October 2015


Blog and PT shop talk27 Oct 2015 09:04 am

This was the first article I published in Advance Magazine for Physical Therapists… it led to the crazy idea of writing a book and publishing other articles!  It has been quite an adventure…

Reversal: When Therapists Become Patients

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We see patients every day. It’s real easy to forget they are people too, not just another “total knee” or “laminectomy”. Ever patient has a story. When taking a history how well do you really get to know your patients? I always used to wonder what they were going through, what things were like for them. I came to the seemingly obvious realization that a diagnosis affects people more than we know outside of the controlled therapy sessions. There are so many other factors involved in Rehab other than just mobility. I had to live through my “discovery”.

I graduated from Physical Therapy school at the University of Michigan- Flint in December 2003. I moved to San Diego, California a month after graduation in the hopes of finding a great job, an active lifestyle, and a nice girl. I found almost everything I was looking for in San Diego, but then I got some stunning news last September. I was diagnosed with a golf ball sized brain meningioma on my Tentoral membrane. The tumor was applying pressure to my brain stem (specifically the Pons) and my cerebellum. I was having severe symptoms of dizziness and nausea before I got things checked out. I had just started doing more swimming and surfing.   At first I thought I had an ear infection or maybe a Vestibular Problem, nothing too serious. Then I started getting headaches and nausea. That’s when I knew something wasn’t right.

According to the American Cancer Society 2% of all cancer related deaths were attributed to brain cancer. Males have a 0.66% lifetime risk of being diagnosed with a primary malignant brain tumor and a 0.50% chance of dying from a brain tumor. (1)   But men are at risk none the less, I never thought it could happen to me. It did. Meningiomas are the most common type of primary brain tumors at 27.4%.  (2) Meningiomas affect mainly elderly African-American women.(3) The Glioma family of tumors account for 44.4% of all tumors, with Glioblastoma being the most common type of Glioma at 51.9% and Astrocytoma representing 21.6% of all Gliomas.(2)

I’ve never been sick before. I always thought my first surgery was going to be orthopedic, not neuro and not so soon. I figured I’d have surgery at the hospital where I used to work because I knew the staff pretty well and I was familiar with how things were run there.  After much deliberation, I also chose to do my rehab where I used to work because I didn’t want to be alone and I knew I would be in good hands. When I first moved to San Diego I was torn between working in a hospital vs. working in a private clinic. I chose the hospital. I’m glad I made that decision because not only did I meet a lot of new people but it also opened the door for many other work related opportunities.

Knowing the staff where you have surgery has its perks and draw backs. (See side bar) I got the best treatment, but I also had a lot of visitors. I liked the friendly atmosphere, but it left me with very little privacy. The only awkward moments I had were taking showers with the assistance of the CNAs. It took me a few weeks to get used to that. I’m a pretty shy guy, and then I figured they see naked people all the time. At least none of my friends / old co-workers would see me naked!

Pros and Cons of going through rehab where you work (could be a side bar)

Pros

  • You’ll get the best care.
  • Your co-workers will be great advocates for you
  • Lots of support.
  • You’ll be familiar with protocols/policies and procedures.

Cons

  • So many visitors, very little privacy.
  • Your co-workers will see you at your worst.
  • It’s like you’re still going to work.
  • Different perceived roles with your co-workers.

 

The hardest thing for me to deal with in rehab was knowing what needed to be done to progress, but not being able to do it. I was discharged in a wheelchair to my apartment with my dad in early December. My dad had just recently retired so I would have someone with me at all times. He spent over 6 months away from home in Michigan to stay with me in San Diego. This in itself was a huge adjustment. I’m used to being on my own and doing things by myself.

I really think it was harder on my family than it was on me because I knew what to look for in terms of progress. I had to explain to my dad every day that things were going well, specifically with weight shifting and balance. He would only look at the big functional goals like walking distance and speed. It was tough trying to tell both my parents to stay patient because I shared their impatience.   They were so used to cheering me on as an athlete that I think it was a difficult adjustment for them to make.

I turned to my old co-workers for support once I started outpatient therapy. Actually they were the ones that took me out to happy hours and would help me escape my overprotective parents. We usually kept things professional during my therapy sessions. Sure, we would joke around, but there was mutual respect on both sides. What I really appreciated was my therapist asking me what I wanted to work on at the beginning of each session, while still setting certain objectives each session. I also appreciated the feedback on the identification of my impairments so I could attempt to correct them. Sometimes we get so used to telling patients what to do, we forget to tell them why we are doing certain activities. Setting my own goals really kept me going. The goals I set for myself helped me to focus on what I needed to do.

Things to remember when working with patients 

  1. Check-in periodically – Always ask their opinion on how they feel things are going
  2. Involve them in the treatment planning
  3. Help them set attainable functional goals
  4. Explain why they are doing certain activities
  5. Listen to their concerns. Don’t forget they spend more time with you than with their docs.
  6. Remind them that maximum progress is made outside of the therapy sessions through their HEP.

People ask me how I dealt with everything. My response to them is every day was different with new challenges. I know this is a cliché, but I had to take it one day at a time. I would wake up every morning and certain things would be a little easier. Each day brought a different challenge. Treating and beating each new challenge individually made the days go by faster. I never let go of the belief that I’m still a regular guy. It just takes me a little longer to do common everyday activities. I literally grew to hate the wheelchair and the walker so I would force myself to progress. I’m also still a pretty immature guy so I took the time to laugh at myself and all the difficult situations I put myself in.

I can’t even imagine going through rehab as an elderly adult. I have so much respect for them. The physical and psychological demands were enormous on me, an active young man. Their stage in life would obviously bring about different challenges/goals.  The biggest realization I made was that when patients go home, their impairments go with them. Unlike us, they get no vacation or breaks from the impairments. We get to go home at the end of the day and leave things at work. Putting on my shoes as a patient has definitely opened my eyes as a therapist.

Sources

  1. Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Edwards BK (eds.) Seer Cancer Statistics Review, 1973-1999: National Cancer Institute, Bethesda, MD, 2002.
  2. Report, Primary Brain Tumors in the United States, 1992-1997.
  3. http://www.emedicine.com/NEURO/topic209.htm
Blog and rehab26 Oct 2015 02:21 pm

2015 eric rebirthdaySunday was the 10 year anniversary of the brain tumor surgery that changed my life forever.   I wanted to celebrate, but honestly I felt like I was in a “funk.”  Maybe it was PTSD or a bout of “Survivor’s Guilt” because I finally had some time to sit down and reflect on things.  In the past 10 years, I’ve gone from young physical therapist to rehab patient to author to survivor advocate to nonprofit professional.   It has been a crazy ride!  I’ve met so many great people, but at the same time I’ve LOST so many good friends to tumors/cancer.  It doesn’t get any easier losing people.  I’ve noticed that many other advocates do not have as hard a time dealing with this.  I wonder how they do it.  Memories of the friends we’ve lost live on, but at the same time I always lament the potential new memories that we could have shared.  I have always had a hard time saying goodbye. I have gotten close to a number of survivors because we have so much in common. It has always been easy for me to form these bonds.

As a physical therapist, I always referred patients to other people/professionals if I couldn’t help them.  Often, I would never hear from them again.  However in cancer advocacy/ social media, we often get updates on how survivors are doing.  Of course, I like hearing the good news or seeing the funny things my friends share on social media.  However, whenever I hear of a friend passing or struggling… it always hits me hard.  It inspires me to work harder, but at the same time it hurts.  I didn’t think that it would hurt this much, but it always makes me sad thinking that I put my family and friends through a similar situation.  I naturally get close to people all the time because I like to joke around with them and always try to listen/learn something new from people.

Maybe this “funk” is “Survivor Guilt” because part of me still feels very lucky to be able to do the things I do.  I do realize that my situation could have been much worse.  Based in the location of the tumor, I could have woken up from surgery on a permanent mechanical ventilator or even stuck in a “vegetative state.”   I feel that my prior and current physical activity level may have aided in my recovery, but I am still very curious about HOW I am able to do so much after major brain surgery.  Thank goodness my cognition wasn’t impaired so I can discover how I was able to do this!  I think that exercise/physical activity made my recovery more efficient, by perhaps increasing blood/lymphatic circulation or somehow exercise makes the neurons more efficient.  Everything I’m doing now is to honor those of us that had to deal with a tumor/cancer diagnosis AND make things easier for future tumor/cancer patients.  I support early detection/prevention, but there is still a very large need for resources for newly diagnosed patients and ALL those who are affected by a tumor/cancer diagnosis.  My “funk” is temporary, but I’ve learned to use it to fuel my activities.  I’m truly sorry for scaring my family and friends 10 years ago.  I can’t even imagine what you went through… Thanks for having my back all these years, I’ll make you proud…

Please support my quest to teach the world “How to Kick mAss” next year.

More exciting things are in the works!   STAY TUNED!

Blog and rehab24 Oct 2015 07:56 am

9781450224284_COVER.inddThese are my thoughts before major brain surgery 10 years ago.

Thursday, October 20, 2005

Looks like the incision is going to be bigger than I initially thought it was going to be… All the way around my ear. I’m told that the hair will grow back, but maybe I’ll just keep it shaved all the time now. Yesterday morning I threw up twice. I couldn’t keep anything down. Luckily, I had another appointment with the neurosurgeon that afternoon. He took me off of prednisone and is starting me on dexamethasone, another steroid. I’ve heard some nasty stuff about the side effects. I’m gonna try to stay off the medication as much as I can. But sometimes I really need it.

In case you are wondering what I’m going though, imagine the worst hangover you’ve ever had… the unsteadiness, the feeling of nausea, and the headache… add a little numbness on your left cheek and tongue and there you have it. Now grant it, I’m not like this all the time, but there are some mornings when the only reason I get out of bed is to rush to the bathroom to throw up. The steroids help immensely, but on the days I’m off of them… yuck. Not pleasant to be around… I have a hard time walking a straight line, but I can do it if I go really slow. Everything moves really slow, not like elderly person slow, but definitely slower than normal. Now would be a good time to race me if you want to win.

I’ve kinda shifted my focus from movies to reading. Currently on: Lance Armstrong’s It’s Not about the Bike, Harry Potter The Half Blood Prince, and the Essence of Swiss Ball Training. Definitely not bored anymore. Thank God I’m not bored. I almost watched the Olivia Newton John roller skating epic Xanadu earlier this week! Damn! That definitely has to be my lowest point. When I realized what I was watching, I was like “OK, I need to put an end to this downward spiral!” You can only watch so much TV and that was my breaking point. I also found out I suck at video games. In Halo I keep running into walls, in Madden I can’t pass or play defense, in racing I can’t take turns without hitting the wall… I wasted too much time the past few years “playing” outside or going to the gym so I’m a little behind in my gaming skills…

As for my mental state… honestly I think right now I’m more worried about the Foley catheter. You would be, too, if you knew where it goes and how it gets there. (It’s basically a tube they stick in your penis that runs to all the way up to your bladder to help with urine excretion.) I’ve been told that I’ll probably be out when they put it in, but I’ll wake up with it in me and I’ll be awake when they take it out… that’s gonna hurt =(

Dude, I’m gonna be buck naked in front of bunch of people. I don’t know how I feel about that! I don’t like being naked in front of myself, let alone 10-15 strangers! Hopefully I’ll at least get some cute nurses to take care of me… My OR time is from 7:30 to 3:30… Jeez, that’s got to be enough time to get everything! It seems like a long time to me. I wonder if they take coffee breaks or lunch breaks.

Anyways the reality of brain surgery is finally sinking in. I’ve had 2 pre-op appointments this week. I guess there is a serious chance that I might lose the hearing in my left ear. Apparently they will cut into the Mastoid and Temporal bones. They are trying to avoid the semi-circular canals if possible, but if they can’t access the whole tumor they will need to go through the semicircular canals to get everything. If that happens, there is a 99% chance I lose the hearing in the left ear and I will definitely have more problems with dizziness for a few more months.

Kinda sucks that the initial problem that I was having could be a side effect for the treatment of the tumor. Well, at least I have another ear and I won’t be completely deaf. Whoa. This is real, no more talk… this is gonna happen! So on Saturday, I’m going to SeaWorld to take my mind off of things. Sunday will be another day of football. Monday will be my quiet prep day. I guarantee I’ll feel like shit DOS (day of surgery), but Wed POD 1(post-op day 1) I should be able to take visitors. Probably not for too long but it will be nice to have visitors. By Thursday I should be much better and able to tolerate more. No crazy bar hopping or anything, but maybe a friendly game of “Cranium.”.. har har har.

 

Monday, October 24, 2005

Looks like I’ll get admitted tonight. Just got a call from the hospital. Was supposed to go in at 5AM tomorrow. Slight curveball. I know a lot of you wish you could be here with me. I’ll strike a deal. This is the playlist I’ll be listening to tonight on my iPod. Just play one of the songs and you’re there with me.

Lose Yourself -Eminem
Mr. Brightside – The Killers
It’s So Easy – Guns N Roses
Breakout – Foo Fighters
Higher Ground – Red Hot Chili Peppers
Gold Digger – Kanye West
Jesus Walks – Kanye West
Ready or Not –The Fugees
Superstition – Stevie Wonder
In the Air Tonight – Phil Collins
A Little Respect – Erasure (don’t laugh)
The Promise – When in Rome
Only You – Yaz ( I like these song OK!)
Don’t Stop Believing – JOURNEY!
Blaze of Glory – Bon Jovi
THE FINAL COUNTDOWN – EUROPE!

See what happens next… pick up the kindle edition of Reversal:  When a Therapist Becomes A Patient… Only $9.99 AND 100% of royalties go to mAss Kickers Foundation.

Blog and mAss Kickers news and reviews19 Oct 2015 05:44 pm

The 2015 Celebration of Life was this past Friday.  A group of tumor/cancer survivors created this event five years ago to say thanks to the people that were there for us during the most difficult times in our lives:  our family, our friends, and fellow survivors.  This year Patti McDonald, Vi Ariola, and I did the toasts.  We showed the latest Tumors Suck videos.  It is getting harder to get people together because everyone is very involved in a variety of different organizations, most notably: Relay for Life, Leukemia and Lymphoma Society, Stupid Cancer, and First Descents.  We welcome ALL to come and celebrate another year together!  The purpose of the “Celebration of Life” is to formally say thanks to the people who were there for us in the most difficult times in our lives!  We rarely get to do that.  I don’t think I ever officially said “thanks!” to all my supporters.  We formally recognized them by honoring them with toasts.

Something strange happened that night…  I’ve noticed that I always get choked up whenever my family is there for a presentation!  My mom, my dad, and my brother went through so much because of me.  It is very humbling.  Somehow I got them to write “essays” about their experiences with having a loved one going into surgery!  Very surprised they did it!  When they aren’t present for a talk, I’m fine.  I still can’t believe how strong they were for the situation I put them in!  I’ve spoken at numerous universities, hospitals, ceremonies, and events all over the world, but put me in front of the people that were there for me when I was “lost”… I get very emotional.  I can’t help it! I was confused, scared, and for the first time in my life not confident.  I’ve noticed that I now wear my emotions on my sleeve, which is funny because before surgery, I was a very stoic guy!  When I’m excited about something, you can tell. I’m also more apt to have an emotional responses to heart-wrenching stories.  I always blame my “allergies” when that happens.  The past year was particularly tough losing a couple close friends to brain tumors.  It does not get any easier.  There is a part of me that realizes how close I was to leaving this world or having severely debilitating side effects.  It is very humbling.  I strongly believe that my prior and current physical activity level played a very large role in my survivorship and subsequent “thrivership”.  I’m VERY interested in WHY my survivor friends who are physically active tend to do better after treatment.  I’m very curious.  The human body is not supposed to be stationary. I think that there must be some relationship between physical activity/exercise and post oncology treatment quality of life.

Anyways, after a very busy September of traveling, I can finally rest!  Actually this week, I’m experimenting with the Google hangout in a classroom setting.  I’ve done it a couple times, but I’m still trying to perfect it!  Then I can rest!  I will try to take some screen shots and post it on facebook!  Starting to plan MKF activities for next year!

Blog and Random blog12 Oct 2015 10:45 am

The Golden Gate Bridge in San Francisco, CA at sunset.Last week, I went up to San Francisco because flights were so cheap!  $75 each way! I had a very packed trip!  10 years ago was actually the last time I got drunk, but I like this song about San Francisco!  I spent the summer in San Francisco Bay area before PT school.  My younger cousin, Mike – who I haven’t seen in over 10 years, picked me up from the airport.  Then we went out to dinner and caught up on everything.  It was cool catching up with him!  He was one of the “little” cousins when we were growing up.  He’s an attorney now.  I was very impressed with all he’s been able to accomplish!  After a late dinner, he dropped me off at my friend, Natalie’s place in SF.  To make things more exciting, her place was located on a big hill, with a big flight of stairs to her apartment!  On top of that, the bathroom had an old school clawfoot tub giving me another challenge!  Good thing I never shy away from challenges… hee hee hee!  I crashed on her couch and took an Uber car to Fisherman’s Wharf for a lunch meeting the next morning!  I got there early and explored Fisherman’s Wharf on my own.  The last time I was there was ~15 years ago!  I remembered going to a magic shop and trying to learn how to do magic tricks so I could impress my friends with my magic skillz.  The problem is I’m not very good at deception.  I suck at doing magic, but it is pretty funny to see how pathetic I am! I also stopped by a puppet shop. It conjured up memories of constantly messing with people with my koala puppet!  I’m sure it was annoying, but I cracked myself up… For lunch, I met up with Samantha from the SAMFund and Erard/Mitch from the Belgian organization, Esperity. We had lunch at Fog Harbor Fish House and had a great view of the Golden Gate Bridge and Alcatraz.  We were pleasantly surprised to be able to watch the Blue Angels practice their show for Fleet Week.  After lunch we walked around Pier 39 and I got to hangout with the Esperity guys.  We def eat too much whenever we get together…  I took another Uber car to back to Natalie’s apartment and took my “siesta” before dinner at Stem.  We met up with a bunch of SF survivors and the Esperity San Francisco team and ate yet again!

metreonOn Friday, I was invited by Esperity to attend a meeting at Impact Hub, a co-working space filled with entrepreneurs.   It was very interesting to see how they run their meetings.  I was planning on visiting another PhD program at UCSF, but I completely forgot that it was a holiday weekend.  Most of the faculty I needed to meet with were gone.  I had lunch with the Esperity San Francisco Team and caught a movie at the Metreon in downtown SF.   I went there often when I spent a summer in SF before PT school!  I saw The Martian, then an old friend from undergrad picked me up. We picked up dinner and took it back to his place in San Mateo to see his family.  I went to college with Roger and his wife, Suki, so it was great to catch up with them and meet their kids!  Later that evening, when the kids went to bed some other old friends from college met up with us.  They act exactly the same, but a little older and with kids!  The evening was filled with lots of laughing/reminiscing about all the stupid stuff we used to do in college!

TSP52015.10.9C

The following morning, we had breakfast and more old friends from college came over to watch the Michigan-Northwestern football game. It was so cool seeing my college friends as parents.  It actually was the first time I met their kids!  Too funny!  I always like holding conversations with the kids because I could definitely see the personality traits/influence of their parents in them! My flight to San Diego was delayed because President Obama was in SF, so I was able to hangout a little bit longer.  I was exhausted because I delayed my daily “siesta”!  I like getting to the airport early in case any problems arise… I never know how things will go with passing security and gate checking the mAss Kicker Mobile!  I grabbed a bite to eat at the airport then took my siesta.  It was a busy trip, but great to meet up with family, old friends, and oncology advocates.

Pictures from Day 1

Pictures from Day 2

Pictures from Day 3

This week is the Celebration of Life in San Diego.  I’ll be doing a toast this year to honor the people that stood by us during and after treatment!  Will be a great night!  I want to recognize all the people who have been there for me since the beginning and honor them with a toast!  Please try to stop by!  But if you can’t make it, please consider a tax deductible online donation!  Click here to donate online to support mAss Kickers Foundation activities next year!  More international travel is in the works, but still hammering out the details!

I’VE GOT EVEN MORE COOL STUFF IN THE WORKS! hee hee hee… Make a donation and I’ll fill ya in!  I’m realizing that mAss Kickers Foundation is definitely going to need more official help next year!

Blog and reviews05 Oct 2015 10:18 am

unc-chapel-hill-logoMy first trip to UNC-Chapel Hill was packed!  I am very interested in their PhD program in Exercise Physiology with an emphasis on post-oncology treatment exercise/physical activity.  I’ve noticed that most of the post treatment “thrivers” that are physically active after treatment are actually doing quite well.  I always wondered why.  Are they more physically active because they take advantage of what they can do (thrive) OR are they able to thrive as a result of their physical activity?  There must be some correlation between “post-treatment thrivership” and physical activity and exercise…  I do know that exercise/physical activity has benefits. In Physical Therapy school my research mentor, Dr. Jacqueline Drouin, looked at the Effects of Moderate Intensity Exercise on different parameters in Women Undergoing Radiation Therapy for Breast Cancer.  I was initially drawn to her research before my brain tumor diagnosis because sadly my family has been affected by cancer on multiple occasions!

Anyways, I was very fortunate to know a few people in Chapel Hill who could help me navigate the campus.  My cousin Nick Galvez (who is also a physical therapist) picked me up from the airport and dropped me off at my friend Dr. Carmina Valle’s place.  Carmina is a professor in the UNC School of Social Work.  She was gracious enough to let me stay in the guest room of their house close to campus.  I had a very busy schedule because the following day:  I was going to lecture at the DPT program, then talk to someone about returning to school for a PhD, and then explore the accessibility of the campus in Chapel Hill. On top of that I wanted to meet the members of the North Carolina chapter of the Philippine Nurses Association. The campus reminded me of Ann Arbor with the historic architecture, the rich traditions, the school pride, the rivalries, and the restaurants. It is a great College town!  After my meeting I got to meet up with some old friends from First Descents for dinner at this fancy-smancy restaurant in Chapel Hill.  It was great to catch up with them!  After dinner, they dropped me off for dessert at the house of a member of the Philippine Nurses Association.  It was great meeting with them and there is def a sense of family in that community!  I def felt like I was at an uncle or auntie’s house!

dept of exercise and sport scienceOn day 2, Carmina gave me a driving tour of the UNC-Chapel Hill campus before she went to work.  It definitely reminded me of Ann Arbor!  Later that morning, I had the opportunity to attend a presentation at the School of Social Work by Dr. Ted Trimble, Director of the Center of Global Health at the US National Cancer Institute.  It was very interesting to see that internationally there are many cancers associated with obesity.  Diet and exercise play such a large role in overall health and well being.  I personally am addicted to SUGAR, but at least I’m more aware of it when I eat.  I’m doing better limiting my sugar intake, but the Western Diet is so high in sugar.  Seriously, start reading labels… notice that there is no “Recommended Daily Allowance” for sugar!  That’s kinda weird… I started out by eliminating carbonated drinks and limiting my cookie/dessert intake, but I’m still trying to figure out how to decrease my overall sugar intake.  I have noticed that almost every processed food has some form of sugar in it!  Even the “heathy ones”!  Later in the day, I got to meet with and check out Dr. Claudio Battaglini‘s lab.  He is really cool guy looking at the role of exercise post oncology treatment.  I was very impressed with all the equipment in his lab.  I am familiar with much of it, but I do realize that I need to get more lab time.  I’ve been out of academia for over 10 years!

Anyways, here are pictures from Day 1 and Day 2.  It was cool because you walk everywhere at UNC, and all the buses were free to ride!  I am really concerned about returning to school because I haven’t been in school in over 10 years!  I figured that my passion for “post treatment oncology thrivership” will only help to drive my goal of getting involved with oncology exercise research.  I was VERY impressed with UNC.  The only knock on UNC was the weather, but I’m comparing it to near perfect weather in San Diego.  It was cooler temperature-wise and raining, but a welcome change of scenery.  Except for the the weather, it was a great trip and has me thinking… I was concerned about the accessibility of the campus.  I will definitely visit the disabled student office the next time I come to Chapel Hill! I was pleasantly surprised, but I would have to look at manual chair option + wijit. I’m not 100% confident that the mAss Kicker Mobile could navigate the bus system and drastic changes in weather.  Rain is one thing, but hurricanes/snow is a whole different beast.  This trip definitely got me thinking…

In a couple weeks, we are having the Celebration of Life.  I will be a 10-year survivor on Oct 25.  I’m inviting all the people who were there for me in the beginning to say “thanks” for helping me get through the first few years.  But more importantly I wanna personally say “thanks” to the people who helped create the “post-brain tumor version of myself!”  It will be a very emotional night for me.  If you can’t make to the event, please support me here so mAss Kickers Foundation can continue international outreach!