What is new in the oncology rehab and integrative medicine world...
CRA July news & updates
Protein Recommendations for Cancer Patients
 Katherine Husmann, B.S.–Nutrition and Foods M.S. Student at Texas State University and Krystle Zuniga, PhD, RD, LD 

Protein is found in every cell of the body and it is needed to build and maintain bones, skin, red blood cells, enzymes, hormones, and muscles, carry body compounds and medications, fight infections and strengthen the immune system, and maintain fluid balance. 1,2 Sources of protein from our diet come from dairy products, meat, poultry, fish, eggs, nuts, seeds, tofu, vegetables, and certain legumes and grains. 1,2 Protein consumed from meat and other animal products are considered complete proteins, which supply all of the amino acids the body is unable to make on its own. 1 Most incomplete proteins come from different plant sources, therefore, one should consume a variety of different plant proteins per day to ensure the intake of all of the amino acids your body needs. 1 An individual’s protein needs vary based on physical activity level, sex, age, and health. Sufficient intake of protein daily is vital because the body does not store protein the way it stores carbohydrates and fats.

Most diets provide an adequate amount of protein; however, cancer patients going through cancer treatment may have increased protein needs. 2 Even before the start of cancer treatment, cancer can result in physiological and metabolic changes that can increase the nutritional needs for protein. 3 Unintended weight loss during cancer treatment is usually an indicator of a loss of muscle protein. If the body does not get enough calories, the body uses protein for energy rather than supporting vital body functions. 2 Also, certain cancers and cancer treatments commonly cause adverse side effects making it hard to eat or can reduce the absorption of nutrients from food. Inadequate protein intake can increase the risk of malnutrition which can result in weakness, fatigue, reduced ability to fight infections, or the inability to complete cancer treatment. 4

Sufficient protein intake is vital during all stages of cancer treatment, recovery, and for long-term survival. 3 Evidence has shown increased protein intake promoted muscle protein building in patients with cancer. 5 While the optimal protein intake for cancer patients has not been determined, experts recommend a range between a minimum of 1 gram of protein per kilogram of body weight per day and a target range of 1.2-2 grams per kilogram of body weight per day. 5 For example, a 150lb woman undergoing cancer treatment should aim for a minimum of 68 grams of protein a day.

Cancer and cancer treatment can cause adverse side effects resulting in increased nutritional needs in certain nutrients such as protein. Cancer patients should seek professional help, such as seeing a registered dietitian to help maintain or increase protein intake with food. 5
1.    Dietary proteins. https://medlineplus.gov/dietaryproteins.html Accessed: June 6, 2018.
3.    Doyle C, Kushi LH, Byers T, Courneya KS, Denmark-Wahnefried W, Grant B, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2006 Nov-Dec;56(6):323-53. PMID: 17135691
4.    Nutrition in Cancer Care (PDQ®)–Patient Version. https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-pdq . Accessed June 6, 2018.
5.    Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017 Feb;36(1):11-48. DOI: 10.1016/j.clnu.2016.07.015
Types of Complementary Therapies:
During Cancer Treatment
Some people with cancer may consider using  complementary therapy   in addition to standard cancer treatment. This approach is called integrative medicine when it has been discussed with and approved by your health care team.

Many people use complementary therapies to:
  • Reduce the side effects of cancer treatment
  • Improve their physical and emotional well-being
  • Improve their recovery from cancer

Type of complementary therapies
Researchers have found that the following complementary therapies can reduce pain and improve well-being:

Physical activity.  
Participating in  physical activity   may help people with cancer:
  • Build strength and endurance
  • Relax and cope with stress
  • Relieve pain, fatigue, anxiety, and depression
  • Live longer
Talk with a physical therapist or a trainer who works with people with cancer. They can help find the best exercise plan for you.

Professional nutrition counseling with a registered dietitian helps patients:
  • Manage weight changes
  • Learn which foods to eat during treatment and recovery
  • Cope with nausea
  • Learn about herbs and supplements that may interfere with cancer treatment
  • Learn how to eat in a way that could lengthen their lives

This type of therapy  involves the use of very tiny needles and/or pressure to stimulate points on the body. Research shows that acupuncture:
  • Releases chemicals, such as beta-endorphin and serotonin, in the brain to relieve pain
  • Can help reduce chemotherapy-induced nausea and vomiting
  • Can help relieve certain symptoms:
  • Hot flashes
  • Dry mouth
  • May relieve the other symptoms listed below:
  • Headache
  • Fatigue
  • Sleep problems
  • Appetite loss and weight changes
  • Diarrhea and constipation
  • Anxiety during procedures
  • Swallowing difficulties
  • Lymphedema

Mind and body practices.  
It is important to manage stress and depression during and after treatment. It can help you have the best chance of recovery. Many mind and body practices can help improve quality of life:

Yoga.  Yoga uses breathing exercises, mediation, and poses to stretch and flex different muscle groups. Yoga has been found to help regulate stress hormones and improve mood and physical well-being. It can also reduce pain, fatigue, nausea, sleep problems, and inflammation.

Tai chi and qigong.   Tai chi and qigong combine a series of fluid movements with slow, regulated breathing. These mind-body practices have been found to improve quality of life, reduce sleep problems, and decrease inflammation.

Meditation.  Meditation is the focusing of attention to calm the mind and relax the body. It decreases chronic pain and improves mood and many other aspects of quality of life. Studies have also shown that meditation can lower stress hormones and improve immune function. Meditation can be self-taught or guided by others. There are many different types, including:
  • Focused meditation
  • Open awareness/mindfulness
  • Compassion or loving-kindness meditation 

Music therapy.  
Trained therapists can guide a person through  music therapy . It can improve recovery and general well-being. Music therapy works well for people receiving palliative treatments and those staying in the hospital. 

Research shows that massage can: 
  • Reduce pain
  • Decrease tension and stress
  • Help with recovery after surgery
  • Ease anxiety and depression
  • Help with sleep problems and fatigue
A Note From Agnes Nowakowski:
Oncology Acupuncture @ CRA
Part of my doctoral program has included shadowing at various oncology clinics. This month I’ve had the privilege of learning from medical oncologist, radiation oncologist and nurse practitioners at both Austin Cancer Center and Texas Oncology. I’m grateful for the opportunity and the warm reception from the staff at both locations. I was very happy at the excitement from patients as they witnessed collaboration between various practitioners, and that integrative oncology is advancing patient centered care. I was particularly inspired at the dedication and genuine concern all practitioners showed their patients. Their patients wellbeing and comfort was of the utmost concern, while still discussing cutting edge research and clinical trials.

As Austin and central Texas keeps pushing forward to integrate various modalities into cancer care, Cancer Rehab Austin continues to be at the forefront of providing personalized treatment options. Personally, I am humbled by the outpouring of support we’ve had from our patients and the entire community in creating a healing space for all oncology patients. It is thanks to you, as you’ve requested holistic options from your oncologists, that has driven the collaborations between conventional and complementary services. Minds are being opened, discussions are continuing, programs are being developed, all in service to you. Rest assured, we are tirelessly working behind the scenes to foster relationships and continue educating on the immense benefits of integrative oncology. I am eternally grateful to you, our most important asset, as I continue my passion of providing exceptional care, one poke at a time.
Wishing you many blessings and continued healing,

Join us in congratulating our physical therapist Angela!
Dr. Angela Wicker-Ramos PT, DPT has been hired as Director of Health and Wellness for Texas Oncology's new Survivorship Program! She will have the opportunity to bring the rehab, integrative, and wellness services offered at CRA to Texas Oncology! We are honored here at CRA to be a leader in changing cancer care and survivorship care in Austin.
Our CRA Family is Growing!
A big welcome to our 2 new team members.
Dr. Melissa Cofer PT, DPT, CLT
Melissa Cofer, PT, DPT, CLT is a physical therapist and certified lymphedema therapist.

Melissa’s education and training includes:
  • Doctorate of Physical Therapy from Texas State University
  • Master of Arts in Women’s and Gender Studies from The University of Texas at Austin
  • Bachelor of Arts in Sociology from The University of Texas at Austin
  • Academy of Lymphatic Studies (ACOLS) Certified Lymphedema Therapist

Melissa has specialty training in oncology rehabilitation and lymphedema therapy. She initiated and developed the outpatient lymphedema program at Baylor Scott & White (Pflugerville/Round Rock). Melissa also has clinical training in cancer rehab, lymphedema, and pelvic health from Oncology Rehab (Denver, CO) and St. David’s South Austin Medical Center.

She has presented on lymphedema and cancer rehab to support groups, physicians, and therapists. Melissa is a member of the American Physical Therapy Association, the Section on Women’s Health, and the Oncology Section.
Dr. Mari Galle L.Ac, DACM
Mari is a Doctor of Acupuncture and Chinese Medicine through the National Certification Commission for Acupuncture and Oriental Medicine. A graduate of AOMA Graduate School of Integrative Medicine, she is passionate about understanding patients' ailments from a holistic approach.

She earned a Bachelor of Science degree in Biology with a concentration in Nutrition which has given her a strong foundation of biological processes that when combined with her studies in Traditional Chinese Medicine allows for a great understanding of the human body, mind and spirit.
CRA's Upcoming Workshop
Learning what you can and cannot control throughout cancer...
and how to be good with both.
Control: Learning what you can and cannot control throughout cancer and how to be good with both.

When: Saturday August 4th 2:00-3:30 pm
Where: Cancer Rehab Austin

Renee will be sharing her story with you and the one big lesson she has learned time and time again: - how to stay in control when life is spinning out of control -

Renee Sendelbach is the author of "Renee in Cancerland." She is is a 40 year old wife and mom and has been dealing with breast cancer for 10 years. She was first diagnosed at age 30, with Stage 1 and re-diagnosed at 32 with metastatic Breast cancer, and MDS at age 38. 
Recurring Free Weekly Exercise Classes
Weekly Yoga Class every Thursday from 12:00-1:00
Location: Body Business Fitness on 2700 Anderson Lane

In this hatha based practice, expect gentle movement linked with breath, deep held stretches, restoratives, and deep guided relaxation. Open to all levels and limitations. Take time for yourself to quiet your mind and turn on your bodies natural healing and relaxation response. This class is intended for anyone impacted by cancer.

Please get cleared by your medical doctor to perform physical activity prior to attending this class. This class will assist in modifications appropriate for all levels and stages of treatment or recovery.

About the Instructor Kimberly Wharton: Kimberly began her teaching journey in 2002, after her 200hr training in NYC in ISHTA Yoga (Integrated Science of Hatha,Tantra and Ayurveda) with Alan Finger. After relocating to Los Angeles, Kimberly was named in Backstage Magazine's "Best of L.A." under favorite yoga class. She has gone through additional trainings with Kia Miller (Yoga Works techniques), Jillian Pransky (Restoratives), Judith Lasater (Restoratives), and Jasmine Lieb (Therapeutics), where she discovered the amazing healing abilities of yoga. She is continually expanding her knowledge, having the opportunity to learn from Leslie Kaminoff, Max Strom, Gary Kraftsow, Shari Goodhartz (Anusara based), and Dr. Richard Miller. While in Los Angeles, Kimberly had the opportunity to teach for Team Survivor, a non-profit organization providing free healing modules for women living with cancer, and continues similar work here with Cancer Rehab Austin.

She holds a lighthearted space, focusing on breath, alignment, and self inquiry. Kimberly has taught over 3,000 classes for local studios as well as Teacher Trainings. Kimberly holds a BFA in Musical Theater and a Modern Dance Minor from the Boston Conservatory. She has advanced yoga therapy training: RYT500.
Weekly Pilates Class every Friday from 4:00-5:00
Location: Body Business Fitness on 2700 Anderson Lane

This weekly Friday class from 4:00-5:00 is designed for those dealing with cancer treatment, recovering from treatment, or impacted by a loved one's cancer journey. Pilates is an innovative and safe system of mind-body exercise using a floor mat or a variety of equipment. These exercises evolved from principles of Joseph Pilates and can transform the way your body feels, looks and performs. Our Modified Pilates Mat Class is low impact which will help you build strength, flexibility and overall body awareness.

Through proper breathing, correct body alignment and concentration we will teach you how to move efficiently. Our goal is to educate you, motivate you to regain control of your bodies, lives and assist with your pain management. Through our mat class we will teach you how to assist your lymphatic system, strengthen your muscular system, improving your balance and overall confidence. This class is intended for anyone impacted by cancer.
Please get cleared by your medical doctor to perform physical activity prior to attending this class. This class will assist in modifications appropriate for all levels and stages of treatment or recovery.

About the Instructor Gladys Nicholls: Gladys received her Bachelors in Physical Therapy in 1981 from the University of Puerto Rico and set out to further specialize in Orthopedics and Manual Therapy while traveling the world as a military wife. She took her first Pilates class 17 years ago at Pilates Center of Austin while she was opening a new Rehab Facility for Seton at Seton Southwest. She was hooked. She completed her Pilates Certification Program in 2001 and incorporates the principles in her patient care. She believe in mind-body exercise as a tool to assist with conventional medical treatment.
Services Offered at CRA
Oncology Physical Therapy

Contact us to schedule an appointment:  (Click here for more info)

(512) 524-0964

Lymphedema Treatment

Contact us to schedule an appointment:  (Click here for more info)

(512) 524-0964

Contact us to schedule an appointment: (Click here for more info)
(512) 731-2462
Massage Therapy

Contact us to schedule an appointment: (Click here for more info)
(512) 576-1050
Yoga Therapy

CRA offers private yoga sessions taught by Kimberly Wharton. 

Schedule today with Kimberly:
(323) 363-3050
Free Nutritional Consults

Free nutrition consultations are offered at by Dr. Krystle Zuniga Phd, RD.  (Click here for more info)

For more information or to set up an appointment, contact Krystle Zuniga at: kezuniga@gmail.com.
Cancer Rehab Austin | Phone: 512-524-0964 | Fax: 512-524-0936 
email: angela@cancerrehabaustin.com| Website: www.cancerrehabaustin.com