As cancer survivorship improves, you will see more patients with chronic side effects & impairments. One of these side effects is chemotherapy-induced peripheral neuropathy (CIPN).
Unfortunately, CIPN can be challenging to treat, & much research still needs to be done to determine the best methods to treat CIPN. As today’s guest said, “we are really good at treating the cancer. We’re not good at treating the side effects.”
That statement is exactly why it’s so important for you to listen to today’s episode & start implementing Dr. Katie Schmitt’s protocol for your patients with CIPN.
CIPN is more than pesky numbness & tingling
CIPN is a dose-dependent neuropathy that happens bilaterally, typically in a stocking or glove-like pattern (affecting fingers/hands &/or toes/feet). CIPN may develop after the first chemotherapy session or even months after treatment has finished.
Many patients experience sensory manifestations of CIPN such as numbness, tingling, burning, & even pain.
However, CIPN is not just a sensory experience. CIPN can also affect motor neurons as well, resulting in weakness, cramping, muscle pain, reduction or loss of deep tendon reflexes, foot drop, & gait disturbances.
Additionally, CIPN can affect the autonomic nervous system, contributing to constipation, urogenital dysfunction, orthostatic hypotension, optic neuropathy, & arrhythmia.
Above all, CIPN is a significant dose-limiting side effect, meaning that patients may have their treatment dose REDUCED because of how adversely it affects patients’ lives. This means that patients may not get the full recommended dosing for their diagnosis, which absolutely can affect their long-term survival.
For more on how CIPN develops & affects your patients, Dr. Schmitt recommends the article Chemotherapy-Induced Peripheral Neuropathy: Epidemiology, Pathomechanisms, & Treatment.
Common contributors to CIPN
CIPN can occur due to exposure to chemotherapy, immunotherapy, & even the cancer itself.
Common neurotoxic chemotherapies include platinum-based chemotherapies, taxanes, & vinca alkaloids.
Immunotherapies can also be neurotoxic & contribute to CIPN. Right now, we know that thalidomide & bortezomib cause CIPN. As more immunotherapy agents are developed, we may learn that more agents are neurotoxic too, so make sure to keep an eye on emerging evidence.
Dr. Schmitt mentions in our interview that some diagnoses may contribute to CIPN, including multiple myeloma.
It’s important to not forget that patients may also have pre-existing neuropathy issues that are then exacerbated by the above agents.
How to treat CIPN in your patients
The first thing Dr. Schmitt recommends is to TOUCH YOUR PATIENT’S FEET. Here’s how:
- Massage the heel & fat pad
- Then press through the bottom of the foot, looking for trigger points
- Address each trigger point as you find them, holding for 30-90 seconds
- Move to the ball of the foot, spreading the toes as you move distally
- Now on the top of the foot, work between each metatarsal, pressing proximally again looking for trigger points
- Address each trigger point as you find them, holding for 30-90 seconds
- Then massage the toes themselves, distracting one at a time (ideally, to the point of a manipulation)
- Mobilize each metatarsal, again checking for any restrictions
- Finally, move any swelling proximally towards the knee lymphatics (hello MLD?)
- Repeat on the other foot
Start light, but build your pressure gradually.
Dr. Schmitt notes that her patients who have the best results are typically performing their self-massage 2-3 times per day.
Introducing the manual therapy technique above is the first week. In week 2, Dr. Schmitt incorporates ankle exercises, including gastrocnemius, soleus, & fascial stretching. Additionally, strength training should be included here, so break out the therabands for ankle 4-ways.
In week 3, Dr. Schmitt adds in balance training, such as tandem stance, single leg stance, head turns, eyes closed, & more interventions.
As you continue progressing with your patient, it’s important to incorporate what your patient wants to get back to doing.
Don’t forget to integrate aerobic exercise into all this – work with your patient to find what type of aerobic exercise does your patient like to do & how to implement that into their daily life.
Watch Dr. Schmitt’s video on Chemotherapy Induced Peripheral Neuropathy Manual Technique
About Dr. Katie Schmitt, PT
In 2013 I decided to go back to school for PT. I was an actor and retail manager, traveling the country with my husband working on a web series called Sleep Here Now, where we reviewed bed and breakfasts across the country. As an actor I had never taken physics or chemistry, I just knew that I wanted to help kids with asthma, like me, get stronger without medication. In 2015, I was accepted to Columbia University Medical Center and attended their DPT program. Along the course of my clinical affiliations, I started to work on the connection between cancer and the diaphragm, balance, breathing and CIPN. It was at my last clinical, working with dancers in LA, where I started to research and develop the manual therapy technique I use for CIPN today and just taught at CSM 2023. In 2018, my husband and I left NYC for Charleston to be closer to his family. I have great bosses at the Medical University of South Carolina and was able to work my way from a part time PRN PT to starting and running an outpatient PT office at the MUSC Hollings Cancer Center. This past year, I became lymphedema certified and am now a Board-Certified Clinical Specialist in Oncologic Physical Therapy. In my free time, I am researching more about CIPN, and traveling with my husband. We just came back from London where I got to see MacBeth at the Globe, which has been a dream since 5th grade. I am so excited to be a part of the onco-PT community, bringing research and clinical pearls to life to help our amazing patients.
Check out Dr. Schmitt’s website: https://drkatiedpt.com/
Transcript
Elise – @TheOncoPT (00:02.167)
Hey OncoPT and welcome to this episode of the OncoPT Podcast. Now if you’re like me, you may have originally read the guest of this episode and thought, oh I know who this is. Because I kind of did the same thing for many years in my practice, only to discover somewhat recently rather sadly on my part that this…
Dr. Katie Schmitt is someone different entirely and has a masterful grasp on an extremely common impairment that many of our patients face, and we haven’t talked about in a while on the Onco PT podcast. So I’m so excited to have Dr. Katie Schmitt for the first time here on the Onco PT podcast to talk about very something special. So Katie, welcome to the Onco PT podcast.
Dr. Katie (00:46.326)
Thank you so much. Thank you for having me. I am so excited to be here to talk about neuropathy. This is my favorite thing to talk about and I’m so excited to talk to you about neuropathy because I have learned so much from your podcast. So I’m so excited to share with others about my favorite topic.
Elise – @TheOncoPT (01:03.299)
Okay, you and I both like neuropathy, but if I love neuropathy this much, you love neuropathy like off the charts this much.
And I’m really excited because like I mentioned at the top of this episode, we haven’t really dove into CIPN and how it really affects our patients within cancer world, right? A lot of listeners right now have heard the term CIPN. They understand like, yes, chemotherapy causes peripheral neuropathy. Maybe they understand a little bit about it. But for a long time, I was kind of skirting by with some absolute basics
just kind of fumbling through things as we go. So I would love to know before we get into too far, first of all, why are you so excited about CIPN? How did you get into this excitement and passion specifically for CIPN within cancer rehab?
Dr. Katie (02:01.582)
Sure. So I had another career before this. I was an actor, I traveled the country, did a bunch of different stuff, and then I decided I didn’t want to live in my car anymore, and I would go back to school. And I decided to go back to school for PT, and originally it’s because I was a dancer, so I had PT and I thought, great! PT’s magic, I’d love to know how to do this. And throughout studying, I was learning more and more about…
the diaphragm and balance and cancer and breathing and cancer has affected my family in many different ways. So I thought, alright, maybe this is my way to kind of fight cancer. And through my, I think my fourth clinical affiliation is where it really started to click. And so I was working with the amazing, this woman Karen, she runs Fusion Arts out in LA. She’s fantastic with dancers and performers.
and we were working on ballerinas and it just so happened that we met the woman who runs WeSpark, which is a non-for-profit cancer organization in California, and she said, well, what do you know about neuropathy? What do you know about balance? And I was talking about breathing and the diaphragm and we decided instead of my clinical affiliation, or sorry, instead of my, like, you know, you have to do a one-off presentation. Hey, my boss, this is my presentation on my thing. We would do a four week workshop.
Elise – @TheOncoPT (03:16.744)
Mm-hmm.
Dr. Katie (03:20.85)
neuropathy and breathing and balance for all the patients. And so we came up with this 45 minute long thing and we did some training stuff and we ended with the neuropathy massage that I’ve been working on since I was a student and the first week patients would come back and they’d be like I felt different. I feel different in my feet. Like this is phenomenal. So we got to do it for four weeks and patients were telling me they were feeling a difference. So I said alright
Elise – @TheOncoPT (03:23.068)
Oh my god.
Elise – @TheOncoPT (03:34.516)
Mm-hmm.
Dr. Katie (03:49.378)
there’s something to this. And I kind of took what I was learning with working with ballerinas, with Morton’s neuroma, with plantar fasciitis, and sort of turned that, combined it with the information you learn about diabetic neuropathy to kind of come up with this technique. So then I graduated and I was working in New York for about a month, maybe two, and my husband, who was Mr. New York for the longest time, lost it and said, nope, that’s it, I’m over it. I want to be in South Carolina. I want to be with my brother. I want to be with my family.
Elise – @TheOncoPT (04:01.628)
Mm-hmm.
Dr. Katie (04:19.446)
So we made the move down to Charleston and I started out as in a bunch of different clinics and offices but I was talking about neuropathy. And so I started talking to one of the neuro-oncologists at Hollings Cancer Center which is part of the Medical University of South Carolina. I was like, you know, I can really help your patients. We can do something about this. So I started treating them but I wasn’t working for MUSC at the time. So I started as a
Elise – @TheOncoPT (04:21.708)
Mm-hmm.
Elise – @TheOncoPT (04:36.187)
Mm-hmm.
Dr. Katie (04:45.974)
PRN PT on the weekends and then made the transition to being there full-time. And then during COVID, I have an amazing boss and I said, why don’t we have PT at the cancer center? This is dumb. And he said, yeah, I agree. So we came up with bullet points and figured out how to pitch it as a business and show, yeah, this is the business of treating the side effects of the treatment that we’re giving these patients. We’re really good at treating the cancer. We’re not good at treating the side effects. So
Elise – @TheOncoPT (05:04.579)
Mm-hmm.
Elise – @TheOncoPT (05:08.951)
Mm-hmm.
Elise – @TheOncoPT (05:14.103)
Yes.
Dr. Katie (05:14.93)
Weaseled My Way in the Door was working one day a week, spread it to two days a week, then five days a week, and now we are a full-time practice at the cancer hospital, which is fabulous. And in the meantime, I’ve been able to really study neuropathy and how it helps our patients, and helps our patients with neuro issues, with hematological cancers, with breast cancer, even some patients with idiopathic neuropathy, and it’s really wildly successful.
and it’s simple. So my goal is to come out here and say, all right, here’s a protocol that I think we can all follow, kind of like we’d follow a rotator cuff protocol. We can help fix someone’s neuropathy. I’ve seen the changes. Usually it takes about eight to 11 weeks. The patients are getting on board, the oncologists are getting on board. And it’s just so lovely to not be able to say, or to be able to say, instead of gabapentin, here’s PT. And let’s see if this can help fix it. And it’s, this is why I’m so excited about it.
Elise – @TheOncoPT (05:51.614)
Mm-hmm.
Elise – @TheOncoPT (06:10.253)
Mm-hmm.
Dr. Katie (06:12.418)
That was my long-winded answer of where I came from and where I am now.
Elise – @TheOncoPT (06:16.903)
First of all, I really like all of the bullet points that you hit with that answer because it brings up, actually my first question, which I did not prep you for, you mentioned during your, like, well, how did I get here? Neuromassage that you learned in PT school. Did I hear that correctly?
Dr. Katie (06:36.418)
So the massage stuff came from working with a lot of dancers and working on like Morton’s neuroma plantar prosthesis, working in between the toes, working with ballerinas because they just have like the craziest feet and then applying that to the research from diabetic neuropathy and there’s a great study that came out, it might have been in 2018 about Thai foot massage and how you apply that for neuropathy and it works.
Elise – @TheOncoPT (06:42.583)
Okay.
Elise – @TheOncoPT (06:46.707)
Yes, okay.
Dr. Katie (07:05.662)
It’s fabulous.
Elise – @TheOncoPT (07:10.015)
First of all, that’s really, really cool. I love that. I love how much that you took.
your background and your experience in like the performing arts and then working very intensely with this dance, these dancers, this group of dancers to then apply that into oncology and sometimes, whoo, Katie, I feel like this is a whole other episode brewing that we are not going to get into because obviously we have you here for CIPN and I don’t want to monopolize your time. But I feel like this is such a great example of taking all of the different areas of PT
Now, Oncopetie is a thing, right? We know that Oncopetie is, we work with patients who have cancer who have had cancer. Right now I’m actually working with a former Rockette.
Dr. Katie (07:56.878)
amazing.
Elise – @TheOncoPT (07:56.943)
in my practice and I have encountered her through oncology but what she’s dealing with now I think are actually some like very long-standing issues as a result of her career in dance anyways whoo we’re gonna have to put a pin in that because we could I’m sure chat about that all day long because I have questions
But I love that you took this very, very focused experience with dancers and are now being able to apply, this is what we show is working. How can we take this and really marry it to some of the research that is available in CIPN? And I know there’s some good research that has been out, that is coming out about CIPN, but a lot of what really informs our practice, including even for the oncology specialist certification exam, I would say like half of that literature is actually like diabetic neuropathy.
and other kinds of neuropathy. So how do you, like as a practicing clinician, you’ve been working with CIPN for a few years, how do you kind of take…
these different areas where neuropathy affects different patient populations and we know that the research again is really prevalent when it comes to diabetic neuropathy. How are you taking that and then marrying that into your oncopathy practice with oncology patients?
Dr. Katie (09:18.026)
So I think that kind of goes to what we all do as Oncopeteers is you take what you’ve learned in ortho, what you’ve learned in neuro, what you’ve learned in PEDs, and then you have to apply it all to the patient that’s sitting in front of you. And none of this stuff happens in a vacuum. So you’re like, okay, let me throw everything at you. Kind of like my patient with axillary web syndrome and rotator cuff issues and range of motion for picking up her child. So you throw everything together. I think it happened because where I went to school, I went to Columbia.
Elise – @TheOncoPT (09:41.087)
Mm-hmm.
Dr. Katie (09:47.826)
and they’re very big on let’s get a bunch of research, let’s make sure it’s all current research. And so I fell into this very jargony article about neuropathy and why it happens. And it’s definitely if you need a nap, it’s a really good article to read before for falling asleep. But it really goes into, okay, why does neuropathy happen? And it’s kind of, there’s a neuroinflammation that’s happening on the nerves.
Elise – @TheOncoPT (10:10.57)
Mm-hmm.
Dr. Katie (10:15.062)
and it’s kind of like where copper wire is wrapped in plastic and the plastic gets messed up. And then it also affects your ion channels and it affects the way the muscles fire and so that’s why you start to lose some of your strength. And it can happen because of the like the traditional chemo that we see like the cisplatin, the taxanes, it can happen because of the new stuff like
Dr. Katie (10:42.118)
It can happen because of multiple myeloma which attacks the cells themselves and sometimes I Don’t have the research for this yet, but sometimes patients with breast cancer will come to me and say hey I felt this neuropathy coming on when I got diagnosed or before I started treatment. It’s really super fascinating But taking that information right taking that information and saying okay. I know how to play with a nerve I learned that in neuro
Elise – @TheOncoPT (11:01.683)
interesting.
Dr. Katie (11:08.518)
I know how to play with a muscle. I learned that with resistance bands training in ortho. And then I can come together and I can apply this stuff to the patients I see in front of me.
Elise – @TheOncoPT (11:19.108)
Okay, I’m really excited now and I know I’m getting ahead of myself. So let’s take a couple steps back. For the listener who’s brand new, what is CIPN?
Dr. Katie (11:30.678)
The traditional definition, I guess, you’d give like your first patient sitting in front of you. It is a dose-dependent neuropathy that happens bilaterally. It usually happens to the hands and the feet. It comes on like a stocking or a glove, so it starts at the toes or the fingers, usually goes up to the forearm or the knee, and then it gets better kind of the same way. All this stuff gets better first, it lingers in the toes and the fingers, and then it gets better. According to the
it can happen at the first treatment session or it can happen six months after chemo is finished. So you thought you were good, you’re walking around, you’re doing great, bam neuropathy. It is something that’s supposed to go away but usually on its own it doesn’t really do a good job of going away and so patients come in and they have 10 out of 10 complaints and it’s not pain. This is a conversation I’ve had with patients many times. If you call it pain they’re going to get mad at you.
Elise – @TheOncoPT (12:25.433)
Mm-hmm.
Dr. Katie (12:27.446)
It’s numbness, it’s tingling, it’s burning, it’s feeling of cold like something is in your shoe like you’re walking on rocks and it throws off people’s balance and It throws off their quality of life
Elise – @TheOncoPT (12:44.043)
One of the misnomers, I think, and you briefly touched on this already, I think CIPN, Chemotherapy Induced Peripheral Neuropathy, is a little bit of a misnomer now that we understand more about oncology kind of in general. So we know some chemos can cause CIPN. Can we revisit some of those other contributors to CIPN in addition to chemotherapy?
Dr. Katie (13:09.71)
Yeah, definitely. I think what’s really important to kind of tease out and an interesting point is I don’t know if we’re teasing it out because we’re trying to talk about all the different people that we can treat or because we’re trying to figure out more about the why this causes the neuropathy because it’s interesting the different why you have neuropathy we kind of treat the same way which is interesting but that’s my whole other like I’ll dive into that research down the road.
Elise – @TheOncoPT (13:33.982)
Mm-hmm.
Dr. Katie (13:38.978)
So talking about, yes, we have the chemotherapy induced peripheral neuropathy. You have your patients with diabetic neuropathy. And you may have patients who have cancer and diabetes and you don’t quite know why they have the neuropathy, but you know it’s there. You can have neuropathy from multiple myeloma. It’s one of the hematological cancers. And one of the side effects of multiple myeloma is that it goes and it destroys the myelin along the nerves. So that can be an issue as well. And then we also find our idiopathic neuropathy.
Elise – @TheOncoPT (13:50.999)
Mm-hmm.
Dr. Katie (14:08.33)
So someone comes in, they said, I don’t really know why I have it. You kind of have to tease it out. Is it like a demyelinating thing? Are they running up against like a Guillain-Barre or a Myasthenia gravis? Or is it just something that’s sort of floating in their past medical history all by itself? Yeah.
Elise – @TheOncoPT (14:30.187)
You’re already, Kate, like within, we’ve been in this conversation like 15 minutes already. You’re already making me think back to.
previous patients that I’ve seen. So I’ve seen a patient who was on Keytruda previously had a pre-existing nerve injury that just seemed to be getting worse and genuinely like this is the first time I’m really reflecting on that and thinking like I bet she had a little bit of CIPN that was starting to manifest like that was starting to manifest potentially because of the Keytruda. Maybe it was a different agent that I’m forgetting. But also I’ve had a couple patients with multiple myeloma now that I’m thinking
Huh, I don’t think I was screening for that because I didn’t think that their chemotherapies were, you know, were going to lead to CIPN.
Dr. Katie (15:17.31)
Right, because you’re talking about like Revlimid or immune therapy. Yeah, you’re not always talking about like Velcade for sure. That’s one of the ones that’s going to cause it, but yeah thinking about all the immune therapies and you’re thinking okay this is supposed to be much different, but I think and especially with the blood cancers, and I could be wrong, so if you have a listener who’s like nope this is wrong, just let me know, it’s a systemic treatment. So we’re treating the whole body and then the chemo pools in the fingertips and it pools in the feet just because of gravity.
Elise – @TheOncoPT (15:21.052)
Mm-hmm.
Elise – @TheOncoPT (15:34.673)
Mm-hmm.
Elise – @TheOncoPT (15:39.939)
Totally.
Dr. Katie (15:45.398)
And so that’s creating some of these sort of pooling side effects.
Elise – @TheOncoPT (15:45.781)
Mm-hmm.
Elise – @TheOncoPT (15:49.187)
Mm-hmm. Can we talk big picture here? Like very zoom out. What happens to make CIP unhappen? Like what physiologically takes place that causes a person to have this damage or injury to their peripheral nerves?
Dr. Katie (16:10.358)
Sure. So the jargon of it is it causes the neuropathy or the chemotherapy, the way that it attacks the cells and the way that it attacks the different cell cycle for where it’s trying to fight the cancer causes a neuro inflammation. It also causes a swelling of the mitochondria. So they’re not firing properly. They’re not doing their job properly. It messes with your voltage gated ion channels. So think about that drawing that you used to draw in physiology when you were trying to get into PT school in the first place.
Your calcium and your sodium, they’re not firing properly. So I go back to sort of that Copper wires wrapped in plastic your plastic has been destroyed and then it’s kind of like you’re a flashlight also and your battery is loose So you have this sort of muscle twitch and muscle clonus And that’s caused from the chemotherapy itself and then you can certainly I’ll give you the link for sure this article
Elise – @TheOncoPT (16:59.295)
Yes.
Dr. Katie (17:07.186)
You can dig into, okay, my patient is on this type of drug. What does that mean? When we, I did the CSM 2023, it got to present about neuropathy. And I hope everybody stayed awake for the first 15 minutes. That’s when we talked about, okay, taxanes do this and apothelons do this and immunotherapy does this. And it’s very interesting because they all have different rates of CIPN. And when you look at like the APTA fact sheet for treating CIPN, it’s…
Elise – @TheOncoPT (17:11.107)
Mm-hmm.
Elise – @TheOncoPT (17:31.319)
Mm-hmm.
Dr. Katie (17:36.29)
they rank it about 68% of a side effect for what your patients are gonna see if they’ve been on chemotherapy. And there’s so many different levels within there for what we might expect our patients to have if they’re on chemotherapy. And again, another topic for a different podcast, but I’ve started to talk to one of the heads of the hospital where I work and seeing, okay, we know that this is a side effect, we know that our patients are gonna get this. If you’re gonna put someone on a platinum drug,
Elise – @TheOncoPT (17:42.381)
Mm-hmm.
Dr. Katie (18:06.158)
Can they see me first? Can I treat this first? Right? Can we decrease the likelihood that they’re gonna get the neuropathy or can we decrease the severity of the neuropathy so that they can go through their entire chemo regimen and you don’t have to stop it because they’re having these symptoms? So really cool stuff that I’m sure I’m not the only one doing. There’s probably a lot of great people out there studying this right now, but following that sort of perspective surveillance model that Nicole Stout put into place, how do I, she’s amazing.
Elise – @TheOncoPT (18:08.708)
Yeah!
Elise – @TheOncoPT (18:22.615)
Bingo.
Dr. Katie (18:36.571)
how do we treat all along the lines if we know we’re gonna cause this stuff for patients.
Elise – @TheOncoPT (18:44.771)
Katie, I can tell that you’ve already prepared for the oncology specialty certification exam because the way you’re just linking everything together and all these different hot topics, because I’m always thinking about how can I make that preparation a little easier? And you just flow so easily from all of those different topics. I mean, chef’s kiss, perfection. So I, and that’s, ugh.
Ugh, so many different ways that we could take this. Let me kind of rein in my thoughts here. CIPN is obviously very bothersome for our patients, but one of the things that sometimes flies under the radar is it’s actually quite…
it can limit significantly like the dosage that patients are receiving. And whether or not we like to think about this, this has potentially significant ramifications on their long-term survivor, survivorship, survival, excuse me. And so that is something like, this is not just a little numbness and tingling in the fingertips and the toes. Like this is very, A, bothersome for patients, but potentially can alter the treatment plan that they’re on and that absolutely
is way bigger than I think we give it credit for.
Dr. Katie (20:01.65)
I just had a patient the other day and she’s phenomenal. She wrote back to her oncologist and she said, you know what? I’ve been dealing with this neuropathy for two years. I’ve been going to other places. I’m going to see Katie now. It’s making a difference and I have to say I wish you told me that this would be such a big side effect up front. I don’t know if I would have changed my cancer treatment, but I really would have liked to know about it. And it’s so important that we take that
Elise – @TheOncoPT (20:22.372)
Yes!
Dr. Katie (20:27.062)
position because if we can decrease those symptoms you can get people through the full treatment and the full dosage and you can follow The NCCM guidelines a lot better than someone who’s saying you know what I’m on my fourth Episode of cisplatin. I can’t feel my feet. I can’t move around the house. I’m out. I’m done. We need to give them another option
Elise – @TheOncoPT (20:46.829)
Right.
Elise – @TheOncoPT (20:50.239)
And if we’re gonna catastrophize a little bit, like I know we already talked about the potential survivorship ramifications of this, but if a lot of my patients, and I’m sure this is the same for you, Katie, a lot of my patients are older.
and they are already at risk of falling. And then you throw in CIPN on top of this. I mean, this is a recipe for a fall. And especially, like, that is, the hospital is the last place that we want these patients. And that is potentially like, if they have a fall and they injure themselves, they may not be going home. And this is something like, this is very much on my mind because my grandmother, two years ago, had a fall, broke her hip, and that was the catalyst
that was she is no longer safe to live on her own, she is now in a facility. And that is something that absolutely is of concern to patients. And maybe if it’s not of concern to that patient, it should be our concern. But it’s definitely the concern of their spouses, their caregivers, their family members who ultimately have to pick up the pieces of this, you know, oh, just it’s just a little numbness and tingling. No, it’s not right.
Dr. Katie (21:59.506)
Right. And if you fall and you’re in the middle of chemotherapy and you fall and you have to go to subacute rehab or acute rehab, you can’t get chemotherapy. So your treatment’s been delayed because you’re trying to walk again where we could maybe have done something about this earlier on. I do have to make a shout out. There’s a wonderful hemongologist that I work with and he’s starting to tongue test people before he puts people on chemo.
Elise – @TheOncoPT (22:23.979)
Oh my God.
Dr. Katie (22:24.106)
Yeah, it’s amazing. And he’s like, okay, you scored worse than a 12.5, that’s it, go to PT before we start you on chemo or your stem cell transplant. Like this is phenomenal.
Elise – @TheOncoPT (22:34.611)
Oh my god. It gives me such happy little butterflies. Like, this is what we’ve been working for.
Dr. Katie (22:41.59)
Yeah.
Elise – @TheOncoPT (22:46.259)
I don’t think I can beat around the bush any longer, Katie. Like, let’s dive in. What can we actually do for the patient who has CIP at? I mean, like, we’ve talked about what it is. What do we do about it, right?
Dr. Katie (22:57.406)
Yeah, yes, this is my favorite part and I’m giddy when I talk about this stuff and I’m giddy when my patient sits in front of me and they come into the office and they say, all right, I have all these things and you’re like, yep, I’ve heard it, and they say I have 10 on 10 pain and I can’t do anything and I get really excited and my students now get really excited and we’re like, this is it, we’re gonna fix this. So through looking at what the APTA has put out about neuropathy, through looking at all the research, through looking at like working with dancers and
Elise – @TheOncoPT (23:00.279)
Thank you.
Dr. Katie (23:26.798)
doing this for the past five years, I’ve kind of come up with a protocol that I would like to suggest for everyone. So Day one, you do your eval, you say, all right, I’m gonna teach you a little bit about why neuropathy happens. I’m gonna give you the explanation about the copper wires. I’m gonna teach you about the flashlight, telling people so they understand and go, okay, yeah, this makes sense now. I’m not crazy. I understand this.
And then getting into, I think the manual therapy part of treating neuropathy is the biggest part. Yes, we’re gonna get into balance, we’re gonna get into TheraBand exercises, we’re gonna have a walking program. But if you had Morton’s neuroma or you had plantar fasciitis, we’d touch your foot. So you came to me, I’m a PT, I’m gonna touch your foot. And I’m gonna get my patients to touch their foot and I’m gonna get their significant other to touch their foot. And…
Elise – @TheOncoPT (24:21.026)
Mm-hmm.
Dr. Katie (24:22.198)
What I tell everyone, because the significant other looks at me and they’re like, I don’t like feet. Like, okay, here’s the deal. You rub the foot of your loved one and when they get better they’re gonna rub your back. That kind of wins people over. A little bit of bribery. So thinking about the foot and thinking about what you’re gonna do, here’s my secrets and I would love for everyone to take this and run with it and use it for their patient tomorrow.
Elise – @TheOncoPT (24:36.533)
Oh, nice. Very nice.
Dr. Katie (24:51.394)
There’s a video on my website. There’s a video on the website of the hospital that I work with. You can totally use this. So you’re gonna take the foot and you’re gonna start with the heel and you’re gonna massage the fat pad and then you’re gonna follow the Thai foot massage guidelines and you’re gonna massage through to each foot and then you’re gonna expand the ball of the foot because your patients have probably said
It feels constricted, it feels tight, it feels like something’s holding on to my foot. So you’re gonna take the ball and you’re gonna spread it out. And then you’re gonna play with the toes because the toes are probably tingly, they’re probably cold. The first time you do this on someone you’re gonna have to go light but not too light then it’s ticklish. Otherwise they’re gonna hate you and eventually they’re gonna love you. And then you get into the top of the foot. And this is where I think it’s the secret to treating neuropathy.
Elise – @TheOncoPT (25:17.854)
Mm-hmm.
Elise – @TheOncoPT (25:26.659)
Mm-hmm.
Dr. Katie (25:43.618)
kind of like you would treat your Morton’s neuroma, you’re going in between the big toe and the second toe and you’re going down in between those metatarsals and you’re looking for the trigger points that are in between those feather-shaped muscles and you’re trying to find your trigger point, hold on to it, give it 30 to 90 seconds, tell your patient to breathe, they’re looking at you, their eyebrows are very high, you get them to relax, you get the trigger point to relax and then you move on and then you joint moam all those metatarsals
Elise – @TheOncoPT (25:48.715)
Mm-hmm. Uh-huh.
Dr. Katie (26:13.238)
These three feet or these three toes work differently than these toes. If you think about your prosthetic and how prosthetics are made. So you’re hinging these guys, you’re kind of going back and forth on these two. You pop the toes, push the swelling back over that talo curl joint up to the lymph nodes behind the knee. Done. That’s their massage. So excited. And that’s what they’re going to work on. The patients that I have who are having the best results with this are doing this two to three times a day.
Yes, it’s a lot, but do it after breakfast, after lunch, after dinner. I tell my patients to do it three times a day. If they come back to me a week later and they’re like, yeah, I did it once a day. Great, fabulous. I’m happy with that. Week two, no, I have to preface this. I see patients only once a week because I’m the only one that works in my department. So I need to get in like 50 patients a week. And when I first started treating, I was treating during COVID. So I didn’t wanna bring a lot of immune compromised folks.
Elise – @TheOncoPT (26:43.337)
Okay.
Elise – @TheOncoPT (26:47.349)
Right?
Elise – @TheOncoPT (27:03.685)
Mm-hmm.
Dr. Katie (27:13.062)
into a space, make them come down, make them show up. So we decided once a week if people are good with their homework, we’ll work and it actually really does which is awesome. And I’ve had some patients where I’ve never met them in person, we’ve done the whole thing over telehealth, and they get better too which is really cool. Right? It’s so cool. And it’s all about like getting your patient to do their homework which it doesn’t matter what branch of PT you work in, that’s what it’s all about anyway.
Elise – @TheOncoPT (27:31.431)
Oh my God.
Elise – @TheOncoPT (27:41.502)
Mm-hmm.
Dr. Katie (27:42.17)
So the massage and I have a video on my website there like I said there’s a video on the hospital’s website so making it easy for the patient to follow along with and then the second week we’re going to think about those ion channels and we’re going to add in an ankle exercise so we do if you’ve ever sprained your ankle you might have done the ankle four-way where you take therabands you’re going dorsiflexion, plantar flexion, inversion, eversion, yep. So we’re working them through that exercise.
And then we’re adding a gastroc stretch, a soleus stretch, a fascia stretch thinking, okay, that’s all connected all the way down the chain. How do I stretch out the back of the leg? And then week three, we’re starting to add on some balance stuff. So you’ve got your tandem stance, you’ve got your single leg stance, add some head turns, add some eyes closed. And then as you progress your patient, you’re thinking, okay, what do you wanna do? Do you wanna do yoga? Are you a rockette? Do you need to go back to a kick line?
Do you want to play pickleball? It’s a big thing in Charleston. It’s probably like sweeping the country. Yeah, do you want to play pickleball? So let’s get you back to that stuff that you want to do. And meanwhile, still reminding you, do the massage every day, do your ankle exercise, do your stretches, do your walking, and you’re kind of combining everything that is on that really nice fact sheet from the APTA. Aerobics, strength, balance.
Elise – @TheOncoPT (28:43.592)
It’s big here too. Yep, yep.
Dr. Katie (29:06.23)
and we’re adding in the missing piece of get in between the metatarsals of the foot and then we can help get rid of that neuropathy. And that’s it! You’re ready!
Elise – @TheOncoPT (29:19.795)
I know you said like you were giddy about this, like I’m giddy about this. Like I don’t know if you could see my eyes just getting bigger as you talk through that. That is so exciting. And I think this is the first time I’ve really had someone sit down with me and explain all the way through, not just like here are the agents that cause CIPN, but what does it physiologically do at that cellular level?
Dr. Katie (29:25.764)
Yeah.
Elise – @TheOncoPT (29:47.803)
And then tie, oh my God, and then tying those interventions directly back to what is happening. Oh, my gosh, Katie, I have chills right now. This is so exciting.
Dr. Katie (30:00.562)
It’s so exciting. Like, thank you for sharing. It’s so exciting. And I, with the neuropathy, that’s how I was able to convince the neuro-oncologist. And that’s how I was able to convince my boss. And that’s how I’m able to convince the people at the cancer center who are probably like, yeah, I can do this exactly. So I’ve talked with this oncologist. He knows I’m going to share this story. I, one of the heads of the department, usually they give out Gabapet and they’re like, I don’t know.
Take some Gabapent and good luck, goodbye. So I’m very loud about neuropathy and I keep talking about it. And so one of the heads of the department had a patient and he was a patient with GI and lung cancer and the patient’s like, I have neuropathy. I can’t get back on my bike. I can’t do anything. I need to walk around. And so the oncologist says, I don’t know. There’s this girl. She thinks she can do something. She says she can fix neuropathy. I don’t know. Give it a shot. So.
Elise – @TheOncoPT (30:30.459)
Mm-hmm.
Dr. Katie (30:55.926)
The patient comes in and he tells me that this is what the oncologist has said. I say, all right, great, this is my chance to really prove the point. And now the patient has been doing fantastic. He’s going to be one of the stories in our newsletter. He has convinced the director of the hospital that this is very, very important. And they have said, all right, let’s do more research on this and let’s see. I’m going to prescribe cisplatin for a lot of my patients.
yeah let’s start thinking about doing trials for PT before, after, during and it’s amazing because it’s so simple. I was able to talk you through like how do we treat neuropathy in maybe three minutes and that’s what makes me so excited about it is it can be a protocol that’s just as simple as like rotator cuff. Here you go. Yeah and then just apply it to whoever’s in front of you to make it special for them and then you’ve said all right
Elise – @TheOncoPT (31:23.7)
Mm-hmm.
Elise – @TheOncoPT (31:38.445)
Right.
Elise – @TheOncoPT (31:51.779)
Mm-hmm.
Dr. Katie (31:52.766)
Wherever you are, whatever cancer hospital you were treated at, they probably do a really good job of treating the cancer. And you’re here and you’re feeling good. And… sorry. You’re here and you’re feeling. Now we want you to be feeling good. And so now come to PT, come to OT, come to speech. Let us deal with all the side effects and get you back to being you. And that’s what it’s all about.
Elise – @TheOncoPT (32:18.507)
I like you have channeled your giddiness through the computer and I’m over here just like basking in the excitement. If you are so in the case of you now have oncologists who are really embracing this of wow this is really working what can we do to get ahead of this because again we already talked about in this interview that.
neuropathy can be a dose limiting side effect. How would you take this program that you just very briefly walked us through, how would you then adjust that for like a true prehab situation where you are really getting a patient who let’s say they’re gonna be on cisplatin or any of these other neurotoxic agents and they’re at risk of CIPN, but they don’t have anything yet and they haven’t started treatment yet.
Dr. Katie (33:10.351)
So my goal eventually, we all have these big goals for what we want to do with oncology PT, is that as soon as you get your diagnosis you get a referral to PT. You see us, we can say all right this is what they have planned for you, this is what I think you might run up against, let me take your baseline, let me do all this stuff. That’s my ideal world. Again I work in a clinic all by myself. This is not really happening anytime soon where I get every single patient with
Elise – @TheOncoPT (33:19.32)
Yes.
Elise – @TheOncoPT (33:34.404)
Mm-hmm. Yep.
Dr. Katie (33:36.97)
So I work at MUSD, which is, I work at Hollings Cancer Center, which is part of MUSD in Charleston, and we have an amazing media team. And so they have listened to me as I’m saying, all right, we need to do this video and that video and this other video, because part of it is you’re going to go on chemotherapy. There’s going to be a bunch of steroids in there. You’re going to go through your nadir period. You’re going to crash. And then two days later, you’re going to be awake at 3 in the morning going, all right, what do I do now? So at 3 in the morning, you’re going to go on the Hollings website.
Elise – @TheOncoPT (34:02.335)
Mm-hmm.
Dr. Katie (34:05.43)
and you’re gonna pick from our myriad of videos and you’re gonna do a stretching video or you’re gonna do a neuropathy video or you’re gonna do an ankle four-way video. And that’s what we’re doing right now is to educate the nurses on the infusion side and the folks that are with these patients right now who are saying, all right, how are you doing today? We’re gonna hook you up. You’re gonna be here for three hours. Oh, you’re talking about neuropathy? Okay, well, here’s a pamphlet that we have that’s gonna tell you a little bit about neuropathy. Here’s a video, go follow it along.
Elise – @TheOncoPT (34:35.544)
Mm-hmm.
Dr. Katie (34:36.894)
and then if you feel like you need more PT, let’s get you into PT. And it’s been really nice that some of the providers have seen these videos and they have, I have a radiation oncologist who’s just phenomenal and she’s done all these great programs for patients, but she’ll walk down the hallway and watch people kind of limp or have their antelagic gait down the hallway and she’ll be like, I don’t treat you, but do you have neuropathy? Okay great, you’re gonna go to PT.
Elise – @TheOncoPT (34:41.323)
Mm-hmm
Dr. Katie (35:04.942)
So I guess it’s about what can everyone do right now is just be loud. Be loud to the folks who run your institution. Be loud to the neurologists in your area. Be loud to the oncologists in your area and say, hey, we can do this. We’re PTs. This is within our scope of practice. Patients can have this covered by their insurance and it can help your outcomes be better and be stronger.
a lot of the NCI designated institutions are saying, well, how do I have better outcomes? Because I want to rise in the ranks of being an NCI designated place. So if you can say, hey, I can help, that’s a huge thing. And again, this is, yes, I get to do this right now with a cancer hospital, but I started at a regular outpatient orthopedic clinic and started getting their attention this way. And I think sometimes people are afraid to approach
Elise – @TheOncoPT (35:37.759)
Yeah.
Elise – @TheOncoPT (35:50.882)
Mm-hmm.
Dr. Katie (35:57.378)
the surgeons or the oncologists because they think they’re really busy, they’re not going to listen. Yeah, they’re super busy. But they’ll listen and they’ll be really excited and I’ve had oncologists who write me back, head and neck surgeons, and they’re writing me back at midnight after they finish their surgery and they’re like, thanks for seeing my patient. This is great. So they’re just people just like us and just be loud about how we can help.
Elise – @TheOncoPT (36:21.363)
And I really love a story that you, the story that you led with, with all of this is, your patient was the one who ultimately went back and was such an advocate for your services, whether or not they intended to be, but just them sharing their experience of, look at how far I’ve come, look at what I’m now able to do. Physicians listen to that. I mean, if I, you know, and I think that’s sometimes, especially as new grads or like newer to oncology, we very much have that mindset of like, oh, oncologists are busy.
Dr. Katie (36:41.965)
Mm-hmm.
Elise – @TheOncoPT (36:51.297)
leg they probably don’t have time for me. Maybe, maybe not. It’s always worth a try. But one of my best ways that I have found to get in with an oncologist is if I have a patient who gets me in the door first by like, hey, I went to PT and I saw Elise or I saw Katie and we redid this thing or like, now I’m feeling so much better. Like look at what I went and did. Like I went and got to hold my grandbaby for the first time. That, oh my God. Oh my God.
Dr. Katie (37:04.77)
Mm-hmm.
Dr. Katie (37:16.094)
Mm-hmm. 100%. You’re right. Yep. If you can get the patient to advocate for you, yeah, that’s hands down way better advertising.
Elise – @TheOncoPT (37:27.507)
Okay, so when is the CPG coming out on chemotherapy induced peripheral neuropathy? Because I need to get my hands on it, Katie. Like, let’s go.
Dr. Katie (37:36.718)
So I am as a, I just became a board certified oncology PT this year. Thank you and thank you for your help for getting ready for that test. I just did my first CSM this year so I’m kind of getting to know everyone and everyone in the oncology community is phenomenal. There’s so many people and I can’t like I feel like I’m giving my Emmy speech just trying to thank everybody. So whoever can point me in the right direction of how we.
Elise – @TheOncoPT (37:42.324)
Yee!
Elise – @TheOncoPT (37:45.631)
You’re welcome.
Dr. Katie (38:04.174)
come up with another, there is the fact sheet. And the fact sheet kind of puts you in the right step. But there’s so much more that we need to do, especially because right now for even thinking about like your functional outcome measure, when you’re going to give a patient, insurance really likes you to say, here’s your form, fill it out. There really is no good form for neuropathy right now, unless you have breast cancer and then you can use the fact GOG, but it’s not, I don’t love it, but it’s what we have.
Elise – @TheOncoPT (38:08.426)
Mm-hmm.
Agreed.
Elise – @TheOncoPT (38:26.732)
Mm-hmm
Yep.
Elise – @TheOncoPT (38:33.153)
Hahaha!
Dr. Katie (38:35.318)
So whoever can point me in the right direction of saying, yeah, let’s revamp what we have and let’s put this out here. And I’m very excited to do a virtual class for the APTA where we dive deeper into this and talk more. And we’ll all do the massage together and we’ll all do the ankle exercises together. And I’m really excited. I have been trying for the past three years to get this published. So we have…
Elise – @TheOncoPT (38:42.139)
Mm-hmm.
Elise – @TheOncoPT (38:51.499)
Yee!
Dr. Katie (39:01.654)
a case study of two patients with multiple myeloma, and then we turned it into a study of 26 patients with different cancer types, and then we decreased it back down to a study of just 17 patients with multiple myeloma. And unlike the other Katie Schmitt, I cannot seem to get published to save my butt, but I can talk about all this stuff. So if anyone is really good at getting published, let me know. There we go.
Elise – @TheOncoPT (39:26.339)
Call us up y’all. We need to get this KD published. So.
Elise – @TheOncoPT (39:36.074)
I’m just so thrilled, Katie, at…
A, how easily you made it all seem to have a very strategic, implementable process for treating this. Because one of the things that I, and this was several years ago, we may have literally learned more information since it was first communicated to me, but I remember when I was first working with patients in my student clinical internship, the conversation around CIPN was very much like, well, this is what we’re trying, this is what seems to be working for about 50% of our patients.
like if it doesn’t work, then we’re kind of out of options. And it was very much, it’s so exciting to now in 2023 be having this conversation about.
These are some strategies that are now working better, that are better informed because of research. We’re also seeing this work very well clinically, and I will definitely be implementing this ASAP in my own practice. It’s just so exciting that over the past five years of my practice, I’ve been able to see these changes for the better of really actually being able to show up and treat patients and not just have this like, well, we hope it works.
Dr. Katie (40:52.979)
Yeah.
Elise – @TheOncoPT (40:53.403)
If not, sorry.
Dr. Katie (40:56.066)
That’s always the thing that’s really scary as a PT and as a new PT and as a new PT and a specialty. And I always remind myself when I was in, I think it was my third clinical and I was treating a patient with sciatic nerve pain and you’re like, okay, just trust me. Give me a few more weeks because I know that I’ve read the literature that says if I dry needle you here and if we do some clamshells and if I work on your glute med, it’s going to get better.
And that’s one of the things that I can now confidently say to my patients is I say, all right, the first week you’re going to feel something. You’re going to be like, yeah, all right, my feet feel a little bit different. Weeks two, three, four, you’re going to be like, I don’t know. Is she right? I don’t know. I can’t trust this girl. Stick with it. Week five, week six, week seven, that’s when you’re starting to walk more. That’s when you’re starting to go out and do the things that you want to do. That’s when the sheets don’t bother your feet at night. And so I think coming together as an oncology PT community and saying, all right,
Elise – @TheOncoPT (41:44.62)
Mm-hmm.
Dr. Katie (41:52.506)
let’s try this and let’s try this in Colorado and let’s try it in Texas and let’s try it in Carolina and let’s try it in New York and then all coming together and saying hey we’re of the mindset that this is working and if someone’s out there and they’re saying you know what I went to CSM and I do this already and it’s great and then I also added stereo agnosis where I draw letters on my patient’s foot and that’s really helpful we can just make it stronger and stronger and then that gives you the confidence to say yeah.
Trust us, we’re this big hive mind of oncology PTs and we know that this works, not because we want it to work and not because we just think it’s really cool, but because we have the proof.
Elise – @TheOncoPT (42:35.415)
What kind of advice or what key points would you encourage newer oncopTs to include within their treatment plan for a patient with CIPN? We kind of talk through like, here’s your week by week step. What are maybe some things that like we tend to forget or we accidentally don’t include in our plan that we should?
Dr. Katie (42:56.938)
Yeah, I know that looking at all the research, I’m bad at reminding patients to have the aerobic part of it. I get about 40 minutes with my patients. I’m spending a good 23 minutes on the manual therapy part of it, but having tap into what your patient likes to do as far as is it a walking program? Is it a cycling program? Is it, do they like to, I don’t know, roller skate? Or are you dealing with a lot of cancer related fatigue on top of the neuropathy and you’re thinking, okay,
Elise – @TheOncoPT (43:10.916)
Mm-hmm.
Elise – @TheOncoPT (43:16.364)
Mm-hmm.
Dr. Katie (43:25.13)
I have a patient who’s really deconditioned, they’ve been through some stuff. How do I also have an aerobic portion? Teach them about the six minute walk test, make them do it around their kitchen island. And tapping into knowing what your…
Elise – @TheOncoPT (43:34.423)
Mm-hmm.
Dr. Katie (43:41.638)
guess what your limitations are in your clinic and then seeing what kind of patient you have so that you can say all right I really want to do I know that it’s manual it’s a TheraBand exercise it’s balance it’s stretching it’s aerobics I really want to do this because I’m good at it and I can help my patient with it and then I’m gonna lean into my patient to do some of this other stuff and I’m gonna lean into the caregiver because I find in the cancer setting like patients have had this trauma thrust upon them
Elise – @TheOncoPT (43:59.176)
Mm-hmm.
Dr. Katie (44:11.21)
and they don’t get to decide a lot of stuff. Like you’re gonna do this drug, now you’re gonna do this, now you’re gonna do this. So you can come to them, and I really learned this a lot more with my pediatric patients. If you give your patient, you say, all right, here’s everything that I wanna do to treat your neuropathy. What do you feel like you’re gonna be really good at? What can I trust you to take charge of so that I can focus on some other stuff? And then you’re giving them this sense of control over a situation they didn’t have control over before.
And I’ve had patients take that and run with it. I had a patient who was like, every week I’m going to graph my pain at 9 o’clock and at 3 o’clock and at 6 o’clock and we’re going to come up with all these really cool ways to figure out how I’m feeling on days that I’ve done the neuropathy massage and on days that I’ve just done the stretching. Like, this is phenomenal. So tap into what your patient really likes and what you can give them control over and what part you can have them play in it and their consistency with this.
goes up and then they start to get really good at stuff. And kind of like with the oncologist, then they’re telling their neighbors and they’re telling people at the supermarket, like, oh, hey, watch this video, we can fix your neuropathy. And it’s so cool when people take it and they run with it.
Elise – @TheOncoPT (45:16.654)
Mm-hmm.
Elise – @TheOncoPT (45:26.615)
So you’ve been talking about different resources throughout this interview. So where can people go and like watch those videos that you’ve been talking about?
Dr. Katie (45:36.578)
Sure. So they can go to my website. It’s Dr. Katie DPT, pretty easy. And there’s the neuropathy massage video and there’s the ankle four-way video and within the next few weeks there will be a video for the hands because this does also work really well for the hands. And there will be the protocol. I’m going to, like I said, I’m having a hard time getting this published so I’m just going to put the protocol up on my website and there it is. Everyone can follow it. There’s also, I work for the Medical University of South Carolina. It’s Hollings Cancer Center.
Elise – @TheOncoPT (46:00.578)
Love it.
Dr. Katie (46:06.738)
my media team is fabulous. So if you look up Hollings Cancer Center Physical Therapy, you’ll come up with our page, which is a big picture of me working on someone’s foot. And if you scroll down to the side, there’s our YouTube channel. And so there’s videos for the neuropathy massage, for the ankle four-way video, for balance, for…there’s videos for graft versus host disease stretching, for post breast cancer exercises. And I think that YouTube has become…
Elise – @TheOncoPT (46:23.923)
Yay!
Dr. Katie (46:36.006)
such a great resource for patients. And COVID is not a good thing, but COVID was a good thing because it’s taught people to be a lot more internet savvy. So even your folks who are like, oh yeah, I’m 87 and I watch TikTok all day long. Like this is phenomenal. Great. Go do the video. And we’re getting more and more great videos out there that people can trust and it makes it easy for them to do on their own. And it makes it easy for them to do it two in the morning when they’re like, okay, my steroids kicked in, now what?
Elise – @TheOncoPT (46:39.372)
Yes.
Elise – @TheOncoPT (46:46.655)
Mm-hmm.
Elise – @TheOncoPT (46:52.483)
great.
Elise – @TheOncoPT (47:06.411)
Bingo. Oh my gosh. I will of course be linking to those in the show notes. Is there anything you would like to leave people with today, Katie, as we close out our interview?
Dr. Katie (47:20.194)
I guess two things. First, please go rub all of your patient’s feet. It definitely is going to help. If you don’t like touching feet, my student has come up with, she likes to say, oh I caught myself on vegetables and she’ll put on a pair of gloves or she’ll have a towel on her lap so that way she can you know do it in her own way and it doesn’t make the patient feel bad. And then B, you have so many people who listen to your podcast and it’s such a great podcast and
I’m gonna ask everybody out there, find what you really love. I made a model of the foot when I was still a student to figure out how the Achilles tendon twists into the calcaneus, and that kind of led me down this road. Figure out what you’re passionate about it, and please dive into it, be nerdy about it, and then share it with us, because we need to know what to do with all those other topics. Like, yeah, I’ll talk about neuropathy all day long.
thoracic spine rib pain or some neck fibrosis? I’m gonna turn to the research, but I need you to be excited about it and tell me what to do. Yeah.
Elise – @TheOncoPT (48:24.143)
I love that. And y’all know we’re all nerds on this podcast. So like lean into the nerdiness because we need more of it.
This conversation was long overdue, Katie. Obviously, A, to have you on the podcast, but B, like I said, this is the first time that I genuinely had someone sit down and talk me through the physiological changes of what happens when a person is developing CIPN, but then truly tying that into very purposeful intentional interventions.
Oh my god, like talk about, again tying it back, talk about like the nerdiness leaning into that becoming a very… Like
feasible logi- like it’s a very logical logistic way to implement a very standardized pathway for something that bothers patients a lot and affects not only their quality of life, but potentially also life expectancy for some of the ways that we’ve talked about. And that’s really, really important. And so it makes me very excited to think about again, like I’m getting giddy again, to think about we have a better plan because of what you’ve taught us today and how we can address
that for our patients to ultimately get them back to what they want to do and what they love to do. And that like that just gets me fired up. I’m just so excited about that.
Dr. Katie (49:51.406)
whole point. Like you go into being an oncology PT and you want to just get someone. We all probably have someone in our families or in our lives who’s had cancer and you can see the things that they can’t do anymore. And so you as the oncology PT get to say, you know what? You can do this again. And that’s what it’s all about.
Elise – @TheOncoPT (50:08.779)
That’s my favorite part. Oh my God. Katie, this was wonderful. We will definitely be having you back on the podcast. We’ve got like as you were talking, I’ve thought of three more interview topics to have you on, so you’ll definitely come back. Don’t worry. Where can people follow you, connect with you if they want to keep this conversation going?
Dr. Katie (50:11.771)
Yeah.
Dr. Katie (50:30.506)
Yeah, definitely check out my website, DrKDDPT. You can send me an email through there. It’s also drkddpt at gmail. You can send me an email through there. And then I am on Instagram, but it’s usually pictures of like the ocean or furniture that I’ve made, so it’s not usually neuropathy stuff, but you can find me on there too.
Elise – @TheOncoPT (50:50.904)
Well thank you so much Katie, I really appreciate your time and again like you have such a gift for explaining things in a really easy to understand way I’m really grateful for that so thank you so much for coming on here and sharing all this wealth of information for me and my listeners.
Dr. Katie (51:07.118)
Thank you.
Dr. Katie (51:11.69)
This has been so fantastic and again, I can talk about this all day long and if anyone has a question or if you’re like, you know what, I went on and I looked at the video and I still can’t figure out the whole metatarsal thing, shoot me an email. We’ll have a conversation. We’ll spend half an hour working on stuff and that way we can all just treat people even more.