October is Breast Cancer Awareness Month. Although great progress has been made in prevention, treatment and reconstructive surgery, breast cancer is still very real, and there are few people who do not know someone who has been touched by this disease. It is important to note that men as well as women may develop breast cancer.

When the diagnosis is cancer, the first question is, "Will I survive?" If treatment is successful and the cancer is in remission, life is still forever changed. What does it take to get back to a full life? It is only natural to be fatigued and lack endurance, which should improve over time. However, a graded exercise program will stimulate the body's healing and improve your outlook, as well.

What happens months - even years - after surgery, radiation or reconstruction? The active threat of cancer may be more distant, but about 10 percent of patients experience lymphedema (swelling in the hand, arm, chest) within five years. Also, 30 percent develop burning or tingling in the shoulder, arm, chest wall or mastectomy scar after lymph node dissection, lumpectomy or mastectomy. This can cause continuous or intermittent pain either right after surgery or years later. They also may experience scarring that "tightens down," resulting not only in pain, but limited movement, flexibility and strength. This can affect the ability to perform daily activities.

Many people feel there's nothing they can do - they just have to "live with it." The good news is that there is a lot that can be done before and after treatment to reduce the risk of lymphedema, maintain freedom of movement and build strength - even years after the initial cancer. A therapy program involving soft-tissue treatment, stretching and exercise can help avoid needless suffering.

Can therapy help? Let's look at several examples:

Ms. P. had a lumpectomy and radiation with no lymph nodes removed. Three months after treatment, she experienced difficulty shaving under her arm due to scar tissue and was not able to reach fully above her head. She had pain across the front of the shoulder, and compression on the nerves caused tingling down the arm. Over a four-week period, manual therapy (including myofascial release and massage) was used to release tight tissue and reduce pain. A specific stretching program and revision of her existing exercise program at the gym helped develop a pain-free range of motion, as well as increased endurance and strength. Her workstation was also assessed and she found that there were modifications she could make that would keep the numbness from returning.

Mrs. M. had bilateral radical mastectomies over 10 years ago. Her implants became infected after reconstructive surgery and she developed extensive scarring. Multiple surgeries eventually resulted in a removal of the implants. She was not given any pre- or post-treatment therapy or stretching. Over the years, she experienced a gradual decline in use of both arms, and her middle back was locked and low back painful. She experienced shoulder pain with limited movement and assumed that she would just have to "live with it." An individualized therapy program helped her regain full motion, minimize the pain and return to regular activities. Having been in pain for so long, she had to learn again how to listen to her body rather than block out discomfort. She is now able to monitor her activity, reduce flare-ups and learn when a "tune-up" is needed.

Finally, Mr. R. had a simple lumpectomy, removal of a few lymph nodes and chemotherapy. Treatment was short-term and minimally invasive. Two years later, he was unable to use his arm due to pain and had lymphedema (swelling) in the arm. He received compression garments that helped the swelling somewhat, but still had symptoms. In therapy, it was noted that the lymphedema had started after his recent heart surgery. As the chest scar tightened, circulation was compromised; swelling began and limitation followed. Manual therapy and myofascial release helped soften and stretch the scar to open the chest and improve circulation. Symptoms resolved and compression garments were no longer continuously needed.

These are just a few examples of people who have been helped by an individualized therapy program developed to meet their specific needs. If you answer yes to any of the questions below, therapy can help you return to a more active life:

• Do you have problems reaching both arms above your head and out to the side equally?

• Is it difficult to shave under the affected arm or reach behind your head?

• Do you notice tightness, pulling or pain across scar into the chest, abdomen or other parts of your body?

• Are some self-care activities such as lifting, pushing the vacuum or opening a jar difficult?

• Compare both arms - is there swelling or a difference in size at wrist, elbow or shoulder?

• Have you noticed weakness or tingling/numbness in the arm?

Virginia Taft, OTR/L, ATP, is a licensed occupational therapist and owner of Coeur d'Alene Hand Therapy and Healing Center, and has been practicing in North Idaho for over 30 years. She employs physical and occupational therapists specializing in hand rehabilitation, repetitive motion injuries (such as tendonitis, carpal tunnel syndrome, back, neck and arm pain), ergonomics and other conditions such as fibromyalgia, scar release and breast cancer recovery.