Client had a bilateral mastectomy and lymph node dissection on her right axilla 3 years ago after being diagnosed with stage breast cancer.She had a recurrence 18 month ago under her right axilla, she needed 2 more surgeries and they needed to move her right latissimus dorsi for reconstruction. Since then she has a decrease in upper body strength and limited range of motion.

She has good energy, she walks 1 to 5 times a week.She states that she has a lot of nervous ( rajasic ) energy.She always feels like she needs to get a lot of things in her house done before she is able to settle down.She sleep used to be good but in the last two months she noticed that she is waking up earlier.Her anxiety has increased and she feels a tightness in Der abdomen.

She states that her anxiety has increased and she is feeling less optimistic for the future.

She is not affiliated with any religious group, but does believe in a higher power.Her believes mostly align with buddhism.She is open to exploring yoga philosophy .

She is curious intellectually, she likes to read and write.She used to enjoy helping her community for example helping immigrants and children.But after her cancer treatment ,she adopted a nomadic life style , so she was not able to help out with projects in her community she stoped the humanitarian work.She would like to get back to ii.

Since the client likes to read and is open to yoga philosophy .I would recommend reading the book The Yamas and Niyamas by Deborah Adele to start exploring yoga philosophy . And then having a discussion with me about the teachings of the Yamas and Niyamas.

Or start reading the yoga sutras of Patanjali before bed and discuss one sutra with me during our yoga therapy session.

1.Arm raises coordinated with the breath, to encourage deep breathing and to decrease anxiety.
2.Arms behind the head, elbows back to inhale goin into cow, then elbows forward to exhale spine round forward into cat.To increase ROM in her arm and flexibility of her spine.
3.hand in prayer position in front of her chest then palms are pushing towards each other and hold on the count of 5.repeat 3 times. to increase upper body strength.

Contra indications would be any pain when working on the asana or any increase in anxiety

1. 5 Pose Variations to Build Upper Body Strength
Jake Panasevich

2.Yoga as an Intervention for the Reduction of Symptoms of Anxiety and Depression in Children and Adolescents: A Systematic Review

I was able to find many yoga postures for upper body strength, but during my assessment I found the she is experiencing pain even with pushing the palms together in prayer position, where do I go from here?

• Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
• Balanced pranayama considering contraindications, meditation/centering.
• Include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client.