Working with a Client with Breast Cancer: A Yoga Therapy Case Study

Lisa Alexander has been studying in the Breathing Deeply Advanced Yoga Therapy Program under the mentorship of Brandt Passalacqua.

Watch this video as Lisa, a recent program graduate, shares with us a client case that required a particularly agile treatment plan. Her client was a 76-year-old woman who was undergoing aggressive cancer treatment. Having done Yoga for 40 years, she approached Lisa seeking alternative methods to mitigate the difficult side-effects of the conventional medicines she was taking. Yoga Therapy would help give her some measure of control over mind, body and spirit.

 Given the ever-changing nature of her client’s abilities and energy levels, Lisa tells us how and why she chose the methods she did. She touches on the value of truly listening to her client’s needs, thereby making the treatment both effective and soul-nourishing at a time when her body was feeling sapped. 

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Transcription:

Brandt Passalacqua:

Hi, I’m here with Lisa Alexander who has just graduated from the Breathing Deeply Advanced Program. So she is a new therapist, but has been studying yoga therapy for several years with us and she’s going to talk to us about a case she worked with. I’m glad to see you Lisa. Why don’t you start with your client and what her condition was and we’ll take it from there.

Lisa Alexander:

Okay, well thanks for having me and letting me do this. My client is a 76 year old woman who was diagnosed with aggressive breast cancer. Her diagnoses were two positives and she had had a lumpectomy. So about six weeks after she had her surgery, she was deciding whether she should do this aggressive therapy. She sought out a few different oncologists. She was a retired oncological nurse and she really knew that the side-effects would be pretty terrible. She was just looking for some alternative methods to deal with this as well because she has been doing yoga for 40 years. When she worked in England, they treated the whole body, spirit, person and they did conventional medicine. They also did mind/body/spirit, therapies. They did yoga therapy, they did nutritional therapy. She was seeking something like that, which is kind of missing here, she thought.

Her final decision was that she felt, in her words, “bullied” into taking this conventional therapy, but she also needed something holistic, something that she felt was in her control. She was a yoga student of the studio that I own and where I teach and she called me one day. I hadn’t seen her in a long time and she said, “I understand that you’re doing yoga therapy and I think this is what I’m seeking to do as additional yoga treatment to my conventional treatment”. I did an intake with her and she needed something right away.

Unlike most of my cases where you have an intake, where you do muscle testing or you look at the whole picture and you send them home with something to do, she wasn’t interested in that. She wanted to see me every week the day before her treatment. She knew that she wouldn’t really be able to do a lot of physical things because it would take her probably the rest of the week to recover. I felt like my work was about giving her certain things that she could do at home – meditation, breath work, mantras, chanting. She loved all that. I knew that piece would probably be easy because she was a practitioner for so many years. And then the yoga physical therapy piece, I would work with her each week that she came in.

Brandt

So she was looking for a physical practice because that was her best day of the week, is what you’re saying?

Lisa 

Yes

Brandt 

I see. And then you were giving her other things she could do as her treatment. So you’re just doing mostly treatment mitigation, trying to reduce the effects of the – was she on chemo?

Lisa 

She was on a very aggressive chemo. She was on Taxol and Herceptin at the same time plus taking steroids the night before the treatments.

Brandt

She was looking to reduce the effects of those and also sort of tend to her physical self?

Lisa

Yes. She was an oncological nurse, so she understood how important it was to not let lymphedema sit in or scar tissue built up. She had a port put in. The second or third week I saw her, we started working on actual wall walks. Because she had surgery on her right side, she had the port on the right side, we just started working that arm. We worked both sides, but we started working that arm. She was a little tender. She did get permission from her doctors to exercise as long as she felt fine.

So really for the first two or three weeks that I saw her, we worked on just some little movement like this, some moving and breathing training. We also did the wall walks and within three or four weeks she felt better. I started to add in some warriors with a lot of moving and breathing techniques, the joint freeing series. She loved Ujjayi breathing. We did a “centering”, we did Ujjayi breathing, we did some joint freeing series to warm up the joints. We went to the wall, did a wall walk. I started to add in Warrior 1 and Warrior 2 with this movement, Goddess movement straight up.

Brandt

And that was all in service of making sure her scar tissue didn’t build up and to keep up her mobility?

Lisa

Yes.

Brandt

What was the breathing training for? Why were you giving her breathing exercises?

Lisa

She just really connected to breath work and felt like just breathing in made her feel very whole. It made her feel like her cells were healthy.  Because they were killing her cells, she felt breath work was really important with the moving and breathing exercises.

Brandt

I see. So it gets her more mentally buoyant as well, I’m hearing that it was helping her mental states further?

Lisa

She loved chanting and mantra work. That was very helpful in the days that she had her treatment. So when they put the intravenous in her arm, and the medicine into her arm, and then she had to stay there three, four hours, she would meditate and she would chant silently. She said it was just a way of her having control and settling and grounding. She also walked two miles every day. And on the days that she just really needed to rush, she didn’t. I did offer her a yoga nidra. I thought that would be helpful. She ended up not liking that at all. She was too restless with the steroids and she just felt like the chanting grounded her better. So I was like, “do what it’s best for you and what feels good”.

Brandt

So you were able to give her different options and did she feel like she was – I mean it must’ve been nice for her just to be picking from different things that could help her mental states, right?

Lisa

Yeah. And I got her mala beads, so we did Om Namaha Shivaya. She loved that. She was open to a lot of things. I thought she’d be really open to the yoga nidra, but she was just too restless and those other things worked better for her. So I suggested just keep doing what felt best for her.

She had Taxol every single week along with the Herceptin and they said that by week two, she would lose all her hair and she would be vomiting all the time. So we were just trying to mitigate some of that with the work we did.

If I can give you one little story,  she came in probably around week six or seven and she was pale. There was no energy in her body. In fact, I didn’t want to work with her. I said, “today might not be a good day. Why don’t we see each other next week?” And she said, “I’m here. Can we please try?” And I’m like, “Oh, of course. And if you’re not feeling well then we’ll just stop.” And she goes, “I’ll go home.” So we did a lot of breath work. I didn’t do our typical, because I kept adding in each week so I did a lot of breathing exercises. We did some meditation, we did some joint freeing, very gentle at the end. We did a nice Savasana with Nari Shodna and all the color in her face came back. I think it’s just a testament to the human body and the human spirit and I think we’re meant to move.

She could, she wanted to, she was willing to, and she felt so much better for it. Personally, I’ve never seen anything like that. I mean, I’ve never worked with cancer clients before, but I know people and I know people that have been sick and I’ve witnessed that. She was unlike most people I’ve witnessed. At first I was a little nervous like, “no, you look really tired.” But she wanted to do it and we went slow and she was so happy that she did it because she felt better.

Brandt

Maybe you could talk just a little bit about your relationship. It seems like you must have had a pretty solid relationship with her.

Lisa

We did. Like I said earlier, I had known her from the studio many years ago. She came to my classes and then with her schedule change, she went to other teachers and I’d see her in passing if she was at the studio at a class. But I hadn’t really seen her in probably a few years. But I knew her. During our time together, we definitely made a connection. Working so closely with somebody being so vulnerable and sick and sharing her anger, I felt closer to her. We did have a really nice client-therapist relationship.

Brandt

To be able to support someone in that way and to have that for her, it must have been really nice during such a hard time.

Lisa

Yeah. It really was.

Brandt

You worked with her for several more weeks. How would you say it went overall? Did you see her through a certain portion of her treatment?

Lisa

I did. I worked with her 19 times over six months. There was Christmas and the holidays in between, so we took a few weeks off there. But around Thanksgiving she finished the Taxol which was the pretty aggressive treatment. She was still on the Herceptin, but she finished it and from that point on, she had three weeks off before she started radiotherapy. She told me that she had to keep her arms in this position for at least 10, 15 minutes when she went in to get her markers done. For the next three weeks and beyond that with all the joint freeing series and all the Asanas that we did for the port and for her surgery now, we started to hold that, so she would get stronger.

And by the time she did her radiation treatment, she could easily hold her arms up for 10 -15 minutes. She was so thrilled the first time she came back after her first treatment, she was amazed. She goes, “It was a breeze.” Not the treatment, but just being able to hold her arms up and she said, “That’s all the work we’ve done.” So she was excited about that and we kept that up. She was pretty tired though, with all of it, of course. The radiation was tiring for her. She said she felt tired unlike the kind of tired that she’s ever known in her life. But she never in six months missed a week. Never.

Brandt

Yeah, she was a good client. She was dedicated.

Lisa

I could not have asked for a better client. And she never lost her hair.

Brandt

Oh, interesting.

Lisa

Which was shocking to people. And she never vomited once.

Brandt

Right. All because of yoga therapy. No, I’m just kidding.

Lisa

No. We don’t know. She had anti-nausea medicine, but she just said she would never have had the energy to do some of the stuff she did, had she not done this piece of it.

Brandt

And so how did you end it? How did you guys decide to be done with your work? Was she finished? Did she feel like she was?

Lisa

She wasn’t. She would have still joined me each week, but each winter she goes to England, they have an apartment there because he has dual citizenship. So for the winter she went to England. In fact, I heard from her today. She’s home. She got home a few weeks ago. She still has to have Herceptin for a year so that’ll be up in September. But she’s quarantined because she came back from England and she is still able to have her treatment. She also let me know that she’s still walking two miles a day.

Brandt

Great. I mean you did really wonderful work with her and I got to be your practicum advisor through that and I saw the decisions you were making. Maybe you could just speak, just a small amount, about your experience of working with her in the context of being in the practicum versus being on your own, I guess.

Lisa

Yeah, sure. There’s nothing like having support. This was my first cancer client and it was interesting because in that piece of it, for our school, when the presenter was presenting on cancer, when Debbie said, “if you’re not comfortable with your own death, you shouldn’t probably work with cancer clients”. And that struck me. That just struck me. Am I okay with my own death?

It made me think about it and then all of a sudden, at the end of the summer, here this person was, and I was ready. I felt I wanted to do this, but I don’t know if I would have been ready if I didn’t have you or my practicum colleagues to go to and say,  “this is happening… is this the right direction? Am I thinking in the right direction?” And so the practicum was so helpful and it made me less worried that I would do something not good for this person, that I might not give the right protocol or I might not give the right breath work or the right meditation. It was extremely useful, extremely helpful and I felt very supported.

Brandt

Well yeah, I was there listening to you as you assigned her things you did an excellent job. And she definitely had the outcome she was looking for.

And it’s a good example of how yoga therapists can support people going through these treatments because we’re not going to cure them. So the question is always, “what is our role?” And you kind of really nailed that. You said, “I can help you get through this. I can help you feel a little bit more agency and I can mitigate some of the symptoms of the treatment”, which is our role, and you did that beautifully. I just also want to say that, you’re presenting this now, but I got to work with you with a lot of different clients and I have to say, you’re definitely a capable yoga therapist and we’re so proud that you’ve gone through our program.

Thank you for sharing that case study with us. I’m looking forward to seeing what you do with yoga therapy in the future. I’m excited. Thank you.

Lisa

Thank you for all your support.