The client is a female in her mid 40s.
Jan 2023 she was diagnosed with breast cancer and went through 6 months of chemo treatment.
June 2023 she had surgery.
She is currently on a new chemo treatment series that will last 8 months.
She has symptoms of chemo-induced neuropathy in the hands and feet.
She experiences fatigue and brain fog from the chemo.

Even though she is currently in treatment, she had to go back to work to keep her medical insurance.

She has the support of her family and colleagues during this time.

Client Goals:
1) Work with the breath
2) Become more “flexible” physically and mentally

Yoga therapy goals:

Koshas: _x_Annamaya _x_Pranamaya _x_Manomaya __Vijñanamaya __Anandamaya

Integral Yoga: _x__Hatha _x__Raja ___Bhakti ___Karma ___Jnana ___Japa

Short term:
I would like to work on decreasing her neuropathy symptoms as well as maintain strength in her body overall.

Long term
I would like to help her develop tools she can use to maintain her peace in the flux around her and reduce her stress so she can heal.

YCat Manual

Stress Management Manual

Adaptive Yoga Manual

Healing Relationships Manual

Zhi WI, Baser RE, Zhi LM, et al. Yoga for cancer survivors with chemotherapy-induced peripheral neuropathy: Health-related quality of life outcomes. Cancer Med. 2021;10(16):5456-5465. doi:10.1002/cam4.4098
https://pubmed.ncbi.nlm.nih.gov/34213086/

• Yes

Awareness practice
Neck warmups: right/left, chin glide, waterfall, head tilt with PNF (proprioceptive neuromuscular facilitation – isometric contraction against the hand), arm rotations
Shoulder circles with scapular awareness
Elbow circles to alternate
Hands on hips lateral stretch – breathe into ribcage
Diaphragmatic breathing into pelvic floor
Hand/forearm exercise/stretches
Ankle scrub with strap
Feet/toe mobility/massage, marma point
Ankle roll with ball of foot on ground
Hip tilt with feet on floor
Fig 8 hips
Yoga nidra

The client should continue to practice yoga nidra.

The client had her infusion a few days ago. It was a long day. (It’s a 7 hour infusion.) The infusion room is a “horrible place.” It’s very "busy and noisy," and there is no privacy so it’s very difficult to meditate. However, while the infusion was dripping, she did practice some imagery that I had shared with her last time, which helped. She also mentioned she had a “panic attack” when she found out some bad news about her insurance. She had not practiced yoga nidra that morning because she had been feeling good. As a result, she wasn’t mentally prepared for the stress and became overwhelmed. Now she knows she needs to practice every day, even if she doesn’t feel like she needs it.

Due to her recent surgery, our practice remained seated or standing with no matwork. Last week she had mentioned wanting to be able to have more breath capacity, so today we did some explorations around the breath. We were able to have her analyze what it felt like in her body to set up her posture, engage her diaphragm and take full abdominal breaths deep down to the pelvic floor.

Another focus for today was doing more detailed movements with the small joints of her hands and feet to address the chemotherapy-induced neuropathy. Although her feet were also affected, her hands had the worst symptoms, so we concentrated our work on the hands and wrists. She enjoyed the practices and said it was more fun than the ones her PT gave her, so she was more likely to do them.

I’d like to elaborate on the hand stretches and strengthening to help with neuropathy.

• Yes

Awareness practice
Eye movements with hands/thumbs, peripheral vision
Neck warmups: right/left, chin glide, waterfall, head tilt with PNF, arm rotation
Shoulder tap with elbow/wrist touch, alternate
Reed – lateral stretch – hands on hips
Dynamic twist
Standing – around the world with ribcage (side to side first/front back) then transitioned to seated to stabilize the hips better
She taught the hand movements for fun
Back of hand to back of hand for forearm/pointer stretch
Reverse book
Seated isolated pelvic tilt/wave cat/cow with cactus arms
Diaphragmatic Breathing with pelvic floor awareness
Standing – fig 8 hips
Standing hip tilt, feet on floor
Kneeling hip circles
Happy puppy
Toe mobility – lift big toe, piano other toes up, reverse
Spread toes apart
Calf raises, rocking on feet, toes up
Dynamic calf/hamstring stretch
Standing hip glide with twist
Yoga nidra

We talked about coming up with a mental barrier to keep out negative energy while having her infusion.

The client shared that she had been tolerating the fusion “quite well.” She had been practicing yoga nidra as well as the hand practices once or twice a day. She would practice the hand movements with her son. Now her hands don’t feel so stiff in the mornings. She also let me know that she recently got word from her doctor that she should schedule her PT appointment in October. She was so appalled! We had been doing gentle movements the whole time since the surgery. She attributed her quick recovery and healing due to our work together. She said if she had been sedentary up till now, she would not be handling the new treatments as well as she had been.

The client was very active before she had cancer. We talked about keeping up the strength of her body as much as we could now so that she could eventually go back to running and other sports more easily later. To that end, we focused our session on articulation around the hips as well as mobility and strength work in the feet. This had the added benefit of countering the neuropathy in her feet, too. It took some work for her to do some of the hip movements, but she enjoyed it. She mentioned that it was amazing that adjusting “just one detail” could make a difference in how the movement felt.

The client had been some experiencing quite a bit of stressful situations as part of cancer journey, so I want to offer her another stress reducing technique as part of her toolbox.

• Yes

Awareness practice
Eye exercises with arm movement, including peripheral vision and face massage
Neck warmups: right/left, chin glide, waterfall, head tilt with PNF, arm rotation
Shoulder taps with elbow/wrist circles to alternate
Cactus arms side stretch
Dynamic twist
Seated isolated pelvic tilt to wave cat/cow with cactus arms
Standing Hip tilt on flat feet
Figure 8s
Around the world seated to keep the hip/pelvis stable
Hip glide standing
Vrksasana (Tree pose) with preparation
Bouncy twist
Eyes/tongue/hands practice
Yoga nidra

She wanted to continue to practice the hip movements on her own. She said she wanted to “try something new” and “learn to dance.”

The client shared that her energy was good today even after having an infusion a few days ago. Her colleagues and friends had been so supportive, taking turns to visit her during her infusions. She also mentioned that her doctor originally wanted her to take part in some trials for new drugs. Unfortunately, because of her unique situation with the type of cancer she had, she didn’t fit the parameters so couldn’t be a participant. That was pretty disappointing for her.

She also revealed right before we finished our session that HR informed her she had to start working full-time starting the following Monday or her benefits would run out. She said she was doing “what she needs to do to survive.” The practices have been helping her immensely. “There’s no use getting upset because it is what it is.”

I am so grateful that she was willing to share these experiences with me. She is a private person, so it was very meaningful for me to be part of these conversations. Again, she was very appreciative of learning the yogic tools to help with these challenges that kept coming her way. On the physical side, we workshopped Vrksasana (Tree) for our main pose. To prepare for the pose, we made sure to do some mobility and strength work with the feet and ankles to provide a stable base. Lastly, I wanted to offer her another practice to help the mind in dealing with stress. She enjoyed the eyes/tongue/hands practice and already planned on adapting the eye portion of it whenever she worked too long.

We met for 1 intake and 3 sessions.

On the physical level, we were able to achieve improvements in a fairly short amount of time. The most noticeable one was the reduction of neuropathy symptoms in her hands. Through our stretches and movements, we were able to increase circulation and mobility, which reduced the feelings of pain and stiffness. She reported she was "back to 98%" functionality for her hands. (Annamaya, Hatha, Manomaya) During this period, working with awareness and the breath, she also learned to “slow down” and be more mindful. (Pranamaya, Manomaya) It wasn’t the forceful, physical breath she had initially requested because her goal shifted and changed, but she was very appreciative of what she learned and used the mental and physical practices daily.

I didn’t mention it under each session, but a running theme throughout our check-ins was how the practices of yoga nidra and meditation allowed her to connect with herself to find that place of stillness and peace. This gave her the grounding and mental resilience to deal with so many of the obstacles she experienced from day to day. (Raja, Manomaya) She shared that those mental practices were the most valuable tools that she gained from our sessions together. Otherwise, it would have been so difficult to move forward and she would be experiencing much more anxiety in her life. I felt that we were quite successful in accomplishing what she wanted in the time that we had.

I told her that she could contact me after she met with the PT and we could strategize and plan practices that would support the exercises the PT gave her.