When Amy Driga developed tendonitis in her wrist as a teen, her doctor told her to stop doing two things she loved, playing piano and playing flute. He also referred her to an occupational therapist (OT). The OT took a different approach.
“She asked, ‘Do you like piano and flute? Then why would you quit?’” recalls Driga. The occupational therapist fitted Driga with a splint, gave her stretching exercises and got her back to making music.
The experience was formative for Driga. She knew, then and there, that she wanted to be an occupational therapist, too. “This woman was saying, ‘I want you to do what’s important to you, let’s make that happen,’ rather than saying, ‘No, if it’s a problem, stop.’”
In 2019, Driga will celebrate 20 years of work as an occupational therapist at the Cross Cancer Institute, where, alongside other team members in the department of rehabilitation medicine, she helps people deal with the physical and cognitive issues caused by cancer or its treatment, so they can do the things that are most important to them again.
The issues Driga treats are wide-ranging. Among them, she helps patients manage pain and fatigue, fits patients with walkers or other mobility aids and sees patients whose cancer has affected their movement. Driga works closely with physiotherapists, speech therapists and assistants in the department to give patients treatment that addresses their specific needs.
The needs, aims and goals of patients in rehabilitation can vary greatly. Patients may be aiming to be able to play with their grandkids, walk a dog or, if you’re Kimberley Boulton, run a marathon.
Boulton was training to run a Boston-qualifying marathon time of under three hours and 35 minutes when she was diagnosed with breast cancer at age 32. In 2015 and 2016, she had a mastectomy, chemotherapy and radiation. She lost some range of motion in her arm due to initial treatments, and again when scar tissue caused tightness. Both times, she turned to rehabilitation services at the Cross, which she says alleviated additional financial hardship since the rehab is covered by Alberta Health Services and ensured the best possible care.
“Another physiotherapist wouldn’t necessarily have experience working with someone who had been through cancer treatments,” Boulton says. Now cancer-free, she has run two half marathons, one full marathon and has completed the 200-kilometre Enbridge Ride to Conquer Cancer since finishing her treatments.
Of course, not everyone has a marathon goal. Driga’s occupational therapy focuses on day-to-day living and preparing inpatients for hospital discharge. The rehabilitation department has a kitchen and a bathroom where Driga and other OTs help people find new ways to perform everyday tasks. For example, someone with brain cancer might have weakness on one side of their body that makes daily tasks difficult, much like a stroke patient. Driga will use kitchen props, including a dishwasher and stove, to help assess and build strength.
“Can they load things?” she says, giving an example of the types of questions she asks while helping patients as they use the kitchen props. “Can they grab? Cognitively, can they remember to turn the burner off after they’ve used the stove? Is there anything that helps make holding a utensil easier? How can you keep doing the activities that you need to do, and want to do, if you have impairments?”
Answering this last question means rehabilitation at the Cross Cancer Institute is tailored to each patient, no matter where they are in their cancer trajectory. Patients can also self-refer for occupational therapy and speech therapy, meaning they can call rehabilitation at any time during or after their cancer treatments, without requiring a doctor’s note. In one day, Driga might fit someone with a walker or other mobility aid, lead a class on managing cancer-related fatigue and cut a foam chunk into just the right shape to make sitting more comfortable. “It’s a combination of science and arts,” she says. “You have to be really creative.”
A lot of science, and a little creativity, will help Boulton again this fall. She has one final reconstructive surgery and, backed by the rehab team at the Cross, she will keep her eyes on the prize during recovery.
“I’m stubborn,” she says. “I will never, ever give up on my Boston goal.”
Patients outside Edmonton and Calgary can access rehab services closer to home, thanks to the Jack Ady Cancer Centre (JACC) in Lethbridge and the Central Alberta Cancer Centre (CACC) in Red Deer.
Physiotherapist Alexander Grant has been working with the JACC rehabilitation program since it opened in 2015, thanks to an enhanced care grant from the Alberta Cancer Foundation. He says it’s “wonderful” that people in the south zone can get treatment without driving to Calgary.
Grant frequently treats lymphedema, the chronic swelling associated with many cancer treatments. He also helps with sensory and balance issues after chemotherapy and does rehabilitation for people with head and neck cancers. Grant, along with the physiotherapist and occupational therapists at the CACC in Red Deer, are all certified lymphedema therapists, a condition most physiotherapists aren’t familiar with treating. “All fully licensed physiotherapists in Alberta are licensed to treat lymphedema,” Grant says. “But the extra training and certification I have allows me to use more specialized treatments and provides more specific training in clinical decision-making. This is especially useful for complicated cases of lymphedema. We also have specialized equipment to help us treat and diagnose, that you wouldn’t otherwise find in another physiotherapy department.”
Whether they’re north, south or central, the cancer centre rehab teams collaborate to provide patients with the best possible care. “Having a specialized service means we’re connected to all the other oncology rehab sites across the province,” says Grant. “Whatever research is going on, whatever methods they are using, we’re keeping up, to provide the same standard and knowledge.”