, I really do, you know, Rebeca, I mean this with complete sincerity, that session at CSM was absolutely practice changing. And I think it just opened so much more to, you know, cause cardio like, and I know we keep coming back to this, cardiovascular and cardiopulm stuff was such a like very finite limited thing or like,
Alex Hill (she/her) (42:18)
Yeah.
Dr. Rebeca Segraves, PT, DPT (42:22)
These are huge areas that we can really start to segment and create education around. For our rehab therapists that are encountering these specialized populations, but able to use technology across the board, right?
Elise – @TheOncoPT (42:45)
semester in PT school. And I think the applicability, like I did not connect the dots on like, I get it if I’m working inpatient, you know, in the acute care setting, like, yeah, I have to look at these things really closely, but I don’t think I ever saw a physical therapist take vitals up until that point. And it was such an eye opening, like, I get it now. And so, you know, bringing some of this into the oncology practice. And again, especially with this
Alex Hill (she/her) (42:49)
Okay.
Elise – @TheOncoPT (43:15)
layer of what I now know because you taught it to me about what happens to a person’s physiology when they’re pregnant. It’s a no -brainer. Again, I would rather have maybe a little kind of, you know, not great data from the patient’s phone than no data and miss something and have a catastrophic conclusion to that patient experience. So, my god, cannot say enough good things.
Alex Hill (she/her) (43:31)
.
Yeah.
Okay.
Elise – @TheOncoPT (44:21)
Mm -hmm.
Alex Hill (she/her) (44:27)
Mm -hmm.
Elise – @TheOncoPT (44:30)
Okay, I’m gonna kind of wrap this up, because otherwise I feel like we could literally go down those 17 other tangents that I was getting lost in previously. Let’s say that there’s an oncopT listening to this episode, and tomorrow they have a pregnant oncology patient scheduled. What is one thing that they should make sure and do when they see that patient? And I kind of have an idea of what the answer is gonna be, but I’ll let you go with it.
Alex Hill (she/her) (44:31)
You
The one thing.
I need to think about that. Besides vitals. Vitals are given.
Elise – @TheOncoPT (45:09)
Okay, I was like, I feel like vitals is the first answer and then we can go from there. Okay, in addition to vitals, good consideration, absolutely.
Alex Hill (she/her) (45:13)
The vitals labs.
where they’re at in their pregnancy, and having a clear understanding of what the proposed treatment plan is, because that can change. but that’s going to give you a good indication of in terms of like where they’re at gestation wise. and also what to kind of prepare for prognostics.
maybe people that you need to make sure that you are talking to on their medical team, education that you can provide them. I think for me, like that would be the biggest thing is where they at in their gestation, what’s their treatment plan, and obviously like the stage of cancer, type of cancer location, that kind of thing.
Elise – @TheOncoPT (46:08)
Mm hmm. Love that.
Alex Hill (she/her) (46:10)
Keep it easy, keep it simple. As we just talked for, I don’t even know how long we’ve been talking, but there’s so many things that you can get overwhelmed with and try to do so many things. Just start with the basics. Just where are they at in their journey?
Elise – @TheOncoPT (46:21)
Mm hmm.
Alex Hill (she/her) (46:47)
Hahaha!
Elise – @TheOncoPT (46:52)
Mm -hmm.
Mm -hmm.
Alex Hill (she/her) (47:23)
Mmm.
Thank you.
Hmm.
Dr. Rebeca Segraves, PT, DPT (47:59)
back in their care, who’s gonna catch it? And who’s gonna make sure that that ball gets across the line? We really have to figure out is this person equipped for the journey ahead and where can we help them start building a foundation that’s going to last into their recovery, which we don’t know. We don’t have a cap on when it comes to postpartum recovery. We really don’t have a cap on when it comes to even oncology or cancer recovery. And so that’s really…
Elise – @TheOncoPT (48:00)
Mm -hmm.
Alex Hill (she/her) (48:19)
I guess I’ll change my answer to what Susan said.
Elise – @TheOncoPT (48:23)
No, I like both of these answers. I feel like the theme that I’m picking up on is like, slow down, take the history and really sit with the history and then really think about who is on that patient’s team. And then where are those gaps and where can we connect them? Where can we serve as the connector? Maybe instead of the quarterback, we can be a connector here and get them connected with the…
Dr. Rebeca Segraves, PT, DPT (48:29)
Really the most important thing you can do in that first visit is establish an idea of who this person has around them
Alex Hill (she/her) (48:41)
Yep.
Dr. Rebeca Segraves, PT, DPT (48:47)
I’d love, yeah.
Alex Hill (she/her) (48:49)
Right.
Elise – @TheOncoPT (48:50)
most appropriate resources at that time. Where can people follow you and learn more from you?
Alex Hill (she/her) (49:04)
Well.
Elise – @TheOncoPT (49:10)
Mm -hmm.
Dr. Rebeca Segraves, PT, DPT (49:20)
I feel like I think I wanna leave the audience with Enhanced Recovery After Delivery, our program. It started really out as more training for professionals and we’re starting to realize individuals and families need to know they have a right to access rehab along any point of their journey. And this, it makes me think of
Elise – @TheOncoPT (49:46)
Yeah.
Dr. Rebeca Segraves, PT, DPT (49:48)
just this population, although rare, the fact that we are even talking about this means that they don’t have access to rehab guaranteed in the hospital after birth, knowing they may actually be going down the street a few blocks to the cancer center. And so enhanced recovery after deliveries is where you can really find our mission and our work of expanding access to rehab across the maternity spectrum.
Alex Hill (she/her) (50:03)
Awesome. And mine is Anko Pelvic PT Everywhere, YouTube, X, Facebook. I also think I have Pinterest, but I’m never on Pinterest, but I think I have Pinterest.
But on go pelvic PT. But I just was like resharing my real, like I don’t know what to do with this.
Elise – @TheOncoPT (50:16)
But you’re on Pinterest.
Dr. Rebeca Segraves, PT, DPT (50:19)
whether there’s a cancer diagnosis there or not.
Elise – @TheOncoPT (50:23)
That’s what I do.
Alex Hill (she/her) (50:27)
It’s all a learning curve with social media.
Well now that I have merch, maybe I can’t do Pinterest now a little bit better.
Elise – @TheOncoPT (50:35)
There you go. See, very applicable for Pinterest. You’re good. You’re so good. my God. Yeah. Onco Pelvic PT on all the things. Also Instagram, TikTok. I know she didn’t mention those, but it’s also on there. Man, Rebeca, I feel like I also see you all the time on Twitter slash X and probably LinkedIn too. I mean, just like all the things. So I will link to all of those in the show notes. But
Dr. Rebeca Segraves, PT, DPT (50:37)
I would love to see your stuff on Pinterest.
Alex Hill (she/her) (50:39)
hahahaha
Dr. Rebeca Segraves, PT, DPT (50:48)
On Copelvic BT, no, I could see totally on Pinterest. It’s so awesome.
Alex Hill (she/her) (50:48)
yeah.
Yes. Yeah.
Elise – @TheOncoPT (51:03)
Rebeca Alex, thank you so much for having this conversation. Thank you first of all for suggesting having this conversation. It was really nice to kind of like wrap this up as something I envisioned and then it’s actually happening. I know we don’t have when we’re presenting and all those things, but I just want to make sure it doesn’t go un -talked about or unnoticed. They are presenting at CSM for sure on this topic.
in Houston 2025. So if you are interested at all, make sure to register, because it’s going to be a really good conference. I’m really, really excited for it. So just going to drop that pitch there. And maybe I’ll have you all back on leading up to the conference to talk more about this stuff. So we’ll see.
Alex Hill (she/her) (51:48)
We’re done. You know I’m always down to do literally anything for you Queen Dr. Elise.