Cancer survivors need evidence on how to optimize physical function.

About two months ago I was walking in Georgetown on a perfectly sunny Sunday afternoon. The sidewalk I was on had no uneven sections, and it was dry with no ice or snow. Suddenly, I was falling forward. I attempted to catch myself and just could not coordinate my legs to stop the fall. I used my right arm and shoulder to break the fall and the sidewalk won out. As I sat up on the sidewalk I was in pain and found I could not move my arm. I decided I should to drive to an ER. After the Xray and it was clear that I didn’t break anything, I went home. After the fall I thought that perhaps I should have an MRI of my brain because I, like other brain tumor survivors, know the tumor can recur with no other fanfare than the occurrence of a symptom. For months prior to the fall I noticed my balance was off and it seemed like this was happening more often than in the past. I was walking with a slower and more intentional gait and when I stood upright I often swayed to the back losing balance and needing to brace myself with one foot. I thought both motor symptoms were something that may be related to my tumor or its treatment, but the problems were subtle. As with many cancer survivors while I am probably overly vigilant, I had previously just chalked these symptoms up to “changes I just need to live with.” In the back of my mind, I ignored both the imbalance and the fall until a few weeks ago. At that time, I noticed that for no apparent reason I was also hitting walls as I walked upstairs or turned corners. I thought this was strange and so, coupled with the events described earlier and this new experience, I wanted to know if there was any change in my MRI that might explain these mild balance symptoms. I arranged to reschedule my standard six month follow up and move up my MRI and clinic visit. On exam I had minor signs of balance problems but nothing out of the ordinary. The MRI was “extremely” stable as well. The neuro-oncology group requested a more detailed study of my cerebellum for this visit and that did not find anything remarkable either. Even the atrophy differences between the two lobes of my cerebellum had remained perfectly stable. This of course was great news, no evidence of tumor growth or for that matter any change. But what do I do about my balance problems? I was told when asking about the discrepancy that I need to realize that my cerebellum has been compromised (tumor, surgical resection, radiation, and chemotherapy), I will have balance and coordination problems and perhaps other functional changes as well from time to time, but anatomically things look completely stable. The explanation that was presented for the discrepancy between the MRI and my experience of the past several months made perfect sense to me and helped to calm my concerns. However the bottom line for me is that my balance/coordination is a problem. The staff performed a very complete work up. They addressed the pathology issue which is their responsibility. Recurrence was thoroughly investigated and ruled out. I am very appreciative. But what can I do about the balance problems? Do I see a balance specialist? Do I try to exercise on a balance board on my own? Do I see a neurologist? Do I see a physiatrist who has experience in the manageJ Cancer Surviv (2009) 3:73–74 DOI 10.1007/s11764-009-0090-5