January 4, 2012
Systematic
review: conservative treatments for secondary
lymphedema - 7thSpace
Interactive –
Several
conservative (i.e ., nonpharmacologic, nonsurgical) treatments exist for
secondary lymphedema. The optimal treatment is unknown.
We examined the
effectiveness of conservative treatments for secondary lymphedema, as well as
harms related to these treatments.
Methods: We searched MEDLINE,
EMBASE, Cochrane Central Register of Controlled Trials, AMED, and CINAHL from
1990 to January 19, 2010. We obtained English- and non-English-language
randomized controlled trials or observational studies (with comparison groups)
that reported primary effectiveness data on conservative treatments for
secondary lymphedema.
For English-language studies, we extracted data in
tabular form and summarized the tables descriptively. For non-English-language
studies, we summarized the results descriptively and discussed similarities
with the English-language studies.
Results: Thirty-six English-language
and eight non-English-language studies were included in the review.
Most
of these studies involved upper-limb lymphedema secondary to breast cancer.
Despite lymphedema's chronicity, lengths of follow-up in most studies were
under six months.
Many trial reports contained inadequate descriptions
of randomization, blinding, and methods to assess harms. Most observational
studies did not control for confounding.
Many studies showed that active
treatments reduced the size of lymphatic limbs, although extensive
between-study heterogeneity in areas such as treatment comparisons and
protocols, and outcome measures, prevented us from assessing whether any one
treatment was superior. This heterogeneity also precluded us from statistically
pooling results.
Harms were rare (<1% incidence) and mostly minor
(e.g ., headache, arm pain).
Conclusions: The literature contains no
evidence to suggest the most effective treatment for secondary lymphedema.
Harms are few and unlikely to cause major clinical problems.
Author:
Mark OremusIan DayesKathryn WalkerParminder Raina
Credits/Source: BMC Cancer
2012, 12:6
Predicting the Risk for Developing
Lymphedema - Clinical Oncology News – by
Karen Blum
San
Francisco—Researchers have developed a set of statistical models that are more
than 70% accurate in predicting the five-year risk for lymphedema following
axillary lymph node removal during breast cancer surgery.
The models will
soon be available online to all physicians, free of charge. The study was
presented at the 2011 Breast Cancer Symposium, by Jose Bevilacqua, MD, PhD,
surgical oncologist at Hospital Sirio Libanes in Sao Paulo,
Brazil.
Although fewer
women these days need axillary lymph node dissection (ALND), which has led to a
decrease in lymphedema, “the ability to pre- and postoperatively identify those
at risk is an important step forward,” said Andrew Seidman, MD, attending
physician in the Breast Cancer Medicine Service at Memorial-Sloan Kettering
Cancer Center, in New York City, who was not involved with the study. “It
allows us to appropriately triage patients for early intervention, or refer
them to trials aimed at preventing lymphedema. This has real practical
implications.”
In what is
believed to be the largest prospective study of lymphedema occurrence,
researchers followed 1,054 women with breast cancer undergoing ALND between
August 2001 and November 2002 at the Brazilian National Cancer Institute in Rio
de Janeiro. They used measuring tape to calculate arm volume before surgery,
the day after surgery, one month following surgery and then at six-month
intervals. Lymphedema was defined as a volume difference of at least 200 mL
between arms six months or more following surgery; the overall five-year
incidence was 30.3%.
Using
clinical factors including age, body mass index (BMI), ipsilateral arm
chemotherapy infusions, level of ALND, location of radiotherapy, development of
postoperative seroma, infection and early edema, researchers developed three
models and corresponding nomograms to predict the risk for developing
lymphedema at five years. The three models used data from different time
points.
The first model,
used preoperatively, analyzed risk factors including age, BMI and the number of
chemotherapy cycles before surgery. The second model, used within six months
following surgery, considered the risk factors from the first model, plus the
extent of ALND and the location of the radiotherapy field. The third model,
used at six months or more following surgery, considered the risk factors from
the second model, plus the development of seroma or early edema.
Comparing the
models’ predictions with the incidence of lymphedema, researchers found
concordance indexes of 0.706, 0.729 and 0.736 for models 1, 2 and 3. The
concordance index is the probability that, given two randomly selected
patients, the patient with the worse outcome is, in fact, predicted to have a
worse outcome. “For the sake of comparison, these modeling tools are as
accurate for predicting a woman’s risk for developing lymphedema as mammography
is for the detection of breast cancer,” Dr. Bevilacqua said.
The models also
identified a novel association between arm lymphedema and ipsilateral
neoadjuvant chemotherapy infusion.
The researchers
are making their calculation tools available free over the Internet. A tool to
calculate arm volume is now available at www.armvolume.com. The models to
estimate risk for lymphedema will be available at www.lymphedemarisk.com after the
study is published.
Program Curbs Shoulder Morbidity Post Breast
Cancer - The Oncology Report – by Bruce
Jancin
SAN ANTONIO �
Long-term upper-extremity pain and functional impairment following breast
cancer surgery are reduced by an innovative physical therapy�centered surveillance
program, according to a 5-year prospective study.
The program was developed at
the breast care center of Walter Reed National Military Medical Center,
Bethesda, Md. It begins with a preoperative patient interview and structured
evaluation by a physical therapist. The assessment includes what physical
therapists call an upper-quarter screen, which evaluates shoulder range of
motion, strength, and arm volume. Self-reported pain, fatigue, function, and
activity level are recorded.
At that time, the patient is
also instructed in a home exercise program she is to start 2 weeks post
surgery. These are simple range-of-motion exercises focused on forward flexion
overhead; abduction; internal and external rotation of the glenohumeral joint;
and scapular retraction, Nicole L. Stout explained at the San Antonio Breast
Cancer Symposium.
The patient is subsequently
seen by the physical therapist (in conjunction with her regular follow-up
visits with an oncologist or surgeon) at 1, 3, 6, 9, 12, and 60 months post
surgery. If upper-extremity dysfunction worsens, more intensive interventions
are introduced.
The rationale for this
prospective surveillance program lies in an understanding that the shoulder and
arm impairments caused by breast cancer surgery and radiation therapy are
typically subtle initially, but if left unidentified and uncorrected, they
often progress to serious rotator cuff damage, "frozen" shoulder, and
debilitating lymphedema, according to Ms. Stout, a civilian research physical
therapist at the military center.
She had previously presented
her 1-year prospective outcomes. This time around, she presented prospective
5-year follow-up data on 86 breast cancer patients who participated in the
program. This is the first prospective cohort study in the United States to
track breast cancer�related upper-extremity
morbidity and functional outcomes for this long a time period.
The 12-month and 5-year
visits included formal assessment of upper-extremity outcomes using the Harvard
Alumni Activity Survey, the Upper Limb Disability
Questionnaire, and the Short Form-36.
At 5 years, 11% of the women
had stage I/II lymphedema and 38% had subclinical lymphedema (defined as less
than 3% arm volume swelling as measured by a Perometer). These results compare
favorably with those of published studies on lymphedema, which have reported
long-term rates of stage I-III arm swelling in the 40%-60% range, she noted.
In all, 18% of patients
reported arm numbness at 5 years, 17% noted shoulder pain, 3% had neck pain,
and 1% had chest wall pain.
One-third of subjects
reported fatigue of level 3 or more on a 10-point visual analog scale. Again,
other investigators have documented long-term rates of clinically significant
fatigue in the 50%-60% range.
At 5 years post surgery,
patients demonstrated less impairment of physical activity than at preoperative
baseline. At baseline, 33% had significant limitations in terms of carrying
heavy objects, performing household chores, and other physical activities.
After 5 years of prospective surveillance and tailored physical therapy, only
20% of patients had physical activity limitations.
However, 68% of patients
reported experiencing some restrictions on their social activity at 5 years,
and 52% experienced limitations on their recreational activities.
The study was funded by the
medical center. Ms. Stout declared having no financial conflicts of
interest.
Beating cancer with a paddle -
North Shore Outlook – By Maria Spitale-Leisk
Paddling
through the waters of False Creek in a long canoe adorned with a dragon head,
Esther Matsubuchi remained brave.
But
in the back of her mind, lymphedema was lurking. Matsubuchi, a breast cancer
survivor, was told by her doctor that she could potentially develop this
debilitating condition that causes permanent swelling of the arms.
Don’t
knit. Don’t garden. Don’t play the piano. Basically, don’t move your upper body
too much she was told. But the Lynn Valley resident didn’t heed that
advice.
Instead,
she paddled through the oft-choppy waters of False Creek under the careful
watch of Dr. Don McKenzie, a University of British Columbia sports-medicine
expert.
The
contrarian doctor believed there was no strong correlation between lymphedema
and upper body movements in breast cancer patients. In 1996 he tested that
theory by rounding up two dozen breast cancer survivors between the ages of 30
and 60, including Matsubuchi, and placing them two across in a close-quarters
dragon boat that doubled as a lab. They called themselves Abreast in a
Boat.
They
started cautiously.
“We
paddled a total of four minutes in one hour,” said Matsubuchi.
It
was wet and cold outside during practices in early April. But the conditions
didn’t dampen spirits inside the boat — nor did the blisters, bruises and aches
and a few misfiring paddles that accidentally struck other
occupants.
The
ladies celebrated the end of three months of lymphedema testing by entering the
Vancouver Dragon Boat Festival. Up against younger and stronger mixed-gender
teams, the result Abreast in a Boat recorded was best filed under personal
accomplishment. And Dr. McKenzie’s theory prevailed: not a single woman on the
team developed lymphedema.
His
findings prompted some breast cancer oncologists to change they way they
counsel patients about lymphedema.
The
same year Abreast in a Boat was formed,
Francoise Doe found a lump in her breast during a self exam. She was working as
a special education aid in the North Vancouver School District at the time. Her
first chemotherapy session fell on her daughter’s 16th birthday.
“It
was low-key event,” recalled Doe.
During
her recovery period in 1997, she learned of Abreast in Boat through a breast
cancer support group. A self-described “non-amphibious person,” Doe needed a
change of scenery.
“I
just wanted to put cancer aside,” she said. “I needed a break from
that.”
In
the midst of recuperating from her battle with breast cancer, Doe was also
going through a separation and in search of support. She found solace with the
paddle-boating cancer survivors from False Creek.
Just
as Doe was stepping into a dragon boat, another North Vancouver resident,
Rosemary Shandler, was reeling from her own breast cancer
diagnosis.
She
cheered weakly from the sidelines as a sea of pink-clad ladies furiously
paddled their dragon boat through False Creek to the rhythm of the drum
beat.
“I
cried like a baby,” she said. “It was just so inspiring to me. They had gotten
back in touch with their bodies, their health and their strength.”
Shandler
vowed to seek them out — when she was well enough. In 2000, now fragile only
from emotional scars she made good on her promise to join Abreast in a Boat
False Creek, which by this time had teams throughout the Lower
Mainland.
Shandler
had plenty to offer, bringing marathon running endurance to the team. But that
doesn’t mean she wasn’t happily exhausted after her first time out on the
water.
“I
found that during the first season I would be sitting out at the end of the
[dragon] boat and I had a feeling of such joy,” said Shandler, who paddles with
Abreast in Barnet in the Burrard Inlet.
The
Barnet Marine Park setting is quite tranquil. Eagles, herons and harbour seals
share the water with these teak-hulled canoes — rigged with decorative Chinese
dragon heads and tails — that majestically glide across the waters of the
Burrard Inlet.
Abreast
in a Boat is a support group of sorts, but participants try to not talk about
the ‘c-word’.
“We
don’t have a chance,” said Matsubuchi. “We are not allowed to talk in the
boat.”
Still,
there’s no elephant onboard. Personal stories are shared. It took Matsubuchi a
bit longer to open up about her cancer.
“People
don’t talk about [cancer], in places like Japan and China,” said Matsubuchi,
who is of Japanese heritage.
“My
parents used to go to funerals and come home not knowing how the person died.
They presumed it was cancer because the person had looked pale
lately.”
Quashing
that cancer stigma is a mission undertaken by the women of Abreast in a Boat.
They courageously tell their tales all over the world, from the Pacific
Northwest to the Eastern United States, Europe and Asia.
This
past October, all three North Vancouver women took part in an international
dragon boating regatta for female cancer survivors, in Putrajaya, Malaysia. The
hybrid team — comprised of members from the six Lower Mainland Abreast in a
Boat groups — earned a silver and two bronze medals.
Another
North Vancouver woman was on the wait list for this trip, an 86-year-old who
had paddled alongside Matsubuchi for many years. They were carpooling
companions. But in October, her friend’s health took a turn for the
worse.
“At
the funeral today everyone said we were twins,” said Matsubuchi.
Doe
said Malaysia was never on her bucket list. However, when the opportunity to
paddle in the tropical waters of Southeast Asia came up, she
jumped.
Doe
enjoyed the people and weather in Malaysia. She also learned that talking about
cancer in that region of the world is considered taboo.
“That’s
why we travel — to show other women there is life after breast cancer,” said
Doe.
The
North Shore Dragon Busters — a local Abreast in a Boat affiliate — have been
paddling out of Deep Cove for the past decade. If you are a breast cancer
survivor and interested in joining them, email
[email protected].
Marshall Medical Centers to host breast cancer
survivor luncheon - Sand Mountain Reporter – By
Elizabeth Summers –
Breast
cancer survivors in Marshall County will have an opportunity to reach out to
other survivors during a special luncheon Jan. 20.
Marshall
Medical Centers and the Foundation for Marshall Medical Centers, in conjunction
with the University of Alabama at Birmingham School of Nursing, will host a
free informational luncheon at the Marshall Professional Center in
Guntersville. The center is across the street from Zaxby's restaurant, on U.S.
431 in Guntersville.
During
the luncheon event, Dr. Karen Meneses of the UAB School of Nursing will offer
tips on lymphedema or the swelling of arms and hands; emotions and how to deal
with the fear of recurrence; sexuality; and maintaining good health following a
battle with breast cancer.
Andrea
Oliver, director of the Foundation for Marshall Medical Centers, said the
luncheon will highlight the results of a focus group and their
findings.
"The
program is made possible via a grant from the Susan G. Komen for a Cure
Foundation with a goal to help improve the quality of life and survivorship
experience for breast cancer survivors in the Marshall Medical Centers service
area," Oliver said.
The free
Lunch ‘N Learn event will begin at 11:30 a.m. and end at 1 p.m.
Breast
cancer survivors must reserve a seat by calling 866-662-0630 or the Foundation
For Marshall Medical Centers at 256-571-8026 or 256-753-8026 for Arab
residents.
During
2011, an estimated 230,480 women and 2,140 men were diagnosed with new cases of
breast cancer. Of those, 39,520 women and 450 men died from the disease,
according to the American Cancer Society.
The
luncheon is a follow-up to a small focus group study held in July 2011 and will
focus on how to maintain health following a breast cancer diagnosis and
subsequent treatments, Oliver said.
"The
smaller focus group was held on July 8," Oliver said. "They assessed what needs
were being unmet in the Marshall Medical Centers service area for local breast
cancer survivors.
"(Dr.
Karen) Meneses and Silvia Camata, of the UAB School of Nursing, joined the
Marshall Cancer Center staff, the Foundation for Marshall Medical Centers and
eight women, all breast cancer survivors with years since diagnose ranging from
less than 1 year to 16 years.
"The
participants acknowledged that Marshall Medical Centers had played a big role
in helping them through their diagnosis and treatment, but also mentioned
several issues have had an impact on their quality of life since breast
cancer.
"Among
the problems were fatigue, lymphedema, pain, changes in body image and
acceptance of their new selves, side effects of medication, depression, and
bone health.
"Additionally,
how to maintain health issues such as check up, taking care of bone health,
nutrition and physical activities were among key concerns," she
said.
"Participants
made several suggestions to help Marshall Medical Centers improve their
services for breast cancer survivors. The capabilities to access support and
education materials and services as well as formal support groups hosted in
Marshall County were among the most popular suggestions.
"Additionally,
one-on-one type of support was mentioned several times as important to breast
cancer survivors. With this information and feedback at hand, the Marshall
Cancer Center is working toward being more effective in providing these
services."
January 5, 2012
New season of
paddling nears for Abreast in a Boat -
Richmond Review –
The
Richmond chapter of Abreast in a Boat will be
holding an information meeting Thursday, Jan. 12.
Abreast
in a Boat is a group of women living with breast cancer who participate in
dragon boat racing to raise awareness about breast cancer and to encourage
those living with it to live full and active lives.
The
non-profit group’s aim is to send a message of hope to people living with the
disease, and to those who support them.
Leading
healthy and active lives is so important to an individual’s recovery and
ability to move forward in life. Participating in dragon boating provides fun,
challenge and a chance to meet new people. The boat is a floating support
group, a symbol of hope, and a vivid demonstration that one can have a full and
active life after cancer.
Before
the Abreast In A Boat organization formed in 1996, there was a belief among
some health professionals and breast cancer survivors that women recovering
from the disease should avoid upper-body exercise. It was thought that this
type of exercise could cause lymphedema, a painful swelling of the arm and
chest area that is sometimes the result of surgery.
Dr. Don Mackenzie, a Richmond
resident, and doctor of physiotherapy at University of B.C. challenged what we
now know to be erroneous beliefs.
He
got 20 women breast cancer survivors to try dragon boating. His findings and
the outreach efforts of Abreast In A Boat have inspired over 150 teams around
the world and thousands of women catching the wave of life through dragon
boating.
Today,
studies not only prove that survivors can exercise without increasing their
risk of lymphedema but that those with active lifestyles reduce the risk of
cancer recurrence.
The
five-year-old Richmond chapter is one of five in the Lower Mainland. Twice a
week for four months beginning in spring, 20 women paddle up and down the
Middle Arm, in preparation for a series of regattas.
This
past year six novices joined the Richmond crew, which paddled out of the
Richmond Yacht Club, and the group is hoping to attract more newcomers this
year.
Experience
in paddling isn’t necessary to join the group.
The
information meeting will take place at 7 p.m. at Accent Inn Vancouver Airport
Hotel, 10551 St. Edwards Dr. To register or for more information, contact Bunny
Ross at [email protected]
January 6, 2012
Prospective
surveillance model emerges as standard of care for breast
cancer treatment - EurekAlert
Model associated with
significant cost savings
Alexandria, VA, January 6,
2012 – Early diagnosis and treatment of breast cancer-related lymphedema by a
physical therapist can significantly reduce costs and the need for intensive
rehabilitation, according to an article published in the January issue of
Physical Therapy (PTJ), the scientific journal of the American
Physical Therapy Association (APTA).
The study, led by APTA
member and spokesperson Nicole Stout, PT, MPT, CLT-LANA, compared a prospective
surveillance model with a traditional model of impairment-based care and
examined the direct treatment costs associated with each program. Treatment and
supply costs were estimated based on the Medicare 2009 physician fee schedule.
Researchers estimated that treatment for breast cancer-related lymphedema costs
$636.19 a year when the prospective surveillance model was used vs $3,124.92
for traditional treatment of advanced lymphedema.
The goal of a prospective
surveillance model for cancer rehabilitation is to identify impairment at the
earliest onset to alleviate impairment or prevent it from progressing. Soon
after diagnosis, a physical therapist will perform a preoperative examination
to establish a baseline level of function. Follow-up examinations are then
conducted postoperatively at 1 month and then 3-month intervals, for up to 1
year. In contrast, a traditional model focuses on treating lymphedema once it
has progressed and patients already have functional limitations.
"This study begins to paint
a picture of evidence showing that prevention of chronic conditions such as
lymphedema—using rehabilitation models of care—may result in significant cost
savings," said Stout.
Breast cancer-related
lymphedema is characterized by abnormal swelling of the arm and hand, which can
be disfiguring. A chronic condition, it is associated with decreased arm
function, disability, and diminished quality of life. If the condition is not
diagnosed early and managed, a patient can be at risk for infection and further
shoulder complications.
In place for more than 10
years, the prospective surveillance model was developed at the National Naval
Medical Center in Bethesda—now part of the Walter Reed National Military
Medical Center—and is the standard of care for all patients diagnosed with
breast cancer at the medical center. Several research articles have been
published demonstrating clinical effectiveness of the prospective surveillance
model in reducing lymphedema, shoulder morbidity, and fatigue, including the
February 2010 article in the journal Breast Cancer Research and
Treatment.
Although further analysis of
indirect costs and utility is necessary to fully assess cost effectiveness, the
prospective surveillance model is emerging as the standard of care for breast
cancer treatment.
###
The American Physical
Therapy Association (APTA) represents more than 77,000 physical therapists,
physical therapist assistants, and students of physical therapy nationwide.
Learn more about conditions physical therapists can treat and find a physical
therapist in your area at www.moveforwardpt.com. Consumers
are encouraged to follow us on Twitter (@moveforwardpt) and
Facebook
January 9, 2012
A new outlook
for the new year - MiamiHerald.com - By
Andrea Torres
Andrea Torres, a producer at
The Miami Herald, is chronicling her breast cancer journey in Tuesday’s
Tropical Life.
It looked like the worst
part of the life-saving treatment for breast cancer was behind me. My future
was hopeful. I just had to be patient.
I had adopted a new routine
to battle the morning sadness. I began to browse through a small booklet
titledMyself: Together Again by breast cancer survivor Debbie
Horwitz. It has a series of photographs showing the breast reconstruction
progress she underwent when she was 32.
I had become a beneficiary
of her last year’s resolution: “We are going to continue to empower and educate
women with knowledge of the reconstruction process through relevant and
descriptive images and information, as a means of helping them cope,” Horwitz
said in a video posted on her website, MyselfTogetherAgain.org.
Her booklet
helped me start my day with a new attitude. The last photo, labeled “Whole
Again,” showed Horwitz’s permanent implants. Her breast looked beautiful. I was
on my way there.
As my hair began to grow
back, I stopped wearing wigs. And the world didn’t stop and stare. Except for a
cute little boy with big green eyes. As his mother and I stood in line at the
drugstore, he was examining me with curiosity. In a failed attempt at
discretion when I glanced back, he looked away and began to whistle. I laughed.
His mother scolded him, “DON’T bother the young lady!”
“Hi, it’s OK. What’s your
name?” I asked.
“My name is
Jordan. Can I ask you a question?”
I smiled. “Of
course, I bet is about my hair.”
“Did you just
come back from war?”
“Almost.”
And then he had to go, so I
couldn’t explain how I felt like I had been a prisoner of war.
After months of avoiding
crowds, I celebrated New Year’s Eve at Walt Disney World’s Epcot Center in
Orlando. And for the first time in my life, it felt great to be stuck in
pedestrian traffic. Long lines did not bother me. By the time 2012 had arrived,
I had undergone about a dozen sessions of daily radiation therapy at the
University of Miami’s Sylvester Comprehensive Cancer Center, and my immune
system was holding up.
The anxiety rush as I walked
into the therapy room was part of the routine. I took off my clothes from the
waist up. I had gotten used to being topless for the weekday outpatient
treatment. And no one was horrified.
On a bad day, fear would
boil up when a red “BEAM ON” sign lit up and a buzzing sound filled the room.
As the machine, known as the linear accelerator, rotated around me, my heart
would sometimes beat faster, and my mind would scream out possible side
effects: “Lymphedema. Secondary cancer. Narrowed coronary arteries. Rib
fracture.”
On a good day, I closed my
eyes and a brief self-guided meditation would help me picture a peaceful beach
in Nantucket, a desolated forest in Chile, or the top of a mountain in Peru, as
the radiation easily destroyed the cancer cells. The healthy cells that were
damaged were able to survive and repair themselves. That was the ideal.
Aside from some minor skin
irritation, the only evident side effect from radiation that I was struggling
with was fatigue. Time slows down when you are tired. Breast cancer survivors
say the feeling can last for weeks or months after the treatment ends.
“It feels like you are
dragging your feet all the time. You have to take it easy,” said a cancer
survivor.
“Radiation
drains you,” another warned.
Taking vitamins to get a
boost was not advised. UM radiation oncologist Dr. Cristiane Takita, whom I had
been meeting with for a weekly hug and a reminder to rub a clear alcohol-free
aloe gel on the radiated area, said I should avoid taking supplemental
antioxidant vitamins.
“Vitamins C, E, A and D
might interfere with radiation’s ability to destroy cancer cells,” Takita said.
“Vitamins that come from food are OK. When radiation is finished, you can resume
taking your supplements.”
This is because there is a
potential conflict. Radiation creates free radicals, highly energized molecules
that damage cells. These free radicals target cancer cells. Antioxidants keep
free radicals from forming, or neutralizes them.
During our first meeting of
2012, she was unusually enthusiastic.
“Everything is going really
well. This is great! Great! Great! Great! Great! And you are almost done,” she
said. “There is no time for depression. This is almost over. You are halfway
through.”
Read more here:
http://www.miamiherald.com/2012/01/10/v-fullstory/2581368/a-new-outlook-for-the-new-year.html#storylink=cpy
January 10,
2012
Physical therapy
'could reduce cost of lymphedema
treatment' - Spire Healthcare –
Early diagnosis and
treatment of breast cancer lymphedema by a physical therapist could
significantly reduce the cost and need for intensive rehabilitation, according
to latest research.
Scientists writing an article published in the
January issue of the journal Physical Therapy for the American Physical Therapy
Association (APTA) suggested that a prospective surveillance model for the
treatment of breast cancer-related lymphedema was significantly lower in cost
compared to a traditional model of impairment-based care.
APTA member
and spokesperson Nicole Stout, who led the programme, said: "This study begins
to paint a picture of evidence showing that prevention of chronic conditions
such as lymphedema - using rehabilitation models of care - may result in
significant cost savings."
Researchers found that the prospective
surveillance model cost around $636.19 (£411.83) a year compared to $3,124.92
for the traditional treatment of advanced lymphedema, also known as a lymphatic
obstruction.
The condition is a blockage of the lymph vessels that drain
fluid from tissues throughout the body and could affect the workings of the
immune system.
Posted by Jeanette Royston
Health News is provided
by Adfero in collaboration with Spire Healthcare. Please note that all copy
above is ©Adfero Ltd. and does not reflect views or opinions of Spire
Healthcare unless explicitly stated. Additional comments on the page from
individual Spire consultants do not necessarily reflect the views or opinions
of other consultants or Spire
Healthcare.
January 10,
2012
Medical
People - The Ledger –
Dr. Andres
Medina, a cardiac, thoracic and vascular surgeon, has joined Watson Clinic. He
will perform cardiovascular surgical procedures at Lakeland Regional Medical
Center. Medina earned his medical degree from Ohio State University in
Columbus. He did his internship and residency in general surgery at the
Memorial Health University Medical Center, Mercer School of Medicine, in
Savannah, Ga. He performed his residency in general surgery and completed
fellowships in cardiothoracic surgery and heart and lung transplants at the
University of Miami/Jackson Memorial Hospital in Miami. Medina served as
clinical assistant professor of surgery in Thoracic and Cardiovascular Surgery
Department at the University of Miami School of Medicine. Medina is
board-certified in general surgery and thoracic surgery. His areas of expertise
include minimally invasive cardiac and thoracic approaches, including daVinci
robotic surgery, transcatheter aortic valve replacement, off-pump coronary
artery bypass grafting, and video-assisted thoracoscopic surgery
lobectomy.
Kelley
Giovannucci, physical therapy assistant; and Rizwana Mir, physical therapist;
have joined Luz Rivera, physical therapist, as having certification in
lymphedema therapy. All practice at Lakeland Regional Rehabilitation and Sports
Medicine Clinic. Lymphedema or swelling caused by the abnormal buildup of fluid
can result in a feeling of heaviness, pain and a decline in
mobility.
Support to breast cancer
survivors - Daily Examiner –
CLARENCE Valley women recovering from breast cancer surgery are being
encouraged to register now for the new term of the 2012 YWCA NSW Encore
Program.
The program, funded by NSW Health, is described as an innovative and
inspiring approach to recovery from breast cancer surgery.
It is a proven exercise program offered free in Grafton by YWCA
NSW.
Encore program co-ordinator Kate Guthrey said the program involved
gentle exercise for those who had breast cancer surgery, and it met the
physical needs and supported the well-being of women after the trauma of
surgery in a nurturing and supportive environment.
"It can help whether your surgery was a few months ago or 20 years
ago," she said.
A new study published in December 2011 in the Journal of Cancer
Survivorship by University of Missouri's Sinclair School of Nursing researchers
highlighted the benefits of exercise for women who have experienced breast
cancer, including those who develop lymphedema, swelling that commonly occurs
after breast cancer treatment.
Lymphoedema can occur any time after cancer treatment and is usually
caused by the removal or radiation of lymph nodes as part of the treatment
process.
"The Encore Program was created to improve movement, flexibility and
strength after breast cancer surgery. It helps to reduce the potential risk of
lymphedema and can assist in the management of lymphedema," Ms Guthrey
said.
The Incidence of Breast Cancer in Australia, published by the Federal
Government's Cancer Australia in June 2011, showed the number of women
diagnosed with breast cancer in Australia increased from 5291 in 1982 to 12,567
in 2007, but NSW had one of the lower incidence rates, with ACT being the
highest and Northern Territory the lowest.
The YWCA Encore Program starts in Grafton on February 16 and will run
for eight weeks until April 5, each Thursday from 1pm to 3pm.
"Because medical clearance is required, it's important to register as
soon as possible in order to secure a place, at least two weeks prior to the
class beginning because the classes are small and intimate, so places fill up
quickly," Ms Guthrey said.
Register by calling 9285 6264 or 1800 305 150.
The program incorporates gentle floor and hydrotherapy exercises and
is an opportunity for relaxation and information sharing.
Exercise programs for most people who have experienced cancer can
reduce anxiety and depression, improve mood, boost self-esteem and reduce
symptoms of fatigue.
January 12,
2012
This one has
tables and a lot of stuff in the full article, but I also found the abstract to
use if the formatting is unusable Tina
Newswise —
Articles featured in this issue include-- -
Newswise
Abstract--Lymphedema is a debilitating complication
following mastectomy, affecting the arm functions and quality of life (QOL)
effects of upper-limb exercises on lymphedema in clinical settings. However,
there is a dearth of evidence regarding the effect of home-based exercises on
lymphedema; therefore, we examined the effect of a home-based exercise program
on lymphedema and QOL in postmastectomy patients. Thirty-two female
postmastectomy lymphedema patients participated in an individualized home-based
exercise program for 8 weeks. Arm circumference, arm volume, and QOL (36-Item
Short Form Health Survey) were measured before and after the program. Data were
analyzed with the use of paired t-tests for circumferential and
volumetric measures and Wilcoxon signed ranks tests for QOL. Significance level
was set at p < 0.01 with Bonferroni correction
(alpha/n = 0.05/5 = 0.01). Analysis showed a statistically
significant improvement in the affected upper-limb circumference and volume
(~122 mL reduction, p < 0.001) and in the QOL scores
(p < 0.001) at the end of the home-based exercise program. The
individualized home-based exercise program led to improvement in affected
upper-limb volume and circumference and QOL of postmastectomy lymphedema
patients.
INTRODUCTION
Lymphedema is a chronic, debilitating
complication that breast cancer survivors face after breast cancer treatment [1–8].
Incidence of secondary arm lymphedema varies from 5 to 56 percent [4,7–12].
About 60 percent of patients who undergo axillary lymph node resection and
irradiation will eventually develop lymphedema [13].
Lymphedema develops when the lymphatic flow is
impaired and excess fluid and protein accumulate in the interstitial
space. The hemodynamic factors at the site oflymphedema may also play a role in
its development [1]. Affected women can experience pain, swelling, arm
tightness, heaviness of the arm, and recurrent skin infections. If left
untreated, lymphedema may predispose the affected limb to the development of
other secondary complications like recurrent bouts of cellulitis or
lymphangitis, axillary vein thrombosis, severe functional impairment, cosmetic
embracement, and lymphangiosarcoma [9]. Breast cancer survivors may find
lymphedema more distressing than mastectomy, because hiding the physiological
manifestations and loss of function of lymphedema is harder. Overall, these
factors lead to decreased quality of life (QOL) for breast cancer survivors
[14–15]. Rehabilitative interventions are considered the mainstay for the
treatment of lymphedema, and exercises form an integral component of such
rehabilitation [16].
For decades, any kind of strenuous activity has been feared to
exacerbate the lymphedema. Current clinical guidelines indicate that women with
and at risk for lymphedema should protect the affected arm from overuse
[17–18]. For this reason, patients with lymphedema avoid using the affected
limb, leading to weakness and, hence, predisposing the limb to injury even from
small household tasks. Further, such fear poses an additional barrier to
patients staying physically active, potentially translating to weight gain,
which has been shown to be associated with a worse clinical course for women
with lymphedema [5]. However, the evidence shows no association between
lymphedema and strenuous activity; hence, upper-limb resistance exercises can
help in recovery [19–26]. Previous studies support the view that upper-limb
exercises may decrease lymphedema risk by improving the lymphatic return and
lymphangiogenesis, i.e., regeneration of new collaterals [27–31]. On the other
hand, avoiding activity of the affected limb may lead to poor lymphatic
clearance and, hence, stasis of the lymphatic fluid in the affected limb [32].
During the early 6 to 12 months after mastectomy, pain and decreased shoulder
movements are more common than lymphedema [33]; these can also be prevented by
upper-limb exercises [34]. Particularly, strength training will help not only
in recovering arm strength but also in recovering bone mineral loss due to
cancer treatment. Inactivity of the affected limb may lead to prolonged arm
weakness, poor scapulohumeral function, bone mineral loss and, finally,
lymphedema [35–36].
Since the 1990s, efforts have been made by
McKenzie and other researchers to disprove the concept that strenuous
exercise of the affected upper limb may lead to or worsen lymphedema [19–22]. A
few recent clinical trials [19–29], including a well-controlled trial by
Schmitz et al. [26], have proved that upper-limb exercises have beneficial
effects for lymphedema without exacerbating it. Most of the exercise
interventions were provided in hospitals, clinics, or fitness centers. These
interventions may not be helpful for those patients who cannot afford the cost
of or who lack transportation to institution-based rehabilitation. So, a need
existed for the development of an exercise program that these patients could
easily follow and perform at their homes.
Evidence is lacking regarding the effect of
home-based exercise programs on lymphedema and QOL of breast cancer
patients. So, this study was carried out to evaluate the effects of a
home-based exercise program on lymphedema and QOL of breast cancer patients. We
hypothesized that a structured home-based program of progressive resistance
exercises of the upper limbs combined with deep breathing and self-care would
help relieve the symptoms of lymphedema and improve the QOL of breast cancer
patients. Hence, this study may give valuable evidence supporting the
importance of home-based exercise programs in the reduction of postmastectomy
lymphedema symptoms and thereby improve the QOL of breast cancer
patients.
METHODS
This study was a pre-post intervention study in
which measurements were taken before and after the 8-week home-based
exercise program. Convenience sampling was used to select the participants. The
contralateral upper limb was used as the control so that any physiological
change happening would happen equally on both the limbs.
Subjects
Breast cancer patients who had undergone
mastectomy surgery and had completed neoadjuvant chemo- and radiation
therapy from March 2006 to February 2008 were referred to the study by the
concerned oncologist and oncology surgeon. We screened 137 patients for the
inclusion and exclusion criteria given subsequently; of these, 38 met the ideal
inclusion criteria. Six were lost to follow up. Therefore, a total of 32
patients (all women) completed the exercise program. The flow of participants
through the study is shown in the Figure.
Figure. Flow of participants through study.
Inclusion and Exclusion
Criteria
Patients were included if they had undergone
unilateral mastectomy and completed chemo- and radiation therapy for stage I
or II breast cancer 1.5 years or more before participating in the study. Also,
the patients must have subsequently developed ipsilateral upper-limb lymphedema
with a difference of 2 cm or more at any one measurement point or 200 mL or
more compared with the contralateral upper limb. Patients were excluded if they
had primary lymphedema, secondary lymphedema due to other system pathology,
stage III lymphedema, bilateral disease, diagnosed cancer recurrence, and any
contraindication to the affected upper-limb exercises (e.g., venous
thrombosis).
Measurements
All the measurements were taken at baseline and
at the completion of 8 weeks of the home-based exercise
program.
Lymphedema Measurement
Lymphedema was measured two ways: using
circumferential measurements and a volumetric method. Patients using
compression sleeves were advised to remove them 3 to 4 hours before the
following measurements were taken:
1.
Upper-limb circumference was taken using cloth
measuring
tape on bilateral upper-limbs at four levels, i.e., at the metacarpophalangeal
joints, wrist joint, 15 cm distal to the lateral epicondyle, and 10 cm proximal
to the lateral epicondyle. Patients were positioned prone with their upper
limbs at their sides and their elbows straight while the circumference
measurements were taken [20–21]. Two measurements were taken and their mean was
used. The calculated difference between each circumference (in centimeters) at
all four levels between the affected and contralateral upper limbs was taken as
outcome.
2.
Volumetric measurements were taken by the water
displacement
method, which is based on Archimedes’ Principle. Two readings were taken: (1)
at the ulnar styloid process level and (2) 45 cm proximal to the ulnar styloid
process level for each upper limb. During measurement, patients were advised to
keep their upper limb straight and immerse it slowly by sliding their fingers
straight down inside the wall of the volumeter, which was filled with water.
Water displaced was collected from the point of immersion of upper limb until
the marked level was reached and no further dripping of water was observed. The
collected water was transferred into a graduated cylinder and the volumetric
reading was taken to the nearest 5 mL level. This method of volumetric
measurement has been used previously by McKenzie and Kalda [22]. The outcome
measure was the calculated difference in volume (in milliliters) displaced
between the affected and contralateral upper
limbs.
Quality of Life
QOL was measured by using the 36-Item Short Form
Health Survey (SF-36) QOL questionnaire. The SF-36 has been widely
used as a reliable and valid tool to measure general QOL of patients with
various medical conditions, including cancer. It is a 36-item scale with 8
major components that cover physical, social, and emotional functioning as well
as vitality, bodily pain, mental health, and general health. Completely filled
questionnaires were scored using the SF-36 Health Survey Manual and
Interpretation Guide [37].
Home-Based Exercise
Program
Education about postmastectomy lymphedema and
the home-based exercise program (Table 1) was given before
the initiation of the exercise program. A qualified physiotherapist gave the
initial sessions of exercise prescription and training. Patients practiced the
exercise sequence three to four times; once their performance was found
satisfactory, the exercise program (handout) along with logbook were given to
the patient. Patients were advised to increase the weight only when 2 sets of
15 repetitions became easy to perform. Patients were monitored telephonically
every week and at a fourth-week follow up in the hospital or at home for those
patients who were not able (30%) to come in for follow up.
Table
1.
Progressive resistance exercise program to enhance muscle
strength and endurance of upper limb and scapular muscles (modified from
Franklin et
al. and Harris et al. [1–2]). Participants used household items (e.g., water
bottle, salt packets).
Parameter
Description
Warm Up
Active range of motion exercises for glenohumeral joint for 5
min.
Muscle Groups
Rhomboids, middle trapezius (scapular retraction), latissimus
dorsi (shoulder extension), serratus anterior
(scapular protraction), lower trapezius (scapular depression), biceps (elbow
flexion), triceps (elbow extension), forearm muscles (wrist flexion,
extension), hand muscles (ball squeeze).
Frequency
5 d/wk.
Intensity
Start with light resistance 50%–60% of 10 repetition maximum
weight progress within tolerance.
Repetitions
1 set of 8–10, increase gradually to
10–15.
Sets
1 set, progress to 2 sets; at 2 sets of 12–15 repetitions,
increase resistance weight by 5%–10%.
Stretching Exercises
Pectoralis major and minor, latissimus
dorsi.
Deep Breathing Exercises
Deep breathing exercises between each
set.
Indication to Reduce Workload
Excessive fatigue, postexercise muscle soreness >48 h, slight
increase in arm edema lasting <1 h, pain
during or following exercise.
Indication to Terminate
Pain, discomfort, marked increase in arm edema, dizziness,
general malaise.
Self-Care Advice
Daily monitoring of affected arm for any injury or redness,
gentle distal to proximal self-massage, wearing
of compression garment, avoid insect bites, avoid sleeping on affected side,
limb elevation, etc.
1. Franklin BA, Whaley MH, Howley ET, Balady GJ. ACSM’s
guidelines for exercise testing and prescription. 6th ed. Philadelphia (PA):
Lippincott Williams and Wilkins;
2000.
2. Harris SR, Hugi MR, Olivotto IA, Levine M; Steering Committee
for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer.
Clinical practice guidelines
for the care and treatment of breast cancer: 11. Lymphedema. CMAJ.
2001;164(2):191–99. [PMID:
11332311]
Statistical Analysis
Data were analyzed using SPSS version 16 (SPSS
Inc; Chicago, Illinois) and Microsoft Excel 2007 (Microsoft Corp.; Redmond,
Washington).
Descriptive analysis was done for patient age
and time since mastectomy. Paired t-tests were used for
comparison of mean values of the pre- and postexercise circumferential and
volumetric measurements and the Wilcoxon signed ranks test was used for SF-36
QOL scores. The significance level was set at p < 0.01 using
Bonferroni correction (α /n = 0.05/5 = 0.01).
RESULTS
The mean ± standard deviation age of the
postmastectomy lymphedema patients was 46.56 ± 6.98 years and time since
mastectomy was 2.08 ± 0.65 years. A statistically significant reduction in
affected upper-limb circumference was found at three levels of measurement
(p < 0.001), except at the metacarpophalangeal joint level
(p = 0.04) and in the affected upper-limb volume (p
< 0.001) (Table 2) following the 8-week home-based exercise
program. Also, a statistically significant difference was found for QOL scores
in all SF-36 domains postintervention (Table 3). Result analysis
of the data is shown in Tables 2 and 3.
Table
2.
Pre-post exercise program changes in affected upper-limb
circumference and
volume. Data presented as mean ± standard deviation.
Measurement
Preexercise
Postexercise
Pre-Post Change
MCP Joints (cm)
19.17 ± 1.46
19.03 ± 1.37
0.14 ± 0.9
Wrist Joint (cm)
16.45 ± 2.09
16.20 ± 1.96
0.25 ± 0.13
15 cm DLE (cm)
22.16 ± 3.11
21.47 ± 2.83
0.69 ± 0.28
10 cm PLE (cm)
31.02 ± 4.38
30.06 ± 4.44
0.96 ± 0.06
Volume (mL)
2306.32 ± 627.82
2183.49 ± 597.45
122.83 ± 30.37
DLE = distal to lateral epicondyle, MCP = metacarpophalangeal,
PLE = proximal
to lateral epicondyle.
Table
3.
Pre-post exercise program changes in 36-Item Short Form Health
Survey quality
of life scores.
Parameter
Preexercise
Postexercise
Change in Score
Physical Function
33.90
44.40
10.50
Role Physical
37.30
43.40
6.10
Bodily Pain
37.60
46.10
8.50
General Health
42.20
44.60
2.40
Vitality
45.80
52.10
6.30
Social Function
37.75
45.90
8.15
Role Emotional
32.60
44.20
11.60
Mental Health
37.30
44.40
7.10
Physical Component Summary
41.25
46.30
5.05
Mental Component Summary
38.55
48.30
9.75
DISCUSSION
Lymphedema is a chronic, progressive, long-term
adverse effect of breast cancer treatment resulting in affected
upper-limb swelling, pain, heaviness, and discomfort. This not only affects the
normal functional use of the affected upper limb but also causes psychological
distress by altering the patient’s body image because of visible swelling of
the arm. Together, these symptoms greatly reduce QOL [14–15]. Several therapies
have been used to treat lymphedema, but rehabilitative interventions remain the
treatment mainstay and exercises play an important role in such
rehabilitation.
Therefore, we carried out this study to evaluate
the effect of an 8-week home-based exercise program of progressive
resistance exercises, deep breathing, and self-care on the lymphedema and QOL
of postmastectomy patients. The results of our study showed that the home-based
exercise program led to statistically significant reductions in the
circumference and volume (Table 2) of the affected upper limb and
improved QOL scores (Table 3) of breast cancer patients. Providing
a logbook and continuous monitoring resulted in good adherence to the exercise
program (89% as per logbook records). Mean change in arm volume was 122 mL. In
fact, in our study, exercise acted as a therapeutic intervention instead of
worsening the lymphedema symptoms.
Many justifications can be given regarding the
use of gradual, progressive upper-limb exercise training along with deep
breathing in the rehabilitation of lymphedema [19]. Gradually increasing the
physiological stress to the affected upper limb through flexibility,
resistance, and aerobic exercises will be better than inactivity in
postmastectomy patients. Possible mechanisms by which affected upper-limb
exercise improves or helps prevent lymphedema symptoms include that such
exercise not only enhances lymphatic flow [38–41] but also improves protein
resorption [42]. Lymphatic flow increases as a result of decreased
intrathoracic pressure during inspiration phase [43]; this leads to speculation
that increased pulmonary work during exercise may help in decreasing the
lymphedema [44]. Also, affected upper-limb venous drainage has been found to be
compromised most frequently in lymphedema patients [45]. Stretching exercises
may help reduce the soft tissue contractures and, hence, decrease the blood and
lymphatic obstruction [44].
Progressive resistance exercises may also cause
self-contraction of the lymphatic vessels by regulating sympathetic nerves
innervating these vessels. Hence, the exercises enhance control over the
internal contraction of these vessels by resetting their sympathetic drive,
which in turn is important for the long-term management of lymphedema [38–39].
Because skeletal muscle contraction is a primary force in propelling lymph
fluid throughout the lymphatic system, it can enhance lymphatic clearance. Lane
et al. injected an isotope into the hands of nondisabled women and determined
that 5 minutes of exercises using an arm ergometer enhanced lymphatic clearance
in the hand [30].
In addition, deep breathing while performing any
exercise for lymphedema is doubly important. First, deep breathing is
vital to ensure an adequate supply of oxygen to the tissues when the body is
undergoing greater than usual exertion. Second, deep breathing creates pressure
change in the abdomen, which acts like a vacuum in the thoracic cavity, helping
to drain lymphatic vessels [44]. Moseley et al. reported that 38 women with
secondary arm lymphedema who performed 10 minutes of gentle arm exercises
combined with deep breathing everyday for 1 month achieved a statistically
significant reduction in arm volume of 101 mL (9.0%) [31]. In our study, we
found a similar reduction in arm volume of 122 mL, which might be due to longer
duration of the exercise program compared with Moseley et al.’s
study.
The contralateral upper limb was used as the
control so that any physiological change in arm composition due to exercise
would happen equally on both limbs. This method is similar to previous studies
[20,22]. The outcome measures we used did not give accurate information
regarding changes at the tissue level, but regular exercises cause hypertrophy
of muscles and adipose tissue loss. Not much change was seen in arm
circumference clinically, so any effect of exercise on lymphedema is unknown to
us; other tissue changes may have occurred that masked any positive change
regarding accumulation of lymphatic fluid.
The participants also reported improvement in
their affected upper-limb health (i.e., decreased pain, heaviness, and
discomfort along with softening of fibrotic areas during daily household work)
due to the exercise program. Many participants continued doing the exercises
even after completion of the study period. Results showed a trend toward
improved QOL scores in all aspects, including physical, social, and emotional
well-being as well as general and mental health and vitality scores after the
completion of the prescribed home-based exercise program (Table
3). Increase in physical functioning scores proved the fact that
affected upper-limb progressive resistance exercises had a beneficial effect on
postmastectomy lymphedema. Participants reported more confidence in using the
affected upper limb during regular household work and were even able to lift
groceries with ease. Due to this, they were less often reminded of having
lymphedema, which may have improved vitality and general health scores. These
results are similar to the study by McKenzie and Kalda, which was also an
8-week exercise program [22]. Recent studies by Ahmed et al. and Schmitz et al.
reported 80 and 88 percent adherence rates to twice a week supervised exercise
programs for 6 months and 1 year, respectively [23,25]; in our study, adherence
was found to be 89 percent. Reason for this may be that the self- directed
exercise program for a short period of 8 weeks included many features thought
to comprise effective home training, including baseline evaluation, written
guidelines for home exercise, education about the exercise monitoring and
self-care, daily activities log, once weekly telephonic monitoring by the
therapist, and interim evaluation (fourth week). It may also be the fact that
self-directed exercises performed in the home and community facilities are more
convenient, and therefore, participants adhered more to the prescribed exercise
program. In our study, none of the participants reported increased lymphedema
symptoms as a result of the exercise program.
The prescribed 8-week home-based exercise
program improved the affected upper-limb symptoms and also led to improved
QOL. Home-based exercise programs should be considered for improving the
symptoms of lymphedema resulting from breast cancer treatments.
Lack of an appropriate control group and a small
sample size were two important limitations of our study. Also, we did
not follow the patients to determine the long-term effects of the exercise
program. Long-term studies with larger sample sizes and appropriate control
groups should be undertaken. Studies should also be done comparing effects of
home-based versus institution-based exercise programs.
CONCLUSIONS
A home-based exercise program was found to
effectively improve affected upper-limb symptoms and led to improved QOL of
breast cancer patients. Hence, this home-based exercise program should be
considered for improving the secondary lymphedema and associated symptoms
resulting from breast cancer treatments.
ACKNOWLEDGMENTS
Author Contributions:
Study concept and
design: A. P. Gautam, A. G. Maiya.
Acquisition of
data: A. P. Gautam.
Analysis and interpretation of
data: A. P. Gautam.
Drafting of
manuscript: A. P. Gautam.
Critical revision of manuscript for important
intellectual content: A. G. Maiya, M. S. Vidyasagar.
Statistical analysis:
A. P. Gautam.
Administrative, technical, or material
support: M. S. Vidyasagar.
Study supervision:
A. G. Maiya, M. S. Vidyasagar.
Financial Disclosures:
The authors have declared that no competing interests
exist.
Funding/Support:
This material was unfunded at the time of manuscript
preparation.
Institutional Review:
Ethical clearance for the study was approved by the hospital ethical
committee. A written consent for willing participation in the home-based
exercise program was taken from all the patients before the baseline
measures.
Participant Follow-Up:
The authors do not plan to inform participants of the publication of
this study. However, participants for whom contact information is available
have been encouraged to check the study Web site for updated
publications.
REFERENCES
1.
Sakorafas GH, Peros G ,
Cataliotti L, Vlastos G . Lymphedema following axillary lymph node dissection
for breast cancer. Surg Oncol. 2006;15(3):153–65. [PMID: 17187979]
http://dx.doi.org/10.1016/j.suronc.2006.11.003
2.
Coen JJ, Taghian AG ,
Kachnic LA, Assaad SI, Powell SN. Risk of lymphedema after regional nodal
irradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys.
2003;55(5):1209–15. [PMID: 12654429]
http://dx.doi.org/10.1016/S0360-3016(02)04273-6
Erratum
in: Int J Radiat Oncol Biol Phys.
2003;56(2):604.
3.
Hinrichs CS, Watroba NL, Rezaishiraz H, Giese W, Hurd
T,
Fassl KA, Edge SB. Lymphedema secondary to postmastectomy radiation: Incidence
and risk factors. Ann Surg Oncol. 2004;11(6):573–80. [PMID: 15172932]
http://dx.doi.org/10.1245/ASO.2004.04.017
4.
Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL.
Arm
edema in breast cancer patients. J Natl Cancer Inst. 2001;93(2):96–111. [PMID: 11208879]
http://dx.doi.org/10.1093/jnci/93.2.96
5.
Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in
a
cohort of breast carcinoma survivors 20 years after diagnosis. Cancer.
2001;92(6):1368–77. [PMID: 11745212]
http://dx.doi.org/10.1002/1097-0142(20010915)92:6<1368::AID-CNCR1459>3.0.CO;2-9
6.
Hayes S, Cornish B, Newman B. Comparison of methods
to
diagnose lymphedema among breast cancer survivors: 6-month follow-up. Breast
Cancer Res Treat. 2005;89(3): 221–26. [PMID: 15754119]
http://dx.doi.org/10.1007/s10549-004-2045-x
7.
Ozaslan C, Kuru B. Lymphedema after treatment of breast
cancer.
Am J Surg. 2004;187(1):69–72. [PMID: 14706589]
http://dx.doi.org/10.1016/j.amjsurg.2002.12.003
8.
Tengrup I, Tennvall-Nittby L, Christiansson I, Laurin M. Arm
morbidity
after breast-conserving therapy for breast cancer. Acta Oncol.
2000;39(3):393–97. [PMID: 10987237]
http://dx.doi.org/10.1080/028418600750013177
9.
Shih YC, Xu Y, Cormier JN, Giordano S, Ridner SH,
Buchholz
TA, Perkins GH, Elting LS. Incidence, treatment costs, and complications of
lymphedema after breast cancer among women of working age: A 2-year follow-up
study. J Clin Oncol. 2009;27(12):2007–14. [PMID: 19289624]
http://dx.doi.org/10.1200/JCO.2008.18.3517
10.
Clark B, Sitzia J, Harlow W. Incidence and risk of arm
oedema
following treatment for breast cancer: A three-year follow-up study. QJM.
2005;98(5):343–48.
[PMID: 15820971]
http://dx.doi.org/10.1093/qjmed/hci053
11.
Petrek JA, Heelan MC. Incidence of breast
carcinoma-related
lymphedema. Cancer. 1998;83(12 Suppl American): 2776–81. [PMID:
9874397]
12.
Johansson K, Ohlsson K, Ingvar C, Albertsson M, Ekdahl
C.
Factors associated with the development of arm lymphedema following breast
cancer treatment: A match pair case-control study. Lymphology
2002;35(2):59–71.
[PMID:
12081053]
13.
Armer JM, Stewart BR, Shook RP. 30-month post-breast
cancer
treatment lymphoedema. J Lymphoedema. 2009;4(1): 14–18. [PMID:
20182653]
14.
Passik SD, McDonald MV. Psychosocial aspects of upper
extremity
lymphedema in women treated for breast carcinoma. Cancer. 1998;83(12 Suppl
American):2817–20.
[PMID:
9874404]
15.
Pyszel A, Malyszczak K, Pyszel K, Andrzejak R, Szuba A.
Disability,
psychological distress and quality of life in breast cancer survivors with arm
lymphedema. Lymphology. 2006; 39(4):185–92. [PMID:
17319631]
16.
Harris SR, Campbell KL, McNeely ML. Upper extremity
rehabilitation
for women who have been treated for breast cancer. Physiother Can.
2004;56:202–14.
http://dx.doi.org/10.2310/6640.2004.00022
17.
Lymphedema: What every woman with breast cancer
should
know [Internet]. Atlanta (GA): American Cancer Society; 2009 (cited 2009 May
8). Available from: http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/
Lymphedema/WhatEveryWomanwithBreastCancerShouldKnow/index.
18.
Understanding breast cancer: After treatment: Life issues:
Lymphedema
[Internet]. Dallas (TX): Susan G . Komen for the Cure; 2009 (cited 2009 May 8).
Available from:
http://ww5.komen.org/BreastCancer/Lymphedema.html.
19.
McKenzie DC. Abreast in a boat—A race against breast
cancer.
CMAJ. 1998;159(4):376–78. [PMID:
9732719]
20.
Harris SR, Niesen-Vertommen S. Challenging the myth of
exercise-induced
lymphedema following breast cancer: A series of case reports. J Surg Oncol.
2000;74(2):95–99.
[PMID: 10914817]
http://dx.doi.org/10.1002/1096-9098(200006)74:2<95::AID-JSO3>3.0.CO;2-Q
21.
Harris SR, Hugi MR, Olivotto IA, Levine M; Steering
Committee
for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer.
Clinical practice guidelines for the care and treatment of breast cancer: 11.
Lymphedema. CMAJ. 2001;164(2):191–99. [PMID:
11332311]
22.
McKenzie DC, Kalda AL. Effect of upper extremity exercise
on
secondary lymphedema in breast cancer patients: A pilot study. J Clin Oncol.
2003;21(3):463–66. [PMID: 12560436]
http://dx.doi.org/10.1200/JCO.2003.04.069
23.
Ahmed RL, Thomas W, Yee D, Schmitz KH. Randomized
controlled
trial of weight training and lymphedema in breast cancer survivors. J Clin
Oncol. 2006;24(18):2765–72.
[PMID: 16702582]
http://dx.doi.org/10.1200/JCO.2005.03.6749
24.
Kilbreath SL, Refshauge KM, Beith JM, Lee MJ.
Resistance
and stretching shoulder exercises early following surgery for breast cancer: A
pilot study. Rehabil Oncol. 2006;
24(1):9–14.
25.
Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R,
Lewis-Grant
L, Bryan CJ, Williams-Smith CT, Greene QP. Weight lifting in women with breast
cancer related lymphedema. N Engl J Med. 2009;361(7):664–73.
[PMID: 19675330]
http://dx.doi.org/10.1056/NEJMoa0810118
26.
Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ,
Gross
CR, Lytle LA, Ahmed RL. Physical activity and lymphedema (the PAL trial):
Assessing the safety of progressive strength training in breast cancer
survivors. Contemp Clin Trials. 2009;30(3):233–45. [PMID: 19171204]
http://dx.doi.org/10.1016/j.cct.2009.01.001
27.
Box RC, Reul-Hirche H, Bullock-Saxton JE, Furnival CM.
Physiotherapy
after breast cancer surgery: Results of a randomised controlled study to
minimise lymphedema. Breast Cancer Res Treat. 2002;75(1):51–64. [PMID: 12500934]
http://dx.doi.org/10.1023/A:1016591121762
28.
Johansson K, Tibe K, Weibull A, Newton RC. Low
intensity
resistance exercise for breast cancer patients with arm lymphedema with or
without compression sleeve. Lymphology. 2005;38(4):167–80. [PMID:
16515225]
29.
Johansson K, Piller N. Weight-bearing exercise and its
impact
on arm lymphoedema. J Lymphoedema. 2007;2(1): 15–22.
30.
Lane KN, Dolan LB, Worsley D, McKenzie DC. Upper
extremity
lymphatic function at rest and during exercise in breast cancer survivors with
and without lymphedema compared with healthy controls. J Appl Physiol.
2007;103(3): 917–25. [PMID: 17585046]
http://dx.doi.org/10.1152/japplphysiol.00077.2007
31.
Moseley AL, Piller NB, Carati CJ. The effect of gentle arm
exercise
and deep breathing on secondary arm lymphedema. Lymphology. 2005;38(3):136–45.
[PMID:
16353491]
32.
Trettin H. [Neurologic principles of edema in inactivity].
Z
Lymphol. 1992;16(1):14–16. In German. [PMID:
1288027]
33.
Thomas-Maclean RL, Hack T, Kwan W, Towers A,
Miedema
B, Tilley A. Arm morbidity and disability after breast cancer: New directions
for care. Oncol Nurs Forum. 2008;35(1):65–71. [PMID: 18192154]
http://dx.doi.org/10.1188/08.ONF.65-71
34.
Turner J, Hayes S, Reul-Hirche H. Improving the physical
status
and quality of life of women treated for breast cancer: A pilot study of a
structured exercise intervention. J Surg Oncol. 2004;86(3):141–46. [PMID: 15170652]
http://dx.doi.org/10.1002/jso.20065
35.
Cheema B, Gaul CA, Lane K, Fiatarone Singh MA.
Progressive
resistance training in breast cancer: A systematic review of clinical trials.
Breast Cancer Res Treat. 2008; 109(1):9–26. [PMID: 17624588]
http://dx.doi.org/10.1007/s10549-007-9638-0
36.
Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD,
Friedenreich
CM, Ladha AB, Proulx C, Vallance JK, Lane K, Yasui Y, McKenzie DC. Effects of
aerobic and resistance exercise in breast cancer patients receiving adjuvant
chemotherapy: A multicenter randomized controlled trial. J Clin Oncol
2007;25(28):4396–4404. [PMID: 17785708]
http://dx.doi.org/10.1200/JCO.2006.08.2024
37.
Ware JE, Snow KK, Kosinski MK, Gandek B. SF-36 health
survey
manual and interpretation guide. Boston (MA): The Health Institute, New England
Medical Center; 1993.
38.
Witte CL, Witte MH. Contrasting patterns of lymphatic and
blood
circulatory disorders. Lymphology. 1987;20(4):171–78.
[PMID:
3328023]
39.
Witte MH, Witte CL. Lymphatics and blood vessels,
lymphangiogenesis
and hemangiogenesis: From cell biology to clinical medicine. Lymphology.
1987;20(4):257–66.
[PMID:
2451095]
40.
Mortimer PS. Investigation and management of
lymphedema.
Vasc Med Rev. 1990;1:1–20.
http://dx.doi.org/10.1177/1358836X9000100102
41.
Mortimer PS. Managing lymphoedema. Clin Exp Dermatol.
1995;20(2):98–106.
[PMID: 8565266]
http://dx.doi.org/10.1111/j.1365-2230.1995.tb02665.x
42.
Leduc O, Bourgeois P, Leduc A. Manual of lymphatic
drainage:
Scintigraphic demonstration of its efficacy on colloidal protein resorption.
In: Partsch H, editor. Progress in lymphology IX. Amsterdam (the Netherlands):
Elsevier; 1989. p. 421–23.
43.
Wittlinger G ,
Wittlinger H, Harris RH. Textbook of Dr. Vodder’s manual lymph drainage. New
York (NY): Thieme; 2004.
44.
Brennan MJ, Miller LT. Overview of treatment options and
review
of the current role and use of compression garments, intermittent pumps, and
exercise in the management of lymphedema. Cancer. 1998;83(12 Suppl
American):2821–27.
[PMID:
9874405]
45.
Svensson WE, Mortimer PS, Tohno E, Cosgrove DO.
Colour
Doppler demonstrates venous flow abnormalities in breast cancer patients with
chronic arm swelling. Eur J Cancer. 1994;30A(5):657–60. [PMID: 8080682]
http://dx.doi.org/10.1016/0959-8049(94)90539-8
Submitted for publication May 17, 2010. Accepted
in revised form January 20, 2011.
This article and any supplementary material
should be cited as follows:
Gautam AP, Maiya AG, Vidyasagar MS. Effect of
home-based exercise program on lymphedema and quality of life in female
postmastectomy patients: Pre-post intervention study. J Rehabil Res Dev.
2011;48(10):1261–68.
DOI:10.1682/JRRD.2010.05.0089
January 12,
2012
The Benefits of
Healing Touch - Huffington Post – by Julie
Chen
Many of
my patients express their frustration that massage therapy generally is not
covered by their health insurance, yet the health benefits seem tremendous for
them. I believe that the growing trend of discontent with lack of coverage for
massage therapy is not just limited to patients, but from health practitioners
as well.
What is
even more unfortunate is that sometimes health care practitioners rarely fully
lay hands on patients even for office visits and evaluations anymore. As a part
of most healing modalities in the past, the simple touch therapy of examining
and treating the patient imparts a level of healing that is now becoming lost
in modern day medicine.
Many of
my patients joke that doctors these days don't even put their hands on the
patient anymore except for a cursory exam at the first visit or unless
absolutely necessary. It is unfortunate that along with declining time allowed
with each patient, even the simple but effective practice of laying of hands on
patients is slowly becoming lost as well.
Even as
recent as just a few decades ago, the laying of hands and massage therapy or
manual therapy was considered a normal natural part of medicine. In more recent
times, massage and manual therapy is seen as more of a luxury rather than a
necessary part of healing and wellness.
This is an unfortunate change
in Western healing philosophy since studies show that massage and manual
therapy are beneficial for many medical conditions and health concerns, which
is likely the reason why manual therapy is still considered an important part
of healing in most other parts of the world.
Based
on numerous studies as listed below, massage and manual therapy is in my
opinion an essential part of health and healing based on improvement of
circulation, muscle function and stress reduction, just to name a few.
Nowadays in medicine, we are all well aware of how stress affects our
body negatively. We see time and time again that patients who are stressed,
anxious or depressed tend toward more negative health outcomes than those who
are feeling balanced, calm and positive.
Studies
indicate that manual therapy likely helps with stress reduction as well as
other aspects of physiology. But even taking those other physiological benefits
aside, the reduction of stress alone has tremendous health benefits to
patients, as related to more positive outcomes to overall health and daily
functioning.
So, my
recommendation to everyone reading this article is to stop thinking of massage
or manual therapy as a luxury. It is well worth the investment on a regular
basis if you can afford it. It is likely worthwhile to double check with your
insurance company and ask whether you have some coverage within your physical
therapy coverage, which many of my patients were not aware of and were
pleasantly surprised.
My
second recommendation is to find a physician who still uses the healing
modality of touch in the clinic. Frequently, just simply laying hands on a
patient during an exam allows the physician to both heal and diagnose all in
one motion.
I am a
firm believer that the therapeutic alliance between a patient and a health care
practitioner is stronger when there is a respectful level of healing touch
involved in treatment and diagnosis. In order to achieve an accurate level of
diagnosis, we were taught in medical school to obtain at least 90 percent of
the diagnosis from the patient. In order to do that, we would need to lay our
hands on our patients to fully evaluate and diagnose them... and that is what I
would recommend that you look for in your physician.
Overall, I agree with my patients that insurance companies do not
cover for this vastly beneficial healing modality enough. Not only do they not
allow physicians more time with patients for visits (short visits are necessary
in order to keep a clinic financially afloat based on the current system), but
frequently they do not cover for hands-on therapy such as massage or manual
therapy. Unfortunately then, it is left to us to pursue this topic with our
physicians and our insurance companies and see if there is coverage hidden in
the fine print of the physical therapy coverage.
If
there is, I highly recommend that you utilize the services and not wait until
you have longstanding chronic pain, insomnia, irritable bowel syndrome or
hypertension, just to name a few adverse consequences of longstanding stress
and discomfort.
I like
to frequently remind my patients that our body is not cut off at the neck; such
that what is in our mind does affect our body, and what is happening in our
body does affect our mind. So, why not make use of a healing modality that
seems to treat both our mind and body?
Ultimately, if you have to put in some leg work on your end to figure
out an affordable way to achieve regular manual or massage therapy, either
through your physical therapy coverage or an affordable massage clinic in your
neighborhood, in the long run, your mind and body will both be better off for
it.
For more by Julie Chen, M.D., click here.
For
more on personal health, click here.
Flickr photo by Nick Webb
References:
Anderson PG, Cutshall SM. Massage
therapy: a comfort intervention for cardiac surgery patients. Clin Nurse Spec.
2007;21(3):161-5; quiz 166-7.
Bernas
M, Witte M, Kriederman B, Summers P, Witte C. Massage therapy in the treatment
of lymphedema. Rationale, results, and applications. IEEE Eng Med Biol Mag.
2005;24(2):58-68.
Billhult A, Bergbom I, Stener-Victorin E. Massage relieves nausea in
women with breast cancer who are undergoing chemotherapy. J Altern Complement
Med. 2007;13(1):53-7.
Billhult A, Stener-Victorin E, Bergbom I. The experience of massage
during chemotherapy treatment in breast cancer patients. Clin Nurs Res.
2007;16(2):85-99; discussion 100-2.
Buckle
S. Aromatherapy and massage: the evidence. Paediatr Nurs.
2003;15(6):24-7.
Button
C, Anderson N, Bradford C, Cotter JD, Ainslie PN. The effect of
multidirectional mechanical vibration on peripheral circulation of humans. Clin
Physiol Funct Imaging. 2007;27(4):211-6.
Cambron
JA, Dexheimer J, Coe P. Changes in blood pressure after various forms of
therapeutic massage: a preliminary study. J Altern Complement Med.
2006;12(1):65-70.
Dryden
T, Baskwill A, Preyde M. Massage therapy for the orthopaedic patient: a review.
Orthop Nurs. 2004;23(5):327-32; quiz 333-4.
Furlan
AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database
Syst Rev. 2008;(4):CD001929.
Gordon
C, Emiliozzi C, Zartarian M. Use of a mechanical massage technique in the
treatment of fibromyalgia: a preliminary study. Arch Phys Med Rehabil.
2006;87(1):145-7.
Kaye
AD, Kaye AJ, Swinford J, Baluch A, Bawcom BA, Lambert TJ, Hoover JM. The effect
of deep-tissue massage therapy on blood pressure and heart rate. J Altern
Complement Med. 2008;14(2):125-8.
Kutner
JS, Smith MC, Corbin L, Hemphill L, Benton K, Mellis BK, Beaty B, Felton S,
Yamashita TE, Bryant LL, Fairclough DL. Massage therapy versus simple touch to
improve pain and mood in patients with advanced cancer: a randomized trial. Ann
Intern Med. 2008;149(6):369-79.
Maa SH,
Tsou TS, Wang KY, Wang CH, Lin HC, Huang YH. Self-administered acupressure
reduces the symptoms that limit daily activities in bronchiectasis patients:
pilot study findings. J Clin Nurs. 2007;16(4):794-804.
McNeill
JA, Alderdice FA, McMurray F. A retrospective cohort study exploring the
relationship between antenatal reflexology and intranatal outcomes. Complement
Ther Clin Pract. 2006;12(2):119-25.
Plews-Ogan M, Owens JE, Goodman M, Wolfe P, Schorling J. A pilot
study evaluating mindfulness-based stress reduction and massage for the
management of chronic pain. J Gen Intern Med. 2005;20(12):1136-8.
Sherman
KJ, Cherkin DC, Deyo RA, Erro JH, Hrbek A, Davis RB, Eisenberg DM. The
diagnosis and treatment of chronic back pain by acupuncturists, chiropractors,
and massage therapists. Clin J Pain. 2006;22(3):227-34.
Skillgate E, Vingard E, Alfredsson L. Naprapathic manual therapy or
evidence-based care for back and neck pain: a randomized, controlled trial.
Clin J Pain. 2007;23(5):431-9.
Vernon
H, Humphreys K, Hagino C. Chronic mechanical neck pain in adults treated by
manual therapy: a systematic review of change scores in randomized clinical
trials. JManipulative Physiol Ther. 2007;30(3):215-27.
Wilkinson SM, Love SB, Westcombe AM, et al., Effectiveness of
aromatherapy massage in the management of anxiety and depression in patients
with cancer: a multicenter randomized controlled trial. J Clin Oncol.
2007;25(5):532-9.
Wu HS,
Lin LC, Wu SC, Lin JG. The psychologic consequences of chronic dyspnea in
chronic pulmonary obstruction disease: the effects of acupressure on
depression. J Altern Complement Med. 2007;13(2):253-61.
Yang
MH, Wu SC, Lin JG, Lin LC. The efficacy of acupressure for decreasing agitated
behaviour in dementia: a pilot study. J Clin Nurs.
2007;16(2):308-15.
Orem
Rehabilitation & Skilled Nursing - Daily
Herald –
State-of-the-Art Therapy A Passion for
the Art of Caring The Orem Rehabilitation & Skilled Nursing therapy team is
passionate about bringing the latest techniques and programs to our patients.
Through continuing education, our physical and occupational therapists apply
the latest research to improve balance and reduce fall-risk. They also utilize
therapeutic modalities combined with a comprehensive therapy program for
strengthening, balance training, pain reduction, wound-healing, urinary
incontinence, and increasing range of motion. In addition, we have therapists
certified in specialty areas of practice such as: • Wound Care • Neurological
Conditions • Electrical Stimulation For Swallowing Dysfunction • Lymphedema •
Pulmonary Programs Our speech-language pathologists incorporate research-based
swallowing, language and cognitive procedures to address the needs of our
patients. At the heart of our therapy programs is a deep appreciation for, and
understanding of, the special needs of our more mature patients. This goes
beyond the science and research in order to tap into the art of caring for
these unique needs.
January
14, 2012
Nursing
with empathy: Childhood cancer
survivor beats odds, helps others - Glens Falls Post-Star
– by Meg Hargarty
Although the odds were stacked against her that she would survive
cancer as a 3-year-old, Joanna Burgess never let her illness stand in the way
of realizing her dream of helping others.
Now, at 49, the former South Glens Falls resident is a wound, ostomy
and continence nurse in North Carolina.
Joanna recently received the Great Comebacks Regional Award for
rebounding from her bladder cancer and making a difference in the lives of her
patients.
"Seeing the transformation when a patient goes from being withdrawn
to, ‘OK, I can learn to take care of (an ostomy bag),' is rewarding," she said.
"(Winning the award) will globally and extensively get my story
out."
Great Comebacks is sponsored by ConvaTec, a developer and marketer of
medical technologies for community and hospital care, in partnership with the
Crohn's and Colitis Foundation; the United Ostomy Associations of America; the
Intestinal Disease Education and Awareness Society; the Wound, Ostomy and
Continence Nurses Society; and the American Society of Colon and Rectal
Surgeons.
Joanna developed rhabdomyosarcoma, a type of bladder cancer, when she
was little more than a toddler. Her father, South Glens Falls retired pastor
Clayton Burgess, recalled local surgeon Harry "Mac" DePan delivering the grim
diagnosis to him and Joanna's mother, Shirley.
"He didn't hide anything. He came out and said, ‘Children don't
survive this cancer," Clayton said.
Given a 10 percent chance of survival, Joanna was immediately
transferred to a Boston hospital, where she underwent a urostomy to replace her
bladder. Ironically, the massive doses of chemotherapy and cobalt radiation
meant to spare her life would cause her body to break down in the
future.
The most outward effects of the harsh treatment are Joanna's small
stature - she never grew past 4 feet 11 inches - and a noticeable
limp.
The 1981 graduate of South High said she was thought of as the
"mystery girl" at school.
"I walked a little differently. I think a lot of kids thought I had
polio," she recalled. "I didn't know they thought that. Later on my friends
told me."
Joanna graduated from college and was a nurse for five years when her
body began to show signs of the damaging effects of the cobalt radiation
treatments given to her as a child. She endured a series of operations,
including plastic surgery for burns on her back, two hip replacements, bypass
grafts on her legs to improve circulation and an elective colostomy to
eliminate the pain of radiation-induced colitis.
Her life was put on hold for about 20 years.
"Basically they had to re-create my body," Joanna said.
Today she still wears the colostomy and ostomy bags, uses support
hose for lymphedema and has limited mobility. The hip replacements won't last
forever, she said, and she thinks she'll need more surgery in the
future.
Despite everything Joanna endured, she remained grateful to be alive
and made the most of the years spent recovering from her operations. She
volunteered at a clinic in Honduras, explored the field of holistic nursing and
aided in the launch of a clinic devoted to those suffering from
lymphedema.
Joanna loved pediatrics and wanted to work with ostomy patients. She
had a "synchronistic opportunity" to work with a 3-year-old boy diagnosed with
rhabdomyosarcoma and decided to begin coursework to become a WOCN.
"Now I was able to witness what a parent goes through when their
child gets this diagnosis. It's still a terrible diagnosis and still very life
threatening," she said.
At the point when Joanna was finding the most fulfillment both in her
personal life - she met the man who would become her husband- and
professionally by pursuing her WOCN certification, her doctors advised her not
to go back to work, fearing her physical condition was too
"fragile."
Joanna decided to follow her own path and has been a WOCN at WakeMed
Cary Hospital in North Carolina for three years. She brings a type of empathy
to her patients other nurses who haven't walked her path can't
provide.
"When a person has to have an ostomy, people cannot imagine what it
is going to be like and there is a lot of shame associated with it. People
don't talk about it because it has to do with something you don't talk about in
society," Joanna said. "I tell them I have an ostomy, and they can't believe
it. They immediately feel hope, and if I can teach them a way to change their
perception, it can make all the difference."
As the southeast regional winner of the Great Comebacks award, Joanna
said she is now able to raise awareness of ostomy issues on a broader level
through workshops
and conferences and by telling her own journey through
illness.
She hopes to help start an outpatient ostomy clinic at WakeMed, but
most importantly, she wants to continue to be an empathetic resource to her
patients and their families.
"Your story touches something in someone else whether they have the
same thing or not. We're all dealing with something difficult, and it's a way
to connect with each other," she said.
January
15, 2012
This
next one is some kind of blog about printers, I never found anything
referencing lympheema there:
hp photosmart
c4280 all-in-one driver download - Kashmir
Observer –
mphedema, a frequent cause of leg
edema and often included in the differential diagnosis of venous disease, is
also discussed. ...
January
16, 2012
i earns highest
level certification - bcrnews.com –
PERU
— Sonnie (Ryba) Blocki, PT, MS and certified lymphedema therapist of United
Physical Therapy LLC in Peru, attended a three-day continuing education
training in Estes Park, Colo. The conference was hosted by Klose Training and
Consulting LLC.
The conference
brought together lymphedema therapists, physicians, researchers, and
world-renowned experts to share research, experiences, and resources in order
to advance the treatment of lymphedema and improve the quality of life of
cancer survivors.
Lymphedema is a
condition that is most associated with the swelling of a limb following breast
cancer. However, it can also occur due to a condition from birth, cancer
treatment, or other injury. It is estimated there are currently 5 million
people in the U.S. who suffer with lymphedema, and they often go undiagnosed,
untreated and mistreated.
As a
LANA-certified therapist, Blocki consults with physicians in the diagnosis and
treatment of lymphedema.
Big
Spike in Knee Surgeries Calls for Compression Therapy Devices
to Lessen Risk of Blood Clots – SBWire –
Tampa, FL -- (SBWIRE) -- 01/16/2012 -- New
statistics show a big increase in knee replacement surgery since the late
1990s. From 1997 to 2009, knee surgery increased for women ages 45 to 64 by 157
percent and men in the same range by 144 percent. The Agency for Healthcare
Research and Quality attributes this to advances in knee surgery, better
implants, and obesity that can cause the joints to be more compromised. Right
after knee surgery, patients must be mindful of preventing blood clots as they
are immobile while they initially heal.
“Sequential compression devices
can be great for many patients who cannot walk or get around much in the first
few weeks,” said Greg Grambor, president of Vascular PRN, which helps
healthcare professionals nationwide fill prescriptions for SCDs and IPCs. “Patients should
talk to their doctor about their risk for a blood clot, find out if mechanical
compression is good for them, and be proactive before the day of the
surgery.”
The American Journal of Surgery notes that compression therapy
devices can lessen the chances of DVT post-surgery by 60 percent. Many patients
get mechanical compression therapy devices along with medicine to help prevent
blood clots. Knee and hip surgery carry a higher risk of blood clots, so
patients should be prepared when they have these types of surgeries to address
any concerns ahead of time.
“Blood vessels can get damaged during
surgery and when you are restricted to bed rest, SCDs can help blood flow from
the superficial veins to the deep veins,” said Grambor. “The devices are
comfortable and there are some choices depending on how portable you want the
compression therapy system to be.”
Vascular PRN is known for its full
line of sequential mechanical compression devices for the full leg, calf, and
foot. To learn more about renting or buying a Sequential Compression Device, SCD boots, or Lymphedema boots visit http://www.vascularprn.com/ or
call 800.886.4331.
January
16, 2012
Visiting Sloth City? Exercise your
options - The Grand Rapids Press - MLive.com – by Sue
Schroder
My inner sloth has been
having its way with me.
My recent failure to
exercise is a combination of my own inertia coupled with bronchitis followed by
the cold from hell. My maintenance therapy gets only minuscule
blame.
Those in active chemo may
face limited exercise options as I did when the chemical warfare did heavy
collateral damage to my energy and strength, drastically lowered my white blood
count and left me susceptible to infection.
Once outside the
treatment-dictated shalt-nots of human contact, is exercise really worth the
effort we’d have to put into it?
If you care about reducing
the risk and/or recurrence of some cancers and actually increasing the energy
levels chemo knocks out of us, the answer is a resounding yes.
Reduce your risk
The National Cancer
Institute reports “strong evidence” that physical activity is associated with
reduced risk of colon and breast cancers. It also cites several studies
reporting links between physical activity and reduced risk of endometrial, lung
and prostate cancers.
So how do those of us with a
near-mortal fear of Spandex go about rebuilding our bodies and regaining our
strength?
Consider exercise programs
designed specifically for cancer survivors.
One of the longest-running
is Cancer Well-fit. The program has been offered for more than 10 years at the
Michigan Athletic Club (the MAC) and the East Hills Athletic Club through the
Lacks Cancer Center of Saint Mary’s Health Care.
“We don’t have much control
over cancer, and people who’ve gone through our program tell us they feel they
gain some control in their lives. We know the classes actually reduce fatigue
and increase energy levels,” said Kristi Tuck, fitness director of the MAC and
East Hills, and the woman in charge of the Cancer Well-fit program.
Certified
program
Cancer Well-fit is a 14-week
program that includes 10 weeks of sessions conducted by the only nationally
recognized certified cancer exercise trainers in Michigan, according to the
Lacks Cancer Center website. It also includes an additional four weeks of open
membership.
Classes for 8-10 people are
focused on strength training through weight training, Tuck said. Balance and
stability, flexibility and core strength training are part of the program.
Open to patients who have
recently been or are currently being treated for cancer and are referred by
their doctors, classes are geared to people dealing with the effects of
treatment, whatever the cancer.
Cost: $50 for patients of
The Lacks Cancer Center (support partner included) or $150 for participants who
are not patients at the Lacks Cancer Center (support partner
included.)
For more information, visit
lackscancercenter.org; to
register, call the Lacks Cancer at Saint Mary’s, 685-5222.
Gilda’s Club Grand Rapids
and Gilda’s Club Lowell both offer fitness and wellness classes free to Gilda’s
members and open to supporting family and friends.
“In most cases, the type and
level of exercise for someone on a cancer journey will be dependent on their
current health status and/or treatment plan,” said Wendy Wigger, vice president
of community relations and program development.
Here is a small sample of
Gilda’s monthly classes:
(Visit gildasclubgr.org for information
on all classes and membership information.)
Fitness & Movement
Taught by a certified
physical therapist, this variety fitness class offers a combined exercise of
core strength, Tai Chi, meditation and gentle strength training.
Movement &
Lymphedema
This program combines dance
with gentle exercise and lymphedema awareness, and is designed to increase
range of motion and to decrease lymphedema.
A brochure from the
University of Colorado Cancer Center also can help with planning and monitoring
post-cancer exercise.
Cancer survivors can download the brochure.
Editor’s note: Sue Schroder,
former features editor for The Grand Rapids Press, was diagnosed with
non-Hodgkin’s lymphoma in late 2009. Email her at [email protected].
January
17, 2012
Sports Medicine,
Life Therapies opens in Dickson - The
Tennessean –
Baptist Sports
Medicine and Life Therapies recently opened a new outpatient rehabilitation
clinic at 10250 Ramsey Way in Dickson.
The clinic offers
orthopedic physical therapy, sports medicine and lymphedema therapy and is led
by physical therapists Bill Rion and Celeste Crider.
“We are pleased to
now have a presence here, as well as a facility to offer our services to the
Dickson community,” said Rion in a press release. “We are so grateful for the
outreach and support we have received thus far and are excited to establish
lasting relationships with the people of Dickson.”
The opening of
this clinic marks the 20th Baptist Sports Medicine and Life Therapies facility
in Middle Tennessee and the first in Dickson. The clinic is located in the
Crestview Office Park directly across from Dickson Medical
Associates.
For more
information, call (615) 441-2707.
SJH Sports
RebahCare debuts Harrison Township location
- Gloucester County Times - NJ.com – By
John Barna -
HARRISON TWP. —
SJH Sports RehabCare has opened its newest location in Mullica Hill at SJH
Tomlin Station Park.
Located at 201
Tomlin Station Road, Suite D, the facility offers sports and orthopedic
physical therapy, occupational therapy, spine care, worker's compensation
services including FCE and Pre-Work Screens and lymphedema
services.
In highlighting
the opening of this new location, SJH Sports RehabCare Tomlin Station Park
would like to introduce two new staff members to the Gloucester County
community.
Kristy Meade, who
has over 10 years clinical experience, will oversee SJH Sports RehabCare at
Tomlin Station Park site. Meade graduated with a Masters Degree in Physical
Therapy from Sacred Heart University in Fairfield, Conn. She is also a
Certified Athletic Trainer. Kristy's special interests include post-surgical
patients, athletic injuries, body mechanics and postural education with a
specialty focus on trends in ACL rehabilitation.
Victoria Rink, is
the OT clinical coordinator for all SJH RehabCare inpatient and outpatient
facilities and SJH Sports RehabCare locations. Rink is a Certified Hand
Therapist with over 17 years of experience treating upper extremity disorders.
She is a graduate of Thomas Jefferson University's Honors Program. Her
specialty is in treating complex post-surgical cases and trauma, including
nerve injury, hand replant and hand transplantation
rehabilitation.
For more
information, call 856-241-2533 or by email [email protected].
January 17,
2012
Breast Cancer Survivor from Cortlandt Publishes Book
on Mastectomy - Patch.com – ByJessie Jafet –
The authors
provide comprehensive information on mastectomy and breast reconstruction
surgery in their book released today.
Though there is
plenty of information online about mastectomy, Amy Curran Baker thought it
would be helpful to many women if she wrote a single-resource guide that
explains the recovery process from beginning to end.
A breast cancer
survivor herself, the 43-year-old Baker has authored “Now What? A Guide to Recovery After
Mastectomy,” officially released today, Jan. 17
(the book has been available online since Dec. 31). She hopes that women who
are searching for answers about their own journey with mastectomy will find
them in her book.
Baker, a
Cortlandt resident, was 39 years old with two young daughters when she was
diagnosed with the disease in 2008. Even with significant family experience
with breast cancer—her mother, maternal grandmother, and her maternal aunt had
all been diagnosed—she still had many questions about the procedure she opted
for: bilateral mastectomy with “direct to implant reconstruction.”
Copious research,
along with her daily work as an occupational therapist, gave her an unique
perspective to write the book.
“Being an OT I
realized that there were a lot of basic recovery and rehabilitation issues that
women might never be told about after mastectomy,” Baker said.
“Things like how
to manage activities such as dressing and bathing, getting a good night’s
sleep, caring for children, home management, and returning to work.” She added
that the book is full of suggestions from other women who have “been there” and
who offer their advice on what works and what doesn’t in the recovery
process.
The book is
geared toward anyone who has been diagnosed with breast cancer and is
contemplating mastectomy with or without breast reconstruction—in addition to
those with a hereditary predisposition to breast cancer who may be
contemplating prophylactic mastectomy. Reconstruction, she emphasized, should
be a personal choice.
“Sometimes I hear
people say that women need breast reconstruction after a mastectomy in order to
feel “whole again” and that bothers me a little bit,” Baker said—explaining
that it was her personal decision to reconstruct. She does not like to think of
a particular part of the body as defining the “wholeness” of a person or a
woman.
With her
co-authors, who are her sisters (nurses themselves), she covers other topics
including range of motion exercises, post-surgical drain care, lymphedema
prevention, breast prostheses, and what to look for in terms of complications
with healing, wound management, scar massage, emotional recovery, and
more.
Baker also wants
readers to know that mastectomy is not what it used to be. “Techniques for
breast reconstruction have come a long way in recent years and options are
available,” she said.
“And many women
don’t know that there is a federal law called the Women’s Health and Cancer
Rights Act that requires group health insurers that cover mastectomy to also
cover breast reconstruction, breast prostheses, and treatment for physical
complications like lymphedema that may result from mastectomy.”
This
comprehensive book not only benefits those looking for information: portions of
the proceeds will go to two breast cancer support organizations that have been
“near and dear” to Baker: Support Connection in Yorktown
and FORCE (Facing Our Risk of Cancer Empowered) a
national hereditary cancer support organization.
Baker said she is
happy to share all that she has learned. “I feel fortunate that I had access to
really great physicians who were doing cutting edge work in the areas of
mastectomy and breast reconstruction.”
January
19, 2012
Health
Calendar - Santa Maria Times –
Lymphedema Prevention Exercise Class: 9 a.m. Tuesdays, Marian Health
and Wellness Center, 1207 E. Main St., Santa Maria. This is a fun, therapeutic
program for cancer survivors and others with chronic conditions of all ages and
fitness levels to increase range of motion and reduce the risk of lymphedema.
Info and to make a reservation: 739-3780.
January
20, 2012
Health Matters:
Flying with a medical condition - WZVN-TV –
FORT MYERS, FL -
Every year is a victory for
breast cancer survivor Carol Thisted.
"I just turned 71 and I'm so
happy I had another birthday."
She enjoys life, family and
traveling despite suffering from lymphedema. An after effect from her cancer
surgery, the removal of lymph nodes led to chronic fluid retention and
swelling. It first appeared after a flight last year.
"I went on vacation in
August and flew in an airplane and came home and I said to my doctor ‘my ankles
are rather swollen and my arm is a little swollen too'," says
Thisted.
Carol manages her condition
with daily wraps and compression garments, something she has to consider when
taking flight. Health conditions can spike at 30,000 feet.
"The pressures when you're
flying are less, atmospheric pressure is less so you tend to swell more when
you're flying," says Jackie Speas, a lymphedema therapist with Lee Memorial
Health System.
"I'd be sure to wear my arm
compression stocking and I would probably even wear some compression socks on
my ankles and my feet cause they do swell also," says Thisted.
People with vascular
conditions also need to consider their medical condition, especially when you
consider sitting in cramped quarters for long stretches of time.
"I'm on blood thinners
because of blood clots and we want to avoid those so when I fly I make sure
that I have a layover to get off of the plane after two or three hours," says
Pamela Cupp, a frequent flyer.
Travelers who take long
flights, more than four hours, face a two to three fold risk of developing a
clot. So it's important to move around even in a tight space.
"You have the change of
getting blood clots because of lack of circulation. So you do want to move your
legs and pump your ankles up and down, so you get that blood flow back up,"
says Heather Parker, an exercise specialist with Lee Memorial Health
System.
Before
any trip, confer with your doctor about any medical conditions, because keeping
up with your health doesn't take a vacation.
January
21, 2012
Trainer helps
cancer patients regain strength and fitness
- Staunton News Leader – by Maria
Longley
FISHERSVILLE — For many cancer patients who've had chemotherapy, radiation
therapy or surgery, starting or resuming an exercise routine can seem
daunting.
Muscles might have
atrophied during recovery. Respiratory and circulatory systems may have been
weakened. Fatigue and pain drain energy.
Brian Lacy, a
personal trainer at Augusta Health's Lifetime Fitness Center, hopes to help
cancer patients and survivors make a fitness comeback. Lacy recently completed
a new certification in cancer exercise training to address the specific
challenges faced by people whose bodies have been through the wringer while
fighting the disease.
Lacy studied
information on 25 different types of cancer, their surgeries and treatments,
breast reconstruction, upper and lower body lymphedema prevention, cancer pain
and fatigue and other topics.
After patients get
their doctors' OK to begin an exercise regimen, Lacy assesses clients and comes
up with a plan that safely meets their goals, such as building strength,
increasing flexibility and range of motion and even raising their tolerance of
cancer treatments.
"Someone who has
lost a lot of their body weight would benefit from some resistance training,"
he said.
Cancer patients
face some unique difficulties when it comes to exercising safely. For example,
one of the common symptoms of chemotherapy is nausea and
dizziness.
"If a client has
those symptoms, then we would stay away from exercises that challenge balance,"
he said.
Cancer survivors
also are more at risk of developing heart disease and diabetes, which makes
getting fit all the more important, Lacy said. Lacy would like to set up a
group exercise program at Augusta Health's cancer center that would create a
group exercise program for patients.
Doctors often
recommend exercise as a way to reduce symptoms, maintain muscle tone and
strength and improve mental state, said Meg Shrader, a registered nurse whose
job at Augusta Health is to help cancer patients navigate through the treatment
process.
Shrader has been
in remission from breast cancer for six years, so she knows personally how
cancer and treatment of the disease can ravage the body.
Two years ago,
Shrader began working with Lacy after realizing on a business trip how badly
she needed to strengthen her upper body.
She boarded a
plane bound for a conference she was going to attend and couldn't lift her
suitcase into the overhead compartment. "It was an 'aha' moment," she said. "As
far as cardiovascular fitness, I was good. But I felt I was too young to have
such a weak upper body and decided to do something about it."
Like many women,
Shrader didn't have great upper body strength to begin with and didn't worry
about it. But two mastectomies and breast reconstruction surgery helped weaken
the muscles in her chest, she said. Lacy worked with Shrader's occupational
therapist to devise an exercise regimen that would strengthen her muscles, but
that wouldn't exacerbate the swelling in her arms, or lymphedema, set off by
her cancer surgeries. Lymphedema happens when the lymph system is damaged or
blocked, leading to swelling, commonly in the arms and legs, from fluid
build-up in the soft tissues.
Shrader said
Lacy's new training is a tremendous resource at Lifetime Fitness, a facility
that offers an environment geared toward people with specific medical problems,
as well as those who just want to maintain their health. The Medical Fitness
Association named Lifetime Fitness center of the year in 2011 for earning a
perfect score during its certification process.
"It's been a very
rewarding," said Lacy, who's worked at the fitness center five years. "When I
hear a client say to me, 'I went on vacation and was able to play with his
grandkids instead of lying in a hotel room,' it doesn't get better than
that."
Shrader says at 51
she's in the best shape of her life, thanks to Lacy's training.
"I flew to a
conference in December, and I shoved that bag right up there," she
said.
January 22,
2012
Solid reputation helps therapy firm
grow - Detroit Free Press – By Patricia Anstett –
When Linda Gibbs
and her partner Kimberly Turner opened their Advanced Physical Therapy Center
in Grand Blanc 20 years ago, they were the only independent physical therapy
clinic around for miles and one of the few run by women.
"We took a
chance," Gibbs said, explaining how most physical therapy businesses were run
by large hospital systems and doctor groups.
"I told myself
that together, if we could do the best therapy with patients, we'll get results
and doctors will send patients to us," she said. "That's exactly what
happened."
By building a
solid reputation among patients and doctors for their work treating low back
and neck pain, Advanced Physical Therapy has grown from one to seven locations
and from three to 130 employees. The company is not affiliated with a Wayne
County physical therapy firm that has a nearly identical name.
Gibbs and Turner
opened two more clinics in Davison about 13 months ago, then another in
Clarkston in November, their first Oakland County site.
The company
specializes in low-back and neck pain, Gibbs said. "We get a lot of orthopedics
problems, shoulders, knees and necks," said therapist Heather
Schoen.
But over the years
the company added a heated pool and aquatics therapy at its Grand Blanc site,
and it has expanded its services and technologies to a range of noninvasive
therapies.
"Women drive 50
miles just for treatment," said Gibbs, citing one program popular with breast
cancer patients who develop lymphedema, a painful, chronic arm swelling that
occurs after surgery.
At the Clarkston
site, Schoen is building programs that cater to women, including a class for
new moms and programs for women with uterine prolapse, pelvic pain, pain during
intercourse and incontinence. "These are life-changing problems," Schoen said.
"Many of the women are in their 20s."
Schoen uses
trigger-point release, which applies pressure to tightened muscles, to relax
the pelvis and tension spots. The therapy "only takes a couple sessions and
people notice a huge result" that is sometimes permanent, she
said.
Others like Tony
Nahas of Davisburg, come after surgery, when pain doesn't go away.
Nahas, who had
shoulder surgery in November, was exercising recently at the company's
Clarkston facility to correct some imbalance and posture issues that his doctor
and Schoen thought were causing the shoulder pain that still keeps him awake at
night.
The company offers
free physical therapy evaluations by appointment though patients need a
doctor's prescription for physical therapy.
Gibbs continues to
look for therapies that prove effective. Her staff this month will be trained
to perform the Graston Technique, another type of trigger-point release that
uses metal instruments in the therapy. "It's very gentle actually," Gibbs said,
and is growing in demand from doctors.
Gibbs said the
demand for noninvasive therapies should continue to boost the need for therapy
in the future.
"Patients get
better with therapy," she said. "It works."
Contact Patricia
Anstett: 313-222-5021 or [email protected]
More Details:
Advanced Physical Therapy Center
Founded: 1991, Grand Blanc
Employees: 130
Locations: Seven sites in Flint area as well as a new clinic in Clarkston at
5625 Water Tower Place.
Hours in
Clarkston:
7 a.m.-4 p.m. weekdays. Offers a range of physical therapy services from back
to pelvic pain.
Contact: Phone: 248-620-4260. Web address: www.advanced physical therapy
.com
KEYWORDNEWS
DOCS:
January 7, 2012
Prospective
surveillance model can reduce treatment costs for breast cancer-related
lymphedema - News-Medical-Net –
Model
associated with significant cost savings
Early
diagnosis and treatment of breast cancer-related lymphedema by a physical
therapist can significantly reduce costs and the need for intensive
rehabilitation, according to an article published in the January issue of
Physical
Therapy (PTJ), the scientific journal of the American Physical
Therapy Association (APTA).
The
study, led by APTA member and spokesperson Nicole Stout, PT, MPT, CLT-LANA,
compared a prospective surveillance model with a traditional model of
impairment-based care and examined the direct treatment costs associated with
each program. Treatment and supply costs were estimated based on the Medicare
2009 physician fee schedule. Researchers estimated that treatment for breast cancer-related lymphedema costs
$636.19 a year when the prospective surveillance model was used vs $3,124.92
for traditional treatment of advanced lymphedema.
The
goal of a prospective surveillance model for cancer rehabilitation is to
identify impairment at the earliest onset to alleviate impairment or prevent it
from progressing. Soon after diagnosis, a physical therapist will perform a
preoperative examination to establish a baseline level of function. Follow-up
examinations are then conducted postoperatively at 1 month and then 3-month
intervals, for up to 1 year. In contrast, a traditional model focuses on
treating lymphedema once it has progressed and patients already have functional
limitations.
"This
study begins to paint a picture of evidence showing that prevention of chronic
conditions such as lymphedema-using rehabilitation models of care-may result in
significant cost savings," said Stout.
Source:
American Physical Therapy
Association
January 20,
2012
Health Matters:
Flying with a medical condition - NBC
2 Fort Myers –
FORT MYERS, FL -
Every year is a victory for
breast cancer survivor Carol Thisted.
"I just turned 71 and I'm so
happy I had another birthday."
She enjoys life, family and
traveling despite suffering from lymphedema. An after effect from her cancer
surgery, the removal of lymph nodes led to chronic fluid retention and
swelling. It first appeared after a flight last year.
"I went on vacation in
August and flew in an airplane and came home and I said to my doctor ‘my ankles
are rather swollen and my arm is a little swollen too'," says
Thisted.
Carol manages her condition
with daily wraps and compression garments, something she has to consider when
taking flight. Health conditions can spike at 30,000 feet.
"The pressures when you're
flying are less, atmospheric pressure is less so you tend to swell more when
you're flying," says Jackie Speas, a lymphedema therapist with Lee Memorial
Health System.
"I'd be sure to wear my arm
compression stocking and I would probably even wear some compression socks on
my ankles and my feet cause they do swell also," says Thisted.
People with vascular
conditions also need to consider their medical condition, especially when you
consider sitting in cramped quarters for long stretches of time.
"I'm on blood thinners
because of blood clots and we want to avoid those so when I fly I make sure
that I have a layover to get off of the plane after two or three hours," says
Pamela Cupp, a frequent flyer.
Travelers who take long
flights, more than four hours, face a two to three fold risk of developing a
clot. So it's important to move around even in a tight space.
"You have the change of
getting blood clots because of lack of circulation. So you do want to move your
legs and pump your ankles up and down, so you get that blood flow back up,"
says Heather Parker, an exercise specialist with Lee Memorial Health
System.
Before
any trip, confer with your doctor about any medical conditions, because keeping
up with your health doesn't take a vacation.
PUB MED DOCS:
January 3, 2012
J Mal Vasc. 2011 Dec 21. [Epub
ahead of print]
[Designing
a therapeutic education program for patients with lymphedema: Live with
lymphedema.]
[Article
in French]
Blaise S, Villemur B, Richaud C, Rastel D, Bucci B, Evra V, Bouchet JY; les membres du réseau GRANTED,
Satger B.
Source
Department of
Vascular Medicine, clinique de médecine vasculaire, Grenoble University
Hospital, BP 217, 38043 Grenoble cedex 09, France; Réseau GRANTED, 38400
Saint-Martin-d'Hères, France.
Abstract
BACKGROUND:
Lymphedema is a
chronic condition considered to be rare in its primary form and potentially
frequent in women after breast surgery for cancer: 27,000new cases annually.
Therapeutic management is a serious challenge. In France, the health
authorities (Haute Autorité de santé [HAS]) have recently proposed that
appropriate management practices for lymphedema include "patient education".
The HAS and the National institute for health care prevention and education
also published a methodology guide devoted to structuring a therapeutic
education program for patients with chronic disease. Current hospital
regulations state that this education program is part of the care to be
delivered to patients with chronic disease and that it must comply with the
national directives. The purpose of our present work was to present the concept
and the contents of a patient education program entitled "Live with lymphedema"
designed for patients with lymphedema and developed within the
inpatient-outpatient network GRANTED in Sud-Isère.
METHODS:
A standard
detailed educative approach was applied. It was designed after the educational
program for patients with lower limb arterial occlusive disease authorized by
the Rhône-Alpes regional health agency. It was adapted to the specific
problematic of patients with lymphedema, including medical management,
rehabilitation, dermatology and nutritional aspects. It was developed in
cooperation with patients and favors local associative actions.
RESULTS:
The specifically
structured program included three therapeutic education consultations and five
workshops. Less than one year after its institution, more than 30 patients have
participated in the program.
DISCUSSION:
We report a
structured patient education program designed for patients with lymphedema.
This program was authorized by the Rhône-Alpes regional health agency in March
2011and is in compliance with the national directives and HAS
guidelines.
Copyright © 2011
Elsevier Masson SAS. All rights reserved.
PMID:
22196687 [PubMed - as supplied by publisher]
January 9, 2012
J Cutan Pathol. 2012
Jan;39(1):52-5. doi: 10.1111/j.1600-0560.2011.01785.x.
Lymphangiosarcoma
arising after 33 years within a background of chronic filariasis: a case report
with review of literature.
Krishnamoorthy N, Viswanathan S, Rekhi B, Jambhekar NA.
Source
Department of
Pathology, Tata Memorial Hospital, Mumbai, India.
Abstract
Cutaneous
angiosarcoma or lymphangiosarcoma represents an uncommon aggressive tumor known
to arise on a background of chronic lymphedema secondary to various etiologies,
principally following surgery or irradiation. There have been rarely reported
cases of angiosarcoma following infective conditions that eventuate with
lymphatic stasis. We report a case of angiosarcoma arising after 33 years
within a background of filariasis. Awareness of this association can lead to
early diagnosis and appropriate treatment of this potentially fatal malignant
tumor. Krishnamoorthy N, Viswanathan S, Rekhi B, Jambhekar NA.
Lymphangiosarcoma arising after 33 years within a background of chronic
filariasis: a case report with review of literature.
Copyright © 2011
John Wiley & Sons A/S.
PMID:
22211335 [PubMed - in process]
Med Oncol. 2011 Dec;28 Suppl
1:22-30. Epub 2010 Sep 9.
Whether
drainage should be used after surgery for breast cancer? A systematic review of
randomized controlled trials.
He XD, Guo ZH, Tian JH, Yang KH, Xie XD.
Source
Evidence Based
Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199
Donggang West Road, Lanzhou, Gansu, 730000, China,
[email protected].
Abstract
A systematic
review of randomized controlled trials (RCTs) was conducted to evaluate whether
patients benefit from the suction drainage after axillary lymph node dissection
(ALND) in breast cancer surgery. RCTs of drainage versus no drainage after ALND
in women with breast cancer were retrieved from PubMed, EMBASE, Cochrane
Library and Chinese Biomedical database. Two authors independently assessed the
quality of included trials and extracted data. Odds ratio (OR) for dichotomous
outcomes and mean difference (MD) for continuous outcomes were presented with
95% confidence intervals (CI). A total of 1115 titles were indentified from the
databases; 1109 obvious irrelevant studies were excluded by examining the
titles, abstracts, full texts because of duplicates, no RCT, different modality
of drainage, drain for lymphedema, application of fibrin sealant and so on. And
then, only 6 RCTs to compare drainage with no drainage after ALND in breast
cancer surgery were included in the systematic review and a total of 585
patients were included in the pathological diagnosis of breast cancer in women
before surgery, management by ALND with or without addition surgical
procedures. The study demonstrated that insertion of a drain in the axilla
after breast cancer surgery resulted in a statistically significant reduction
in the rate of seroma (OR = 0.36, 95% CI, 0.16 to 0.81, P = 0.01), the volume
of aspiration (MD = -100.10, 95% CI, -174.36 to -25.85, P = 0.008), or the
frequency of seroma aspiration (MD = -1.03, 95% CI, -1.35 to -0.71, P <
0.00001), but prolonged the length of hospital stay (MD = 1.52, 95% CI, 0.36 to
2.68, P = 0.01). There was no statistically significant difference in the
incidence of wound infection (OR = 0.67, 95% CI, 0.34 to 1.32, P = 0.25)
between drainage group and no drainage group. Based on the current evidence,
insertion of a drain in the axilla following ALND in breast cancer surgery
effectively decreased seroma formation, volume of aspiration as well as the
frequency of seroma aspiration without increasing the incidence of wound
infection, but extending their stay in hospital.
PMID:
20827578 [PubMed - in process]
J Vasc Surg. 2011 Dec 29. [Epub
ahead of print]
Technique,
results, and postoperative patency of lymphaticovenous side-to-end anastomosis
in peripheral lymphedema.
Maegawa J, Yabuki Y, Tomoeda H, Hosono M, Yasumura K.
Source
Department of
Plastic and Reconstructive Surgery, Yokohama City University Hospital,
Yokohama, Japan.
Abstract
OBJECTIVE:
Lymphaticovenous
anastomosis has been used for patients with peripheral lymphedema. However, the
efficacy of this procedure is controversial due to a lack of evidence regarding
postoperative patency. We sought to determine midterm postoperative patency of
lymphaticovenous side-to-end anastomoses (LVSEAs) using indocyanine green
fluorescence lymphography.
METHODS:
This was a
retrospective observational study set in a teaching hospital. Of 107 patients
with chronic lymphedema who underwent 472 LVSEAs, 57 (223 anastomoses)
consented to fluorescence lymphography and comprised the study cohort. The
intervention consisted of a microsurgical LVSEA performed with a suture-stent
method. Patients also had preoperative and postoperative complex decongestive
physiotherapy. Anastomosis patency was assessed using indocyanine green
fluorescence lymphography ≥6 months after surgery. Patency rates were
calculated using Kaplan-Meier analysis. We assessed volume reduction on the
operated-on limb and compared this between patients in whom anastomoses were
patent and those in whom anastomoses were not obviously patent.
RESULTS:
Patency could be
evaluated only at the dorsum of the foot, ankle, and lower leg because the
near-infrared rays emitted by the special camera used could not penetrate the
deep subcutaneous layer containing collective lymphatics in areas such as the
thigh. Several patterns were observed on fluorescence lymphography: straight,
radial, and L-shaped. Cumulative patency rates of LVSEAs were 75% at 12 months
and 36% at 24 months after surgery. No significant difference in volume change
of the affected limb was seen between the 34 patients with patent anastomosis
(600 ± 969 mL) and the 24 patients without obvious evidence of patency (420 ±
874 mL).
CONCLUSIONS:
Although further
study is required to determine factors leading to anastomotic obstruction and
to optimize the results of microlymphatic surgery, the present LVSEA technique
appears promising.
Copyright © 2011
Society for Vascular Surgery. Published by Mosby, Inc. All rights
reserved.
PMID:
22209609 [PubMed - as supplied by publisher]
Case Rep Dermatol. 2011
Sep;3(3):251-8. Epub 2011 Nov 30.
A
case of yellow nail syndrome with dramatically improved nail discoloration by
oral clarithromycin.
Suzuki M, Yoshizawa A, Sugiyama H, Ichimura Y, Morita A, Takasaki J, Naka G, Hirano S, Izumi S, Takeda Y, Hoji M, Kobayashi N, Kudo K.
Source
Department of
Respiratory Medicine, National Center for Global Health and Medicine,
Infection, Oncology, Nippon Medical School, Tokyo.
Abstract
An 80-year-old
woman was admitted to our hospital with pneumonia and exacerbation of
sinobronchial syndrome (SBS). She presented with yellow discoloration of the
nail beds of all fingers and toes, and her nails were recognized as growing
slowly. Chest X-ray revealed bronchiectasis in the bilateral lower lobe and
bilateral pleural effusion. We diagnosed her as having yellow nail syndrome
(YNS), based on the triad of yellow nails, lymphedema, and lung disease. After
treatment with antibiotics [ampicillin/sulbactam and clarithromycin (CAM)] for
pneumonia and SBS, her general condition improved, and the yellow nails
disappeared in some fingers. When she was previously treated with 200 mg CAM
for SBS, her yellow nails had not shown improvement. This time, her yellow
nails improved after treatment with 400 mg CAM. The literature reports vitamin
E, zinc, and topical corticosteroid plus active vitamin D3 to be effective in
the treatment of yellow nails. Two studies have reported treatment for YNS
using CAM, though they found a lack of efficacy. Thus, the present case is the
first to report improved yellow nails using CAM alone. We conclude that not
only SBS and lung disease but also YNS were improved by treatment with 400 mg
CAM.
PMID:
22220146 [PubMed - in process] PMCID: PMC3250669
BMC Cancer. 2012 Jan 4;12(1):6.
[Epub ahead of print]
Systematic
review: conservative treatments for secondary lymphedema.
Oremus M, Dayes I, Walker K, Raina P.
Abstract
ABSTRACT:
BACKGROUND:
Several
conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for
secondary lymphedema. The optimal treatment is unknown. We examined the
effectiveness of conservative treatments for secondary lymphedema, as well as
harms related to these treatments.
METHODS:
We searched
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, AMED, and
CINAHL from 1990 to January 19, 2010. We obtained English- and
non-English-language randomized controlled trials or observational studies
(with comparison groups) that reported primary effectiveness data on
conservative treatments for secondary lymphedema. For English-language studies,
we extracted data in tabular form and summarized the tables descriptively. For
non-English-language studies, we summarized the results descriptively and
discussed similarities with the English-language studies.
RESULTS:
Thirty-six
English-language and eight non-English-language studies were included in the
review. Most of these studies involved upper-limb lymphedema secondary to
breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most
studies were under six months. Many trial reports contained inadequate
descriptions of randomization, blinding, and methods to assess harms. Most
observational studies did not control for confounding. Many studies showed that
active treatments reduced the size of lymphatic limbs, although extensive
between-study heterogeneity in areas such as treatment comparisons and
protocols, and outcome measures, prevented us from assessing whether any one
treatment was superior. This heterogeneity also precluded us from statistically
pooling results. Harms were rare (<1% incidence) and mostly minor (e.g.,
headache, arm pain).
CONCLUSIONS:
The literature
contains no evidence to suggest the most effective treatment for secondary
lymphedema. Harms are few and unlikely to cause major clinical
problems.
PMID:
22216837 [PubMed - as supplied by publisher]
January
15, 2012
J Rehabil Res Dev.
2011;48(10):1261-8.
Effect
of home-based exercise program on lymphedema and quality of life in female
postmastectomy patients: Pre-post intervention study.
Gautam AP, Maiya AG, Vidyasagar MS.
Source
Department of
Physiotherapy, Manipal College of Allied Health Sciences, Manipal University,
Manipal-576104, Karnataka, India. Email: [email protected].
[email protected].
Abstract
Lymphedema is a
debilitating complication following mastectomy, affecting the arm functions and
quality of life (QOL) of breast cancer patients. Studies have shown the
beneficial effects of upper-limb exercises on lymphedema in clinical set tings.
However, there is a dearth of evidence regarding the effect of home-based
exercises on lymphedema; therefore, we examined the effect of a home-based
exercise program on lymphedema and QOL in postmastectomy patients. Thirty-two
female postmastectomy lymphedema patients participated in an individualized
home-based exercise program for 8 weeks. Arm circumference, arm volume, and QOL
(36-Item Short Form Health Survey) were measured before and after the program.
Data were analyzed with the use of paired t-tests for circumferential and
volumetric measures and Wilcoxon signed ranks tests for QOL. Significance level
was set at p < 0.01 with Bonferroni correction (alpha/n = 0.05/5 = 0.01).
Analysis showed a statistically significant improvement in the affected
upper-limb circumference and volume (~122 mL reduction, p < 0.001) and in
the QOL scores (p < 0.001) at the end of the home-based exercise program.
The individualized home-based exercise program led to improvement in affected
upper-limb volume and circumference and QOL of postmastectomy lymphedema
patients.
PMID:
22234669 [PubMed - in process]
Ann Surg. 2012 Jan 9. [Epub
ahead of print]
Microvascular
Breast Reconstruction and Lymph Node Transfer for Postmastectomy Lymphedema
Patients.
Saaristo AM, Niemi TS, Viitanen TP, Tervala TV, Hartiala P, Suominen EA.
Source
From the
Department of Plastic Surgery, Turku University Central Hospital, Turku,
Finland.
Abstract
OBJECTIVE:
Postoperative
lymphedema after breast cancer surgery is a challenging problem. Recently, a
novel microvascular lymph node transfer technique provided a fresh hope for
patients with lymphedema. We aimed to combine this new method with the standard
breast reconstruction.
METHODS:
During 2008-2010,
we performed free lower abdominal flap breast reconstruction in 87 patients.
For all patients with lymphedema symptoms (n = 9), we used a modified lower
abdominal reconstruction flap containing lymph nodes and lymphatic vessels
surrounding the superficial circumflex vessel pedicle. Operation time, donor
site morbidity, and postoperative recovery between the 2 groups (lymphedema
breast reconstruction and breast reconstruction) were compared. The effect on
the postoperative lymphatic vessel function was examined.
RESULTS:
The average
operation time was 426 minutes in the lymphedema breast reconstruction group
and 391 minutes in the breast reconstruction group. The postoperative abdominal
seroma formation was increased in patients with lymphedema. Postoperative
lymphoscintigraphy demonstrated at least some improvement in lymphatic vessel
function in 5 of 6 patients with lymphedema. The upper limb perimeter decreased
in 7 of 9 patients. Physiotherapy and compression was no longer needed in 3 of
9 patients. Importantly, we found that human lymph nodes express high levels of
endogenous lymphatic vessel growth factors. Transfer of the lymph nodes and the
resulting endogenous growth factor expression may thereby induce the regrowth
of lymphatic network in the axilla. No edema problems were detected in the
lymph node donor area.
CONCLUSION:
Simultaneous
breast and lymphatic reconstruction is an ideal option for patients who suffer
from lymphedema after mastectomy and axillary dissection.
PMID:
22233832 [PubMed - as supplied by publisher]
Int Angiol. 2011
Dec;30(6):527-33.
Dose
finding for an optimal compression pressure to reduce chronic edema of the
extremities.
Partsch H, Damstra RJ, Mosti G.
Source
Private
Practictioner, Vienna, Austria - [email protected].
Abstract
AIM:
The optimal
pressure to reduce chronic extremity swelling is still a matter of debate. The
aim of this paper was to measure volume reduction of a swollen extremity
depending on the amount of pressure exerted by compression stockings and
inelastic bandages.
METHODS:
Thirty-six
patients with unilateral breast cancer related arm lymphedema were investigated
in a lymph clinic in the Netherlands, 42 legs with chronic edema of the lower
extremities were examined in a phlebological centre in Italy. The arm-patients
were randomized to receive inelastic arm bandages with a pressure between 20-30
mmHg or 44-68 mmHg. The leg patients were either treated with compression
stockings (23-32 mmHg) or with inelastic bandages (pressure 53-88 mmHg).
Water-displacement volumetry and measurement of leg circumference was performed
before and after compression.
RESULTS:
In the
arm-patients low pressure after 2 hours achieved a higher degree of volume
reduction (-2.3%, 95% CI 1.0-3.6) than high pressure (-1.5%, 95% CI 0.2-2.8)
(n.s.). In patients with leg edema compression stockings in the range between
20 and 40 mmHg showed a positive correlation between exerted pressure and
volume reduction, bandages applied with an initial resting pressure of more
than 60 mm Hg resulted in a decreasing volume reduction.
CONCLUSION:
There is
obviously an upper limit beyond which further increase of compression pressure
seems counterproductive. For inelastic bandages this upper limit is around 30
Hg on the upper and around 50-60 mmHg on the lower extremity.
PMID:
22233613 [PubMed - in process]
Int Angiol. 2011
Dec;30(6):499-503.
The
lymphovenous microsurgical shunts for treatment of lymphedema of lower limbs:
indications in 2011.
Olszewski WL.
Source
Department of
Surgical Research and Transplantology, Medical Research Center, Polish Academy
of Sciences, Warsaw, Poland - [email protected].
Abstract
The microsurgical
lympho-venous shunts have become one of the generally accepted modalities in
treatment of limb lymphedema. This review highlight the indications for this
procedure after over 40 years. This study was based on the personal experience
of one surgeon and on the review of the literature. Patients with
postinflammatory, postsurgical, idiopathic and hyperplastic lymphedema of lower
limbs were included in the study. Basing on the review of results of the last
40 years the contemporary indications are: 1) lymphedema with local segmental
obstruction but still partly patent distal lymphatics seen on functional
lymphoscintigraphy (standard walking or pneumatic compression) and without an
active inflammatory process in the skin, subcutaneous tissue and lymph vessels
(DLA-dermatolymphangioadenitis); 2) classified according the etiology of
lymphedema, this operation can bring about satisfactory results in cases of
hyperplastic, postsurgical and postinflammatory types of lymphedema, whereas
primary idiopathic lymphedema of non-genetic type should be treated with
conservative means, although in a small number of cases an improvement was
observed after lympho-venous shunting as long as 10 years. Microsurgical lymph
node or lymphatic vessel to vein shunts have their established position among
the therapy modalities for lymphedema of lower limbs in a strictly defined
group of patients using lymphoscintigraphic imaging.
PMID:
22233610 [PubMed - in process]
J Obstet Gynaecol Res. 2012 Jan
10. doi: 10.1111/j.1447-0756.2011.01727.x. [Epub ahead of print]
Re-consideration
of lymphadenectomy for stage Ib1 cervical cancer.
Kato H, Todo Y, Suzuki Y, Ohba Y, Minobe SI, Okamoto K, Yamashiro K, Sakuragi N.
Source
Divisions of
Gynecologic Oncology Pathology, National Hospital Organization, Hokkaido Cancer
Center, Department of Obstetrics and Gynaecology, Hokkaido University School of
Medicine, Sapporo, Japan.
Abstract
Aim: Because of
less frequent lymph node metastasis and parametrial involvement, patients with
stage Ib1 cervical cancer may benefit from a curtailment of surgery. We
retrospectively investigated the distribution of lymph node metastasis in stage
Ib1 patients. After comparing the data with that of higher stages and sentinel
lymph node navigation (SLNN), the appropriate extent of lymphadenectomy (LA) in
stage Ib1 disease was newly suggested. Method: A total of 303 patients
underwent a radical hysterectomy with LA and the region-specific rate of node
metastasis was obtained. SLNN was performed for 50 patients using (99m) Tc
phytate injection into the cervix and intra-operative detection by a
gamma-probe. Results: The rate of node metastasis and the average number of
nodes removed, respectively, were: 23/189 (12.2%), 65.2 in stage Ib1; 14/47
(29.8%), 70.1 in stage Ib2; 7/20 (35.0%), 78.2 in stage IIa; and 26/47 (55.3%),
69.1 in stage IIb. Lymph node metastasis in stage Ib1 was prevalent in the
obturator (Ob) (9.5%), inter-iliac (Ii) (4.9%), superficial common iliac (Sc)
(2.3%), cardinal (Cd) (2.2%) and external iliac (Ei) (1.7%) nodes. In patients
with upper stage disease, lymph node metastasis could occur in all lymph nodes.
In stage Ib1 patients, the sentinel nodes were assigned only to the Ob, Ii, Sc
and Ei nodes, being identical with frequent metastatic sites in stage Ib1
(excluding Cd). Conclusion: The extent of LA can be routinely completed with
the removal of Ob, Ii, Ei, Sc and Cd nodes, which may provide a higher quality
of life, including the reduction of lymphedema by preventing the removal of the
inguinal nodes.
© 2012 The
Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of
Obstetrics and Gynecology.
PMID:
22229927 [PubMed - as supplied by publisher]
January
19, 2012
Br J Community Nurs. 2011 Oct;16
Suppl:S4-S12.
Use
of compression bandaging in managing chronic oedema.
Todd M.
Abstract
Compression
bandaging is a major component of most community nurses' practice in the
management of venous leg ulcers. For lymphoedema practitioners, compression
therapy is the linchpin in the management of chronic oedema and lymphoedema.
There are several types of compression bandage available, with some being part
of a recognized system of compression delivery. In order for nurses to select
and apply the correct type and level of compression bandaging, there needs to
be a substantial level of knowledge of the principles of compression theory and
competence in the application of bandaging. There are also issues surrounding
patient concordance, and nurses need to be able to assess and address any
barriers to concordance to ensure the most effective regimen of treatment is
delivered.
PMID:
22240574 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16
Suppl:S28-9.
An
interview with Karen Morgan.
Morgan K.
Abstract
Karen Morgan is
Lymphoedema Clinical Nurse Specialist, Abertawe Bro Morgannwg University Health
Board (ABMUHB) Lymphoedema
Health Board (ABMUHB)
Lymphoedema Clinic.
PMID: 22240571 [PubMed - in
process]
Br J Community Nurs. 2011 Oct;16
Suppl:S22-7.
An
integrative treatment for lower limb lymphoedema in India.
Bose KS, Aggithaya GM.
Abstract
Lymphoedema is a
chronic disease which requires frequent visits to therapist in developed
countries. In most developing countries, it is the disease of rural area caused
by lymphatic filariasis (LF). The aim is to develop a low cost home-based
self-care protocol using the combinations of locally available treatment
modalities. The integrated treatment has the elements of therapy from modern
dermatology, Ayurveda and yoga, administered by the doctors of respective
system of medicine on the basis of pathophysiological understanding in
lymphology. The sequence of treatment components that each patient followed is
skin wash, soaking the limb in herbal Phanta solution, care of bacterial entry
points, a set of yoga exercises, Indian manual lymph drainage and compression
bandaging. A total of 1209 limbs in 889 patients were treated using integrated
medicine during October 2004-May 2011. All patients received an initial 14 days
of supervised treatment and training for self-care and home-based treatment to
be continued for life. Patients followed up twice. Volume reduction for large
sized limbs at 3 months following treatment was 41.1%, with a confidence
interval (CI) of 5.7-6.9 litres. Reduction was 25.7 % for small limbs with a CI
of 1.5-1.7 litres. Entry points were present in 86.2% limbs at baseline and in
71.7% limbs at the end of 3 months. Inflammatory episodes reduced from
80%-8.6%.
PMID:
22240570 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16
Suppl:S20-1.
Lymphangioma
or lymphangiectasia? An update for lymphoedema nurses.
Pike C.
Abstract
This article is
prompted by a recent enquiry to the British Lymphology Society, expressing
uncertainty over the definition of lymphangioma. It may be prudent to publicize
information on this potentially confusing area more widely, as clinicians need
to know what lymphangioma is, or is not.
PMID:
22240569 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16
Suppl:S14-9.
Non-concordance
in lymphorrhea of the lower limbs: a case study.
Jones J.
Abstract
Obesity and a
sedentary lifestyle are fast becoming major problems for not only the NHS as a
whole but also the lymphoedema therapist. Lymphorrhea in this group of patients
can be a recurrent problem, causing strain on already stretched services and on
the patient and their family. What happens when the ideas of the patient and
therapist regarding treatment are not the same? This article aims to address
these issues by looking at a case study of such a patient, and the surprising
outcome that resulted when the patient got his own way.
PMID:
22240568 [PubMed - in process]
January
22, 2012,
Br J Community Nurs. 2011 Oct;16
Suppl:S22-7.
An
integrative treatment for lower limb lymphoedema in India.
Bose KS, Aggithaya GM.
Abstract
Lymphoedema is a
chronic disease which requires frequent visits to therapist in developed
countries. In most developing countries, it is the disease of rural area caused
by lymphatic filariasis (LF). The aim is to develop a low cost home-based
self-care protocol using the combinations of locally available treatment
modalities. The integrated treatment has the elements of therapy from modern
dermatology, Ayurveda and yoga, administered by the doctors of respective
system of medicine on the basis of pathophysiological understanding in
lymphology. The sequence of treatment components that each patient followed is
skin wash, soaking the limb in herbal Phanta solution, care of bacterial entry
points, a set of yoga exercises, Indian manual lymph drainage and compression
bandaging. A total of 1209 limbs in 889 patients were treated using integrated
medicine during October 2004-May 2011. All patients received an initial 14 days
of supervised treatment and training for self-care and home-based treatment to
be continued for life. Patients followed up twice. Volume reduction for large
sized limbs at 3 months following treatment was 41.1%, with a confidence
interval (CI) of 5.7-6.9 litres. Reduction was 25.7 % for small limbs with a CI
of 1.5-1.7 litres. Entry points were present in 86.2% limbs at baseline and in
71.7% limbs at the end of 3 months. Inflammatory episodes reduced from
80%-8.6%.
PMID:
22240570 [PubMed - in process]
January
22, 2012
J Cancer Surviv. 2012 Jan 13.
[Epub ahead of print]
Community-based
exercise program effectiveness and safety for cancer survivors.
Rajotte EJ, Yi JC, Baker KS, Gregerson L, Leiserowitz A, Syrjala KL.
Source
Clinical Research
Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-220,
P.O. Box 19024, Seattle, WA, 98109, USA.
Abstract
PURPOSE:
Clinical trials
have demonstrated the benefits of exercise for cancer survivors. This
investigation determined the effectiveness and safety of a disseminated
community-based exercise program for cancer survivors who had completed
treatment.
METHODS:
Personal trainers
from regional YMCAs received training in cancer rehabilitation and supervised
twice-a-week, 12-week group exercise sessions for survivors. At baseline and
post-program, validated measures assessed patient-reported outcomes (PRO) and
physiologic measurements.
RESULTS:
Data were
collected from 221 survivors from 13 YMCA sites and 36 separate classes. All
participants had data available at one time point, while matched baseline and
post-program PRO and physiologic data were available for 85% (N = 187).
Participants with matched data were largely female (82%), with mean age of 58
(range, 28-91 years). Time since diagnosis ranged from 1 to 48 (mean, 5.6
years), and mean time since last treatment was 3.0 (range, 1-33 years).
Physiological improvements were significant in systolic (P < 0.001) and
diastolic (P = 0.035) blood pressure, upper and lower body strength, the 6-min
walk test (P = 0.004), and flexibility (P < 0.001). Participants reported
improvements in overall health-related quality of life (P < 0.001), social
support (P = 0.019), body pain (P = 0.016), fatigue (P < 0.001), insomnia
(P < 0.001), and overall musculoskeletal symptoms (P = <0.001). Few
injuries or lymphedema events occurred during classes.
CONCLUSIONS:
Community-based
exercise groups for cancer survivors of mixed diagnoses and ages, who have
completed active treatment, have physiologic and psychosocial benefits, and are
safe. IMPLICATIONS FOR CANCER SURVIVORS: Survivors may expect significant
benefit from participating in a community-based exercise program tailored to
meet their individual needs as a survivor.
PMID:
22246463 [PubMed - as supplied by publisher]
Hematol Oncol Clin North Am.
2012 Feb;26(1):169-94. Epub 2011 Dec 16.
Contemporary
quality of life issues affecting gynecologic cancer survivors.
Carter J, Penson R, Barakat R, Wenzel L.
Source
Gynecology
Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New
York, NY 10065, USA; Psychiatry and Behavioral Sciences, Memorial
Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Abstract
Regardless of
cancer origin or age of onset, the disease and its treatment can produce short-
and long-term sequelae (ie, sexual dysfunction, infertility, or lymphedema) that
adversely affect quality of life (QOL). This article outlines the primary
contemporary issues or concerns that may affect QOL and offers strategies to
offset or mitigate QOL disruption. These contemporary issues are identified
within the domains of sexual functioning, reproductive issues, lymphedema, and
the contribution of health-related QOL in influential gynecologic cancer
clinical trials.
Copyright © 2012
Elsevier Inc. All rights reserved.
PMID:
22244668 [PubMed - in process]
MEDNEWS
DOCS:
January
3, 2012
New Treatment Direction For Rare Metabolic
Diseases
A research team led by biochemist Scott Garman at the University of
Massachusetts Amherst has discovered a key interaction at the heart of a
promising new treatment for a rare childhood metabolic disorder known as Fabry
disease. The discovery will help understanding of other protein-folding
disorders such as Alzheimer's, Parkinson's and Huntington's diseases, as well.
Findings are featured as the cover story in the current issue of
Chemistry & Biology.
People born with Fabry disease
have a faulty copy of a single gene that codes for the alpha-galactosidase
(α-GAL) enzyme, one of the cell's "recycling" machines. When it performs
normally, α-GAL breaks down an oily lipid known as GB3 in the cell's recycling
center, or lysosome. But when it underperforms or fails, Fabry symptoms result.
Patients may survive to adulthood, but the disorder leads to toxic lipid
build-up in blood vessels and organs that compromise kidney function or lead to
heart disease, for
example.
The faulty gene causes its damage by producing a misfolded
protein, yielding an unstable, poorly functioning α-GAL enzyme. Like origami
papers, these proteins are unfolded to start and only become active when folded
into precise shapes. At present, enzyme replacement therapy (ERT) is the only
FDA-approved treatment for such lysosomal storage disorders as Fabry, Pompe and
Gaucher diseases, but ERT requires a complicated and expensive process to
purify and replace the damaged α-GAL enzyme, and it must be administered by a
physician.
Instead of replacing the damaged enzyme, an alternative route
called pharmacological chaperone (PC) therapy is currently in Phase III
clinical trials for Fabry disease. It relies on using smaller, "chaperone"
molecules to keep proteins on the right track toward proper folding, but their
biochemical mechanism is not well understood, says Garman.
Now, he and
colleagues report results of a thorough exploration at the atomic level of the
biochemical and biophysical basis of two small molecules for potentially
stabilizing the α-GAL enzyme. He says their use in PC therapy could one day be
far less expensive than the current standard, ERT, and can be taken
orally.
This work, which improves knowledge of a whole class of
molecular chaperones, represents the centerpiece of UMass Amherst student
Abigail Guce's doctoral thesis and was supported by the National Institutes of
Health. Other members of the team are graduate students Nat Clark and Jerome
Rogich.
"The interactions we looked at are exactly the things occurring
in the clinical trial right now," Garman says. Further, "the same concept is
now being applied to other protein-folding diseases such as Parkinson's and Alzheimer's disease. Many
medical researchers are trying to keep proteins from misfolding by using small
chaperone molecules. Our studies have definitely advanced the understanding of
how to do that."
In their current paper, Garman and colleagues compare
the ability of two small chaperone molecules, galactose and
1-deoxygalactononjirimycin (DGJ) to stabilize the α-GAL protein, to help it
resist unfolding in different conditions such as high temperature and different
pH levels.
They found that each chaperone has very different affinities:
DGJ binds tightly and galactose binds loosely to the α-GAL, yet they differ in
only two atomic positions. "Tight is better, because you can use less drug for
treatment," Garman says. "We now can explain DGJ's high potency, its tight
binding, down to individual atoms."
In earlier studies as in the current
work, the UMass Amherst team used their special expertise in X-ray
crystallography to create three-dimensional images of all atoms in the protein
to understand how it carries out its metabolic mission. They also found a new
binding site for small molecules on human α-GAL that had never been observed
before.
Crystallography on the two chaperones bound to the α-GAL enzyme
showed that a single interaction between the enzyme and DGJ was responsible for
DGJ's high affinity for the enzyme. Other experiments also showed the ability
of the 11- and 12-atom chaperones to protect the large, 6,600-atom α-GAL from
unfolding and degradation.
For the first time, by making a single change
in one amino acid in protein, they forced the DGJ to bind weakly, indicating
that one atomic interaction is responsible for DGJ's high affinity.
"It
was surprising to find these two small molecules that look very much the same
have very different affinities for this enzyme," says Garman, "and we now
understand why. The iminosugar DGJ has high potency due to a single ionic
interaction with α-GAL. Overall, our studies show that this small molecule
keeps the enzyme from unfolding, or when it unfolds, the process happens more
slowly, all of which you need in treating disease."
The UMass Amherst
team plans to next use the principles, assays and experiments they developed
here on enzymes defective in other human diseases to examine new therapies for
them and related disorders.
JANUARY 9, 2012
Significant Cost Savings Associated With Emergence Of
Prospective Surveillance Model As Standard Of Care For Breast Cancer
Treatment
Early diagnosis and treatment of breast cancer-related lymphedema by a physical
therapist can significantly reduce costs and the need for intensive
rehabilitation, according to an article published in the January issue of
Physical Therapy (PTJ), the scientific journal of the American
Physical Therapy Association (APTA).
The study, led by APTA member and
spokesperson Nicole Stout, PT, MPT, CLT-LANA, compared a prospective
surveillance model with a traditional model of impairment-based care and
examined the direct treatment costs associated with each program. Treatment and
supply costs were estimated based on the Medicare 2009 physician fee
schedule. Researchers estimated that treatment for breast cancer-related
lymphedema costs $636.19 a year when the prospective surveillance model was
used vs $3,124.92 for traditional treatment of advanced lymphedema.
The
goal of a prospective surveillance model for cancer rehabilitation is to
identify impairment at the earliest onset to alleviate impairment or prevent it
from progressing. Soon after diagnosis, a physical therapist will perform a
preoperative examination to establish a baseline level of function. Follow-up
examinations are then conducted postoperatively at 1 month and then 3-month
intervals, for up to 1 year. In contrast, a traditional model focuses on
treating lymphedema once it has progressed and patients already have functional
limitations.
"This study begins to paint a picture of evidence showing
that prevention of chronic conditions such as lymphedema - using rehabilitation
models of care - may result in significant cost savings," said Stout.
Breast cancer-related lymphedema is characterized by abnormal swelling
of the arm and hand, which can be disfiguring. A chronic condition, it is
associated with decreased arm function, disability, and diminished quality of
life. If the condition is not diagnosed early and managed, a patient can be at
risk for infection and further shoulder complications.
In place for
more than 10 years, the prospective surveillance model was developed at the
National Naval Medical Center in Bethesda - now part of the Walter Reed
National Military Medical Center - and is the standard of care for all patients
diagnosed with breast cancer at the medical
center. Several research articles have been published demonstrating clinical
effectiveness of the prospective surveillance model in reducing lymphedema,
shoulder morbidity, and fatigue, including the February
2010 article in the journal Breast Cancer Research and
Treatment.
Although further analysis of indirect costs and utility
is necessary to fully assess cost effectiveness, the prospective surveillance
model is emerging as the standard of care for breast cancer
treatment.
January 15, 2012
New, Noninvasive Way To Identify Lymph Node
Metastasis
Using two cell surface markers found to be highly expressed in breast cancer lymph node
metastases, researchers at Moffitt Cancer Center, working with colleagues at
other institutions, have developed targeted, fluorescent molecular imaging
probes that can non-invasively detect breast cancer lymph node metastases. The
new procedure could spare breast cancer patients invasive and unreliable
sentinel lymph node (SLN) biopsies and surgery-associated negative side
effects.
Their study was published in a recent issue of Clinical
Cancer Research (18:1), a publication of the American Association for
Cancer Research.
"The majority of breast cancer patients, up to 74
percent, who undergo SLN biopsy are found to be negative for axillary nodal, or
ALN, metastases," said corresponding author David L. Morse, Ph.D., an associate
member at Moffitt whose research areas include experimental therapeutics and
diagnostic imaging. "Determining the presence or absence of ALN metastasis is
critical to breast cancer staging and prognosis. Because of the unreliability
of the SLN biopsy and its potential for adverse effects, a noninvasive, more
accurate method to assess lymph node involvement is needed."
The
authors note that the postoperative complications to the SLN biopsy can include
lymphedema, seroma formation,
sensory nerve injury and limitations in patient range of motion. In addition,
biopsies fail to identify disease in axillary lymph nodes in five to 10 percent
of patients.
In developing targeted molecular probes to identify breast
cancer in axillary lymph nodes, the research team from Moffitt, the University
of Arizona and University of Florida used two surface cell markers - CAIX and
CAXII. CAIX is a cell surface marker known to be "highly and broadly expressed
in breast cancer lymph node metastases" and absent in normal tissues.
CAIX and CAXII are both integral plasma membrane proteins with large
extracellular components that are accessible for binding of targeted imaging
probes, explained Morse. In addition, several studies have shown that CAIX
expression is associated with negative prognosis and resistance to chemo and
radiation therapy for breast cancer. CAXII is a protein expressed in over 75
percent of axillary lymph node metastases.
The researchers subsequently
developed their targeting agents by using monoclonal antibodies specific for
binding CAIX and CAXII, both of which are known to promote tumor growth.
According to the researchers, a number of noninvasive optical imaging
procedures for SLN evaluation have been investigated, but the approaches have
lacked the ability to target tumor metastasis biomarkers.
"These
methods provide only anatomic maps and do not detect tumor cells present in
lymph nodes," explained Morse. "Using mouse models of breast cancer metastasis
and a novel, monoclonal anti-body-based molecular imaging agents, we developed
a targeted, noninvasive method to detect ALN metastasis using fluorescence
imaging."
In addition to the imaging study with mice, the researchers
also reported that the combination of CAIX and CAXII covered 100 percent of
patient-donated samples used in their tissue microarray (TMA) study.
"The imaging probes detected tumor cells in ALNs with high sensitivity,"
explained Morse. "Either CAIX or CAXII were expressed in 100 percent of the
breast cancer lymph node metasatsis samples we surveyed in this study. These
imaging probes have potential for providing a noninvasive way to stage breast
cancer in the clinic without unneeded and costly surgery."
January 23, 2012
What Francis Collins doesn't know about "integrative
oncology" – ScienceBlogs –
I was
disturbed several months ago when I learned that the director of the National
Institutes of Health, Francis Collins, had agreed to be the keynote speaker at
the Eight International Society for Integrative Oncology
Conference in Cleveland, OH. I say "doubly" disturbed
because it disturbed me that Francis Collins would agree to speak at such a
function and, perhaps even more, because the host institution was Case Western Reserve University,
the institution where I both completed my surgery residency and my PhD in Physiology and Biophysics.
Sadly, it now appears that my old stomping grounds at University Hospitals has
been thoroughly infiltrated with quackademic medicine, as evidenced by this
clinical trial of reiki for psoriasis that's
making the rounds of news services and the offering of acupuncture, reiki, and even
reflexology at various UH facilities through the University Hospitals Connor Integrative Medicine
Network. Let me tell you, there was none of this
pseudoscience going on when I finished my residency there in 1996. Seeing it
there now provokes a reaction in me not unlike Sylvester Junior's reaction when
his father Sylvester embarrasses him, particularly when I noted that the
director of the CWRU Comprehensive Cancer Center, Dr. Stanton L. Gerson, was to
give one of the keynote talks, entitled, "The Future of Integrative
Oncology." (Hint for those of you not familiar with
classic Looney Tunes cartoons: A paper bag is involved.) I guess that by
expressing my extreme disappointment and embarrassment that the institution
where I learned to become a surgeon has during the last 15 years gone woo, I've
probably just killed any opportunity I might have to work at the Case Comprehensive Cancer Center
ever again. Oh, well, add it to the list, along with Beth Israel and my alma mater
the University of
Michigan.)
Back
when I first learned about it, I thought about blogging the meeting, but
without much concrete to go on, all I could do was to write a critical post about his decision to
accept the offer to be the keynote speaker at the Society for Integrative
Oncology (SIO). Then yesterday I saw popping up in my e-mail a notice from the
American Society of Clinical Oncology (ASCO), along with a link to a story in
its publication The ASCO Post entitled NIH Director Calls for Rigorous Evaluation of
Integrative Medicine to Provide Evidence of
Efficacy.
Et tu,
Dr. Collins?
Francis Collins "gets it" about as well as Josephine
Briggs
We here
at SBM have written frequently and copiously about the National Center for
Complemnatary and Alternative Medicine, a.k.a. NCCAM,
a.k.a. the Barad-dûr to SBM's Minas Tirith. OK, I exaggerate.
Just a bit. NCCAM director Josephine Briggs is a real scientist, and I have no
doubt that she wants to make NCCAM more scientifically rigorous than it has
been in the past. Unfortunately, NCCAM is a political, not a scientific,
construct, because CAM is an ideological, not a
scientific, construct. There is nothing tying together the disparate
"disciplines," treatments, and woo lumped together under the rubric of CAM/IM
other than that they either (1) have not been scientifically demonstrated to
have efficacy; (2) have been demonstrated not to have efficacy; or (3) are diet
and exercise or other interventions that should fall under the purview of SBM
but have been co-opted by CAM/IM believers along with the woo because they are
modalities that have proven health benefits and including them along with all
the pseudoscience makes the pseudoscience seem more plausible. It's not for
nothing that I frequently refer to diet, nutrition, and pharmacognosy as the
"Trojan horses" of CAM. These modalities have more than a modicum of
plausibility (although it should be pointed out that the way they are
represented by CAM often does not, vastly overselling the benefits or fusing
science-based recommendations with pseudoscience). "Energy healing,"
acupuncture, reiki, the vast majority of TCM, Ayurveda, and many other
modalities that fall under the CAM umbrella do not, and that is the
problem.
Unfortunately, it's quite obvious that Collins does not "get" this.
Although he changed the title of his talk from the original title of "Faith,
Spirituality and Science in Oncology," the actual talk he gave, entitled "Seeking Out the Most Effective Interventions for
Cancer Prevention and Treatment," still falls hook, line, and sinker for one of the favorite
arguments of CAM proponents, the argumentum ad populum (i.e., appeal
to popularity):
"Many new frontiers exist in integrative medicine," NIH Director
Francis Collins, MD, PhD, stated in his keynote address at the Eighth
International Conference of the Society for Integrative Oncology (SIO) in
Cleveland. "The evidence is overwhelming that these approaches are being used
by many individuals in the United States, including those with cancer," he
said. "For wellness, immune function, and pain-related symptoms, there is a
significant increase in interest among cancer survivors compared to other
people who use complementary and alternative medicine."
Survey
data show that over a lifetime, complementary and alternative medicine (CAM) is
used by "65% of cancer survivors vs 53% of noncancer respondents," he said.
When questioned about motivations to use CAM, cancer survivors "are more likely
to be using this because they are unhappy that medical treatments have not
helped them or because it has been recommended by the provider," he
noted.
As Steve Novella has pointed out,
the appeal to popularity is the most ubiquitous argument used in CAM
apologetics. In brief, it argues that, because CAM is
seemingly popular, there must be something to it and we should study it. If you
look at the figures, on the surface Collins' figures appear to be correct.
However, such figures are hugely inflated by inclusion of
things like massage, vitamins and supplements, yoga, and prayer. That's how
studies of tai chi in fibromyalgia, for instance, make it into the New England Journal of
Medicine labeled as "CAM" when in fact they are
merely studies that demonstrate that gentle exercise appears to be helpful in
alleviating fibromyalgia symptoms. As Steve also pointed out, most hard-core
CAM modalities are actually used by a very small percentage of the population,
with most falling in single digit percentages. For example, acupuncture use is
around 6.5%; Ayurveda, 0.6%; chelation therapy, 0.3%; energy healing, 1.7%;
naturopathy, 1.5%; and homeopathy, 3.7%. These are hardly impressive numbers.
In addition, these numbers are not significantly different from numbers
reported 10 or 20 years ago - belying the claim that CAM use is increasing. In
any case, the number I usually see for the percentage of cancer patients
reporting having used CAM is less than 50%. I don't know where Collins got his
figure of 65%.
In
fact, while looking for the source of Collins' information, I found this recent meta-analysis that,
while claiming to find that CAM usage among cancer patients is increasing,
still only estimated it at 40% in American patients, way lower than the 65%
claimed by Dr. Collins. It's actually a fairly maddening study in that the
definition of CAM therapies for purposes of inclusion in the various studies is
not listed in the paper. Rather, it's listed in an online supplement mentioned
in the paper that I couldn't find. In any case, particularly interesting to me
was this passage in the discussion:
Surveys that restricted CAM use to certain categories or treatments
yielded lower prevalence estimates than surveys that did not. This is
exemplified by the study from Abu Realh et al,120 who confined their definition of CAM use to mind-body
approaches, counseling, and attendance to self-help groups and found that 12%
of respondents were "CAM users." Accordingly, studies with broad definitions of
CAM use tended to inflate estimates: for example, many of the included surveys
with very high usage rates had integrated prayer and exercise defined as CAM,
and the usage rate would have been approximately halved if these therapies had
not been included. We planned to systematically address the question of how
different definitions for the term CAM would influence the results in surveys.
However, this was not feasible because authors seldom stated how they defined
CAM for the purpose of their study. Moreover, even in studies from the same
country, in which the same type of definition was used, the CAM treatments
included varied substantially.
It's a
shame that Dr. Collins apparently either doesn't recognize such distinctions or
was too unconcerned to look more in depth into whether claims of CAM use in
cancer patients by CAM advocates are accurate. They are, as Steve and I have
pointed out, hugely inflated by the inclusion of modalities that aren't really
medicine (prayer, for instance) or through the inclusion of of modalities that
are arguably not CAM, such as vitamin use (which might or might not be
science-based depending upon the specific use), exercise, and nutrition. Even
sensationalistic news coverage
comes up with lower estimates than Collins did. Next up on Collins' hit parade
is a citation of a study from M. D. Anderson Cancer Center that reports that
52% of cancer patients are using CAM during phase I trials, but that 23% don't
disclose that information to trialists. This is indeed a disturbing figure, but
it is not a justification for NCCAM, a specialty known as "integrative
oncology," or CAM itself. Rather, it's a figure that tells us that we should do
more research in drug interactions with natural products, something that could
easily be done under the auspices of non-CAM funding mechanisms in the
NIH.
In
fact, I find this whole line of argument confusing. Collins went on to proclaim
how the goals of NCCAM are "very much aligned" with those of the SIO and then
used the following as his examples:
"We need to do this research, not only to find out what works, but to
find out what interventions actually may be harmful," no matter how unlikely
that may seem, Dr. Collins commented. For example, he pointed to the story of
beta-carotene in cancer prevention. In the 1980s, epidemiologic evidence
suggested that beta-carotene might decrease lung cancer risk. Double-blind
clinical trials were initiated, and in the 1990s, those trials showed that "not
only is beta-carotene not protective, it actually increased lung cancer
risk--16% in one study and 28% in another--and so the studies were halted." A
follow-up study in 2004 corroborated those results.
This
is, of course, a massive straw man coupled with a non sequitur. No one
seriously argues that scientists shouldn't try to find out what works and what
doesn't. In addition, the examples Collins cites are not in any way
"alternative," "integrative," or "complementary." Beta-carotene is a chemical
found in some foods that can act as a drug or nutrient. There was preliminary
epidemiological evidence
suggesting that beta-carotene might decrease the risk of lung cancer.
Scientists then did what scientists do: They performed randomized, double-blind
clinical trials to test the hypothesis, which seemed plausible when the trials
were initiated. Unfortunately, the results of these clinical trials turned out
not to be what had been anticipated; not only did beta-carotene not prevent
lung cancer, but it increased the risk of dying of lung cancer in
smokers. How this relates to "CAM" or "IM" is tenuous at
best. This is SBM at work. The same is true of the other example cited by
Collins, that of vitamin E and selenium as preventatives for prostate cancer
that, when tested in randomized clinical trials, actually slightly increased the risk of prostate
cancer. So, while I agree with Collins that "That's the
kind of data we need if we are going to be giving rational recommendations to
patients and providers about how to practice better prevention and treatment,"
I disagree that such studies are in fact "integrative" or "alternative" or
"complementary" or whatever CAM proponents like to call such supplementation
these days. They are, in fact, SBM. Beta-carotene and the vitamin E/selenium
combination are simply proposed therapies that had a modicum of plausibility to
them as a preventative strategy for different cancers that failed when tested
in rigorous randomized clinical trials. This happens all the time in SBM; it's
why we do clinical trials.
In
essence, whether he knows it or not, Collins has fallen for the old "bait and switch" of CAM/IM, just
as NCCAM director Josephine Briggs has.
"Personalized" medicine and CAM
I've
written many times before about how CAM co-opts the idea of "personalized
medicine" for itself when in fact what "personalized medicine" means in CAM
tends to involve practitioners "making it up as they go along"
and the co-opting of the term as a
strategy to attack evidence-based medicine as being "one
size fits all." Some, such as Dr. Stanislaw Burzynski, co-opt the term as a science-y-sounding
way to make his very own "make it up as you go along"
mish-mash of targeted cancer therapies, antineoplastons, and chemotherapy sound
as though he knows what he's doing.
Collins, disappointingly, buys into this frame. Whether he does this
knowingly or unknowingly, I don't know. (I suspect the latter.) First, he touts
NIH initiatives, such as the Cancer Genome Atlas, a project
that will sequence the genomes of many cancers and try to draw conclusions about the genetic
abnormalities that drive cancer growth and determine
responsiveness to various therapies. It's an ambitious (and risky project that
has almost nothing to do with CAM, although CAM proponents have tried to claim
such projects as their own, the most hilariously off-base example being
so-called Ayurvedomics. This is a strategy
that appears to be echoed in one of the talks given at the SIO conference by
Jeffrey A. Dusek, PhD, entitled, "Mind-Body Strategies and
Epigenetics." In any case, Collins points out how "big
numbers" are needed to be able to draw any useful correlations and
understandings of patterns of genetic derangements in various cancers. No doubt
this is true, but it is also irrelevant to CAM, as is this example he
cites:
As "a dramatic example" of the new targeted, personalized approach to
cancer treatment, Dr. Collins described the case of a woman, a nonsmoker who
was diagnosed with very aggressive, stage IV non-small cell lung cancer in both
lungs about 4 years ago. Following standard chemotherapy, she participated in a
clinical trial with crizotinib (Xalkori). Prominent lung metastases shown on
x-ray in July 2009 "were essentially gone by November 2009," Dr. Collins
reported. "So she has had a dramatic response, and she continues to do
extremely well," he added.
"Of
course this drug doesn't work for everybody with this kind of lung cancer. So
what's the difference? It depends on whether the particular cancer has a fusion
involving the ALK gene," Dr. Collins explained. "Crizotinib was not developed
with that particular target in mind, but it turned out after the fact that this
was going to be a very responsive situation." The success of crizotinib when
used in a targeted personalized approach led to its approval by the FDA several
months ago. Yet the drug may not have been approved if it "had been tried on
thousands of people with lung cancer without having stratified them by the
specific molecular findings," Dr. Collins said.
Triumphs such as these are promising harbingers of a potential new
age of personalized medicine and illustrate the potential power of such
approaches. They do not, however, illustrate anything about CAM. Neither does
the other example cited, that of a promising new approach of modulating the
immune system to stimulate a patient's own cells to attack cancer cells in
chronic lymphocytic leukemia. This sort of science-based immunotherapy is
related to claims of "boosting the immune system" promoted by CAM aficionados
only by coincidence or in the way that the germ theory of disease as understood
today is related to miasma theory from 200 years ago. Yet Collins seems to
think that these promising avenues in the science-based treatment of cancer are
somehow related to "integrative oncology." In fact, he falls for the "bait and
switch" even harder:
"We also have great excitement about a new era in therapeutics based
on natural remedies," Dr. Collins said. The NCI has an ongoing program looking
for anticancer activity in extracts from plants, marine invertebrates, and
microbes. "We are also seeking opportunities by looking at traditional
medicines, many of them from China, for how we can decrease the side effects of
treatment."
All of
which is pharmacognosy, not "CAM," As David Kroll pointed out not too
long ago:
But pharmacognosy - the study of natural products - is *not*
alternative medicine. It is, in fact, the basis for at least 25% of our
prescription drugs and up to 60% of some classes of over-the-counter
drugs.
And:
What worries me more is how pharmacognosy is approached by NCCAM and
how damaging their supported studies can be in leading us to dismiss
potentially useful botanical medicines. In attempting to show political
supporters the benefits of alternative medicines, NCCAM seems to spend a
disproportionate share of their appropriation on expensive clinical trials. My
concern has been that clinical trials are warranted when sufficient basic
science has been conducted. However, the rush to clinical trials has instead
led to multiple clinical trials failures.
The
problem, of course, is that NCCAM and "integrative oncology" are not about
pharmacognosy, other than "rebranding" it and fusing it with pseudoscience.
They are about magical thinking and what Harriet Hall likes to call tooth fairy science. Dr. Briggs
might have brought more scientific rigor and a more true pharmacognosy-like
approach to NCCAM for the moment, but she will not be NCCAM director forever.
One day she will retire or move on. When that happens, the institutional
inertia will likely cause NCCAM to revert to its old ways.
What Francis Collins doesn't know about "integrative
oncology"
One of
the reasons that quackademic medicine can flourish is that respected scientists
like Francis Collins do not understand what it is about. That's because in
general they are unaware of what "integrative medicine" is all about, and many
quackademics are quite good at cloaking their woo in convincing-sounding
scientific language. Certainly, they have donned the language of evidence-based
medicine and of "patient-centered" care like the proverbial cloak of
invisibility in the Harry Potter novels and movies to hide the pseudoscience,
as Kimball Atwood so eloquently
described and I reiterated. I won't retread old
ground other than to point out that "integrative" oncology in reality means
"integrating" quackery and pseudoscience into science-based medicine. I will,
however, take a look at the agenda for the SIO meeting at
which Collins was the keynote speaker.
A brief
perusal of the SIO meeting program reveals a
few tidbits, in no particular order, some with and some without my
comment:
I could
go on, given that there is a lot more there, but I'll wind up with my favorite
session of all, one that I might have actually been interested in attending.
Yes, I'm talking about the Integrative Tumor Board. For those of you not
familiar with what a tumor board is, it's a meeting where all the relevant
specialties are together in one room to discuss the cases of individual cancer
patients in order to formulate the best evidence-based treatment plan that the
multidisciplinary team can come up with. Of course, this tumor board has a
bit...laxer definition of "specialty." This tumor board includes two medical
oncologists (one of whom is the medical director of the M.D. Anderson Integrative Medicine
Center), an MD/acupuncturist, a naturopath
from Bastyr university, a nutritionist from Nutritional Solutions (now
there's an idea for a future post!) and a nurse who is interested in "mind-body"
medicine. One notes that there are no surgeons, no
radiation oncologists, and no genetics counselors, most of whom tend to be on
tumor boards, depending upon the tumor type. One wonders what sorts of cases
this tumor board discussed and what recommendations its members gave for the
cases chosen to be presented.
It's
extremely disappointing that Dr. Collins agreed to appear as the keynote
speaker for the SIO conference, but it's even more disappointing that, instead
of using his forum to challenge the SIO to abandon pseudoscience, he instead
fell right into their frame of co-opting science-based modalities as being
somehow "alternative." He even bragged about how much support the NIH has given
to such research, pointing out that the Office of Cancer Complementary and Alternative
Medicine (which has the unfortunate acronym OCCAM) in the
National Cancer Institute has a budget even larger than that of NCCAM and
saying:
While NCCAM is an important focus of efforts at NIH, other institutes
within NIH also have initiatives in complementary and alternative medicine, Dr.
Collins noted. "The NCI has the largest one by far," he said, and "the budget
for CAM in the NCI is actually slightly larger than the entire budget of NCCAM.
The total investment that NIH makes in complementary and alternative medicine
research in 1 year is about a half-billion dollars. I wish it was more, but I
wish everything we are doing in biomedical research could be more," he
said.
As I've
said before, I wish it were less (as in zero), and all the money wasted on
pseudoscience or putting a pseudoscience spin on what should be SBM distributed
to the rest of the NIH. There is nothing that NCCAM or OCCAM does that requires
a special, dedicated office or center in the NIH. Unfortunately, Collins uses
the dire funding situation of the NIH to make the wrong argument about CAM
research funding:
"The opportunities for medical research have never been greater than
they are right now, and yet the threat to the support of biomedical research
has--in the memories of anybody who is currently working in the field--never
been greater either," Dr. Collins stated. He noted that in fiscal year 2011,
"for only the second time in 40 years, the NIH budget sustained a real cut." If
the failure of the Joint Select Committee on Deficit Reduction (the so-called
supercommittee) to cut $1.2 trillion from the budget results in sequestering of
discretionary budgets, "a dramatic downturn in support for biomedical research"
could occur in fiscal year 2013, Dr. Collins said.
We now
know, of course, that the supercommittee did fail to come to an agreement and
that sequestering of discretionary budgets is all but assured in 2013. To me
that's all the more reason that waste such as NCCAM and OCCAM should be rooted
out of the NIH, in order to make the best possible use of the remaining funds.
Look at it this way. Only the top 7% of new research grant applications to the
NCI are currently being funded, down from the top 16% back when I got my R01 in
2005, with no improvement in sight. In some NIH institutes, I've been told,
it's only the top 5% being funded. Meanwhile, investigators used to have two
opportunities to revise and resubmit rejected proposals; now they can only
revise and resubmit once. When funding gets this tight, there are lots of
innovative projects, chock full of good science, that don't make the cut and
don't get funded. I fully agree with Dr. Collins that the case for funding
medical research has never been stronger and that the threat to the NIH has
never been greater. At least 20 years ago, which was the last time funding was
so tight, there appeared to be hope that an end was in sight. Not so
today.
I
realize that Dr. Collins was tailoring his address to his audience. I also
realize that Collins is not just a scientist and administrator, but a
politician. He has to be to have become director of the NIH and to have held
all the other prominent leadership positions he has held during his career.
Even so, it's hard not to come to the conclusion that, like so many physicians
and scientists, he just doesn't "get" the problem of CAM and pseudoscience
infiltrating medicine. At least, I hope that's the case. What would be worse is
if he either didn't care or supported it.
January
24, 2012
Hoveround opens new
headquarters - Bradenton Herald –
Physical
therapy business to hold open house
BRADENTON -- Request Physical Therapy, 2722
Manatee Ave. W., is having an open house from 4 to 7 p.m. Friday.
The
therapy center treats lymphedema, neck and lower back pain, total joint
replacements. dizziness and vertigo and sports injuries. The business has an
expanded studio that offers yoga, tai chi, massage and pilates.
There
will be a ribboncutting ceremony, raffle prizes, refreshments and yoga
demonstrations.
For more
information, call 941-744-9046.
January
25, 2012
Business notes - Waynesville
Smoky Mountain News – I cant find the name of who wrote the article
sorry
This
was a one time screening on one day passed now - Glens Falls
Post-Star
As I research Axillary Web Syndrome (AWS) more, I am learning that
there are preventative actions I should be (and should have been) taking
against lymphedema since my surgery almost a year ago. This research prompted
me to contact my care team to get additional information. I sent the following
email to my oncologist, radiation oncologist and the oncology resource nurse at
the cancer center:
I have been going to PT (physical
therapy) for a few weeks now and Lisa is scheduling me 2x's/week for the next 3
weeks. I have experienced some relief and increase in ROM (range of motion),
but I still have a very tight cord running down my arm, through my bicep and
into my elbow.
I have not been able to find much
information about AWS online and it seems any one I ask can't provide me with
any additional information from what I have already read. I would like to know
what my likelihood of developing lymphedema is now that I have this cording
(?). I've read that there is a correlation between the two and it increases the
odds, so does that mean I am doomed to get edema no matter what? Or are there
preventative actions (besides PT) I can take now so that it doesn't happen to
me?
I have been consistently working out
(running and strength training) since August. Should I have been, and should I
now be, wearing a compression sleeve to help increase my chances of not getting
lymphedema? Or should I not wear a sleeve until it presents so that my arm
doesn't become dependent on a sleeve if it's not necessary? I am happy with my
physical activities and abilities since re-starting training, but PT has
recommended I taper back on strength training and certain exercises, which I am
disappointed with and I wonder, is this going to be the case for the rest of my
life? I am scared and I don't want to have arm swelling that will never go
away; especially in my dominant arm. If there is anything I can do, or anyone I
can speak to that could help to increase my odds of not having this happen,
please let me know.
I didn't realize that lymphedema could
occur this far out from surgery. I thought I was in the clear, but now that
I've been researching I see that if lymphedema is going to happen it's likely
to occur within 4 years after surgery... so I still have a ways to go and the
AWS is not a good sign. I didn't realize the radiation could trigger something
like this. I thought the risks from radiation where a possible dry cough for
about a month and weakening of my ribs.
I'm just slightly disappointed with
the lack of information I've been given and able to find (sigh :/). Any thing
you could offer would be appreciated.
Since sending the email above I received an email back from the
oncology resource nurse (Vickie Yattaw), I am scheduled to see Dr. Stoutenburg
(my oncologist) tomorrow, and I have spoken with Dr. Frank (my radiation
oncologist) on the phone.
I received conflicting advice from Vickie and Dr. Frank in regards to
wearing the compression sleeve on my arm during exercise, so I am going to see
what Dr. Stoutenburg has to say tomorrow and then make an educated guess based
on information from all three.
I do enjoy speaking with Dr. Frank. He just has a way about
explaining things that I appreciate. He started by explaining Mondor's Disease
to me and said that AWS is believed to be a variant of this disease. He also
told me, although associations can be made with AWS and lymphedema, having AWS
does not imply causation- so this cording in my arm isn't necessarily going to
cause me to get lymphedema. He also said if he were to compare me to other
patients, he would put me in a category of "low-risk" for lymphedema because I
did not have lots of nodes removed, I am a healthy weight and active, but he
couldn't not say my chances are zero. He said sometimes people just have bad
luck. I think I'm due for some good luck, so I'm going to stick with good
thoughts - and keep buying my weekly lotto ticket! I asked why I wasn't given
more information about preventative measures and he said there are no studies
actually proving the prevention claims, at this point it is just people
advocating (not scientific proof), so if they were to tell me to wear a
compression sleeve, it may aggravate my arm and become lymphedema (like a self
fulfilling prophecy). Still not sure of my feelings on this.
As someone who has never had breast cancer before, I'm not sure how I
was supposed to know this stuff. It seems like there is not a lot being done in
regards to research and treatment for AWS or lymphedema in the medical field.
For anyone suffering from these conditions I hope that changes. I hope
oncologists find it important to educate their patients from the beginning of
their treatments about the preventative actions they can take. I know there are
no studies proving the prevention claims, but they seem like good all around
practices. If a patient's care team doesn't tell them what to look for how are
they supposed to know?
Any way, I hope to be fortunate enough not to get lymphedema (Vickie
said the risk lasts for up to 10 years after surgery-geesh! a girl can't buy a
break!). There is no cure for lymphedema, so if I do get it I will be presented
with a whole new set of challenges. The smallest thing, like bugs bite on my
hand could set it off.
Tomorrow, I have a PT session and then meet with Dr. Stoutenburg. I
look forward to hearing his thoughts on all this. This has been a lot to wrap
my head around. I guess because I thought after treatment the only thing I
would have to be concerned with was not having a recurrence. So begins another
life lesson and learning to live with the long-term side effects of breast
cancer treatment.
January
26, 2012
Indian River Health Listings Updated Jan. 26,
2012 – TCPalm –
Talk
Lymphedema: Talk: Lectures on swelling/edema management. Lymphedema Therapy
Center, 787 37th St. Ste. E-100, Vero Beach, 11 am, Jan. 24, 31, Feb. 7. RSVP:
772-569-9747.
Hospital Stay Has Kept Woman From Seeing Her New
Home - The Ledger – By Chase Purdy –
TAMPA | Yvonne
Gallimore's new home was arguably the biggest Christmas gift of her life. Only,
she's never seen it. Time hasn't been on her side lately.
In
May 2011, the 54-year-old Lakeland woman was removed from her home to receive
emergency medical treatment for a leg infection. The wound, indirectly caused
by her lymphedema, a condition that creates blockage in a person's body that
prevents fluids from draining well, had left her weighing more than 800 pounds
and unable to move freely within her subsidized apartment.
When
removed from her home, authorities had to rip down a wall of her house,
effectively rendering her homeless in the process. Since her extrication,
Gallimore has found herself in and out of hospital wards, often for months at a
time.
But
in June, an anonymous donor boosted Gallimore's spirits by offering to build
her a new house. The project was completed by the end of December, but because
she was transferred to Tampa General Hospital in October for bariatric
treatment, Gallimore remains confined to a hospital bed.
“I
was here before the house got done,” Gallimore said. “It's going good, though.
I'm getting treatment.”
Excited
about her new home and the opportunity of spending more time with her
grandchildren, Gallimore said she's looking forward to getting out of the
hospital and into her own place. But she's also committed to patience. Since
starting bariatric treatment in October, she said she's lost more than 100
pounds.
“They've
been wrapping her legs and she's been shrinking some and dropping some weight,”
said Chandra Greer, Gallimore's friend and home nurse.
Michel
Murr, the director of bariatric surgery at Tampa General Hospital, described
his approach to treatment as comprehensive. It's a process that involves up to
five types of experts, including a bariatrician, dietician, psychologist,
physical exercise physiologist, and surgeon. Together, the team works to reduce
stress, promote behavior modification, and physical exercise.
“We
prepare in all possible ways for the operation,” Murr said. “Once that's
completed . . . we move on to meet with the surgical team, which is me and a
couple of other doctors.
The
surgeon said he performs one surgery, one done microscopically, to remove
excess weight.
The
results don't appear overnight, but rather, over the course of several years,
Murr said.
“What
we see is that patients will average about 10 to 15 pounds a month,” he said.
“The end result in 15 to 20 years is very, very good. It's safe to assume that
whatever excess weight a person has, they will lose half or 60
percent.”
[
Chase Purdy can be reached at [email protected] or
863-802-7516. Follow him on Twitter: @chasepurdy ]
Business Briefcase: Scotlyn Group provides
lymphedema services - The Daily News Journal
–
MURFREESBORO — Lymphedema services
are now provided by the Scotlyn Group therapists in Murfreesboro.
Linda Bullard, PTA/CLT; Don Bullard
PTA/CLT; and Lynn Teal, PT/CLT, are now located within Donnelly Physical
Therapy, located at 610 East Clark Blvd. in Murfreesboro.
Lymphedema services require a
physician referral and are covered by most insurances including Medicare
and Medicare replacement policies. For more information, call 615-319-4571 or
615-415-0033
January
29, 2012
Do Cancer Survivors Handle Stress Better or Worse
Than Others? – GoodTherapy.org –
The emotional impact of a cancer diagnosis is
overwhelming. People who undergo cancer treatment come through recovery having
learned how to deal with an immense amount of stress. Some individuals cope
better than others. Research examining reactions to stress in cancer survivors
has provided mixed results. Several studies suggest that cancer survivors are more
resilient than their healthy counterparts, due to the fact that they have faced
enormous stressors during their ordeal. Other evidence implies that people who
have overcome cancer are hypersensitive to life stressors as a result of being
traumatized from the course of their treatment. Because stress is known to have
negative physical and psychological consequences, both extremely deleterious to
recovery and future health, Erin S. Costanzo of the Department of Psychiatry
and Carbone Cancer Center at the University of Wisconsin-Madison wanted to find
out if this segment of the population was at increased risk for negative stress outcomes.
Costanzo and her colleagues examined how
daily stressors would affect cancer survivors and their quality of life (QOL)
based on symptoms of pain, fatigue, and depression in relation to healthy
individuals. Costanzo enlisted 111 cancer survivors and had them
complete daily diaries detailing their stressful interactions over the course
of 8 days. Cortisol samples were taken four times each day, and the
participants were assessed for physical and psychological symptoms. The results
were compared to the diaries of healthy participants. The study revealed that
overall, cancer survivors coped as well with daily stressors as healthy
individuals. Indeed, in some instances, the cancer participants were even more
resilient at overcoming minor stressors. However, there was no evidence that
the experience of going through a cancer treatment protocol provided enhanced
coping resources in all areas. In particular, the cancer survivors were more
sensitive to interpersonal and relationship stressors than the
control group. “Results also highlight the importance for researchers and
clinicians to focus not only on the distress associated with the experience of
cancer, but also to attend to other more modest stressors in understanding the
well-being of cancer survivors,” said Costanzo. She added, “Therapeutic
interventions with stress management components that target strategies for
coping with everyday life demands may have an added benefit of optimizing
cancer survivors’ QOL.”
Reference:
Costanzo,
E. S., Stawski, R. S., Ryff, C. D., Coe, C. L., & Almeida, D. M. (2012,
January 23). Cancer Survivors’ Responses to Daily Stressors: Implications for
Quality of Life. Health Psychology. Advance online publication.
doi: 10.1037/a0027018
Lymphedema
may cause pain after surgery - ABC2 News –
BALTIMORE
- One possible painful and uncomfortable side effect from Cancer treatment is
something known as Lymphedema. This is the swelling that occurs in a patient's
arms or legs and can be debilitating.
There
is no cure, but there are some ways to improve the quality of life of someone
suffering from Lymphedema.
Kathryn
Doran is a Physical Therapist at Cancer Treatment Centers of America (CTCA) in
Philadelphia. She focuses on ways that rehabilitation can help ease the
symptoms of Lymphedema.
First
of all what is Lymphedema? Doran says that it is a compromise to the lymphatic
system caused by most cancer related surgeries and treatments. It can be seen
as swollen arm, leg, face and any affected body part.
At
CTCA, all cancer patients have a cancer diagnosis and many of them choose
surgery options, but that surgery puts them at risk for developing Lymphedema,
so it's important to educate them about the risks and prevention, she
said.
So
what are some of the risk factors for developing Lymphedema?
Overexertion,
heavy lifting, blood pressure or needle sticks on the surgical arm or leg,
infection, sunburn, insect bites, radiation treatment and scar tissue. During
the surgery, in addition to removing the cancerous tumor, the surgeon might
also go in and remove some lymph nodes for staging. This too could be connected
to Lymphedema, often those who have had lymph nodes taken out are at a higher
risk.
Duran
says, before and after surgery, "patients should be aware of certain triggers
such as, inflammatory response, lifting objects, over exerting and
infection."
What
are the symptoms of Lymphedema?
Achiness
or heaviness in the arm or leg, felling of tightness with clothing such as
jewelry or socks and weakness in the arm or leg.
How
can physical therapy help ease the symptoms of Lymphedema?
"Manual
lymph drainage, which is different than a massage, compression garments or
bandages, patient education for skin care and exercise," said
Doran.
Doran
says "at CTCA, we practice a proactive approach to manage Lymphedema takes
place. They believe anyone who has had cancer related surgeries, should be
educated on the signs and symptoms of Lymphedema, and know how to treat
it."
January
30, 2012
SALFORD ART CLUB ANNUAL EXHIBITION
2012- Salford Star –
Brave Brenda Battles Adversity
Salford pensioner Brenda Bitler
has been a member of Salford Art Club for a little over four
years, and within twenty minutes of this year's Salford Art Club
Exhibition opening she found out she had sold her first ever piece of
work…
"Does that mean I'm a professional now?"
Brenda, quipped. Her personal success was a standout moment at the official
opening of this year's Exhibition held at the Salford City Museum and Art
Gallery.
Brenda's proud daughter Lynn
Kirkley `put me in the picture', telling of her mother's achievement…
"I'm really chuffed for her as she's had cancer" Lynn explained "She's
suffering from Lymphedema (swelling of the arms and legs) which makes it
difficult for her draw and paint but she's managed to produce something that
someone wants to part with money for. I'm really chuffed and
proud."
Lynn Kirkley,
herself a member of the Salford Art Club with a piece of work on show, admitted
that she was jealous of her mother…"I am!" she smiled "You're dead
right!"
This year's Exhibition consists of 92 pieces
by members, including two pieces by Betty Murray, a long-time
member of Salford Art Club, who sadly passed away last year. The work displayed
is in a variety of media, but mainly contains paintings.
In celebration of the opening of the
Bridgewater Canal 250 years ago, many of the works are on the theme of water
and bridges, and they left me with a feeling of tranquillity and calmness. I
can honestly and wholeheartedly recommend this year's exhibition as a perfect
way to unwind, draw inspiration or even pick up an excellent piece of unique
work at a rock bottom price. But my words cannot do justice to the countless
hours of dedication and devotion shown in each piece of work, and I urge you to
visit the exhibition before it closes on April 22nd.
There is also the added bonus of being able
to see a work by L.S. Lowry, created in 1959 and titled
Yachts, an interesting and vibrant piece which shows Lowry in a
different light as compared to his typecast work with dark industrial scenes.
This scene is painted with water colours, a medium Lowry tended not to use due
to its quick drying and limited work time.
Another picture is by the internationally
renowned artist Geoffrey Key, President of Salford Art Club, which
is titled Summer Park, an interesting abstract composition in
Key's signature style.
A special mention must also go to this
year's Salford Art Club Award Winners, Ken Shackman, whose
painting won the Betty Murray Award for Still Life Imagery;
Ged Buckley, whose figurative work won the John Clare
Award and Lesley Lewis, who won the Geoffrey Key
Award. Wilf Ainsworth was presented with the John
Dumville Award for the best picture in last year's show. This award is
voted for by members of the public who visit the exhibition and simply choose
their favourite picture.
"When my wife was Mayor four years ago we
came and opened it the standard was very high" said the current Mayor of
Salford, Councillor Eric Burgoyne "If anything this year's has exceeded
that, some of the pictures are absolutely brilliant...The Exhibition shows the
talent we've got here and shows the positive side of life in
Salford."
B-TOWN UNDERCOVER: Shawn Underwood Hangs Out At
Sundance - The B-Town Blog – by Shawn Underwood –
Every time I run into Scott (slave driver)
Schaefer he inquires after a ‘bit’ for The B-Town Blog—like I have nothing else
to do. Note to self—do not post fun excursions with stupid pictures on
Facebook. Scott will come calling…
Last week I was in Utah at the Sundance Film
Festival. By happenstance Sundance coincided with a therapy trip for me.
Seriously. I have lymphedema in my left leg and well, it’s a long story but if
you are interested in medical stuff, you can follow up on my lymphedema blog. My surgery and
follow up treatment are documented. But I digress.
My friend’s husband scored several premiere
tickets for us. The one and only Sundance Kid made an appearance before the
movie and can I just say, HANDSOME, HOT AND SUPER HOT!!! You get the picture,
and oh yeah, he said something too but I was distracted. Go
figure.
The first movie we ‘premiered’ in Park City,
was suitably named; ‘The Queen of Versailles’. It detailed the rise and
subsequent fall of the King of Time-Shares, Mr. Segal and wife, Jackie, a
former over-exposed, Mrs. America. The documentary/reality show is a testament
to waste and bad taste, with the opening scene documenting the construction of
the ‘biggest house in America.’ It ended as a riches to rags story. Mr. Time
–Share’s final line, ‘are we done here?’ Very telling. Theater gossip says Mr.
Time-Share is suing Sundance and the movie producer for defamation.
Coincidentally, this was also one of the first movies sold at Sundance, where
none of the movies (for the first time in Sundance history) had distribution
before being premiered. Mrs. Segal sat near the front of the theater. Her
husband, very noticeably absent.
Luckily, the second show we had tickets for
took place at the Sundance resort. Let me just say—LOVE what Bob’s done with
the resort. No messing with the masses in order to board a shuttle bound for a
high school posing as a movie theater. Sundance Resort houses the original
‘screening room’. We lined up forMonsieur Lazhar, a Canadian film
that appears on the recently announced Oscar shortlist for foreign
language films. The film has also been nominated for a Genie award—the Canadian
Oscar. Based on the play Evelyne de la Cheneliere, Monsieur Lazhar
walks unannounced into the principal’s office to apply for a recently vacated
teachers position. He is unaware the teacher has committed suicide. The
principal—nearly undone by the act of the well-liked teacher, hires him.
Eventually we discover the Algerian immigrant, Mr. Lazhar is battling his
personal demons yet he is able to move past this and bond with his students.
There are moments of lightness in the film—a relief in an otherwise very
emotional story. Well worth seeing, however we didn’t SEE anyone famous—that
happened later in the evening during dinner.
Mr. Chris Rock attended Sundance
to preview his new film, “2 Days in New York.” Chris and I split a
steak and Caesar salad at a great steak house in Park City. Well sort of – I
split a steak with my friend and Chris sat across from us. It’s like we shared
a dinner together. Really.
So as I was saying, later in the evening at
the Canyon Resort VIP big deal party I ran into, oh you know…Jason
Ritter, Jesse Eisenberg (the Facebook dork dude), Hercules aka:
Kevin Sorbo, Entertainment Tonight guy and Bare Naked Ladies lead
singer guy (close second to Bob in HOT category). For some reason, I had a
sudden attack of shyness and talked to ummm, nobody. Nobody famous anyway, but
I got my groove on and learned a few new dance moves from the mostly
twenty-something guests.
And finally, Mr. B-Town Blog (super famous)
wants to know how Sundance Resort and Park City compare to B-town. Well we have
the Tin Theater in Tin-sel town also know as Burien, the Hi-Liners put on a
fine show, AND I hear Mr. B-Town Blog is starting his own radio
station.
Why the Pink Ribbon campaign
matters - Montreal Gazette –
MONTREAL
- Léa Pool's documentary film Pink Ribbons, Inc., which premiered at the
Toronto International Film Festival last fall and opens in Canadian theatres
Friday, is critical of the pink-ribbon campaign associated with the fight
against breast cancer.
Some
of the questions raised by the documentary, which is inspired by a book by the
same name by Samantha King, are very interesting and will help us move forward
in the fight against breast cancer. However, the Quebec Breast Cancer
Foundation believes it is important to set some of the facts straight in order
to reassure the Quebec public, and help people realize that their support for
the pink ribbon is still vital for women.
First
of all, breast cancer research has paid off. Thanks to the many investments in
research by organizations such as ours, the survival rate increased from 71 per
cent in 1974 to 88 per cent in 2008.
But
in spite of this improvement, too many women still die from this disease. It is
essential to maintain our investment in research in order to continue
increasing survival rates. Moreover, 40 per cent of the money for research
comes from non-profit organizations such as ours.
Still,
the film eloquently demonstrates that we must focus more closely on
understanding the causes of breast cancer, which unfortunately are still
unknown. To this end, we are proud to say that of the $8.1 million we donated
to research projects last fall, 21 per cent of the grant money is to be spent
on research into the causes of this cancer.
There
are many ways that people can contribute to the fight against breast cancer.
Indeed, much of the money that goes to support this fight comes from the public
at large.
For
some people, it is through participation in popular fundraising events, such as
the CIBC Run for the Cure, that this support is expressed. Others like to
organize their own initiatives, like a sporting event or a spaghetti supper.
Still others donate money directly to the breast cancer organization of their
choice.
Finally,
there are people who choose to buy a product from which a portion of the
proceeds go to organizations such as ours. However, consumers must remain
vigilant when buying these "pink" products, and make sure the companies selling
them are donating the money raised to reputable and responsible
organizations.
For
a survivor like me who is currently battling the disease, it's very touching to
see thousands of people participating in the fight against breast cancer in the
way that works for them.
In
addition to money raised for research, there is also money raised to support
delivery of services. It is critical to support this delivery of services to
women with breast cancer as well as their families. That is why the Quebec
Breast Cancer Foundation provides grants to a financial aid program for
low-income patients, cofunds mobile mammography units for women in remote
regions, invests in the treatment of lymphedema, offers yoga classes and
supports many other services.
The
pink ribbon is the symbol of a cause. It has enabled us to save lives through
research and allows us to help Quebec women in need. It is therefore essential
to continue using it to make advances, save lives and help those affected by
this disease. We just need to closely monitor the way the pink ribbon is
used.
Nathalie
Le Prohon is chairperson of the Quebec Breast Cancer Foundation.
January
31, 2012
Advances in Cancer Care: Diagnosis, Treatment and
Survivorship – TribLocal –
This
was a one time meeting on 2/4 that has now passed
LoTempio Plastic Surgery for Women Opens in New York
City – MarketWatch –
World-renowned cosmetic and plastic
surgeon, Dr. Maria M. LoTempio brings her expertise to women in New York City,
setting up roots on Manhattan's East Side
NEW YORK, Jan. 31, 2012
/PRNewswire via COMTEX/ -- LoTempio Plastic Surgery for Women, owned and
operated by Board Certified plastic surgeon, Dr. Maria M. LoTempio, opened its
office at 630 Third Avenue in Manhattan, New York. The practice specializes in
reconstructive and cosmetic surgery exclusively for female patients, performing
a full range of procedures for the body and face. Dr. LoTempio is also a highly
recognized specialist in microsurgical breast reconstruction - one of the only
surgeons in the world to treat patients with upper and lower extremity
lymphedema by performing a vascularized lymph node transfer.
"I am committed to helping women
restore and improve their bodies and their self image," explains Dr. LoTempio.
"I've found that the first step to ensuring best results for my patients is
educating them on the various options when it comes to plastic and cosmetic
surgeries."
Dr. LoTempio has changed the lives
of many women, particularly those in need of breast reconstruction, by offering
an alternative to the traditional silicone implant: a natural augmentation
which uses the fat and tissue from other parts of the body to build or enhance
breasts.
In her New York City based
practice, Dr. LoTempio offers patients a full range of cosmetic and
reconstructive options. Services include lymph node procedures; breast
reconstruction and microsurgery, augmentation, reduction and lifts;
liposuction, abdominoplasty, face, brow and neck lifts, facial injectables,
blepharoplasty and rhinoplasty.
Prior to setting up roots in New
York City, Dr. LoTempio treated patients around the world, focusing on complex
cases, such as, cancer patients who suffered from a single or double mastectomy
and patients who suffered from lymphedema.
For more information visit
www.lotempioplasticsurgery.com or call 866.719.3437
SOURCE LoTempio Plastic Surgery for
Women
Copyright (C) 2012 PR
Newswire.
February
1, 2012
Exercise after breast cancer surgery can enhance
recovery - Times Herald-Record – By Gloria Smith Zawaski –
Diagnosed
with breast cancer? You don't have to take it sitting down anymore. It's now
recommended that you pick yourself up. Dust yourself off. And even do a few
repetitions with weights.
Exercise
— sometimes even surprisingly intense exercise — is now recommended to help
women regain strength and range of motion following breast
surgery.
It is
also precisely what the doctor ordered to help fight many of the physical side
effects of certain treatments as well as the psychological
challenges
"When
I'm here at Studio Ayo, I feel like cancer never happened," says Liz Critelli,
44, who received a breast cancer diagnosis in the spring of 2009. It wasn't the
first time that cancer would rock her world. Her first encounter was back when
she battled Hodgkin's lymphoma at age 18. "The radiation I received back then
probably contributed to my recent breast cancer diagnosis," she says
matter-of-factly.
Critelli
took a year off work as a hairdresser at Joann's Family Hair Salon to undergo
surgeries and receive chemotherapy treatment. She took even less time off from
her exercise program — she walked in her neighborhood very soon after surgery
and was back at Studio Ayo in the Town of Wallkill in January
2010.
According to Critelli, the medication she
takes affects her hormones and could threaten bone density. When she doesn't
move, she says she feels it in her joints. "I want to be strong and healthy. I
don't want to ache," Critelli says.
"I'd had
nerve damage in my left arm. Now that's 90 percent better. Exercise helps me
gain physical strength and from that comes mental strength," she adds. "I can
honestly say I now feel like this all never happened."
Each
individual's recovery differs
According to Dr. Paul Reichman, a surgeon
with Horizon Family Medical Group, prescribing "early mobility following breast
surgery is similar to what an orthopedist might prescribe following surgery to
an arm or leg. It can help restore mobility and flexibility," he says. How
quickly a patient returns to exercise depends largely on the kind of surgery
that has been performed. Generally, a patient who has had a lumpectomy —
removal or a tumor from the breast — will recover from the surgery more quickly
than someone who has had a mastectomy, an operation that involves the removal
of one or both breasts. Every patient is different.
The way
breast cancer surgery is performed today is also making an important difference
when it comes to postop exercise. If breast cancer cells spread, they typically
travel away from the breast through the lymphatic system.
In the
past, to determine whether breast cancer had spread or "metastasized" to other
parts of the body, a surgeon removed many and sometimes even all of the lymph
nodes under the armpit, in order to have them tested for the presence of cancer
cells.
Lessening risk of tissue
swelling
Removing
lymph nodes puts patients at risk for developing lymphedema, a condition
causing the swelling of the soft tissues of the arm or hand that is sometimes
accompanied by numbness, discomfort and even infection.
Today, a
procedure called sentinel node surgery is employed instead. By injecting a dye
near the tumor and monitoring where the dye travels, the surgeon can tell what
nodes will first be affected. The surgeon can then remove these surgical nodes
exclusively. Removing fewer lymph nodes can reduce the patient's chances of
developing lymphedema.
"We once
didn't know if exercise would make lymphedema worse, but studies today now
reveal that slow, progressive weightlifting does not worsen swelling," says Dr.
G. Varuni Kondagunta, oncologist with Crystal Run Health Care.
This is
good news to patients who once feared that lifting anything heavy could
aggravate or cause this condition.
Kondagunta says that treatments prescribed
to help prevent the recurrence of breast cancer — from radiation to drugs such
as Tamaxifen or aromatose inhibitors such as Femara and Arimidex that
manipulate hormonal status — can cause a host of side effects. Many of these
can be alleviated through exercise. "Some aromatose inhibitors cause a decline
in bone density. Weight-bearing exercises can decrease this loss," she
adds.
Kondagunta maintains that it will be easier
for a person who was previously active to get into an exercise regime. "People
who were once sedentary should be carefully monitored," she says.
Whether
exercise and diet can help prevent a breast cancer recurrence is a question
that is still hotly debated. "Exercise may decrease hormonal production that
can decrease risk, but this has not been shown in larger studies," Kondagunta
says.
Overexposure to estrogen
Hope
Nemiroff, director of Breast Cancer Options, which provides services and
support to women in six counties in the Hudson Valley, encourages women to
exercise as soon as the doctor recommends and as a prevention strategy as
well.
"Regular
exercise and a diet low in fat and high in fruits and vegetables lowers levels
of estradiol and estrone, two kinds of estrogen," she says. Although women need
estrogen to create strong bones, overexposure to estrogen can lead to breast
cancer.
"Eighty
percent of all breast cancers are fueled by estrogen. Exercise is a natural way
to reduce and balance estrogen levels, and it can reduce other hormones and
growth factors that can cause breast cells to turn into cancer," Nemiroff says.
"Exercise is a lifestyle intervention that breast cancer patients and survivors
can use to improve quality of life, improve mood, physical functioning and
symptoms of fatigue."
When
Karen Smith received her breast cancer diagnosis in June 2010, she didn't waste
time on self-pity. Nor did she dream of taking self-indulgent vacations when
her treatment was over.
"As soon
as I could, I wanted to take the eight-week, five-day-a-week Boot Camp training
class offered at Studio Ayo," Smith says with a laugh.
Smith
kept working at her job in the office of a local elementary school through much
of her treatment. "I didn't always feel as well as I said I did. I never wanted
to be seen as a victim," she says.
Damola
Akinyemi, founder of Studio Ayo, believes the healing process is about more
than "just sticking a weight in someone's hand. We try to be there at every
step and surround the patient with support," he says. Support is more than just
words of encouragement.
"We cook
for people, raise money, and we pray."
According to Critelli and Smith, his words
of encouragement and support are definitely not patronizing or laced with pity.
He is far more apt to support their determination to get moving and get
strong.
"This is
the most positive place I've ever been," says Critelli.
Through
strength, determination and a can-do attitude, both women say that they are now
in top physical shape and feel better than they ever have in life. "If I had to
give advice to anyone, I'd say don't let the disease take over your life," says
Smith. "Tell it who's in charge."
Lymphedema After Breast Cancer -
KOB.com – by Joan Lucas -
Lymphedema, a swelling that occurs in the
arm, breast, or chest area after breast cancer treatment, often occurs after
lymph node removal. Attached to those lymph nodes are networks of tiny lymph
vessels that extend throughout the body and carry a watery fluid called lymph.
When several lymph nodes and their lymph vessels are removed, the fluid has no
place to go and can result in swelling.
Here’s
what can help:
The Lovelace Women’s Hospital Breast Care
Center is New Mexico’s only
breast care center accredited by the National Accreditation Program for Breast
Centers for providing the highest level of quality care to its patients. Our
team of breast health professionals will help you assess your risk of
developing breast cancer, guide you through mammograms and clinical exams and
teach you the proper method of breast self-examination. We also offer
counseling, education and support programs.
For more
information or to schedule a clinical breast exam
or mammogram, call 505.727.6900 or visit our website.
February
2, 2012
Dr. Pamela Tronetti: Swollen sufferers should seek
treatment - Florida Today – Written by dr. pamela tronetti –
“I have
elephant-itis.”
“I have elephant man’s
disease.”
“I have
elephantiasis.”
Things usually happen in threes, so
it didn't surprise me that I had three people in one week with elephantine
symptoms.
But what did they really
have?
The suffix “itis” indicates
inflammation. Arthritis is inflamed joints, tonsillitis is inflamed tonsils and
so on. But I doubt the patient had an inflamed elephant at home.
Elephant man’s disease is a severe
form of neurofibromatosis. The patients have tumors growing along the nerves,
which can cause severe deformities.
Elephantiasis is a tropical illness
in which threadlike worms live in the tissues. Over time, the flares of
infection cause swelling of the limbs.
What the patients were trying to
say is that they had lymphedema. They had swollen limbs from a disruption in
the flow of lymph fluid.
The lymphatic system runs through
the body like a grapevine, following the same path as the blood vessels. The
“grapes” are the lymph nodes that mass at junctures of the body: neck, armpits,
groin and along the aorta.
There are two main differences
between the lymphatic system and the circulatory system.
First, blood moves rapidly because
of the strong pumping of the heart. Lymph is slow moving and relies on overall
body activity and local muscle pressures to shift.
Second, blood flows in all
directions. Lymph only flows from the extremities toward the
heart.
You see, as arterial blood flows
into the tissues of the body, it allows some clear fluid (plasma) to bathe the
cells in nutrients, oxygen and other necessary chemicals. Just like with any
bath, this fluid also cleanses the area of cellular waste, toxins and abnormal
cells. Most of plasma is reabsorbed into the veins and continues in the
circulatory system to be filtered by the liver and kidneys.
About 10 percent remains as lymph.
The lymph flows back to its filters — the lymph nodes through the lymphatic
vessels. The lymph nodes filter the waste products and toxins and contain white
blood cells that can kill bacteria. That’s why during a major infection, the
involved lymph nodes swell.
PUB MED DOCS:
January
24, 2012
ScientificWorldJournal.
2012;2012:341253. Epub 2012 Jan 4.
Morbidity
of inguinofemoral lymphadenectomy in vulval cancer.
Soliman AA, Heubner M, Kimmig R, Wimberger P.
Source
Department of
Obstetrics and Gynaecology, Shatby Maternity University Hospital, University of
Alexandria, Port Said Street, El Shatby, Alexandria 21526, Egypt.
Abstract
Background. The
aim of this study is to detect possible risk factors for development of short-
and long-term local complications after inguinofemoral lymphadenectomy for
vulval cancer. Methods. This retrospective cohort study included 34 vulval
cancer patients that received inguinofemoral lymphadenectomy. The detected
complications were wound cellulitis, wound seroma formation, wound breakdown,
wound infection, and limb lymphoedema. Followup of the patient ran up to 84
months after surgery. Results. Within a total of 64 inguinofemoral
lymphadenectomies, 24% of the inguinal wounds were affected with cellulitis,
13% developed a seroma, 10% suffered wound breakdown, 5% showed lower limb
edema within a month of the operation, and 21.4% showed lower limb edema during
the long-term followup. No significant correlation could be found between
saphenous vein ligation and the development of any of the local complications.
The 3-year survival rate in our cohort was 89.3%. Conclusions. Local
complications after inguino-femoral lymphadenectomy are still very high, with
no single pre-, intra-, or postoperative factor that could be incriminated.
Saphenous vein sparing provided no significant difference in decreasing the
rate of local complications. More trials should be done to study the sentinel
lymph node detection technique.
PMID:
22262953 [PubMed - in process]PMCID: PMC3259693
Microsurgery. 2012 Jan 20. doi:
10.1002/micr.20980. [Epub ahead of print]
Lymphaticovenular
anastomoses for lymphedema treatment: 18 months postoperative
outcomes.
Auba C, Marre D, Rodríguez-Losada G, Hontanilla B.
Source
Department of
Plastic Surgery, Clinica Universidad de Navarra, Pamplona, Spain.
[email protected].
Abstract
The purpose of
this work was to report our initial experience with lymphaticovenular
anastomoses (LVA), a controversial technique for lymphedema treatment. Although
LVA technique was described many years ago, the procedure is not as widespread
as it was supposed to be, taking into account the high impact that lymphedema
has in the quality of life of patients. Thus, 12 patients, 5 with lower limb
and 7 with upper limb lymphedema, underwent LVA surgery under local anesthesia.
Two patients were excluded from the study due to the lack of follow-up. At 18
months, 8 out 10 patients showed a variable objective reduction of the
perimeter of the limbs and 9 patients presented a subjective clinical
improvement. These results joined to the outcomes of the most experienced
surgeons in this field are encouraging, although there are still many issues
that need to be addressed with research to optimize the efficacy of this
technique. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.
Copyright © 2011
Wiley Periodicals, Inc.
PMID:
22262630 [PubMed - as supplied by publisher]
Microsurgery. 2012 Jan 20. doi:
10.1002/micr.20977. [Epub ahead of print]
Lower
limb lymphedema treated with lymphatico-venous anastomosis based on pre- and
intraoperative icg lymphography and non-contact vein visualization: A case
report.
Mihara M, Hara H, Narushima M, Hayashi Y, Yamamoto T, Oshima A, Kikuchi K, Murai N, Koshima I.
Source
Department of
Plastic and Reconstructive Surgery, University of Tokyo; Department of Vascular
Surgery, Saiseikai Kawaguchi General Hospital.
[email protected].
Abstract
Lymphatico-venous
anastomosis (LVA) is used to resolve lymph retention in lymphedema. However,
the postoperative outcome of lower limb lymphedema is poorer than that for
upper limb lymphedema, because of the location lower than the heart level.
Improvement of the therapeutic outcome requires application of as many
anastomoses as possible in a limited operation time, particularly since there
is a positive correlation between the number of anastomoses and the therapeutic
effect of LVA. In this case, we described a method to increase the efficiency
of lymphatico-venous anastomosis for bilateral severe lower limb lymphedema
through efficient identification of lymph vessels and veins suitable for
anastomosis using indocyanine green (ICG) contrast imaging and AccuVein, a
noncontact vein visualization system, respectively. Ten LVAs were succeeded at
seven incisions, and the operation time was 3 hours and 5 minutes. Accuvein can
be used for identification of subcutaneous venules with a diameter of about
0.5-1.0 mm. We used this approach in surgery for a case of bilateral lower limb
lymphedema, with a resultant improvement in the surgical outcome. © 2012 Wiley
Periodicals, Inc. Microsurgery, 2012.
Copyright © 2011
Wiley Periodicals, Inc.
PMID:
22262581 [PubMed - as supplied by publisher]
Protein Expr Purif. 2012 Jan 10.
[Epub ahead of print]
Preparation
of human vascular endothelial growth factor-D for structural and preclinical
therapeutic studies.
Davydova N, Streltsov VA, Roufail S, Lovrecz GO, Stacker SA, Adams TE, Achen MG.
Source
Ludwig Institute
for Cancer Research, P.O. Box 2008, Royal Melbourne Hospital, Victoria 3050,
Australia.
Abstract
Vascular
endothelial growth factor-D (VEGF-D), a secreted angiogenic and lymphangiogenic
glycoprotein, enhances tumor growth and metastasis in animal models, and its
expression correlates with metastasis and poor patient outcome in some cancers
- it is therefore considered a target for novel anti-cancer therapeutics. The
definition of the structure of the complex of VEGF-D bound to its receptors
would be beneficial for design of inhibitors of VEGF-D signaling aimed at
restricting the growth and spread of cancer. In addition, there is interest in
using VEGF-D protein for therapeutic angiogenesis and lymphangiogenesis in the
settings of cardiovascular diseases and lymphedema, respectively. However,
VEGF-D has proven difficult to express and purify in a highly bioactive form
due to a tendency to exist as monomers rather than bioactive dimers. Here we
describe a protocol for expression and purification of mature human VEGF-D, and
a mutant thereof with reduced glycosylation, potentially suitable for
preclinical therapeutic and structural studies, respectively. The degree of
glycosylation in mature VEGF-D was reduced by eliminating one of the two
N-glycosylation sites, and expressing the protein in Lec3.2.8.1 cells which had
reduced glycosylation capacity. Mature VEGF-D and the glycosylation mutant were
each enriched for the biologically active dimeric form by optimizing the
separation of dimer from monomer via gel filtration, followed by conversion of
remaining monomers to dimers via treatment with cysteine. The glycosylation
mutant of VEGF-D intended for structural studies preserved all the cysteine
residues of mature VEGF-D, in contrast to previous structural studies,
exhibited comparable receptor binding to mature VEGF-D and might facilitate
structural studies of the VEGF-D/VEGFR-3 complex.
Copyright © 2012.
Published by Elsevier Inc.
PMID:
22261343 [PubMed - as supplied by publisher]
J Surg Oncol. 2012 Jan 18. doi:
10.1002/jso.23048. [Epub ahead of print]
Extensive
nodal involvement increases the positivity of blue nodes in the axillary
reverse mapping procedure in patients with breast cancer.
Rubio IT, Cebrecos I, Peg V, Esgueva A, Mendoza C, Cortadellas T, Cordoba O, Espinosa-Bravo M, Xercavins J.
Source
Breast Surgical
Unit, Breast Cancer Center, Department of Gynecology, Hospital Universitario
Vall d'Hebron, Barcelona, Spain. [email protected].
Abstract
BACKGROUND:
The axillary
reverse mapping (ARM) technique has been proposed to prevent arm lymphedema. We
conducted this study to assess the feasibility of the technique and the
outcomes of patients with neoadjuvant chemotherapy (NAC).
METHODS:
From July 2009 to
May 2010, a prospective study was performed in 36 patients with breast cancer
undergoing an ALND. The ARM technique was performed injecting 3 cm(3) of Patent
Blue in the ipsilateral arm. Of the 36 patients, 29 patients received NAC
previously to the ARM and 7 patients had an ALND and ARM performed as first
treatment for positive axillary nodes.
RESULTS:
The
identification rate of blue nodes was 83.3% (30 patients). Sentinel lymph node
(SLN) was performed in 15 of 29 (42%) patients in the NAC group. Of these 15,
two patients (13%) had a concordance between the blue and the hot node. Blue
nodes were positive in 4 (13%) of the 30 patients.
CONCLUSIONS:
The ARM technique
is feasible in patients undergoing NAC. Patients with extensive nodal
involvement have increased risk of having positive blue nodes. More studies are
needed to assess the subgroup of patients with positive axilla that may have
the blue node spared without compromising the oncological treatment. J. Surg.
Oncol © 2012 Wiley Periodicals, Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22258666 [PubMed - as supplied by publisher]
Pediatr Dermatol. 2012
Jan;29(1):113-4. doi: 10.1111/j.1525-1470.2011.01686.x.
Localized
xanthomas associated with primary lymphedema.
Romaní J, Luelmo J, Sáez A, Yébenes M, Sábat M, Fernández-Chico N, Pifarré M, García D, Muñoz C.
Source
Department of
Dermatology, Hospital Parc Taulí, Sabadell, Barcelona, Spain Department of
Pathology, Hospital Parc Taulí, Sabadell, Barcelona, Spain.
Abstract
Cutaneous
xanthomas arising in chronic lymphedema are rare. We present a case of
verruciform xanthoma involving the left foot and toes of a 10-year-old boy who
had developed a primary lymphedema (lymphedema praecox) in the left lower
extremity. Laboratory studies demonstrated a normal lipid profile.
© 2012 Wiley
Periodicals, Inc.
PMID:
22256994 [PubMed - in process]
January
27, 2012
Circulation. 2012 Jan 24. [Epub
ahead of print]
9-Cis
Retinoic Acid Promotes Lymphangiogenesis and Enhances Lymphatic Vessel
Regeneration: Therapeutic Implications of 9-Cis Retinoic Acid for Secondary
Lymphedema.
Choi I, Lee S, Chung HK, Lee YS, Kim KE, Choi D, Park EK, Yang D, Ecoiffier T, Monahan J, Chen W, Aguilar B, Lee HN, Yoo J, Koh CJ, Chen L, Wong AK, Hong YK.
Source
1 University of
Southern California Keck School of Medicine, Los Angeles, CA;
Abstract
BACKGROUND:
The lymphatic
system plays a key role in tissue fluid homeostasis and lymphatic dysfunction
due to genetic defects or lymphatic vessel obstruction can cause lymphedema,
disfiguring tissue swellings often associated with fibrosis and recurrent
infections without available cures to date. In this study, retinoic acids (RAs)
were determined to be a potenttherapeutic agent that is immediately applicable
to reduce secondary lymphedema.
METHODS
AND RESULTS:
We report that
RAs promote proliferation, migration and tube formation ofcultured lymphatic
endothelial cells (LECs) by activating FGF-receptor signaling. Moreover, RAs
control the expression of cell-cycle checkpoint regulators such as p27(Kip1),
p57(Kip2) and the aurora kinases through both an Akt-mediated non-genomic
action and a transcription-dependent genomic action that is mediated by Prox1,
a master regulator of lymphatic development. Moreover, 9-cisRAwas found to
activate in vivo lymphangiogenesis in animals based on mouse trachea, matrigel
plug and cornea pocket assays. Finally, we demonstrate that 9-cisRA can provide
a strong therapeutic efficacy in ameliorating the experimental mouse tail
lymphedema by enhancing lymphatic vessel regeneration.
CONCLUSIONS:
These in vitro
and animal studies demonstrate that 9-cisRA potently activates
lymphangiogenesis and promotes lymphatic regeneration in an experimental
lymphedema model, presenting it as a promising novel therapeutic agent to treat
human lymphedema patients.
PMID:
22275501 [PubMed - as supplied by publisher]
Circulation. 2012 Jan 24. [Epub
ahead of print]
Lymphangiogenesis:
A Potential New Therapy for Lymphedema?
Cooke JP.
Source
Stanford
Cardiovascular Institute, Stanford, CA.
Abstract
At the level of
the capillaries, the systemic circulation loses about 2-4 liters of fluid and
about 100g of protein into the interstitium daily. This ultrafiltrate of the
systemic capillaries is returned to the circulatory system by the lymphatics.
The lymphatic vasculature is highly specialized to perform this service,
beginning with the blind-ended lymphatic capillaries. These vessels are highly
permeable to protein, fluid and even cells, due to fenestrations in their
basement membrane, and discontinuous button-like junctions rather than tight
intercellular junctions as observed in the systemic capillaries(1). The
lymphatic capillaries merge into collectors and larger lymphatic conduits that
are invested with vascular smooth muscle (capable of contracting and propelling
lymph forward) and valves for unidirectional flow. These conduits merge at
lymph nodes, delivering antigens to the immune cells and serving as an early
warning system of pathogen invasion. The lymph nodes drain into conduits that
ultimately merge into the thoracic duct which empties into the left subclavian
vein. (SELECT FULL TEXT TO CONTINUE).
PMID:
22275500 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2012
Jan 24. [Epub ahead of print]
Ipsilateral
hemodialysis access after axillary dissection for breast cancer.
Olsha O, Goldin I, Man V, Carmon M, Shemesh D.
Source
Department of
Surgery, Shaare Zedek Medical Center, P.O. Box 3235, 91031, Jerusalem, Israel,
[email protected].
Abstract
Breast cancer
survivors who have had axillary lymph node dissection (ALND) and who later
develop end-stage renal failure may eventually require hemodialysis access. If
veins available for access in the contralateral arm have been exhausted,
especially after chemotherapy, the ipsilateral arm will have to be considered
for access construction. There are no evidence-based guidelines for lymphedema
prevention, but there are sweeping recommendations to avoid physical injury to
the ipsilateral limb, including needle puncture, after ALND with or without
radiotherapy. Three studies have shown little or no effect of hand surgery in
producing or exacerbating lymphedema after ALND. Dialysis access guidelines
recommend the use of autogenous accesses over synthetic grafts whenever
possible. Three patients after ALND were referred for hemodialysis access
construction in our center. Pre-operative duplex ultrasound confirmed that
patent veins appropriate for autogenous access construction were only present
in the ipsilateral arm. Autogenous arteriovenous fistulas were constructed in
the ipsilateral arm in the three patients. All the three entered our access
surveillance program and were regularly examined. All had more than 20 lymph
nodes removed. One had axillary radiotherapy and anthracycline-based
chemotherapy, one had anthracycline-based chemotherapy without axillary
radiotherapy and one had neither treatment. The access was established 4-10
years after ALND. No patient developed significant lymphedema at two, 20 and 76
months respectively after access construction, with cannulation for dialysis
occurring three times a week. Autogenous hemodialysis access construction does
not seem to contribute to lymphedema development after ALND. Physicians and
other medical personnel caring for patients with breast cancer should not
oppose the use of the ipsilateral arm if it is the only arm with vasculature
suitable for autogenous access construction. Recommendations for lymphedema
prevention may exaggerate the extent of risk attributable to interventions in
the ipsilateral arm.
PMID:
22270939 [PubMed - as supplied by publisher]
Am J Med. 2012
Feb;125(2):134-40.
Current
views on diagnostic approach and treatment of lymphedema.
Murdaca G, Cagnati P, Gulli R, Spanò F, Puppo F, Campisi C, Boccardo F.
Source
Department of
Internal Medicine, University of Genova, Genova, Italy.
Abstract
Lymphedema is a
chronic, progressive, and often debilitating condition. Primary lymphedema is a
lymphatic malformation developing during the later stage of lymphangiogenesis.
Secondary lymphedema is the result of obstruction or disruption of the
lymphatic system, which can occur as a consequence of tumors, surgery, trauma,
infection, inflammation, and radiation therapy. In this review, we report an
update upon the diagnostic approach and the medical and surgical therapy for
both primary and secondary lymphedema.
Copyright © 2012
Elsevier Inc. All rights reserved.
PMID:
22269614 [PubMed - in process]
J Miss State Med Assoc. 2011
Oct;52(10):307-9.
Neu-Laxova
syndrome: a prenatal diagnosis.
Dhillon P, Bofill JA.
Source
Division of
Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of
Mississippi Medical Center, Jackson. 39216, USA.
Abstract
Neu-Laxova
syndrome is a rare autosomal recessive congenital disorder. Prenatal diagnosis
is possible via second trimester ultrasonography. Characteristic ultrasound
findings include hydramnios, severe intrauterine growth restriction,
craniofacial and CNS anomalies, limb contractures, skin lymphedema, skin
restrictions, and akinesia. Fewer than 70 cases have been reported, and no
survival beyond six months of age is known with most neonatal deaths occurring
within the first few days of life. Overall, this is a lethal condition after
birth secondary to severe lung hypoplasia and brain anomalies. Herein we report
a recent case from our institution with prenatal diagnosis.
PMID:
22268252 [PubMed - in process]
January
31, 2012
Eur J Vasc Endovasc Surg. 2012
Jan 24. [Epub ahead of print]
Net
Effect of Lymphaticovenous Anastomosis on Volume Reduction of Peripheral
Lymphoedema after Complex Decongestive Physiotherapy.
Maegawa J, Hosono M, Tomoeda H, Tosaki A, Kobayashi S, Iwai T.
Source
Department of
Plastic and Reconstructive Surgery, Yokohama City University Hospital, 3-9
Fukuura Kanazawa-ku, Yokohama 236-0004, Japan.
Abstract
OBJECTIVE:
The results of
reported lymphaticovenous anastomoses include some effects of complex
decongestive physiotherapy (CDP). The present study aimed to determine the net
effect of lymphaticovenous side-to-end anastomosis (LVSEA) in patients with
lower limb lymphoedema treated by preoperative CDP.
DESIGN:
Retrospective
observational study.
MATERIALS:
37 LVSEAs in 31
patients.
METHODS:
Volumes of the
thigh and leg with oedema were compared between the time of initial
examination, and before (application of CDP) and after LVSEA. The patients were
divided into two groups based on the number of anastomoses and
lymphoscintigraphic findings.
RESULTS:
Preoperative CDP
resulted in a reduction of 593 ml (both leg and thigh; p < 0.001). After
CDP, LVSEA (1-8 anastomoses; average of 5) reduced the volume by 109 ml (52 ml
for the thigh (p = 0.01) and 57 ml for the leg (p = 0.002)). There was no
significant difference in volume reduction on lymphoscintigraphy. Volume was
significantly reduced (by 55 ml in the thigh, p = 0.049; 96 ml in the leg, p =
0.006) in the group that underwent 6-8, but not 1-5 LVSEAs.
CONCLUSIONS:
The net effect of
LVSEA on volume reduction was confirmed, but was not particularly large. The
need for CDP decreased in some patients postoperatively, and these patients
should be considered for evaluation.
Copyright © 2012
European Society for Vascular Surgery. Published by Elsevier Ltd. All rights
reserved.
PMID:
22280803 [PubMed - as supplied by publisher]
February
3, 2012,
Indian J Cancer. 2011
Oct;48(4):397-402.
Comprehensive
decongestive therapy in postmastectomy lymphedema: An Indian
perspective.
Randheer S, Kadambari D, Srinivasan K, Bhuvaneswari V, Bhanumathy M, Salaja R.
Source
Department of
Surgery, JIPMER, Puducherry, India.
Abstract
Background:
Lymphedema following breast cancer treatment is one of the most morbid
conditions affecting breast cancer survivors. Currently, no therapy completely
cures this condition. Comprehensive Decongestive Therapy (CDT), a novel
physiotherapeutic method offers promising results in managing this condition.
This therapy is being widely used in the West. Till date, there are no studies
evaluating the effectiveness and feasibility of this therapy in the east.
Materials and Methods: The therapeutic responses of 25 patients with
postmastectomy lymphedema were analyzed prospectively in this study. Each
patient received an intensive phase of therapy for eight days from trained
physiotherapists, which included manual lymphatic drainage, multi layered
compression bandaging, exercises, and skin care. Instruction in self management
techniques were given to the patients on completion of intensive therapy. The
patients were followed up for three months. Changes in the volume of the
edematous limb were assessed with a geometric approximation derived from serial
circumference measurements of the limb and by water displacement volumetry.
Changes in skin and sub cutis thickness were assessed using high frequency
ultrasound. Results: The reduction in limb volume observed after therapy was
32.3% and 42% of the excess, by measurement and volumetry, respectively. The
maximum reduction was obtained after the intensive phase. The reduction in skin
and subcutis thickness of the edematous limb followed the same pattern as
volume reduction. Patients could maintain the reduction obtained by strictly
following the protocols of the maintenance phase. Conclusions: CDT combined
with long-term self management is effective in treating post mastectomy
lymphedema. The tropical climate is a major factor limiting the regular use of
bandages by the patients.
PMID:
22293250 [PubMed - in process]
J Cult Divers. 2011
Winter;18(4):126-8.
Nursing
education on lymphedema self-management and self-monitoring in a South African
oncology clinic.
Dine JL, Austin MK, Armer JM.
Source
Sinclair School
of Nursing, University of Missouri, USA.
Abstract
Breast cancer is
the leading cause of cancer in South African women. Without comprehensive
national and provincial breast health programs, survivorship issues are in need
of being addressed. Lymphedema secondary to breast cancer treatment (BCLE) is
one of the most physically and psychologically devastating outcomes of
treatment. Nurses at a South African oncology clinic educated survivors with
BCLE in cost-effective self-management and self-monitoring techniques. The
purpose of this paper is to describe these techniques and their relevance to
diverse South African survivors. A case study analysis was performed. The need
for cost-effective survivorship programs is discussed.
PMID:
22288209 [PubMed - in process]
Breast Cancer Res Treat. 2012
Jan 29. [Epub ahead of print]
Upper
limb progressive resistance training and stretching exercises following surgery
for early breast cancer: a randomized controlled trial.
Kilbreath SL, Refshauge KM, Beith JM, Ward LC, Lee M, Simpson JM, Hansen R.
Source
Faculty of Health
Sciences, University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW, 1825,
Australia, [email protected].
Abstract
The aim of this
study was to determine whether an exercise program, commencing 4-6 weeks
post-operatively, reduces upper limb impairments in women treated for early
breast cancer. Women (n = 160) were randomized to either an 8-week exercise
program (n = 81) or to a control group (n = 79) following stratification for
axillary surgery. The exercise program comprised a weekly session and home
program of passive stretching and progressive resistance training for shoulder
muscles. The control group attended fortnightly assessments but no exercises
were provided. The primary outcome was self-reported arm symptoms derived from
the EORTC breast cancer-specific questionnaire (BR23), scored out of 100 with a
low score indicative of fewer symptoms. The secondary outcomes included
physical measures of shoulder range of motion, strength, and swelling (i.e.,
lymphedema). Women were assessed immediately following the intervention and at
6 months post-intervention. The change in symptoms from baseline was not
significantly different between groups immediately following the intervention
or at 6 m post-intervention. The between group difference immediately following
the intervention was 4 (95% CI -1 to 9) and 6 months post-intervention was 4
(-2 to 10). However, the change in range of motion for flexion and abduction
was significantly greater in the exercise group immediately following the
intervention, as was change in shoulder abductor strength. In conclusion, a
supervised exercise program provided some, albeit small, additional benefit at
6 months post-intervention to women who had been provided with written
information and reminders to use their arm. Both the groups reported few
impairments including swelling immediately following the intervention and 6
months post-intervention. Notably, resistance training in the post-operative
period did not precipitate lymphedema.
PMID:
22286332 [PubMed - as supplied by publisher]
Am J Hum Genet. 2012 Jan 24.
[Epub ahead of print]
Mutations
in KIF11 Cause Autosomal-Dominant Microcephaly Variably Associated with
Congenital Lymphedema and Chorioretinopathy.
Ostergaard P, Simpson MA, Mendola A, Vasudevan P, Connell FC, van Impel A, Moore AT, Loeys BL, Ghalamkarpour A, Onoufriadis A, Martinez-Corral I, Devery S, Leroy JG, van Laer L, Singer A, Bialer MG, McEntagart M, Quarrell O, Brice G, Trembath RC, Schulte-Merker S, Makinen T, Vikkula M, Mortimer PS, Mansour S, Jeffery S.
Source
Medical Genetics
Unit, Biomedical Sciences, St. George's University of London, London SW17 0RE,
UK.
Abstract
We have
identified KIF11 mutations in individuals with syndromic autosomal-dominant
microcephaly associated with lymphedema and/or chorioretinopathy. Initial
whole-exome sequencing revealed heterozygous KIF11 mutations in three
individuals with a combination of microcephaly and lymphedema from a
microcephaly-lymphedema-chorioretinal-dysplasia cohort. Subsequent Sanger
sequencing of KIF11 in a further 15 unrelated microcephalic probands with
lymphedema and/or chorioretinopathy identified additional heterozygous
mutations in 12 of them. KIF11 encodes EG5, a homotetramer kinesin motor. The
variety of mutations we have found (two nonsense, two splice site, four
missense, and six indels causing frameshifts) are all predicted to have an
impact on protein function. EG5 has previously been shown to play a role in
spindle assembly and function, and these findings highlight the critical role
of proteins necessary for spindle formation in CNS development. Moreover,
identification of KIF11 mutations in patients with chorioretinopathy and
lymphedema suggests that EG5 is involved in the development and maintenance of
retinal and lymphatic structures.
Copyright © 2012
The American Society of Human Genetics. Published by Elsevier Inc. All rights
reserved.
PMID:
22284827 [PubMed - as supplied by publisher]
Rev Esp Anestesiol Reanim. 2010
Dec;57(10):678.
[Giant
lymphedema-elephantiasis of the right leg].
[Article
in Spanish]
Fernández Jurado MI, Martínez Mezo G, Castilla Moreno M.
Source
Servicio de
Anestesiología y Reanimación, Hospital Regional Universitario Carlos Haya,
Málaga.
PMID:
22283026 [PubMed - in process
MED
NEWS DOCS:
February
1, 2012
UCSB Researchers Discover The
Processes Leading To Acute Myeloid LeukemiaResearchers at UC Santa Barbara have
discovered a molecular pathway that may explain how a particularly deadly form
of cancer develops. The discovery
may lead to new cancer therapies that reprogram cells instead of killing them.
The findings are published in a recent paper in the Journal of Biological
Chemistry.
The UCSB research team described how a certain mutation in
DNA disrupts cellular function in patients with acute myeloid leukemia (AML).
The researchers were prompted to study this process by another research team's
discovery that AML patients have a mutation in a certain enzyme, which was
reported in the New England Journal of Medicine. The enzyme is a protein called
DNMT3A, which leads to changes in how the DNA of AML patients is methylated, or
"tagged." Norbert Reich, professor in the Department of Chemistry and
Biochemistry at UCSB, was already studying that particular enzyme with his
research group, so they began to study the disease process of AML at the
cellular level.
Reich explained that tagging is a way of reading DNA at
the cellular level. This falls within an area of study called epigenetics, a
process that occurs "on top" of genetics. Each person has approximately 200
types of cells, all with the same DNA, and these must be controlled in
different ways. "There is an enzyme - a protein - that tags DNA and controls
which of the genes in your cells, your DNA, gets turned on and off," said
Reich. "So you have 20,000 genes, and you have to control them differently in
your brain than in your liver."
Reich explained that there is current
interest in this broader field of epigenetics as a direction for the treatment
of cancer. "There's definitely the idea that this may be a new way of
developing therapeutics, because you don't have to kill the cancer cell," said
Reich. "Almost every cancer therapy that's out there works on the principle
that a cancer cell needs to be killed."
With epigenetics, instead of
only having DNA sequence coding for certain genes, there is an epigenetic
process, with another layer of information on top of the genetic process. In
this case, that information is the tagging by the methyl groups.
"If
you really think about it, this is part of the answer as to how your cells can
be so different and yet they all have the same DNA," said Reich. "You have the
same genome in every one of your cells, but you do not have the same epigenome,
which is basically the methylation pattern, the tagging pattern. That is
different in every type of your cells. And the way this relates back to cancer,
with leukemia, in those patients, the
tagging is messed up. The patterns are not correct. Our big contribution to
that is we've explained how the mutations in the enzyme could lead to that
disruption of the tagging pattern."
The UCSB group developed a test to
demonstrate that the mutant enzymes in AML can only work on DNA for short
distances. As a result, the precise methylation patterns of a healthy cell are
disturbed, resulting in genes being turned on at the wrong place and time,
which in turn can initiate the growth of cancerous cells.
The team
found that the mutation AML patients have causes a certain complex of four
proteins to be disrupted. "The surprise was that the disruption doesn't stop
the enzyme from being active; it doesn't stop the enzyme from tagging the DNA,"
said Reich. "Instead, it stops the way it can do it. Instead of going to your
DNA and tagging an entire region of chromosome, it goes there, does one thing,
and leaves. That process, that change, is what we see in the AML patients. So
we think we have a molecular explanation for this disease."
Reich said
that the currently prescribed drug Vidaza works by affecting the
same enzyme that is mutated in AML. There is interest in the pharmaceutical
industry in developing other therapeutics to target the enzymes responsible for
tagging the DNA. These epigenetic inhibitors would reprogram rather than kill
the cell.
Traditional cancer therapies use radiation and chemotherapy to
remove or kill cancer cells. "The problem with that is that cancer cells are
often very subtly different from normal cells," said Reich. "So you have one of
the most difficult therapeutic challenges known to man, which is to distinguish
between two human cells - one that's cancerous and one that's not. Instead of
killing the cell, the notion is that if you could just reprogram the cell, then
it goes back to being normal. You intercept the cancer development. This is
still an aspiration; it hasn't been achieved really, but that's what attracts
people to the field of epigenetic-based therapies, because of the prospect of
not having to kill cells."
Celeste Holz-Schietinger and Douglas Matje,
both graduate students working in the Reich lab, are the first and second
authors of the paper.
February 6, 2012
Local groups stepping in after national cancer charity
changes support - Scranton Times-Tribune –by
Erin L. NissleyErin L. Nissley –
After
a national group that helps cancer patients around the country announced it
would be scaling back support of certain programs, local organizations have
been gearing up to fill the gaps.
In
late November, the American Cancer Society sent a letter to local groups
informing them that, as of Jan. 1, it would "no longer provide financial
assistance for wigs, medications, durable medical equipment, lymphedema
supplies or lodging."
Jo-Anne
Sessa, ACS regional vice president, said there are no plans to completely cut
programs, including those that provide cancer patients with wigs and help out
with lodging while they undergo treatment.
She
added, though, that ACS is focusing its resources on areas "where we can make
the most impact," including providing patients with transportation and mileage
reimbursement to and from appointments.
"We've
identified access as the biggest issue across the country," Ms. Sessa said. "In
this economy, it is more challenging (to raise money) and every organization
has to focus their resources."
The
changes to ACS programs will mean cancer patients will depend even more on
local groups for help, said Northeast Regional Cancer Institute President
Robert Durkin. Like many local groups, Northeast Regional Cancer Institute has
suffered deep funding cuts - including the loss of about $1 million a year in
state funding - that makes it difficult to fulfill the needs of cancer patients
in the community, especially when a major resource like ACS makes a decision to
cut support for certain programs.
"We're
local, so we base our resources on what the needs are in the community," Mr.
Durkin said, pointing out that local donations made to ACS do not necessarily
stay in the community.
The
region is lucky to have resources that can help cancer patients, especially a
group like Northeast Regional Cancer Institute, said Dr. Harmar Brereton, a
radiation oncologist at Northeast Radiation Oncology Center.
"The
psychological profundity of having cancer is a really big deal" and cancer
patients need help in a variety of ways, Dr. Brereton said. "It is harder for
all groups to raise funds. We need to get the word out that local groups are
here taking care of these needs, but they need help to do it."
Connecting
cancer patients to resources both local and national is part of the job
description for Kathryn Cramer, an oncology social worker at Northeast
Radiation Oncology Center.
"We
never let anyone do without," she said. "There are programs that can help
patients with medication costs. We can go through churches, the Salvation Army
and the American Cancer Society."
Delta
Medix, which offers treatment for cancer patients, launched a nonprofit
foundation on Oct. 1 that will help cancer patients throughout the region,
regardless of where they obtain treatment. Delta Medix CEO Margo Opsasnick sees
the main focus of the foundation as helping cancer patients with the costs of
genetic testing, which can help with treatment plans for breast cancer patients
and covering co-pays and treatments not covered by insurance. She also hopes
the foundation can focus on helping with smaller needs, like hiring a maid to
help with housework.
"Most
breast cancer patients have to undergo chemotherapy and radiation," she said.
"Wouldn't it be nice for them to come home to a clean house?"
Both
Mrs. Opsasnick and Mr. Durkin said ACS's decision to scale back certain
programs was strange, especially because it came around the same time the group
sent a letter asking a local group to suspend an annual gala fundraiser that
generated tens of thousands of dollars for the charity.
Earlier
this month, ACS officials told The Times-Tribune they made a decision to do
away with Scranton's Ball of Hope after looking at rising costs of the event
and the dip in amount of money raised. October's Ball of Hope cost about
$28,000 and raised about $70,000, according to Erik McGaughney, the American
Cancer Society's income development director for the eastern region of
Pennsylvania.
The
2010 Ball of Hope raised $100,000 and cost about $16,000, he said in previous
interviews. Much of the funds raised went to support a summer camp in Lebanon
County for children with cancer and siblings of children with
cancer.
"It
is certainly puzzling," Mr. Durkin said.
Mrs.
Opsasnick agreed, pointing out that a local group of volunteers organized the
Ball of Hope each year.
"That
group didn't ask for anything from ACS," she said. "Why would you ever turn
down money when you're out there trying to do good things for cancer
patients?"
Contact
the writer: [email protected]
February
7, 2012
SJH RehabCare opens another
location - Vineland Daily Journal –
HARRISON
– South Jersey Healthcare Sports RehabCare, an outpatient orthopedic
rehabilitation provider, recently opened its newest location in Mullica Hill at
201 Tomlin Station Road.
The
facility offers sports and orthopedic physical therapy, occupational therapy,
spine care, worker’s compensation services and lymphedema
services.
The
facility incorporates the Nintendo Wii to enhance participation in therapy
treatment.
“Mullica
Hill ... .is a thriving community, and the staff at SJH Sports RehabCare at
Tomlin Station Park look to continue our commitment to improve the quality of
lives of our patients, and residents in the communities we serve,” said Debbie
Franceschini, director of SJH RehabCare Services.
The
facility has two new staff members:
Kristy
Meade, MSPT, ATC has more than 10 years clinical experience and will oversee
SJH Sports RehabCare. Her special interests include post-surgical patients,
athletic injuries, body mechanics and postural education, with a specialty
focus on trends in ACL rehabilitation.
Victoria
Rink, OTR/L, CHT, is the OT clinical coordinator for all inpatient and
outpatient facilities and SJH Sports RehabCare locations. Rink is a certified
hand therapist with more than 17 years of experience treating upper extremity
disorders.
For more
information, contact SJH Sports RehabCare at (856) 241-2533 or [email protected]. SJH RehabCare
and SJH Sports RehabCare have five convenient locations serving South
Jersey.
February 8,
2012
PolyGel Portable Device for DVT Therapy Helps Patients
Be Compliant After surgery – SBWire –
Tampa, FL
-- (SBWIRE) -- 02/08/2012 -- Major
surgical procedures are events where medical staff must be reminded that
certain patients can be at higher risk for deep vein thrombosis and venous
thromboembolism. Postphlebitic syndrome and pulmonary embolisms can occur in
the hours, days, and weeks after a surgery. An article on Medscape recently
highlighted how prophylaxis with medication and mechanical devices is
critical.
“Each patient must be assessed case-by-case, but the article
‘Deep Venous Thrombosis Prophylaxis in Orthopedic Surgery’ shows that DVT
therapy helped reduce DVT by 60 percent,” said Greg Grambor, president of
Vascular PRN, a company that fills prescriptions for sequential compression devices
and intermittent pneumatic devices for healthcare professionals
nationwide.
The authors of the Medscape article showed that passive
devices such as TED hose and active devices like IPC devices or venous foot
pumps lessened the chance of DVT and did not add the risk of bleeding. Mechanical compression devices
helped to improve blood flow and circulating fibrinolysins. Patient compliance
and efficacy are the most important factors that medical professionals want out
of devices.
“The latest technology is a PolyGel portable device that is
only one pound, the size of a small book, and works off battery power,” said
Grambor. “In the hours after surgery or for at-home care after leaving the
hospital, the PolyGel Ca5 DVTCare System provides the best
compliance.”
The PolyGel portable device lasts for 15 hours when used
for single leg therapy and 8 hours for both legs. Since it is carried over the
shoulder in a compact case, patients can go from their hospital bed, down the
hall to physical therapy, and move about their home when healing in the weeks
after a surgery. The PolyGel’s two segmented cuffs wrap comfortably around the
leg to promote blood flow.
“The PolyGel is super simple to put on the
patient and effortless to keep on the patient,” said Grambor. “You don’t have
to worry about the patient being hooked up to a power source or what happens
when they go to the bathroom.”
And when the PolyGel device needs to be
cleaned, it can be done with mild soap and a washcloth, and it can be charged
in an outlet once the 8 to 15 hours of use is up. It continues to operate while
charging, providing for totally uninterrupted therapy during those critical
post surgery hours.
Vascular PRN has decades of experience helping
nursing homes, surgery centers and hospitals, managed care organizations, and
other institutions with their DVT product needs. To learn more about the
PolyGel portable device, Sequential Compression Devices, IPC devices, or
Lymphedema boots visit http://www.vascularprn.com/ or
call 800.886.4331.
February 8,
2012
ImpediMed L-Dex® U400 device receives expanded U.S.
coverage - Proactive Investors Australia –
ImpediMed’s (ASX:
IPD) L-Dex® U400 device will receive greater coverage in the U.S. as an aid in
the clinical assessment of unilateral lymphoedema of the arm in females,
following the passing of the Patient Protection and Affordable Care
Act.
As a result of the passing of the Act, which makes certain
indigenous tribes and organisations eligible to access the health plans for
federal employees, ImpediMed expects an increase in covered lives for federal
healthcare plans from 1 May 2012.
The estimated number of employees of
indigenous tribes or organisations who are eligible to access federal health
plans is about 350,000.
Direct family members of these employees are
also eligible and include spouse and children up to the age of 26.
As a
result, coverage under federal plans could be expected to increase by an
estimated 700,000 covered lives.
Lymphoedema occurs when the lymphatic
system does not work properly, resulting in the long-term swelling of parts of
the body.
Stanford
Breast Cancer Lymphedema Registry
Meanwhile, the first patient
has been enrolled into the Stanford Breast Cancer Lymphedema
Registry.
Stanford University Medical Center initiated the registry
which will collect and analyse data from breast centres and physicians’ offices
across the U.S.
The registry collects clearly defined health and
demographic information on patients with specific health characteristics, in
this case, breast cancer.
The Stanford Breast Cancer Lymphedema Registry
has been designed to investigate the impact of lymphoedema surveillance upon
breast cancer survivors.
Within a year, researchers expect to have
gained further substantial insights into the value of systematic early
surveillance to prevent and minimise the lymphoedema risk in women treated for
breast cancer.
Patient enrolment will increase in the coming months as
the registry is rolled out to physician sites.
Data generated from
ImpediMed’s L-Dex® U400 device will make-up one arm of the registry.
The
L-Dex® U400 device is the first medical device with a US Food and Drug
Administration clearance to aid health care professionals, clinically assess
secondary unilateral lymphoedema of the arm and leg in women and the leg in
men.
February 13,
2012
High Desert Pharmaceuticals gets boost from export
deal - Northern Nevada Business Weekly – by Rob Sabo –
An
overseas distribution agreement could bring a much-needed financial lift to
High Desert Pharmaceuticals.
The
small Reno company, founded in 2007, recently found a distributor to export the
company’s products to Belgium, Holland, Germany, Switzerland, Poland and
Israel. High Desert Pharmaceuticals has two primary products:
CompressionAssist, used by people who wear heavy compression stockings to
combat lymphedema, which causes painful swelling in the lower legs; and
GloveGlide, used by medical professionals and others who wear surgical gloves.
The products allow easy fitting and donning of compression stockings or of PVC,
nitrile, and latex gloves.
“We
are hoping that is a nice opener for us on a global scale,” says John Wyaux,
High Desert’s executive vice president. The company’s other principal, Dieter
Berndt, is a chemist who created, patented and trademarked the two products.
High Desert Pharmaceuticals won “Product of the Year” for 2009 by Caregiver.com
for CompressionAssist.
The
company’s products are manufactured at a small Carson City facility, while the
small bottles are labeled and boxed in China. Hoping to extend its reach, High
Desert has begun marketing CompressionAssist to schools that train medical
staff about lymphedema. Other potential sources of revenue include medical
offices, hospitals and hospices.
“The
three major lymphedema schools train 400 to 500 students each year, and 200
returning students each year, and those are our potential customers,” Wyaux
says.
For
GloveGlide, High Desert Pharmaceuticals is targeting workers who routinely use
surgical gloves, such doctors, mechanics, law enforcement and security
screeners at airports. Getting the word out about the products, finding the
right channels, and getting potential customers to spend money on a new product
have been major obstacles to widespread use, Wyaux says.
“Given
the state of the economy, we have had to be resourceful,” he says.
Last
year was the first in which High Desert Pharmaceuticals posted a modest profit,
Berdt says. The company has been self-funded since its inception. However, in
order to advance the company’s products, High Desert Pharmaceuticals is seeking
project financing to attract new capital.
Berdt
says he came up the idea to create a donning lubricant after taking his wife to
a doctor’s appointment and watching a nurse struggle to put on latex gloves. He
had extensive experience working with silicone-based products, so he began
experimenting with different types of lubricants. An added side effect he
stumbled across was an 80 to 90 percent reduction in sweat inside the
gloves.
New
products include a long-lasting surface wipe called NanoSept that uses
nanotechnology to counter bacteria, fungi and viruses.
“It
is nearly indefinite,” Berndt says. “It will virtually last forever, unless it
is abraded.”
Berndt
hopes to eventually place the small NanoSept wipes inside the packaging of
electronic devices such as cell phone and tablet computers so consumers can
permanently keep the surfaces of their electronics clean. Hospital settings,
and commercial uses such as keyboards and phones or escalator handrails are
other potential use for the wipes, Wyaux says.
Berndt
says High Desert Pharmaceuticals will commercially introduce the NanoSept wipes
this year, and he plans to establish a pilot program with the product at
several Washoe County schools later this year.
“It
has spectacular potential,” he says.
February 13,
2012
Actress Zina Bethune killed in
hit-and-run - Entertainment Weekly – by Lanford Beard –
Zina
Bethune, a 66-year-old actress and dancer, was fatally struck in a presumed
double hit-and-run when she stopped to help an injured animal, reports the
L.A. Times. Bethune
was a famed ballerina, who taught dance to disabled children for the last 30
years. She herself had overcome diagnoses of scoliosis and lymphedema before
training with George Balanchine and the New York City Ballet at age
14.
Though
she went by Zina Feeley in everyday life, she made her professional name (Zina
Bethune) in 1958 on The
Guiding Light and had roles on Santa
Barbara, Party
of Five, and the 1960s medical drama The
Doctors and the Nurses. She also choreographed for the 1987 TV
series Nutcracker:
Money, Madness & Murder.
Los
Angeles police are investigating the incident, which took place just after
midnight on Sunday. Bethune is believed to have stopped to check on an injured
animal when a car going the opposite direction hit her and threw her across the
intersection, when another car struck her and dragged her 200 yards. The blows
resulted in severe head injuries, and Bethune was pronounced dead at the scene.
Neither of the drivers who struck Bethune have been formally
identified.
February 15,
2012
Health Calendar: Week of Feb. 16,
2012- Daily Breeze – By Sandy
Geretydailybreeze.com
-
Saturday
Lymphedema
A to Z.
Cancer Support Community-Redondo Beach will host Steffy Trousdale, LVN, COF, to
discuss the signs, symptoms and treatment options for Lymphedema from 10 a.m.
to noon Saturday at 109 W. Torrance Blvd., Redondo Beach. Call 310-376-3550, or
visit www.cancersupportredondobeach.org.
February
15, 2012
Complications from breast cancer treatment should be
treated sooner, says UM-Flint researcher
- minbcnews.com - by Kevin Usealman –
FLINT -- A
University of Michigan researcher has concluded 11 years of study
on breast cancer complications. Cindy Pfizer is an associate director of
research in U of M Flint's physical therapy department. The study, which she
began in 2001 while in Washington is in conjunction with researchers at Walter
Reed National Military Medical Center and the National Institutes of Health
Clinical Center.
They say in their conclusion they found that early
diagnosis and treatment of breast cancer-related complications such as
lymphedema, can reduce costs by as much as $2,500 per patient as well as the
need for intensive rehabilitation.
The research team
developed a model for surveillance of complications that result from the
treatment of breast cancer, so they can be identified and treated before the
patient begins to notice problems. The other primary investigator in the study
was Ellen Levy, a researcher from the National Institutes of Health. Pfalzer
continues to aid in data analysis, database updating and manuscript generation
while at her position at UM-Flint.
February
17, 2012
Supporters rally for imprisoned Hash Bash organizer
from Royal Oak - Royal Oak Daily Tribune – By Catherine
Kavanaugh –
Imprisoned last
year following a drug raid at his Royal Oak house, Hash Bash organizer and
medical marijuana proponent Adam Brook has a growing base of supporters trying
to make his time behind bars more comfortable.
Brook, 43, is four months
into a two-year sentence after pleading guilty to two counts of possessing a
firearm while committing a felony.
He suffers from lymphedema, an
incurable condition that causes the legs and arms to swell and is often brought
by on cancer treatment. Brook had thyroid cancer.
“Adam is not a well
man,” said Melissa Griggs, who is selling “Free Adam Brook Now” T-shirts for $10
each to raise money for his prison store account. “His legs are swollen, the
skin is splitting open and he needs special pressurized wraps.”
Griggs
acknowledges Brook has no chance for an early release, parole or probation
because of the mandatory sentence for his firearm pleas.
However, she
said Brook is on a lot of peoples’ minds as plans are made for the 2012 Hash
Bash in Ann Arbor, where she also will sell the T-shirts.
Griggs said
she is among those who people believe Brook was singled out by Oakland County
law enforcement for being a marijuana activist.
“I believe they put him
in prison because of who he is,” Griggs said. “He’s a political prisoner. He
organized the Hash Bash for 20 years and he was the 1994 High Times freedom
fighter of the year.”
Griggs said Brook was at physical therapy when his
home was raided on Jan. 12, 2011.
Undercover police with the Oakland
County Narcotics Enforcement Team (NET) said they seized 600 grams of
marijuana, two handguns, a shotgun, a bullet-proof vest, marijuana candy, a
triple-beam scale, and a tally sheet with names and prices from Brook’s house
on Whitcomb Avenue. Continued...
Brook
was charged with violating drug and weapons laws. He once had a state-approved
medical marijuana card but it had expired and the 1.3 pounds of marijuana he
possessed exceeded the 2.5 ounces allowed to medical marijuana
patients.
Last October, Brook was sentenced to two years in prison after
pleading guilty to two counts of possessing a firearm while committing a
felony. He also pleaded no contest to one count each of delivery and/or
manufacture of marijuana and being a felon in possession of a firearm. His
prior felony conviction was for carrying a concealed weapon in the late
1980s.
Oakland Circuit Judge Rudy Nichols didn’t sentence Brook to any
time for the drug charge or being felon with a firearm. Brook is serving his
two years at the Parnell Correctional Facility, a minimum-security prison in
Jackson.
With the 41st annual Hash Bash set for April 7, a lot of people
are just finding out why Brook doesn’t have a lead role in its organization.
Griggs said she is selling donated T-shirts because people want to help him
until his Oct. 5, 2013, release date.
“Every cent of the money raised
will go to Adam’s commissary account so he can buy decent soap that doesn’t dry
out his skin, shampoo, and T-shirts so he isn’t cold,” Griggs said.
Her
effort is drawing attention to Brook’s case on social media. One Facebook
posting by a supporter says, “He’s in jail for an antique pistol…and a Normandy
Beach flak jacket from an American hero that landed on D-Day to save
Europe.”
Oakland County Prosecutor Jessica Cooper refuted that and
laughed at the notion Brook is a political prisoner.
“I have no idea who
he is,” she said.
Cooper said a black powder six-shot Fillipieta gun
found at Brook’s house was alleged to be antique but three other weapons also
were seized.
“The antique handgun is not an issue,” Cooper said. “They
neglect to talk about the .380 pistol filly loaded in the nightstand, a
Remington 1100 shot gun in the closet and a .357 next to a chair.” Continued...
Brook’s
supporters contend the firearms were legally registered to another person in
the household. However, Brook couldn’t be anywhere there was a gun because of
the prior felony conviction.
His supporters also say the 600 grams of
marijuana at the house were “used up” from a vaporizer process that lets people
inhale active cannabinoids while avoiding harmful smoke toxins.
Cooper
said marijuana was found in jars and bags and there was scale to measure out
quantities. Police also seized Vicodin and THC candy from Brook’s house, she
added.
“If we had prosecuted on all drug counts he could be doing two
years plus two years,” Cooper said.
Griggs said Brook accepted a plea
deal to protect his family from assets being seized. She is selling the “Free
Adam Brook Now” T-shirts for $10 each to people who buy them in person from her
but has to add packaging and shipping costs to mail orders.
February
17, 2012
Grey's Anatomy Doc Speak: What's a
Gliosarcoma? – Wetpaint – by
Dan Clarendon –
Tumors
and lymph nodes and mania, oh my! If all of the medical lingo from last night's
double-header has got your head spinning double-time, have no fear. We've got
you covered. Here's a recap of some of the conditions covered on last night's
episodes of
Grey's Anatomy and
Private
Practice.
Erica suffered from a gliosarcoma,
a rare, malignant, cancerous tumor formed by glial cells in the brain
(basically cells whose job it is to support the neural cells). These cancers
rarely spread outside of the brain, but they have been known to move to the
blood, lungs, liver, and lymph nodes.
Bailey's patient's arm was so
enlarged because she had lymphedema,
a drastic swelling in the arms or the legs caused by a block in
the
lymphatic system. The lymphatic system is responsible for
draining fluid from organs and incorporating that fluid back into the
bloodstream. When there is a blockage, this fluid will build up and create
swelling. The most common cause of lymphedema is the removal or damage of lymph
nodes through cancer treatment.
Sheldon diagnosed Sam's sister Corinne
with hypomania,
a form of bipolar disorder in which affected individuals will often have
intense and unpredictable feelings of euphoria and irritability. Individuals
with hypomania experience no psychotic symptoms associated with mania.
Hypomania usually manifests in a decreased need for sleep and a large amount of
energy, as well as an outgoing and competitive disposition. Individuals with
hypomania often live full-functioning lives because the condition can be
treated by mood-stabilizers and monitored closely by
psychiatrists.
February
19, 2012
Hospital Calendars for the Week of Feb.
19 - PennLive.com –
Tues
- Lymphedema Support Group: 6:30 pm, WellSpan Adams Health Center,
Room 211. Community Multiphasic Blood Screening Program (Inclement weather
make-up date)
February
19, 2012
Breast cancer patients gain strength, mobility,
confidence with better than before program - The
Bridgeton News - NJ.com - By
Lauren T. Taniguchi -
Women
battling breast cancer can regain strength, independence and self-confidence
with the guidance of Better Than Before, a rehabilitative fitness program on
DVD that demonstrates how post-surgery exercises should be performed to support
recovery.
The 50-minute program offers four stages of exercises to help
breast cancer patients safely stretch, achieve mobility and prevent
complications such as lymphedema after undergoing mastectomies, lumpectomies or
reconstructive surgeries.
“Most of what we try to do these days is to
get patients back into society, back into daily living, so they can do normal
activities and get back to their families and jobs,” said Dr. Peter Neumann, a
reconstructive plastic surgeon who gave direction during the program’s
development.
“Another aspect is that after surgery, nobody really deals
with the emotional problems of patients feeling they don’t have the ability to
do what they did before,” Neumann added. “By getting their strength back, they
feel better about themselves, and it prevents depression and family
unrest.”
The program was developed about 15 years ago, when patient Jill
Forrest and her trainer, Lauren Antorino Griffin, worked with Neumann to record
a demonstration of exercises to help women after surgery.
Forrest was a
teacher and outgoing proponent of education, and, though she has since passed
away, her husband, Ed, continues to reach out to breast cancer patients with
Neumann and Griffin in Jill’s memory.
Unfortunately, Neumann said
post-surgery rehabilitation resources in the health care industry are still
lacking, a decade and a half after the program was developed.
“Patients
are stuck, and half the things offered to them in the hospital they don’t
listen to because they’re still so nervous about their treatment,” Neumann
said.
“Most get a rubber ball to squeeze and information from their
friends or the Internet, but not all of that information has been
screened.”
However, Better Than Before has been distributed to fulfill
the great need at medical facilities around the United States and
Europe.
With physician approval, patients can start using Better Than
Before almost immediately following surgery, Neumann said.
“In the
beginning, there are stretching exercises that are safe ways to get mobility in
the arm. The second part is strengthening — using very light weights and/or
resistance to gain strength, especially in the biceps and triceps, as well as
through the pectorals of the chest to get strength back,” Neumann explained.
“The third portion is really for full mobility, all the daily living
activities you’d do as far as picking something off a top shelf or going into a
closet and twisting to pull out a specific shirt. The fourth is
maintenance.”
Neumann, a former member of the board of directors of a
division of the American Cancer Society, said a patient should consult with her
doctor before beginning this or any rehabilitative program. In addition,
patients should listen to their bodies and take care to do only what feels
right.
“We have found this program is completely safe, but if it doesn’t
feel good, maybe you’re not at that point yet. Don’t skip to the end; go
through the program slowly until you get the feeling and strength so you can
move to the next portion,” Neumann said.
Within three to four months of
exercise, most will have regained a significant measure of agility and
strength. Neumann said that by the maintenance stage of the program, most
patients have learned the exercises and begin doing them casually, even during
a morning shower, to stay strong and limber.
Better Than Before is
available for $19.99 online at breastcancerexercises.net, and a
third of all proceeds from DVD sales are donated to the American Cancer Society
to support efforts to find a cure for breast cancer.
“The DVD is all
ages and stages appropriate and is a perfect post-operative gift because better
than flowers, better than sympathy, give her Better Than Before,” wrote Ed
Forrest
February
20, 2012 –
The Week in Sonoma Valley, Feb.
20-26 - Santa Rosa Press Democrat –
Sorry
a one time meeting already passed
February
20, 2012
Lichen Sclerosus Exhibiting Histologic Signs of
Lymphedema: An- Archives of
Dermatology –
We
appreciate the interest of Carlson et al in our article on vulvar VX 1 as well
as their comment about the possible etiologic roles of lymphostasis and
...
You
have to be a member of some group to access this
February
23, 2012
Pinnacle Hand Therapy helps patients with movement,
more - Daily Press – By Phyllis Johnson –
"We take better care of our cars than we do our bodies. We know
that an engine will not last if we do not change the oil, yet we expect to get
years of use from our hands with no preventative care." — Pinnacle Hand
Therapy
The sign outside Pinnacle Hand Therapy LLC doesn't begin to describe
all of the medical services available inside the Middle Ground Boulevard
company
The 8-year-old practice offers hand therapy, lymphedema treatment,
wound care and pediatric therapy. Among the 10 employees, there are three
certified hand therapists and two certified lymphedema therapists who treat
swelling due to a blockage of the lymph passages.
Phyllis Ross, owner and an adjunct professor at Howard University's
Occupational Therapy Department, went into this line of work because she has a
passion for it. She decided to treat lymphedema after seeing breast cancer
survivors who had swelling problems. She gave them complete decongestive
therapy by using compression and massage. Patients use compression wraps and
garments, followed by wrapping at night. It's an ongoing process with measured
successes, something that makes it all worthwhile, she said.
"I love seeing people get better. It's gratifying to see their
progress," said Ross. "We evaluate their physical ability when they come in and
constantly compare it to the baseline to see how far they've
come."
Ross's previous line of work included serving time in the U.S. Navy
during Desert Storm and experience working in hospitals. She migrated back to
the Peninsula to be near family. It's been a good move for her, she said, and
she enjoys her work.
She also enjoys teaching students occupational therapy. "There's a
need for continuing education in the area of hand therapy."
Ross says people often take the things they normally do for granted.
When movement is impaired, there has to be treatment and therapy to bring
normal movement back.
"It's reassuring to a patient to see continued progress. It's a
measurable thing," she said.
A steady stream of people use the practice. There is a room where a
small number of people are getting therapy in a group setting.
"A new patient is able to come in and see someone else further along
in the same treatment and see how well they're doing. That's reassuring for a
new patient," she said.
One patient, Danny Engle of Hampton, showed where he had cut his hand
and later had surgery. Pinnacle Hand Therapy is helping restore motion to his
hand.
"This is the second place I've been for therapy. The staff is very
courteous and patient. They really take care of people here. I've never seen
anyone lose their patience. They're very flexible. Phyllis stayed late for
several hours recently to work with me. It means a lot," said Engle. "The staff
doesn't feel you owe them. They feel they owe you."
Another patient, Robert Raney of Suffolk, has been going to Pinnacle
practice since it opened in 2003. He comes for help with lymphedema and for
therapy for his arms and fingers. He requires special splints for two of his
fingers.
"I was one of her first patients," Raney said. "She gets me to
exercise to effectively help with therapy."
Ross has a good manner with the patients and staff. It's clearly a
place where patients feel right at home. "We often see local high school
athletes come in with injuries, too."
Her staff works with younger students as well when they have problems
with sensory processing, coordination, dyspraxia, motor skills and handwriting.
The practice offers training and hope. Physical activity and using
manipulatives are forms of treatment for motor skills. They use various
techniques for those with autism.
"We see a lot of children sent here from the Children's Hospital of
the King's Daughters who need hand therapy," said Ross. "We're happy to help
them."
Her plans for the future include the development of a continuing
education training course for therapists interested in hand therapy or
lymphedema therapy.
"We stay busy. Even on holidays, we have drop-ins come in for help,"
said Ross. "We're happy to assist people in restoring function so they can
return to whatever job, hobby or other activity they enjoy."
Company details
Pinnacle Hand Therapy
704 Middle Ground Blvd., Suite D, Newport News,
757-595-4880.
Hours: 8 a.m.-5 p.m. Monday through Friday.
The practice is accepting patients from Newport News, Hampton,
Yorktown, Seaford, Grafton, Langley Air Force Base, Fort Monroe and
Gloucester.
February
25, 2012,
Freeze column: Knee surgery -
Salisbury Post –
A
little over three months ago, I started to experience tightness in one of my
knees. On a few of my morning runs, that actually locked up. After a few more
days, I couldn’t climb steps with that left knee, and couldn’t pedal a bike
either. Climbing a ladder was definitely out.
My
two favorite physical therapists offered advice. Drs. Delaine Fowler and Pam
Roseman had some ideas, and we tried a few things.
Delaine,
who owns Fowler Physical Therapy, and Pam, owner of Lymphedema Solutions
Physical Therapy, are both experienced runners. They suggested that I get an
opinion from Dr. Robert Humble, an orthopedic surgeon with a reputation for
getting athletes back on the road quickly.
The
idea of surgery didn’t appeal to me, but something had to happen. Other runners
offered opinions, with most thinking I couldn’t run for a minimum of 14 days
and possibly as much as a month after the surgery.
I
did go to Salisbury Orthopedics Associates and met with Dr. Humble. He and
Physician’s Assistant Ryan Schenk and staff told me what to expect, and were
able to schedule arthroscopic surgery on Feb. 1, just two weeks later.
Arthroscopic
surgery involves two small holes in the knee through which a scope is inserted
and the knee is inflated with a sterile fluid. Dr. Humble would use the scope
to see and repair the damage, saying, “I can fix anything but an ACL, and that
isn’t your issue.” He made me confident of success.
On
the morning before the actual surgery, I had to get my run in. There was even a
fleeting thought of running to Rowan Regional Medical Center’s Outpatient
facility on Julian Road, figuring that no one would have done that before. I
didn’t do that — which later pleased the nurses who took care of me.
My
only previous surgeries were a tonsillectomy and a colonoscopy. Getting your
tonsils out in those days meant plenty of ice cream and some good memories. My
colonoscopy was enjoyable, too, although most people can’t understand why
anybody would think that.
Upon
arriving at the Outpatient Center, I was welcomed quickly, with the paperwork
processed very efficiently. Ameran Hill took care of that. My neighbor Vanessa
Bradley was in that same area, being the first of several staff that I already
knew. My daughters, Ashley and Amber, as well as Laura Kerr were there to make
sure that I didn’t wisecrack to the nurses too much. They also reminded me that
I couldn’t wait for Danica Patrick to show up, even though I was sure that she
was coming.
Dona
Peacock came out and called my name, saying “Aren’t you the guy who writes for
the Salisbury Post?” That immediately opened the door to some interesting
conversation. Dona and Leigh Ann Williams made sure that I was comfortable as
anybody can be while wearing one of those “open rear” gowns.
Next
the nurses who would assist in the surgery came by, and I knew them both. Word
had spread that there might just be a Salisbury Post column about this
experience. Rhonda Smith and Lauren Daniel enjoyed talking with my daughters as
we waited on Dr. Humble and the operating room. The anesthesiologist, Michael
Jones, stopped by and made sure that I would be easy enough to put to sleep.
Dr.
Humble came in, making last preparations. They let me walk to the bathroom one
more time, and then it was “Showtime.” They rolled my bed to the operating room
and put a warm blanket on me since it was much cooler in that room. Kim
Alexander told me that they were going to put something in my IV, and after
what seemed like seconds later, I woke up feeling great with a bandaged knee.
It
took just minutes and I was on my way out of the building, a short three hours
after entering the door. Kay Meilinger, my recovery nurse, must have done a
great job, because I hardly got to know her.
I
spent that afternoon on the couch with a succession of ice packs. The second
day brought a stiff knee and a shower. The swelling began to go down, and I had
no trouble walking by the third day. There was no real pain, just an off and on
ache with stiffness, usually depending on how long I stood.
My
running resumed exactly one week later, meaning that I only missed six days.
Dr. Humble told me that it would take at least a couple of months to recover
full strength in the knee, saying that even pro athletes often aren’t back up
to speed until the next season. With that said, my knee is getting better, now
three weeks after the surgery, and I haven’t ruled out playing major league
baseball next season.
To
the staff at RRMC’s Outpatient Center, you did make a good column, and made
another experience at RRMC very pleasurable. I definitely was cared for by a
group of people who take pride in the work they do. Thank you!
February
24, 2012
Surviving cancer, giving back -
Metrowny.com
Refusing
to accept the statement, ‘You’re just getting old,’ may be the reason
36-year-old Lisa Johnson is alive today.
After beating cervical cancer
in 2004 and celebrating four years of being cancer free, Johnson developed
secondary lymphedema, in 2008. This resulted in a chronic swelling of her left
leg, which developed as a result of lymph nodes that were removed during the
initial surgery she had to remove her cervical cancer years prior.
Initially, Johnson injured herself by rolling off of her sandal and just
assumed her leg was swollen due to the injury, doctors agreed. One doctor even
said her leg was enlarged as a result of old age; however, at age 33, she knew
something else was wrong.
Johnson decided to do her own research. After
dealing with the discomfort of walking around with one leg larger than then
other for three years, she stumbled upon information that indicated how
lymphedema can be caused. Johnson then took her findings to Roswell Park Cancer
Institute in October 2011. There - she was provided with the proper diagnosis
and treatment.
Upon her arrival at Roswell, Johnson’s left leg was 28
percent larger than her right leg.
“You have to just keep doing
research to find out what’s wrong with you,” said Johnson. “You can’t give up.”
As a way of thanking Roswell Park for helping her, Johnson will again is
host the annual “Stick it to Cancer,” event.
“I like helping people and
I wanted to give back for the help that was given to me,” said Johnson.
The event will be held from 2 to 7 p.m. Saturday, April 21 at the Town
of Tonawanda Boys and Girls Club, 54 Riverdale Ave., Town of Tonawanda.
At the event, Johnson will learn to ride a bicycle for the first time in
front of the entire crowd. For safety she will wear knee and elbow pads, a
helmet, and be wrapped head to tow in bubble wrap.
A game called, Boo
Boo Bing-OW, will be played while she rides. Johnson will place baseball cards
in the spokes of her bicycle to make some noise while additional baseball cards
will be sold to raise money for cancer. Johnson will call out players’ names on
the baseball cards while she is riding to give friends and family a chance to
win prizes.
In addition to her ride, a blood drive and basket raffle
will be held throughout the duration of the fund-raiser. Baseball cards will be
sold until 4 p.m., basket raffle drawing will take place at 6 p.m. (winners do
not need to be present), and a 50/50 split drawing that will take place after
the basket raffle.
Admission for the event is $10 per person, $5 for
presenting blood donors and free for children 10 and under. Admission includes
a set of raffle tickets, non-alcoholic beverages and snacks. Raffle tickets
will be sold for $5 per sheet or $20 for five sheets, baseball cards will be
sold for $5 each. For those individuals who wish to just donate blood, there is
no cost.
Proceeds from the event will benefit Roswell and the Town of
Tonawanda Paramedics.
For additional information, contact Johnson at
[email protected], search for “StickItToCancer” on Facebook or visit http://stickittocancer.wordpress.com.
KEYWORD
NEWS – NONE
PUB
MED DOCS:
February
5, 2012
Rev Med Interne. 2012 Jan 30.
[Epub ahead of print]
[Management
of limb lymphedema.]
[Article
in French]
Vignes S.
Source
Unité
de lymphologie, centre national de référence des maladies vasculaires rares,
hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
Abstract
Lymphedema
results from impaired lymphatic transport with increased limb volume.
Cellulitis is the main complication, but psychological or functional discomfort
may occur throughout the course of lymphedema. Lymphedema management is based
on complete decongestive physiotherapy (multilayer low stretch bandage, manual
lymph drainage, skin care, exercises). First phase of treatment leads to a
reduction of lymphedema volume. The second phase stabilizes the volume and is
based on elastic compression. Resection surgery is a useful tool in external
genitalia lymphedema.
Copyright
© 2012 Société nationale française de médecine interne (SNFMI). Published by
Elsevier SAS. All rights reserved.
PMID:
22296831 [PubMed - as supplied by publisher]
February
7, 2012
J Am Acad Orthop Surg. 2012
Feb;20(2):78-85.
Factitious
disorders of the upper extremity.
Birman MV, Lee DH.
Source
Department
of Orthopaedic Surgery, Columbia University, New York, NY, USA.
Abstract
Factitious
disorders of the upper extremity can manifest in many different forms;
therefore, it is critical to recognize warning signs in the history and
examination indicating that the patient may be creating the symptoms and
physical manifestations of the presenting illness. These disorders present in
such predictable patterns as lymphedema, Secretan syndrome, ulcerations and
wound manipulation, clenched fist, subcutaneous emphysema, pachydermodactyly,
nail deformities, and self-mutilation. Management recommendations include
assigning therapeutic responsibility to one person and the involvement of a
multidisciplinary team. Thorough documentation is essential for the protection
of both the patient and the treating physician. Treatment of patients with
factitious disorders of the upper extremity requires patience and insight to
avoid being manipulated into performing unnecessary surgical
procedures
J Radiat Res (Tokyo).
2012;53(1):125-9.
The
Clinical Characteristic Differences between Thrombosis-related Edema and
Lymphedema Following Radiotherapy or Chemoradiotherapy for Patients with
Cervical Cancer.
Wang PL, Cheng YB, Kuerban G.
Source
Center
of Oncology, The Fifth Affiliated Hospital of Xinjiang Medical
University.
Abstract
Thrombosis-related
edema and lymphedema are two principal types of lower extremity edema results
from radiotherapy alone or chemoradiotherapy for patients with cervical cancer.
To characterize differences between them, a retrospective study was performed.
We collected data including age, race, body weight, FIGO stage, histology type,
platelet count, haemoglobin, time of definitely diagnosis, therapeutic regimen,
edema type and which leg edema firstly occurred in. Of 40 patients who were
eligible for this study, 32 were diagnosed as thrombosis-related edema and 8
diagnosed as lymphedema. The differences in patient age (p = 0.004), propotion
of race (p = 0.021), the latent time (p = 0.002) and the mean platelet count (p
= 0.019) were statistically significant. Among 32 patients with
thrombosis-related edema, 34.4% were in stage II and 53.1% in stage III, 78.1%
were squamous cell carcinoma. Among 8 patients with lymphedema, 87.5% were in
stage II and 62.5% were squamous cell carcinoma. The differences were not
statistically significant for weight (p = 0.94), histology type (p = 0.648),
edema site (p = 0.236), haemoglobin (p = 0.088) between the two grouping
patients. Although the small patient cohort is a limitation, the results
suggest that the patients with thrombosis-related edema may have higher
proportion, lower age, shorter latent edema time and more platelet count than
those with lymphedema. Also, thrombosis-related edema was likely inclined to
Uigur and lymphedema to Han race. We did not find statistical differences in
weight, edema site, histology type and haemoglobin between patients with
thrombosis-related edema and lymphedema.
PMID:
22302053 [PubMed - in process]
Rev Med Interne. 2012 Jan 30.
[Epub ahead of print]
[Management
of limb lymphedema.]
[Article
in French]
Vignes S.
Source
Unité
de lymphologie, centre national de référence des maladies vasculaires rares,
hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
Abstract
Lymphedema
results from impaired lymphatic transport with increased limb volume.
Cellulitis is the main complication, but psychological or functional discomfort
may occur throughout the course of lymphedema. Lymphedema management is based
on complete decongestive physiotherapy (multilayer low stretch bandage, manual
lymph drainage, skin care, exercises). First phase of treatment leads to a
reduction of lymphedema volume. The second phase stabilizes the volume and is
based on elastic compression. Resection surgery is a useful tool in external
genitalia lymphedema.
Copyright
© 2012 Société nationale française de médecine interne (SNFMI). Published by
Elsevier SAS. All rights reserved.
PMID:
22296831 [PubMed - as supplied by publisher]
Clin Physiol Funct Imaging. 2012
Mar;32(2):126-32. doi: 10.1111/j.1475-097X.2011.01066.x. Epub 2011 Nov
10.
The
washout rate of a subcutaneous (99m) Tc-HSA depot in lower extremity
lymphoedema.
Jensen MR, Simonsen L, Karlsmark T, Bülow J.
Source
Department
of Clinical Physiology and Nuclear and Medicine Department of Dermatology and
Venereology, Bispebjerg Hospital, University Hospital of Copenhagen,
Copenhagen, Denmark.
Abstract
Purpose:
Lymphoscintigraphy is currently the leading diagnostic modality of lower
extremity lymphoedema but has been criticized for being unreliable. Washout
rate constants have been investigated and proven to be of diagnostic value in
several studies of breast-cancer-related lymphoedema; however, the
applicability in lower extremity lymphoedema needs further evaluation. The aim
of the study was to verify if washout of (99m) Tc-Human Serum Albumin ((99m)
Tc-HSA) is a reliable diagnostic tool in lower extremity lymphoedema. Methods:
Twenty healthy volunteers and eight patients (11 legs) with lymphoscintigraphy
verified lower extremity lymphoedema participated in the study. A depot
consisting of 0·1 ml 10 MBq/ml (99m) Tc-HSA was injected subcutaneously into
the dorsum of each foot. The depot washout rate was measured using a portable
scintillation detector system and time-activity curves were generated. After
30 min of supine rest and 10 min of standardized ergometric exercise,
measurements were recorded for 20 min. Following correction for physical decay
of (99m) Tc, the depot washout rate constant was calculated using linear
regression analysis. Finally depot half-life was calculated from the washout
rate constant. Results: Median half-life for healthy volunteers was 9·4 h
(range 2·5-28·3 h). Median half-life for lymphoedema patients was 10·7 h (range
1·5-35·1 h). No statistical significant difference could be detected between
healthy volunteers and lymphoedema patients (P = 0·78). Conclusions: The
washout rate of a subcutaneous (99m) Tc-HSA depot is not a reliable diagnostic
tool in examination of lower extremity lymphoedema. Additional examinations
revealed in vivo instability of the utilized (99m) Tc-HSA as the likely
reason.
©
2011 The Authors. Clinical Physiology and Functional Imaging © 2011
Scandinavian Society of Clinical Physiology and Nuclear Medicine.
PMID:
22296633 [PubMed - in process]
February
10, 2012
Head Neck. 2012
Mar;34(3):448-53. doi: 10.1002/hed.21538. Epub 2010 Nov 12.
Near-infrared
fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Source
Division
of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The
University of Texas Health Science Center, Houston, Texas; Memorial Hermann
Center for Lymphedema Management, Memorial Hermann - Texas Medical Center,
Houston, Texas. [email protected].
Abstract
BACKGROUND:
Lymphedema
is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions
where treatment options are limited. Although upper and lower extremity
lymphedema may be effectively treated with manual lymphatic drainage (MLD)
therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS
AND RESULTS:
Herein,
we describe the compassionate use of an investigatory technique of
near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy
and function, help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor response to therapy in a patient with head and neck lymphedema after
surgery and radiation treatment.
CONCLUSION:
NIR
fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are
needed to assess the efficacy of MLD therapy when directed by NIR fluorescence
imaging. © 2010 Wiley Periodicals, Inc. Head Neck, 2012.
Copyright
© 2010 Wiley Periodicals, Inc.
PMID:
22311465 [PubMed - in process]
Am J Pathol. 2012 Feb 3. [Epub
ahead of print]
ProxTom
Lymphatic Vessel Reporter Mice Reveal Prox1 Expression in the Adrenal Medulla,
Megakaryocytes, and Platelets.
Truman LA, Bentley KL, Smith EC, Massaro SA, Gonzalez DG, Haberman AM, Hill M, Jones D, Min W, Krause DS, Ruddle NH.
Source
Department
of Epidemiology and Public Health, Yale University School of Medicine, New
Haven, Connecticut.
Abstract
Lymphatic
vessels (LVs) are important structures for antigen presentation, for lipid
metabolism, and as conduits for tumor metastases, but they have been difficult
to visualize in vivo. Prox1 is a transcription factor that is necessary for
lymphangiogenesis in ontogeny and the maintenance of LVs. To visualize LVs in
the lymph node of a living mouse in real time, we made the ProxTom transgenic
mouse in a C57BL/6 background using red fluorescent LVs that are suitable for
in vivo imaging. The ProxTom transgene contained all Prox1 regulatory sequences
and was faithfully expressed in LVs coincident with endogenous Prox1
expression. The progenies of a ProxTom × Hec6stGFP cross were imaged using
two-photon laser scanning microscopy, allowing the simultaneous visualization
of LVs and high endothelial venules in a lymph node of a living mouse for the
first time. We confirmed the expression of Prox1 in the adult liver, lens, and
dentate gyrus. These intensely fluorescent mice revealed the expression of
Prox1 in three novel sites: the neuroendocrine cells of the adrenal medulla,
megakaryocytes, and platelets. The novel sites identified herein suggest
previously unknown roles for Prox. The faithful expression of the fluorescent
reporter in ProxTom LVs indicates that these mice have potential utility in the
study of diseases as diverse as lymphedema, filariasis, transplant rejection,
obesity, and tumor metastasis.
Copyright
© 2012 American Society for Investigative Pathology. Published by Elsevier Inc.
All rights reserved.
PMID:
22310467 [PubMed - as supplied by publisher]
Asia Pac J Public Health. 2012
Feb 15. [Epub ahead of print]
Physical,
Psychological, and Social Aspects of Quality of Life in Filarial Lymphedema
Patients in Colombo, Sri Lanka.
Wijesinghe RS, Wickremasinghe AR.
Source
University
of Queensland, Herston, Australia.
Abstract
Quality
of life (QOL) was assessed in 141 filarial lymphedema patients and 128 healthy
people in the Colombo district, Sri Lanka, by administering modified,
translated, and validated (in Sri Lanka) versions of the Short Form 36 health
survey questionnaire (SF-36) and the 30-item General Health questionnaire
(GHQ-30). The GHQ-30 assesses the current mental health status. The SF-36
measures health on 8 multi-item dimensions covering functional state,
well-being, and overall evaluation of health (physical functioning, role
limitations resulting from physical health problems, role limitations resulting
from emotional problems, energy/fatigue, emotional well-being, social
functioning, pain and general health). By SF-36, patients experienced poorer
physical functioning, more role limitations resulting from physical health
conditions, less emotional well-being, poorer social functioning, and more pain
than healthy individuals. By GHQ-30, mental well-being of healthy controls was
significantly better than that of patients. The significant difference in the
QOL as perceived by filarial lymphedema patients and healthy individuals
reiterates the importance of morbidity control in patients affected by this
disease.
PMID:
22308536 [PubMed - as supplied by publisher]
Breast. 2012 Feb 2. [Epub ahead
of print]
Angiosarcoma
of the breast: A difficult surgical challenge.
Hui A, Henderson M, Speakman D, Skandarajah A.
Source
Department
of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Melbourne
3050, Australia.
Abstract
BACKGROUND
AND OBJECTIVES:
Breast
angiosarcoma presents following radiotherapy after breast conserving surgery,
in the setting of chronic lymphoedema after axillary dissection or as a primary
tumour. The Peter MacCallum Cancer Centre has significant experience due to
large breast and sarcoma units and as a primary radiotherapy centre. Our aims
were to evaluate the management and locoregional and distant outcomes after
breast angiosarcoma.
METHODS:
Retrospective
study of all patients from the prospective breast and sarcoma databases with a
diagnosis of primary or secondary breast angiosarcoma at Peter MacCallum Cancer
Centre was performed between January 2000 and December 2010. Mode of
presentation, management, loco-regional recurrence and survival rates were
reviewed.
RESULTS:
Eight
women developed angiosarcoma in the setting of breast conservation with a
median latency of 7 years post radiotherapy. Six patients had primary breast
angiosarcoma. All breast angiosarcomas were managed with total mastectomy with
5 patients requiring autologous tissue transfer. Four patients had adjuvant
radiotherapy and three patients had adjuvant paclitaxel. The median follow-up
was 2.5 years (6 month-10 years) with 7 episodes of local recurrence in four
patients and 7 patients with distal metastases including two deaths from
distant disease.
CONCLUSIONS:
Primary
angiosarcoma occurs de novo, presenting as a breast mass. Secondary
angiosarcoma presents predominantly as a skin lesion, in the setting
post-operative radiotherapy for breast conserving therapy. Angiosarcoma remains
a rare and difficult management problem with poor loco-regional and distal
control. Secondary AS is an iatrogenic condition that warrants close follow-up
and judicial use of radiotherapy in breast conserving therapy.
Crown
Copyright © 2012. Published by Elsevier Ltd. All rights reserved.
PMID:
22305554 [PubMed - as supplied by publisher]
February
11, 2012
Head Neck. 2012
Mar;34(3):448-53. doi: 10.1002/hed.21538. Epub 2010 Nov 12.
Near-infrared
fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Source
Division
of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The
University of Texas Health Science Center, Houston, Texas; Memorial Hermann
Center for Lymphedema Management, Memorial Hermann - Texas Medical Center,
Houston, Texas. [email protected].
Abstract
BACKGROUND:
Lymphedema
is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions
where treatment options are limited. Although upper and lower extremity
lymphedema may be effectively treated with manual lymphatic drainage (MLD)
therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS
AND RESULTS:
Herein,
we describe the compassionate use of an investigatory technique of
near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy
and function, help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor response to therapy in a patient with head and neck lymphedema after
surgery and radiation treatment.
CONCLUSION:
NIR
fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are
needed to assess the efficacy of MLD therapy when directed by NIR fluorescence
imaging. © 2010 Wiley Periodicals, Inc. Head Neck, 2012.
Copyright
© 2010 Wiley Periodicals, Inc.
PMID:
22311465 [PubMed - in process]
February
17, 2012
Can Respir J. 2012
Jan;19(1):35-6.
Yellow
nails, lymphedema and chronic cough: Yellow nail syndrome in an eight-year-old
girl.
Siddiq I, Hughes DM.
Abstract
Yellow
nail syndrome is a rare disease and reported mainly in adults. A case of yellow
nail syndrome involving an eight-year-old girl with associated discoloured
yellowish nails on the fingers and toes, lymphedema and chronic cough, and
sputum production is reported.
PMID:
22332131 [PubMed - in process]
J Clin Oncol. 2012 Feb 13. [Epub
ahead of print]
Prospective
Study of Factors Predicting Adherence to Surveillance Mammography in Women
Treated for Breast Cancer.
Shelby RA, Scipio CD, Somers TJ, Soo MS, Weinfurt KP, Keefe FJ.
Source
Duke
University Medical Center, Durham, NC.
Abstract
PURPOSEThis
prospective study examined the factors that predicted sustained adherence to
surveillance mammography in women treated for breast cancer. METHODSBreast
cancer survivors (N = 204) who were undergoing surveillance mammography
completed questionnaires assessing mammography-related anticipatory anxiety,
persistent breast pain, mammography pain, and catastrophic thoughts about
mammography pain. Adherence to mammography in the following year was
assessed.ResultsIn the year after study entry, 84.8% of women (n = 173)
returned for a subsequent mammogram. Unadjusted associations showed that
younger age, shorter period of time since surgery, and having upper extremity
lymphedema were associated with lower mammography adherence. Forty percent of
women reported moderate to high levels of mammography pain (score of ≥ 5 on a 0
to 10 scale). Although mammography pain was not associated with adherence,
higher levels of mammography-related anxiety and pain catastrophizing were
associated with not returning for a mammogram (P < .05). The impact of
anxiety on mammography use was mediated by pain catastrophizing (indirect
effect, P < .05). CONCLUSIONFindings suggest that women who are younger,
closer to the time of surgery, or have upper extremity lymphedema may be less
likely to undergo repeated mammograms. It may be important for health
professionals to remind selected patients directly that some women avoid repeat
mammography and to re-emphasize the value of mammography for women with a
history of breast cancer. Teaching women behavioral techniques (eg, redirecting
attention) or providing medication for reducing anxiety could be considered for
women with high levels of anxiety or catastrophic thoughts related to
mammography.
PMID:
22331949 [PubMed - as supplied by publisher]
Phlebology. 2012;27 Suppl
1:139-42.
Lymphatic
complications after varicose veins surgery: risk factors and how to avoid
them.
Pittaluga P, Chastanet S.
Source
Riviera
Vein Institute, 6 Rue Gounod 06000, Nice, France. [email protected];
[email protected].
Abstract
INTRODUCTION:
Lymphatic
complication (LC) after varicose veins (VVs) surgery is an annoying event with
a variable frequency in the literature.
METHOD:
Retrospective
study reviewing all surgeries carried out for VVs from January 2000 to October
2010. Postoperative LC we reported: lymphatic fistula, lymphocele including the
minor ones and lymphoedema.
RESULTS:
During
the period studied, 5407 surgical procedures for VVs were performed in 3407
patients (74.7% women) with a mean age of 53.4 years. A postoperative LC
occurred in 118 cases (2.2%): lymphocele on limb in 1.3%, inguinal LC (fistula
or lymphocele) in 0.7% and a lymphoedema in 0.2%. The population with a LC was
older (59.6 vs. 53.3 years, P < 0.05), had a higher frequency of C4-C6
(22.0% vs. 6.5%, P < 0.05), a higher incidence of obesity (31.4% vs. 5.4%, P
< 0.05) and was more often treated by a redo surgery or a crossectomy
stripping (48.3% vs. 13.4% and 38.1% vs. 21.8%, respectively, P < 0.05). We
have observed a dramatic decrease in incidence of LC after January 2004 (1.3%
vs. 5.3%, P < 0.05) corresponding to a new surgical practice for the
treatment of VVs: stripping, crossectomy and redo surgery at the groin were
less frequent (74.6% vs. 7.7%, 74.6% vs. 0.2% and 11.3% vs. 0.1%, respectively,
P < 0.05), while isolated phlebectomy was more often performed during this
period (78.4% vs. 8.4%, P < 0.05).
CONCLUSION:
LC
after VVs surgery is not rare but frequently limited to lymphocele on limbs.
Older age, more advanced clinical stage and obesity were associated with a
higher frequency of LC. A mini-invasive and selective surgery has significantly
reduced the occurrence of LC.
PMID:
22312081 [PubMed - in process]
February
21, 2012
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Interdisciplinary
Lymphology: The Best Place for Each Discipline in a Team.
Foeldi E, Dimakakos EP.
Source
Foeldi
Clinic for Lymphology, Hinterzarten, Germany.
Abstract
The
term lymphology includes both the physiology and the pathology of the lymphatic
system. Many disciplines are involved in the study of the lymphatic system, to
correctly diagnose lymphatic diseases and to ultimate provide the best
available treatment for the patient. Lymphedema is one of the most common
lymphatic diseases, potentially causing significant problems for the patient
and for the health system in general. The aim of this article is to discuss the
best placement and role for each discipline within an interdisciplinary team in
order to provide an effective management of lymphedema and related lymphatic
diseases.
PMID:
22336902 [PubMed - as supplied by publisher]
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Multidisciplinary
Lymphedema Treatment Program.
Papadopoulou MC, Tsiouri I, Salta-Stankova R, Drakou A, Rousas N, Roussaki-Schulze AV, Giannoukas AD.
Source
University
Hospital of Larissa, Larissa, Greece.
Abstract
Lymphedema
is an underrecognized and undertreated condition that requires a
multidisciplinary approach in an individualized program that will address the
special needs of each patient. In an ideal setting of an outpatient management
program the team should be composed of a vascular surgeon, a dermatologist, a
physiotherapist, a dietician, a psychologist, a social worker, and an office
employee, working together in the assessment and management of all aspects of
lymphedema. All treatment strategies and actions taken should ultimately focus
on the improvement of the quality of life of patients suffering from lymphedema
and on the prevention of lymphedema in high-risk patients.
PMID:
22336900 [PubMed - as supplied by publisher]
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Wound
Physicians: Lymphedema Is Not a Problem That Will Go Away if
Ignored.
Lazarides MK, Mani R.
Source
Democritus
University Hospital, Alexandropoulis, Greece.
PMID:
22336899 [PubMed - as supplied by publisher]
Eur J Surg Oncol. 2012 Feb 13.
[Epub ahead of print]
Analysis
of direct oil contrast lymphography of upper limb lymphatics traversing the
axilla - A lesson from the past - Contribution to the concept of axillary
reverse mapping.
Pavlista D, Eliska O.
Source
Oncogynecologic
Center, Department of Obstetrics and Gynecology, First Faculty of Medicine,
Charles University in Prague and General University Hospital, Apolinarska 18,
Prague 12801, Czech Republic.
Abstract
INTRODUCTION:
Axillary
reverse mapping (ARM) is a method to preserve upper extremity (UE) lymphatics
during axillary surgery in breast cancer patients. This may reduce the
incidence of lymphedema. Very precise method to demonstrate lymphatic drainage
is direct X-ray lymphography.
MATERIALS
AND METHODS:
The
evaluation of direct lymphography X-ray images of the axilla and proximal part
of the upper extremity was performed in 9 subjects. As contrast was used
Lipiodoil injected on the dorsal side of hand.
RESULTS:
The
lymph from UE is drained by 2-4 main afferent collectors, which in 5 of 9 cases
entered into one node in the lateral axilla (ARM node). This node was
considered to be the sentinel lymph node for the UE. In 4 cases a cranial
collector was shown, which led directly to nodes in the upper part of the
axilla. This collector had numerous anastomoses with other collectors before
entering the axillary nodes. The most important finding is the demonstration of
numerous lymphatic anastomoses that take place between all imaged nodes in the
axilla including the caudal nodes, which is the most frequent localization of
the breast sentinel lymph node.
CONCLUSION:
The
relationship of lymphatic drainage of the UE and breast are closely related and
share numerous connections. These connections represent the main problem of the
ARM concept because they may pose potencional route for metastatic cancer cells
in sentinel node positive breast cancer patients. Further studies are necessary
to improve understanding of this method. Axillary reverse mapping - breast
cancer - lymphedema - sentinel node biopsy.
Copyright
© 2012. Published by Elsevier Ltd.
PMID:
22336143 [PubMed - as supplied by publisher]
February
26, 2012
Int J Low Extrem Wounds. 2012
Feb 21. [Epub ahead of print]
Reporting
an Alliance Using an Integrative Approach to the Management of Lymphedema in
India.
Ryan TJ, Narahari SR.
Source
Oxford
University and Oxford Brookes University, Oxford, Oxfordshire, UK.
Abstract
In
India 553 million persons are estimated to live in areas endemic for LF;
approximately 21 million have symptomatic filariasis. Of the approximately
16.02 million cases of lymphedema caused by LF globally, 7.44 million (46.4%)
are in India. India had seen diethyl carbamizine, and/or albendazole, delivered
to whole populations, beginning the project to eliminate the disease. But new
populations have developed the infection. In 2003 the need in resource-poor
countries for morbidity control of lymphatic filariasis (LF) became clear,
prompting the study by the Institute of Applied Dermatology in Kerala, India.
Under this study,self help and family members assisted in home-based care,
combining compression bandaging, yoga exercises, heat therapy using steaming,
and skin care according to Ayurvedic medicine. Lymphedema presents with
different patterns in the skin with gross changes in the epidermis, dermis, or
subcutaneous tissue. Skilled and time-consuming counselling is important to
give patients support. An almost immediate reduction in inflammatory episodes
from 80.4% to 8.6% shows up within 2 or 3 weeks, and therefore, intake of
antibiotics can be stopped. The second major response is reduction in the size
of the limb. Volume reduction for large-sized limbs at 3 months is 39%, with a
confidence interval of 4.9 to 5.9 L.
PMID:
22354118 [PubMed - as supplied by publisher]
Arch Dermatol. 2012
Feb;148(2):260-2.
Lichen
sclerosus exhibiting histologic signs of lymphedema: an essential factor in the
pathogenesis of verruciform xanthoma.
Carlson JA, Carlson GD, Murphy M, Rohwedder A.
Source
Albany
Medical College, 47 New Scotland Ave, MC-81, Albany, NY 12208.
[email protected].
PMID:
22351836 [PubMed - in process]
Clin Cancer Res. 2012 Feb 20.
[Epub ahead of print]
Connexin
47 mutations increase risk for secondary lymphedema following breast cancer
treatment.
Finegold D, Baty C, Knickelbein K, Perschke S, Noon S, Campbell D, Karlsson J, Huang D, Kimak M, Lawrence E, Feingold E, Meriney S, Brufsky AM, Ferrell R.
Source
pediatrics/human
genetics, university of pittsburgh.
Abstract
PURPOSE:
Secondary
lymphedema is a frequent complication of breast cancer associated with surgery,
chemotherapy, or radiation following breast cancer treatment. The potential
contribution of genetic susceptibility to risk of developing secondary
lymphedema following surgical trauma, radiation, and other tissue insults has
not been studied.
EXPERIMENTAL
DESIGN:
To
determine if women with breast cancer and secondary lymphedema had mutations in
candidate lymphedema genes, we undertook a case - control study of 188 women
diagnosed with breast cancer recruited from the University of Pittsburgh Breast
Cancer Program (http://www.upmccancercenter.com/breast/index.cfm) between
2000-2010.Candidate lymphedema genes, GJC2 (encoding connexin 47 [Cx47]),
FOXC2, HGF, MET, and FLT4 (encoding VEGFR3), were sequenced for mutation.
Bioinformatics analysis and in vitro functional assays were used to confirm
significance of novel mutations.
RESULTS:
Cx47
mutations were identified in individuals having secondary lymphedema following
breast cancer treatment but not in breast cancer controls or normal women
without breast cancer. These novel mutations are dysfunctional as assessed
through in vitro assays and bioinformatics analysis, and provide evidence that
altered gap junction function leads to lymphedema.
CONCLUSIONS:
Our
findings challenge the view that secondary lymphedema is solely due to
mechanical trauma and support the hypothesis that genetic susceptibility is an
important risk factor for secondary lymphedema. A priori recognition of genetic
risk 1) raises the potential for early detection and intervention for a high
risk group, and 2) allows the possibility of altering surgical approach and/or
chemo- and radiation therapy, or direct medical treatment of secondary
lymphedema with novel connexin modifying drugs.
PMID:
22351697 [PubMed - as supplied by publisher]
Gene. 2012 Feb 14. [Epub ahead
of print]
Novel
mutation in the FOXC2 gene in three generations of a family with
lymphoedema-distichiasis syndrome.
Sutkowska E, Gil J, Stembalska A, Hill-Bator A, Szuba A.
Source
Department
and Clinic of Orthopaedic and Traumatologic Surgery-Division of Rehabilitation,
Wroclaw Medical University, Borowska str. 213, 50-556 Wroclaw,
Poland.
Abstract
Lymphoedema-distichiasis
syndrome (LDS, OMIM #153400) is a genetic disorder with an autosomal dominant
pattern of inheritance caused by mutations in the FOXC2 gene. Affected
individuals typically present with lower extremity lymphoedema and
distichiasis. The most common types of mutations in FOXC2 gene include small
deletions and insertions, but duplications, duplications-insertions, missense
and nonsense mutations were also found. Herein, we describe three generations
of a family diagnosed with LDS caused by a new mutation in the FOXC2 gene. This
mutation is a frameshift due to a deletion of two nucleotides (CC) in C repeats
between C586 and C591. This mutation leads to protein truncation as a result of
an earlier insertion of a stop codon. To the best of our knowledge, this is the
first description of this mutation in the literature and could be coupled with
an atypical lymphoscintigram.
Copyright
© 2012 Elsevier B.V. All rights reserved.
PMID:
22349027 [PubMed - as supplied by publisher]
Ann Dermatol. 2011 Dec;23(Suppl
3):S303-5. Epub 2011 Dec 27.
Unilateral
psoriasis in a woman with ipsilateral post-mastectomy lymphedema.
Kim M, Jung JY, Na SY, Na SJ, Lee JH, Cho S.
Source
Department of
Dermatology, Seoul National University College of Medicine, Seoul,
Korea.
Abstract
Psoriasis is a
multi-factorial disease with various clinical manifestations. We present a case
of unilateral psoriasis associated with ipsilateral lymphedema that developed
after mastectomy for breast cancer. A 42-year-old Korean woman was referred to
our clinic with a 1-month history of multiple erythematous scaly patches on the
right arm, back, and breast and was diagnosed with psoriasis by a skin biopsy.
Three years previously, she had been diagnosed with breast cancer (T1N2),
underwent a right quadrantectomy and axillary lymph node dissection, and
completed adjuvant chemotherapy followed by high-dose adjuvant radiotherapy.
She had started rehabilitation therapy on the right arm for secondary
lymphedema 30 months previously. Because of the long interval between radiation
and psoriasis, we speculated that changes in the local milieu caused by the
lymphedema might be a causative factor. We hereby report a rare case of
unilateral psoriasis following post-mastectomy lymphedema.
PMID:
22346263 [PubMed - in process] PMCID: PMC3276782
Breast. 2012 Feb 16. [Epub ahead
of print]
Factors
associated with long-term functional outcomes and psychological sequelae in
women after breast cancer.
Khan F, Amatya B, Pallant JF, Rajapaksa I.
Source
Department
of Medicine, Dentistry & Health Sciences, University of Melbourne, Grattan
Street, Parkville, VIC 3050, Australia; Department of Rehabilitation Medicine,
RoyalMelbourne Hospital, 34-54 Poplar Road Parkville, Melbourne VIC 3052,
Australia.
Abstract
The
objective of this study was to examine factors impacting long-term functional
outcomes and psychological sequelae in survivors of breast cancer (BC). A
clinical assessment and structured interview assessed the impact of BC on
participants' (n = 85) current activity and restriction in participation, using
validated questionnaires: Functional Independence Measure (FIM), Perceived
Impact Problem Profile (PIPP) and Depression Anxiety Stress Scale (DASS).
Participants showed good functional recovery (median motor FIM score = 78).
Three-quarters (74%) reported pain, 32% reported upper limb weakness, 31% pain
limiting shoulder movement and 29% lymphoedema. One third (32%) reported
greatest impact on psychological wellbeing. A substantial number of
participants reported high levels of depression (22%), anxiety and stress (19%
each). Factors associated with poorer current level of functioning and
wellbeing included: younger participants, recent diagnoses, aggressive tumour
types, receiving chemotherapy, shoulder limitation due to pain, and
lymphoedema. BC survivors require long-term management of psychological
sequelae impacting activity and participation.
Copyright
© 2012 Elsevier Ltd. All rights reserved.
PMID:
22342676 [PubMed - as supplied by publisher]
Cancer Radiother. 2012 Feb 17.
[Epub ahead of print]
[Upper
limb lymphedema after breast cancer treatment.]
[Article
in French]
Ben Salah H, Bahri M, Jbali B, Guermazi M, Frikha M, Daoud J.
Source
Service
de radiothérapie carcinologique, CHU Habib-Bourguiba, 3029 Sfax,
Tunisie.
Abstract
PURPOSE:
To
study the frequency and risk factors for upper limb lymphedema through a series
of patients treated for breast cancer.
PATIENTS
AND METHODS:
It
is a retrospective study about 222 patients treated for breast cancer during
the period between February 1993 and December 2003 in Sfax hospitals. Average
age was 51years (27-92years). Tumour was T2 in 59% of cases. All patients had
surgery with lymph node dissection. Infiltrating ductal carcinoma was the most
frequent histological type (80% of cases), with predominant SBR II grade (62%).
The mean number of removed lymph nodes was 12 (2-33). Axillary lymph node
metastasis was detected in 124 patients. Radiotherapy was delivered in 200
patients, including axillary irradiation in 30 cases. The mean follow-up was
68months (12-120).
RESULTS:
Lymphedema
appeared in 23% of cases (51 patients), 14months after surgery (mean period).
Lymphedema affected the brachium in 17% of cases, the forearm in 12% of cases
and all upper limb in 71% of cases. Fifty percent of patients had
rehabilitation. However, improvement of lymphedema was obtained in 18 cases.
Parameters predicting lymphedema were studied. Significant risk factors were
obesity, infection and a number of removed lymph node above 10. The type of
surgery, axillary irradiation and shoulder abduction deficit did not predict
lymphedema.
CONCLUSION:
Lymphedema
of the arm is a frequent consequence of breast cancer treatment. The risk of
lymphedema is correlated with obesity, infection and a number of removed lymph
node above 10.
Copyright
© 2012 Société française de radiothérapie oncologique (SFRO). Published by
Elsevier SAS. All rights reserved.
PMID:
22342349 [PubMed - as supplied by publisher]
MED
NEWS:
February
11, 2012
Highlighting A Rare Subset Of Diseases Involving The
Lymphatic System –
A clinically challenging and under-studied subset of diseases
affecting the lymphatic system and grouped under the disease spectrum
lymphangiomatosis and Gorham's disease is the focus of a special issue of
Lymphatic Research and Biology, a peer-reviewed journal published by
Mary Ann Liebert, Inc.. The issue is available free online.*
Guest
Editor, and Journal Associate Editor Francine Blei MD, MBA, St. Luke's
Roosevelt Hospital, NY, has compiled a collection of articles that highlight
the complex characteristics of these diseases, which can be localized, affect
multiple sites, or be systemic, may be congenital or acquired, and may cause
symptoms that range from mild to severe to life-threatening. The articles focus
on current knowledge, ongoing research, and how these diseases differ from
other lymphatic disorders.
"This disease spectrum affects a patient
population that is small in number, but the effects of the disease(s) are
devastating," says Stanley G. Rockson, MD, Editor-in-Chief of Lymphatic
Research and Biology and Allan and Tina Neill Professor of Lymphatic Research
and Medicine, Stanford University School of Medicine, CA. The collection of
articles in this special issue, "highlights the current state of knowledge (and
ignorance) in this paradoxically neglected area of lymphatic health and
disease."
February 14, 2012
Link Between NSAIDs And Reduced Cancer Metastasis
Strengthened By Study
A new study reveals key factors that promote the spread of cancer to lymph nodes and
provides a mechanism that explains how a common over-the-counter
anti-inflammatory medication can reduce the spread of tumor cells through the
lymphatic system. The research, published by Cell Press in the February 14
issue of the journal Cancer Cell, opens new avenues for the design
of antimetastatic therapies.
The lymphatic system consists of a network
of vessels that carry lymphatic fluid from the body organs back to the general
circulation. Along the way, lymphatic fluid percolates through lymph nodes.
Unfortunately, cancer cells sometimes spread (via a process called metastasis)
through the lymphatic system and can form secondary tumors in the lymph nodes.
The spread of cancer cells to the lymph nodes is an important indicator of
disease progression.
"Some tumors secrete protein growth factors that
can act on the lymphatic vessels to facilitate metastasis. For example,
elevated levels of the growth factor VEGF-D in human tumors correlate with
lymph node metastasis and poor patient prognosis," explains the senior study
author, Steven Stacker, associate professor from the Tumour Angiogenesis
Program, Peter MacCallum Cancer Centre in Melbourne, Australia. "However, thus
far, mechanisms underlying the transit of cancer cells through the larger
lymphatic vessels and into the lymph nodes remain elusive."
In the
current study, Stacker and colleagues investigated how collecting lymphatic
vessels, conduits that drain lymphatic fluid from tissues into lymph nodes, are
altered during VEGF-D-driven metastasis. The researchers discovered that VEGF-D
was linked to prostaglandin pathways, which are important regulators of
lymphatic vessel dilation. Nonsteroidal anti-inflammatory drugs (NSAIDS), which are known
inhibitors of prostaglandin synthesis, reduced lymphatic vessel dilation and,
therefore, inhibited tumor metastasis.
"This key interaction between
lymphatic system growth factors and prostaglandins reveals a mechanism for
physically preparing collecting vessels for tumor cell dissemination and a
mechanism by which NSAIDs can reduce cancer metastases through the lymphatic
system," concludes Dr. Stacker. "These insights may assist with the design of
additional therapeutics for cancer patients and enhance current approaches that
aim to prevent the spread of cancer cells through the lymphatic system and
potentially to distant organs."
February
21, 2012
Two Possible Options Identified For Treating Epstein
Barr Virus-Fueled Lymphomas In Immunosuppressed
Patients
Some 90 percent of people are exposed to the Epstein Barr virus (EBV)
at some point in their life. Even though it is quickly cleared from the body,
the virus can linger silently for years in small numbers of infected B cells.
According to researchers at Children's Hospital Bostonand the Immune Disease
Institute (IDI), the immune system subdues the virus by watching for a single
viral protein called LMP1, knowledge that has already helped suggest two new
treatments for the EBV-fueled cancers seen in some
immunosuppressed patients.
The study team, led by Klaus Rajewksy, MD,
and Baochun Zhang, MD, PhD, of the Program in Cellular and Molecular Medicine
at Children Hospital Boston and the IDI, reported their results online in the
journal Cell.
While the immune system's T cells rapidly
clear most EBV-infected B cells, about one in a million infected cells escapes
destruction. Within these cells, the virus enters a latent phase, kept in check
by the watchful eye of so-called memory T cells. This uneasy relationship
usually holds steady the rest of a person's life, unless something - such as
infection with HIV or use of anti-rejection
drugs following a transplant - suppresses the immune system and breaks the
surveillance. The virus can then reawaken and drive the development of B cell
cancers like AIDS-associated B cell lymphoma and post-transplant
lymphoproliferative disorder.
To better understand how the immune
system maintains its watch and how the virus turns cells cancerous, Rajewsky
and his team had generated a model mimicking latent EBV infection by
engineering mice whose B cells contained an inducible version of viral LMP1.
Researchers have long known that EBV needs LMP1 to turn B cells cancerous, but
modeling this relationship in vivo had proven challenging.
"We had
previously attempted to develop an animal model of LMP1 transformation of B
cells," said Rajewsky, who recently moved to the Max Delbrück Center for
Molecular Medicinein Germany, "but we had never been able to get the mice in
our models to actually produce any mature B cells. The immune response against
the LMP1-producing B cells was so robust that the cells were eliminated very
early on."
Their breakthrough came when Zhang and colleagues
reengineered the model to lack T cells. "The mice were initially fine, but
succumbed within two to three months to aggressive B cell lymphomas," Rajewsky
said. "The profile mimicked very closely what we see in immunosuppressed
lymphoma patients." In additional experiments with Rajewsky's original model,
the team eliminated the mice's T cells before activating the viral protein in B
cells, sparking a similar but even more rapid fatal disease.
The team
also made several observations with possible clinical application. First, they
noted that in the mouse model the LMP1 producing B cells were being attacked by
a specific kind of T cell called a CD4+ T cell. "Transplant patients who
develop B cell lymphomas because they are immunosuppressed by their
anti-rejection drugs are often treated with T cells that carry the CD8 marker,"
Rajewsky noted. "These results would argue for also considering CD4+ T cells
for treatment."
Second, they found that tumors in the LMP1 producing
mice often displayed targets recognized by another kind of immune cell called a
natural killer (NK) cell. Seeing an opportunity, Rajewsky worked with cancer
immunologist Glenn Dranoff, MD and colleagues at Dana-Farber Cancer Institute,
to test a potential therapeutic agent that uses a portion of the NK cell
activating receptor called NKG2D,fused to the stimulatory Fc portion of an
antibody, a combination capable of activating and directing immune attack
against tumor cells. In a transplantation model of LMP1-fueled lymphomas, the
NKG2D-Fc fusion proved quite capable of reducing tumor growth and prolonging
survival of the recipients.
"These preclinical results suggest
administration of the NKG2D-Fc fusion protein, perhaps combined withtreatment
with CD4+ T cells, could benefit some patients with EBV-driven lymphomas,"
Rajewsky said. "What we can say with certainty, though, is that LMP1 is the
immune system's primary surveillance trigger following EBV infection and
clearance, knowledge that we think will open doors to additional treatment
options."
February 25, 2012-02-27
Exploiting A Weakness In Cancer's Defense
System
Researchers at the EPFL have identified an important mechanism that
could lead to the design of more effective cancer vaccines. Their discovery
of a new-found role of the lymphatic system in tumour growth shows how tumours
evade detection by using a patient's own immune system.
Tumour cells
present antigens or protein markers on their surfaces which make them
identifiable to the host immune system. In the last decade, cancer vaccines
have been designed that work by exposing the patient's immune cells to
tumour-associated antigens and so priming them to kill cells that present those
antigens. These have caused much excitement, not least because by acting so
specifically on cancer cells, they could potentially eliminate the unpleasant
side effects of chemo- and radiotherapy.
Like soldiers protecting
a fort
However, clinical trials of such vaccines have had a very
low success rate to date, mainly because tumours have various mechanisms for
evading detection by immune cells, even when those immune cells - called T
cells - have been primed to seek them out. Those mechanisms are, in general,
poorly understood. But in a paper to be published this week in Cell Reports,
the laboratories of Melody Swartz at EPFL and Stéphanie Hugues at UNIGE provide
a key insight into one of them. They describe for the first time how, like
soldiers protecting a fort, lymph vessels surrounding a tumour ward off T cell
attack.
Plenty of research has shown that tumours can induce the growth
of lymph vessels in their vicinity, and that this growth is correlated with
metastasis and poor prognosis. It was assumed that these lymph vessels simply
provided an escape route for cancer cells, transporting them to distant sites.
In the new study, led by postdoc Amanda Lund, the researchers show that lymph
vessels actually suppress the immune response, deleting the attacking T cells
or leaving them "functionally exhausted" by the time they reach the tumour.
They studied a type of tumour that expresses large amounts of VEGF-C, a
molecule that is naturally expressed in humans and that stimulates lymphatic
growth. Having engineered the tumour cells to express a foreign antigen, they
compared the efficacy of a vaccine designed to prime T cells to kill cells
carrying that antigen, either when VEGF-C was present or when its activity was
blocked . With VEGF-C suppressed, the vaccine's efficacy increased and tumour
growth slowed fourfold.
A weakness in cancer's defense system
exploited
The researchers went on to show that the endothelial
cells which line lymph vessels "scavenge" tumour-specific antigens and present
them to the tumour-specific T cells in a suppressive manner. This, in turn,
promotes the local deletion of those T cells. According to Prof Swartz, that
means that first targeting the lymph vessels associated with a tumour could, in
theory, significantly increase the efficacy of existing cancer vaccines. "It
would be like removing the soldiers from around the fort before sending in your
opposing army," she says. "If you disable the lymph vessels' suppressive
functions, our data suggest that tumour-killing T cells would do their job a
lot more effectively." Future clinical trials are needed to put that theory to
the test.
GOOGLE:
January
31, 2012
Advances in Cancer Care: Diagnosis, Treatment and
Survivorship – TribLocal –
Sorry
this is a one-time meeting that has passed
February
6, 2012
Local groups stepping in after national cancer charity
changes support - Scranton Times-Tribune –by
Erin L. NissleyErin L. Nissley –
After
a national group that helps cancer patients around the country announced it
would be scaling back support of certain programs, local organizations have
been gearing up to fill the gaps.
In
late November, the American Cancer Society sent a letter to local groups
informing them that, as of Jan. 1, it would "no longer provide financial
assistance for wigs, medications, durable medical equipment, lymphedema
supplies or lodging."
Jo-Anne
Sessa, ACS regional vice president, said there are no plans to completely cut
programs, including those that provide cancer patients with wigs and help out
with lodging while they undergo treatment.
She
added, though, that ACS is focusing its resources on areas "where we can make
the most impact," including providing patients with transportation and mileage
reimbursement to and from appointments.
"We've
identified access as the biggest issue across the country," Ms. Sessa said. "In
this economy, it is more challenging (to raise money) and every organization
has to focus their resources."
The
changes to ACS programs will mean cancer patients will depend even more on
local groups for help, said Northeast Regional Cancer Institute President
Robert Durkin. Like many local groups, Northeast Regional Cancer Institute has
suffered deep funding cuts - including the loss of about $1 million a year in
state funding - that makes it difficult to fulfill the needs of cancer patients
in the community, especially when a major resource like ACS makes a decision to
cut support for certain programs.
"We're
local, so we base our resources on what the needs are in the community," Mr.
Durkin said, pointing out that local donations made to ACS do not necessarily
stay in the community.
The
region is lucky to have resources that can help cancer patients, especially a
group like Northeast Regional Cancer Institute, said Dr. Harmar Brereton, a
radiation oncologist at Northeast Radiation Oncology Center.
"The
psychological profundity of having cancer is a really big deal" and cancer
patients need help in a variety of ways, Dr. Brereton said. "It is harder for
all groups to raise funds. We need to get the word out that local groups are
here taking care of these needs, but they need help to do it."
Connecting
cancer patients to resources both local and national is part of the job
description for Kathryn Cramer, an oncology social worker at Northeast
Radiation Oncology Center.
"We
never let anyone do without," she said. "There are programs that can help
patients with medication costs. We can go through churches, the Salvation Army
and the American Cancer Society."
Delta
Medix, which offers treatment for cancer patients, launched a nonprofit
foundation on Oct. 1 that will help cancer patients throughout the region,
regardless of where they obtain treatment. Delta Medix CEO Margo Opsasnick sees
the main focus of the foundation as helping cancer patients with the costs of
genetic testing, which can help with treatment plans for breast cancer patients
and covering co-pays and treatments not covered by insurance. She also hopes
the foundation can focus on helping with smaller needs, like hiring a maid to
help with housework.
"Most
breast cancer patients have to undergo chemotherapy and radiation," she said.
"Wouldn't it be nice for them to come home to a clean house?"
Both
Mrs. Opsasnick and Mr. Durkin said ACS's decision to scale back certain
programs was strange, especially because it came around the same time the group
sent a letter asking a local group to suspend an annual gala fundraiser that
generated tens of thousands of dollars for the charity.
Earlier
this month, ACS officials told The Times-Tribune they made a decision to do
away with Scranton's Ball of Hope after looking at rising costs of the event
and the dip in amount of money raised. October's Ball of Hope cost about
$28,000 and raised about $70,000, according to Erik McGaughney, the American
Cancer Society's income development director for the eastern region of
Pennsylvania.
The
2010 Ball of Hope raised $100,000 and cost about $16,000, he said in previous
interviews. Much of the funds raised went to support a summer camp in Lebanon
County for children with cancer and siblings of children with
cancer.
"It
is certainly puzzling," Mr. Durkin said.
Mrs.
Opsasnick agreed, pointing out that a local group of volunteers organized the
Ball of Hope each year.
"That
group didn't ask for anything from ACS," she said. "Why would you ever turn
down money when you're out there trying to do good things for cancer
patients?"
Contact
the writer: [email protected]
February
7, 2012
SJH RehabCare opens another
location - Vineland Daily Journal –
HARRISON
– South Jersey Healthcare Sports RehabCare, an outpatient orthopedic
rehabilitation provider, recently opened its newest location in Mullica Hill at
201 Tomlin Station Road.
The
facility offers sports and orthopedic physical therapy, occupational therapy,
spine care, worker’s compensation services and lymphedema
services.
The
facility incorporates the Nintendo Wii to enhance participation in therapy
treatment.
“Mullica
Hill ... .is a thriving community, and the staff at SJH Sports RehabCare at
Tomlin Station Park look to continue our commitment to improve the quality of
lives of our patients, and residents in the communities we serve,” said Debbie
Franceschini, director of SJH RehabCare Services.
The
facility has two new staff members:
Kristy
Meade, MSPT, ATC has more than 10 years clinical experience and will oversee
SJH Sports RehabCare. Her special interests include post-surgical patients,
athletic injuries, body mechanics and postural education, with a specialty
focus on trends in ACL rehabilitation.
Victoria
Rink, OTR/L, CHT, is the OT clinical coordinator for all inpatient and
outpatient facilities and SJH Sports RehabCare locations. Rink is a certified
hand therapist with more than 17 years of experience treating upper extremity
disorders.
For more
information, contact SJH Sports RehabCare at (856) 241-2533 or [email protected]. SJH RehabCare
and SJH Sports RehabCare have five convenient locations serving South
Jersey.
February 8,
2012
PolyGel Portable Device for DVT Therapy Helps Patients
Be Compliant After surgery – SBWire –
Tampa, FL
-- (SBWIRE) -- 02/08/2012 -- Major
surgical procedures are events where medical staff must be reminded that
certain patients can be at higher risk for deep vein thrombosis and venous
thromboembolism. Postphlebitic syndrome and pulmonary embolisms can occur in
the hours, days, and weeks after a surgery. An article on Medscape recently
highlighted how prophylaxis with medication and mechanical devices is
critical.
“Each patient must be assessed case-by-case, but the article
‘Deep Venous Thrombosis Prophylaxis in Orthopedic Surgery’ shows that DVT
therapy helped reduce DVT by 60 percent,” said Greg Grambor, president of
Vascular PRN, a company that fills prescriptions for sequential compression devices
and intermittent pneumatic devices for healthcare professionals
nationwide.
The authors of the Medscape article showed that passive
devices such as TED hose and active devices like IPC devices or venous foot
pumps lessened the chance of DVT and did not add the risk of bleeding. Mechanical compression devices
helped to improve blood flow and circulating fibrinolysins. Patient compliance
and efficacy are the most important factors that medical professionals want out
of devices.
“The latest technology is a PolyGel portable device that is
only one pound, the size of a small book, and works off battery power,” said
Grambor. “In the hours after surgery or for at-home care after leaving the
hospital, the PolyGel Ca5 DVTCare System provides the best
compliance.”
The PolyGel portable device lasts for 15 hours when used
for single leg therapy and 8 hours for both legs. Since it is carried over the
shoulder in a compact case, patients can go from their hospital bed, down the
hall to physical therapy, and move about their home when healing in the weeks
after a surgery. The PolyGel’s two segmented cuffs wrap comfortably around the
leg to promote blood flow.
“The PolyGel is super simple to put on the
patient and effortless to keep on the patient,” said Grambor. “You don’t have
to worry about the patient being hooked up to a power source or what happens
when they go to the bathroom.”
And when the PolyGel device needs to be
cleaned, it can be done with mild soap and a washcloth, and it can be charged
in an outlet once the 8 to 15 hours of use is up. It continues to operate while
charging, providing for totally uninterrupted therapy during those critical
post surgery hours.
Vascular PRN has decades of experience helping
nursing homes, surgery centers and hospitals, managed care organizations, and
other institutions with their DVT product needs. To learn more about the
PolyGel portable device, Sequential Compression Devices, IPC devices, or
Lymphedema boots visit http://www.vascularprn.com/ or
call 800.886.4331.
February 8,
2012
ImpediMed L-Dex® U400 device receives expanded U.S.
coverage - Proactive Investors Australia –
ImpediMed’s (ASX:
IPD) L-Dex® U400 device will receive greater coverage in the U.S. as an aid in
the clinical assessment of unilateral lymphoedema of the arm in females,
following the passing of the Patient Protection and Affordable Care
Act.
As a result of the passing of the Act, which makes certain
indigenous tribes and organisations eligible to access the health plans for
federal employees, ImpediMed expects an increase in covered lives for federal
healthcare plans from 1 May 2012.
The estimated number of employees of
indigenous tribes or organisations who are eligible to access federal health
plans is about 350,000.
Direct family members of these employees are
also eligible and include spouse and children up to the age of 26.
As a
result, coverage under federal plans could be expected to increase by an
estimated 700,000 covered lives.
Lymphoedema occurs when the lymphatic
system does not work properly, resulting in the long-term swelling of parts of
the body.
Stanford
Breast Cancer Lymphedema Registry
Meanwhile, the first patient
has been enrolled into the Stanford Breast Cancer Lymphedema
Registry.
Stanford University Medical Center initiated the registry
which will collect and analyse data from breast centres and physicians’ offices
across the U.S.
The registry collects clearly defined health and
demographic information on patients with specific health characteristics, in
this case, breast cancer.
The Stanford Breast Cancer Lymphedema Registry
has been designed to investigate the impact of lymphoedema surveillance upon
breast cancer survivors.
Within a year, researchers expect to have
gained further substantial insights into the value of systematic early
surveillance to prevent and minimise the lymphoedema risk in women treated for
breast cancer.
Patient enrolment will increase in the coming months as
the registry is rolled out to physician sites.
Data generated from
ImpediMed’s L-Dex® U400 device will make-up one arm of the registry.
The
L-Dex® U400 device is the first medical device with a US Food and Drug
Administration clearance to aid health care professionals, clinically assess
secondary unilateral lymphoedema of the arm and leg in women and the leg in
men.
February 13,
2012
High Desert Pharmaceuticals gets boost from export
deal - Northern Nevada Business Weekly – by Rob Sabo –
An
overseas distribution agreement could bring a much-needed financial lift to
High Desert Pharmaceuticals.
The
small Reno company, founded in 2007, recently found a distributor to export the
company’s products to Belgium, Holland, Germany, Switzerland, Poland and
Israel. High Desert Pharmaceuticals has two primary products:
CompressionAssist, used by people who wear heavy compression stockings to
combat lymphedema, which causes painful swelling in the lower legs; and
GloveGlide, used by medical professionals and others who wear surgical gloves.
The products allow easy fitting and donning of compression stockings or of PVC,
nitrile, and latex gloves.
“We
are hoping that is a nice opener for us on a global scale,” says John Wyaux,
High Desert’s executive vice president. The company’s other principal, Dieter
Berndt, is a chemist who created, patented and trademarked the two products.
High Desert Pharmaceuticals won “Product of the Year” for 2009 by Caregiver.com
for CompressionAssist.
The
company’s products are manufactured at a small Carson City facility, while the
small bottles are labeled and boxed in China. Hoping to extend its reach, High
Desert has begun marketing CompressionAssist to schools that train medical
staff about lymphedema. Other potential sources of revenue include medical
offices, hospitals and hospices.
“The
three major lymphedema schools train 400 to 500 students each year, and 200
returning students each year, and those are our potential customers,” Wyaux
says.
For
GloveGlide, High Desert Pharmaceuticals is targeting workers who routinely use
surgical gloves, such doctors, mechanics, law enforcement and security
screeners at airports. Getting the word out about the products, finding the
right channels, and getting potential customers to spend money on a new product
have been major obstacles to widespread use, Wyaux says.
“Given
the state of the economy, we have had to be resourceful,” he says.
Last
year was the first in which High Desert Pharmaceuticals posted a modest profit,
Berdt says. The company has been self-funded since its inception. However, in
order to advance the company’s products, High Desert Pharmaceuticals is seeking
project financing to attract new capital.
Berdt
says he came up the idea to create a donning lubricant after taking his wife to
a doctor’s appointment and watching a nurse struggle to put on latex gloves. He
had extensive experience working with silicone-based products, so he began
experimenting with different types of lubricants. An added side effect he
stumbled across was an 80 to 90 percent reduction in sweat inside the
gloves.
New
products include a long-lasting surface wipe called NanoSept that uses
nanotechnology to counter bacteria, fungi and viruses.
“It
is nearly indefinite,” Berndt says. “It will virtually last forever, unless it
is abraded.”
Berndt
hopes to eventually place the small NanoSept wipes inside the packaging of
electronic devices such as cell phone and tablet computers so consumers can
permanently keep the surfaces of their electronics clean. Hospital settings,
and commercial uses such as keyboards and phones or escalator handrails are
other potential use for the wipes, Wyaux says.
Berndt
says High Desert Pharmaceuticals will commercially introduce the NanoSept wipes
this year, and he plans to establish a pilot program with the product at
several Washoe County schools later this year.
“It
has spectacular potential,” he says.
February 13,
2012
Actress Zina Bethune killed in
hit-and-run - Entertainment Weekly – by Lanford Beard –
Zina
Bethune, a 66-year-old actress and dancer, was fatally struck in a presumed
double hit-and-run when she stopped to help an injured animal, reports the
L.A. Times. Bethune
was a famed ballerina, who taught dance to disabled children for the last 30
years. She herself had overcome diagnoses of scoliosis and lymphedema before
training with George Balanchine and the New York City Ballet at age
14.
Though
she went by Zina Feeley in everyday life, she made her professional name (Zina
Bethune) in 1958 on The
Guiding Light and had roles on Santa
Barbara, Party
of Five, and the 1960s medical drama The
Doctors and the Nurses. She also choreographed for the 1987 TV
series Nutcracker:
Money, Madness & Murder.
Los
Angeles police are investigating the incident, which took place just after
midnight on Sunday. Bethune is believed to have stopped to check on an injured
animal when a car going the opposite direction hit her and threw her across the
intersection, when another car struck her and dragged her 200 yards. The blows
resulted in severe head injuries, and Bethune was pronounced dead at the scene.
Neither of the drivers who struck Bethune have been formally
identified.
February 15,
2012
Health Calendar: Week of Feb. 16,
2012- Daily Breeze – By Sandy
Geretydailybreeze.com
-
Saturday
Lymphedema
A to Z.
Cancer Support Community-Redondo Beach will host Steffy Trousdale, LVN, COF, to
discuss the signs, symptoms and treatment options for Lymphedema from 10 a.m.
to noon Saturday at 109 W. Torrance Blvd., Redondo Beach. Call 310-376-3550, or
visit www.cancersupportredondobeach.org.
February
15, 2012
Complications from breast cancer treatment should be
treated sooner, says UM-Flint researcher
- minbcnews.com - by Kevin Usealman –
FLINT -- A
University of Michigan researcher has concluded 11 years of study
on breast cancer complications. Cindy Pfizer is an associate director of
research in U of M Flint's physical therapy department. The study, which she
began in 2001 while in Washington is in conjunction with researchers at Walter
Reed National Military Medical Center and the National Institutes of Health
Clinical Center.
They say in their conclusion they found that early
diagnosis and treatment of breast cancer-related complications such as
lymphedema, can reduce costs by as much as $2,500 per patient as well as the
need for intensive rehabilitation.
The research team
developed a model for surveillance of complications that result from the
treatment of breast cancer, so they can be identified and treated before the
patient begins to notice problems. The other primary investigator in the study
was Ellen Levy, a researcher from the National Institutes of Health. Pfalzer
continues to aid in data analysis, database updating and manuscript generation
while at her position at UM-Flint.
February
17, 2012
Supporters rally for imprisoned Hash Bash organizer
from Royal Oak - Royal Oak Daily Tribune – By Catherine
Kavanaugh –
Imprisoned last
year following a drug raid at his Royal Oak house, Hash Bash organizer and
medical marijuana proponent Adam Brook has a growing base of supporters trying
to make his time behind bars more comfortable.
Brook, 43, is four months
into a two-year sentence after pleading guilty to two counts of possessing a
firearm while committing a felony.
He suffers from lymphedema, an
incurable condition that causes the legs and arms to swell and is often brought
by on cancer treatment. Brook had thyroid cancer.
“Adam is not a well
man,” said Melissa Griggs, who is selling “Free Adam Brook Now” T-shirts for $10
each to raise money for his prison store account. “His legs are swollen, the
skin is splitting open and he needs special pressurized wraps.”
Griggs
acknowledges Brook has no chance for an early release, parole or probation
because of the mandatory sentence for his firearm pleas.
However, she
said Brook is on a lot of peoples’ minds as plans are made for the 2012 Hash
Bash in Ann Arbor, where she also will sell the T-shirts.
Griggs said
she is among those who people believe Brook was singled out by Oakland County
law enforcement for being a marijuana activist.
“I believe they put him
in prison because of who he is,” Griggs said. “He’s a political prisoner. He
organized the Hash Bash for 20 years and he was the 1994 High Times freedom
fighter of the year.”
Griggs said Brook was at physical therapy when his
home was raided on Jan. 12, 2011.
Undercover police with the Oakland
County Narcotics Enforcement Team (NET) said they seized 600 grams of
marijuana, two handguns, a shotgun, a bullet-proof vest, marijuana candy, a
triple-beam scale, and a tally sheet with names and prices from Brook’s house
on Whitcomb Avenue. Continued...
Brook
was charged with violating drug and weapons laws. He once had a state-approved
medical marijuana card but it had expired and the 1.3 pounds of marijuana he
possessed exceeded the 2.5 ounces allowed to medical marijuana
patients.
Last October, Brook was sentenced to two years in prison after
pleading guilty to two counts of possessing a firearm while committing a
felony. He also pleaded no contest to one count each of delivery and/or
manufacture of marijuana and being a felon in possession of a firearm. His
prior felony conviction was for carrying a concealed weapon in the late
1980s.
Oakland Circuit Judge Rudy Nichols didn’t sentence Brook to any
time for the drug charge or being felon with a firearm. Brook is serving his
two years at the Parnell Correctional Facility, a minimum-security prison in
Jackson.
With the 41st annual Hash Bash set for April 7, a lot of people
are just finding out why Brook doesn’t have a lead role in its organization.
Griggs said she is selling donated T-shirts because people want to help him
until his Oct. 5, 2013, release date.
“Every cent of the money raised
will go to Adam’s commissary account so he can buy decent soap that doesn’t dry
out his skin, shampoo, and T-shirts so he isn’t cold,” Griggs said.
Her
effort is drawing attention to Brook’s case on social media. One Facebook
posting by a supporter says, “He’s in jail for an antique pistol…and a Normandy
Beach flak jacket from an American hero that landed on D-Day to save
Europe.”
Oakland County Prosecutor Jessica Cooper refuted that and
laughed at the notion Brook is a political prisoner.
“I have no idea who
he is,” she said.
Cooper said a black powder six-shot Fillipieta gun
found at Brook’s house was alleged to be antique but three other weapons also
were seized.
“The antique handgun is not an issue,” Cooper said. “They
neglect to talk about the .380 pistol filly loaded in the nightstand, a
Remington 1100 shot gun in the closet and a .357 next to a chair.” Continued...
Brook’s
supporters contend the firearms were legally registered to another person in
the household. However, Brook couldn’t be anywhere there was a gun because of
the prior felony conviction.
His supporters also say the 600 grams of
marijuana at the house were “used up” from a vaporizer process that lets people
inhale active cannabinoids while avoiding harmful smoke toxins.
Cooper
said marijuana was found in jars and bags and there was scale to measure out
quantities. Police also seized Vicodin and THC candy from Brook’s house, she
added.
“If we had prosecuted on all drug counts he could be doing two
years plus two years,” Cooper said.
Griggs said Brook accepted a plea
deal to protect his family from assets being seized. She is selling the “Free
Adam Brook Now” T-shirts for $10 each to people who buy them in person from her
but has to add packaging and shipping costs to mail orders.
February
17, 2012
Grey's Anatomy Doc Speak: What's a
Gliosarcoma? – Wetpaint – by
Dan Clarendon –
Tumors
and lymph nodes and mania, oh my! If all of the medical lingo from last night's
double-header has got your head spinning double-time, have no fear. We've got
you covered. Here's a recap of some of the conditions covered on last night's
episodes of
Grey's Anatomy and
Private
Practice.
Erica suffered from a gliosarcoma,
a rare, malignant, cancerous tumor formed by glial cells in the brain
(basically cells whose job it is to support the neural cells). These cancers
rarely spread outside of the brain, but they have been known to move to the
blood, lungs, liver, and lymph nodes.
Bailey's patient's arm was so
enlarged because she had lymphedema,
a drastic swelling in the arms or the legs caused by a block in
the
lymphatic system. The lymphatic system is responsible for
draining fluid from organs and incorporating that fluid back into the
bloodstream. When there is a blockage, this fluid will build up and create
swelling. The most common cause of lymphedema is the removal or damage of lymph
nodes through cancer treatment.
Sheldon diagnosed Sam's sister Corinne
with hypomania,
a form of bipolar disorder in which affected individuals will often have
intense and unpredictable feelings of euphoria and irritability. Individuals
with hypomania experience no psychotic symptoms associated with mania.
Hypomania usually manifests in a decreased need for sleep and a large amount of
energy, as well as an outgoing and competitive disposition. Individuals with
hypomania often live full-functioning lives because the condition can be
treated by mood-stabilizers and monitored closely by
psychiatrists.
February
19, 2012
Hospital Calendars for the Week of Feb.
19 - PennLive.com –
Tues
- Lymphedema Support Group: 6:30 pm, WellSpan Adams Health Center,
Room 211. Community Multiphasic Blood Screening Program (Inclement weather
make-up date)
February
19, 2012
Breast cancer patients gain strength, mobility,
confidence with better than before program - The
Bridgeton News - NJ.com - By
Lauren T. Taniguchi -
Women
battling breast cancer can regain strength, independence and self-confidence
with the guidance of Better Than Before, a rehabilitative fitness program on
DVD that demonstrates how post-surgery exercises should be performed to support
recovery.
The 50-minute program offers four stages of exercises to help
breast cancer patients safely stretch, achieve mobility and prevent
complications such as lymphedema after undergoing mastectomies, lumpectomies or
reconstructive surgeries.
“Most of what we try to do these days is to
get patients back into society, back into daily living, so they can do normal
activities and get back to their families and jobs,” said Dr. Peter Neumann, a
reconstructive plastic surgeon who gave direction during the program’s
development.
“Another aspect is that after surgery, nobody really deals
with the emotional problems of patients feeling they don’t have the ability to
do what they did before,” Neumann added. “By getting their strength back, they
feel better about themselves, and it prevents depression and family
unrest.”
The program was developed about 15 years ago, when patient Jill
Forrest and her trainer, Lauren Antorino Griffin, worked with Neumann to record
a demonstration of exercises to help women after surgery.
Forrest was a
teacher and outgoing proponent of education, and, though she has since passed
away, her husband, Ed, continues to reach out to breast cancer patients with
Neumann and Griffin in Jill’s memory.
Unfortunately, Neumann said
post-surgery rehabilitation resources in the health care industry are still
lacking, a decade and a half after the program was developed.
“Patients
are stuck, and half the things offered to them in the hospital they don’t
listen to because they’re still so nervous about their treatment,” Neumann
said.
“Most get a rubber ball to squeeze and information from their
friends or the Internet, but not all of that information has been
screened.”
However, Better Than Before has been distributed to fulfill
the great need at medical facilities around the United States and
Europe.
With physician approval, patients can start using Better Than
Before almost immediately following surgery, Neumann said.
“In the
beginning, there are stretching exercises that are safe ways to get mobility in
the arm. The second part is strengthening — using very light weights and/or
resistance to gain strength, especially in the biceps and triceps, as well as
through the pectorals of the chest to get strength back,” Neumann explained.
“The third portion is really for full mobility, all the daily living
activities you’d do as far as picking something off a top shelf or going into a
closet and twisting to pull out a specific shirt. The fourth is
maintenance.”
Neumann, a former member of the board of directors of a
division of the American Cancer Society, said a patient should consult with her
doctor before beginning this or any rehabilitative program. In addition,
patients should listen to their bodies and take care to do only what feels
right.
“We have found this program is completely safe, but if it doesn’t
feel good, maybe you’re not at that point yet. Don’t skip to the end; go
through the program slowly until you get the feeling and strength so you can
move to the next portion,” Neumann said.
Within three to four months of
exercise, most will have regained a significant measure of agility and
strength. Neumann said that by the maintenance stage of the program, most
patients have learned the exercises and begin doing them casually, even during
a morning shower, to stay strong and limber.
Better Than Before is
available for $19.99 online at breastcancerexercises.net, and a
third of all proceeds from DVD sales are donated to the American Cancer Society
to support efforts to find a cure for breast cancer.
“The DVD is all
ages and stages appropriate and is a perfect post-operative gift because better
than flowers, better than sympathy, give her Better Than Before,” wrote Ed
Forrest
February
20, 2012 –
The Week in Sonoma Valley, Feb.
20-26 - Santa Rosa Press Democrat –
Sorry
a one time meeting already passed
February
20, 2012
Lichen Sclerosus Exhibiting Histologic Signs of
Lymphedema: An- Archives of
Dermatology –
We
appreciate the interest of Carlson et al in our article on vulvar VX 1 as well
as their comment about the possible etiologic roles of lymphostasis and
...
You
have to be a member of some group to access this
February
23, 2012
Pinnacle Hand Therapy helps patients with movement,
more - Daily Press – By Phyllis Johnson –
"We take better care of our cars than we do our bodies. We know
that an engine will not last if we do not change the oil, yet we expect to get
years of use from our hands with no preventative care." — Pinnacle Hand
Therapy
The sign outside Pinnacle Hand Therapy LLC doesn't begin to describe
all of the medical services available inside the Middle Ground Boulevard
company
The 8-year-old practice offers hand therapy, lymphedema treatment,
wound care and pediatric therapy. Among the 10 employees, there are three
certified hand therapists and two certified lymphedema therapists who treat
swelling due to a blockage of the lymph passages.
Phyllis Ross, owner and an adjunct professor at Howard University's
Occupational Therapy Department, went into this line of work because she has a
passion for it. She decided to treat lymphedema after seeing breast cancer
survivors who had swelling problems. She gave them complete decongestive
therapy by using compression and massage. Patients use compression wraps and
garments, followed by wrapping at night. It's an ongoing process with measured
successes, something that makes it all worthwhile, she said.
"I love seeing people get better. It's gratifying to see their
progress," said Ross. "We evaluate their physical ability when they come in and
constantly compare it to the baseline to see how far they've
come."
Ross's previous line of work included serving time in the U.S. Navy
during Desert Storm and experience working in hospitals. She migrated back to
the Peninsula to be near family. It's been a good move for her, she said, and
she enjoys her work.
She also enjoys teaching students occupational therapy. "There's a
need for continuing education in the area of hand therapy."
Ross says people often take the things they normally do for granted.
When movement is impaired, there has to be treatment and therapy to bring
normal movement back.
"It's reassuring to a patient to see continued progress. It's a
measurable thing," she said.
A steady stream of people use the practice. There is a room where a
small number of people are getting therapy in a group setting.
"A new patient is able to come in and see someone else further along
in the same treatment and see how well they're doing. That's reassuring for a
new patient," she said.
One patient, Danny Engle of Hampton, showed where he had cut his hand
and later had surgery. Pinnacle Hand Therapy is helping restore motion to his
hand.
"This is the second place I've been for therapy. The staff is very
courteous and patient. They really take care of people here. I've never seen
anyone lose their patience. They're very flexible. Phyllis stayed late for
several hours recently to work with me. It means a lot," said Engle. "The staff
doesn't feel you owe them. They feel they owe you."
Another patient, Robert Raney of Suffolk, has been going to Pinnacle
practice since it opened in 2003. He comes for help with lymphedema and for
therapy for his arms and fingers. He requires special splints for two of his
fingers.
"I was one of her first patients," Raney said. "She gets me to
exercise to effectively help with therapy."
Ross has a good manner with the patients and staff. It's clearly a
place where patients feel right at home. "We often see local high school
athletes come in with injuries, too."
Her staff works with younger students as well when they have problems
with sensory processing, coordination, dyspraxia, motor skills and handwriting.
The practice offers training and hope. Physical activity and using
manipulatives are forms of treatment for motor skills. They use various
techniques for those with autism.
"We see a lot of children sent here from the Children's Hospital of
the King's Daughters who need hand therapy," said Ross. "We're happy to help
them."
Her plans for the future include the development of a continuing
education training course for therapists interested in hand therapy or
lymphedema therapy.
"We stay busy. Even on holidays, we have drop-ins come in for help,"
said Ross. "We're happy to assist people in restoring function so they can
return to whatever job, hobby or other activity they enjoy."
Company details
Pinnacle Hand Therapy
704 Middle Ground Blvd., Suite D, Newport News,
757-595-4880.
Hours: 8 a.m.-5 p.m. Monday through Friday.
The practice is accepting patients from Newport News, Hampton,
Yorktown, Seaford, Grafton, Langley Air Force Base, Fort Monroe and
Gloucester.
February
25, 2012,
Freeze column: Knee surgery -
Salisbury Post –
A
little over three months ago, I started to experience tightness in one of my
knees. On a few of my morning runs, that actually locked up. After a few more
days, I couldn’t climb steps with that left knee, and couldn’t pedal a bike
either. Climbing a ladder was definitely out.
My
two favorite physical therapists offered advice. Drs. Delaine Fowler and Pam
Roseman had some ideas, and we tried a few things.
Delaine,
who owns Fowler Physical Therapy, and Pam, owner of Lymphedema Solutions
Physical Therapy, are both experienced runners. They suggested that I get an
opinion from Dr. Robert Humble, an orthopedic surgeon with a reputation for
getting athletes back on the road quickly.
The
idea of surgery didn’t appeal to me, but something had to happen. Other runners
offered opinions, with most thinking I couldn’t run for a minimum of 14 days
and possibly as much as a month after the surgery.
I
did go to Salisbury Orthopedics Associates and met with Dr. Humble. He and
Physician’s Assistant Ryan Schenk and staff told me what to expect, and were
able to schedule arthroscopic surgery on Feb. 1, just two weeks later.
Arthroscopic
surgery involves two small holes in the knee through which a scope is inserted
and the knee is inflated with a sterile fluid. Dr. Humble would use the scope
to see and repair the damage, saying, “I can fix anything but an ACL, and that
isn’t your issue.” He made me confident of success.
On
the morning before the actual surgery, I had to get my run in. There was even a
fleeting thought of running to Rowan Regional Medical Center’s Outpatient
facility on Julian Road, figuring that no one would have done that before. I
didn’t do that — which later pleased the nurses who took care of me.
My
only previous surgeries were a tonsillectomy and a colonoscopy. Getting your
tonsils out in those days meant plenty of ice cream and some good memories. My
colonoscopy was enjoyable, too, although most people can’t understand why
anybody would think that.
Upon
arriving at the Outpatient Center, I was welcomed quickly, with the paperwork
processed very efficiently. Ameran Hill took care of that. My neighbor Vanessa
Bradley was in that same area, being the first of several staff that I already
knew. My daughters, Ashley and Amber, as well as Laura Kerr were there to make
sure that I didn’t wisecrack to the nurses too much. They also reminded me that
I couldn’t wait for Danica Patrick to show up, even though I was sure that she
was coming.
Dona
Peacock came out and called my name, saying “Aren’t you the guy who writes for
the Salisbury Post?” That immediately opened the door to some interesting
conversation. Dona and Leigh Ann Williams made sure that I was comfortable as
anybody can be while wearing one of those “open rear” gowns.
Next
the nurses who would assist in the surgery came by, and I knew them both. Word
had spread that there might just be a Salisbury Post column about this
experience. Rhonda Smith and Lauren Daniel enjoyed talking with my daughters as
we waited on Dr. Humble and the operating room. The anesthesiologist, Michael
Jones, stopped by and made sure that I would be easy enough to put to sleep.
Dr.
Humble came in, making last preparations. They let me walk to the bathroom one
more time, and then it was “Showtime.” They rolled my bed to the operating room
and put a warm blanket on me since it was much cooler in that room. Kim
Alexander told me that they were going to put something in my IV, and after
what seemed like seconds later, I woke up feeling great with a bandaged knee.
It
took just minutes and I was on my way out of the building, a short three hours
after entering the door. Kay Meilinger, my recovery nurse, must have done a
great job, because I hardly got to know her.
I
spent that afternoon on the couch with a succession of ice packs. The second
day brought a stiff knee and a shower. The swelling began to go down, and I had
no trouble walking by the third day. There was no real pain, just an off and on
ache with stiffness, usually depending on how long I stood.
My
running resumed exactly one week later, meaning that I only missed six days.
Dr. Humble told me that it would take at least a couple of months to recover
full strength in the knee, saying that even pro athletes often aren’t back up
to speed until the next season. With that said, my knee is getting better, now
three weeks after the surgery, and I haven’t ruled out playing major league
baseball next season.
To
the staff at RRMC’s Outpatient Center, you did make a good column, and made
another experience at RRMC very pleasurable. I definitely was cared for by a
group of people who take pride in the work they do. Thank you!
February
24, 2012
Surviving cancer, giving back -
Metrowny.com
Refusing to accept the statement, ‘You’re
just getting old,’ may be the reason 36-year-old Lisa Johnson is alive today.
After beating cervical cancer in 2004 and celebrating four years of
being cancer free, Johnson developed secondary lymphedema, in 2008. This
resulted in a chronic swelling of her left leg, which developed as a result of
lymph nodes that were removed during the initial surgery she had to remove her
cervical cancer years prior.
Initially, Johnson injured herself by
rolling off of her sandal and just assumed her leg was swollen due to the
injury, doctors agreed. One doctor even said her leg was enlarged as a result
of old age; however, at age 33, she knew something else was wrong.
Johnson decided to do her own research. After dealing with the
discomfort of walking around with one leg larger than then other for three
years, she stumbled upon information that indicated how lymphedema can be
caused. Johnson then took her findings to Roswell Park Cancer Institute in
October 2011. There - she was provided with the proper diagnosis and treatment.
Upon her arrival at Roswell, Johnson’s left leg was 28 percent larger
than her right leg.
“You have to just keep doing research to find out
what’s wrong with you,” said Johnson. “You can’t give up.”
As a way of
thanking Roswell Park for helping her, Johnson will again is host the annual
“Stick it to Cancer,” event.
“I like helping people and I wanted to give
back for the help that was given to me,” said Johnson.
The event will
be held from 2 to 7 p.m. Saturday, April 21 at the Town of Tonawanda Boys and
Girls Club, 54 Riverdale Ave., Town of Tonawanda.
At the event, Johnson
will learn to ride a bicycle for the first time in front of the entire crowd.
For safety she will wear knee and elbow pads, a helmet, and be wrapped head to
tow in bubble wrap.
A game called, Boo Boo Bing-OW, will be played
while she rides. Johnson will place baseball cards in the spokes of her bicycle
to make some noise while additional baseball cards will be sold to raise money
for cancer. Johnson will call out players’ names on the baseball cards while
she is riding to give friends and family a chance to win prizes.
In
addition to her ride, a blood drive and basket raffle will be held throughout
the duration of the fund-raiser. Baseball cards will be sold until 4 p.m.,
basket raffle drawing will take place at 6 p.m. (winners do not need to be
present), and a 50/50 split drawing that will take place after the basket
raffle.
Admission for the event is $10 per person, $5 for presenting
blood donors and free for children 10 and under. Admission includes a set of
raffle tickets, non-alcoholic beverages and snacks. Raffle tickets will be sold
for $5 per sheet or $20 for five sheets, baseball cards will be sold for $5
each. For those individuals who wish to just donate blood, there is no cost.
Proceeds from the event will benefit Roswell and the Town of Tonawanda
Paramedics.
For additional information, contact Johnson at
[email protected], search for “StickItToCancer” on Facebook or visit http://stickittocancer.wordpress.com.
March 1, 2012
Waterside will alter seats for big
customers - Bucks Herald –
Published on Thursday 1 March 2012 14:24
A TOWN centre theatre has reassured guests after a woman avoided
the venue for fear she could not fit into a seat.
The Aylesbury mother, who has asked to remain anonymous, has had to
refuse her 17-year-old special needs son a trip to the Waterside Theatre for
fear that the seats were too small, given her health.
The 39 year old of Walton Court suffers from lymphedema, a gland
condition meaning her legs and hips retain fluid, making her too large for a
normal seat.
“My friends have all been and told me I probably wouldn’t fit in
any of the seats,” she said.
“Because of the arms I just wouldn’t fit into the chairs, because
they don’t lift up at all.
“This means each time I see something I would like to go and watch
at the theatre I don’t even bother looking into getting tickets and have had to
put off taking my son when he’s asked me.
“Not all disabled people use wheelchairs.”
But the Waterside Theatre has responded saying it is happy to
accommodate anyone with such a condition.
John Coughlan, creative learning manager at the venue, said:
“Seating in the auditorium is designed to be removable in order for us to meet
the needs of our customers with access requirements.
“In line with our policies, if a customer makes us aware on booking
a ticket that they are unable to use the seating provided due to a medical
condition or access requirement, we would endeavour to provide alternative,
suitable seating at no additional cost, to ensure they are able to enjoy the
performance comfortably.”
Training
like an athlete is tough work, but worth it - Montreal
Gazette –
A
regimen designed for football players can be effective for everyone
The
idea that there's no such thing as being "too big" to play football is
changing. So is the belief that football players need to spend their off-season
in the weight room pushing more and more weight. Instead, studies exploring the
relationship between football performance and fitness testing have shown that
explosive power and maximal running speed are better markers of on field
playing ability.
Liam
Mahoney, a former Concordia Stinger and now a receiver for the Hamilton
Tiger-Cats, used to live by the bigger-is-better philosophy. But he found the
added size made him slower and less reactive than he was at a lighter
weight.
"I
don't need to get stronger or lift more weight," said 6-foot-1, 200-pound
Mahoney. "What I need is more core strength and more explosive speed off the
line."
Mahoney's
role on the field is to run routes, find open space and catch the ball. So
while he still spends time in the weight room, his main focus is on building
the kind of strength and quickness that allows him to outrun and outmanoeuvre
the competition.
"When
I run a route, I always have guys pushing me and hanging on me," said Mahoney.
"So I need a strong core to do my job on the field."
To
help achieve his goals, Mahoney went looking for a trainer who could design a
sport-specific, position-specific and fitness-specific program. He needed
someone who understood football and had the knowledge and creativity to design
a program that would improve his athletic skills on the field.
He
found what he was looking for closer to home than he thought he would. Trainer
Michael Alfonso played football with Mahoney at Vanier College. Unlike Mahoney,
however, Alfonso hung up his cleats. He didn't abandon the sport, though. He
became a certified strength and conditioning specialist whose main focus is
training football players to stay healthy and perform better on the
field.
"I
help bridge the gap from the weight room to the field by building a training
program that simulates their playing style," Alfonso said of the Speed Science
Training System.
In
football, that means lots of short, high-intensity bursts of power punctuated
by periods of rest, which is exactly the type of workout Alfonso's clients can
expect.
In
the case of Mahoney, testing revealed that he needed to increase the power
output of his first two steps off the line. So with Alfonso's help, he's been
building explosive strength in his lower body. After three months of hard work,
Mahoney has mastered an impressive 51-inch standing box jump (a jump from the
floor to the top of a box) and makes it look easy (see video).
It's
not just pro football players who can benefit from this type of conditioning.
Charles Héroux is a 38-year-old account manager who coaches football in his
spare time. Not happy with the extra pounds he put on over the years, Héroux
knew he needed to change things up.
His
workout routine meant running when he wanted to lose weight and hitting the gym
when he wanted to bulk up. But that routine had grown old. What he wanted was a
workout similar to what his players were doing. So Héroux sat down with Alfonso
and put together a plan, not just to lose 40 pounds but to improve his overall
fitness. He started the plan in January, and so far, it seems to be
working.
"I've
never trained like that before," said Héroux. "I almost puke my guts out, but
I'm happy."
While
his first few weeks were tough, he's pleased with his progress. He's even
happier that he gets it all done in 40 minutes, three times a
week.
"I've
lost 15 pounds," he said. "My body is changing; I'm standing straighter and my
energy level is up."
Before
you get inspired and sign up for the nearest training program that promises to
build athletic speed and power, keep in mind that you have to be prepared to
work hard - probably harder than you have ever worked before.
"If
you want to get in better shape and you want to be lean, you need to train like
an athlete," said Alfonso.
And
you have to make sure you have a trainer who knows what he or she is doing.
These aren't cookiecutter programs prescribed for any Joe or Jill. They're
high-intensity workouts that need to be tailored to individual strengths and
weaknesses and consistently rejigged as you progress.
Alfonso
uses lots of specialized equipment to build the kind of fitness and athleticism
his clients want. And he keeps the workouts challenging, changing them up often
so that both mind and body stay stimulated.
In
addition to the impressive physical results, the challenge, intensity and
diversity of an athletic based program will recharge your batteries and make
you love going to the gym.
"Put
a big guy on a treadmill for 45 minutes, and he will hate his life," said
Alfonso. "But 45 minutes of this kind of training really gets the guys
going."
FOOTBALL
TRAINING
Click
on this column on the Health page to watch John Mahoney's video of Montreal
Alouettes Marc-Olivier Brouillette and Hamilton Tiger-Cats receiver Liam
Mahoney (above) working out at Speed Science Training System gym with trainer
Michael Alfonso: montrealgazette.com/health
LACE
UP FOR LOCAL EVENTS
April
29: 5K Walk for Lymphedema, 8 to 11 a.m. at Jean Drapeau Park. Visit
infolympho.ca.
May
27: The Kidney Walk for the Kidney Foundation of Canada. 5K, 10 a.m. at
Lafontaine Park, École Le Plateau. Call 514-938-4515, Local 228 or visit
kidney.ca/quebec.
Ongoing:
One Million Kilometres, One Million Dollars. Choose an activity, like walking,
running, skating or skiing, count your kilometres and ask friends and family to
sponsor you. No minimum contribution. Benefits the Montreal Children's
Hospital's Family Resource Centre.
1millionkm.com;
514-934-4846.
If
your organization is planning a walk or run in the Montreal region, fax the
details (registration, date, time, location, distance, website, phone number)
to Race Calendar at 514-987-2638, email artslife@ montrealgazette.com or write
to Race Calendar, Arts & Life, The Gazette, 1010 Ste. Catherine St. W.,
Suite 200, Montreal H3B 5L1.
[email protected]
©
Copyright (c) The Montreal Gazette
March
12, 2012
Lymphedema: Separating Fact From
Fiction - Cancer Network – By Sarah A. McLaughlin,
MD
ABSTRACT:
Lymphedema is a feared complication of cancer treatment and one that negatively
impacts survivorship. The incidence of breast cancer–related lymphedema ranges
from 6% to 70%, but lymphedema may be a common and under-reported morbidity. No
standard guidelines for its diagnosis and assessment exist. Although the true
etiology of lymphedema remains unknown, radiation, chemotherapy, type of breast
surgery, and extent of axillary surgery are commonly cited risk factors.
However, the relationship between the number of nodes removed and the risk of
lymphedema is not clearly correlated. Clinical trials are focusing on ways to
reduce the need for axillary dissection even in the setting of a positive
sentinel node, to help minimize axillary morbidity. Risk-reduction practices,
including avoidance of skin puncture and blood pressures in the ipsilateral
upper extremity, and precautionary behaviors such as wearing compression
garments during air travel continue to be advocated by the medical and survivor
communities, despite a lack of rigorous evidence supporting their benefit.
Emerging data support exercise in at-risk and affected women with lymphedema
when started gradually and increased cautiously.
Introduction
The
most recent survivorship data from the Surveillance, Epidemiology, and End
Results (SEER) database demonstrate a significant increase in the number of US
cancer survivors over the last 30 years, from roughly 3 million in 1973 to
nearly 12 million in 2008.[1] As a result, issues of survivorship have
stimulated new focus for clinical trials, not only to determine the most
effective therapeutic regimen (surgery, drug, or radiation) but also to
identify the one with the least influence on future quality of life. Lymphedema
has long been a feared complication of surgical cancer treatment, and notably
one that negatively impacts survivorship. Fear of lymphedema stems from patient
concerns regarding the chronic, progressive nature of the condition and the
clinician’s relative inability to predict or prevent its development.
Furthermore, decades of physician and allied health teachings based on opinion
and theory have perpetuated the myths shrouding lymphedema risk, prevention,
and
A
vast body of literature documents the occurrence of breast cancer–related
lymphedema, with more than 1400 articles indexed in PubMed-MEDLINE databases
alone. Importantly, lymphedema also exists after surgery for
non–breast-cancer-related malignancies, but data documenting this occurrence
are rare in comparison. Recently, Cormier et al found only 47 studies between
1972 and 2008 with more than 10 patients that prospectively evaluated
lymphedema as a primary or secondary outcome after treatment for melanoma,
bladder, sarcoma, penile, prostate, vulvar, cervical, endometrial, or head and
neck cancers.[2] The authors’ analysis of these studies demonstrated the
overall incidence of lymphedema to be 16.3% after melanoma, 10.1% after
genitourinary cancers, and 19.6% after gynecologic malignancies, and notes that
lymphedema rates are higher when the lower rather than upper extremity is
affected. Given the abundance of breast cancer data, this review will focus on
breast cancer–related lymphedema. However, the principles and controversies
discussed are relevant regardless of the type of malignancy to which the
lymphedema is attributed.
Incidence
and Diagnosis
The
incidence of breast cancer–related lymphedema has been difficult to quantify
due to delayed onset of symptoms and the lack of standardized diagnostic
criteria. A recent meta-analysis reports the incidence of breast cancer–related
lymphedema to range from 0 to 3% after lumpectomy alone to as high as 65% to
70% after modified radical mastectomy (removal of breast and axillary lymph
nodes) with regional nodal radiation.[3] Overall, 80% to 90% of women who will
develop lymphedema do so within 3 years of treatment,[4,5] but the risk
persists years later as the remaining 10% to 20% will develop lymphedema at a
rate of 1% per year.[5] Petrek et al followed 263 patients and found that
nearly 50% developed lymphedema by 20 years.[5] These data suggest that
lymphedema is probably more common than generally reported, and clearly the
length of follow-up in a given study influences the reported incidence. A
uniform definition of lymphedema does not exist. Although volume displacement
methods are considered the gold standard for diagnosis, these methods are
cumbersome and unable to identify subclinical lymphedema. Thus, displacement
methods are rarely used in clinical settings. Circumferential arm measurements
performed with a nonelastic tape measure are commonly used to determine upper
extremity size differences. It is essential to obtain baseline preoperative
measurements of the ipsilateral and contralateral extremities, as differences
of up to 2 cm may naturally exist between the dominant and nondominant arms at
baseline.[6] Published literature demonstrates significant heterogeneity, as
studies lack agreement on the location and minimal number of measurements
performed. Furthermore, they use multiple definitions of what constitutes
lymphedema, including measurement changes greater than 2 cm, volume increase of
more than 200 mL, or percentage increases in volume (> 10% or > 20%)
compared with baseline when controlled for changes in the contralateral
arm.[7,8] Aside from objective measurements, some studies define lymphedema by
patient subjective symptoms or patient perceptions of swelling.
Controversy
remains as to whether a measurement change or a patient’s perception of
swelling should be considered diagnostic. While a measurement change is
objective, measurements may be affected by inter-rater and even intra-rater
variability affecting reproducibility. Perhaps more importantly, a defined
measurement change may be asymptomatic in an obese patient, while a thin woman
may be bothered by more subtle measurement changes not meeting measured
criteria for lymphedema. Alternatively, a patient’s perception of swelling may
more accurately diagnose symptomatic lymphedema, but this perception may be
influenced by sensory changes from the surgery and additional adjuvant
therapies. Further, women with surgery in their dominant arm may perceive
functional issues to a greater degree than if it were the nondominant arm that
was affected.[9] In fact, one study found only 41% of women with perceived
swelling had circumferential arm measurement changes greater than 2 cm, the
objective threshold used in the study to define lymphedema.[9] Several
contemporary studies have evaluated the differences between measured and
perceived lymphedema and have validated patient perceptions against physical
therapist–directed measurements.[4,10] These studies conclude that each
evaluation method is valid but not interchangeable, and they do not endorse one
method over another.
The
clinical introduction of a single-frequency bioelectrical impedance device
manufactured by Impedimed (Mansfield, Australia) can minimize both inter-rater
and intra-rater variability seen with other measurement techniques. The device
produces easily interpretable values measuring the changes in extracellular
fluid when compared with the unaffected contralateral upper extremity. A score
increase of 10 or more or one that registers outside the normal range should
prompt intervention with a compression garment or a referral for physical
therapy. Some investigators report that measurement of bioimpedance has
improved sensitivity in detecting subclinical lymphedema up to 4 months prior
to standard measurement changes.[11] For these reasons, the current National
Lymphedema Network (NLN) breast cancer–related lymphedema guidelines recommend
that all breast cancer patients receive pre- and post-treatment measurements
(of any type) on both arms and encourage the use of bioimpedance spectroscopy
or infrared perometry as alternatives to tape measures, to limit measurement
variations.[12]
Is
It All About the Nodes?
Over
the years, many retrospective studies have reported risk factors for
lymphedema. Axillary node dissection (ALND), mastectomy, obesity, radiation,
infection, and ipsilateral upper extremity injury consistently rank as the most
influential causes of damage or disruption to the lymphatic system and thus
lymphedema. However, the magnitude of association between breast cancer
treatment factors and lymphedema is inconsistent across studies.[8] Tsai et al
reviewed 98 studies conducted in the United States and Canada through January
2008 for lymphedema risk factors.[8] The authors report a significantly
increased risk for lymphedema in women undergoing mastectomy compared with
lumpectomy (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.15–1.76),
ALND compared with no dissection (RR, 3.47; CI, 2.34–5.15), ALND compared with
sentinel lymph node biopsy (SLNB) (RR, 3.07; CI, 2.20–4.29), radiation therapy
vs no radiation therapy (RR, 1.92; CI, 1.61–2.28), and positive vs negative
axillary lymph nodes (RR, 1.54; CI, 1.32–1.80). While this meta-analysis
demonstrates a comprehensive, contemporary review of lymphedema risk factors,
the heterogeneity of the data must be considered, as 11 different definitions
for lymphedema were used and follow-up ranged between 1 month and 30
years.
Though
the most intuitively obvious risk factor for lymphedema is the number of nodes
removed, the relationship between the number of lymph nodes removed and the
risk of lymphedema remains unresolved. Several retrospective studies have shown
that the number of nodes removed and the risk of lymphedema do not
correlate.[13,14] Others find an increasing risk of lymphedema as more nodes
are removed.[15-17] Despite various lengths of follow-up, from 6 to 60 months,
the prospective trials vetting SLNB as the standard of care for axillary
staging demonstrate significantly reduced rates of lymphedema after SLNB (0 to
7%) compared with ALND (12% to 16%).[18-21] These studies certainly support the
concept that the risk of lymphedema is proportional to the extent of axillary
surgery. Importantly, though, they also confirm that even with SLNB a small but
clear risk of lymphedema remains. A recent study by Goldberg et al suggests
that it is not the number of lymph nodes removed but instead the degree of
dissection and disruption of the lymphatic system that results in
lymphedema.[22] The authors reviewed 600 women having SLNB with a median
follow-up of 5 years and found an overall incidence of lymphedema of 5%. When
stratifying the data according to the number of nodes removed, they found no
significant association between the mean, median, or range of number of nodes
excised and lymphedema (P = .93). Furthermore,
the authors completed a subset analysis of the women having more than 10 lymph
nodes removed at SLNB. None of these women developed lymphedema. Interestingly,
when these SLNB patients having > 10 nodes removed were compared with a
separate group of women having 10 to 17 nodes removed at ALND, 11% of the ALND
patients had measured lymphedema (P
= .04). The fact that women having more than 10 nodes removed during SLNB did
not develop lymphedema but women with the same number of nodes removed after
ALND did reaffirms that the relationship between the nodes removed and
lymphedema is complex. Perhaps it is the relative magnitude of lymphatic
destruction and individual patient ability to form collateral lymphatic
channels, rather than the number of nodes removed, that influences lymphedema
risk. For example, a patient with many nodes removed at SLNB and no finding of
lymphedema may have more lymphatic collaterals and therefore will have suffered
relatively less lymphatic disruption despite a larger than “normal” number of
SLNs removed. On the other hand, women having ALND and a relatively small
number of total nodes excised may have suffered an overall greater degree of
lymphatic disruption and therefore develop lymphedema. Unfortunately, the
number of nodes within each patient’s nodal basin and the patient’s ability to
protect or form new lymphatic collaterals during or after treatments is
unknown. Therefore, simply the number of nodes removed may be insufficient to
determine lymphedema risk.
If,
however, the degree of lymphatic disruption or damage is the key driver of
lymphedema risk, then it is plausible that radiation can also act primarily or
synergistically to influence lymphedema risk. Axillary radiation alone is not
without complications, as these patients can have a 2- to 4.5-fold increase in
the risk of lymphedema. A recent meta-analysis by Shah and Vicini finds
lymphedema in 9% to 65% of patients after lumpectomy alone (no nodal surgery)
and regional nodal radiation and in 58% to 65% of women after mastectomy alone
and regional nodal radiation.[3] Additionally, the synergistic effect of
surgery and radiation is well documented to result in a 3.5- to 10-fold higher
risk of lymphedema when compared with surgery alone.[3,23,24]
Finally,
accumulating data suggest that chemotherapy may also affect lymphatic
destruction. Norman et al found anthracycline-based chemotherapy regimens
increase the risk of lymphedema.[25] Their prospective review of 631 breast
cancer survivors followed for 5 years found an elevated hazard ratio (HR) of
1.46 (95% CI, 1.04–2.04) for lymphedema among breast cancer patients receiving
anthracycline-based chemotherapy vs no chemotherapy. This risk persisted after
stratifying for stage at diagnosis or number of positive nodes. Furthermore,
the authors concluded that treatment combinations involving ALND or
chemotherapy resulted in approximately four- to five-fold increases in the HRs
for lymphedema (HR, 4.16 [95% CI, 1.32–12.45]for SLNB/chemotherapy/no
radiation)compared with no treatment. While further validation of this finding
is needed, the concept that chemotherapy independently influences lymphedema
risk demonstrates that this risk can be affected not only by locally directed
therapies but also by systemic ones.[25]
Changes
in Surgical Management
Changes in the surgical management of the
axilla have been instrumental in reducing axillary morbidity, especially
lymphedema. SLNB is now the standard of care for axillary staging, as its
accuracy, low false-negative rate, and low rate of axillary recurrence have
been documented in more than 70 studies. Current research to further minimize
morbidity from axillary surgery focuses on reducing the need for completion
axillary dissection in the setting of a positive axillary node. The American
College of Surgeons (ACOSOG) Z0011 trial published in early 2011 documents the
first prospective randomized data showing that at a median of 6 years
follow-up, SLNB alone does not result in inferior survival in women with T1 or
T2 tumors and one or two positive sentinel nodes who received breast
conservation surgery, chemotherapy and/or hormonal therapy, and whole breast
radiation therapy.[26] In the study, more than 70% of the women with a positive
SLNB had no additional positive nodes, suggesting that in select cases SLNB can
be both diagnostic and therapeutic. While this trial is viewed as
practice-changing, it is important to note that the trial called for standard
whole breast radiation but did not standardize the radiation tangents other
than to say that third field–directed axillary radiation was forbidden. As a
result it is possible that radiation tangents were adjusted higher in
node-positive women who were randomized to the SLNB-only arm. If standard
radiation tangents cover approximately 30% to 50% of the level I and 25% of the
level II axillary nodes,[27] then adjusting the tangents “higher” has the
intention of covering more nodes than standard. These data are important from
the perspective of morbidity, as an adjustment in the tangents may result in
increased rates of axillary morbidity above what is seen with standard whole
breast tangents and SLNB alone. The radiation ports are currently being
evaluated retrospectively. An additional prospective trial, ACOSOG Z1071, is
evaluating the validity, accuracy, and false-negative rate of SLNB after
neoadjuvant chemotherapy in women who present with node-positive disease at
diagnosis. The investigators hypothesize that SLNB after neoadjuvant
chemotherapy will appropriately and reliably stage the axilla and therefore
allow elimination of ALND in women converted by neoadjuvant chemotherapy from
node-positive to node-negative status. The trial accrued quickly and results
are pending. Remaining questions to be answered include that of which women may
be able to forgo axillary surgery (SLNB or ALND)
altogether.
Lymphedema Prevention and Early
Intervention: A Worthy Goal - Cancer Network –
By
Atilla Soran, MD, MPH, David N. Finegold, MD, Adam Brufsky, MD,
PhD
The etiology and
risk factors of breast cancer–related lymphedema (BCRL) are multifactorial and
not fully understood. BCRL risk factors are divided into three main categories.
There are treatment-related factors, including surgery, radiotherapy,
chemotherapy, and combined treatments. Secondly, there are disease-related
factors, including tumor stage at time of diagnosis, pathologic nodal status,
number of removed lymph nodes, and the location of the tumor in the breast.
Finally, there are patient-related factors, including age at diagnosis, high
body mass index (BMI), comorbidities, history of infection or inflammation,
hand dominance, sedentary lifestyle, and excessive use of the affected
limb.
BMI is one of the
patient-related factors affecting BCRL. Several studies showed that a majority
of the patients with BCRL were overweight or obese. BMI is a risk factor for
increased severity of BCRL, infection, and wound healing. Advanced age also
appears to be a risk factor that contributes to the severity of BCRL and
quality of life. Further validation studies must be conducted to obtain more
information about the effects of the patient’s age on BCRL.[1,2]
Level of hand use
is another significant factor for BCRL, notwithstanding controversy in the
literature. Two studies from our group confirmed that patient occupation is a
risk factor for BCRL.[3,4] We modified the previous classification system of
the level of hand use by three objective criteria, according to the status of
occupational workload. Group I included working continuously less than 30
minutes at a time and 8 hours or less per day. Group II included working
continuously between 30 and 60 minutes at a time, and 8 hours or less per day.
Group III included working continuously for more than 1 hour and at least 8
hours per day. Based on this new classification, we confirmed that occupation
is an important risk factor for increased severity of BRCL, and patients with
occupations requiring more upper extremity activity and long periods of work
had an independent risk for more severe disease outcome. Therefore, patients
with BCRL should be advised to adjust their daily use of upper extremities to
prevent increased severity of BRCL. As the study authors stated, a uniform
definition of lymphedema does not exist and the diagnosis of BCRL remains a
challenge. Nevertheless, the new techniques for diagnosis of lymphedema,
including DEXA (dual emission x-ray absorptiometry) and BIS (broadband
impedence spectroscopy), are promising. Such technologies represent significant
improvements over traditional ones, by providing standardized cutoffs, limiting
observer variability, increasing sensitivity with the potential for subclinical
detection, and accurately measuring the extracellular fluid space.
Early diagnosis of
lymphedema translates to more treatment options; less edema, smaller limbs,
improvement in joint aches, and reduced muscle pain and tightness; a decreased
infection rate; increased patient desire to continue treatment; decreased
medical costs; and an improved quality of life. Diagnosis of subclinical
lymphedema facilitates early interventions such as education and preventive
recommendations such as the use of over-the-counter compression sleeves,
physical therapy consultation, daily exercise, and avoiding overuse of the
affected arm.
Surgical prevention
of BCRL with axillary reverse mapping (ARM) marks the drainage of the arm with
blue dye to determine the anatomical variation in the lymphatics and thus
provides a roadmap for their preservation. However, the preservation of ARM
nodes and lymphatics is not always possible. Several problems remain to be
resolved in the practical use of this technique, including insufficient
identification rates of the ARM nodes and lymphatics, persistent blue dye
retention at the site of injection, and involvement of the ARM nodes with
metastatic foci in patients with axial lymph node metastases. In a minority of
patients, the sentinel lymph node draining the breast may also be the same as
the ARM node draining the upper extremity.
For severe BCRL,
excisional operations and debulking procedures have been reported as effective
me-thods to alleviate symptoms by removing fibrosclerotic connective tissue,
excess adipose tissue, and excess skin. Liposuction was introduced as an
excisional technique to remove subcutaneous fat, to reduce the limb’s overall
size. Preventive surgical strategies to avoid a diagnosis of BCRL include
pedicled omentoplasty and lymphovenous anastomosis in high-risk patients.
Contemporary advances have resulted in the development of microsurgical
reconstruction, enabling the creation of fine connections between distal
lymphatics and subdermal venules (lymphaticovenular anastomosis [LVA]). The
advantage of LVA is that the subdermal location of the smaller vessels
eliminates the pressure imbalance be-tween the lymphatic and venular
anastomosis, potentially eliminating the potential for thrombosis and
back-flow. In addition, the subdermal location of the anastomosis permits the
use of small incisions with minimal dissection and morbidity, allowing the
procedures to be performed with local anesthesia and requiring only short-term
hospitalization. Early reports of LVA for the treatment of lymphedema have been
promising. Other surgical techniques such as lympho-lymphatic anastomosis and
lymphatic grafting have been proposed as reconstructive techniques that are
associated with im-proved patency over time.[5]
Low-level laser
therapy (LLLT) is a new modality that has been evaluated in the management of
various musculoskeletal disorders. It is presumed that by increasing lymphatic
flow, LLLT reduces the surplus of both tissue protein and fluid, and thereby
improves limb performance. LLLT is believed to encourage lymphangiogenesis and
stimulate lymphatic motoricity. Thus the greatest benefit from LLLT is achieved
over a long period of time, and it has been suggested that patients with
early-stage lymphedema might respond better to LLLT than those at advanced
stages. Patients with BCRL gained additional benefits from LLLT, such as
reduction in limb circumference and pain, increase in extremity range of
motion, and an improvement in scar mobility when LLLT was used in conjunction
with conventional treatment modalities.[6]
Pneumatic
compression devices (PCD) have been developed during the last 25 years as both
alternatives to manual lymphatic drainage (MLD) and as complementary treatments
to be used along with MLD. More recently developed lower-pressure devices, when
used with appropriate training and education, are believed to be safer than
their older counterparts and have been cleared by the US Food and Drug
Administration (FDA) for home use.[7] A prospective study suggests that the
devices may provide better maintenance edema control than self-administered
massage in BCRL.[8] In another study, participants’ use of professional MLD
therapy, self-MLD, and bandaging declined after they initiated use of the newer
PCD.[9] Truncal/chest/arm advanced pneumatic compression therapy vs arm-only
pneumatic compression in self-care for arm lymphedema without truncal
involvement has been studied. Findings revealed a statistically significant
reduction in both the number of symptoms and overall symptom burden within each
group, and reduction in BIS and arm circumference was achieved in both groups;
however, there was no statistically significant difference in reduction between
groups.[10] These findings indicate that both configurations are effective;
however, there may be no added benefit to advanced pneumatic treatment of the
truncal lymphatics prior to arm massage when the trunk is not also
affected.
Treatments for
lymphedema (LE) should only be ordered after qualified practitioners have
completed a thorough diagnostic evaluation. Use of PCD is the current
international standard of care for managing BCRL. A number of other promising
treatments have been reported, but they have not yet been subjected to
sufficient rigorous research for them to be recommended as the standard of
care. Our lack of understanding of the cellular and molecular mechanisms in the
development of LE has complicated effective preventive strategies. As the
author states, many of the current recommendations for prevention of LE are
anecdotal, with scant scientific evidence. Research priorities in this area
should focus more on how to prevent patients from developing BCRL, and on how
to accurately diagnose it in the subclinical phase to enable early intervention
with the goal of preventing the occurrence of severe lymphedema.
Financial
Disclosure: The
authors have no significant financial interest or other relationship with the
manufacturers of any products or providers of any service mentioned in this
article.
LympheDIVAs for Lymphedema
sufferers - Edmonton Journal (blog) –
If
you’ve never heard of Lymphedema (and I hadn’t until today), you
probably don’t know that, not only is it an unpleasant side effect of breast
cancer treatment that causes permanent swelling in the arms, it poses both
comfort and fashion challenges.
Since
March is Lymphedema Awareness Month, it’s a good time to do a fashionable
favour for sufferers from this condition, which is treated with massage and
compression sleeves.
The
bandage-like sleeves are usually hot, heavy and made from rough fabric. But a
US company called LympheDIVAs has created stylish versions in comfy, breathable
materials in everything from nude shades to bright colours to crazy
patterns.
March
13, 2012
Lymphedema: Still a Problem Without an
Answer - Cancer Network - By
Rosemarie Hardin, MD, Lisa K. Jacobs, M
It is ironic that
we were asked to comment on the article by Dr. McLaughlin in this issue of
ONCOLOGY. A few months ago, one of us (LKJ) was attending a patient in the
breast clinic who had recovered well from a lumpectomy with sentinel node
biopsy followed by completion axillary lymph node dissection (ALND). She handed
me an educational packet for me, my fellow, and the support staff. She was
extremely appreciative of her surgical and medical care, but she had one
complaint. She had developed lymphedema after her ALND. She sought the
appropriate therapy approximately 4 months after the start of swelling in her
upper extremity and with the aid of compression garments had significant
symptomatic improvement in a matter of a few weeks, improving her functional
status and quality of life. She became her own advocate and made several copies
of the literature she had reviewed, to distribute to all of her providers. This
patient identified a need for heightened awareness of this
complication.
Early detection of
breast cancer at a “curable” stage, combined with remarkable advancements in
multidisciplinary care, has resulted in a precipitous rise in the number of
survivors. The increased number of women living with the long-term effects of
breast cancer treatment is a driving force in the development of survivorship
clinics.
Lymphedema, the
most significant complication of surgical therapy, will be a prominent focus in
those clinics. With early diagnosis and therefore fewer axillary node
dissections, we may see this complication less frequently than we did in the
days of the radical mastectomy. Despite the less aggressive surgical approach
of sentinel lymph node biopsy now commonly taken, there is still a risk of
lymphedema; the article by Dr. McLaughlin quotes an incidence of up to 7%. For
all patients who develop lymphedema, it is a complication that has a
significant impact on their quality of life.
Much of the
challenge in managing lymphedema is the inconsistency in diagnostic standards.
If it is impossible to reach a consensus on diagnosis, it is also impossible to
reach consensus on treatment recommendations. In Dr. McLaughlin’s article, the
incidence is quoted as being between 6% and 70%. Our lack of understanding of
the disease results in this tremendous variability and indicates that we are
likely grossly underestimating the incidence in our practices. The diagnostic
method known to most of us clinically is the inter-arm circumference
discrepancy, in which the arm is measured every 4 cm from the wrist to the
shoulder. A 2-cm difference between the arms has been adopted as diagnostic of
lymphedema. However, this does not account for women with earlier stages of
lymphedema who might not have progressed to this degree of swelling yet or who
have intermittent swelling. This 2-cm cutoff certainly helps to confirm
lymphedema but it should not rule out lymphedema if it is clinically
suspected.
As physicians
caring for breast cancer patients, can we recite the staging system of
lymphedema as readily as the staging system of breast cancer? Do we recognize
that symptoms such as pain, aching, or tightness in the extremity may precede
the actual onset of the swelling? There must be heightened awareness of
lymphedema signs and symptoms in order for the appropriate action to be taken.
Careful physical examination may reveal subtle changes in the extremity without
gross swelling. Lymphedema may also affect areas other than the extremity,
including the chest wall or truncal area and breast. When initiated in the
early stages of lymphedema, treatment is most successful and results in better
long-term outcomes. That leads to the next question: What are the appropriate
therapeutic interventions? Unfortunately, lymphedema specialists are not widely
available and compression garments are not always covered by insurance
companies. These are areas that will have to be addressed in survivorship
clinics. The lack of progress in lymphedema research and treatment can be
attributed to the lack of standard diagnostic criteria, limited awareness of
and evaluation for lymphedema in follow-up visits, and findings that can be
subtle. Educating patients about risk and management without clear
evidence-based data is a significant obstacle to improving treatment. For
example, resistance exercise, which is now deemed beneficial, was previously
believed to increase the risk of lymphedema, so patients were routinely
cautioned to restrict these activities. With the trend toward personalized
care, we have been able to select some populations of patients that can be
spared aggressive surgical approaches in the axilla, but we are still limited
in our ability to inform patients about risks and treatments of lymphedema. The
next steps to improved lymphedema managment will involve awareness, education,
and research. We compliment Dr. McLaughlin on having the insight to shed light
on this topic. It is likely that, as we continue to develop survivorship
clinics, we will hear more about lymphedema in our practices. As Dr. McLaughlin
poignantly stated in her article, “as long as axillary surgery and radiation
remain pillars of breast cancer treatment, lymphedema will remain a potential
complication.”
March
9, 2012
How to treat
lymphedema - Clinical Advisor –
A
man aged 56 years underwent a liver transplant five years ago. He recently
presented with bilateral leg swelling that has progressively worsened. He has
no deep venous thrombosis or venous insufficiency. A diagnosis of lymphedema
has been made. What are the most effective therapies available to treat this
condition? — Jeannie Brennan, ANP-C, ACNP-C, Phoenix
Complete decongestive therapy (CDT) (also called combined, complex, or
comprehensive decongestive therapy) is the gold standard of treatment for
lymphedema. The goals of therapy are to decrease swelling, increase lymph
drainage from the congested area, reduce skin fibrosis and improve the
condition of the skin, enhance the patient's functional status and quality of
life, relieve pain and discomfort and decrease the risk of cellulitis.
Components of CDT include manual lymph drainage, compression
bandaging, lymphatic exercise, skin care and patient education. Lymphedema is a
chronic condition, so the patient must be educated in the important areas of
risk reduction; self-lymph drainage; skin care; signs and symptoms of
infections; proper fit and care of garments; and the importance of a healthy
diet, exercise and weight management. There are lymphedema treatment centers
(including one in Scottsdale, Ariz.) that provide expertise in lymphedema
management. — Eileen F. Campbell, MSN, CRNP (161-4)
March
8, 2012
Initial trials show promising results in stem cell
treatment - Zee News –
Havana:
About 1700 patients were treated until December, 2011, with stem cells, a
treatment with promising results, according to official sources quoted by
media.
Results are similar to those reached in developed countries,
avoiding important amputations to patients, told to Gramma newspaper Doctor
Porfirio Hernandez, coordinator of the National Group for Regenerative Medicine
at the Ministry of Public Health.
According to Hernandez, the treatment
is still trial phase under strict selection criteria, although 10 of the 15
Cuban provinces already receive that service.
Hernandez said that Cuba
has contributed significantly to the international scientific literature in the
sphere, as in the case of improvements experienced by those patients suffering
from chronic Lymphedema in lower limbs.
Hernandez also mentioned the
case of a minor suffering from Idiopathic pulmonary fibrosis (IPF), who was
treated with a procedure based on stem cells, avoiding a lung
transplant.
With the capacity of splitting without limits, stem cells
can regenerate tissues damaged by diseases, trauma or aging.
It is
mainly obtained by bone marrow, peripheral blood, cornea, brain, lung and
endometrium.
600 lbs Cedar Rapids woman pleas for help with weight
loss - The Gazette: Eastern Iowa Breaking News and
Headlines (blog)
Pierce says a
string of medical conditions have brought her to a debilitating
weight
CEDAR
RAPIDS — A 36-year-old woman who says health problems have caused her to weigh
more than 600 pounds is looking for help as she tries to lose enough of the
extra weight to qualify for gastric bypass surgery.
Charity
Pierce of Cedar Rapids hasn’t left her home since November. She said she’s
always been heavy, but a string of medical conditions have brought her to a
debilitating weight.
“Anyone
can see I have lymphedema in my left leg, from the very bottom ankle all the
way up my whole entire left side,” she said. “It’s like carrying another person
around, and it’s really hard to exercise that way.”
Also
known as lymphatic obstruction, the condition causes fluid to build up in the
body after lymph nodes have been damaged. Pierce said that in her case, the
swelling in her leg began after a fall down a flight of stairs in
2001.
She said
her health history includes another complication as well: She once spent eight
months in a hospital fighting the effects of a flesh-eating bacteria
infection.
So now,
Pierce said, she stays inside her apartment to hide.
“This
side of my stomach has lymphedema. This side has been cut away (from the
infection). This leg has lymphedema and this leg doesn’t,” she
said.
Pierce
said she has to lose weight to help the swelling go down and improve her
health. And she knows some people will criticize her for having been obese
before the lymphedema struck.
“‘You
need to just do it on your own,’” is how she characterized others’ advice.
“Well, that’s easier said than done.”
Her
refrigerator isn’t full of junk, but she’s living on food stamps, so eating
healthfully is a challenge.
Pierce
estimates her weight between 610 and 630 pounds; she needs to get down to 500
to be eligible for the weight loss surgery she hopes will give her a fresh
start. So she turned to the Internet, posting a video about her plight on
KCRG-TV9’s Facebook page.
“As long
as I stay hidden in the house, nobody is going to know my story,” she
said.
She’s
hoping for drastic measures to save her life so she can see her 16-year-old
daughter, Charly, grow up.
“She’s
my life. She’s my rock. She’s my world,” Pierce said.
March 7,
2012
Cedar Rapids Woman Pleas for Help with Weight
Loss – KCRG –
Same article as
previous one
March 7,
2012
Lymphedema and the role of physical
therapy - Coeur d'Alene Press – By SHEREE DiBIASE,
PT
Lymphedema
affects approximately two million people in the United States. Its incidence is
on the rise because each year approximately 500,000 Americans will be treated
for some type of cancer that will be treated for some removal or the
destruction of their lymph nodes. One out of every five of those people will
then develop lymphedema.
Lymphedema
occurs when the normal drainage of fluid in our body is disrupted. As the fluid
accumulates, the area will become red, hot, swollen and painful. Often the arm
or leg will double in size. In a normal lymph system, the body utilizes a
network of nodes and ducts. Those nodes and ducts maintain the balance of the
body's fluid, they filter our waste products and fight bacteria.
However,
when lymph nodes have been removed or destroyed by radiation this lymphatic
system loses its ability to maintain this delicate fluid balance. As a result,
there is an accumulation of protein-rich fluid that becomes a breeding ground
for bacteria. If this swelling in the tissue is left untreated, it can lead to
permanent tissue damage, scarring and long-term disability.
Presently,
it is seen most often in women who have had breast cancer surgery where lymph
nodes have been removed and radiation therapy has been done. This swelling in
their arms can occur weeks, months or even years later after
surgery.
That
is exactly what happened for Sarah Micheals. She had decided to take an
airplane trip to New York City to visit her daughter. Five years earlier she
had breast cancer surgery and had been doing just fine since then. However, the
next morning after she woke up at her daughter's home, something just didn't
seem right. She felt like she was getting the flu. Her body ached and her right
arm had a strange red streak on it. Throughout the day the pain in her arm
became worse and her arm started to swell. She got so swollen she could barely
hold her coffee cup and she had to remove her rings. Finally her daughter took
her to the ER, where it was discovered she was suffering from an infection in
that arm resulting from lymphedema. She was given antibiotics, which cured the
infection, however, the swelling in her arm remained. She then was referred to
physical therapy for treatment of the swelling.
Physical
therapy care for lymphedema consists of Manual Lymph Drainage Massage (MLDM),
Medical Compressions Bandaging (MCB), special exercises that milk the lymph
system and supplement the massage, skin care and treatment of any
infections.
The
physical therapy care will help decongest the swollen body part, eliminate
fiber tissue and improve the immune system function. Once the body part has
reduced in size a protective garment needs to be worn on that extremity to
avoid re-accumulation of that lymph fluid. This protective garment helps to
maintain the natural fluid balance of the affected body part.
If
you are a cancer patient who has had any lymph nodes removed or radiated here
are some guidelines you should follow in order to prevent this chronic,
progressive disease.
•
Wear a protective garment for flying of when doing any new actives you are not
accustomed to.
•
Wear gloves during household chores or gardening to avoid minor cuts, animal
scratches, bug bites and puncture wounds. Use antibacterial ointment right away
if you do get a wound and consult your physician immediately.
•
Avoid injections and blood pressure monitoring on the body part.
•
Exercise at a moderate pace and keep "muscle pump" active. (Swimming in 75 to 85
degree F water is one of the best forms of exercise due to the natural pressure
gradient in the water).
•
Avoid hot baths such as Jacuzzi tubs, whirlpools, heat from hair dryer and sun
exposure.
•
Avoid any deep tissue massage.
•
Wear clothing that is not restrictive to allow appropriate lymph flow. Wear your
rings and watch on other extremity.
•
Eat a diet low in sodium and saturated fats. Discontinue use of alcohol and
nicotine.
•
Keep skin clean and well moisturized. Use electric razors only.
If
you have further questions regarding Lymphedema or you are wondering whether
you have this disease, you can go online to the National Lymphedema Network at
www.lymphnet.org or call them at
(800) 541-3259.
Sheree
DiBiase, PT, is a licensed physical therapist and the owner of Lake City
Physical Therapy in Coeur d'Alene and the Spokane Valley. She has been
practicing outpatient physical therapy for more than 20 years and was an
Adjunct Professor at Loma Linda University, School of Physical Therapy for
seven years, she instructed in Applied Kinesiology, Biomechanics and Gait
Analysis. Both of her offices provide care for cancer related fatigue, weakness
and lymphedema. She can be reached at (208) 667-1988.
At Last - Possible Therapy for
Lymphedema - dailyRx – By:
Laurie
Stoneham
Lymphedema may have new treatment in Lymfactin
(dailyRx)
About one in five women has painful swelling following breast cancer
surgery. There are currently only limited options for dealing with this
condition - lymphedema - but that may be about to change.
A new medication - Lymfactin - is currently being tested to treat
breast cancer related lymphedema. The drug will be used in combination with
surgery.
Pre-clinical data has been presented on Lymfactin, which is being used
at the Gordon Research Conference for Molecular Mechanisms in Lymphatic
Function & Disease.
“Currently there is no advanced pharmacologically-based therapeutic
for lymphedema,” said principal investigator of the upcoming "first in human"
trial for Lymfactin, Stanley G. Rockson, M.D., director of the Center for
Lymphatic and Venous Disorders at Stanford University School of
Medicine.
“Although the research Is still early, the preliminary data show a
remarkable improvement in the ability to successfully conduct lymph node
transplant surgery with the benefit of Lymfactin.”
Lymphedema occurs from damage or trauma to the lymph nodes that can
cause blockages in the lymphatic system and result in fluid build-up. About 20
percent of patients with breast cancer suffer from the condition that can cause
painful inflammation and swelling in the limbs - usually the arm closest to the
breast that was treated for cancer.
The therapy with this medication involves removing a lymph node flap
from the patient's lower abdomen. The lymph node is injected with Lymfactin and
placed into the axillary (underarm) region.
A number of previous laboratory and animal studies have been conducted
to test the effectiveness of transferring lymph nodes. One such study showed
that the transfer alone resulted in a 20 percent improvement in
mice.
When the lymph node was injected with a medicine containing a gene
known as vascular endothelial growth factor C (VEGF-C), overall improvement
jumped to about 80 percent. Lymfactin is a VEGF-C gene therapy.
"I think this is extremely exciting," David N. Finegold, M.D.,
professor of pediatrics and human genetics at the University of Pittsburgh,
told dailyRx.
"The current therapies for secondary lymphedema are extremely limited
largely involving compression and bandaging," said Dr. Finegold, who has not
been involved with these studies.
He continued, "With the significant advances in treatment of breast
cancer, there may be as many as 400,000 to 600,000 women suffering from
secondary lymphedema. The possibility of alleviating this concerning
complication of treatment will provide hope for significant improvement in
quality of life for women suffering from this condition," Dr. Finegold
said.
Wendy Chaite, founder of the Lymphatic Research Foundation, a national
organization devoted to advancing lymphatic research, calls this treatment
"very promising," adding, “Lymphedema is one of those seldom discussed but far
too common conditions that biotech and pharmaceutical companies have yet to
explore."
Lymfactin is an investigational therapy being developed by Laurantis
Pharma Oy in Finland. The company plans to begin a phase I/II study in early
2013.
March 6,
2012
Gift From Cancer? A New Look -
New York Times –
ONE
Friday afternoon early this year, in a limestone town house on the Upper East
Side, the topic of conversation was “cancer things, like lymphedema,” said
Sherry Kreek, who is undergoing chemotherapy for breast cancer.
The
conversation wasn’t happening in an oncologist’s waiting room or at a luncheon,
but at Sharon
Dorram Color at Sally Hershberger, a homey six-chair
salon where Ms. Kreek, 62, is the manager.
Three
women with microshort hair, strangers before they sat down, had all gone to Ms.
Dorram, whose clients include Christie Brinkley and Linda Evangelista, to have
their hair dyed for the first time since it had grown back after cancer
treatment. They weren’t shy about talking about their new hair and what to do
with it, whether they liked their wigs, or much else about the disease they
shared.
“This
was a more upbeat, happy place to talk than a treatment center,” Ms. Kreek
said.
A
decade ago, the women who came to see Ms. Dorram, then at John Frieda, after
chemo or radiation therapy did so furtively. They removed their wigs in the
bathroom or booked early morning appointments so they didn’t have to be in a
room with healthy clients.
“You
feel vulnerable,” said Ms. Kreek, who met Ms. Dorram at John Frieda, when she
returned to blond after her first round of chemotherapy in 2003. “You don’t
want to come into a room with ladies with tons of hair, going, ‘I liked it when
you did that last time.’ It’s like, ‘Shut up.’ ”
Now,
for many women who have lost hair during cancer treatments, dyeing is
empowering — and doing it in an open, chatty session makes it all the better.
“They’re feeling good again,” said Alexis Antonellis, a colorist at Oscar
Blandi who often sees clients who want hair colored after chemotherapy. “They
want to go back to who they were. They’re so excited to sit back in the chair
and get their life back. It’s really nice. You’ve got to see the smiles.”
Even
Ms. Kreek, who wears a stunning blond shoulder-length wig because her hair is
not yet long enough to color, has become less guarded. “I used to make them
wash my wig on my head,” she said. “Now I just hand it off.”
She’s
planning to have Ms. Dorram dye her hair in the next week or so, in time for a
vacation to Palm Beach, Fla. “I haven’t been anything but a blonde since I was
a kid,” she said. “A lot of that was not natural, but to have this ash-colored
hair is not me. I am definitely a blonde. I’m not a gray-haired person, no
matter what my body says.”
One
might expect cancer patients to be leery of chemical processes, especially
those that have been explored for possible carcinogenicity, as hair color has.
The International
Agency for Research on Cancer, part of the World Health
Organization and dedicated to identifying cancer causes, said personal hair dye
is “not classifiable as to its carcinogenicity to humans,” based on a lack of
evidence from studies in people. On its Web site, the
National Cancer Institute writes that while “some studies
have indicated that people who began using hair dyes before 1980 have an
increased risk of developing non-Hodgkin’s lymphoma, the evidence for increased
risks of other cancers from hair-dye use is limited and conflicting.”
“Nothing
is off the table,” Ms. Antonellis said of the dyes she uses. “But I’m
constantly thinking about respecting the integrity of what they have and where
they are in treatment.”
Dr.
James Speyer, medical director at the Cancer Institute at NYU Langone Medical
Center, who is also Ms. Kreek’s oncologist, said he encouraged women to dye
their hair if it made them feel better. “It is my understanding that there is
no risk,” he said. “It is perfectly fine for women to color their hair. It’s
obviously important to them, and there’s no risk of the normal hair dye causing
additional cancers.”
And
it’s not just a female issue. “How people look is a very important part of
their whole approach to the diagnosis of cancer and to the treatment of cancer,
and anything we can do to help them work through that period is so important to
their overall sense of well-being.”
Amy
Katz, 48, of Westport, Conn., whose breast cancer was diagnosed in June 2008,
noticed her hair growing in gray after treatment. “You start looking like Jamie
Lee Curtis,” she said. The first person she called was her oncologist. “You’re
eating perfectly and doing everything right,” she said. “You’re walking on
eggshells, so I asked, ‘Do you think I can color my hair?’ ”
“Blondie,”
her oncologist told her, “I want you to color your hair any color you want.”
John
Barrett, who has a namesake salon at Bergdorf Goodman, said hair usually grows
back curlier and slightly grayer. “Generally when the hair grows back, it grows
back quite differently, but it goes back to its normal texture within a year,”
he said. “I tend to recommend that people wait a little while before deciding on
a color, but then I usually suggest that they go lighter and try having a few
highlights.”
After
her oncologist’s O.K., Ms. Katz returned to blond. “People made me feel like I
looked like Sharon Stone, whether I did or didn’t,” she said.
The
most important thing for her was that she began to look as she did before
cancer. “You want to prove that you can climb Mount Kilimanjaro and get over to
the other side and get your life back to where it was,” she said. “You want to
know that you can do it, and having the same hair color is part of that.”
Some
survivors celebrate the newest phase of their lives with a radically different
style. Kate King, an actress in her 40s who also had cancer, had her post-chemo
hair dyed blonder than it had been. “Before cancer, I looked like the girl next
door, like Jennifer Aniston,” she said. “Now I feel like I have Annie Lennox
inside me. It empowered me to bring out that aspect of my personality.
“Of all of the changes that did occur, my
hair has made the biggest difference,” said Ms. King, from the Upper West Side.
“I was so afraid to lose it and frightened by what I saw in the mirror, and then
I realized it was such a gift. The last thing I expected was to get a whole new
look out of cancer.”
March 6, 2012
K.
Alitalo wins Lymphatic Research Leadership Award for VEGF-C lymph node
transplant research -
EurekAlert
-
Lymphatic
Research Foundation marks National Lymphedema Awareness Day by presenting the
2012 Lymphatic Research Leadership Award to Kari Alitalo, M.D. Ph.D.,
University of Helsinki for 'advancing lymphatic science'
(Ventura,
Calif. March 6, 2012) The Lymphatic Research Foundation (LRF) today presented
the 2012 Lymphatic Research Leadership Award to Professor Kari Alitalo, MD,
from the Hartman Institute at the University of Helsinki.
The
award is presented in recognition of Dr. Alitalo's outstanding dedication and
contributions to the field of lymphatic research.
"Dr.
Alitalo research continues to have significant impact on advancing lymphatic
science and of helping to put the lymphatic system 'on the map' of biomedical
research worldwide," said Wendy Chaite, Founder, Lymphatic Research Foundation.
"We are enormously proud to include Dr. Alitalo in our distinguished list of
award winners and hope to incentivize more groundbreaking research in to this
field for which we currently understand far too little."
The
LRF-Lymphatic Research Leadership Award recognizes individuals who have made a
significant contribution toward promoting and supporting the growing field of
lymphatic research and/or to find improved treatments and a cure for lymphatic
disease, lymphedema and related disorders. Past recipients have included
Stephen Goldman, PhD and Henry Chang, MD (2002); Stanley Rockson, MD (2004),
Waldemar Olszewski, MD (2006); Guillermo Oliver, PhD (2008); and David Zawieja,
PhD (2010).
The
award was presented on Lymphedema Awareness Day during a special meeting of the
LRF held near the Gordon Research Conference on Molecular Mechanisms in
Lymphatic Function & Disease, Ventura, California.
About
Dr. Alitalo
Dr.
Alitalo is Director, Academy of Finland Center of Excellence in Cancer Biology,
University of Helsinki and Academy Professor, Research Council for Health,
Academy of Finland.
Dr.
Alitalo's work is widely cited; and he is credited with being the first to
isolate and characterize lymphangiogenic growth factor (VEGF-C), its receptor
(VEGFR-3) and isolate lymphatic endothelial cells for molecular analysis. He
has devised molecular therapies that hold promise for new treatments of
lymphedema and lymphatic metastasis.
Professor
Alitalo made the discovery that the growth factor VEGF-C regulates the growth
and development of the lymphatic system in humans and other mammals.
Together
with his colleagues Dr. Tuomas Tammela and Dr. Anne Saaristo, they identified
that if VEGF-C is injected into tissues in mice and subsequently in pigs,
growth of new lymphatic vessels and the restoration of the lymphatic
architecture is catalyzed. Previous studies have shown that transferring lymph
nodes from the inguinal region to the axillary region in patients with
secondary lymphedema following their treatment for breast cancer was found to
offer a slight improvement in their condition.
Removal
of old scar tissue from the axilla is considered an important step of this
procedure.
Professor
Alitalo and his team then showed that by combining VEGF-C injections with lymph
node transfer in animal models using mice and then pigs, the response seen was
even better than lymph node transfer alone. The results in mice indicated that
lymphedema treated with lymph node transfer alone resulted in about 20%
improvement. However, when combined with the administration of VEGF-C, the
overall response was increased to around 80%.
###
About
Disorders of the Lymphatic System, Lymphatic Disease, Lymphedema and Related
Disorders
The
most prevalent lymphatic disorder is lymphatic insufficiency, or lymphedema.
This is an accumulation of lymphatic fluid in the interstitial tissue causing
swelling, most often in the arm(s) and/or leg(s), and occasionally in other
parts of the body. The severity of this disease varies from very mild
complications to a disfiguring, painful and disabling condition. In addition,
patients are often susceptible to serious life-threatening cellulite infections
(deep skin), and if untreated, can spread systemically or require surgical
intervention. It remains a lifelong functional problem requiring daily
treatment for maintenance. Eventually the skin becomes fibrotic (thickening of
the skin and subcutaneous tissues) with loss of normal architecture, function
and mobility.
Primary
Lymphedema is an inherited condition in approximately 0.6% of live births. The
lymphatic vessels are either missing or impaired and can affect from one to as
many as four limbs and/or other parts of the body, including internal organs.
It can be present at birth, develop at the onset of puberty or present in
adulthood, with no apparent causes. Other lymphatic diseases include lipedema,
cystic hygromas, lymphangiomas, lymphangiectasias, lymphangiomatosis and other
mixed vascular/lymphatic malformation syndromes and conditions, such as
Turner-Weber and Klippel Trenauney Syndrome.
Secondary
Lymphedema (acquired regional lymphatic insufficiency) is a common problem
among adults and children in the United States. It can occur following any
trauma, infection or surgery that disrupts the lymphatic channels or results in
the loss of lymph nodes. Among the more than 3 million breast cancer survivors
alone, acquired or secondary lymphedema is believed to be present in
approximately 30% of these individuals, predisposing them to the same long-term
problems as described above. Lymphedema also results from prostate, uterine,
cervical, abdominal, orthopedic cosmetic (liposuction) and other surgeries,
malignant melanoma, and treatments used for both Hodgkin's and non-Hodgkin's
lymphoma. Radiation, sports injuries, tattooing, and any physical insult to the
lymphatic pathways can also cause lymphedema. Even though lymphatic
insufficiency may not immediately present at the time any of the events occur,
these individuals are at life-long risk for the onset of lymphedema.
About
Lymphatic Research Foundation
LRF
is a 501(c)(3) not-for profit organization whose mission is to advance research
of the lymphatic system and to find the cause of and cure for lymphatic
diseases, lymphedema, and related disorders.
The
lymphatic system is vital to the health of every individual. Scientific
investigation of the lymphatic system will provide preventive and therapeutic
benefits for a broad array of diseases. As an integral part of the immune
system, it is both critical to the body's surveillance against cancer, and it
can provide pathways for cancer to metastasize.
Unraveling
the mysteries of the lymphatic system is vital to understanding many other
disease processes. It plays a role in inflammatory and auto-immune disorders
such as arthritis and systemic lupus, and is key to understanding the spread of
AIDS and many infections. The Lymphatic Research Foundation fosters and
supports research to discover the links between lymphatic function, diseases,
and levels of wellness.
LRF's
immediate goals are to increase public and private funding for lymphatic
research and to increase public awareness. More information is available at www.lymphaticresearch.org.
March
3, 2012
Homegrown beef with no hormones, antibiotics on
sale - Salisbury Post –
SALISBURY
— Burleson Farms offers all-natural beef for sale in Rowan County.
Lanny
Burleson started raising cattle naturally three years ago after retiring from
East Rowan High School, where he taught agriculture for 24 years.
While
his family has raised cattle on a Stanly County farm since the 1950s, Burleson
said he decided to try raising all-natural cattle with no hormones or
antibiotics.
He
sells the beef at Variety Produce in Rockwell, as well as online at
www.burlesonbeef.com.
Burleson
cattle eat grasses and hay grown on the family farm, and all beef is homegrown
from birth to harvest.
“Our
cattle are well cared for as they grow, free from the growth-enhancing
antibiotics, added hormones, preservatives and animal by-products commonly used
in commercial feed lots,” Burleson said.
Their
diet is supplemented with small amounts of grain prior to processing to enhance
the beef’s marbling and flavor, he said.
Burleson
Farms cattle are guaranteed to be at least 50 percent Angus, crossbred with
European breeds to gain hybrid vigor and efficiency while maintaining the
tenderness and flavor of Angus beef, Burleson said.
Beef
is sold in eighths, quarters or half sides. An eighth side of beef weighs
between 50 and 60 pounds ($5.75 per pound), a quarter side between 100 and 125
pounds ($5.50 per pound) and a half side about 250 pounds ($5 per pound). Two
adults typically eat a quarter side of beef per year. The beef is packaged,
vacuum sealed, weighed and labeled according to the type of cut.
To
learn more, email [email protected] or call 704-239-3841.
Roseman
opens Lymphedema Solutions Physical Therapy
SALISBURY
— Pam Roseman has opened Lymphedema Solutions Physical Therapy Inc. at 322
Mocksville Ave.
Roseman
has an advanced master’s of health science and a doctorate of physical therapy.
She is also certified in manual therapy and as a lymphedema therapist. Roseman
has 21 years of physical therapy experience.
Lymphedema
is defined as an abnormal accumulation of fluid in the tissues. Lymphedema can
also be defined as swelling, which can manifest in the arms, legs, face or
trunk.
The
office is open Monday through Friday from 8 a.m. to 5 p.m. The phone number is
704-213-4952.
Saving
Grace horses getting a free dewormer shipment
As
a part of its platinum level sponsorship of the Professional Association of
Therapeutic Horsemanship International, Bimeda will ship boxes of Equimax
dewormer to Saving Grace Farm in Salisbury.
All
shipments will be sent in time for spring deworming. Generally, horses should
be dewormed twice a year, usually in the spring and fall.
Saving
Grace Farm serves the community by providing Equine Facilitated Learning and
Therapeutic Horsemanship activities, serving people with special needs and
at-risk youth.
The
PATH Intl. Premier Accredited Center Program uses accreditation and licensing
systems to improve equine-assisted activities and therapies.
For
information on Saving Grace Farm, visit http://savinggracefarm.com or call
704-638-2339. For more information on the program, visit
www.pathintl.org.
Sloop
Heating & Air Conditioning honored for training hours
Trane’s
Charlotte/Greensboro District Sales Office presented S.A. Sloop Heating &
Air Conditioning Inc. with an award for 342 Technical/Business Training Hours
in 2011.
This
award goes annually to the Trane dealer with the most training hours within the
district.
Terry
Clendenin with Trane presented this award to Stanley and Brenda Sloop, owners
of the business at 705 West Ryder Ave. in Landis on March 1.
S.A.
Sloop is a Trane Comfort Specialist dealer, a distinction held by few Trane
dealers nationwide. Only dealers that meet Trane standards and who demonstrate
a commitment to customer satisfaction earn the designation.
Bank
of the Carolinas no longer listed on Nasdaq exchange
MOCKSVILLE
— Bank of the Carolinas Corp., the parent company of Bank of the Carolinas,
announced its common stock will no longer be traded on the Nasdaq Stock
Market.
Trading
of the company's common stock is expected to be available for quotation on the
OTC Pink market, commonly referred to as the “Pink Sheets.” The company also
plans to pursue the quotation of its common stock on the OTC Bulletin
Board.
Nasdaq
rules require a minimum market value of $5 million.
The
company chose not to appeal Nasdaq’s decision to suspend trading.
“Clearly
we are disappointed that trading in our stock on Nasdaq has been suspended,”
Stephen R. Talbert, president and chief executive officer of the company, said
in a news release. “Due to market conditions, we are not in a position to
satisfy Nasdaq’s continued listing requirements at this time. However, we
remain committed to strengthening our company and focusing on the needs of our
customers.”
The
move is not expected to have any effect on the company’s operations or
customers.
Bank
of the Carolinas Corp. operates 10 banking offices, including ones in
Cleveland,
Food
Lion to pick up Energy Star award March 15 in Washington
SALISBURY
— The U.S. Environmental Protection Agency has awarded Food Lion, Harveys and
Reid’s with its 11th consecutive Energy Star award.
The
2012 Sustained Excellence Awards are given to a select group of organizations
that have exhibited outstanding leadership year after year. Winners have
reduced greenhouse gas emissions by setting and achieving aggressive goals,
employing innovative approaches, and showing others what can be achieved
through energy efficiency.
“We
are honored to receive this ENERGY STAR Sustained Excellence award and are
committed to being strong corporate citizens in the communities in which we
operate,” said Susan Sollenberger, director of energy, maintenance and
equipment purchasing at Delhaize America.
Award
winners are selected from about 20,000 organizations that participate in the
Energy Star program.
Company
representatives will receive the award on March 15 in Washington,
D.C.
Concord,
Landis, Lexington and Mocksville.
Reid-Hairston
earns Biltmore Who’s Who honor for social work
SALISBURY
— Velveeta Reid-Hairston, president and owner of Family Training and Assessment
Services LLC, has been selected as a member of the Biltmore Who’s Who Executive
and Professional Registry for community social work and
networking.
Reid-Hairston,
who received her undergraduate degree from Livingstone College and a master’s
degree in clinical social work from Norfolk State University, is a certified
clinical sexual offender treatment specialist.
She
is a contract trainer specialist and has experience in child welfare/foster
care and adoption services. She founded the nonprofit The Shepherd’s Heart
Ministry, which provides financial resource assistance to seniors, as well as
empowerment opportunities/strategies to meet basic daily needs for
survival.
She
is employed with the Department of Health and Human Services-Division of
Services for the Blind in Greensboro and is a member of Alpha Alpha Zeta
Chapter of Zeta Phi Beta Sorority Inc. of Salisbury. She attends Jerusalem
Baptist Church in East Spencer.
Reid-Hairston
is also the administrative assistant to her husband, Tommy H. Hairston Sr., of
Hairston Funeral Home Inc. She and her husband have four adult children and six
grandchildren.
Kannapolis
Gentiva Home Health office recognized for sales success
The
Kannapolis Gentiva Home Health office, 297 East 22nd St., was selected as the
national crew of the week for its sales success.
Employees
were recognized on the national ring the bell call.
The
week’s admissions were 132 percent of the weekly goal, tying a record weekly
admissions set earlier in the month.
The
office billed a record for revenue in the week, with a 52 percent gross margin
year to date so far.
Submit
information about new businesses, honors and management promotions to
[email protected]. Include a daytime phone number.
March
1, 2012
Rep. Floyd: Capitol Hill Wrapup
- The Chattanoogan –
The
House of Representatives Thursday moved legislation to provide small business
entrepreneurs with a “one stop opportunity” webpage to help incentivize and
encourage small business activity throughout Tennessee.
Countless
studies have shown small businesses are the backbone of Tennessee’s
economy.
House lawmakers
have consistently shown they are committed to removing regulatory roadblocks
and refashioning government to be a resource for job creators in Tennessee.
Today’s legislation provided more evidence of this long-standing
commitment.
Under
House Bill 2612, the General Assembly directs the Department of Economic and
Community Development, in conjunction with the Office of the Comptroller’s
Small Business Advocate, to develop a web page to aid job creators desiring to
form a small business in obtaining information concerning state laws,
regulations, and requirements that apply to the specific type of small business
the user desires to form. The web page must contain hyperlinks to relevant
laws, regulations and requirements, including:
(1)
Forms or documents which a state department or agency requires to be filed for
that type of business to operate in the state;
(2) Contact information and
web sites for boards and commissions which regulate the specific type of entity
to be formed; and
(3) Notices regarding potential and pending rule making
hearings for the various boards and commissions.
The
main sponsor brought the bill to the House Floor and stated, “This is one of a
number of items that is designed to encourage and grow small business
opportunities in the State of Tennessee.” The bill, which is consistent with
the Governor’s calls to help Tennessee’s job creators, now goes to the Senate
for action.
House
Punishes Sex Promoters
With
a vote of 90-0, the House of Representatives passed tough new legislation
targeting individuals who promote sex as a profession, also known as “pimps.”
The bill, House Bill 2853, adds the names of individuals convicted of promoting
prostitution to the sex offender registry. First time offenders will be listed
for ten years. Individuals with second offenses would be there for
life.
The
legislation was inspired by findings from Tennessee Bureau of Investigation
(TBI) 2011 report on human trafficking in Tennessee and the detrimental effects
that activity has on individuals throughout the State. The study can be
accessed here.
Asked
why she decided to carry this bill, the Representative leading it stated,
“These offenders exploit adults and children for profit and that is a bad
thing. I believe the public has a right to know who these individuals
are.”
The
bill is a portion of a legislative package to combat human trafficking in
Tennessee being ushered through the General Assembly by the House Majority. “We
are going to do everything we can to stop this heinous activity. This is one
more piece of trying to make sure Tennessee is no longer a magnet for human
trafficking,” concluded the Representative.
Comptroller
Wilson Provides In-Depth Report on Tennessee’s Financial Condition to House
Majority
Tennessee
is in a historically strong financial position according to a review of the
State’s fiscal affairs. In the middle of the week, the Tennessee Comptroller
gave an in-depth report on this subject to Members of the
Majority.
During
his presentation, the Comptroller outlined several positive indicators of
Tennessee’s current status, among them:
-
The State budget is balanced on a recurring basis;
-
the current State debt is not excessive and Tennessee has one of the lowest debt
ratios in the nation;
-
the State’s retirement plan is sound; and,
-
the Tennessee unemployment trust fund is solvent.
Though
the report was encouraging about current financial positions, the Comptroller
discussed challenges that lie ahead for the State to remain on such sure
footing. He stated that, without proper fiscal leadership, the State will have
limited reserves and be haunted by past goals instead of present priorities. He
also talked about a reduced opportunity for tax reductions and capital
projects, both major priorities of the Majority Party for the future well being
of the State.
Lawmakers
Honor Inspirational Tennessee Hero
During
a recent session of the General Assembly, one Representative took some time to
share the inspirational story of Blake McMeans with his colleagues in
the House.
McMeans
was once a rising tennis star, ranked as high as fourth in the nation at one
point, who saw his dreams dashed on a cold winter’s night in 1994 because he
made the decision to drive home under the influence. McMeans crashed into a
tree and was airlifted to a hospital where he would spend nearly four months in
a coma. Doctors were convinced he would never recover, but McMeans had other
plans.
Today,
he runs the Blake McMeans Promise Tour which is designed to educate and
motivate students to make the right choices with their lives. The tour has
touched thousands of lives across Tennessee.
To
honor McMeans’ service, lawmakers authored House Joint Resolution 542. The
resolution unanimously passed both Chambers of the General
Assembly.
One
Representative remarked, “Blake McMeans’ touching story has launched numerous
collaborative efforts throughout our great State and has empowered thousands of
young people to be become responsible, mature leaders dedicated to living life
to the fullest.” He continued, “I believe the least we could do is recognize
his service to Tennessee and lift him up as an example of how to make a
difference in society.”
In
Brief
Lawmakers
Move Local Redevelopment Bill to Encourage Job Growth--At
the conclusion of the week, the House advanced legislation to provide
transparency and accountability in tax increment financing (TIF) law.
Additionally, House Bill 2231, streamlines the Tennessee Code to place all TIF
references into one section of the Code. TIF is an economic development tool
that local governments use to redevelop areas. Without TIF, some of the
redevelopment projects may never occur, costing areas potential economic growth
and jobs.
Teachers
First Amendment Rights Protected by Legislation--On
Thursday, House Members took a strong step to protect the First Amendment
rights of school personnel, including teachers and administrators.
Representatives sought to ensure educators can participate in programs that
take place either before or after school hours and do not interfere with their
school duties. The legislation passed 93-0. The companion version of the bill
is currently in the Senate Education Committee.
Ford
Raises Awareness About Lymphedema--In
an effort to show support for National Lymphedema Day, House Members are urging
individuals to wear turquoise on National Lymphedema Day, Tuesday, March
6th, to raise awareness about the debilitating condition. Lymphedema
refers to swelling that generally occurs in one of your arms or legs. It
affects thousands of individuals a year. “This is a very special cause and one
worthy of the support of our community,” said a supportive Representative. “It
is incumbent upon all of us to support those affected by this
disorder.”
Tennesseans
Strongly Support Voter ID—Eighty
two percent of Tennesseans consider the new voter identification law “a good
idea that should be kept in place,” according to a new Middle Tennessee State
University (MTSU) poll. About four in five Tennesseans (83 percent) say they
have heard that voters will be asked to show a photo ID at the polls starting
this year, up significantly from last fall’s 71 percent.
Secretary
of State Unveils New Tennessee Business Spotlight—With
nearly 900 companies and more than 100,000 employees, auto manufacturers,
suppliers and parts retailers make up a large segment of Tennessee’s economy.
In March, the Secretary of State’s office is highlighting five of these
businesses in its Tennessee Business Spotlight. The Tennessee Business
Spotlight is a new program featured on the Secretary of State’s web site that
highlights selected companies with overviews of their products and operations
including employment figures, photos, and links to their Internet and social
media sites. March’s theme is “Tennessee - Wheels in Motion.” To view the
Tennessee Business Spotlight, go to www.spotlight.tnsos.net.
*
* *
I
want to thank Rep. Richard Floyd for his work and keeping everyone updated.
Fine job.
Joe Blevins
Guild, Tn.
March
1, 2012
LACE UP FOR LOCAL EVENTS -
Montreal Gazette –
April
29: 5K Walk for Lymphedema, 8 to 11 am at Jean Drapeau Park. Visit infolympho.ca. May 27: The
Kidney Walk for the Kidney Foundation of Canada.
March
14, 2012
Lymph system, what? - Coeur
d'Alene Press – By
SHEREE DiBIASE, PTThe
Coeur d' Alene Press
The
Lymph system is a major system in our body that probably is the least
understood and one of the systems that is barely talked about in health care
today. However, really it is of vital importance on a daily basis for our
health and overall well-being. The lymph systems primary function is to protect
the body from infection and disease via the immune response system according to
the National Lymphedema Network. It does this by the production, maintenance
and distribution of lymphocytes. The lymphocytes are the "infection fighting
cells."
The
spleen and thymus gland produce the lymphocytes. These cells then fight the
unhealthy cells and they are transported by little watersheds and vessels to
the bloodstream and ultimately flushed out of the body. The Lymph system could
be called the body's own "garbage disposal system," it gets rid of all the
junk.
The
lymph system is made up of more than 700-800 lymph nodes throughout the
body.
There
are chains of nodes and then clusters of nodes in strategic areas. The clusters
are located in a specific area to protect that area from invasion. For example,
when you get a sore throat often you will often have enlarged lymph nodes on
either side of your neck. These nodes collect and filter the waste, and
regulate the protein levels, so we know we are "fighting off something" when
they are enlarged.
The
lymph system has lymph fluid that is clear and colorless. It is made up of
protein, water, cellular debris and fatty acids. Now imagine the lymph vessels
as a stream, which runs in one direction. They have a one-way value only and
this pushes the lymph in that direction. All streams run back toward the heart.
So the bloodstream needs to be able to handle the load each day of the lymph
cleaning system. The lymph fluid can be mobilized by massage, compression; the
"muscle pump" which is why exercising is so important, external pressure,
breathing patterns, etc.
If
the lymph fluid builds up in the tissue and is not flushed each day, as it
should be it could harden the surrounding tissue. It also loves to bind to the
fatty tissue and then it is especially hard to mobilize. The skin integrity is
then compromised due to too much fluid and breakdown of the tissues can occur
and then the efficiency of the muscle pump decreases. The lymph vessels will
dilate and the one-way values cease to function and the area becomes swollen.
This can happen anytime there is any accumulation of swelling, whether from an
injury, a bruise, a localized tendonitis or post-surgically. You do not want
fluid that is ever stagnant, because that is where infection can
brew.
When
the body is functioning efficiently the lymph system will activate itself no
problem. However, if nodes have been damaged or destroyed as with radiation or
surgical lines that interrupt the lymph streams flow pattern, then the lymph
system cannot handle the load and will shut down. We see fluid get backed up
behind C-sections scar lines, and even edema from a total joint.
If
this happens to you do not be dismayed. There are things you can do to mobilize
the flow of protein rich fluid. The first thing to do some very basic things
like drinking more water, up to eight glasses a day. Decreasing your sodium
intake to below 1,800mg a day (the average American consumes 3,500mmg a day).
Stop smoking because this slows the lymph system down and decreases tissue
healing.
Make
sure you are sleeping at least eight hours a night to ensure the body's healing
mechanisms. Then increase your leafy greens veggies, fruits and decrease all
processed foods to a minimum.
Next
seek the assistance of your physical therapist, which has been specifically
educated in the care of the lymph system. Remember, the lymph system can be
trained how to move fluid around areas of scarring. We also teach the system
how to transport edema around an area that there is restriction with four
specific steps.
The
four steps include specific muscle pump strategies, compression techniques or
kinsiotex taping, manual lymph drainage massage and meticulous skin care. The
therapists who are trained in edema reduction know and use these steps to
assist the lymph system in re-booting itself whether it is from an orthopedic,
cancer or immune system related problem. Please know your therapists can get
your lymph system back on track.
Sheree
DiBiase is a licensed physical therapist and the owner of Lake City Orthopedic
and Sports Physical Therapy in Coeur d'Alene and the Spokane Valley. She has
been practicing outpatient physical therapy for more than 20 years and was an
Adjunct Professor at Loma Linda University, School of Physical Therapy for
seven years, she instructed in Applied Kinesiology, Biomechanics and Gait
Analysis. Both of her offices provide care for cancer related fatigue, weakness
and lymphedema. She can be reached at (208) 667-1988.
March
17, 2012
After almost 10 years, man finds relief from
misunderstood disease - Salisbury Post - By
David Freeze –
Lymphedema
has plagued Alvin Merritt for many years, but because it went undiagnosed until
recently, he didn’t know there was help available.
Now,
Merritt has regained the quality of life he thought was gone for
good.
Lymphedema
is the most common cause of disability in the world, says Dr. Pam Roseman, a
physical therapist who specializes in lymphedema. In this country, 3-5 million
people are living with it.
Lymphedema,
according to the Mayo Clinic website, refers to swelling that generally occurs
in an arm or leg. Although lymphedema tends to affect just one arm or leg,
sometimes both arms or both legs may be affected.
The
condition is caused by a blockage in the lymphatic system, which prevents lymph
fluid from draining well, and as the fluid builds up, the swelling
continues.
Most
lymphedema sufferers don’t know they have the condition, and Alvin Merritt was
one of these. Merritt was severely injured in a motorcycle accident near his
home in Cleveland, Ohio in October 2002. Though he doesn’t remember much about
the accident, Merritt thinks it started when a car in front of him skidded out
of control.
Following
the accident, Merritt had multiple medical issues that included a minor stroke,
memory loss, impaired vision, and inability to swallow. To improve his chance
of survival and recovery, doctors induced a coma that continued for 45 days.
Merritt did survive, but the most lingering issue was a badly swollen left leg.
Doctors told him that he might never walk again, and that blood clots had
caused the leg to swell. The possibility of amputation was
discussed.
For
more than 9 years, Merritt fought to cope with his disability. He looked for
work that he was physically capable of doing. Long term movement or even
standing made the condition worse. With many pleasant memories of the south,
Merritt eventually moved to the China Grove area, hoping to find work and to be
near family members. Merritt had family in Mocksville and found China Grove to
be an easy commute back to Cleveland or to still more family members in
Augusta, Ga.
Merritt
had served in the Marines from 1994-1998, so he visited the Hefner VA Medical
Center in Salisbury for treatment. Doctors tried to find the cause of the
swelling and prescribed water pills, elevated legs, and compression socks,
though these had been recommended to Merritt for years. He knew they wouldn’t
work, and he asked for more help. He was referred to Rowan Regional Medical
Center shortly after another VA doctor mentioned lymphedema. A doctor at Rowan
Regional referred Merritt to Pam Roseman, owner of Lymphedema Solutions on
Mocksville Avenue.
Merritt
credits Roseman for an almost complete recovery after only a month of
treatment. “She gave me my life back,” he said. “The leg is back to near normal
size for the first time since the accident nine and a half years ago. Previous
to meeting her, I would spend my days like this. Up for breakfast, then watch
TV till lunch, and sit on the porch till supper time. I didn’t have much going
on.”
Roseman,
who has a doctorate in physical therapy, said, “There are no diagnostic tests
for lymphedema. I look for swelling with no pain, with the arm or leg feeling
heavy or tight, and often the inability to wear shoes. Early treatment is
essential, but even in Alvin’s case we were able to make quick
progress.”
Lymphedema
is a lifelong progressive condition. Without treatment, limbs can become
infected or deformed. Skin can become hardened. Lymphedema can be present even
if it is not visible. Women who have had breast cancer treatment are
susceptible, with 26 percent developing lymphedema after treatment, and 45
percent developing the condition 5 or more years later.
Roseman
pointed out that the lymphatic system is responsible for removing extra fluid
from the body and is part of the body’s immune system. She treats Merritt’s
condition with skin care, manual massage, exercise and compression. The manual
massage promotes flow of the lymphatic fluid from the limbs toward the lymph
nodes. Lymph nodes are in the neck area, armpits, and the groin
area.
“We
have to get the lymph flow moving,” Roseman said. “I teach Alvin how to manage
it, and his self-treatment only takes about 30 minutes a day. Part of his work
is to massage the affected area, and he has to keep lotion on the skin.
Lymphedema dries out the skin. I want him to exercise and he now has a
hip-length compression stocking. At night, he will sleep in a Reid Sleeve,
which is full-leg, foam covered version of a compression
stocking.”
Merritt,
who turned 41 this past Friday, knows that he will always have lymphedema, but
now it is manageable.
“I’m
so glad I met Pam,” he says. “My sleeping has returned to normal. I am just so
much happier. I can now walk straighter and without a limp. I plan on walking
more and eventually starting running.
“That
is a long way from using a walker and being treated for anxiety and depression.
I thought I would have to use a motorized wheelchair for the rest of my life.
My mom, Genevieve, only checks on me once a day now, so we know that I am
getting better.”
“Alvin
does have his life back,” said Roseman, who is a certified lymphedema
therapist. “He is now looking for work after being disabled for so long.
Lymphedema remains misunderstood by most doctors, but their awareness and that
of the general public is slowly increasing. Lymphedema can be managed with
complete decongestive therapy, so our goal is to help others like
Alvin.”
Lymphedema
Solutions Physical Therapy is located at 322 Mocksville Avenue in Salisbury.
The office number is 704-213-4952. Roseman also offers home care through
Gentiva Health Services.
March
20, 2012
Child's health battle - Fraser
Coast Chronicle –
TWO Hervey Bay parents unable to meet treatment costs for their sick
one-year-old daughter have pleaded for changes to the medical benefits
scheme.
Glenn and Amy Rivera said they were left to feel helpless as their
child, Brianna, struggled with the rare medical condition,
Lymphedema.
The illness caused Brianna's legs and feet to fill with fluid and she
suffered arthritis-like pain unless medically designed compression garments
were worn.
Two of the socks are needed for each leg and cost the family $300 and
$150 respectively.
"She gets cramps in her ankles and knees and at night time she will
wake up screaming," Amy said.
"It is very difficult on us as parents - we can't really afford $900
every couple of months."
Glenn and Amy moved to the region recently from New South Wales and
said the compression garments Brianna needed had been covered under the medical
benefits scheme there.
Amy said they were struggling to comprehend how products used to treat
a child's illness could be subsidised in one state, but not
another.
"Because she is only 22-months-old and she grows so fast, we need to
replace the socks every couple of months," Amy said.
"Nobody has been able to explain to us why the benefits scheme is not
the same all around Australia - it makes no sense."
Glenn said he was forced to move his young family to the area and
accept a new job as caretaker of a local charity organisation.
He said his wage was minimal which, combined with rising living costs,
made financing treatment for his daughter's illness difficult.
Brianna will visit The Royal Brisbane Children's Hospital for further
treatment next week.
The Chronicle contacted Queensland Health in relation to the Rivera
family's complaint.
They were unable to provide a response by the time The Chronicle went
to print.
March
19, 2012
Health happenings calendar: March
20 - Bradenton Herald –
Lymphedema
Support: meets by appointment. Information: Marsha Shuford,
941-798-2141.
March 19, 2012
Massage Therapist Develops Unique Lymphatic Drainage
System - The Epoch
Times
You know there’s lymph somewhere inside you, but what, exactly, is it
doing for you?
A
less-talked-about but no-less-crucial constituent of the vascular system, lymph
is a light oily substance that floats in the layer of fat just below the skin,
moving around in its own system of vessels.
Lymph is
essentially plasma that transports hormones and fat to cells. It’s responsible
for moving large particles and everything fat-soluble. It also transports
waste, debris, bacteria, toxins, and other unwanted material from cells for
elimination.
One of
the crucial functions of lymph is to deal with toxins—to “take out the
trash.”
And
here’s the kicker—the lymphatic system has no pump. The motion of lymph depends
upon exercise. Our sedentary lifestyles combined with the sheer volume of
toxins our bodies are bombarded daily with make it easier for the tiny vessels
lymph travels through to become clogged.
When
lymph drainage is sluggish or impaired, the waste and toxins that should be
eliminated can be stored in our fat. There they stay, causing symptoms from
stiffness and puffiness to skin irritation, fatigue, severe swelling, physical
pain, and weight gain.
Mild and
severe symptoms can be relieved with lymphatic drainage.
Manual
lymphatic drainage was pioneered by Emil Voder in the 1930s to help lymphedema
patients. Voder’s technique of gentle massage has been the mainstay for
lymphedema patients until now.
Canadian
Innovator
Registered Massage Therapist Marie Graff has created a unique method
of manual lymphatic drainage. The results have pleasantly surprised patients at
the downtown health and wellness clinic Bodyone where Graff is the proprietor,
heading a team of massage therapists, acupuncturists, and
aestheticians.
Graff
Lymphatic Recovery (GLR) uses a combination of all-natural fat-splitting
ingredients that are absorbed by the skin, in combination with aggressive
lymphatic drainage massage to help unclog parts of the lymphatic system that
are not circulating properly.
“The
primary problem,” says Graff, “is that when the lymph gets backed up and
stagnant, it gets thick like lard. The [lymph] vessels are microscopic. You are
not going to get lard into a microscopic vessel.”
Graff’s
method of splitting the fatty molecules uses ingredients you might find in your
refrigerator, which break up the congestion below the skin. The aggressive
massage flushes waste and toxins through the lymph vessels and into the
elimination channels of the spleen and liver.
“Many
of the things that weight the body down come from toxicity,” explains Graff.
“Toxicity is corrosive and aggressive to tissue. Getting it out is important
and in modern life we accumulate toxins like never before.”
Purposeful stimulation of the lymphatic system has a surprising
number of uses.
Pre- and
Post-Operative
A number
of Graff’s clients have found GLR treatments helpful in recovering after
liposuction, breast enhancement, and other kinds or surgery where the lymphatic
system had been damaged.
“Some
plastic surgeons in France and the United States will not do elective surgery
without a regime of lymphatic drainage before and after surgery,” says Graff,
“the results of healing are so much greater.”
Forty-three-year-old IT professional Irina experienced serious
complications after cosmetic surgery.
“There
was no movement in the tissue in my cheeks, chin, and sides. The tissue was
swollen and very tight. Touching and moving the skin on my face would result in
needles-picking sensation with a shooting pain. I would get very strong
headaches and severe pain in my temples area in the evenings.”
In
essence Irina had lost the use of her face.
After
seven GLR treatments, Irina reported that her condition improved
significantly.
“I was
able to start feeling my face again. I stopped to feel as if I had a hockey
mask on top of my face.”
Swollen?
For other
patients, like Margaret, the lack of proper lymph circulation created serious
problems.
“I had
severe total body swelling … pain greatly inhibiting my ability to walk, climb
stairs, or sit without pain,” recalls Margaret.
“Prior to
the treatment my feet and legs were so swollen I could not get boots
on.”
After
seven days of intensive GLR treatments, Margaret wrote in a letter of
thanks.
“I can
walk now with no pain except in one localized area [where a previous injury had
occurred]. … At the end of my last day of treatment, my body congestion [and]
inflammation were reduced by over, in my estimation, 85 percent. …You provided
a solution that was drug-free, effective, and not available anywhere
else.”
GLR has also helped patients with recurring skin problems. Ana, 42,
works in IT as a business analyst.
“I
had severe acne mainly on the chin area and a lot of scarring. The area looked
inflamed and I used to get pimples, [which were] very painful.”
Before
her GLR treatments, Ana had been prescribed antibiotics. “It helped for a few
months, then the problem reoccurred.”
After
10 sessions of GLR, Ana reported a lasting change. “I didn’t have the chin acne
problem since the treatment last year in June.”
Lorena,
a 39-year-old educator at University of Toronto had been diagnosed with adult
acne that covered her chest and back. She was offered a
prescription.
“There
were a lot of potential side effects, and I was not prepared to risk
it.”
“GLR
did improve my symptoms by eventually taking away the acne altogether. … My
skin felt completely renewed and nourished.”
March
19, 2012
Your
vote for the North
Penn YMCA can help local cancer patients - The Reporter - By BRADLEY
SCHLEGEL
Sorry
this has passed
March
23, 2012
NCCN Breast Cancer Guidelines Have 'Major'
Changes – Medscape –
Lymphedema
of the arm occurs in a "significant" number of patients and can become a
"serious quality-of-life issue" with this more extensive lymph node
...
You
have to be a member to access this article sorry
March
24, 2012
Mother & Daughter Beat Cancer -
KFYR-TV –
Last
March, a Mandan woman was diagnosed with breast cancer. Seven months later her
mother was given the same grim news. Coni Couch and Roxi Polzin are now happily
cancer free but have been left with mounting medical bills.
On Saturday
afternoon, friends organized a benefit for them to help with their medical
costs since neither has insurance. Couch is a proud breast cancer survivor but
admits it took her a while to accept the news.
"It just never really
hit me until the day I looked in the mirror, I got out of the shower and looked
in the mirror and I was totally bald, I had lost all my hair and it`s like I
don`t know why but that day it`s like you really have cancer. You really lived
through this," she said.
Shortly after having the cancer removed, Couch
discovered she had Lymphedema. She says the money raised at Saturday`s benefit
will also cover the costs associated with that.
If you`d like to donate
money, you can go to Dakota Community Bank and Trust. An account has been set
up under Coni Couch and Roxi Polzin.
March
25, 2012
Ex-chief secretary Malathi loses last stand against
cancer - Times of India –
CHENNAI:
Former Tamil Nadu chief secretary S Malathi died in a private hospital on
Sunday morning after a prolonged battle with cancer. She was 57.
An
IAS officer from the 1977 batch, Malathi opted for voluntary retirement in
August 2011. She was known as an honest and forthright government servant who
expected the best from those who worked with her.
"Her work
ethic was inspiring. She was meticulous, organised and straightforward. Every
government order, every bit of information was at her fingertips," said
additional chief secretary Sheela Chunkath, who knew Malathi since 1980 when
they were posted together in Trichy.
Malathi
started her career as a sub-collector in Trichy in 1979 and held various
positions including collector of North Arcot district (1987-89) and secretary
of the municipal administration and water supply department
(1996-2001).
"She was
someone who young officers could look up to. She guided us, was supportive,
planned her work and meetings carefully, and never wasted her time or ours,"
said J Radhakrishnan, who worked under her for close to four years. Malathi was
diagnosed with breast cancer in July 2003 when she headed the statistics
department. She underwent treatment while continuing to work, and in seven
months her condition improved. She continued to rise in the ranks and became
home secretary in 2006. A scarf to cover hair thinned by chemotherapy and a
swollen left hand due to lymphedema were the only signs of her
illness.
In May
2010, as home secretary, she was diagnosed with recurrent breast cancer in the
liver. Malathi was expected to take over from K S Sripathi as chief secretary
but she was moved to the vigilance department to give her time to
recuperate.
In August
2010, Malathi wrote a series of moving pieces on her experience for The Times
of India. "I want people to understand that you can fight cancer. Taken with
the right mindset, coming to terms with this illness is not that difficult. The
trick is to be positive but prepared for the worst," she told TOI during a
meeting to edit the pieces.
She
wrote: "After seven years you do get a feeling of having been cured... [so
hearing the diagnosis] was truly shattering... From the totally despondent
thought that I would die in a few days to the dread of therapy to how it will
affect my daughter to how expensive the treatment will be, my mind was
travelling in several directions but getting nowhere... The immediate desire
was to sit in a corner and cry, but then the need to look dignified gets the
better of you and stone-faced I left the hospital."
Malathi
became chief secretary in September 2010 in the DMK regime, only the second
woman to hold the top bureaucrat's post. In May 2011 when the AIADMK took over,
she was transferred to the statistics department. Though she had three more
years of service, she resigned in August.
At her
farewell party when colleagues wished her health and happiness, Malathi told
them that she didn't have much time left. "It was hard to hear that from
someone who was always a fighter," said Chunkath. "But she said it with such
strength and grace," she said.
Malathi wrote for TOI: "I am not sure what the future holds for me: Will I get over this
instalment of cancer and if so, for how long? In the time I have left, I shall
live every day to the full, and be a good human being, treasuring
relationships. Cancer has reinforced my effort to realize myself. If you are
unfortunate enough to be diagnosed with cancer, things are not that bleak,
there is hope. But cancer or no cancer, eat healthy, do not abuse the body and
learn to treasure every day."
March
27, 2012
Tickets now on-sale for 2012 Stylin' Against Breast
Cancer - Quad-Cities Online –
Press
release submitted by Trinity Regional Health System
Dueling
pianos return for wine and cheese party
The Trinity Health Foundation is
now accepting reservations for the 2012 Stylin' Against Breast Cancer. Trinity
Health Foundation, in partnership with Always a Woman, Midwest Hope and
Healing, The American Cancer Society, the Trinity Cancer Center and women who
do not represent an organization but who are advocates of breast health and
survivors, organize the events each year to raise funds for projects that
benefit local breast cancer survivors and promote education about breast cancer
and breast health.
On Wednesday, April 25, the group will host a wine
and cheese party from 6-9:30 p.m., at the Quad-Cities Waterfront Convention
Center, 2021 State St., Bettendorf. Penguins Entertainment will once again
provide "dueling pianos" during the event. The party will also include a raffle
as well as light hors d'oeuvres and wine served by area men who have a personal
connection to someone diagnosed with breast cancer. Tickets for the wine and
cheese party are $25 per person with a reservation or $30 at the
door.
The third winner of the Roxanne Kramer Award will be honored
during the seventh annual Stylin' against Breast Cancer luncheon and fashion
show that features local breast cancer survivors modeling clothing from area
stores on Thursday, April 26, also at the Quad-Cities Waterfront Convention
Center. Doors open at 11 a.m. with the luncheon beginning at 11:30 a.m. Tickets
are $30 per person.
One hundred percent of the proceeds from both events
benefit stay in the Quad-Cities area to fund projects that help local breast
cancer patients and promote education about breast cancer and breast health. To
reserve tickets, call the Trinity Health Foundation at (309) 764-7610, email
[email protected] or visit www.trinityhealthfoundation.com.
About the
Roxanne Kramer Award
The Roxanne Kramer Award is an annual honor to be
given to an outstanding individual(s), organization or business that has
tirelessly contributed to the quality of life of breast cancer survivors and
which through deed, word and ongoing advocacy, has helped educate the community
about breast cancer and breast health.
Kramer, a breast cancer survivor
herself, owns "Always a Woman" boutique in Moline and co-founded the Quad City
Breast Cancer & Lymphedema Support Group.
March
28, 2012
Researchers identify genetic basis of tropical foot
and leg lymphedema – EurekAlert –
Researchers
identify genetic basis of tropical foot and leg lymphedema
Wearing
shoes and genomics are tied together in strategy to eliminate
podoconiosis
Farmers
in the highlands of southern Ethiopia scratch out a subsistence living from the
region's volcanic red clay. The soil supports the farms, but fine-grained,
volcanic rock particles in the dirt threaten the farmers and their families.
Continual exposure of bare feet to the volcanic soil causes 1 in 20 people to
develop a painful inflammation of the lower extremities that, over time, leads
to foot disfigurement. Doctors call it podoconiosis. The locals call it mossy
foot. And those affected suffer social stigma as well as debilitating
discomfort.
Now,
researchers think they know why some 4 million people in at least 10 countries
worldwide develop this incapacitating condition. One-fifth carry genetic
variants that cause their immune system to react to the volcanic dust. This
disease-producing response, triggered by exposure from the lack of shoes,
provides a dramatic example of the interaction between genes and the
environment.
Writing
in the March 29, 2012 New England Journal of Medicine, an international
team that includes researchers from the National Human Genome Research
Institute (NHGRI), part of the National Institutes of Health, describes the
genetic link that turns dirt into a toxin.
"This
study draws attention to a neglected tropical disease with a devastating impact
on poor people and their communities," said NHGRI Scientific Director Dan
Kastner, M.D., Ph.D. "It demonstrates the global reach of genomics research
into the lives of people in parts of the world where endemic diseases very
often go unchecked."
Doctors
have known for a long time that podoconiosis runs in families and that
continual exposure to volcanic soil triggers it. Wearing shoes and socks, or
even washing off the dirt, prevents the condition. But doctors have been
perplexed that only some people develop the disease, while others with the same
environmental exposure are spared.
To
sort this out, the international collaborators conducted a genome-wide
association study—or GWAS—analyzing DNA from 194 volunteers from the Ethiopian
highlands affected by podoconiosis, along with DNA from another 203 unaffected
individuals from the same region. The researchers collaborated with field
workers from the non-profit Mossy Foot Treatment and Prevention Association in
southern Ethiopia to collect the data and samples.
The
researchers generated a dataset from study-participant DNA, screening more than
550,000 single-nucleotide polymorphisms (SNPs), which are sites in an
individual's DNA that contain a different chemical base when compared to a
standard reference human genome sequence. They found significant podoconiosis
association for eight SNPs within or nearby a stretch of DNA on chromosome 6,
called the HLA class II locus.
The
researchers performed a second validation step, called a family-based
association study, using DNA samples from 202 sets of child-parent trios from
affected families. The researchers detected six SNPs that showed significant
association—those that mapped to HLA class II region genes and most strongly
associated with podoconiosis in the GWAS, validating the GWAS results.
Further
analysis of direct HLA tests of 94 affected persons and 94 controls confirmed
that podoconiosis susceptibility is increased by inheriting altered DNA in the
HLA class II locus from one or both parents. The researchers estimated that the
SNPs found through the GWAS—which alone comprise a portion of the genetic
factors in podoconiosis—¬¬ explained about 16 percent of the variance in the
disease occurrence. They also found that individuals with those gene variants
were 2 to 3 times as likely to become affected if exposed to the volcanic rock
soil.
"This
is the first study of a non-communicable disease to have used genome-wide
association for any African population, and it is the first study that has
attempted to use a systematic genomic approach to shed light on the genetic
basis of podoconiosis," said Charles Rotimi, Ph.D., co-author and senior
investigator in NHGRI's Inherited Disease Research Branch and director of the
trans-NIH Center for Research on Genomics and Global Health (CRGGH).
The
HLA class II locus is also particularly associated with T cell-mediated
immunity, according to co-author Adebowale Adeyemo, M.D., NHGRI staff scientist
and CRGGH deputy director. The research findings point to the fact that
podoconiosis is likely to be a T cell-mediated inflammatory disease. Mineral
particles are absorbed through the skin of the foot and build up in the
lymphatic system, causing inflammation and scarring that can obstruct blood
vessels in an affected individual's feet.
"We
found a result that is consistent with the clinical observations of
inflammation and provides a way forward for scientific study of the disease,"
Adeyemo said. "Our hope is that other studies will follow, including a gene
expression and immunology study, and a study of the soil."
Fasil
Tekola Ayele, Ph.D., the study's lead author and a CRGGH post-doctoral fellow,
coordinated the field work in the Ethiopian villages, where he said it is very
common to see people with podoconiosis. "It may even be more prevalent than
other diseases, like HIV, tuberculosis and malaria," he said.
"One
aspect that makes podoconiosis disturbing is that it is almost 100 percent
preventable by wearing shoes. So it is a disease of poverty to a very large
extent," Dr. Rotimi said. Public health campaigns are underway to encourage use
of footwear in endemic areas. Philanthropic groups distribute free shoes for
children in impacted communities and make shoes to fit affected
adults.
Depending
on the stage, podoconiosis can be reversible to a large extent with basic foot
hygiene that includes regularly washing off the dirt and wearing shoes and
socks. "At the later stage, surgery may be the only remedy," Dr. Adeyemo said.
"In time, it becomes a very hopeless situation." Doctors can surgically remove
prominent skin nodules, but ongoing exposure to the soil can lead to recurrence
that is sometimes worse for the person with podoconiosis.
Researchers
in NHGRI's Social and Behavioral Research Branch (SBRB) are among groups
engaged in research to learn about the social and behavioral factors that
perpetuate the disease. SBRB and its collaborators are launching a study of
public health interventions, including measuring the effectiveness of
intervention strategies and messages that promote foot health, including foot
hygiene and shoe use.
In
addition to the NIH researchers who conducted the GWAS, the study team included
members from the Brighton and Sussex Medical School and the Clinical
Transplantation Laboratory in the United Kingdom and the Armauer Hansen
Research Institute in Addis Ababa, Ethiopia. Part of the team led by senior
authors Gail Davey, M.D., and Melanie Newport, M.D, Ph.D., of the Brighton and
Sussex Medical School, conducted preliminary epidemiology work in the Ethiopian
highlands and also had developed a clinical staging system for people with the
condition—from early to late stages.
In
addition to his role at CRGGH, Dr. Rotimi is president of the African Society
of Human Genetics. He considers this study of podoconiosis to be a step toward
addressing health disparities. "So far, 95 percent of what has been done in
GWAS research has been on European populations and some Asian populations," Dr.
Rotimi said. "This study is a wonderful example of the mission of CRGGH,
including training African scientists, applying state-of-the-art science and
answering questions about diseases that would otherwise not be dealt
with."
March
27, 2012
Henry Ford Wyandotte Physical Rehabilitation Center
Hosts Friday Open House at Former Blockbuster Site -
Patch.com – ByJason Alley
While
the business relocated just across the street, officials are excited about the
possibilities of their new location.
After
a few months of work, the Henry Ford Wyandotte Physical Rehabilitation Center
is ready to open at
the former Blockbuster site at Biddle and
Eureka.
Formerly
known as Wyandotte Hospital Rehabilitation and Orthopedic Center, it used to
operate out of the third floor of the Chase
Bank building, which is mere yards away from the new
spot.
“The
new facility is a great improvement and much easier to find,” said Denise
Dailing, administrator for rehabilitation services. “The building’s large
windows let in a huge amount of natural light and that, combined with the
bright wall and accent colors, give our patients a beautiful, energizing
environment for their rehabilitation.”
A
grand opening for the new outpatient rehabilitation facility, 3323 Biddle, is
set for 5 to 9 p.m. Friday. Visitors will be able to take a self-guided tour of
the facility and learn about the outpatient rehabilitation services offered.
Everyone who stops in can receive a free five-minute chair massage and enter to
win a 30-minute massage. (Wyandotte
Patch readers have an
additional opportunity to win a half-hour
massage.)
Services
offered through the outpatient rehabilitation program have not changed with the
relocation. Professional therapists continue to offer physical, occupational,
speech and massage therapy services, as well as a variety of specialized
programs that focus on specific areas of the rehabilitation
process.
These
programs include:
·Driver
Assessment. This program helps people regain the ability to drive after an
injury or illness.
·Hand
Therapy. Therapists with advanced training treat hand and arm injuries. It is
available to acute post-operative patients on a walk-in basis.
·Industrial
Rehabilitation. The Return to Work Center facilitates the process of rebuilding
job skills after an illness or injury.
·Joint
Replacement. Therapists meet with patients about upcoming elective surgeries
and make recommendations about post surgical care.
·Lymphedema.
In order to drain accumulated protein-rich fluid, this conservative approach
consists of four parts: skin care, lymphatic drainage, bandaging and
exercise.
·Sports
medicine. Efforts are focused on treating chronic athletic-type injuries, acute
post-surgical conditions and injuries caused from overuse or repetitive
motions.
·Vestibular
rehabilitation. Therapists help patients retrain balance and decrease feelings
of dizziness.
Therapy
programs are individualized and are established through consultations with the
patient’s physician. Walk-in service and appointments are available. For more
information, call 734-284-4499.
March
28, 2012
Genetic Variants Explain
Podoconiosis - Doctors Lounge –
Genetic
variants in the HLA class II region are associated with podoconiosis, a
neglected tropical disease, according to a study published in the March 29
issue of the New England Journal of Medicine.
WEDNESDAY,
March 28 (HealthDay News) -- Genetic variants in the HLA class II region are
associated with podoconiosis, a tropical lymphedema resulting from long-term
barefoot exposure to soil derived from volcanic rock, according to a study
published in the March 29 issue of the New England Journal of
Medicine.
Fasil
Tekola Ayele, Ph.D., M.P.H., of the National Human Genome Research Institute in
Bethesda, Md., and colleagues conducted a genome-wide association study of 194
case patients and 203 controls from southern Ethiopia. Findings were validated
by family-based association testing in 202 family trios and HLA typing in 94
case patients and 94 controls.
The
researchers found that there was a significant genome-wide association between
podoconiosis with the single nucleotide polymorphism (SNP) rs17612858, located
5.8 kb from the HLA-DQA1 locus (in the allelic model: odds ratio [OR],
2.44; in the additive model: OR, 2.19) and suggestive significant associations
with seven other SNPs in or near HLA-DQB1, HLA-DQA1, and
HLA-DRB1. These associations were confirmed using family-based
association testing. HLA typing showed that the alleles HLA-DRB1*0701
(OR, 2.00), DQA1*0201 (OR, 1.91), and DQB1*0202 (OR, 1.79) and
the HLA-DRB1*07017-DQB1*0202 haplotype (OR, 1.92) were risk variants for
podoconiosis.
"Association
between variants in HLA class II loci with podoconiosis (a noncommunicable
disease) suggests that the condition may be a T-cell-mediated inflammatory
disease and is a model for gene-environment interactions that may be relevant
to other complex genetic disorders," the authors write.
March
29, 2012
Pat Burns Award: Twelve caregivers
honoured - Canada NewsWire –
MONTREAL, March 29, 2012 /CNW Telbec/ - In conjunction with the 4th
National Conference to Defeat Cancer, the jury of the Pat Burns Award has
announced the recipient of the annual Pat Burns Award and the names of the
award finalists. Inspired by Jason Burns, son of the late head coach of the
Montreal Canadiens and president of the Pat Burns Foundation, this award was
created by the Coalition Priorité Cancer au Québec to honour a caregiver who
has particularly stood out in providing support to a person living with
cancer.
"Six months ago, at the start of the nomination period for the Pat
Burns Award, I could hardly imagine the immense generosity that the
participants would demonstrate in sharing with us such a significant part of
their lives," Mr. Burns, president of the Pat Burns Award, said at the awards
presentation.
A gift of $10,000 is shared by the 2011 Pat Burns Award recipient and
the two finalists. The award is graciously offered by the Fédération québécoise
des massothérapeutes (FQM) and the Fondation québécoise de la
massothérapie.
Pat Burns Award recipient
Ms Julie Chapdelaine
At age 27, Julie's husband, Marc-André Benoît, was diagnosed with
a form of leukemia called granulocytic sarcoma. His legs almost totally
paralysed, Marc-André had to undergo major back surgery, followed by physical
rehabilitation and multiple chemotherapy treatments. In addition to quitting
her job and spending five days a week at her husband's side in hospital, Julie,
then aged 30, was able to see to his comfort, as well as that of their two
children, handle daily tasks and look after herself, too. Today, as the family
slowly gets back to a normal life, Marc-André declares that Julie's presence at
his side has made all the difference and that she "deserves all the honours in
the world."
Finalists (tie)
Ms Pauline Guilbault-Corbeil
"A true 'love catalyst', a woman of courage with an enormous
heart, Pauline unfailingly supported her son. Confident and reassuring, she was
both mom and confidant. Throughout Charles' illness, Pauline was an equally
generous mother to her two other sons, both of whom also suffer from a
handicapping disease. Her entire life has involved, and will continue to
involve, providing support to her loved ones. Pauline has ably balanced family,
outings with friends and sports activities."
- Chantal Charron, Charles' spouse
Ms Natacha Berger
"Natacha Berger is the mother of three: Thomas, Nicolas and Joanna
Comtois. Joanna died in February 2011 at age 14 from bone cancer. Diagnosed in
June 2004 with Ewing's sarcoma, after a full year of treatments, she was in
remission for three years. Sadly, she relapsed in 2008. Soon after, in the fall
of that year, her father committed suicide. We could go on at great length
about Joanna and the path she followed. But it's imperative to emphasize that
none of that would have been possible without the exemplary support, the
devoted care and the attention that her mother gave her while fully respecting
her daughter's needs and wishes."
- Louise Geoffrion, Leucan Montréal
The Pat Burns Award recipient receives $5000 and the two finalists,
$2500 each.
Coalition Priorité Cancer au Québec president Dr. Pierre
Audet-Lapointe thanked everyone who proposed a candidate for the Pat Burns
Award, as well as the jury members.
"We are proud that this initiative spotlights in a new way the key
role played by caregivers," Dr. Audet-Lapointe said. "Without them, the lives
of people living with cancer would often be unbearable."
The application period for the second edition of the Pat Burns Award
will open officially this fall.
Nine honourable mentions
The jury members also decided to give honourable mentions to nine
caregivers to salute their altruism and in acknowledgement of the testimonials
to their humane nature that accompanied their nominations.
About the Coalition
Coalition Priorité Cancer au Québec was founded in 2001 to protect and give a voice to people affected by
cancer (patients, survivors, informal caregivers, their families and their
loved ones) to help support cancer-related community organizations and health
professionals) and to help organize the fight against cancer.
The Coalition's members represent more than 1.5 million
people
Alliance des Communautés Culturelles pour l'Égalité dans la Santé et
les Services Sociaux (ACCÉSSS), Alliance du personnel professionnel et
technique de la santé et des services sociaux (APTS), Association des
radio-oncologues du Québec (AROQ), Association du cancer de l'Est du Québec,
Association des laryngectomisés de Montréal Inc, Care-Ring-Voice Network,
Canadian Breast Cancer Network (CBCN), Colorectal Cancer Association of Canada
(CCAC), Association québécoise des registraires en oncologie (AQRO),
Association des retraitées et retraités de l'éducation et des autres services
publics du Québec (AREQ), Centrale des syndicats du Québec (CSQ), Chaire de
recherche en environnement cancer Guzzo de l'université de Montréal, Chaire de
recherche et de traitement du cancer de l'UQAM, Quebec Clinical Research
Organization in Cancer (Q-CROC), Fédération des travailleurs et travailleuses
du Québec (FTQ), la Fédération québécoise des massothérapeutes, la Fondation
québécoise de la massothérapie FQM, Fondation Monique Fitz-Back, Fondation
québécoise du cancer (FQC), Fondation Rêvez la vie, Foundation of Stars, Hope
and Cope / L'espoir c'est la vie, HPV Awareness Corporation, Institut de
l'anémie - Recherche et éducation (IARE), Lymphoma Foundation Canada,
Lymphedema Association of Quebec, Libera Mutatio, Leukemia & Lymphoma
Society of Canada, Mains de l'espoir de Charlevoix, Myeloma Canada, Nova
Montréal, Ordre des technologues en imagerie médicale et en radio-oncologie du
Québec, Ordre professionnel des technologistes médicaux du Québec (OPTMQ),
Organisation multiressources pour les personnes atteintes de cancer (OMPAC),
Organisation québécoise pour les personnes atteintes de cancer (OQPAC),
Organisme gaspésien pour les personnes atteintes de cancer (OGPAC), Ovaire
espoir Québec, Ovarian Cancer Canada (OCC), Palliative Home-care Society of
Greater Montreal, ProCure-The Force Against Prostate Cancer, Professionnals
Networking for Caregivers, Quebec Lung Association (QLA), Regroupement des
onco-psychologues du Québec (ROPQ), Réseau des femmes en environnement, Réseau
FADOQ.
For further information:
Source : Coalition Priorité Cancer au Québec
For information and/or interview requests:
Sylvie Piché
Cell : (514) 296-0694
Michel Racette
Cell :
(514) 576-9327
April
2, 2012
They love Lou C's: Boutique changing lives of women
with cancer - News Courier – By Lora Scripps
—
Cassandra Johnson is the type of person many work a lifetime to
become.
A warrior. A mother of three who is chock-full of spirit, rooted
in love and grounded in faith.
It hasn’t been an easy road.
In
2009, at age 38, she had a stroke.
“I had always dealt with high blood
pressure,” she said. “I had the stroke and it took out my left
side.”
She was in the hospital for months. During her stay, doctors
discovered she had breast cancer.
“They ended up having to do a
mastectomy, which took it to a whole other level,” she said. “It had seeped
into my bones. Of course, I didn’t know what was going on.”
She was also
diagnosed with lymphedema — blockage of the lymph nodes — and had to have her
lymph nodes removed.
After being released and able to go home, Cassandra
heard about a lady named Lou Covington from a friend. She told her about Lou
C’s Boutique, a special boutique that’s aim is to help women look and feel
better during their journey with cancer.
Lou C’s
Boutique
Lou C’s Boutique first opened in 2004. Lou and her husband
transformed a house into a unique boutique. It is located at 207 Coman
St.
Lou said her mother gave her the inspiration.
“My mother had
colon cancer,” she said. “But, you know cancer is cancer.”
Her mother
would tell her about friends who would have to travel outside Athens to get the
necessities they needed while working to overcome different forms of
cancer.
Lou thought to herself, “I love people and I try to make people
feel better about themselves, ” why not open a place where she could help
someone else.
“To me mental health is just as important as bone health
or breast care or anything else,” Lou said. “Without your mental health and
strength in God, you can’t get through this.”
At first, Cassandra didn’t
have insurance or Medicaid for the items she needed. So, she didn’t have the
chance to meet Lou right away.
“I had to go through the ropes to get
that in order and working,” she said.
During that time she would travel
to the Athens-Limestone Hospital Wellness Center. There she met another woman
who wanted to introduce her to Lou. Cassandra took her up on the
offer.
It’s no wonder Cassandra and Lou became fast friends. In truth,
the two, simply, share the same attributes.
“When I found her I found a
great lady,” Cassandra said.
She visited the boutique. Lou fit Cassandra
with a compression sleeve. The sleeve would be used to help with blood flow and
circulation in her arm.
Unfortunately, Cassandra’s insurance didn’t
cover the sleeve she needed.
“She helped me anyway,” Cassandra said.
“She was willing to work with me.”
Other items had to
wait.
“Finally, things started coming around for Cassandra,” Lou said,
adding she offered to pay out-of-pocket.
Lou let Cassandra pay what she
could. The rest came from Lou’s Angel Closet.
The Angel Closet, created
by Lou, contains items for women that insurance won’t cover. It is available to
women who are willing to do all they can to pay for their services, but who may
be struggling financially.
Cassandra said her first meeting with Lou
opened up a whole new world to her.
Cassandra has three children, now
ages, 22, 17 and 9. Her health problems brought change for
everyone.
“For me, my whole household, my family — we all came together
in times when we needed to,” a teary-eyed Cassandra said. “We pulled together
and by the grace of God we made it through.”
She admitted she honestly
didn’t know if she was going to make it. “I keep on looking towards Heaven,”
she said. “That gets me through a lot.”
It is a story of faith that
touches Lou’s heart.
Cassandra offered to pay when she couldn’t, said
Lou. “That’s what makes giving so awesome,” she said. “You can tell when
someone is deserving. She said she would save up and do without. That’s not
acceptable to me.
“People say ‘Lou isn’t your job depressing?’ and I say
‘No’ because I meet the most awesome women,” Lou said. “She (Cassandra) is not
in here saying, ‘Poor, pitiful me.’”
Cassandra, a choir and youth
director at Peace Missionary Baptist Church hasn’t let her situation slow her
down.
“I’m determined I’m going to do everything to the best of my
ability,” Cassandra said. “I might operate from a wheelchair, but I’m going to
get there some kind of way. Things are going great for me now.”
Lou said
that attitude and the attitude of so many women she comes in contact with has,
at times, made her feel ashamed of herself.
However, Lou has nothing to
be ashamed of. Like Cassandra, she too, is a warrior — a warrior for other
women who are in the midst of the most trying times in their
lives.
“Cancer is a terrible thing, but it also draws a lot of
miracles,” Lou said. “It pulls people together.
“I want this to be the
best part of their experience that it can be,” she said. “I want to make it a
good time instead of dreading it. A lot of ladies go without.”
The women
Lou helps believe she is special.
“She is such a unique and fabulous
lady who is always willing to help out,” Cassandra said.
Not only does
Lou have the boutique, but she also organizes The Pink Ribbon Hope Chest
survivor group. The group meets at 6 p.m. the third Tuesday of each month at
Athens-Limestone Hospital.
Coming
together
Alice Cosco said when the
Athens Ladies Civitan group heard about Lou C’s they wanted to do all they
could to help.
As a member of a group whose main focus is community, she
suggested helping Lou to the Ladies Civitan board. “I felt this was a really
good cause to give back to women in the community,” Alice said.
She told
the group about Lou helping others out of her own pocket.
The group
recently gave Lou $700 to help purchase supplies — supplies so important to
breast cancer patients in the recovery process.
The donation came from
the club’s newly formed Helen Hammond Cancer Fund. Hammond was a member of the
club who just last week lost her three-year battle with lung cancer.
“We
really felt strongly about giving back to deserving women in this community,”
Alice said.
“The Ladies Civitan have many options to give and they chose
this one,” Lou said.
“I am just overwhelmed and
speechless.”
Others in the community have helped as well including the
East Limestone Fire Department, Walk Awhile in my Shoes, and a number of
personal donors.
The donations go directly to the shop and on to people
who Stephanie Mitchell said “deserve to have these types of
services.”
“Lou C’s Boutique is a place where women can go to look and
feel better on their journey with cancer,” Stephanie said.
Stephanie, a
certified Zumba instructor, is organizing a Zumba Party to help support breast
cancer fighters. The event will take place from 5:30-7:30 p.m. April 17, at the
Valley Event Center. Tickets are $5. Donations will be given to Lou C’s
Boutique. Participants don’t have to participate in Zumba fitness to
attend.
“People pulling together make it all worthwhile,” Lou said. “In
one way or another we are all in this together and no one should go through
this alone. We need to be aware all the time.
“I will do all I can to
help those fighting cancer and with the help of the community — they should not
be alone or be without.”
Systematic
review: conservative treatments for secondary
lymphedema - 7thSpace
Interactive –
Several
conservative (i.e ., nonpharmacologic, nonsurgical) treatments exist for
secondary lymphedema. The optimal treatment is unknown.
We examined the
effectiveness of conservative treatments for secondary lymphedema, as well as
harms related to these treatments.
Methods: We searched MEDLINE,
EMBASE, Cochrane Central Register of Controlled Trials, AMED, and CINAHL from
1990 to January 19, 2010. We obtained English- and non-English-language
randomized controlled trials or observational studies (with comparison groups)
that reported primary effectiveness data on conservative treatments for
secondary lymphedema.
For English-language studies, we extracted data in
tabular form and summarized the tables descriptively. For non-English-language
studies, we summarized the results descriptively and discussed similarities
with the English-language studies.
Results: Thirty-six English-language
and eight non-English-language studies were included in the review.
Most
of these studies involved upper-limb lymphedema secondary to breast cancer.
Despite lymphedema's chronicity, lengths of follow-up in most studies were
under six months.
Many trial reports contained inadequate descriptions
of randomization, blinding, and methods to assess harms. Most observational
studies did not control for confounding.
Many studies showed that active
treatments reduced the size of lymphatic limbs, although extensive
between-study heterogeneity in areas such as treatment comparisons and
protocols, and outcome measures, prevented us from assessing whether any one
treatment was superior. This heterogeneity also precluded us from statistically
pooling results.
Harms were rare (<1% incidence) and mostly minor
(e.g ., headache, arm pain).
Conclusions: The literature contains no
evidence to suggest the most effective treatment for secondary lymphedema.
Harms are few and unlikely to cause major clinical problems.
Author:
Mark OremusIan DayesKathryn WalkerParminder Raina
Credits/Source: BMC Cancer
2012, 12:6
Predicting the Risk for Developing
Lymphedema - Clinical Oncology News – by
Karen Blum
San
Francisco—Researchers have developed a set of statistical models that are more
than 70% accurate in predicting the five-year risk for lymphedema following
axillary lymph node removal during breast cancer surgery.
The models will
soon be available online to all physicians, free of charge. The study was
presented at the 2011 Breast Cancer Symposium, by Jose Bevilacqua, MD, PhD,
surgical oncologist at Hospital Sirio Libanes in Sao Paulo,
Brazil.
Although fewer
women these days need axillary lymph node dissection (ALND), which has led to a
decrease in lymphedema, “the ability to pre- and postoperatively identify those
at risk is an important step forward,” said Andrew Seidman, MD, attending
physician in the Breast Cancer Medicine Service at Memorial-Sloan Kettering
Cancer Center, in New York City, who was not involved with the study. “It
allows us to appropriately triage patients for early intervention, or refer
them to trials aimed at preventing lymphedema. This has real practical
implications.”
In what is
believed to be the largest prospective study of lymphedema occurrence,
researchers followed 1,054 women with breast cancer undergoing ALND between
August 2001 and November 2002 at the Brazilian National Cancer Institute in Rio
de Janeiro. They used measuring tape to calculate arm volume before surgery,
the day after surgery, one month following surgery and then at six-month
intervals. Lymphedema was defined as a volume difference of at least 200 mL
between arms six months or more following surgery; the overall five-year
incidence was 30.3%.
Using
clinical factors including age, body mass index (BMI), ipsilateral arm
chemotherapy infusions, level of ALND, location of radiotherapy, development of
postoperative seroma, infection and early edema, researchers developed three
models and corresponding nomograms to predict the risk for developing
lymphedema at five years. The three models used data from different time
points.
The first model,
used preoperatively, analyzed risk factors including age, BMI and the number of
chemotherapy cycles before surgery. The second model, used within six months
following surgery, considered the risk factors from the first model, plus the
extent of ALND and the location of the radiotherapy field. The third model,
used at six months or more following surgery, considered the risk factors from
the second model, plus the development of seroma or early edema.
Comparing the
models’ predictions with the incidence of lymphedema, researchers found
concordance indexes of 0.706, 0.729 and 0.736 for models 1, 2 and 3. The
concordance index is the probability that, given two randomly selected
patients, the patient with the worse outcome is, in fact, predicted to have a
worse outcome. “For the sake of comparison, these modeling tools are as
accurate for predicting a woman’s risk for developing lymphedema as mammography
is for the detection of breast cancer,” Dr. Bevilacqua said.
The models also
identified a novel association between arm lymphedema and ipsilateral
neoadjuvant chemotherapy infusion.
The researchers
are making their calculation tools available free over the Internet. A tool to
calculate arm volume is now available at www.armvolume.com. The models to
estimate risk for lymphedema will be available at www.lymphedemarisk.com after the
study is published.
Program Curbs Shoulder Morbidity Post Breast
Cancer - The Oncology Report – by Bruce
Jancin
SAN ANTONIO �
Long-term upper-extremity pain and functional impairment following breast
cancer surgery are reduced by an innovative physical therapy�centered surveillance
program, according to a 5-year prospective study.
The program was developed at
the breast care center of Walter Reed National Military Medical Center,
Bethesda, Md. It begins with a preoperative patient interview and structured
evaluation by a physical therapist. The assessment includes what physical
therapists call an upper-quarter screen, which evaluates shoulder range of
motion, strength, and arm volume. Self-reported pain, fatigue, function, and
activity level are recorded.
At that time, the patient is
also instructed in a home exercise program she is to start 2 weeks post
surgery. These are simple range-of-motion exercises focused on forward flexion
overhead; abduction; internal and external rotation of the glenohumeral joint;
and scapular retraction, Nicole L. Stout explained at the San Antonio Breast
Cancer Symposium.
The patient is subsequently
seen by the physical therapist (in conjunction with her regular follow-up
visits with an oncologist or surgeon) at 1, 3, 6, 9, 12, and 60 months post
surgery. If upper-extremity dysfunction worsens, more intensive interventions
are introduced.
The rationale for this
prospective surveillance program lies in an understanding that the shoulder and
arm impairments caused by breast cancer surgery and radiation therapy are
typically subtle initially, but if left unidentified and uncorrected, they
often progress to serious rotator cuff damage, "frozen" shoulder, and
debilitating lymphedema, according to Ms. Stout, a civilian research physical
therapist at the military center.
She had previously presented
her 1-year prospective outcomes. This time around, she presented prospective
5-year follow-up data on 86 breast cancer patients who participated in the
program. This is the first prospective cohort study in the United States to
track breast cancer�related upper-extremity
morbidity and functional outcomes for this long a time period.
The 12-month and 5-year
visits included formal assessment of upper-extremity outcomes using the Harvard
Alumni Activity Survey, the Upper Limb Disability
Questionnaire, and the Short Form-36.
At 5 years, 11% of the women
had stage I/II lymphedema and 38% had subclinical lymphedema (defined as less
than 3% arm volume swelling as measured by a Perometer). These results compare
favorably with those of published studies on lymphedema, which have reported
long-term rates of stage I-III arm swelling in the 40%-60% range, she noted.
In all, 18% of patients
reported arm numbness at 5 years, 17% noted shoulder pain, 3% had neck pain,
and 1% had chest wall pain.
One-third of subjects
reported fatigue of level 3 or more on a 10-point visual analog scale. Again,
other investigators have documented long-term rates of clinically significant
fatigue in the 50%-60% range.
At 5 years post surgery,
patients demonstrated less impairment of physical activity than at preoperative
baseline. At baseline, 33% had significant limitations in terms of carrying
heavy objects, performing household chores, and other physical activities.
After 5 years of prospective surveillance and tailored physical therapy, only
20% of patients had physical activity limitations.
However, 68% of patients
reported experiencing some restrictions on their social activity at 5 years,
and 52% experienced limitations on their recreational activities.
The study was funded by the
medical center. Ms. Stout declared having no financial conflicts of
interest.
Beating cancer with a paddle -
North Shore Outlook – By Maria Spitale-Leisk
Paddling
through the waters of False Creek in a long canoe adorned with a dragon head,
Esther Matsubuchi remained brave.
But
in the back of her mind, lymphedema was lurking. Matsubuchi, a breast cancer
survivor, was told by her doctor that she could potentially develop this
debilitating condition that causes permanent swelling of the arms.
Don’t
knit. Don’t garden. Don’t play the piano. Basically, don’t move your upper body
too much she was told. But the Lynn Valley resident didn’t heed that
advice.
Instead,
she paddled through the oft-choppy waters of False Creek under the careful
watch of Dr. Don McKenzie, a University of British Columbia sports-medicine
expert.
The
contrarian doctor believed there was no strong correlation between lymphedema
and upper body movements in breast cancer patients. In 1996 he tested that
theory by rounding up two dozen breast cancer survivors between the ages of 30
and 60, including Matsubuchi, and placing them two across in a close-quarters
dragon boat that doubled as a lab. They called themselves Abreast in a
Boat.
They
started cautiously.
“We
paddled a total of four minutes in one hour,” said Matsubuchi.
It
was wet and cold outside during practices in early April. But the conditions
didn’t dampen spirits inside the boat — nor did the blisters, bruises and aches
and a few misfiring paddles that accidentally struck other
occupants.
The
ladies celebrated the end of three months of lymphedema testing by entering the
Vancouver Dragon Boat Festival. Up against younger and stronger mixed-gender
teams, the result Abreast in a Boat recorded was best filed under personal
accomplishment. And Dr. McKenzie’s theory prevailed: not a single woman on the
team developed lymphedema.
His
findings prompted some breast cancer oncologists to change they way they
counsel patients about lymphedema.
The
same year Abreast in a Boat was formed,
Francoise Doe found a lump in her breast during a self exam. She was working as
a special education aid in the North Vancouver School District at the time. Her
first chemotherapy session fell on her daughter’s 16th birthday.
“It
was low-key event,” recalled Doe.
During
her recovery period in 1997, she learned of Abreast in Boat through a breast
cancer support group. A self-described “non-amphibious person,” Doe needed a
change of scenery.
“I
just wanted to put cancer aside,” she said. “I needed a break from
that.”
In
the midst of recuperating from her battle with breast cancer, Doe was also
going through a separation and in search of support. She found solace with the
paddle-boating cancer survivors from False Creek.
Just
as Doe was stepping into a dragon boat, another North Vancouver resident,
Rosemary Shandler, was reeling from her own breast cancer
diagnosis.
She
cheered weakly from the sidelines as a sea of pink-clad ladies furiously
paddled their dragon boat through False Creek to the rhythm of the drum
beat.
“I
cried like a baby,” she said. “It was just so inspiring to me. They had gotten
back in touch with their bodies, their health and their strength.”
Shandler
vowed to seek them out — when she was well enough. In 2000, now fragile only
from emotional scars she made good on her promise to join Abreast in a Boat
False Creek, which by this time had teams throughout the Lower
Mainland.
Shandler
had plenty to offer, bringing marathon running endurance to the team. But that
doesn’t mean she wasn’t happily exhausted after her first time out on the
water.
“I
found that during the first season I would be sitting out at the end of the
[dragon] boat and I had a feeling of such joy,” said Shandler, who paddles with
Abreast in Barnet in the Burrard Inlet.
The
Barnet Marine Park setting is quite tranquil. Eagles, herons and harbour seals
share the water with these teak-hulled canoes — rigged with decorative Chinese
dragon heads and tails — that majestically glide across the waters of the
Burrard Inlet.
Abreast
in a Boat is a support group of sorts, but participants try to not talk about
the ‘c-word’.
“We
don’t have a chance,” said Matsubuchi. “We are not allowed to talk in the
boat.”
Still,
there’s no elephant onboard. Personal stories are shared. It took Matsubuchi a
bit longer to open up about her cancer.
“People
don’t talk about [cancer], in places like Japan and China,” said Matsubuchi,
who is of Japanese heritage.
“My
parents used to go to funerals and come home not knowing how the person died.
They presumed it was cancer because the person had looked pale
lately.”
Quashing
that cancer stigma is a mission undertaken by the women of Abreast in a Boat.
They courageously tell their tales all over the world, from the Pacific
Northwest to the Eastern United States, Europe and Asia.
This
past October, all three North Vancouver women took part in an international
dragon boating regatta for female cancer survivors, in Putrajaya, Malaysia. The
hybrid team — comprised of members from the six Lower Mainland Abreast in a
Boat groups — earned a silver and two bronze medals.
Another
North Vancouver woman was on the wait list for this trip, an 86-year-old who
had paddled alongside Matsubuchi for many years. They were carpooling
companions. But in October, her friend’s health took a turn for the
worse.
“At
the funeral today everyone said we were twins,” said Matsubuchi.
Doe
said Malaysia was never on her bucket list. However, when the opportunity to
paddle in the tropical waters of Southeast Asia came up, she
jumped.
Doe
enjoyed the people and weather in Malaysia. She also learned that talking about
cancer in that region of the world is considered taboo.
“That’s
why we travel — to show other women there is life after breast cancer,” said
Doe.
The
North Shore Dragon Busters — a local Abreast in a Boat affiliate — have been
paddling out of Deep Cove for the past decade. If you are a breast cancer
survivor and interested in joining them, email
[email protected].
Marshall Medical Centers to host breast cancer
survivor luncheon - Sand Mountain Reporter – By
Elizabeth Summers –
Breast
cancer survivors in Marshall County will have an opportunity to reach out to
other survivors during a special luncheon Jan. 20.
Marshall
Medical Centers and the Foundation for Marshall Medical Centers, in conjunction
with the University of Alabama at Birmingham School of Nursing, will host a
free informational luncheon at the Marshall Professional Center in
Guntersville. The center is across the street from Zaxby's restaurant, on U.S.
431 in Guntersville.
During
the luncheon event, Dr. Karen Meneses of the UAB School of Nursing will offer
tips on lymphedema or the swelling of arms and hands; emotions and how to deal
with the fear of recurrence; sexuality; and maintaining good health following a
battle with breast cancer.
Andrea
Oliver, director of the Foundation for Marshall Medical Centers, said the
luncheon will highlight the results of a focus group and their
findings.
"The
program is made possible via a grant from the Susan G. Komen for a Cure
Foundation with a goal to help improve the quality of life and survivorship
experience for breast cancer survivors in the Marshall Medical Centers service
area," Oliver said.
The free
Lunch ‘N Learn event will begin at 11:30 a.m. and end at 1 p.m.
Breast
cancer survivors must reserve a seat by calling 866-662-0630 or the Foundation
For Marshall Medical Centers at 256-571-8026 or 256-753-8026 for Arab
residents.
During
2011, an estimated 230,480 women and 2,140 men were diagnosed with new cases of
breast cancer. Of those, 39,520 women and 450 men died from the disease,
according to the American Cancer Society.
The
luncheon is a follow-up to a small focus group study held in July 2011 and will
focus on how to maintain health following a breast cancer diagnosis and
subsequent treatments, Oliver said.
"The
smaller focus group was held on July 8," Oliver said. "They assessed what needs
were being unmet in the Marshall Medical Centers service area for local breast
cancer survivors.
"(Dr.
Karen) Meneses and Silvia Camata, of the UAB School of Nursing, joined the
Marshall Cancer Center staff, the Foundation for Marshall Medical Centers and
eight women, all breast cancer survivors with years since diagnose ranging from
less than 1 year to 16 years.
"The
participants acknowledged that Marshall Medical Centers had played a big role
in helping them through their diagnosis and treatment, but also mentioned
several issues have had an impact on their quality of life since breast
cancer.
"Among
the problems were fatigue, lymphedema, pain, changes in body image and
acceptance of their new selves, side effects of medication, depression, and
bone health.
"Additionally,
how to maintain health issues such as check up, taking care of bone health,
nutrition and physical activities were among key concerns," she
said.
"Participants
made several suggestions to help Marshall Medical Centers improve their
services for breast cancer survivors. The capabilities to access support and
education materials and services as well as formal support groups hosted in
Marshall County were among the most popular suggestions.
"Additionally,
one-on-one type of support was mentioned several times as important to breast
cancer survivors. With this information and feedback at hand, the Marshall
Cancer Center is working toward being more effective in providing these
services."
January 5, 2012
New season of
paddling nears for Abreast in a Boat -
Richmond Review –
The
Richmond chapter of Abreast in a Boat will be
holding an information meeting Thursday, Jan. 12.
Abreast
in a Boat is a group of women living with breast cancer who participate in
dragon boat racing to raise awareness about breast cancer and to encourage
those living with it to live full and active lives.
The
non-profit group’s aim is to send a message of hope to people living with the
disease, and to those who support them.
Leading
healthy and active lives is so important to an individual’s recovery and
ability to move forward in life. Participating in dragon boating provides fun,
challenge and a chance to meet new people. The boat is a floating support
group, a symbol of hope, and a vivid demonstration that one can have a full and
active life after cancer.
Before
the Abreast In A Boat organization formed in 1996, there was a belief among
some health professionals and breast cancer survivors that women recovering
from the disease should avoid upper-body exercise. It was thought that this
type of exercise could cause lymphedema, a painful swelling of the arm and
chest area that is sometimes the result of surgery.
Dr. Don Mackenzie, a Richmond
resident, and doctor of physiotherapy at University of B.C. challenged what we
now know to be erroneous beliefs.
He
got 20 women breast cancer survivors to try dragon boating. His findings and
the outreach efforts of Abreast In A Boat have inspired over 150 teams around
the world and thousands of women catching the wave of life through dragon
boating.
Today,
studies not only prove that survivors can exercise without increasing their
risk of lymphedema but that those with active lifestyles reduce the risk of
cancer recurrence.
The
five-year-old Richmond chapter is one of five in the Lower Mainland. Twice a
week for four months beginning in spring, 20 women paddle up and down the
Middle Arm, in preparation for a series of regattas.
This
past year six novices joined the Richmond crew, which paddled out of the
Richmond Yacht Club, and the group is hoping to attract more newcomers this
year.
Experience
in paddling isn’t necessary to join the group.
The
information meeting will take place at 7 p.m. at Accent Inn Vancouver Airport
Hotel, 10551 St. Edwards Dr. To register or for more information, contact Bunny
Ross at [email protected]
January 6, 2012
Prospective
surveillance model emerges as standard of care for breast
cancer treatment - EurekAlert
Model associated with
significant cost savings
Alexandria, VA, January 6,
2012 – Early diagnosis and treatment of breast cancer-related lymphedema by a
physical therapist can significantly reduce costs and the need for intensive
rehabilitation, according to an article published in the January issue of
Physical Therapy (PTJ), the scientific journal of the American
Physical Therapy Association (APTA).
The study, led by APTA
member and spokesperson Nicole Stout, PT, MPT, CLT-LANA, compared a prospective
surveillance model with a traditional model of impairment-based care and
examined the direct treatment costs associated with each program. Treatment and
supply costs were estimated based on the Medicare 2009 physician fee schedule.
Researchers estimated that treatment for breast cancer-related lymphedema costs
$636.19 a year when the prospective surveillance model was used vs $3,124.92
for traditional treatment of advanced lymphedema.
The goal of a prospective
surveillance model for cancer rehabilitation is to identify impairment at the
earliest onset to alleviate impairment or prevent it from progressing. Soon
after diagnosis, a physical therapist will perform a preoperative examination
to establish a baseline level of function. Follow-up examinations are then
conducted postoperatively at 1 month and then 3-month intervals, for up to 1
year. In contrast, a traditional model focuses on treating lymphedema once it
has progressed and patients already have functional limitations.
"This study begins to paint
a picture of evidence showing that prevention of chronic conditions such as
lymphedema—using rehabilitation models of care—may result in significant cost
savings," said Stout.
Breast cancer-related
lymphedema is characterized by abnormal swelling of the arm and hand, which can
be disfiguring. A chronic condition, it is associated with decreased arm
function, disability, and diminished quality of life. If the condition is not
diagnosed early and managed, a patient can be at risk for infection and further
shoulder complications.
In place for more than 10
years, the prospective surveillance model was developed at the National Naval
Medical Center in Bethesda—now part of the Walter Reed National Military
Medical Center—and is the standard of care for all patients diagnosed with
breast cancer at the medical center. Several research articles have been
published demonstrating clinical effectiveness of the prospective surveillance
model in reducing lymphedema, shoulder morbidity, and fatigue, including the
February 2010 article in the journal Breast Cancer Research and
Treatment.
Although further analysis of
indirect costs and utility is necessary to fully assess cost effectiveness, the
prospective surveillance model is emerging as the standard of care for breast
cancer treatment.
###
The American Physical
Therapy Association (APTA) represents more than 77,000 physical therapists,
physical therapist assistants, and students of physical therapy nationwide.
Learn more about conditions physical therapists can treat and find a physical
therapist in your area at www.moveforwardpt.com. Consumers
are encouraged to follow us on Twitter (@moveforwardpt) and
January 9, 2012
A new outlook
for the new year - MiamiHerald.com - By
Andrea Torres
Andrea Torres, a producer at
The Miami Herald, is chronicling her breast cancer journey in Tuesday’s
Tropical Life.
It looked like the worst
part of the life-saving treatment for breast cancer was behind me. My future
was hopeful. I just had to be patient.
I had adopted a new routine
to battle the morning sadness. I began to browse through a small booklet
titledMyself: Together Again by breast cancer survivor Debbie
Horwitz. It has a series of photographs showing the breast reconstruction
progress she underwent when she was 32.
I had become a beneficiary
of her last year’s resolution: “We are going to continue to empower and educate
women with knowledge of the reconstruction process through relevant and
descriptive images and information, as a means of helping them cope,” Horwitz
said in a video posted on her website, MyselfTogetherAgain.org.
Her booklet
helped me start my day with a new attitude. The last photo, labeled “Whole
Again,” showed Horwitz’s permanent implants. Her breast looked beautiful. I was
on my way there.
As my hair began to grow
back, I stopped wearing wigs. And the world didn’t stop and stare. Except for a
cute little boy with big green eyes. As his mother and I stood in line at the
drugstore, he was examining me with curiosity. In a failed attempt at
discretion when I glanced back, he looked away and began to whistle. I laughed.
His mother scolded him, “DON’T bother the young lady!”
“Hi, it’s OK. What’s your
name?” I asked.
“My name is
Jordan. Can I ask you a question?”
I smiled. “Of
course, I bet is about my hair.”
“Did you just
come back from war?”
“Almost.”
And then he had to go, so I
couldn’t explain how I felt like I had been a prisoner of war.
After months of avoiding
crowds, I celebrated New Year’s Eve at Walt Disney World’s Epcot Center in
Orlando. And for the first time in my life, it felt great to be stuck in
pedestrian traffic. Long lines did not bother me. By the time 2012 had arrived,
I had undergone about a dozen sessions of daily radiation therapy at the
University of Miami’s Sylvester Comprehensive Cancer Center, and my immune
system was holding up.
The anxiety rush as I walked
into the therapy room was part of the routine. I took off my clothes from the
waist up. I had gotten used to being topless for the weekday outpatient
treatment. And no one was horrified.
On a bad day, fear would
boil up when a red “BEAM ON” sign lit up and a buzzing sound filled the room.
As the machine, known as the linear accelerator, rotated around me, my heart
would sometimes beat faster, and my mind would scream out possible side
effects: “Lymphedema. Secondary cancer. Narrowed coronary arteries. Rib
fracture.”
On a good day, I closed my
eyes and a brief self-guided meditation would help me picture a peaceful beach
in Nantucket, a desolated forest in Chile, or the top of a mountain in Peru, as
the radiation easily destroyed the cancer cells. The healthy cells that were
damaged were able to survive and repair themselves. That was the ideal.
Aside from some minor skin
irritation, the only evident side effect from radiation that I was struggling
with was fatigue. Time slows down when you are tired. Breast cancer survivors
say the feeling can last for weeks or months after the treatment ends.
“It feels like you are
dragging your feet all the time. You have to take it easy,” said a cancer
survivor.
“Radiation
drains you,” another warned.
Taking vitamins to get a
boost was not advised. UM radiation oncologist Dr. Cristiane Takita, whom I had
been meeting with for a weekly hug and a reminder to rub a clear alcohol-free
aloe gel on the radiated area, said I should avoid taking supplemental
antioxidant vitamins.
“Vitamins C, E, A and D
might interfere with radiation’s ability to destroy cancer cells,” Takita said.
“Vitamins that come from food are OK. When radiation is finished, you can resume
taking your supplements.”
This is because there is a
potential conflict. Radiation creates free radicals, highly energized molecules
that damage cells. These free radicals target cancer cells. Antioxidants keep
free radicals from forming, or neutralizes them.
During our first meeting of
2012, she was unusually enthusiastic.
“Everything is going really
well. This is great! Great! Great! Great! Great! And you are almost done,” she
said. “There is no time for depression. This is almost over. You are halfway
through.”
Read more here:
http://www.miamiherald.com/2012/01/10/v-fullstory/2581368/a-new-outlook-for-the-new-year.html#storylink=cpy
January 10,
2012
Physical therapy
'could reduce cost of lymphedema
treatment' - Spire Healthcare –
Early diagnosis and
treatment of breast cancer lymphedema by a physical therapist could
significantly reduce the cost and need for intensive rehabilitation, according
to latest research.
Scientists writing an article published in the
January issue of the journal Physical Therapy for the American Physical Therapy
Association (APTA) suggested that a prospective surveillance model for the
treatment of breast cancer-related lymphedema was significantly lower in cost
compared to a traditional model of impairment-based care.
APTA member
and spokesperson Nicole Stout, who led the programme, said: "This study begins
to paint a picture of evidence showing that prevention of chronic conditions
such as lymphedema - using rehabilitation models of care - may result in
significant cost savings."
Researchers found that the prospective
surveillance model cost around $636.19 (£411.83) a year compared to $3,124.92
for the traditional treatment of advanced lymphedema, also known as a lymphatic
obstruction.
The condition is a blockage of the lymph vessels that drain
fluid from tissues throughout the body and could affect the workings of the
immune system.
Posted by Jeanette Royston
Health News is provided
by Adfero in collaboration with Spire Healthcare. Please note that all copy
above is ©Adfero Ltd. and does not reflect views or opinions of Spire
Healthcare unless explicitly stated. Additional comments on the page from
individual Spire consultants do not necessarily reflect the views or opinions
of other consultants or Spire
Healthcare.
January 10,
2012
Medical
People - The Ledger –
Dr. Andres
Medina, a cardiac, thoracic and vascular surgeon, has joined Watson Clinic. He
will perform cardiovascular surgical procedures at Lakeland Regional Medical
Center. Medina earned his medical degree from Ohio State University in
Columbus. He did his internship and residency in general surgery at the
Memorial Health University Medical Center, Mercer School of Medicine, in
Savannah, Ga. He performed his residency in general surgery and completed
fellowships in cardiothoracic surgery and heart and lung transplants at the
University of Miami/Jackson Memorial Hospital in Miami. Medina served as
clinical assistant professor of surgery in Thoracic and Cardiovascular Surgery
Department at the University of Miami School of Medicine. Medina is
board-certified in general surgery and thoracic surgery. His areas of expertise
include minimally invasive cardiac and thoracic approaches, including daVinci
robotic surgery, transcatheter aortic valve replacement, off-pump coronary
artery bypass grafting, and video-assisted thoracoscopic surgery
lobectomy.
Kelley
Giovannucci, physical therapy assistant; and Rizwana Mir, physical therapist;
have joined Luz Rivera, physical therapist, as having certification in
lymphedema therapy. All practice at Lakeland Regional Rehabilitation and Sports
Medicine Clinic. Lymphedema or swelling caused by the abnormal buildup of fluid
can result in a feeling of heaviness, pain and a decline in
mobility.
Support to breast cancer
survivors - Daily Examiner –
CLARENCE Valley women recovering from breast cancer surgery are being
encouraged to register now for the new term of the 2012 YWCA NSW Encore
Program.
The program, funded by NSW Health, is described as an innovative and
inspiring approach to recovery from breast cancer surgery.
It is a proven exercise program offered free in Grafton by YWCA
NSW.
Encore program co-ordinator Kate Guthrey said the program involved
gentle exercise for those who had breast cancer surgery, and it met the
physical needs and supported the well-being of women after the trauma of
surgery in a nurturing and supportive environment.
"It can help whether your surgery was a few months ago or 20 years
ago," she said.
A new study published in December 2011 in the Journal of Cancer
Survivorship by University of Missouri's Sinclair School of Nursing researchers
highlighted the benefits of exercise for women who have experienced breast
cancer, including those who develop lymphedema, swelling that commonly occurs
after breast cancer treatment.
Lymphoedema can occur any time after cancer treatment and is usually
caused by the removal or radiation of lymph nodes as part of the treatment
process.
"The Encore Program was created to improve movement, flexibility and
strength after breast cancer surgery. It helps to reduce the potential risk of
lymphedema and can assist in the management of lymphedema," Ms Guthrey
said.
The Incidence of Breast Cancer in Australia, published by the Federal
Government's Cancer Australia in June 2011, showed the number of women
diagnosed with breast cancer in Australia increased from 5291 in 1982 to 12,567
in 2007, but NSW had one of the lower incidence rates, with ACT being the
highest and Northern Territory the lowest.
The YWCA Encore Program starts in Grafton on February 16 and will run
for eight weeks until April 5, each Thursday from 1pm to 3pm.
"Because medical clearance is required, it's important to register as
soon as possible in order to secure a place, at least two weeks prior to the
class beginning because the classes are small and intimate, so places fill up
quickly," Ms Guthrey said.
Register by calling 9285 6264 or 1800 305 150.
The program incorporates gentle floor and hydrotherapy exercises and
is an opportunity for relaxation and information sharing.
Exercise programs for most people who have experienced cancer can
reduce anxiety and depression, improve mood, boost self-esteem and reduce
symptoms of fatigue.
January 12,
2012
This one has
tables and a lot of stuff in the full article, but I also found the abstract to
use if the formatting is unusable Tina
Newswise —
Articles featured in this issue include-- -
Newswise
Abstract--Lymphedema is a debilitating complication
following mastectomy, affecting the arm functions and quality of life (QOL)
effects of upper-limb exercises on lymphedema in clinical settings. However,
there is a dearth of evidence regarding the effect of home-based exercises on
lymphedema; therefore, we examined the effect of a home-based exercise program
on lymphedema and QOL in postmastectomy patients. Thirty-two female
postmastectomy lymphedema patients participated in an individualized home-based
exercise program for 8 weeks. Arm circumference, arm volume, and QOL (36-Item
Short Form Health Survey) were measured before and after the program. Data were
analyzed with the use of paired t-tests for circumferential and
volumetric measures and Wilcoxon signed ranks tests for QOL. Significance level
was set at p < 0.01 with Bonferroni correction
(alpha/n = 0.05/5 = 0.01). Analysis showed a statistically
significant improvement in the affected upper-limb circumference and volume
(~122 mL reduction, p < 0.001) and in the QOL scores
(p < 0.001) at the end of the home-based exercise program. The
individualized home-based exercise program led to improvement in affected
upper-limb volume and circumference and QOL of postmastectomy lymphedema
patients.
INTRODUCTION
Lymphedema is a chronic, debilitating
complication that breast cancer survivors face after breast cancer treatment [1–8].
Incidence of secondary arm lymphedema varies from 5 to 56 percent [4,7–12].
About 60 percent of patients who undergo axillary lymph node resection and
irradiation will eventually develop lymphedema [13].
Lymphedema develops when the lymphatic flow is
impaired and excess fluid and protein accumulate in the interstitial
space. The hemodynamic factors at the site oflymphedema may also play a role in
its development [1]. Affected women can experience pain, swelling, arm
tightness, heaviness of the arm, and recurrent skin infections. If left
untreated, lymphedema may predispose the affected limb to the development of
other secondary complications like recurrent bouts of cellulitis or
lymphangitis, axillary vein thrombosis, severe functional impairment, cosmetic
embracement, and lymphangiosarcoma [9]. Breast cancer survivors may find
lymphedema more distressing than mastectomy, because hiding the physiological
manifestations and loss of function of lymphedema is harder. Overall, these
factors lead to decreased quality of life (QOL) for breast cancer survivors
[14–15]. Rehabilitative interventions are considered the mainstay for the
treatment of lymphedema, and exercises form an integral component of such
rehabilitation [16].
For decades, any kind of strenuous activity has been feared to
exacerbate the lymphedema. Current clinical guidelines indicate that women with
and at risk for lymphedema should protect the affected arm from overuse
[17–18]. For this reason, patients with lymphedema avoid using the affected
limb, leading to weakness and, hence, predisposing the limb to injury even from
small household tasks. Further, such fear poses an additional barrier to
patients staying physically active, potentially translating to weight gain,
which has been shown to be associated with a worse clinical course for women
with lymphedema [5]. However, the evidence shows no association between
lymphedema and strenuous activity; hence, upper-limb resistance exercises can
help in recovery [19–26]. Previous studies support the view that upper-limb
exercises may decrease lymphedema risk by improving the lymphatic return and
lymphangiogenesis, i.e., regeneration of new collaterals [27–31]. On the other
hand, avoiding activity of the affected limb may lead to poor lymphatic
clearance and, hence, stasis of the lymphatic fluid in the affected limb [32].
During the early 6 to 12 months after mastectomy, pain and decreased shoulder
movements are more common than lymphedema [33]; these can also be prevented by
upper-limb exercises [34]. Particularly, strength training will help not only
in recovering arm strength but also in recovering bone mineral loss due to
cancer treatment. Inactivity of the affected limb may lead to prolonged arm
weakness, poor scapulohumeral function, bone mineral loss and, finally,
lymphedema [35–36].
Since the 1990s, efforts have been made by
McKenzie and other researchers to disprove the concept that strenuous
exercise of the affected upper limb may lead to or worsen lymphedema [19–22]. A
few recent clinical trials [19–29], including a well-controlled trial by
Schmitz et al. [26], have proved that upper-limb exercises have beneficial
effects for lymphedema without exacerbating it. Most of the exercise
interventions were provided in hospitals, clinics, or fitness centers. These
interventions may not be helpful for those patients who cannot afford the cost
of or who lack transportation to institution-based rehabilitation. So, a need
existed for the development of an exercise program that these patients could
easily follow and perform at their homes.
Evidence is lacking regarding the effect of
home-based exercise programs on lymphedema and QOL of breast cancer
patients. So, this study was carried out to evaluate the effects of a
home-based exercise program on lymphedema and QOL of breast cancer patients. We
hypothesized that a structured home-based program of progressive resistance
exercises of the upper limbs combined with deep breathing and self-care would
help relieve the symptoms of lymphedema and improve the QOL of breast cancer
patients. Hence, this study may give valuable evidence supporting the
importance of home-based exercise programs in the reduction of postmastectomy
lymphedema symptoms and thereby improve the QOL of breast cancer
patients.
METHODS
This study was a pre-post intervention study in
which measurements were taken before and after the 8-week home-based
exercise program. Convenience sampling was used to select the participants. The
contralateral upper limb was used as the control so that any physiological
change happening would happen equally on both the limbs.
Subjects
Breast cancer patients who had undergone
mastectomy surgery and had completed neoadjuvant chemo- and radiation
therapy from March 2006 to February 2008 were referred to the study by the
concerned oncologist and oncology surgeon. We screened 137 patients for the
inclusion and exclusion criteria given subsequently; of these, 38 met the ideal
inclusion criteria. Six were lost to follow up. Therefore, a total of 32
patients (all women) completed the exercise program. The flow of participants
through the study is shown in the Figure.
Figure. Flow of participants through study.
Inclusion and Exclusion
Criteria
Patients were included if they had undergone
unilateral mastectomy and completed chemo- and radiation therapy for stage I
or II breast cancer 1.5 years or more before participating in the study. Also,
the patients must have subsequently developed ipsilateral upper-limb lymphedema
with a difference of 2 cm or more at any one measurement point or 200 mL or
more compared with the contralateral upper limb. Patients were excluded if they
had primary lymphedema, secondary lymphedema due to other system pathology,
stage III lymphedema, bilateral disease, diagnosed cancer recurrence, and any
contraindication to the affected upper-limb exercises (e.g., venous
thrombosis).
Measurements
All the measurements were taken at baseline and
at the completion of 8 weeks of the home-based exercise
program.
Lymphedema Measurement
Lymphedema was measured two ways: using
circumferential measurements and a volumetric method. Patients using
compression sleeves were advised to remove them 3 to 4 hours before the
following measurements were taken:
1.
Upper-limb circumference was taken using cloth
measuring
tape on bilateral upper-limbs at four levels, i.e., at the metacarpophalangeal
joints, wrist joint, 15 cm distal to the lateral epicondyle, and 10 cm proximal
to the lateral epicondyle. Patients were positioned prone with their upper
limbs at their sides and their elbows straight while the circumference
measurements were taken [20–21]. Two measurements were taken and their mean was
used. The calculated difference between each circumference (in centimeters) at
all four levels between the affected and contralateral upper limbs was taken as
outcome.
2.
Volumetric measurements were taken by the water
displacement
method, which is based on Archimedes’ Principle. Two readings were taken: (1)
at the ulnar styloid process level and (2) 45 cm proximal to the ulnar styloid
process level for each upper limb. During measurement, patients were advised to
keep their upper limb straight and immerse it slowly by sliding their fingers
straight down inside the wall of the volumeter, which was filled with water.
Water displaced was collected from the point of immersion of upper limb until
the marked level was reached and no further dripping of water was observed. The
collected water was transferred into a graduated cylinder and the volumetric
reading was taken to the nearest 5 mL level. This method of volumetric
measurement has been used previously by McKenzie and Kalda [22]. The outcome
measure was the calculated difference in volume (in milliliters) displaced
between the affected and contralateral upper
limbs.
Quality of Life
QOL was measured by using the 36-Item Short Form
Health Survey (SF-36) QOL questionnaire. The SF-36 has been widely
used as a reliable and valid tool to measure general QOL of patients with
various medical conditions, including cancer. It is a 36-item scale with 8
major components that cover physical, social, and emotional functioning as well
as vitality, bodily pain, mental health, and general health. Completely filled
questionnaires were scored using the SF-36 Health Survey Manual and
Interpretation Guide [37].
Home-Based Exercise
Program
Education about postmastectomy lymphedema and
the home-based exercise program (Table 1) was given before
the initiation of the exercise program. A qualified physiotherapist gave the
initial sessions of exercise prescription and training. Patients practiced the
exercise sequence three to four times; once their performance was found
satisfactory, the exercise program (handout) along with logbook were given to
the patient. Patients were advised to increase the weight only when 2 sets of
15 repetitions became easy to perform. Patients were monitored telephonically
every week and at a fourth-week follow up in the hospital or at home for those
patients who were not able (30%) to come in for follow up.
Table
1.
Progressive resistance exercise program to enhance muscle
strength and endurance of upper limb and scapular muscles (modified from
Franklin et
al. and Harris et al. [1–2]). Participants used household items (e.g., water
bottle, salt packets).
Parameter
Description
Warm Up
Active range of motion exercises for glenohumeral joint for 5
min.
Muscle Groups
Rhomboids, middle trapezius (scapular retraction), latissimus
dorsi (shoulder extension), serratus anterior
(scapular protraction), lower trapezius (scapular depression), biceps (elbow
flexion), triceps (elbow extension), forearm muscles (wrist flexion,
extension), hand muscles (ball squeeze).
Frequency
5 d/wk.
Intensity
Start with light resistance 50%–60% of 10 repetition maximum
weight progress within tolerance.
Repetitions
1 set of 8–10, increase gradually to
10–15.
Sets
1 set, progress to 2 sets; at 2 sets of 12–15 repetitions,
increase resistance weight by 5%–10%.
Stretching Exercises
Pectoralis major and minor, latissimus
dorsi.
Deep Breathing Exercises
Deep breathing exercises between each
set.
Indication to Reduce Workload
Excessive fatigue, postexercise muscle soreness >48 h, slight
increase in arm edema lasting <1 h, pain
during or following exercise.
Indication to Terminate
Pain, discomfort, marked increase in arm edema, dizziness,
general malaise.
Self-Care Advice
Daily monitoring of affected arm for any injury or redness,
gentle distal to proximal self-massage, wearing
of compression garment, avoid insect bites, avoid sleeping on affected side,
limb elevation, etc.
1. Franklin BA, Whaley MH, Howley ET, Balady GJ. ACSM’s
guidelines for exercise testing and prescription. 6th ed. Philadelphia (PA):
Lippincott Williams and Wilkins;
2000.
2. Harris SR, Hugi MR, Olivotto IA, Levine M; Steering Committee
for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer.
Clinical practice guidelines
for the care and treatment of breast cancer: 11. Lymphedema. CMAJ.
2001;164(2):191–99. [PMID:
11332311]
Statistical Analysis
Data were analyzed using SPSS version 16 (SPSS
Inc; Chicago, Illinois) and Microsoft Excel 2007 (Microsoft Corp.; Redmond,
Washington).
Descriptive analysis was done for patient age
and time since mastectomy. Paired t-tests were used for
comparison of mean values of the pre- and postexercise circumferential and
volumetric measurements and the Wilcoxon signed ranks test was used for SF-36
QOL scores. The significance level was set at p < 0.01 using
Bonferroni correction (α /n = 0.05/5 = 0.01).
RESULTS
The mean ± standard deviation age of the
postmastectomy lymphedema patients was 46.56 ± 6.98 years and time since
mastectomy was 2.08 ± 0.65 years. A statistically significant reduction in
affected upper-limb circumference was found at three levels of measurement
(p < 0.001), except at the metacarpophalangeal joint level
(p = 0.04) and in the affected upper-limb volume (p
< 0.001) (Table 2) following the 8-week home-based exercise
program. Also, a statistically significant difference was found for QOL scores
in all SF-36 domains postintervention (Table 3). Result analysis
of the data is shown in Tables 2 and 3.
Table
2.
Pre-post exercise program changes in affected upper-limb
circumference and
volume. Data presented as mean ± standard deviation.
Measurement
Preexercise
Postexercise
Pre-Post Change
MCP Joints (cm)
19.17 ± 1.46
19.03 ± 1.37
0.14 ± 0.9
Wrist Joint (cm)
16.45 ± 2.09
16.20 ± 1.96
0.25 ± 0.13
15 cm DLE (cm)
22.16 ± 3.11
21.47 ± 2.83
0.69 ± 0.28
10 cm PLE (cm)
31.02 ± 4.38
30.06 ± 4.44
0.96 ± 0.06
Volume (mL)
2306.32 ± 627.82
2183.49 ± 597.45
122.83 ± 30.37
DLE = distal to lateral epicondyle, MCP = metacarpophalangeal,
PLE = proximal
to lateral epicondyle.
Table
3.
Pre-post exercise program changes in 36-Item Short Form Health
Survey quality
of life scores.
Parameter
Preexercise
Postexercise
Change in Score
Physical Function
33.90
44.40
10.50
Role Physical
37.30
43.40
6.10
Bodily Pain
37.60
46.10
8.50
General Health
42.20
44.60
2.40
Vitality
45.80
52.10
6.30
Social Function
37.75
45.90
8.15
Role Emotional
32.60
44.20
11.60
Mental Health
37.30
44.40
7.10
Physical Component Summary
41.25
46.30
5.05
Mental Component Summary
38.55
48.30
9.75
DISCUSSION
Lymphedema is a chronic, progressive, long-term
adverse effect of breast cancer treatment resulting in affected
upper-limb swelling, pain, heaviness, and discomfort. This not only affects the
normal functional use of the affected upper limb but also causes psychological
distress by altering the patient’s body image because of visible swelling of
the arm. Together, these symptoms greatly reduce QOL [14–15]. Several therapies
have been used to treat lymphedema, but rehabilitative interventions remain the
treatment mainstay and exercises play an important role in such
rehabilitation.
Therefore, we carried out this study to evaluate
the effect of an 8-week home-based exercise program of progressive
resistance exercises, deep breathing, and self-care on the lymphedema and QOL
of postmastectomy patients. The results of our study showed that the home-based
exercise program led to statistically significant reductions in the
circumference and volume (Table 2) of the affected upper limb and
improved QOL scores (Table 3) of breast cancer patients. Providing
a logbook and continuous monitoring resulted in good adherence to the exercise
program (89% as per logbook records). Mean change in arm volume was 122 mL. In
fact, in our study, exercise acted as a therapeutic intervention instead of
worsening the lymphedema symptoms.
Many justifications can be given regarding the
use of gradual, progressive upper-limb exercise training along with deep
breathing in the rehabilitation of lymphedema [19]. Gradually increasing the
physiological stress to the affected upper limb through flexibility,
resistance, and aerobic exercises will be better than inactivity in
postmastectomy patients. Possible mechanisms by which affected upper-limb
exercise improves or helps prevent lymphedema symptoms include that such
exercise not only enhances lymphatic flow [38–41] but also improves protein
resorption [42]. Lymphatic flow increases as a result of decreased
intrathoracic pressure during inspiration phase [43]; this leads to speculation
that increased pulmonary work during exercise may help in decreasing the
lymphedema [44]. Also, affected upper-limb venous drainage has been found to be
compromised most frequently in lymphedema patients [45]. Stretching exercises
may help reduce the soft tissue contractures and, hence, decrease the blood and
lymphatic obstruction [44].
Progressive resistance exercises may also cause
self-contraction of the lymphatic vessels by regulating sympathetic nerves
innervating these vessels. Hence, the exercises enhance control over the
internal contraction of these vessels by resetting their sympathetic drive,
which in turn is important for the long-term management of lymphedema [38–39].
Because skeletal muscle contraction is a primary force in propelling lymph
fluid throughout the lymphatic system, it can enhance lymphatic clearance. Lane
et al. injected an isotope into the hands of nondisabled women and determined
that 5 minutes of exercises using an arm ergometer enhanced lymphatic clearance
in the hand [30].
In addition, deep breathing while performing any
exercise for lymphedema is doubly important. First, deep breathing is
vital to ensure an adequate supply of oxygen to the tissues when the body is
undergoing greater than usual exertion. Second, deep breathing creates pressure
change in the abdomen, which acts like a vacuum in the thoracic cavity, helping
to drain lymphatic vessels [44]. Moseley et al. reported that 38 women with
secondary arm lymphedema who performed 10 minutes of gentle arm exercises
combined with deep breathing everyday for 1 month achieved a statistically
significant reduction in arm volume of 101 mL (9.0%) [31]. In our study, we
found a similar reduction in arm volume of 122 mL, which might be due to longer
duration of the exercise program compared with Moseley et al.’s
study.
The contralateral upper limb was used as the
control so that any physiological change in arm composition due to exercise
would happen equally on both limbs. This method is similar to previous studies
[20,22]. The outcome measures we used did not give accurate information
regarding changes at the tissue level, but regular exercises cause hypertrophy
of muscles and adipose tissue loss. Not much change was seen in arm
circumference clinically, so any effect of exercise on lymphedema is unknown to
us; other tissue changes may have occurred that masked any positive change
regarding accumulation of lymphatic fluid.
The participants also reported improvement in
their affected upper-limb health (i.e., decreased pain, heaviness, and
discomfort along with softening of fibrotic areas during daily household work)
due to the exercise program. Many participants continued doing the exercises
even after completion of the study period. Results showed a trend toward
improved QOL scores in all aspects, including physical, social, and emotional
well-being as well as general and mental health and vitality scores after the
completion of the prescribed home-based exercise program (Table
3). Increase in physical functioning scores proved the fact that
affected upper-limb progressive resistance exercises had a beneficial effect on
postmastectomy lymphedema. Participants reported more confidence in using the
affected upper limb during regular household work and were even able to lift
groceries with ease. Due to this, they were less often reminded of having
lymphedema, which may have improved vitality and general health scores. These
results are similar to the study by McKenzie and Kalda, which was also an
8-week exercise program [22]. Recent studies by Ahmed et al. and Schmitz et al.
reported 80 and 88 percent adherence rates to twice a week supervised exercise
programs for 6 months and 1 year, respectively [23,25]; in our study, adherence
was found to be 89 percent. Reason for this may be that the self- directed
exercise program for a short period of 8 weeks included many features thought
to comprise effective home training, including baseline evaluation, written
guidelines for home exercise, education about the exercise monitoring and
self-care, daily activities log, once weekly telephonic monitoring by the
therapist, and interim evaluation (fourth week). It may also be the fact that
self-directed exercises performed in the home and community facilities are more
convenient, and therefore, participants adhered more to the prescribed exercise
program. In our study, none of the participants reported increased lymphedema
symptoms as a result of the exercise program.
The prescribed 8-week home-based exercise
program improved the affected upper-limb symptoms and also led to improved
QOL. Home-based exercise programs should be considered for improving the
symptoms of lymphedema resulting from breast cancer treatments.
Lack of an appropriate control group and a small
sample size were two important limitations of our study. Also, we did
not follow the patients to determine the long-term effects of the exercise
program. Long-term studies with larger sample sizes and appropriate control
groups should be undertaken. Studies should also be done comparing effects of
home-based versus institution-based exercise programs.
CONCLUSIONS
A home-based exercise program was found to
effectively improve affected upper-limb symptoms and led to improved QOL of
breast cancer patients. Hence, this home-based exercise program should be
considered for improving the secondary lymphedema and associated symptoms
resulting from breast cancer treatments.
ACKNOWLEDGMENTS
Author Contributions:
Study concept and
design: A. P. Gautam, A. G. Maiya.
Acquisition of
data: A. P. Gautam.
Analysis and interpretation of
data: A. P. Gautam.
Drafting of
manuscript: A. P. Gautam.
Critical revision of manuscript for important
intellectual content: A. G. Maiya, M. S. Vidyasagar.
Statistical analysis:
A. P. Gautam.
Administrative, technical, or material
support: M. S. Vidyasagar.
Study supervision:
A. G. Maiya, M. S. Vidyasagar.
Financial Disclosures:
The authors have declared that no competing interests
exist.
Funding/Support:
This material was unfunded at the time of manuscript
preparation.
Institutional Review:
Ethical clearance for the study was approved by the hospital ethical
committee. A written consent for willing participation in the home-based
exercise program was taken from all the patients before the baseline
measures.
Participant Follow-Up:
The authors do not plan to inform participants of the publication of
this study. However, participants for whom contact information is available
have been encouraged to check the study Web site for updated
publications.
REFERENCES
1.
Sakorafas GH, Peros G ,
Cataliotti L, Vlastos G . Lymphedema following axillary lymph node dissection
for breast cancer. Surg Oncol. 2006;15(3):153–65. [PMID: 17187979]
http://dx.doi.org/10.1016/j.suronc.2006.11.003
2.
Coen JJ, Taghian AG ,
Kachnic LA, Assaad SI, Powell SN. Risk of lymphedema after regional nodal
irradiation with breast conservation therapy. Int J Radiat Oncol Biol Phys.
2003;55(5):1209–15. [PMID: 12654429]
http://dx.doi.org/10.1016/S0360-3016(02)04273-6
Erratum
in: Int J Radiat Oncol Biol Phys.
2003;56(2):604.
3.
Hinrichs CS, Watroba NL, Rezaishiraz H, Giese W, Hurd
T,
Fassl KA, Edge SB. Lymphedema secondary to postmastectomy radiation: Incidence
and risk factors. Ann Surg Oncol. 2004;11(6):573–80. [PMID: 15172932]
http://dx.doi.org/10.1245/ASO.2004.04.017
4.
Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL.
Arm
edema in breast cancer patients. J Natl Cancer Inst. 2001;93(2):96–111. [PMID: 11208879]
http://dx.doi.org/10.1093/jnci/93.2.96
5.
Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in
a
cohort of breast carcinoma survivors 20 years after diagnosis. Cancer.
2001;92(6):1368–77. [PMID: 11745212]
http://dx.doi.org/10.1002/1097-0142(20010915)92:6<1368::AID-CNCR1459>3.0.CO;2-9
6.
Hayes S, Cornish B, Newman B. Comparison of methods
to
diagnose lymphedema among breast cancer survivors: 6-month follow-up. Breast
Cancer Res Treat. 2005;89(3): 221–26. [PMID: 15754119]
http://dx.doi.org/10.1007/s10549-004-2045-x
7.
Ozaslan C, Kuru B. Lymphedema after treatment of breast
cancer.
Am J Surg. 2004;187(1):69–72. [PMID: 14706589]
http://dx.doi.org/10.1016/j.amjsurg.2002.12.003
8.
Tengrup I, Tennvall-Nittby L, Christiansson I, Laurin M. Arm
morbidity
after breast-conserving therapy for breast cancer. Acta Oncol.
2000;39(3):393–97. [PMID: 10987237]
http://dx.doi.org/10.1080/028418600750013177
9.
Shih YC, Xu Y, Cormier JN, Giordano S, Ridner SH,
Buchholz
TA, Perkins GH, Elting LS. Incidence, treatment costs, and complications of
lymphedema after breast cancer among women of working age: A 2-year follow-up
study. J Clin Oncol. 2009;27(12):2007–14. [PMID: 19289624]
http://dx.doi.org/10.1200/JCO.2008.18.3517
10.
Clark B, Sitzia J, Harlow W. Incidence and risk of arm
oedema
following treatment for breast cancer: A three-year follow-up study. QJM.
2005;98(5):343–48.
[PMID: 15820971]
http://dx.doi.org/10.1093/qjmed/hci053
11.
Petrek JA, Heelan MC. Incidence of breast
carcinoma-related
lymphedema. Cancer. 1998;83(12 Suppl American): 2776–81. [PMID:
9874397]
12.
Johansson K, Ohlsson K, Ingvar C, Albertsson M, Ekdahl
C.
Factors associated with the development of arm lymphedema following breast
cancer treatment: A match pair case-control study. Lymphology
2002;35(2):59–71.
[PMID:
12081053]
13.
Armer JM, Stewart BR, Shook RP. 30-month post-breast
cancer
treatment lymphoedema. J Lymphoedema. 2009;4(1): 14–18. [PMID:
20182653]
14.
Passik SD, McDonald MV. Psychosocial aspects of upper
extremity
lymphedema in women treated for breast carcinoma. Cancer. 1998;83(12 Suppl
American):2817–20.
[PMID:
9874404]
15.
Pyszel A, Malyszczak K, Pyszel K, Andrzejak R, Szuba A.
Disability,
psychological distress and quality of life in breast cancer survivors with arm
lymphedema. Lymphology. 2006; 39(4):185–92. [PMID:
17319631]
16.
Harris SR, Campbell KL, McNeely ML. Upper extremity
rehabilitation
for women who have been treated for breast cancer. Physiother Can.
2004;56:202–14.
http://dx.doi.org/10.2310/6640.2004.00022
17.
Lymphedema: What every woman with breast cancer
should
know [Internet]. Atlanta (GA): American Cancer Society; 2009 (cited 2009 May
8). Available from: http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/
Lymphedema/WhatEveryWomanwithBreastCancerShouldKnow/index.
18.
Understanding breast cancer: After treatment: Life issues:
Lymphedema
[Internet]. Dallas (TX): Susan G . Komen for the Cure; 2009 (cited 2009 May 8).
Available from:
http://ww5.komen.org/BreastCancer/Lymphedema.html.
19.
McKenzie DC. Abreast in a boat—A race against breast
cancer.
CMAJ. 1998;159(4):376–78. [PMID:
9732719]
20.
Harris SR, Niesen-Vertommen S. Challenging the myth of
exercise-induced
lymphedema following breast cancer: A series of case reports. J Surg Oncol.
2000;74(2):95–99.
[PMID: 10914817]
http://dx.doi.org/10.1002/1096-9098(200006)74:2<95::AID-JSO3>3.0.CO;2-Q
21.
Harris SR, Hugi MR, Olivotto IA, Levine M; Steering
Committee
for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer.
Clinical practice guidelines for the care and treatment of breast cancer: 11.
Lymphedema. CMAJ. 2001;164(2):191–99. [PMID:
11332311]
22.
McKenzie DC, Kalda AL. Effect of upper extremity exercise
on
secondary lymphedema in breast cancer patients: A pilot study. J Clin Oncol.
2003;21(3):463–66. [PMID: 12560436]
http://dx.doi.org/10.1200/JCO.2003.04.069
23.
Ahmed RL, Thomas W, Yee D, Schmitz KH. Randomized
controlled
trial of weight training and lymphedema in breast cancer survivors. J Clin
Oncol. 2006;24(18):2765–72.
[PMID: 16702582]
http://dx.doi.org/10.1200/JCO.2005.03.6749
24.
Kilbreath SL, Refshauge KM, Beith JM, Lee MJ.
Resistance
and stretching shoulder exercises early following surgery for breast cancer: A
pilot study. Rehabil Oncol. 2006;
24(1):9–14.
25.
Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R,
Lewis-Grant
L, Bryan CJ, Williams-Smith CT, Greene QP. Weight lifting in women with breast
cancer related lymphedema. N Engl J Med. 2009;361(7):664–73.
[PMID: 19675330]
http://dx.doi.org/10.1056/NEJMoa0810118
26.
Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ,
Gross
CR, Lytle LA, Ahmed RL. Physical activity and lymphedema (the PAL trial):
Assessing the safety of progressive strength training in breast cancer
survivors. Contemp Clin Trials. 2009;30(3):233–45. [PMID: 19171204]
http://dx.doi.org/10.1016/j.cct.2009.01.001
27.
Box RC, Reul-Hirche H, Bullock-Saxton JE, Furnival CM.
Physiotherapy
after breast cancer surgery: Results of a randomised controlled study to
minimise lymphedema. Breast Cancer Res Treat. 2002;75(1):51–64. [PMID: 12500934]
http://dx.doi.org/10.1023/A:1016591121762
28.
Johansson K, Tibe K, Weibull A, Newton RC. Low
intensity
resistance exercise for breast cancer patients with arm lymphedema with or
without compression sleeve. Lymphology. 2005;38(4):167–80. [PMID:
16515225]
29.
Johansson K, Piller N. Weight-bearing exercise and its
impact
on arm lymphoedema. J Lymphoedema. 2007;2(1): 15–22.
30.
Lane KN, Dolan LB, Worsley D, McKenzie DC. Upper
extremity
lymphatic function at rest and during exercise in breast cancer survivors with
and without lymphedema compared with healthy controls. J Appl Physiol.
2007;103(3): 917–25. [PMID: 17585046]
http://dx.doi.org/10.1152/japplphysiol.00077.2007
31.
Moseley AL, Piller NB, Carati CJ. The effect of gentle arm
exercise
and deep breathing on secondary arm lymphedema. Lymphology. 2005;38(3):136–45.
[PMID:
16353491]
32.
Trettin H. [Neurologic principles of edema in inactivity].
Z
Lymphol. 1992;16(1):14–16. In German. [PMID:
1288027]
33.
Thomas-Maclean RL, Hack T, Kwan W, Towers A,
Miedema
B, Tilley A. Arm morbidity and disability after breast cancer: New directions
for care. Oncol Nurs Forum. 2008;35(1):65–71. [PMID: 18192154]
http://dx.doi.org/10.1188/08.ONF.65-71
34.
Turner J, Hayes S, Reul-Hirche H. Improving the physical
status
and quality of life of women treated for breast cancer: A pilot study of a
structured exercise intervention. J Surg Oncol. 2004;86(3):141–46. [PMID: 15170652]
http://dx.doi.org/10.1002/jso.20065
35.
Cheema B, Gaul CA, Lane K, Fiatarone Singh MA.
Progressive
resistance training in breast cancer: A systematic review of clinical trials.
Breast Cancer Res Treat. 2008; 109(1):9–26. [PMID: 17624588]
http://dx.doi.org/10.1007/s10549-007-9638-0
36.
Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD,
Friedenreich
CM, Ladha AB, Proulx C, Vallance JK, Lane K, Yasui Y, McKenzie DC. Effects of
aerobic and resistance exercise in breast cancer patients receiving adjuvant
chemotherapy: A multicenter randomized controlled trial. J Clin Oncol
2007;25(28):4396–4404. [PMID: 17785708]
http://dx.doi.org/10.1200/JCO.2006.08.2024
37.
Ware JE, Snow KK, Kosinski MK, Gandek B. SF-36 health
survey
manual and interpretation guide. Boston (MA): The Health Institute, New England
Medical Center; 1993.
38.
Witte CL, Witte MH. Contrasting patterns of lymphatic and
blood
circulatory disorders. Lymphology. 1987;20(4):171–78.
[PMID:
3328023]
39.
Witte MH, Witte CL. Lymphatics and blood vessels,
lymphangiogenesis
and hemangiogenesis: From cell biology to clinical medicine. Lymphology.
1987;20(4):257–66.
[PMID:
2451095]
40.
Mortimer PS. Investigation and management of
lymphedema.
Vasc Med Rev. 1990;1:1–20.
http://dx.doi.org/10.1177/1358836X9000100102
41.
Mortimer PS. Managing lymphoedema. Clin Exp Dermatol.
1995;20(2):98–106.
[PMID: 8565266]
http://dx.doi.org/10.1111/j.1365-2230.1995.tb02665.x
42.
Leduc O, Bourgeois P, Leduc A. Manual of lymphatic
drainage:
Scintigraphic demonstration of its efficacy on colloidal protein resorption.
In: Partsch H, editor. Progress in lymphology IX. Amsterdam (the Netherlands):
Elsevier; 1989. p. 421–23.
43.
Wittlinger G ,
Wittlinger H, Harris RH. Textbook of Dr. Vodder’s manual lymph drainage. New
York (NY): Thieme; 2004.
44.
Brennan MJ, Miller LT. Overview of treatment options and
review
of the current role and use of compression garments, intermittent pumps, and
exercise in the management of lymphedema. Cancer. 1998;83(12 Suppl
American):2821–27.
[PMID:
9874405]
45.
Svensson WE, Mortimer PS, Tohno E, Cosgrove DO.
Colour
Doppler demonstrates venous flow abnormalities in breast cancer patients with
chronic arm swelling. Eur J Cancer. 1994;30A(5):657–60. [PMID: 8080682]
http://dx.doi.org/10.1016/0959-8049(94)90539-8
Submitted for publication May 17, 2010. Accepted
in revised form January 20, 2011.
This article and any supplementary material
should be cited as follows:
Gautam AP, Maiya AG, Vidyasagar MS. Effect of
home-based exercise program on lymphedema and quality of life in female
postmastectomy patients: Pre-post intervention study. J Rehabil Res Dev.
2011;48(10):1261–68.
DOI:10.1682/JRRD.2010.05.0089
January 12,
2012
The Benefits of
Healing Touch - Huffington Post – by Julie
Chen
Many of
my patients express their frustration that massage therapy generally is not
covered by their health insurance, yet the health benefits seem tremendous for
them. I believe that the growing trend of discontent with lack of coverage for
massage therapy is not just limited to patients, but from health practitioners
as well.
What is
even more unfortunate is that sometimes health care practitioners rarely fully
lay hands on patients even for office visits and evaluations anymore. As a part
of most healing modalities in the past, the simple touch therapy of examining
and treating the patient imparts a level of healing that is now becoming lost
in modern day medicine.
Many of
my patients joke that doctors these days don't even put their hands on the
patient anymore except for a cursory exam at the first visit or unless
absolutely necessary. It is unfortunate that along with declining time allowed
with each patient, even the simple but effective practice of laying of hands on
patients is slowly becoming lost as well.
Even as
recent as just a few decades ago, the laying of hands and massage therapy or
manual therapy was considered a normal natural part of medicine. In more recent
times, massage and manual therapy is seen as more of a luxury rather than a
necessary part of healing and wellness.
This is an unfortunate change
in Western healing philosophy since studies show that massage and manual
therapy are beneficial for many medical conditions and health concerns, which
is likely the reason why manual therapy is still considered an important part
of healing in most other parts of the world.
Based
on numerous studies as listed below, massage and manual therapy is in my
opinion an essential part of health and healing based on improvement of
circulation, muscle function and stress reduction, just to name a few.
Nowadays in medicine, we are all well aware of how stress affects our
body negatively. We see time and time again that patients who are stressed,
anxious or depressed tend toward more negative health outcomes than those who
are feeling balanced, calm and positive.
Studies
indicate that manual therapy likely helps with stress reduction as well as
other aspects of physiology. But even taking those other physiological benefits
aside, the reduction of stress alone has tremendous health benefits to
patients, as related to more positive outcomes to overall health and daily
functioning.
So, my
recommendation to everyone reading this article is to stop thinking of massage
or manual therapy as a luxury. It is well worth the investment on a regular
basis if you can afford it. It is likely worthwhile to double check with your
insurance company and ask whether you have some coverage within your physical
therapy coverage, which many of my patients were not aware of and were
pleasantly surprised.
My
second recommendation is to find a physician who still uses the healing
modality of touch in the clinic. Frequently, just simply laying hands on a
patient during an exam allows the physician to both heal and diagnose all in
one motion.
I am a
firm believer that the therapeutic alliance between a patient and a health care
practitioner is stronger when there is a respectful level of healing touch
involved in treatment and diagnosis. In order to achieve an accurate level of
diagnosis, we were taught in medical school to obtain at least 90 percent of
the diagnosis from the patient. In order to do that, we would need to lay our
hands on our patients to fully evaluate and diagnose them... and that is what I
would recommend that you look for in your physician.
Overall, I agree with my patients that insurance companies do not
cover for this vastly beneficial healing modality enough. Not only do they not
allow physicians more time with patients for visits (short visits are necessary
in order to keep a clinic financially afloat based on the current system), but
frequently they do not cover for hands-on therapy such as massage or manual
therapy. Unfortunately then, it is left to us to pursue this topic with our
physicians and our insurance companies and see if there is coverage hidden in
the fine print of the physical therapy coverage.
If
there is, I highly recommend that you utilize the services and not wait until
you have longstanding chronic pain, insomnia, irritable bowel syndrome or
hypertension, just to name a few adverse consequences of longstanding stress
and discomfort.
I like
to frequently remind my patients that our body is not cut off at the neck; such
that what is in our mind does affect our body, and what is happening in our
body does affect our mind. So, why not make use of a healing modality that
seems to treat both our mind and body?
Ultimately, if you have to put in some leg work on your end to figure
out an affordable way to achieve regular manual or massage therapy, either
through your physical therapy coverage or an affordable massage clinic in your
neighborhood, in the long run, your mind and body will both be better off for
it.
For more by Julie Chen, M.D., click here.
For
more on personal health, click here.
Flickr photo by Nick Webb
References:
Anderson PG, Cutshall SM. Massage
therapy: a comfort intervention for cardiac surgery patients. Clin Nurse Spec.
2007;21(3):161-5; quiz 166-7.
Bernas
M, Witte M, Kriederman B, Summers P, Witte C. Massage therapy in the treatment
of lymphedema. Rationale, results, and applications. IEEE Eng Med Biol Mag.
2005;24(2):58-68.
Billhult A, Bergbom I, Stener-Victorin E. Massage relieves nausea in
women with breast cancer who are undergoing chemotherapy. J Altern Complement
Med. 2007;13(1):53-7.
Billhult A, Stener-Victorin E, Bergbom I. The experience of massage
during chemotherapy treatment in breast cancer patients. Clin Nurs Res.
2007;16(2):85-99; discussion 100-2.
Buckle
S. Aromatherapy and massage: the evidence. Paediatr Nurs.
2003;15(6):24-7.
Button
C, Anderson N, Bradford C, Cotter JD, Ainslie PN. The effect of
multidirectional mechanical vibration on peripheral circulation of humans. Clin
Physiol Funct Imaging. 2007;27(4):211-6.
Cambron
JA, Dexheimer J, Coe P. Changes in blood pressure after various forms of
therapeutic massage: a preliminary study. J Altern Complement Med.
2006;12(1):65-70.
Dryden
T, Baskwill A, Preyde M. Massage therapy for the orthopaedic patient: a review.
Orthop Nurs. 2004;23(5):327-32; quiz 333-4.
Furlan
AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database
Syst Rev. 2008;(4):CD001929.
Gordon
C, Emiliozzi C, Zartarian M. Use of a mechanical massage technique in the
treatment of fibromyalgia: a preliminary study. Arch Phys Med Rehabil.
2006;87(1):145-7.
Kaye
AD, Kaye AJ, Swinford J, Baluch A, Bawcom BA, Lambert TJ, Hoover JM. The effect
of deep-tissue massage therapy on blood pressure and heart rate. J Altern
Complement Med. 2008;14(2):125-8.
Kutner
JS, Smith MC, Corbin L, Hemphill L, Benton K, Mellis BK, Beaty B, Felton S,
Yamashita TE, Bryant LL, Fairclough DL. Massage therapy versus simple touch to
improve pain and mood in patients with advanced cancer: a randomized trial. Ann
Intern Med. 2008;149(6):369-79.
Maa SH,
Tsou TS, Wang KY, Wang CH, Lin HC, Huang YH. Self-administered acupressure
reduces the symptoms that limit daily activities in bronchiectasis patients:
pilot study findings. J Clin Nurs. 2007;16(4):794-804.
McNeill
JA, Alderdice FA, McMurray F. A retrospective cohort study exploring the
relationship between antenatal reflexology and intranatal outcomes. Complement
Ther Clin Pract. 2006;12(2):119-25.
Plews-Ogan M, Owens JE, Goodman M, Wolfe P, Schorling J. A pilot
study evaluating mindfulness-based stress reduction and massage for the
management of chronic pain. J Gen Intern Med. 2005;20(12):1136-8.
Sherman
KJ, Cherkin DC, Deyo RA, Erro JH, Hrbek A, Davis RB, Eisenberg DM. The
diagnosis and treatment of chronic back pain by acupuncturists, chiropractors,
and massage therapists. Clin J Pain. 2006;22(3):227-34.
Skillgate E, Vingard E, Alfredsson L. Naprapathic manual therapy or
evidence-based care for back and neck pain: a randomized, controlled trial.
Clin J Pain. 2007;23(5):431-9.
Vernon
H, Humphreys K, Hagino C. Chronic mechanical neck pain in adults treated by
manual therapy: a systematic review of change scores in randomized clinical
trials. JManipulative Physiol Ther. 2007;30(3):215-27.
Wilkinson SM, Love SB, Westcombe AM, et al., Effectiveness of
aromatherapy massage in the management of anxiety and depression in patients
with cancer: a multicenter randomized controlled trial. J Clin Oncol.
2007;25(5):532-9.
Wu HS,
Lin LC, Wu SC, Lin JG. The psychologic consequences of chronic dyspnea in
chronic pulmonary obstruction disease: the effects of acupressure on
depression. J Altern Complement Med. 2007;13(2):253-61.
Yang
MH, Wu SC, Lin JG, Lin LC. The efficacy of acupressure for decreasing agitated
behaviour in dementia: a pilot study. J Clin Nurs.
2007;16(2):308-15.
Orem
Rehabilitation & Skilled Nursing - Daily
Herald –
State-of-the-Art Therapy A Passion for
the Art of Caring The Orem Rehabilitation & Skilled Nursing therapy team is
passionate about bringing the latest techniques and programs to our patients.
Through continuing education, our physical and occupational therapists apply
the latest research to improve balance and reduce fall-risk. They also utilize
therapeutic modalities combined with a comprehensive therapy program for
strengthening, balance training, pain reduction, wound-healing, urinary
incontinence, and increasing range of motion. In addition, we have therapists
certified in specialty areas of practice such as: • Wound Care • Neurological
Conditions • Electrical Stimulation For Swallowing Dysfunction • Lymphedema •
Pulmonary Programs Our speech-language pathologists incorporate research-based
swallowing, language and cognitive procedures to address the needs of our
patients. At the heart of our therapy programs is a deep appreciation for, and
understanding of, the special needs of our more mature patients. This goes
beyond the science and research in order to tap into the art of caring for
these unique needs.
January
14, 2012
Nursing
with empathy: Childhood cancer
survivor beats odds, helps others - Glens Falls Post-Star
– by Meg Hargarty
Although the odds were stacked against her that she would survive
cancer as a 3-year-old, Joanna Burgess never let her illness stand in the way
of realizing her dream of helping others.
Now, at 49, the former South Glens Falls resident is a wound, ostomy
and continence nurse in North Carolina.
Joanna recently received the Great Comebacks Regional Award for
rebounding from her bladder cancer and making a difference in the lives of her
patients.
"Seeing the transformation when a patient goes from being withdrawn
to, ‘OK, I can learn to take care of (an ostomy bag),' is rewarding," she said.
"(Winning the award) will globally and extensively get my story
out."
Great Comebacks is sponsored by ConvaTec, a developer and marketer of
medical technologies for community and hospital care, in partnership with the
Crohn's and Colitis Foundation; the United Ostomy Associations of America; the
Intestinal Disease Education and Awareness Society; the Wound, Ostomy and
Continence Nurses Society; and the American Society of Colon and Rectal
Surgeons.
Joanna developed rhabdomyosarcoma, a type of bladder cancer, when she
was little more than a toddler. Her father, South Glens Falls retired pastor
Clayton Burgess, recalled local surgeon Harry "Mac" DePan delivering the grim
diagnosis to him and Joanna's mother, Shirley.
"He didn't hide anything. He came out and said, ‘Children don't
survive this cancer," Clayton said.
Given a 10 percent chance of survival, Joanna was immediately
transferred to a Boston hospital, where she underwent a urostomy to replace her
bladder. Ironically, the massive doses of chemotherapy and cobalt radiation
meant to spare her life would cause her body to break down in the
future.
The most outward effects of the harsh treatment are Joanna's small
stature - she never grew past 4 feet 11 inches - and a noticeable
limp.
The 1981 graduate of South High said she was thought of as the
"mystery girl" at school.
"I walked a little differently. I think a lot of kids thought I had
polio," she recalled. "I didn't know they thought that. Later on my friends
told me."
Joanna graduated from college and was a nurse for five years when her
body began to show signs of the damaging effects of the cobalt radiation
treatments given to her as a child. She endured a series of operations,
including plastic surgery for burns on her back, two hip replacements, bypass
grafts on her legs to improve circulation and an elective colostomy to
eliminate the pain of radiation-induced colitis.
Her life was put on hold for about 20 years.
"Basically they had to re-create my body," Joanna said.
Today she still wears the colostomy and ostomy bags, uses support
hose for lymphedema and has limited mobility. The hip replacements won't last
forever, she said, and she thinks she'll need more surgery in the
future.
Despite everything Joanna endured, she remained grateful to be alive
and made the most of the years spent recovering from her operations. She
volunteered at a clinic in Honduras, explored the field of holistic nursing and
aided in the launch of a clinic devoted to those suffering from
lymphedema.
Joanna loved pediatrics and wanted to work with ostomy patients. She
had a "synchronistic opportunity" to work with a 3-year-old boy diagnosed with
rhabdomyosarcoma and decided to begin coursework to become a WOCN.
"Now I was able to witness what a parent goes through when their
child gets this diagnosis. It's still a terrible diagnosis and still very life
threatening," she said.
At the point when Joanna was finding the most fulfillment both in her
personal life - she met the man who would become her husband- and
professionally by pursuing her WOCN certification, her doctors advised her not
to go back to work, fearing her physical condition was too
"fragile."
Joanna decided to follow her own path and has been a WOCN at WakeMed
Cary Hospital in North Carolina for three years. She brings a type of empathy
to her patients other nurses who haven't walked her path can't
provide.
"When a person has to have an ostomy, people cannot imagine what it
is going to be like and there is a lot of shame associated with it. People
don't talk about it because it has to do with something you don't talk about in
society," Joanna said. "I tell them I have an ostomy, and they can't believe
it. They immediately feel hope, and if I can teach them a way to change their
perception, it can make all the difference."
As the southeast regional winner of the Great Comebacks award, Joanna
said she is now able to raise awareness of ostomy issues on a broader level
through workshops
and conferences and by telling her own journey through
illness.
She hopes to help start an outpatient ostomy clinic at WakeMed, but
most importantly, she wants to continue to be an empathetic resource to her
patients and their families.
"Your story touches something in someone else whether they have the
same thing or not. We're all dealing with something difficult, and it's a way
to connect with each other," she said.
January
15, 2012
This
next one is some kind of blog about printers, I never found anything
referencing lympheema there:
hp photosmart
c4280 all-in-one driver download - Kashmir
Observer –
mphedema, a frequent cause of leg
edema and often included in the differential diagnosis of venous disease, is
also discussed. ...
January
16, 2012
i earns highest
level certification - bcrnews.com –
PERU
— Sonnie (Ryba) Blocki, PT, MS and certified lymphedema therapist of United
Physical Therapy LLC in Peru, attended a three-day continuing education
training in Estes Park, Colo. The conference was hosted by Klose Training and
Consulting LLC.
The conference
brought together lymphedema therapists, physicians, researchers, and
world-renowned experts to share research, experiences, and resources in order
to advance the treatment of lymphedema and improve the quality of life of
cancer survivors.
Lymphedema is a
condition that is most associated with the swelling of a limb following breast
cancer. However, it can also occur due to a condition from birth, cancer
treatment, or other injury. It is estimated there are currently 5 million
people in the U.S. who suffer with lymphedema, and they often go undiagnosed,
untreated and mistreated.
As a
LANA-certified therapist, Blocki consults with physicians in the diagnosis and
treatment of lymphedema.
Big
Spike in Knee Surgeries Calls for Compression Therapy Devices
to Lessen Risk of Blood Clots – SBWire –
Tampa, FL -- (SBWIRE) -- 01/16/2012 -- New
statistics show a big increase in knee replacement surgery since the late
1990s. From 1997 to 2009, knee surgery increased for women ages 45 to 64 by 157
percent and men in the same range by 144 percent. The Agency for Healthcare
Research and Quality attributes this to advances in knee surgery, better
implants, and obesity that can cause the joints to be more compromised. Right
after knee surgery, patients must be mindful of preventing blood clots as they
are immobile while they initially heal.
“Sequential compression devices
can be great for many patients who cannot walk or get around much in the first
few weeks,” said Greg Grambor, president of Vascular PRN, which helps
healthcare professionals nationwide fill prescriptions for SCDs and IPCs. “Patients should
talk to their doctor about their risk for a blood clot, find out if mechanical
compression is good for them, and be proactive before the day of the
surgery.”
The American Journal of Surgery notes that compression therapy
devices can lessen the chances of DVT post-surgery by 60 percent. Many patients
get mechanical compression therapy devices along with medicine to help prevent
blood clots. Knee and hip surgery carry a higher risk of blood clots, so
patients should be prepared when they have these types of surgeries to address
any concerns ahead of time.
“Blood vessels can get damaged during
surgery and when you are restricted to bed rest, SCDs can help blood flow from
the superficial veins to the deep veins,” said Grambor. “The devices are
comfortable and there are some choices depending on how portable you want the
compression therapy system to be.”
Vascular PRN is known for its full
line of sequential mechanical compression devices for the full leg, calf, and
foot. To learn more about renting or buying a Sequential Compression Device, SCD boots, or Lymphedema boots visit http://www.vascularprn.com/ or
call 800.886.4331.
January
16, 2012
Visiting Sloth City? Exercise your
options - The Grand Rapids Press - MLive.com – by Sue
Schroder
My inner sloth has been
having its way with me.
My recent failure to
exercise is a combination of my own inertia coupled with bronchitis followed by
the cold from hell. My maintenance therapy gets only minuscule
blame.
Those in active chemo may
face limited exercise options as I did when the chemical warfare did heavy
collateral damage to my energy and strength, drastically lowered my white blood
count and left me susceptible to infection.
Once outside the
treatment-dictated shalt-nots of human contact, is exercise really worth the
effort we’d have to put into it?
If you care about reducing
the risk and/or recurrence of some cancers and actually increasing the energy
levels chemo knocks out of us, the answer is a resounding yes.
Reduce your risk
The National Cancer
Institute reports “strong evidence” that physical activity is associated with
reduced risk of colon and breast cancers. It also cites several studies
reporting links between physical activity and reduced risk of endometrial, lung
and prostate cancers.
So how do those of us with a
near-mortal fear of Spandex go about rebuilding our bodies and regaining our
strength?
Consider exercise programs
designed specifically for cancer survivors.
One of the longest-running
is Cancer Well-fit. The program has been offered for more than 10 years at the
Michigan Athletic Club (the MAC) and the East Hills Athletic Club through the
Lacks Cancer Center of Saint Mary’s Health Care.
“We don’t have much control
over cancer, and people who’ve gone through our program tell us they feel they
gain some control in their lives. We know the classes actually reduce fatigue
and increase energy levels,” said Kristi Tuck, fitness director of the MAC and
East Hills, and the woman in charge of the Cancer Well-fit program.
Certified
program
Cancer Well-fit is a 14-week
program that includes 10 weeks of sessions conducted by the only nationally
recognized certified cancer exercise trainers in Michigan, according to the
Lacks Cancer Center website. It also includes an additional four weeks of open
membership.
Classes for 8-10 people are
focused on strength training through weight training, Tuck said. Balance and
stability, flexibility and core strength training are part of the program.
Open to patients who have
recently been or are currently being treated for cancer and are referred by
their doctors, classes are geared to people dealing with the effects of
treatment, whatever the cancer.
Cost: $50 for patients of
The Lacks Cancer Center (support partner included) or $150 for participants who
are not patients at the Lacks Cancer Center (support partner
included.)
For more information, visit
lackscancercenter.org; to
register, call the Lacks Cancer at Saint Mary’s, 685-5222.
Gilda’s Club Grand Rapids
and Gilda’s Club Lowell both offer fitness and wellness classes free to Gilda’s
members and open to supporting family and friends.
“In most cases, the type and
level of exercise for someone on a cancer journey will be dependent on their
current health status and/or treatment plan,” said Wendy Wigger, vice president
of community relations and program development.
Here is a small sample of
Gilda’s monthly classes:
(Visit gildasclubgr.org for information
on all classes and membership information.)
Fitness & Movement
Taught by a certified
physical therapist, this variety fitness class offers a combined exercise of
core strength, Tai Chi, meditation and gentle strength training.
Movement &
Lymphedema
This program combines dance
with gentle exercise and lymphedema awareness, and is designed to increase
range of motion and to decrease lymphedema.
A brochure from the
University of Colorado Cancer Center also can help with planning and monitoring
post-cancer exercise.
Cancer survivors can download the brochure.
Editor’s note: Sue Schroder,
former features editor for The Grand Rapids Press, was diagnosed with
non-Hodgkin’s lymphoma in late 2009. Email her at [email protected].
January
17, 2012
Sports Medicine,
Life Therapies opens in Dickson - The
Tennessean –
Baptist Sports
Medicine and Life Therapies recently opened a new outpatient rehabilitation
clinic at 10250 Ramsey Way in Dickson.
The clinic offers
orthopedic physical therapy, sports medicine and lymphedema therapy and is led
by physical therapists Bill Rion and Celeste Crider.
“We are pleased to
now have a presence here, as well as a facility to offer our services to the
Dickson community,” said Rion in a press release. “We are so grateful for the
outreach and support we have received thus far and are excited to establish
lasting relationships with the people of Dickson.”
The opening of
this clinic marks the 20th Baptist Sports Medicine and Life Therapies facility
in Middle Tennessee and the first in Dickson. The clinic is located in the
Crestview Office Park directly across from Dickson Medical
Associates.
For more
information, call (615) 441-2707.
SJH Sports
RebahCare debuts Harrison Township location
- Gloucester County Times - NJ.com – By
John Barna -
HARRISON TWP. —
SJH Sports RehabCare has opened its newest location in Mullica Hill at SJH
Tomlin Station Park.
Located at 201
Tomlin Station Road, Suite D, the facility offers sports and orthopedic
physical therapy, occupational therapy, spine care, worker's compensation
services including FCE and Pre-Work Screens and lymphedema
services.
In highlighting
the opening of this new location, SJH Sports RehabCare Tomlin Station Park
would like to introduce two new staff members to the Gloucester County
community.
Kristy Meade, who
has over 10 years clinical experience, will oversee SJH Sports RehabCare at
Tomlin Station Park site. Meade graduated with a Masters Degree in Physical
Therapy from Sacred Heart University in Fairfield, Conn. She is also a
Certified Athletic Trainer. Kristy's special interests include post-surgical
patients, athletic injuries, body mechanics and postural education with a
specialty focus on trends in ACL rehabilitation.
Victoria Rink, is
the OT clinical coordinator for all SJH RehabCare inpatient and outpatient
facilities and SJH Sports RehabCare locations. Rink is a Certified Hand
Therapist with over 17 years of experience treating upper extremity disorders.
She is a graduate of Thomas Jefferson University's Honors Program. Her
specialty is in treating complex post-surgical cases and trauma, including
nerve injury, hand replant and hand transplantation
rehabilitation.
For more
information, call 856-241-2533 or by email [email protected].
January 17,
2012
Breast Cancer Survivor from Cortlandt Publishes Book
on Mastectomy - Patch.com – ByJessie Jafet –
The authors
provide comprehensive information on mastectomy and breast reconstruction
surgery in their book released today.
Though there is
plenty of information online about mastectomy, Amy Curran Baker thought it
would be helpful to many women if she wrote a single-resource guide that
explains the recovery process from beginning to end.
A breast cancer
survivor herself, the 43-year-old Baker has authored “Now What? A Guide to Recovery After
Mastectomy,” officially released today, Jan. 17
(the book has been available online since Dec. 31). She hopes that women who
are searching for answers about their own journey with mastectomy will find
them in her book.
Baker, a
Cortlandt resident, was 39 years old with two young daughters when she was
diagnosed with the disease in 2008. Even with significant family experience
with breast cancer—her mother, maternal grandmother, and her maternal aunt had
all been diagnosed—she still had many questions about the procedure she opted
for: bilateral mastectomy with “direct to implant reconstruction.”
Copious research,
along with her daily work as an occupational therapist, gave her an unique
perspective to write the book.
“Being an OT I
realized that there were a lot of basic recovery and rehabilitation issues that
women might never be told about after mastectomy,” Baker said.
“Things like how
to manage activities such as dressing and bathing, getting a good night’s
sleep, caring for children, home management, and returning to work.” She added
that the book is full of suggestions from other women who have “been there” and
who offer their advice on what works and what doesn’t in the recovery
process.
The book is
geared toward anyone who has been diagnosed with breast cancer and is
contemplating mastectomy with or without breast reconstruction—in addition to
those with a hereditary predisposition to breast cancer who may be
contemplating prophylactic mastectomy. Reconstruction, she emphasized, should
be a personal choice.
“Sometimes I hear
people say that women need breast reconstruction after a mastectomy in order to
feel “whole again” and that bothers me a little bit,” Baker said—explaining
that it was her personal decision to reconstruct. She does not like to think of
a particular part of the body as defining the “wholeness” of a person or a
woman.
With her
co-authors, who are her sisters (nurses themselves), she covers other topics
including range of motion exercises, post-surgical drain care, lymphedema
prevention, breast prostheses, and what to look for in terms of complications
with healing, wound management, scar massage, emotional recovery, and
more.
Baker also wants
readers to know that mastectomy is not what it used to be. “Techniques for
breast reconstruction have come a long way in recent years and options are
available,” she said.
“And many women
don’t know that there is a federal law called the Women’s Health and Cancer
Rights Act that requires group health insurers that cover mastectomy to also
cover breast reconstruction, breast prostheses, and treatment for physical
complications like lymphedema that may result from mastectomy.”
This
comprehensive book not only benefits those looking for information: portions of
the proceeds will go to two breast cancer support organizations that have been
“near and dear” to Baker: Support Connection in Yorktown
and FORCE (Facing Our Risk of Cancer Empowered) a
national hereditary cancer support organization.
Baker said she is
happy to share all that she has learned. “I feel fortunate that I had access to
really great physicians who were doing cutting edge work in the areas of
mastectomy and breast reconstruction.”
January
19, 2012
Health
Calendar - Santa Maria Times –
Lymphedema Prevention Exercise Class: 9 a.m. Tuesdays, Marian Health
and Wellness Center, 1207 E. Main St., Santa Maria. This is a fun, therapeutic
program for cancer survivors and others with chronic conditions of all ages and
fitness levels to increase range of motion and reduce the risk of lymphedema.
Info and to make a reservation: 739-3780.
January
20, 2012
Health Matters:
Flying with a medical condition - WZVN-TV –
FORT MYERS, FL -
Every year is a victory for
breast cancer survivor Carol Thisted.
"I just turned 71 and I'm so
happy I had another birthday."
She enjoys life, family and
traveling despite suffering from lymphedema. An after effect from her cancer
surgery, the removal of lymph nodes led to chronic fluid retention and
swelling. It first appeared after a flight last year.
"I went on vacation in
August and flew in an airplane and came home and I said to my doctor ‘my ankles
are rather swollen and my arm is a little swollen too'," says
Thisted.
Carol manages her condition
with daily wraps and compression garments, something she has to consider when
taking flight. Health conditions can spike at 30,000 feet.
"The pressures when you're
flying are less, atmospheric pressure is less so you tend to swell more when
you're flying," says Jackie Speas, a lymphedema therapist with Lee Memorial
Health System.
"I'd be sure to wear my arm
compression stocking and I would probably even wear some compression socks on
my ankles and my feet cause they do swell also," says Thisted.
People with vascular
conditions also need to consider their medical condition, especially when you
consider sitting in cramped quarters for long stretches of time.
"I'm on blood thinners
because of blood clots and we want to avoid those so when I fly I make sure
that I have a layover to get off of the plane after two or three hours," says
Pamela Cupp, a frequent flyer.
Travelers who take long
flights, more than four hours, face a two to three fold risk of developing a
clot. So it's important to move around even in a tight space.
"You have the change of
getting blood clots because of lack of circulation. So you do want to move your
legs and pump your ankles up and down, so you get that blood flow back up,"
says Heather Parker, an exercise specialist with Lee Memorial Health
System.
Before
any trip, confer with your doctor about any medical conditions, because keeping
up with your health doesn't take a vacation.
January
21, 2012
Trainer helps
cancer patients regain strength and fitness
- Staunton News Leader – by Maria
Longley
FISHERSVILLE — For many cancer patients who've had chemotherapy, radiation
therapy or surgery, starting or resuming an exercise routine can seem
daunting.
Muscles might have
atrophied during recovery. Respiratory and circulatory systems may have been
weakened. Fatigue and pain drain energy.
Brian Lacy, a
personal trainer at Augusta Health's Lifetime Fitness Center, hopes to help
cancer patients and survivors make a fitness comeback. Lacy recently completed
a new certification in cancer exercise training to address the specific
challenges faced by people whose bodies have been through the wringer while
fighting the disease.
Lacy studied
information on 25 different types of cancer, their surgeries and treatments,
breast reconstruction, upper and lower body lymphedema prevention, cancer pain
and fatigue and other topics.
After patients get
their doctors' OK to begin an exercise regimen, Lacy assesses clients and comes
up with a plan that safely meets their goals, such as building strength,
increasing flexibility and range of motion and even raising their tolerance of
cancer treatments.
"Someone who has
lost a lot of their body weight would benefit from some resistance training,"
he said.
Cancer patients
face some unique difficulties when it comes to exercising safely. For example,
one of the common symptoms of chemotherapy is nausea and
dizziness.
"If a client has
those symptoms, then we would stay away from exercises that challenge balance,"
he said.
Cancer survivors
also are more at risk of developing heart disease and diabetes, which makes
getting fit all the more important, Lacy said. Lacy would like to set up a
group exercise program at Augusta Health's cancer center that would create a
group exercise program for patients.
Doctors often
recommend exercise as a way to reduce symptoms, maintain muscle tone and
strength and improve mental state, said Meg Shrader, a registered nurse whose
job at Augusta Health is to help cancer patients navigate through the treatment
process.
Shrader has been
in remission from breast cancer for six years, so she knows personally how
cancer and treatment of the disease can ravage the body.
Two years ago,
Shrader began working with Lacy after realizing on a business trip how badly
she needed to strengthen her upper body.
She boarded a
plane bound for a conference she was going to attend and couldn't lift her
suitcase into the overhead compartment. "It was an 'aha' moment," she said. "As
far as cardiovascular fitness, I was good. But I felt I was too young to have
such a weak upper body and decided to do something about it."
Like many women,
Shrader didn't have great upper body strength to begin with and didn't worry
about it. But two mastectomies and breast reconstruction surgery helped weaken
the muscles in her chest, she said. Lacy worked with Shrader's occupational
therapist to devise an exercise regimen that would strengthen her muscles, but
that wouldn't exacerbate the swelling in her arms, or lymphedema, set off by
her cancer surgeries. Lymphedema happens when the lymph system is damaged or
blocked, leading to swelling, commonly in the arms and legs, from fluid
build-up in the soft tissues.
Shrader said
Lacy's new training is a tremendous resource at Lifetime Fitness, a facility
that offers an environment geared toward people with specific medical problems,
as well as those who just want to maintain their health. The Medical Fitness
Association named Lifetime Fitness center of the year in 2011 for earning a
perfect score during its certification process.
"It's been a very
rewarding," said Lacy, who's worked at the fitness center five years. "When I
hear a client say to me, 'I went on vacation and was able to play with his
grandkids instead of lying in a hotel room,' it doesn't get better than
that."
Shrader says at 51
she's in the best shape of her life, thanks to Lacy's training.
"I flew to a
conference in December, and I shoved that bag right up there," she
said.
January 22,
2012
Solid reputation helps therapy firm
grow - Detroit Free Press – By Patricia Anstett –
When Linda Gibbs
and her partner Kimberly Turner opened their Advanced Physical Therapy Center
in Grand Blanc 20 years ago, they were the only independent physical therapy
clinic around for miles and one of the few run by women.
"We took a
chance," Gibbs said, explaining how most physical therapy businesses were run
by large hospital systems and doctor groups.
"I told myself
that together, if we could do the best therapy with patients, we'll get results
and doctors will send patients to us," she said. "That's exactly what
happened."
By building a
solid reputation among patients and doctors for their work treating low back
and neck pain, Advanced Physical Therapy has grown from one to seven locations
and from three to 130 employees. The company is not affiliated with a Wayne
County physical therapy firm that has a nearly identical name.
Gibbs and Turner
opened two more clinics in Davison about 13 months ago, then another in
Clarkston in November, their first Oakland County site.
The company
specializes in low-back and neck pain, Gibbs said. "We get a lot of orthopedics
problems, shoulders, knees and necks," said therapist Heather
Schoen.
But over the years
the company added a heated pool and aquatics therapy at its Grand Blanc site,
and it has expanded its services and technologies to a range of noninvasive
therapies.
"Women drive 50
miles just for treatment," said Gibbs, citing one program popular with breast
cancer patients who develop lymphedema, a painful, chronic arm swelling that
occurs after surgery.
At the Clarkston
site, Schoen is building programs that cater to women, including a class for
new moms and programs for women with uterine prolapse, pelvic pain, pain during
intercourse and incontinence. "These are life-changing problems," Schoen said.
"Many of the women are in their 20s."
Schoen uses
trigger-point release, which applies pressure to tightened muscles, to relax
the pelvis and tension spots. The therapy "only takes a couple sessions and
people notice a huge result" that is sometimes permanent, she
said.
Others like Tony
Nahas of Davisburg, come after surgery, when pain doesn't go away.
Nahas, who had
shoulder surgery in November, was exercising recently at the company's
Clarkston facility to correct some imbalance and posture issues that his doctor
and Schoen thought were causing the shoulder pain that still keeps him awake at
night.
The company offers
free physical therapy evaluations by appointment though patients need a
doctor's prescription for physical therapy.
Gibbs continues to
look for therapies that prove effective. Her staff this month will be trained
to perform the Graston Technique, another type of trigger-point release that
uses metal instruments in the therapy. "It's very gentle actually," Gibbs said,
and is growing in demand from doctors.
Gibbs said the
demand for noninvasive therapies should continue to boost the need for therapy
in the future.
"Patients get
better with therapy," she said. "It works."
Contact Patricia
Anstett: 313-222-5021 or [email protected]
More Details:
Advanced Physical Therapy Center
Founded: 1991, Grand Blanc
Employees: 130
Locations: Seven sites in Flint area as well as a new clinic in Clarkston at
5625 Water Tower Place.
Hours in
Clarkston:
7 a.m.-4 p.m. weekdays. Offers a range of physical therapy services from back
to pelvic pain.
Contact: Phone: 248-620-4260. Web address: www.advanced physical therapy
.com
KEYWORDNEWS
DOCS:
January 7, 2012
Prospective
surveillance model can reduce treatment costs for breast cancer-related
lymphedema - News-Medical-Net –
Model
associated with significant cost savings
Early
diagnosis and treatment of breast cancer-related lymphedema by a physical
therapist can significantly reduce costs and the need for intensive
rehabilitation, according to an article published in the January issue of
Physical
Therapy (PTJ), the scientific journal of the American Physical
Therapy Association (APTA).
The
study, led by APTA member and spokesperson Nicole Stout, PT, MPT, CLT-LANA,
compared a prospective surveillance model with a traditional model of
impairment-based care and examined the direct treatment costs associated with
each program. Treatment and supply costs were estimated based on the Medicare
2009 physician fee schedule. Researchers estimated that treatment for breast cancer-related lymphedema costs
$636.19 a year when the prospective surveillance model was used vs $3,124.92
for traditional treatment of advanced lymphedema.
The
goal of a prospective surveillance model for cancer rehabilitation is to
identify impairment at the earliest onset to alleviate impairment or prevent it
from progressing. Soon after diagnosis, a physical therapist will perform a
preoperative examination to establish a baseline level of function. Follow-up
examinations are then conducted postoperatively at 1 month and then 3-month
intervals, for up to 1 year. In contrast, a traditional model focuses on
treating lymphedema once it has progressed and patients already have functional
limitations.
"This
study begins to paint a picture of evidence showing that prevention of chronic
conditions such as lymphedema-using rehabilitation models of care-may result in
significant cost savings," said Stout.
Source:
American Physical Therapy
Association
January 20,
2012
Health Matters:
Flying with a medical condition - NBC
2 Fort Myers –
FORT MYERS, FL -
Every year is a victory for
breast cancer survivor Carol Thisted.
"I just turned 71 and I'm so
happy I had another birthday."
She enjoys life, family and
traveling despite suffering from lymphedema. An after effect from her cancer
surgery, the removal of lymph nodes led to chronic fluid retention and
swelling. It first appeared after a flight last year.
"I went on vacation in
August and flew in an airplane and came home and I said to my doctor ‘my ankles
are rather swollen and my arm is a little swollen too'," says
Thisted.
Carol manages her condition
with daily wraps and compression garments, something she has to consider when
taking flight. Health conditions can spike at 30,000 feet.
"The pressures when you're
flying are less, atmospheric pressure is less so you tend to swell more when
you're flying," says Jackie Speas, a lymphedema therapist with Lee Memorial
Health System.
"I'd be sure to wear my arm
compression stocking and I would probably even wear some compression socks on
my ankles and my feet cause they do swell also," says Thisted.
People with vascular
conditions also need to consider their medical condition, especially when you
consider sitting in cramped quarters for long stretches of time.
"I'm on blood thinners
because of blood clots and we want to avoid those so when I fly I make sure
that I have a layover to get off of the plane after two or three hours," says
Pamela Cupp, a frequent flyer.
Travelers who take long
flights, more than four hours, face a two to three fold risk of developing a
clot. So it's important to move around even in a tight space.
"You have the change of
getting blood clots because of lack of circulation. So you do want to move your
legs and pump your ankles up and down, so you get that blood flow back up,"
says Heather Parker, an exercise specialist with Lee Memorial Health
System.
Before
any trip, confer with your doctor about any medical conditions, because keeping
up with your health doesn't take a vacation.
PUB MED DOCS:
January 3, 2012
J Mal Vasc. 2011 Dec 21. [Epub
ahead of print]
[Designing
a therapeutic education program for patients with lymphedema: Live with
lymphedema.]
[Article
in French]
Blaise S, Villemur B, Richaud C, Rastel D, Bucci B, Evra V, Bouchet JY; les membres du réseau GRANTED,
Satger B.
Source
Department of
Vascular Medicine, clinique de médecine vasculaire, Grenoble University
Hospital, BP 217, 38043 Grenoble cedex 09, France; Réseau GRANTED, 38400
Saint-Martin-d'Hères, France.
Abstract
BACKGROUND:
Lymphedema is a
chronic condition considered to be rare in its primary form and potentially
frequent in women after breast surgery for cancer: 27,000new cases annually.
Therapeutic management is a serious challenge. In France, the health
authorities (Haute Autorité de santé [HAS]) have recently proposed that
appropriate management practices for lymphedema include "patient education".
The HAS and the National institute for health care prevention and education
also published a methodology guide devoted to structuring a therapeutic
education program for patients with chronic disease. Current hospital
regulations state that this education program is part of the care to be
delivered to patients with chronic disease and that it must comply with the
national directives. The purpose of our present work was to present the concept
and the contents of a patient education program entitled "Live with lymphedema"
designed for patients with lymphedema and developed within the
inpatient-outpatient network GRANTED in Sud-Isère.
METHODS:
A standard
detailed educative approach was applied. It was designed after the educational
program for patients with lower limb arterial occlusive disease authorized by
the Rhône-Alpes regional health agency. It was adapted to the specific
problematic of patients with lymphedema, including medical management,
rehabilitation, dermatology and nutritional aspects. It was developed in
cooperation with patients and favors local associative actions.
RESULTS:
The specifically
structured program included three therapeutic education consultations and five
workshops. Less than one year after its institution, more than 30 patients have
participated in the program.
DISCUSSION:
We report a
structured patient education program designed for patients with lymphedema.
This program was authorized by the Rhône-Alpes regional health agency in March
2011and is in compliance with the national directives and HAS
guidelines.
Copyright © 2011
Elsevier Masson SAS. All rights reserved.
PMID:
22196687 [PubMed - as supplied by publisher]
January 9, 2012
J Cutan Pathol. 2012
Jan;39(1):52-5. doi: 10.1111/j.1600-0560.2011.01785.x.
Lymphangiosarcoma
arising after 33 years within a background of chronic filariasis: a case report
with review of literature.
Krishnamoorthy N, Viswanathan S, Rekhi B, Jambhekar NA.
Source
Department of
Pathology, Tata Memorial Hospital, Mumbai, India.
Abstract
Cutaneous
angiosarcoma or lymphangiosarcoma represents an uncommon aggressive tumor known
to arise on a background of chronic lymphedema secondary to various etiologies,
principally following surgery or irradiation. There have been rarely reported
cases of angiosarcoma following infective conditions that eventuate with
lymphatic stasis. We report a case of angiosarcoma arising after 33 years
within a background of filariasis. Awareness of this association can lead to
early diagnosis and appropriate treatment of this potentially fatal malignant
tumor. Krishnamoorthy N, Viswanathan S, Rekhi B, Jambhekar NA.
Lymphangiosarcoma arising after 33 years within a background of chronic
filariasis: a case report with review of literature.
Copyright © 2011
John Wiley & Sons A/S.
PMID:
22211335 [PubMed - in process]
Med Oncol. 2011 Dec;28 Suppl
1:22-30. Epub 2010 Sep 9.
Whether
drainage should be used after surgery for breast cancer? A systematic review of
randomized controlled trials.
He XD, Guo ZH, Tian JH, Yang KH, Xie XD.
Source
Evidence Based
Medicine Center, School of Basic Medical Sciences, Lanzhou University, No. 199
Donggang West Road, Lanzhou, Gansu, 730000, China,
[email protected].
Abstract
A systematic
review of randomized controlled trials (RCTs) was conducted to evaluate whether
patients benefit from the suction drainage after axillary lymph node dissection
(ALND) in breast cancer surgery. RCTs of drainage versus no drainage after ALND
in women with breast cancer were retrieved from PubMed, EMBASE, Cochrane
Library and Chinese Biomedical database. Two authors independently assessed the
quality of included trials and extracted data. Odds ratio (OR) for dichotomous
outcomes and mean difference (MD) for continuous outcomes were presented with
95% confidence intervals (CI). A total of 1115 titles were indentified from the
databases; 1109 obvious irrelevant studies were excluded by examining the
titles, abstracts, full texts because of duplicates, no RCT, different modality
of drainage, drain for lymphedema, application of fibrin sealant and so on. And
then, only 6 RCTs to compare drainage with no drainage after ALND in breast
cancer surgery were included in the systematic review and a total of 585
patients were included in the pathological diagnosis of breast cancer in women
before surgery, management by ALND with or without addition surgical
procedures. The study demonstrated that insertion of a drain in the axilla
after breast cancer surgery resulted in a statistically significant reduction
in the rate of seroma (OR = 0.36, 95% CI, 0.16 to 0.81, P = 0.01), the volume
of aspiration (MD = -100.10, 95% CI, -174.36 to -25.85, P = 0.008), or the
frequency of seroma aspiration (MD = -1.03, 95% CI, -1.35 to -0.71, P <
0.00001), but prolonged the length of hospital stay (MD = 1.52, 95% CI, 0.36 to
2.68, P = 0.01). There was no statistically significant difference in the
incidence of wound infection (OR = 0.67, 95% CI, 0.34 to 1.32, P = 0.25)
between drainage group and no drainage group. Based on the current evidence,
insertion of a drain in the axilla following ALND in breast cancer surgery
effectively decreased seroma formation, volume of aspiration as well as the
frequency of seroma aspiration without increasing the incidence of wound
infection, but extending their stay in hospital.
PMID:
20827578 [PubMed - in process]
J Vasc Surg. 2011 Dec 29. [Epub
ahead of print]
Technique,
results, and postoperative patency of lymphaticovenous side-to-end anastomosis
in peripheral lymphedema.
Maegawa J, Yabuki Y, Tomoeda H, Hosono M, Yasumura K.
Source
Department of
Plastic and Reconstructive Surgery, Yokohama City University Hospital,
Yokohama, Japan.
Abstract
OBJECTIVE:
Lymphaticovenous
anastomosis has been used for patients with peripheral lymphedema. However, the
efficacy of this procedure is controversial due to a lack of evidence regarding
postoperative patency. We sought to determine midterm postoperative patency of
lymphaticovenous side-to-end anastomoses (LVSEAs) using indocyanine green
fluorescence lymphography.
METHODS:
This was a
retrospective observational study set in a teaching hospital. Of 107 patients
with chronic lymphedema who underwent 472 LVSEAs, 57 (223 anastomoses)
consented to fluorescence lymphography and comprised the study cohort. The
intervention consisted of a microsurgical LVSEA performed with a suture-stent
method. Patients also had preoperative and postoperative complex decongestive
physiotherapy. Anastomosis patency was assessed using indocyanine green
fluorescence lymphography ≥6 months after surgery. Patency rates were
calculated using Kaplan-Meier analysis. We assessed volume reduction on the
operated-on limb and compared this between patients in whom anastomoses were
patent and those in whom anastomoses were not obviously patent.
RESULTS:
Patency could be
evaluated only at the dorsum of the foot, ankle, and lower leg because the
near-infrared rays emitted by the special camera used could not penetrate the
deep subcutaneous layer containing collective lymphatics in areas such as the
thigh. Several patterns were observed on fluorescence lymphography: straight,
radial, and L-shaped. Cumulative patency rates of LVSEAs were 75% at 12 months
and 36% at 24 months after surgery. No significant difference in volume change
of the affected limb was seen between the 34 patients with patent anastomosis
(600 ± 969 mL) and the 24 patients without obvious evidence of patency (420 ±
874 mL).
CONCLUSIONS:
Although further
study is required to determine factors leading to anastomotic obstruction and
to optimize the results of microlymphatic surgery, the present LVSEA technique
appears promising.
Copyright © 2011
Society for Vascular Surgery. Published by Mosby, Inc. All rights
reserved.
PMID:
22209609 [PubMed - as supplied by publisher]
Case Rep Dermatol. 2011
Sep;3(3):251-8. Epub 2011 Nov 30.
A
case of yellow nail syndrome with dramatically improved nail discoloration by
oral clarithromycin.
Suzuki M, Yoshizawa A, Sugiyama H, Ichimura Y, Morita A, Takasaki J, Naka G, Hirano S, Izumi S, Takeda Y, Hoji M, Kobayashi N, Kudo K.
Source
Department of
Respiratory Medicine, National Center for Global Health and Medicine,
Infection, Oncology, Nippon Medical School, Tokyo.
Abstract
An 80-year-old
woman was admitted to our hospital with pneumonia and exacerbation of
sinobronchial syndrome (SBS). She presented with yellow discoloration of the
nail beds of all fingers and toes, and her nails were recognized as growing
slowly. Chest X-ray revealed bronchiectasis in the bilateral lower lobe and
bilateral pleural effusion. We diagnosed her as having yellow nail syndrome
(YNS), based on the triad of yellow nails, lymphedema, and lung disease. After
treatment with antibiotics [ampicillin/sulbactam and clarithromycin (CAM)] for
pneumonia and SBS, her general condition improved, and the yellow nails
disappeared in some fingers. When she was previously treated with 200 mg CAM
for SBS, her yellow nails had not shown improvement. This time, her yellow
nails improved after treatment with 400 mg CAM. The literature reports vitamin
E, zinc, and topical corticosteroid plus active vitamin D3 to be effective in
the treatment of yellow nails. Two studies have reported treatment for YNS
using CAM, though they found a lack of efficacy. Thus, the present case is the
first to report improved yellow nails using CAM alone. We conclude that not
only SBS and lung disease but also YNS were improved by treatment with 400 mg
CAM.
PMID:
22220146 [PubMed - in process] PMCID: PMC3250669
BMC Cancer. 2012 Jan 4;12(1):6.
[Epub ahead of print]
Systematic
review: conservative treatments for secondary lymphedema.
Oremus M, Dayes I, Walker K, Raina P.
Abstract
ABSTRACT:
BACKGROUND:
Several
conservative (i.e., nonpharmacologic, nonsurgical) treatments exist for
secondary lymphedema. The optimal treatment is unknown. We examined the
effectiveness of conservative treatments for secondary lymphedema, as well as
harms related to these treatments.
METHODS:
We searched
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, AMED, and
CINAHL from 1990 to January 19, 2010. We obtained English- and
non-English-language randomized controlled trials or observational studies
(with comparison groups) that reported primary effectiveness data on
conservative treatments for secondary lymphedema. For English-language studies,
we extracted data in tabular form and summarized the tables descriptively. For
non-English-language studies, we summarized the results descriptively and
discussed similarities with the English-language studies.
RESULTS:
Thirty-six
English-language and eight non-English-language studies were included in the
review. Most of these studies involved upper-limb lymphedema secondary to
breast cancer. Despite lymphedema's chronicity, lengths of follow-up in most
studies were under six months. Many trial reports contained inadequate
descriptions of randomization, blinding, and methods to assess harms. Most
observational studies did not control for confounding. Many studies showed that
active treatments reduced the size of lymphatic limbs, although extensive
between-study heterogeneity in areas such as treatment comparisons and
protocols, and outcome measures, prevented us from assessing whether any one
treatment was superior. This heterogeneity also precluded us from statistically
pooling results. Harms were rare (<1% incidence) and mostly minor (e.g.,
headache, arm pain).
CONCLUSIONS:
The literature
contains no evidence to suggest the most effective treatment for secondary
lymphedema. Harms are few and unlikely to cause major clinical
problems.
PMID:
22216837 [PubMed - as supplied by publisher]
January
15, 2012
J Rehabil Res Dev.
2011;48(10):1261-8.
Effect
of home-based exercise program on lymphedema and quality of life in female
postmastectomy patients: Pre-post intervention study.
Gautam AP, Maiya AG, Vidyasagar MS.
Source
Department of
Physiotherapy, Manipal College of Allied Health Sciences, Manipal University,
Manipal-576104, Karnataka, India. Email: [email protected].
[email protected].
Abstract
Lymphedema is a
debilitating complication following mastectomy, affecting the arm functions and
quality of life (QOL) of breast cancer patients. Studies have shown the
beneficial effects of upper-limb exercises on lymphedema in clinical set tings.
However, there is a dearth of evidence regarding the effect of home-based
exercises on lymphedema; therefore, we examined the effect of a home-based
exercise program on lymphedema and QOL in postmastectomy patients. Thirty-two
female postmastectomy lymphedema patients participated in an individualized
home-based exercise program for 8 weeks. Arm circumference, arm volume, and QOL
(36-Item Short Form Health Survey) were measured before and after the program.
Data were analyzed with the use of paired t-tests for circumferential and
volumetric measures and Wilcoxon signed ranks tests for QOL. Significance level
was set at p < 0.01 with Bonferroni correction (alpha/n = 0.05/5 = 0.01).
Analysis showed a statistically significant improvement in the affected
upper-limb circumference and volume (~122 mL reduction, p < 0.001) and in
the QOL scores (p < 0.001) at the end of the home-based exercise program.
The individualized home-based exercise program led to improvement in affected
upper-limb volume and circumference and QOL of postmastectomy lymphedema
patients.
PMID:
22234669 [PubMed - in process]
Ann Surg. 2012 Jan 9. [Epub
ahead of print]
Microvascular
Breast Reconstruction and Lymph Node Transfer for Postmastectomy Lymphedema
Patients.
Saaristo AM, Niemi TS, Viitanen TP, Tervala TV, Hartiala P, Suominen EA.
Source
From the
Department of Plastic Surgery, Turku University Central Hospital, Turku,
Finland.
Abstract
OBJECTIVE:
Postoperative
lymphedema after breast cancer surgery is a challenging problem. Recently, a
novel microvascular lymph node transfer technique provided a fresh hope for
patients with lymphedema. We aimed to combine this new method with the standard
breast reconstruction.
METHODS:
During 2008-2010,
we performed free lower abdominal flap breast reconstruction in 87 patients.
For all patients with lymphedema symptoms (n = 9), we used a modified lower
abdominal reconstruction flap containing lymph nodes and lymphatic vessels
surrounding the superficial circumflex vessel pedicle. Operation time, donor
site morbidity, and postoperative recovery between the 2 groups (lymphedema
breast reconstruction and breast reconstruction) were compared. The effect on
the postoperative lymphatic vessel function was examined.
RESULTS:
The average
operation time was 426 minutes in the lymphedema breast reconstruction group
and 391 minutes in the breast reconstruction group. The postoperative abdominal
seroma formation was increased in patients with lymphedema. Postoperative
lymphoscintigraphy demonstrated at least some improvement in lymphatic vessel
function in 5 of 6 patients with lymphedema. The upper limb perimeter decreased
in 7 of 9 patients. Physiotherapy and compression was no longer needed in 3 of
9 patients. Importantly, we found that human lymph nodes express high levels of
endogenous lymphatic vessel growth factors. Transfer of the lymph nodes and the
resulting endogenous growth factor expression may thereby induce the regrowth
of lymphatic network in the axilla. No edema problems were detected in the
lymph node donor area.
CONCLUSION:
Simultaneous
breast and lymphatic reconstruction is an ideal option for patients who suffer
from lymphedema after mastectomy and axillary dissection.
PMID:
22233832 [PubMed - as supplied by publisher]
Int Angiol. 2011
Dec;30(6):527-33.
Dose
finding for an optimal compression pressure to reduce chronic edema of the
extremities.
Partsch H, Damstra RJ, Mosti G.
Source
Private
Practictioner, Vienna, Austria - [email protected].
Abstract
AIM:
The optimal
pressure to reduce chronic extremity swelling is still a matter of debate. The
aim of this paper was to measure volume reduction of a swollen extremity
depending on the amount of pressure exerted by compression stockings and
inelastic bandages.
METHODS:
Thirty-six
patients with unilateral breast cancer related arm lymphedema were investigated
in a lymph clinic in the Netherlands, 42 legs with chronic edema of the lower
extremities were examined in a phlebological centre in Italy. The arm-patients
were randomized to receive inelastic arm bandages with a pressure between 20-30
mmHg or 44-68 mmHg. The leg patients were either treated with compression
stockings (23-32 mmHg) or with inelastic bandages (pressure 53-88 mmHg).
Water-displacement volumetry and measurement of leg circumference was performed
before and after compression.
RESULTS:
In the
arm-patients low pressure after 2 hours achieved a higher degree of volume
reduction (-2.3%, 95% CI 1.0-3.6) than high pressure (-1.5%, 95% CI 0.2-2.8)
(n.s.). In patients with leg edema compression stockings in the range between
20 and 40 mmHg showed a positive correlation between exerted pressure and
volume reduction, bandages applied with an initial resting pressure of more
than 60 mm Hg resulted in a decreasing volume reduction.
CONCLUSION:
There is
obviously an upper limit beyond which further increase of compression pressure
seems counterproductive. For inelastic bandages this upper limit is around 30
Hg on the upper and around 50-60 mmHg on the lower extremity.
PMID:
22233613 [PubMed - in process]
Int Angiol. 2011
Dec;30(6):499-503.
The
lymphovenous microsurgical shunts for treatment of lymphedema of lower limbs:
indications in 2011.
Olszewski WL.
Source
Department of
Surgical Research and Transplantology, Medical Research Center, Polish Academy
of Sciences, Warsaw, Poland - [email protected].
Abstract
The microsurgical
lympho-venous shunts have become one of the generally accepted modalities in
treatment of limb lymphedema. This review highlight the indications for this
procedure after over 40 years. This study was based on the personal experience
of one surgeon and on the review of the literature. Patients with
postinflammatory, postsurgical, idiopathic and hyperplastic lymphedema of lower
limbs were included in the study. Basing on the review of results of the last
40 years the contemporary indications are: 1) lymphedema with local segmental
obstruction but still partly patent distal lymphatics seen on functional
lymphoscintigraphy (standard walking or pneumatic compression) and without an
active inflammatory process in the skin, subcutaneous tissue and lymph vessels
(DLA-dermatolymphangioadenitis); 2) classified according the etiology of
lymphedema, this operation can bring about satisfactory results in cases of
hyperplastic, postsurgical and postinflammatory types of lymphedema, whereas
primary idiopathic lymphedema of non-genetic type should be treated with
conservative means, although in a small number of cases an improvement was
observed after lympho-venous shunting as long as 10 years. Microsurgical lymph
node or lymphatic vessel to vein shunts have their established position among
the therapy modalities for lymphedema of lower limbs in a strictly defined
group of patients using lymphoscintigraphic imaging.
PMID:
22233610 [PubMed - in process]
J Obstet Gynaecol Res. 2012 Jan
10. doi: 10.1111/j.1447-0756.2011.01727.x. [Epub ahead of print]
Re-consideration
of lymphadenectomy for stage Ib1 cervical cancer.
Kato H, Todo Y, Suzuki Y, Ohba Y, Minobe SI, Okamoto K, Yamashiro K, Sakuragi N.
Source
Divisions of
Gynecologic Oncology Pathology, National Hospital Organization, Hokkaido Cancer
Center, Department of Obstetrics and Gynaecology, Hokkaido University School of
Medicine, Sapporo, Japan.
Abstract
Aim: Because of
less frequent lymph node metastasis and parametrial involvement, patients with
stage Ib1 cervical cancer may benefit from a curtailment of surgery. We
retrospectively investigated the distribution of lymph node metastasis in stage
Ib1 patients. After comparing the data with that of higher stages and sentinel
lymph node navigation (SLNN), the appropriate extent of lymphadenectomy (LA) in
stage Ib1 disease was newly suggested. Method: A total of 303 patients
underwent a radical hysterectomy with LA and the region-specific rate of node
metastasis was obtained. SLNN was performed for 50 patients using (99m) Tc
phytate injection into the cervix and intra-operative detection by a
gamma-probe. Results: The rate of node metastasis and the average number of
nodes removed, respectively, were: 23/189 (12.2%), 65.2 in stage Ib1; 14/47
(29.8%), 70.1 in stage Ib2; 7/20 (35.0%), 78.2 in stage IIa; and 26/47 (55.3%),
69.1 in stage IIb. Lymph node metastasis in stage Ib1 was prevalent in the
obturator (Ob) (9.5%), inter-iliac (Ii) (4.9%), superficial common iliac (Sc)
(2.3%), cardinal (Cd) (2.2%) and external iliac (Ei) (1.7%) nodes. In patients
with upper stage disease, lymph node metastasis could occur in all lymph nodes.
In stage Ib1 patients, the sentinel nodes were assigned only to the Ob, Ii, Sc
and Ei nodes, being identical with frequent metastatic sites in stage Ib1
(excluding Cd). Conclusion: The extent of LA can be routinely completed with
the removal of Ob, Ii, Ei, Sc and Cd nodes, which may provide a higher quality
of life, including the reduction of lymphedema by preventing the removal of the
inguinal nodes.
© 2012 The
Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of
Obstetrics and Gynecology.
PMID:
22229927 [PubMed - as supplied by publisher]
January
19, 2012
Br J Community Nurs. 2011 Oct;16
Suppl:S4-S12.
Use
of compression bandaging in managing chronic oedema.
Todd M.
Abstract
Compression
bandaging is a major component of most community nurses' practice in the
management of venous leg ulcers. For lymphoedema practitioners, compression
therapy is the linchpin in the management of chronic oedema and lymphoedema.
There are several types of compression bandage available, with some being part
of a recognized system of compression delivery. In order for nurses to select
and apply the correct type and level of compression bandaging, there needs to
be a substantial level of knowledge of the principles of compression theory and
competence in the application of bandaging. There are also issues surrounding
patient concordance, and nurses need to be able to assess and address any
barriers to concordance to ensure the most effective regimen of treatment is
delivered.
PMID:
22240574 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16
Suppl:S28-9.
An
interview with Karen Morgan.
Morgan K.
Abstract
Karen Morgan is
Lymphoedema Clinical Nurse Specialist, Abertawe Bro Morgannwg University Health
Board (ABMUHB) Lymphoedema
Health Board (ABMUHB)
Lymphoedema Clinic.
PMID: 22240571 [PubMed - in
process]
Br J Community Nurs. 2011 Oct;16
Suppl:S22-7.
An
integrative treatment for lower limb lymphoedema in India.
Bose KS, Aggithaya GM.
Abstract
Lymphoedema is a
chronic disease which requires frequent visits to therapist in developed
countries. In most developing countries, it is the disease of rural area caused
by lymphatic filariasis (LF). The aim is to develop a low cost home-based
self-care protocol using the combinations of locally available treatment
modalities. The integrated treatment has the elements of therapy from modern
dermatology, Ayurveda and yoga, administered by the doctors of respective
system of medicine on the basis of pathophysiological understanding in
lymphology. The sequence of treatment components that each patient followed is
skin wash, soaking the limb in herbal Phanta solution, care of bacterial entry
points, a set of yoga exercises, Indian manual lymph drainage and compression
bandaging. A total of 1209 limbs in 889 patients were treated using integrated
medicine during October 2004-May 2011. All patients received an initial 14 days
of supervised treatment and training for self-care and home-based treatment to
be continued for life. Patients followed up twice. Volume reduction for large
sized limbs at 3 months following treatment was 41.1%, with a confidence
interval (CI) of 5.7-6.9 litres. Reduction was 25.7 % for small limbs with a CI
of 1.5-1.7 litres. Entry points were present in 86.2% limbs at baseline and in
71.7% limbs at the end of 3 months. Inflammatory episodes reduced from
80%-8.6%.
PMID:
22240570 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16
Suppl:S20-1.
Lymphangioma
or lymphangiectasia? An update for lymphoedema nurses.
Pike C.
Abstract
This article is
prompted by a recent enquiry to the British Lymphology Society, expressing
uncertainty over the definition of lymphangioma. It may be prudent to publicize
information on this potentially confusing area more widely, as clinicians need
to know what lymphangioma is, or is not.
PMID:
22240569 [PubMed - in process]
Br J Community Nurs. 2011 Oct;16
Suppl:S14-9.
Non-concordance
in lymphorrhea of the lower limbs: a case study.
Jones J.
Abstract
Obesity and a
sedentary lifestyle are fast becoming major problems for not only the NHS as a
whole but also the lymphoedema therapist. Lymphorrhea in this group of patients
can be a recurrent problem, causing strain on already stretched services and on
the patient and their family. What happens when the ideas of the patient and
therapist regarding treatment are not the same? This article aims to address
these issues by looking at a case study of such a patient, and the surprising
outcome that resulted when the patient got his own way.
PMID:
22240568 [PubMed - in process]
January
22, 2012,
Br J Community Nurs. 2011 Oct;16
Suppl:S22-7.
An
integrative treatment for lower limb lymphoedema in India.
Bose KS, Aggithaya GM.
Abstract
Lymphoedema is a
chronic disease which requires frequent visits to therapist in developed
countries. In most developing countries, it is the disease of rural area caused
by lymphatic filariasis (LF). The aim is to develop a low cost home-based
self-care protocol using the combinations of locally available treatment
modalities. The integrated treatment has the elements of therapy from modern
dermatology, Ayurveda and yoga, administered by the doctors of respective
system of medicine on the basis of pathophysiological understanding in
lymphology. The sequence of treatment components that each patient followed is
skin wash, soaking the limb in herbal Phanta solution, care of bacterial entry
points, a set of yoga exercises, Indian manual lymph drainage and compression
bandaging. A total of 1209 limbs in 889 patients were treated using integrated
medicine during October 2004-May 2011. All patients received an initial 14 days
of supervised treatment and training for self-care and home-based treatment to
be continued for life. Patients followed up twice. Volume reduction for large
sized limbs at 3 months following treatment was 41.1%, with a confidence
interval (CI) of 5.7-6.9 litres. Reduction was 25.7 % for small limbs with a CI
of 1.5-1.7 litres. Entry points were present in 86.2% limbs at baseline and in
71.7% limbs at the end of 3 months. Inflammatory episodes reduced from
80%-8.6%.
PMID:
22240570 [PubMed - in process]
January
22, 2012
J Cancer Surviv. 2012 Jan 13.
[Epub ahead of print]
Community-based
exercise program effectiveness and safety for cancer survivors.
Rajotte EJ, Yi JC, Baker KS, Gregerson L, Leiserowitz A, Syrjala KL.
Source
Clinical Research
Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-220,
P.O. Box 19024, Seattle, WA, 98109, USA.
Abstract
PURPOSE:
Clinical trials
have demonstrated the benefits of exercise for cancer survivors. This
investigation determined the effectiveness and safety of a disseminated
community-based exercise program for cancer survivors who had completed
treatment.
METHODS:
Personal trainers
from regional YMCAs received training in cancer rehabilitation and supervised
twice-a-week, 12-week group exercise sessions for survivors. At baseline and
post-program, validated measures assessed patient-reported outcomes (PRO) and
physiologic measurements.
RESULTS:
Data were
collected from 221 survivors from 13 YMCA sites and 36 separate classes. All
participants had data available at one time point, while matched baseline and
post-program PRO and physiologic data were available for 85% (N = 187).
Participants with matched data were largely female (82%), with mean age of 58
(range, 28-91 years). Time since diagnosis ranged from 1 to 48 (mean, 5.6
years), and mean time since last treatment was 3.0 (range, 1-33 years).
Physiological improvements were significant in systolic (P < 0.001) and
diastolic (P = 0.035) blood pressure, upper and lower body strength, the 6-min
walk test (P = 0.004), and flexibility (P < 0.001). Participants reported
improvements in overall health-related quality of life (P < 0.001), social
support (P = 0.019), body pain (P = 0.016), fatigue (P < 0.001), insomnia
(P < 0.001), and overall musculoskeletal symptoms (P = <0.001). Few
injuries or lymphedema events occurred during classes.
CONCLUSIONS:
Community-based
exercise groups for cancer survivors of mixed diagnoses and ages, who have
completed active treatment, have physiologic and psychosocial benefits, and are
safe. IMPLICATIONS FOR CANCER SURVIVORS: Survivors may expect significant
benefit from participating in a community-based exercise program tailored to
meet their individual needs as a survivor.
PMID:
22246463 [PubMed - as supplied by publisher]
Hematol Oncol Clin North Am.
2012 Feb;26(1):169-94. Epub 2011 Dec 16.
Contemporary
quality of life issues affecting gynecologic cancer survivors.
Carter J, Penson R, Barakat R, Wenzel L.
Source
Gynecology
Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New
York, NY 10065, USA; Psychiatry and Behavioral Sciences, Memorial
Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Abstract
Regardless of
cancer origin or age of onset, the disease and its treatment can produce short-
and long-term sequelae (ie, sexual dysfunction, infertility, or lymphedema) that
adversely affect quality of life (QOL). This article outlines the primary
contemporary issues or concerns that may affect QOL and offers strategies to
offset or mitigate QOL disruption. These contemporary issues are identified
within the domains of sexual functioning, reproductive issues, lymphedema, and
the contribution of health-related QOL in influential gynecologic cancer
clinical trials.
Copyright © 2012
Elsevier Inc. All rights reserved.
PMID:
22244668 [PubMed - in process]
MEDNEWS
DOCS:
January
3, 2012
New Treatment Direction For Rare Metabolic
Diseases
A research team led by biochemist Scott Garman at the University of
Massachusetts Amherst has discovered a key interaction at the heart of a
promising new treatment for a rare childhood metabolic disorder known as Fabry
disease. The discovery will help understanding of other protein-folding
disorders such as Alzheimer's, Parkinson's and Huntington's diseases, as well.
Findings are featured as the cover story in the current issue of
Chemistry & Biology.
People born with Fabry disease
have a faulty copy of a single gene that codes for the alpha-galactosidase
(α-GAL) enzyme, one of the cell's "recycling" machines. When it performs
normally, α-GAL breaks down an oily lipid known as GB3 in the cell's recycling
center, or lysosome. But when it underperforms or fails, Fabry symptoms result.
Patients may survive to adulthood, but the disorder leads to toxic lipid
build-up in blood vessels and organs that compromise kidney function or lead to
heart disease, for
example.
The faulty gene causes its damage by producing a misfolded
protein, yielding an unstable, poorly functioning α-GAL enzyme. Like origami
papers, these proteins are unfolded to start and only become active when folded
into precise shapes. At present, enzyme replacement therapy (ERT) is the only
FDA-approved treatment for such lysosomal storage disorders as Fabry, Pompe and
Gaucher diseases, but ERT requires a complicated and expensive process to
purify and replace the damaged α-GAL enzyme, and it must be administered by a
physician.
Instead of replacing the damaged enzyme, an alternative route
called pharmacological chaperone (PC) therapy is currently in Phase III
clinical trials for Fabry disease. It relies on using smaller, "chaperone"
molecules to keep proteins on the right track toward proper folding, but their
biochemical mechanism is not well understood, says Garman.
Now, he and
colleagues report results of a thorough exploration at the atomic level of the
biochemical and biophysical basis of two small molecules for potentially
stabilizing the α-GAL enzyme. He says their use in PC therapy could one day be
far less expensive than the current standard, ERT, and can be taken
orally.
This work, which improves knowledge of a whole class of
molecular chaperones, represents the centerpiece of UMass Amherst student
Abigail Guce's doctoral thesis and was supported by the National Institutes of
Health. Other members of the team are graduate students Nat Clark and Jerome
Rogich.
"The interactions we looked at are exactly the things occurring
in the clinical trial right now," Garman says. Further, "the same concept is
now being applied to other protein-folding diseases such as Parkinson's and Alzheimer's disease. Many
medical researchers are trying to keep proteins from misfolding by using small
chaperone molecules. Our studies have definitely advanced the understanding of
how to do that."
In their current paper, Garman and colleagues compare
the ability of two small chaperone molecules, galactose and
1-deoxygalactononjirimycin (DGJ) to stabilize the α-GAL protein, to help it
resist unfolding in different conditions such as high temperature and different
pH levels.
They found that each chaperone has very different affinities:
DGJ binds tightly and galactose binds loosely to the α-GAL, yet they differ in
only two atomic positions. "Tight is better, because you can use less drug for
treatment," Garman says. "We now can explain DGJ's high potency, its tight
binding, down to individual atoms."
In earlier studies as in the current
work, the UMass Amherst team used their special expertise in X-ray
crystallography to create three-dimensional images of all atoms in the protein
to understand how it carries out its metabolic mission. They also found a new
binding site for small molecules on human α-GAL that had never been observed
before.
Crystallography on the two chaperones bound to the α-GAL enzyme
showed that a single interaction between the enzyme and DGJ was responsible for
DGJ's high affinity for the enzyme. Other experiments also showed the ability
of the 11- and 12-atom chaperones to protect the large, 6,600-atom α-GAL from
unfolding and degradation.
For the first time, by making a single change
in one amino acid in protein, they forced the DGJ to bind weakly, indicating
that one atomic interaction is responsible for DGJ's high affinity.
"It
was surprising to find these two small molecules that look very much the same
have very different affinities for this enzyme," says Garman, "and we now
understand why. The iminosugar DGJ has high potency due to a single ionic
interaction with α-GAL. Overall, our studies show that this small molecule
keeps the enzyme from unfolding, or when it unfolds, the process happens more
slowly, all of which you need in treating disease."
The UMass Amherst
team plans to next use the principles, assays and experiments they developed
here on enzymes defective in other human diseases to examine new therapies for
them and related disorders.
JANUARY 9, 2012
Significant Cost Savings Associated With Emergence Of
Prospective Surveillance Model As Standard Of Care For Breast Cancer
Treatment
Early diagnosis and treatment of breast cancer-related lymphedema by a physical
therapist can significantly reduce costs and the need for intensive
rehabilitation, according to an article published in the January issue of
Physical Therapy (PTJ), the scientific journal of the American
Physical Therapy Association (APTA).
The study, led by APTA member and
spokesperson Nicole Stout, PT, MPT, CLT-LANA, compared a prospective
surveillance model with a traditional model of impairment-based care and
examined the direct treatment costs associated with each program. Treatment and
supply costs were estimated based on the Medicare 2009 physician fee
schedule. Researchers estimated that treatment for breast cancer-related
lymphedema costs $636.19 a year when the prospective surveillance model was
used vs $3,124.92 for traditional treatment of advanced lymphedema.
The
goal of a prospective surveillance model for cancer rehabilitation is to
identify impairment at the earliest onset to alleviate impairment or prevent it
from progressing. Soon after diagnosis, a physical therapist will perform a
preoperative examination to establish a baseline level of function. Follow-up
examinations are then conducted postoperatively at 1 month and then 3-month
intervals, for up to 1 year. In contrast, a traditional model focuses on
treating lymphedema once it has progressed and patients already have functional
limitations.
"This study begins to paint a picture of evidence showing
that prevention of chronic conditions such as lymphedema - using rehabilitation
models of care - may result in significant cost savings," said Stout.
Breast cancer-related lymphedema is characterized by abnormal swelling
of the arm and hand, which can be disfiguring. A chronic condition, it is
associated with decreased arm function, disability, and diminished quality of
life. If the condition is not diagnosed early and managed, a patient can be at
risk for infection and further shoulder complications.
In place for
more than 10 years, the prospective surveillance model was developed at the
National Naval Medical Center in Bethesda - now part of the Walter Reed
National Military Medical Center - and is the standard of care for all patients
diagnosed with breast cancer at the medical
center. Several research articles have been published demonstrating clinical
effectiveness of the prospective surveillance model in reducing lymphedema,
shoulder morbidity, and fatigue, including the February
2010 article in the journal Breast Cancer Research and
Treatment.
Although further analysis of indirect costs and utility
is necessary to fully assess cost effectiveness, the prospective surveillance
model is emerging as the standard of care for breast cancer
treatment.
January 15, 2012
New, Noninvasive Way To Identify Lymph Node
Metastasis
Using two cell surface markers found to be highly expressed in breast cancer lymph node
metastases, researchers at Moffitt Cancer Center, working with colleagues at
other institutions, have developed targeted, fluorescent molecular imaging
probes that can non-invasively detect breast cancer lymph node metastases. The
new procedure could spare breast cancer patients invasive and unreliable
sentinel lymph node (SLN) biopsies and surgery-associated negative side
effects.
Their study was published in a recent issue of Clinical
Cancer Research (18:1), a publication of the American Association for
Cancer Research.
"The majority of breast cancer patients, up to 74
percent, who undergo SLN biopsy are found to be negative for axillary nodal, or
ALN, metastases," said corresponding author David L. Morse, Ph.D., an associate
member at Moffitt whose research areas include experimental therapeutics and
diagnostic imaging. "Determining the presence or absence of ALN metastasis is
critical to breast cancer staging and prognosis. Because of the unreliability
of the SLN biopsy and its potential for adverse effects, a noninvasive, more
accurate method to assess lymph node involvement is needed."
The
authors note that the postoperative complications to the SLN biopsy can include
lymphedema, seroma formation,
sensory nerve injury and limitations in patient range of motion. In addition,
biopsies fail to identify disease in axillary lymph nodes in five to 10 percent
of patients.
In developing targeted molecular probes to identify breast
cancer in axillary lymph nodes, the research team from Moffitt, the University
of Arizona and University of Florida used two surface cell markers - CAIX and
CAXII. CAIX is a cell surface marker known to be "highly and broadly expressed
in breast cancer lymph node metastases" and absent in normal tissues.
CAIX and CAXII are both integral plasma membrane proteins with large
extracellular components that are accessible for binding of targeted imaging
probes, explained Morse. In addition, several studies have shown that CAIX
expression is associated with negative prognosis and resistance to chemo and
radiation therapy for breast cancer. CAXII is a protein expressed in over 75
percent of axillary lymph node metastases.
The researchers subsequently
developed their targeting agents by using monoclonal antibodies specific for
binding CAIX and CAXII, both of which are known to promote tumor growth.
According to the researchers, a number of noninvasive optical imaging
procedures for SLN evaluation have been investigated, but the approaches have
lacked the ability to target tumor metastasis biomarkers.
"These
methods provide only anatomic maps and do not detect tumor cells present in
lymph nodes," explained Morse. "Using mouse models of breast cancer metastasis
and a novel, monoclonal anti-body-based molecular imaging agents, we developed
a targeted, noninvasive method to detect ALN metastasis using fluorescence
imaging."
In addition to the imaging study with mice, the researchers
also reported that the combination of CAIX and CAXII covered 100 percent of
patient-donated samples used in their tissue microarray (TMA) study.
"The imaging probes detected tumor cells in ALNs with high sensitivity,"
explained Morse. "Either CAIX or CAXII were expressed in 100 percent of the
breast cancer lymph node metasatsis samples we surveyed in this study. These
imaging probes have potential for providing a noninvasive way to stage breast
cancer in the clinic without unneeded and costly surgery."
January 23, 2012
What Francis Collins doesn't know about "integrative
oncology" – ScienceBlogs –
I was
disturbed several months ago when I learned that the director of the National
Institutes of Health, Francis Collins, had agreed to be the keynote speaker at
the Eight International Society for Integrative Oncology
Conference in Cleveland, OH. I say "doubly" disturbed
because it disturbed me that Francis Collins would agree to speak at such a
function and, perhaps even more, because the host institution was Case Western Reserve University,
the institution where I both completed my surgery residency and my PhD in Physiology and Biophysics.
Sadly, it now appears that my old stomping grounds at University Hospitals has
been thoroughly infiltrated with quackademic medicine, as evidenced by this
clinical trial of reiki for psoriasis that's
making the rounds of news services and the offering of acupuncture, reiki, and even
reflexology at various UH facilities through the University Hospitals Connor Integrative Medicine
Network. Let me tell you, there was none of this
pseudoscience going on when I finished my residency there in 1996. Seeing it
there now provokes a reaction in me not unlike Sylvester Junior's reaction when
his father Sylvester embarrasses him, particularly when I noted that the
director of the CWRU Comprehensive Cancer Center, Dr. Stanton L. Gerson, was to
give one of the keynote talks, entitled, "The Future of Integrative
Oncology." (Hint for those of you not familiar with
classic Looney Tunes cartoons: A paper bag is involved.) I guess that by
expressing my extreme disappointment and embarrassment that the institution
where I learned to become a surgeon has during the last 15 years gone woo, I've
probably just killed any opportunity I might have to work at the Case Comprehensive Cancer Center
ever again. Oh, well, add it to the list, along with Beth Israel and my alma mater
the University of
Michigan.)
Back
when I first learned about it, I thought about blogging the meeting, but
without much concrete to go on, all I could do was to write a critical post about his decision to
accept the offer to be the keynote speaker at the Society for Integrative
Oncology (SIO). Then yesterday I saw popping up in my e-mail a notice from the
American Society of Clinical Oncology (ASCO), along with a link to a story in
its publication The ASCO Post entitled NIH Director Calls for Rigorous Evaluation of
Integrative Medicine to Provide Evidence of
Efficacy.
Et tu,
Dr. Collins?
Francis Collins "gets it" about as well as Josephine
Briggs
We here
at SBM have written frequently and copiously about the National Center for
Complemnatary and Alternative Medicine, a.k.a. NCCAM,
a.k.a. the Barad-dûr to SBM's Minas Tirith. OK, I exaggerate.
Just a bit. NCCAM director Josephine Briggs is a real scientist, and I have no
doubt that she wants to make NCCAM more scientifically rigorous than it has
been in the past. Unfortunately, NCCAM is a political, not a scientific,
construct, because CAM is an ideological, not a
scientific, construct. There is nothing tying together the disparate
"disciplines," treatments, and woo lumped together under the rubric of CAM/IM
other than that they either (1) have not been scientifically demonstrated to
have efficacy; (2) have been demonstrated not to have efficacy; or (3) are diet
and exercise or other interventions that should fall under the purview of SBM
but have been co-opted by CAM/IM believers along with the woo because they are
modalities that have proven health benefits and including them along with all
the pseudoscience makes the pseudoscience seem more plausible. It's not for
nothing that I frequently refer to diet, nutrition, and pharmacognosy as the
"Trojan horses" of CAM. These modalities have more than a modicum of
plausibility (although it should be pointed out that the way they are
represented by CAM often does not, vastly overselling the benefits or fusing
science-based recommendations with pseudoscience). "Energy healing,"
acupuncture, reiki, the vast majority of TCM, Ayurveda, and many other
modalities that fall under the CAM umbrella do not, and that is the
problem.
Unfortunately, it's quite obvious that Collins does not "get" this.
Although he changed the title of his talk from the original title of "Faith,
Spirituality and Science in Oncology," the actual talk he gave, entitled "Seeking Out the Most Effective Interventions for
Cancer Prevention and Treatment," still falls hook, line, and sinker for one of the favorite
arguments of CAM proponents, the argumentum ad populum (i.e., appeal
to popularity):
"Many new frontiers exist in integrative medicine," NIH Director
Francis Collins, MD, PhD, stated in his keynote address at the Eighth
International Conference of the Society for Integrative Oncology (SIO) in
Cleveland. "The evidence is overwhelming that these approaches are being used
by many individuals in the United States, including those with cancer," he
said. "For wellness, immune function, and pain-related symptoms, there is a
significant increase in interest among cancer survivors compared to other
people who use complementary and alternative medicine."
Survey
data show that over a lifetime, complementary and alternative medicine (CAM) is
used by "65% of cancer survivors vs 53% of noncancer respondents," he said.
When questioned about motivations to use CAM, cancer survivors "are more likely
to be using this because they are unhappy that medical treatments have not
helped them or because it has been recommended by the provider," he
noted.
As Steve Novella has pointed out,
the appeal to popularity is the most ubiquitous argument used in CAM
apologetics. In brief, it argues that, because CAM is
seemingly popular, there must be something to it and we should study it. If you
look at the figures, on the surface Collins' figures appear to be correct.
However, such figures are hugely inflated by inclusion of
things like massage, vitamins and supplements, yoga, and prayer. That's how
studies of tai chi in fibromyalgia, for instance, make it into the New England Journal of
Medicine labeled as "CAM" when in fact they are
merely studies that demonstrate that gentle exercise appears to be helpful in
alleviating fibromyalgia symptoms. As Steve also pointed out, most hard-core
CAM modalities are actually used by a very small percentage of the population,
with most falling in single digit percentages. For example, acupuncture use is
around 6.5%; Ayurveda, 0.6%; chelation therapy, 0.3%; energy healing, 1.7%;
naturopathy, 1.5%; and homeopathy, 3.7%. These are hardly impressive numbers.
In addition, these numbers are not significantly different from numbers
reported 10 or 20 years ago - belying the claim that CAM use is increasing. In
any case, the number I usually see for the percentage of cancer patients
reporting having used CAM is less than 50%. I don't know where Collins got his
figure of 65%.
In
fact, while looking for the source of Collins' information, I found this recent meta-analysis that,
while claiming to find that CAM usage among cancer patients is increasing,
still only estimated it at 40% in American patients, way lower than the 65%
claimed by Dr. Collins. It's actually a fairly maddening study in that the
definition of CAM therapies for purposes of inclusion in the various studies is
not listed in the paper. Rather, it's listed in an online supplement mentioned
in the paper that I couldn't find. In any case, particularly interesting to me
was this passage in the discussion:
Surveys that restricted CAM use to certain categories or treatments
yielded lower prevalence estimates than surveys that did not. This is
exemplified by the study from Abu Realh et al,120 who confined their definition of CAM use to mind-body
approaches, counseling, and attendance to self-help groups and found that 12%
of respondents were "CAM users." Accordingly, studies with broad definitions of
CAM use tended to inflate estimates: for example, many of the included surveys
with very high usage rates had integrated prayer and exercise defined as CAM,
and the usage rate would have been approximately halved if these therapies had
not been included. We planned to systematically address the question of how
different definitions for the term CAM would influence the results in surveys.
However, this was not feasible because authors seldom stated how they defined
CAM for the purpose of their study. Moreover, even in studies from the same
country, in which the same type of definition was used, the CAM treatments
included varied substantially.
It's a
shame that Dr. Collins apparently either doesn't recognize such distinctions or
was too unconcerned to look more in depth into whether claims of CAM use in
cancer patients by CAM advocates are accurate. They are, as Steve and I have
pointed out, hugely inflated by the inclusion of modalities that aren't really
medicine (prayer, for instance) or through the inclusion of of modalities that
are arguably not CAM, such as vitamin use (which might or might not be
science-based depending upon the specific use), exercise, and nutrition. Even
sensationalistic news coverage
comes up with lower estimates than Collins did. Next up on Collins' hit parade
is a citation of a study from M. D. Anderson Cancer Center that reports that
52% of cancer patients are using CAM during phase I trials, but that 23% don't
disclose that information to trialists. This is indeed a disturbing figure, but
it is not a justification for NCCAM, a specialty known as "integrative
oncology," or CAM itself. Rather, it's a figure that tells us that we should do
more research in drug interactions with natural products, something that could
easily be done under the auspices of non-CAM funding mechanisms in the
NIH.
In
fact, I find this whole line of argument confusing. Collins went on to proclaim
how the goals of NCCAM are "very much aligned" with those of the SIO and then
used the following as his examples:
"We need to do this research, not only to find out what works, but to
find out what interventions actually may be harmful," no matter how unlikely
that may seem, Dr. Collins commented. For example, he pointed to the story of
beta-carotene in cancer prevention. In the 1980s, epidemiologic evidence
suggested that beta-carotene might decrease lung cancer risk. Double-blind
clinical trials were initiated, and in the 1990s, those trials showed that "not
only is beta-carotene not protective, it actually increased lung cancer
risk--16% in one study and 28% in another--and so the studies were halted." A
follow-up study in 2004 corroborated those results.
This
is, of course, a massive straw man coupled with a non sequitur. No one
seriously argues that scientists shouldn't try to find out what works and what
doesn't. In addition, the examples Collins cites are not in any way
"alternative," "integrative," or "complementary." Beta-carotene is a chemical
found in some foods that can act as a drug or nutrient. There was preliminary
epidemiological evidence
suggesting that beta-carotene might decrease the risk of lung cancer.
Scientists then did what scientists do: They performed randomized, double-blind
clinical trials to test the hypothesis, which seemed plausible when the trials
were initiated. Unfortunately, the results of these clinical trials turned out
not to be what had been anticipated; not only did beta-carotene not prevent
lung cancer, but it increased the risk of dying of lung cancer in
smokers. How this relates to "CAM" or "IM" is tenuous at
best. This is SBM at work. The same is true of the other example cited by
Collins, that of vitamin E and selenium as preventatives for prostate cancer
that, when tested in randomized clinical trials, actually slightly increased the risk of prostate
cancer. So, while I agree with Collins that "That's the
kind of data we need if we are going to be giving rational recommendations to
patients and providers about how to practice better prevention and treatment,"
I disagree that such studies are in fact "integrative" or "alternative" or
"complementary" or whatever CAM proponents like to call such supplementation
these days. They are, in fact, SBM. Beta-carotene and the vitamin E/selenium
combination are simply proposed therapies that had a modicum of plausibility to
them as a preventative strategy for different cancers that failed when tested
in rigorous randomized clinical trials. This happens all the time in SBM; it's
why we do clinical trials.
In
essence, whether he knows it or not, Collins has fallen for the old "bait and switch" of CAM/IM, just
as NCCAM director Josephine Briggs has.
"Personalized" medicine and CAM
I've
written many times before about how CAM co-opts the idea of "personalized
medicine" for itself when in fact what "personalized medicine" means in CAM
tends to involve practitioners "making it up as they go along"
and the co-opting of the term as a
strategy to attack evidence-based medicine as being "one
size fits all." Some, such as Dr. Stanislaw Burzynski, co-opt the term as a science-y-sounding
way to make his very own "make it up as you go along"
mish-mash of targeted cancer therapies, antineoplastons, and chemotherapy sound
as though he knows what he's doing.
Collins, disappointingly, buys into this frame. Whether he does this
knowingly or unknowingly, I don't know. (I suspect the latter.) First, he touts
NIH initiatives, such as the Cancer Genome Atlas, a project
that will sequence the genomes of many cancers and try to draw conclusions about the genetic
abnormalities that drive cancer growth and determine
responsiveness to various therapies. It's an ambitious (and risky project that
has almost nothing to do with CAM, although CAM proponents have tried to claim
such projects as their own, the most hilariously off-base example being
so-called Ayurvedomics. This is a strategy
that appears to be echoed in one of the talks given at the SIO conference by
Jeffrey A. Dusek, PhD, entitled, "Mind-Body Strategies and
Epigenetics." In any case, Collins points out how "big
numbers" are needed to be able to draw any useful correlations and
understandings of patterns of genetic derangements in various cancers. No doubt
this is true, but it is also irrelevant to CAM, as is this example he
cites:
As "a dramatic example" of the new targeted, personalized approach to
cancer treatment, Dr. Collins described the case of a woman, a nonsmoker who
was diagnosed with very aggressive, stage IV non-small cell lung cancer in both
lungs about 4 years ago. Following standard chemotherapy, she participated in a
clinical trial with crizotinib (Xalkori). Prominent lung metastases shown on
x-ray in July 2009 "were essentially gone by November 2009," Dr. Collins
reported. "So she has had a dramatic response, and she continues to do
extremely well," he added.
"Of
course this drug doesn't work for everybody with this kind of lung cancer. So
what's the difference? It depends on whether the particular cancer has a fusion
involving the ALK gene," Dr. Collins explained. "Crizotinib was not developed
with that particular target in mind, but it turned out after the fact that this
was going to be a very responsive situation." The success of crizotinib when
used in a targeted personalized approach led to its approval by the FDA several
months ago. Yet the drug may not have been approved if it "had been tried on
thousands of people with lung cancer without having stratified them by the
specific molecular findings," Dr. Collins said.
Triumphs such as these are promising harbingers of a potential new
age of personalized medicine and illustrate the potential power of such
approaches. They do not, however, illustrate anything about CAM. Neither does
the other example cited, that of a promising new approach of modulating the
immune system to stimulate a patient's own cells to attack cancer cells in
chronic lymphocytic leukemia. This sort of science-based immunotherapy is
related to claims of "boosting the immune system" promoted by CAM aficionados
only by coincidence or in the way that the germ theory of disease as understood
today is related to miasma theory from 200 years ago. Yet Collins seems to
think that these promising avenues in the science-based treatment of cancer are
somehow related to "integrative oncology." In fact, he falls for the "bait and
switch" even harder:
"We also have great excitement about a new era in therapeutics based
on natural remedies," Dr. Collins said. The NCI has an ongoing program looking
for anticancer activity in extracts from plants, marine invertebrates, and
microbes. "We are also seeking opportunities by looking at traditional
medicines, many of them from China, for how we can decrease the side effects of
treatment."
All of
which is pharmacognosy, not "CAM," As David Kroll pointed out not too
long ago:
But pharmacognosy - the study of natural products - is *not*
alternative medicine. It is, in fact, the basis for at least 25% of our
prescription drugs and up to 60% of some classes of over-the-counter
drugs.
And:
What worries me more is how pharmacognosy is approached by NCCAM and
how damaging their supported studies can be in leading us to dismiss
potentially useful botanical medicines. In attempting to show political
supporters the benefits of alternative medicines, NCCAM seems to spend a
disproportionate share of their appropriation on expensive clinical trials. My
concern has been that clinical trials are warranted when sufficient basic
science has been conducted. However, the rush to clinical trials has instead
led to multiple clinical trials failures.
The
problem, of course, is that NCCAM and "integrative oncology" are not about
pharmacognosy, other than "rebranding" it and fusing it with pseudoscience.
They are about magical thinking and what Harriet Hall likes to call tooth fairy science. Dr. Briggs
might have brought more scientific rigor and a more true pharmacognosy-like
approach to NCCAM for the moment, but she will not be NCCAM director forever.
One day she will retire or move on. When that happens, the institutional
inertia will likely cause NCCAM to revert to its old ways.
What Francis Collins doesn't know about "integrative
oncology"
One of
the reasons that quackademic medicine can flourish is that respected scientists
like Francis Collins do not understand what it is about. That's because in
general they are unaware of what "integrative medicine" is all about, and many
quackademics are quite good at cloaking their woo in convincing-sounding
scientific language. Certainly, they have donned the language of evidence-based
medicine and of "patient-centered" care like the proverbial cloak of
invisibility in the Harry Potter novels and movies to hide the pseudoscience,
as Kimball Atwood so eloquently
described and I reiterated. I won't retread old
ground other than to point out that "integrative" oncology in reality means
"integrating" quackery and pseudoscience into science-based medicine. I will,
however, take a look at the agenda for the SIO meeting at
which Collins was the keynote speaker.
A brief
perusal of the SIO meeting program reveals a
few tidbits, in no particular order, some with and some without my
comment:
- Gillian Flower; Kieran Cooley;
Dugald Seely. Adjunctive cancer care at the Canadian College of
Naturopathic Medicine: A prospective, longitudinal, observational cohort
study. One notes that "naturopathic
oncology" includes homeopathy and a variety of other forms of
quackery. Too bad the abstract is not online. In any
case, one notes that the lead author Gillian Flower offers acupuncture, high dose intravenous vitamin therapy,
acupuncture, and bogus "electrodermal testing" in her practice. - Garrett Sullivan; Qi Chen; Ping
Chen; Julia Chapman; Mark Levine; Jeanne Drisko. Prospective randomized phase I/IIa pilot trial to
assess safety and benefit administering high-dose intravenous ascorbate in
combination with chemotherapy in newly diagnosed advanced stage III or Stage IV
ovarian cancer. That's high dose intravenous vitamin C,
people. - Lucille Marchand, Diana Wilkie, Jun
Mao, Kimberly Fleisher (Discussant: William Collinge). Moderated panel 6.
Massage and Energy Therapy Research. - Alejandro Chaoul; Kelly Bieger;
Tenzin Rinpoche; Amy Spelman; Christina Meyers; Deborah Fry; Ideen Zeinali;
Banu Arun; Janna Taylor. Tibetan Sound Meditation Improves Cognitive
Dysfunction, Mental Health, and Spirituality in Women with Breast
Cancer. - Barrie Cassileth; Amy Matecki; K.
Simon Yeung; Carmencita Mercado-Poe; Marci Coleton; Lisa Bailey; James Lozada;
Martha Tracy; Gary Cecchi. Safety of Acupuncture for Upper Extremity Lymphedema
in Breast Cancer Patients: Lessons from two major Medical
Centers. Define "safety." As a surgeon who sees a fair
number of patients with lymphedema due to breast cancer surgery, the thought of
sticking needles into the lymphedematous limb causes me to shudder, given how
prone limbs with lymphedema are to infection and how--shall we
say?--unconcerned about sterile technique most acupuncturists are. (Just ask
Mark Crislip if you don't believe me.)
I could
go on, given that there is a lot more there, but I'll wind up with my favorite
session of all, one that I might have actually been interested in attending.
Yes, I'm talking about the Integrative Tumor Board. For those of you not
familiar with what a tumor board is, it's a meeting where all the relevant
specialties are together in one room to discuss the cases of individual cancer
patients in order to formulate the best evidence-based treatment plan that the
multidisciplinary team can come up with. Of course, this tumor board has a
bit...laxer definition of "specialty." This tumor board includes two medical
oncologists (one of whom is the medical director of the M.D. Anderson Integrative Medicine
Center), an MD/acupuncturist, a naturopath
from Bastyr university, a nutritionist from Nutritional Solutions (now
there's an idea for a future post!) and a nurse who is interested in "mind-body"
medicine. One notes that there are no surgeons, no
radiation oncologists, and no genetics counselors, most of whom tend to be on
tumor boards, depending upon the tumor type. One wonders what sorts of cases
this tumor board discussed and what recommendations its members gave for the
cases chosen to be presented.
It's
extremely disappointing that Dr. Collins agreed to appear as the keynote
speaker for the SIO conference, but it's even more disappointing that, instead
of using his forum to challenge the SIO to abandon pseudoscience, he instead
fell right into their frame of co-opting science-based modalities as being
somehow "alternative." He even bragged about how much support the NIH has given
to such research, pointing out that the Office of Cancer Complementary and Alternative
Medicine (which has the unfortunate acronym OCCAM) in the
National Cancer Institute has a budget even larger than that of NCCAM and
saying:
While NCCAM is an important focus of efforts at NIH, other institutes
within NIH also have initiatives in complementary and alternative medicine, Dr.
Collins noted. "The NCI has the largest one by far," he said, and "the budget
for CAM in the NCI is actually slightly larger than the entire budget of NCCAM.
The total investment that NIH makes in complementary and alternative medicine
research in 1 year is about a half-billion dollars. I wish it was more, but I
wish everything we are doing in biomedical research could be more," he
said.
As I've
said before, I wish it were less (as in zero), and all the money wasted on
pseudoscience or putting a pseudoscience spin on what should be SBM distributed
to the rest of the NIH. There is nothing that NCCAM or OCCAM does that requires
a special, dedicated office or center in the NIH. Unfortunately, Collins uses
the dire funding situation of the NIH to make the wrong argument about CAM
research funding:
"The opportunities for medical research have never been greater than
they are right now, and yet the threat to the support of biomedical research
has--in the memories of anybody who is currently working in the field--never
been greater either," Dr. Collins stated. He noted that in fiscal year 2011,
"for only the second time in 40 years, the NIH budget sustained a real cut." If
the failure of the Joint Select Committee on Deficit Reduction (the so-called
supercommittee) to cut $1.2 trillion from the budget results in sequestering of
discretionary budgets, "a dramatic downturn in support for biomedical research"
could occur in fiscal year 2013, Dr. Collins said.
We now
know, of course, that the supercommittee did fail to come to an agreement and
that sequestering of discretionary budgets is all but assured in 2013. To me
that's all the more reason that waste such as NCCAM and OCCAM should be rooted
out of the NIH, in order to make the best possible use of the remaining funds.
Look at it this way. Only the top 7% of new research grant applications to the
NCI are currently being funded, down from the top 16% back when I got my R01 in
2005, with no improvement in sight. In some NIH institutes, I've been told,
it's only the top 5% being funded. Meanwhile, investigators used to have two
opportunities to revise and resubmit rejected proposals; now they can only
revise and resubmit once. When funding gets this tight, there are lots of
innovative projects, chock full of good science, that don't make the cut and
don't get funded. I fully agree with Dr. Collins that the case for funding
medical research has never been stronger and that the threat to the NIH has
never been greater. At least 20 years ago, which was the last time funding was
so tight, there appeared to be hope that an end was in sight. Not so
today.
I
realize that Dr. Collins was tailoring his address to his audience. I also
realize that Collins is not just a scientist and administrator, but a
politician. He has to be to have become director of the NIH and to have held
all the other prominent leadership positions he has held during his career.
Even so, it's hard not to come to the conclusion that, like so many physicians
and scientists, he just doesn't "get" the problem of CAM and pseudoscience
infiltrating medicine. At least, I hope that's the case. What would be worse is
if he either didn't care or supported it.
January
24, 2012
Hoveround opens new
headquarters - Bradenton Herald –
Physical
therapy business to hold open house
BRADENTON -- Request Physical Therapy, 2722
Manatee Ave. W., is having an open house from 4 to 7 p.m. Friday.
The
therapy center treats lymphedema, neck and lower back pain, total joint
replacements. dizziness and vertigo and sports injuries. The business has an
expanded studio that offers yoga, tai chi, massage and pilates.
There
will be a ribboncutting ceremony, raffle prizes, refreshments and yoga
demonstrations.
For more
information, call 941-744-9046.
January
25, 2012
Business notes - Waynesville
Smoky Mountain News – I cant find the name of who wrote the article
sorry
This
was a one time screening on one day passed now - Glens Falls
Post-Star
As I research Axillary Web Syndrome (AWS) more, I am learning that
there are preventative actions I should be (and should have been) taking
against lymphedema since my surgery almost a year ago. This research prompted
me to contact my care team to get additional information. I sent the following
email to my oncologist, radiation oncologist and the oncology resource nurse at
the cancer center:
I have been going to PT (physical
therapy) for a few weeks now and Lisa is scheduling me 2x's/week for the next 3
weeks. I have experienced some relief and increase in ROM (range of motion),
but I still have a very tight cord running down my arm, through my bicep and
into my elbow.
I have not been able to find much
information about AWS online and it seems any one I ask can't provide me with
any additional information from what I have already read. I would like to know
what my likelihood of developing lymphedema is now that I have this cording
(?). I've read that there is a correlation between the two and it increases the
odds, so does that mean I am doomed to get edema no matter what? Or are there
preventative actions (besides PT) I can take now so that it doesn't happen to
me?
I have been consistently working out
(running and strength training) since August. Should I have been, and should I
now be, wearing a compression sleeve to help increase my chances of not getting
lymphedema? Or should I not wear a sleeve until it presents so that my arm
doesn't become dependent on a sleeve if it's not necessary? I am happy with my
physical activities and abilities since re-starting training, but PT has
recommended I taper back on strength training and certain exercises, which I am
disappointed with and I wonder, is this going to be the case for the rest of my
life? I am scared and I don't want to have arm swelling that will never go
away; especially in my dominant arm. If there is anything I can do, or anyone I
can speak to that could help to increase my odds of not having this happen,
please let me know.
I didn't realize that lymphedema could
occur this far out from surgery. I thought I was in the clear, but now that
I've been researching I see that if lymphedema is going to happen it's likely
to occur within 4 years after surgery... so I still have a ways to go and the
AWS is not a good sign. I didn't realize the radiation could trigger something
like this. I thought the risks from radiation where a possible dry cough for
about a month and weakening of my ribs.
I'm just slightly disappointed with
the lack of information I've been given and able to find (sigh :/). Any thing
you could offer would be appreciated.
Since sending the email above I received an email back from the
oncology resource nurse (Vickie Yattaw), I am scheduled to see Dr. Stoutenburg
(my oncologist) tomorrow, and I have spoken with Dr. Frank (my radiation
oncologist) on the phone.
I received conflicting advice from Vickie and Dr. Frank in regards to
wearing the compression sleeve on my arm during exercise, so I am going to see
what Dr. Stoutenburg has to say tomorrow and then make an educated guess based
on information from all three.
I do enjoy speaking with Dr. Frank. He just has a way about
explaining things that I appreciate. He started by explaining Mondor's Disease
to me and said that AWS is believed to be a variant of this disease. He also
told me, although associations can be made with AWS and lymphedema, having AWS
does not imply causation- so this cording in my arm isn't necessarily going to
cause me to get lymphedema. He also said if he were to compare me to other
patients, he would put me in a category of "low-risk" for lymphedema because I
did not have lots of nodes removed, I am a healthy weight and active, but he
couldn't not say my chances are zero. He said sometimes people just have bad
luck. I think I'm due for some good luck, so I'm going to stick with good
thoughts - and keep buying my weekly lotto ticket! I asked why I wasn't given
more information about preventative measures and he said there are no studies
actually proving the prevention claims, at this point it is just people
advocating (not scientific proof), so if they were to tell me to wear a
compression sleeve, it may aggravate my arm and become lymphedema (like a self
fulfilling prophecy). Still not sure of my feelings on this.
As someone who has never had breast cancer before, I'm not sure how I
was supposed to know this stuff. It seems like there is not a lot being done in
regards to research and treatment for AWS or lymphedema in the medical field.
For anyone suffering from these conditions I hope that changes. I hope
oncologists find it important to educate their patients from the beginning of
their treatments about the preventative actions they can take. I know there are
no studies proving the prevention claims, but they seem like good all around
practices. If a patient's care team doesn't tell them what to look for how are
they supposed to know?
Any way, I hope to be fortunate enough not to get lymphedema (Vickie
said the risk lasts for up to 10 years after surgery-geesh! a girl can't buy a
break!). There is no cure for lymphedema, so if I do get it I will be presented
with a whole new set of challenges. The smallest thing, like bugs bite on my
hand could set it off.
Tomorrow, I have a PT session and then meet with Dr. Stoutenburg. I
look forward to hearing his thoughts on all this. This has been a lot to wrap
my head around. I guess because I thought after treatment the only thing I
would have to be concerned with was not having a recurrence. So begins another
life lesson and learning to live with the long-term side effects of breast
cancer treatment.
January
26, 2012
Indian River Health Listings Updated Jan. 26,
2012 – TCPalm –
Talk
Lymphedema: Talk: Lectures on swelling/edema management. Lymphedema Therapy
Center, 787 37th St. Ste. E-100, Vero Beach, 11 am, Jan. 24, 31, Feb. 7. RSVP:
772-569-9747.
Hospital Stay Has Kept Woman From Seeing Her New
Home - The Ledger – By Chase Purdy –
TAMPA | Yvonne
Gallimore's new home was arguably the biggest Christmas gift of her life. Only,
she's never seen it. Time hasn't been on her side lately.
In
May 2011, the 54-year-old Lakeland woman was removed from her home to receive
emergency medical treatment for a leg infection. The wound, indirectly caused
by her lymphedema, a condition that creates blockage in a person's body that
prevents fluids from draining well, had left her weighing more than 800 pounds
and unable to move freely within her subsidized apartment.
When
removed from her home, authorities had to rip down a wall of her house,
effectively rendering her homeless in the process. Since her extrication,
Gallimore has found herself in and out of hospital wards, often for months at a
time.
But
in June, an anonymous donor boosted Gallimore's spirits by offering to build
her a new house. The project was completed by the end of December, but because
she was transferred to Tampa General Hospital in October for bariatric
treatment, Gallimore remains confined to a hospital bed.
“I
was here before the house got done,” Gallimore said. “It's going good, though.
I'm getting treatment.”
Excited
about her new home and the opportunity of spending more time with her
grandchildren, Gallimore said she's looking forward to getting out of the
hospital and into her own place. But she's also committed to patience. Since
starting bariatric treatment in October, she said she's lost more than 100
pounds.
“They've
been wrapping her legs and she's been shrinking some and dropping some weight,”
said Chandra Greer, Gallimore's friend and home nurse.
Michel
Murr, the director of bariatric surgery at Tampa General Hospital, described
his approach to treatment as comprehensive. It's a process that involves up to
five types of experts, including a bariatrician, dietician, psychologist,
physical exercise physiologist, and surgeon. Together, the team works to reduce
stress, promote behavior modification, and physical exercise.
“We
prepare in all possible ways for the operation,” Murr said. “Once that's
completed . . . we move on to meet with the surgical team, which is me and a
couple of other doctors.
The
surgeon said he performs one surgery, one done microscopically, to remove
excess weight.
The
results don't appear overnight, but rather, over the course of several years,
Murr said.
“What
we see is that patients will average about 10 to 15 pounds a month,” he said.
“The end result in 15 to 20 years is very, very good. It's safe to assume that
whatever excess weight a person has, they will lose half or 60
percent.”
[
Chase Purdy can be reached at [email protected] or
863-802-7516. Follow him on Twitter: @chasepurdy ]
Business Briefcase: Scotlyn Group provides
lymphedema services - The Daily News Journal
–
MURFREESBORO — Lymphedema services
are now provided by the Scotlyn Group therapists in Murfreesboro.
Linda Bullard, PTA/CLT; Don Bullard
PTA/CLT; and Lynn Teal, PT/CLT, are now located within Donnelly Physical
Therapy, located at 610 East Clark Blvd. in Murfreesboro.
Lymphedema services require a
physician referral and are covered by most insurances including Medicare
and Medicare replacement policies. For more information, call 615-319-4571 or
615-415-0033
January
29, 2012
Do Cancer Survivors Handle Stress Better or Worse
Than Others? – GoodTherapy.org –
The emotional impact of a cancer diagnosis is
overwhelming. People who undergo cancer treatment come through recovery having
learned how to deal with an immense amount of stress. Some individuals cope
better than others. Research examining reactions to stress in cancer survivors
has provided mixed results. Several studies suggest that cancer survivors are more
resilient than their healthy counterparts, due to the fact that they have faced
enormous stressors during their ordeal. Other evidence implies that people who
have overcome cancer are hypersensitive to life stressors as a result of being
traumatized from the course of their treatment. Because stress is known to have
negative physical and psychological consequences, both extremely deleterious to
recovery and future health, Erin S. Costanzo of the Department of Psychiatry
and Carbone Cancer Center at the University of Wisconsin-Madison wanted to find
out if this segment of the population was at increased risk for negative stress outcomes.
Costanzo and her colleagues examined how
daily stressors would affect cancer survivors and their quality of life (QOL)
based on symptoms of pain, fatigue, and depression in relation to healthy
individuals. Costanzo enlisted 111 cancer survivors and had them
complete daily diaries detailing their stressful interactions over the course
of 8 days. Cortisol samples were taken four times each day, and the
participants were assessed for physical and psychological symptoms. The results
were compared to the diaries of healthy participants. The study revealed that
overall, cancer survivors coped as well with daily stressors as healthy
individuals. Indeed, in some instances, the cancer participants were even more
resilient at overcoming minor stressors. However, there was no evidence that
the experience of going through a cancer treatment protocol provided enhanced
coping resources in all areas. In particular, the cancer survivors were more
sensitive to interpersonal and relationship stressors than the
control group. “Results also highlight the importance for researchers and
clinicians to focus not only on the distress associated with the experience of
cancer, but also to attend to other more modest stressors in understanding the
well-being of cancer survivors,” said Costanzo. She added, “Therapeutic
interventions with stress management components that target strategies for
coping with everyday life demands may have an added benefit of optimizing
cancer survivors’ QOL.”
Reference:
Costanzo,
E. S., Stawski, R. S., Ryff, C. D., Coe, C. L., & Almeida, D. M. (2012,
January 23). Cancer Survivors’ Responses to Daily Stressors: Implications for
Quality of Life. Health Psychology. Advance online publication.
doi: 10.1037/a0027018
Lymphedema
may cause pain after surgery - ABC2 News –
BALTIMORE
- One possible painful and uncomfortable side effect from Cancer treatment is
something known as Lymphedema. This is the swelling that occurs in a patient's
arms or legs and can be debilitating.
There
is no cure, but there are some ways to improve the quality of life of someone
suffering from Lymphedema.
Kathryn
Doran is a Physical Therapist at Cancer Treatment Centers of America (CTCA) in
Philadelphia. She focuses on ways that rehabilitation can help ease the
symptoms of Lymphedema.
First
of all what is Lymphedema? Doran says that it is a compromise to the lymphatic
system caused by most cancer related surgeries and treatments. It can be seen
as swollen arm, leg, face and any affected body part.
At
CTCA, all cancer patients have a cancer diagnosis and many of them choose
surgery options, but that surgery puts them at risk for developing Lymphedema,
so it's important to educate them about the risks and prevention, she
said.
So
what are some of the risk factors for developing Lymphedema?
Overexertion,
heavy lifting, blood pressure or needle sticks on the surgical arm or leg,
infection, sunburn, insect bites, radiation treatment and scar tissue. During
the surgery, in addition to removing the cancerous tumor, the surgeon might
also go in and remove some lymph nodes for staging. This too could be connected
to Lymphedema, often those who have had lymph nodes taken out are at a higher
risk.
Duran
says, before and after surgery, "patients should be aware of certain triggers
such as, inflammatory response, lifting objects, over exerting and
infection."
What
are the symptoms of Lymphedema?
Achiness
or heaviness in the arm or leg, felling of tightness with clothing such as
jewelry or socks and weakness in the arm or leg.
How
can physical therapy help ease the symptoms of Lymphedema?
"Manual
lymph drainage, which is different than a massage, compression garments or
bandages, patient education for skin care and exercise," said
Doran.
Doran
says "at CTCA, we practice a proactive approach to manage Lymphedema takes
place. They believe anyone who has had cancer related surgeries, should be
educated on the signs and symptoms of Lymphedema, and know how to treat
it."
January
30, 2012
SALFORD ART CLUB ANNUAL EXHIBITION
2012- Salford Star –
Brave Brenda Battles Adversity
Salford pensioner Brenda Bitler
has been a member of Salford Art Club for a little over four
years, and within twenty minutes of this year's Salford Art Club
Exhibition opening she found out she had sold her first ever piece of
work…
"Does that mean I'm a professional now?"
Brenda, quipped. Her personal success was a standout moment at the official
opening of this year's Exhibition held at the Salford City Museum and Art
Gallery.
Brenda's proud daughter Lynn
Kirkley `put me in the picture', telling of her mother's achievement…
"I'm really chuffed for her as she's had cancer" Lynn explained "She's
suffering from Lymphedema (swelling of the arms and legs) which makes it
difficult for her draw and paint but she's managed to produce something that
someone wants to part with money for. I'm really chuffed and
proud."
Lynn Kirkley,
herself a member of the Salford Art Club with a piece of work on show, admitted
that she was jealous of her mother…"I am!" she smiled "You're dead
right!"
This year's Exhibition consists of 92 pieces
by members, including two pieces by Betty Murray, a long-time
member of Salford Art Club, who sadly passed away last year. The work displayed
is in a variety of media, but mainly contains paintings.
In celebration of the opening of the
Bridgewater Canal 250 years ago, many of the works are on the theme of water
and bridges, and they left me with a feeling of tranquillity and calmness. I
can honestly and wholeheartedly recommend this year's exhibition as a perfect
way to unwind, draw inspiration or even pick up an excellent piece of unique
work at a rock bottom price. But my words cannot do justice to the countless
hours of dedication and devotion shown in each piece of work, and I urge you to
visit the exhibition before it closes on April 22nd.
There is also the added bonus of being able
to see a work by L.S. Lowry, created in 1959 and titled
Yachts, an interesting and vibrant piece which shows Lowry in a
different light as compared to his typecast work with dark industrial scenes.
This scene is painted with water colours, a medium Lowry tended not to use due
to its quick drying and limited work time.
Another picture is by the internationally
renowned artist Geoffrey Key, President of Salford Art Club, which
is titled Summer Park, an interesting abstract composition in
Key's signature style.
A special mention must also go to this
year's Salford Art Club Award Winners, Ken Shackman, whose
painting won the Betty Murray Award for Still Life Imagery;
Ged Buckley, whose figurative work won the John Clare
Award and Lesley Lewis, who won the Geoffrey Key
Award. Wilf Ainsworth was presented with the John
Dumville Award for the best picture in last year's show. This award is
voted for by members of the public who visit the exhibition and simply choose
their favourite picture.
"When my wife was Mayor four years ago we
came and opened it the standard was very high" said the current Mayor of
Salford, Councillor Eric Burgoyne "If anything this year's has exceeded
that, some of the pictures are absolutely brilliant...The Exhibition shows the
talent we've got here and shows the positive side of life in
Salford."
B-TOWN UNDERCOVER: Shawn Underwood Hangs Out At
Sundance - The B-Town Blog – by Shawn Underwood –
Every time I run into Scott (slave driver)
Schaefer he inquires after a ‘bit’ for The B-Town Blog—like I have nothing else
to do. Note to self—do not post fun excursions with stupid pictures on
Facebook. Scott will come calling…
Last week I was in Utah at the Sundance Film
Festival. By happenstance Sundance coincided with a therapy trip for me.
Seriously. I have lymphedema in my left leg and well, it’s a long story but if
you are interested in medical stuff, you can follow up on my lymphedema blog. My surgery and
follow up treatment are documented. But I digress.
My friend’s husband scored several premiere
tickets for us. The one and only Sundance Kid made an appearance before the
movie and can I just say, HANDSOME, HOT AND SUPER HOT!!! You get the picture,
and oh yeah, he said something too but I was distracted. Go
figure.
The first movie we ‘premiered’ in Park City,
was suitably named; ‘The Queen of Versailles’. It detailed the rise and
subsequent fall of the King of Time-Shares, Mr. Segal and wife, Jackie, a
former over-exposed, Mrs. America. The documentary/reality show is a testament
to waste and bad taste, with the opening scene documenting the construction of
the ‘biggest house in America.’ It ended as a riches to rags story. Mr. Time
–Share’s final line, ‘are we done here?’ Very telling. Theater gossip says Mr.
Time-Share is suing Sundance and the movie producer for defamation.
Coincidentally, this was also one of the first movies sold at Sundance, where
none of the movies (for the first time in Sundance history) had distribution
before being premiered. Mrs. Segal sat near the front of the theater. Her
husband, very noticeably absent.
Luckily, the second show we had tickets for
took place at the Sundance resort. Let me just say—LOVE what Bob’s done with
the resort. No messing with the masses in order to board a shuttle bound for a
high school posing as a movie theater. Sundance Resort houses the original
‘screening room’. We lined up forMonsieur Lazhar, a Canadian film
that appears on the recently announced Oscar shortlist for foreign
language films. The film has also been nominated for a Genie award—the Canadian
Oscar. Based on the play Evelyne de la Cheneliere, Monsieur Lazhar
walks unannounced into the principal’s office to apply for a recently vacated
teachers position. He is unaware the teacher has committed suicide. The
principal—nearly undone by the act of the well-liked teacher, hires him.
Eventually we discover the Algerian immigrant, Mr. Lazhar is battling his
personal demons yet he is able to move past this and bond with his students.
There are moments of lightness in the film—a relief in an otherwise very
emotional story. Well worth seeing, however we didn’t SEE anyone famous—that
happened later in the evening during dinner.
Mr. Chris Rock attended Sundance
to preview his new film, “2 Days in New York.” Chris and I split a
steak and Caesar salad at a great steak house in Park City. Well sort of – I
split a steak with my friend and Chris sat across from us. It’s like we shared
a dinner together. Really.
So as I was saying, later in the evening at
the Canyon Resort VIP big deal party I ran into, oh you know…Jason
Ritter, Jesse Eisenberg (the Facebook dork dude), Hercules aka:
Kevin Sorbo, Entertainment Tonight guy and Bare Naked Ladies lead
singer guy (close second to Bob in HOT category). For some reason, I had a
sudden attack of shyness and talked to ummm, nobody. Nobody famous anyway, but
I got my groove on and learned a few new dance moves from the mostly
twenty-something guests.
And finally, Mr. B-Town Blog (super famous)
wants to know how Sundance Resort and Park City compare to B-town. Well we have
the Tin Theater in Tin-sel town also know as Burien, the Hi-Liners put on a
fine show, AND I hear Mr. B-Town Blog is starting his own radio
station.
Why the Pink Ribbon campaign
matters - Montreal Gazette –
MONTREAL
- Léa Pool's documentary film Pink Ribbons, Inc., which premiered at the
Toronto International Film Festival last fall and opens in Canadian theatres
Friday, is critical of the pink-ribbon campaign associated with the fight
against breast cancer.
Some
of the questions raised by the documentary, which is inspired by a book by the
same name by Samantha King, are very interesting and will help us move forward
in the fight against breast cancer. However, the Quebec Breast Cancer
Foundation believes it is important to set some of the facts straight in order
to reassure the Quebec public, and help people realize that their support for
the pink ribbon is still vital for women.
First
of all, breast cancer research has paid off. Thanks to the many investments in
research by organizations such as ours, the survival rate increased from 71 per
cent in 1974 to 88 per cent in 2008.
But
in spite of this improvement, too many women still die from this disease. It is
essential to maintain our investment in research in order to continue
increasing survival rates. Moreover, 40 per cent of the money for research
comes from non-profit organizations such as ours.
Still,
the film eloquently demonstrates that we must focus more closely on
understanding the causes of breast cancer, which unfortunately are still
unknown. To this end, we are proud to say that of the $8.1 million we donated
to research projects last fall, 21 per cent of the grant money is to be spent
on research into the causes of this cancer.
There
are many ways that people can contribute to the fight against breast cancer.
Indeed, much of the money that goes to support this fight comes from the public
at large.
For
some people, it is through participation in popular fundraising events, such as
the CIBC Run for the Cure, that this support is expressed. Others like to
organize their own initiatives, like a sporting event or a spaghetti supper.
Still others donate money directly to the breast cancer organization of their
choice.
Finally,
there are people who choose to buy a product from which a portion of the
proceeds go to organizations such as ours. However, consumers must remain
vigilant when buying these "pink" products, and make sure the companies selling
them are donating the money raised to reputable and responsible
organizations.
For
a survivor like me who is currently battling the disease, it's very touching to
see thousands of people participating in the fight against breast cancer in the
way that works for them.
In
addition to money raised for research, there is also money raised to support
delivery of services. It is critical to support this delivery of services to
women with breast cancer as well as their families. That is why the Quebec
Breast Cancer Foundation provides grants to a financial aid program for
low-income patients, cofunds mobile mammography units for women in remote
regions, invests in the treatment of lymphedema, offers yoga classes and
supports many other services.
The
pink ribbon is the symbol of a cause. It has enabled us to save lives through
research and allows us to help Quebec women in need. It is therefore essential
to continue using it to make advances, save lives and help those affected by
this disease. We just need to closely monitor the way the pink ribbon is
used.
Nathalie
Le Prohon is chairperson of the Quebec Breast Cancer Foundation.
January
31, 2012
Advances in Cancer Care: Diagnosis, Treatment and
Survivorship – TribLocal –
This
was a one time meeting on 2/4 that has now passed
LoTempio Plastic Surgery for Women Opens in New York
City – MarketWatch –
World-renowned cosmetic and plastic
surgeon, Dr. Maria M. LoTempio brings her expertise to women in New York City,
setting up roots on Manhattan's East Side
NEW YORK, Jan. 31, 2012
/PRNewswire via COMTEX/ -- LoTempio Plastic Surgery for Women, owned and
operated by Board Certified plastic surgeon, Dr. Maria M. LoTempio, opened its
office at 630 Third Avenue in Manhattan, New York. The practice specializes in
reconstructive and cosmetic surgery exclusively for female patients, performing
a full range of procedures for the body and face. Dr. LoTempio is also a highly
recognized specialist in microsurgical breast reconstruction - one of the only
surgeons in the world to treat patients with upper and lower extremity
lymphedema by performing a vascularized lymph node transfer.
"I am committed to helping women
restore and improve their bodies and their self image," explains Dr. LoTempio.
"I've found that the first step to ensuring best results for my patients is
educating them on the various options when it comes to plastic and cosmetic
surgeries."
Dr. LoTempio has changed the lives
of many women, particularly those in need of breast reconstruction, by offering
an alternative to the traditional silicone implant: a natural augmentation
which uses the fat and tissue from other parts of the body to build or enhance
breasts.
In her New York City based
practice, Dr. LoTempio offers patients a full range of cosmetic and
reconstructive options. Services include lymph node procedures; breast
reconstruction and microsurgery, augmentation, reduction and lifts;
liposuction, abdominoplasty, face, brow and neck lifts, facial injectables,
blepharoplasty and rhinoplasty.
Prior to setting up roots in New
York City, Dr. LoTempio treated patients around the world, focusing on complex
cases, such as, cancer patients who suffered from a single or double mastectomy
and patients who suffered from lymphedema.
For more information visit
www.lotempioplasticsurgery.com or call 866.719.3437
SOURCE LoTempio Plastic Surgery for
Women
Copyright (C) 2012 PR
Newswire.
February
1, 2012
Exercise after breast cancer surgery can enhance
recovery - Times Herald-Record – By Gloria Smith Zawaski –
Diagnosed
with breast cancer? You don't have to take it sitting down anymore. It's now
recommended that you pick yourself up. Dust yourself off. And even do a few
repetitions with weights.
Exercise
— sometimes even surprisingly intense exercise — is now recommended to help
women regain strength and range of motion following breast
surgery.
It is
also precisely what the doctor ordered to help fight many of the physical side
effects of certain treatments as well as the psychological
challenges
"When
I'm here at Studio Ayo, I feel like cancer never happened," says Liz Critelli,
44, who received a breast cancer diagnosis in the spring of 2009. It wasn't the
first time that cancer would rock her world. Her first encounter was back when
she battled Hodgkin's lymphoma at age 18. "The radiation I received back then
probably contributed to my recent breast cancer diagnosis," she says
matter-of-factly.
Critelli
took a year off work as a hairdresser at Joann's Family Hair Salon to undergo
surgeries and receive chemotherapy treatment. She took even less time off from
her exercise program — she walked in her neighborhood very soon after surgery
and was back at Studio Ayo in the Town of Wallkill in January
2010.
According to Critelli, the medication she
takes affects her hormones and could threaten bone density. When she doesn't
move, she says she feels it in her joints. "I want to be strong and healthy. I
don't want to ache," Critelli says.
"I'd had
nerve damage in my left arm. Now that's 90 percent better. Exercise helps me
gain physical strength and from that comes mental strength," she adds. "I can
honestly say I now feel like this all never happened."
Each
individual's recovery differs
According to Dr. Paul Reichman, a surgeon
with Horizon Family Medical Group, prescribing "early mobility following breast
surgery is similar to what an orthopedist might prescribe following surgery to
an arm or leg. It can help restore mobility and flexibility," he says. How
quickly a patient returns to exercise depends largely on the kind of surgery
that has been performed. Generally, a patient who has had a lumpectomy —
removal or a tumor from the breast — will recover from the surgery more quickly
than someone who has had a mastectomy, an operation that involves the removal
of one or both breasts. Every patient is different.
The way
breast cancer surgery is performed today is also making an important difference
when it comes to postop exercise. If breast cancer cells spread, they typically
travel away from the breast through the lymphatic system.
In the
past, to determine whether breast cancer had spread or "metastasized" to other
parts of the body, a surgeon removed many and sometimes even all of the lymph
nodes under the armpit, in order to have them tested for the presence of cancer
cells.
Lessening risk of tissue
swelling
Removing
lymph nodes puts patients at risk for developing lymphedema, a condition
causing the swelling of the soft tissues of the arm or hand that is sometimes
accompanied by numbness, discomfort and even infection.
Today, a
procedure called sentinel node surgery is employed instead. By injecting a dye
near the tumor and monitoring where the dye travels, the surgeon can tell what
nodes will first be affected. The surgeon can then remove these surgical nodes
exclusively. Removing fewer lymph nodes can reduce the patient's chances of
developing lymphedema.
"We once
didn't know if exercise would make lymphedema worse, but studies today now
reveal that slow, progressive weightlifting does not worsen swelling," says Dr.
G. Varuni Kondagunta, oncologist with Crystal Run Health Care.
This is
good news to patients who once feared that lifting anything heavy could
aggravate or cause this condition.
Kondagunta says that treatments prescribed
to help prevent the recurrence of breast cancer — from radiation to drugs such
as Tamaxifen or aromatose inhibitors such as Femara and Arimidex that
manipulate hormonal status — can cause a host of side effects. Many of these
can be alleviated through exercise. "Some aromatose inhibitors cause a decline
in bone density. Weight-bearing exercises can decrease this loss," she
adds.
Kondagunta maintains that it will be easier
for a person who was previously active to get into an exercise regime. "People
who were once sedentary should be carefully monitored," she says.
Whether
exercise and diet can help prevent a breast cancer recurrence is a question
that is still hotly debated. "Exercise may decrease hormonal production that
can decrease risk, but this has not been shown in larger studies," Kondagunta
says.
Overexposure to estrogen
Hope
Nemiroff, director of Breast Cancer Options, which provides services and
support to women in six counties in the Hudson Valley, encourages women to
exercise as soon as the doctor recommends and as a prevention strategy as
well.
"Regular
exercise and a diet low in fat and high in fruits and vegetables lowers levels
of estradiol and estrone, two kinds of estrogen," she says. Although women need
estrogen to create strong bones, overexposure to estrogen can lead to breast
cancer.
"Eighty
percent of all breast cancers are fueled by estrogen. Exercise is a natural way
to reduce and balance estrogen levels, and it can reduce other hormones and
growth factors that can cause breast cells to turn into cancer," Nemiroff says.
"Exercise is a lifestyle intervention that breast cancer patients and survivors
can use to improve quality of life, improve mood, physical functioning and
symptoms of fatigue."
When
Karen Smith received her breast cancer diagnosis in June 2010, she didn't waste
time on self-pity. Nor did she dream of taking self-indulgent vacations when
her treatment was over.
"As soon
as I could, I wanted to take the eight-week, five-day-a-week Boot Camp training
class offered at Studio Ayo," Smith says with a laugh.
Smith
kept working at her job in the office of a local elementary school through much
of her treatment. "I didn't always feel as well as I said I did. I never wanted
to be seen as a victim," she says.
Damola
Akinyemi, founder of Studio Ayo, believes the healing process is about more
than "just sticking a weight in someone's hand. We try to be there at every
step and surround the patient with support," he says. Support is more than just
words of encouragement.
"We cook
for people, raise money, and we pray."
According to Critelli and Smith, his words
of encouragement and support are definitely not patronizing or laced with pity.
He is far more apt to support their determination to get moving and get
strong.
"This is
the most positive place I've ever been," says Critelli.
Through
strength, determination and a can-do attitude, both women say that they are now
in top physical shape and feel better than they ever have in life. "If I had to
give advice to anyone, I'd say don't let the disease take over your life," says
Smith. "Tell it who's in charge."
Lymphedema After Breast Cancer -
KOB.com – by Joan Lucas -
Lymphedema, a swelling that occurs in the
arm, breast, or chest area after breast cancer treatment, often occurs after
lymph node removal. Attached to those lymph nodes are networks of tiny lymph
vessels that extend throughout the body and carry a watery fluid called lymph.
When several lymph nodes and their lymph vessels are removed, the fluid has no
place to go and can result in swelling.
Here’s
what can help:
- Elevation.
Two to three times a day, elevate the affected arm to reduce the risk of
swelling. Doing this uses the force of gravity to make it harder for fluids to
stay in the elevated arm. To do this, lie down and place your arm on pillows so
that your hand is higher than your wrist and your elbow is higher than your
shoulder. Your entire arm must be above the level of your heart. Do this for 45
minutes at a time. - Use your arm.
Maintain good circulation in your affected arm by continuing to use it in
normal ways, such as for brushing your teeth and hair, bathing, and eating.
Talk to your doctor about exercise that is appropriate. - Exercise your hand three to four times a day
to minimize swelling. You can do
this by holding your hand above the level of your heart and opening and closing
the hand slowly 15 to 25 times. - Practice caution.
Keep your affected arm clean and free of infections by doing your best to avoid
any cuts, scrapes, or bites. If you do get an injury, clean and treat it
thoroughly. - Moisturize.
Use cream regularly to keep your hands, arms, and nails from drying out and
cracking. - Flying.
If you have to travel by air during this time period, ask your doctor if you
should be fitted for a compression sleeve to prevent swelling during your
flight.
The Lovelace Women’s Hospital Breast Care
Center is New Mexico’s only
breast care center accredited by the National Accreditation Program for Breast
Centers for providing the highest level of quality care to its patients. Our
team of breast health professionals will help you assess your risk of
developing breast cancer, guide you through mammograms and clinical exams and
teach you the proper method of breast self-examination. We also offer
counseling, education and support programs.
For more
information or to schedule a clinical breast exam
or mammogram, call 505.727.6900 or visit our website.
February
2, 2012
Dr. Pamela Tronetti: Swollen sufferers should seek
treatment - Florida Today – Written by dr. pamela tronetti –
“I have
elephant-itis.”
“I have elephant man’s
disease.”
“I have
elephantiasis.”
Things usually happen in threes, so
it didn't surprise me that I had three people in one week with elephantine
symptoms.
But what did they really
have?
The suffix “itis” indicates
inflammation. Arthritis is inflamed joints, tonsillitis is inflamed tonsils and
so on. But I doubt the patient had an inflamed elephant at home.
Elephant man’s disease is a severe
form of neurofibromatosis. The patients have tumors growing along the nerves,
which can cause severe deformities.
Elephantiasis is a tropical illness
in which threadlike worms live in the tissues. Over time, the flares of
infection cause swelling of the limbs.
What the patients were trying to
say is that they had lymphedema. They had swollen limbs from a disruption in
the flow of lymph fluid.
The lymphatic system runs through
the body like a grapevine, following the same path as the blood vessels. The
“grapes” are the lymph nodes that mass at junctures of the body: neck, armpits,
groin and along the aorta.
There are two main differences
between the lymphatic system and the circulatory system.
First, blood moves rapidly because
of the strong pumping of the heart. Lymph is slow moving and relies on overall
body activity and local muscle pressures to shift.
Second, blood flows in all
directions. Lymph only flows from the extremities toward the
heart.
You see, as arterial blood flows
into the tissues of the body, it allows some clear fluid (plasma) to bathe the
cells in nutrients, oxygen and other necessary chemicals. Just like with any
bath, this fluid also cleanses the area of cellular waste, toxins and abnormal
cells. Most of plasma is reabsorbed into the veins and continues in the
circulatory system to be filtered by the liver and kidneys.
About 10 percent remains as lymph.
The lymph flows back to its filters — the lymph nodes through the lymphatic
vessels. The lymph nodes filter the waste products and toxins and contain white
blood cells that can kill bacteria. That’s why during a major infection, the
involved lymph nodes swell.
PUB MED DOCS:
January
24, 2012
ScientificWorldJournal.
2012;2012:341253. Epub 2012 Jan 4.
Morbidity
of inguinofemoral lymphadenectomy in vulval cancer.
Soliman AA, Heubner M, Kimmig R, Wimberger P.
Source
Department of
Obstetrics and Gynaecology, Shatby Maternity University Hospital, University of
Alexandria, Port Said Street, El Shatby, Alexandria 21526, Egypt.
Abstract
Background. The
aim of this study is to detect possible risk factors for development of short-
and long-term local complications after inguinofemoral lymphadenectomy for
vulval cancer. Methods. This retrospective cohort study included 34 vulval
cancer patients that received inguinofemoral lymphadenectomy. The detected
complications were wound cellulitis, wound seroma formation, wound breakdown,
wound infection, and limb lymphoedema. Followup of the patient ran up to 84
months after surgery. Results. Within a total of 64 inguinofemoral
lymphadenectomies, 24% of the inguinal wounds were affected with cellulitis,
13% developed a seroma, 10% suffered wound breakdown, 5% showed lower limb
edema within a month of the operation, and 21.4% showed lower limb edema during
the long-term followup. No significant correlation could be found between
saphenous vein ligation and the development of any of the local complications.
The 3-year survival rate in our cohort was 89.3%. Conclusions. Local
complications after inguino-femoral lymphadenectomy are still very high, with
no single pre-, intra-, or postoperative factor that could be incriminated.
Saphenous vein sparing provided no significant difference in decreasing the
rate of local complications. More trials should be done to study the sentinel
lymph node detection technique.
PMID:
22262953 [PubMed - in process]PMCID: PMC3259693
Microsurgery. 2012 Jan 20. doi:
10.1002/micr.20980. [Epub ahead of print]
Lymphaticovenular
anastomoses for lymphedema treatment: 18 months postoperative
outcomes.
Auba C, Marre D, Rodríguez-Losada G, Hontanilla B.
Source
Department of
Plastic Surgery, Clinica Universidad de Navarra, Pamplona, Spain.
[email protected].
Abstract
The purpose of
this work was to report our initial experience with lymphaticovenular
anastomoses (LVA), a controversial technique for lymphedema treatment. Although
LVA technique was described many years ago, the procedure is not as widespread
as it was supposed to be, taking into account the high impact that lymphedema
has in the quality of life of patients. Thus, 12 patients, 5 with lower limb
and 7 with upper limb lymphedema, underwent LVA surgery under local anesthesia.
Two patients were excluded from the study due to the lack of follow-up. At 18
months, 8 out 10 patients showed a variable objective reduction of the
perimeter of the limbs and 9 patients presented a subjective clinical
improvement. These results joined to the outcomes of the most experienced
surgeons in this field are encouraging, although there are still many issues
that need to be addressed with research to optimize the efficacy of this
technique. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.
Copyright © 2011
Wiley Periodicals, Inc.
PMID:
22262630 [PubMed - as supplied by publisher]
Microsurgery. 2012 Jan 20. doi:
10.1002/micr.20977. [Epub ahead of print]
Lower
limb lymphedema treated with lymphatico-venous anastomosis based on pre- and
intraoperative icg lymphography and non-contact vein visualization: A case
report.
Mihara M, Hara H, Narushima M, Hayashi Y, Yamamoto T, Oshima A, Kikuchi K, Murai N, Koshima I.
Source
Department of
Plastic and Reconstructive Surgery, University of Tokyo; Department of Vascular
Surgery, Saiseikai Kawaguchi General Hospital.
[email protected].
Abstract
Lymphatico-venous
anastomosis (LVA) is used to resolve lymph retention in lymphedema. However,
the postoperative outcome of lower limb lymphedema is poorer than that for
upper limb lymphedema, because of the location lower than the heart level.
Improvement of the therapeutic outcome requires application of as many
anastomoses as possible in a limited operation time, particularly since there
is a positive correlation between the number of anastomoses and the therapeutic
effect of LVA. In this case, we described a method to increase the efficiency
of lymphatico-venous anastomosis for bilateral severe lower limb lymphedema
through efficient identification of lymph vessels and veins suitable for
anastomosis using indocyanine green (ICG) contrast imaging and AccuVein, a
noncontact vein visualization system, respectively. Ten LVAs were succeeded at
seven incisions, and the operation time was 3 hours and 5 minutes. Accuvein can
be used for identification of subcutaneous venules with a diameter of about
0.5-1.0 mm. We used this approach in surgery for a case of bilateral lower limb
lymphedema, with a resultant improvement in the surgical outcome. © 2012 Wiley
Periodicals, Inc. Microsurgery, 2012.
Copyright © 2011
Wiley Periodicals, Inc.
PMID:
22262581 [PubMed - as supplied by publisher]
Protein Expr Purif. 2012 Jan 10.
[Epub ahead of print]
Preparation
of human vascular endothelial growth factor-D for structural and preclinical
therapeutic studies.
Davydova N, Streltsov VA, Roufail S, Lovrecz GO, Stacker SA, Adams TE, Achen MG.
Source
Ludwig Institute
for Cancer Research, P.O. Box 2008, Royal Melbourne Hospital, Victoria 3050,
Australia.
Abstract
Vascular
endothelial growth factor-D (VEGF-D), a secreted angiogenic and lymphangiogenic
glycoprotein, enhances tumor growth and metastasis in animal models, and its
expression correlates with metastasis and poor patient outcome in some cancers
- it is therefore considered a target for novel anti-cancer therapeutics. The
definition of the structure of the complex of VEGF-D bound to its receptors
would be beneficial for design of inhibitors of VEGF-D signaling aimed at
restricting the growth and spread of cancer. In addition, there is interest in
using VEGF-D protein for therapeutic angiogenesis and lymphangiogenesis in the
settings of cardiovascular diseases and lymphedema, respectively. However,
VEGF-D has proven difficult to express and purify in a highly bioactive form
due to a tendency to exist as monomers rather than bioactive dimers. Here we
describe a protocol for expression and purification of mature human VEGF-D, and
a mutant thereof with reduced glycosylation, potentially suitable for
preclinical therapeutic and structural studies, respectively. The degree of
glycosylation in mature VEGF-D was reduced by eliminating one of the two
N-glycosylation sites, and expressing the protein in Lec3.2.8.1 cells which had
reduced glycosylation capacity. Mature VEGF-D and the glycosylation mutant were
each enriched for the biologically active dimeric form by optimizing the
separation of dimer from monomer via gel filtration, followed by conversion of
remaining monomers to dimers via treatment with cysteine. The glycosylation
mutant of VEGF-D intended for structural studies preserved all the cysteine
residues of mature VEGF-D, in contrast to previous structural studies,
exhibited comparable receptor binding to mature VEGF-D and might facilitate
structural studies of the VEGF-D/VEGFR-3 complex.
Copyright © 2012.
Published by Elsevier Inc.
PMID:
22261343 [PubMed - as supplied by publisher]
J Surg Oncol. 2012 Jan 18. doi:
10.1002/jso.23048. [Epub ahead of print]
Extensive
nodal involvement increases the positivity of blue nodes in the axillary
reverse mapping procedure in patients with breast cancer.
Rubio IT, Cebrecos I, Peg V, Esgueva A, Mendoza C, Cortadellas T, Cordoba O, Espinosa-Bravo M, Xercavins J.
Source
Breast Surgical
Unit, Breast Cancer Center, Department of Gynecology, Hospital Universitario
Vall d'Hebron, Barcelona, Spain. [email protected].
Abstract
BACKGROUND:
The axillary
reverse mapping (ARM) technique has been proposed to prevent arm lymphedema. We
conducted this study to assess the feasibility of the technique and the
outcomes of patients with neoadjuvant chemotherapy (NAC).
METHODS:
From July 2009 to
May 2010, a prospective study was performed in 36 patients with breast cancer
undergoing an ALND. The ARM technique was performed injecting 3 cm(3) of Patent
Blue in the ipsilateral arm. Of the 36 patients, 29 patients received NAC
previously to the ARM and 7 patients had an ALND and ARM performed as first
treatment for positive axillary nodes.
RESULTS:
The
identification rate of blue nodes was 83.3% (30 patients). Sentinel lymph node
(SLN) was performed in 15 of 29 (42%) patients in the NAC group. Of these 15,
two patients (13%) had a concordance between the blue and the hot node. Blue
nodes were positive in 4 (13%) of the 30 patients.
CONCLUSIONS:
The ARM technique
is feasible in patients undergoing NAC. Patients with extensive nodal
involvement have increased risk of having positive blue nodes. More studies are
needed to assess the subgroup of patients with positive axilla that may have
the blue node spared without compromising the oncological treatment. J. Surg.
Oncol © 2012 Wiley Periodicals, Inc.
Copyright © 2012
Wiley Periodicals, Inc.
PMID:
22258666 [PubMed - as supplied by publisher]
Pediatr Dermatol. 2012
Jan;29(1):113-4. doi: 10.1111/j.1525-1470.2011.01686.x.
Localized
xanthomas associated with primary lymphedema.
Romaní J, Luelmo J, Sáez A, Yébenes M, Sábat M, Fernández-Chico N, Pifarré M, García D, Muñoz C.
Source
Department of
Dermatology, Hospital Parc Taulí, Sabadell, Barcelona, Spain Department of
Pathology, Hospital Parc Taulí, Sabadell, Barcelona, Spain.
Abstract
Cutaneous
xanthomas arising in chronic lymphedema are rare. We present a case of
verruciform xanthoma involving the left foot and toes of a 10-year-old boy who
had developed a primary lymphedema (lymphedema praecox) in the left lower
extremity. Laboratory studies demonstrated a normal lipid profile.
© 2012 Wiley
Periodicals, Inc.
PMID:
22256994 [PubMed - in process]
January
27, 2012
Circulation. 2012 Jan 24. [Epub
ahead of print]
9-Cis
Retinoic Acid Promotes Lymphangiogenesis and Enhances Lymphatic Vessel
Regeneration: Therapeutic Implications of 9-Cis Retinoic Acid for Secondary
Lymphedema.
Choi I, Lee S, Chung HK, Lee YS, Kim KE, Choi D, Park EK, Yang D, Ecoiffier T, Monahan J, Chen W, Aguilar B, Lee HN, Yoo J, Koh CJ, Chen L, Wong AK, Hong YK.
Source
1 University of
Southern California Keck School of Medicine, Los Angeles, CA;
Abstract
BACKGROUND:
The lymphatic
system plays a key role in tissue fluid homeostasis and lymphatic dysfunction
due to genetic defects or lymphatic vessel obstruction can cause lymphedema,
disfiguring tissue swellings often associated with fibrosis and recurrent
infections without available cures to date. In this study, retinoic acids (RAs)
were determined to be a potenttherapeutic agent that is immediately applicable
to reduce secondary lymphedema.
METHODS
AND RESULTS:
We report that
RAs promote proliferation, migration and tube formation ofcultured lymphatic
endothelial cells (LECs) by activating FGF-receptor signaling. Moreover, RAs
control the expression of cell-cycle checkpoint regulators such as p27(Kip1),
p57(Kip2) and the aurora kinases through both an Akt-mediated non-genomic
action and a transcription-dependent genomic action that is mediated by Prox1,
a master regulator of lymphatic development. Moreover, 9-cisRAwas found to
activate in vivo lymphangiogenesis in animals based on mouse trachea, matrigel
plug and cornea pocket assays. Finally, we demonstrate that 9-cisRA can provide
a strong therapeutic efficacy in ameliorating the experimental mouse tail
lymphedema by enhancing lymphatic vessel regeneration.
CONCLUSIONS:
These in vitro
and animal studies demonstrate that 9-cisRA potently activates
lymphangiogenesis and promotes lymphatic regeneration in an experimental
lymphedema model, presenting it as a promising novel therapeutic agent to treat
human lymphedema patients.
PMID:
22275501 [PubMed - as supplied by publisher]
Circulation. 2012 Jan 24. [Epub
ahead of print]
Lymphangiogenesis:
A Potential New Therapy for Lymphedema?
Cooke JP.
Source
Stanford
Cardiovascular Institute, Stanford, CA.
Abstract
At the level of
the capillaries, the systemic circulation loses about 2-4 liters of fluid and
about 100g of protein into the interstitium daily. This ultrafiltrate of the
systemic capillaries is returned to the circulatory system by the lymphatics.
The lymphatic vasculature is highly specialized to perform this service,
beginning with the blind-ended lymphatic capillaries. These vessels are highly
permeable to protein, fluid and even cells, due to fenestrations in their
basement membrane, and discontinuous button-like junctions rather than tight
intercellular junctions as observed in the systemic capillaries(1). The
lymphatic capillaries merge into collectors and larger lymphatic conduits that
are invested with vascular smooth muscle (capable of contracting and propelling
lymph forward) and valves for unidirectional flow. These conduits merge at
lymph nodes, delivering antigens to the immune cells and serving as an early
warning system of pathogen invasion. The lymph nodes drain into conduits that
ultimately merge into the thoracic duct which empties into the left subclavian
vein. (SELECT FULL TEXT TO CONTINUE).
PMID:
22275500 [PubMed - as supplied by publisher]
Breast Cancer Res Treat. 2012
Jan 24. [Epub ahead of print]
Ipsilateral
hemodialysis access after axillary dissection for breast cancer.
Olsha O, Goldin I, Man V, Carmon M, Shemesh D.
Source
Department of
Surgery, Shaare Zedek Medical Center, P.O. Box 3235, 91031, Jerusalem, Israel,
[email protected].
Abstract
Breast cancer
survivors who have had axillary lymph node dissection (ALND) and who later
develop end-stage renal failure may eventually require hemodialysis access. If
veins available for access in the contralateral arm have been exhausted,
especially after chemotherapy, the ipsilateral arm will have to be considered
for access construction. There are no evidence-based guidelines for lymphedema
prevention, but there are sweeping recommendations to avoid physical injury to
the ipsilateral limb, including needle puncture, after ALND with or without
radiotherapy. Three studies have shown little or no effect of hand surgery in
producing or exacerbating lymphedema after ALND. Dialysis access guidelines
recommend the use of autogenous accesses over synthetic grafts whenever
possible. Three patients after ALND were referred for hemodialysis access
construction in our center. Pre-operative duplex ultrasound confirmed that
patent veins appropriate for autogenous access construction were only present
in the ipsilateral arm. Autogenous arteriovenous fistulas were constructed in
the ipsilateral arm in the three patients. All the three entered our access
surveillance program and were regularly examined. All had more than 20 lymph
nodes removed. One had axillary radiotherapy and anthracycline-based
chemotherapy, one had anthracycline-based chemotherapy without axillary
radiotherapy and one had neither treatment. The access was established 4-10
years after ALND. No patient developed significant lymphedema at two, 20 and 76
months respectively after access construction, with cannulation for dialysis
occurring three times a week. Autogenous hemodialysis access construction does
not seem to contribute to lymphedema development after ALND. Physicians and
other medical personnel caring for patients with breast cancer should not
oppose the use of the ipsilateral arm if it is the only arm with vasculature
suitable for autogenous access construction. Recommendations for lymphedema
prevention may exaggerate the extent of risk attributable to interventions in
the ipsilateral arm.
PMID:
22270939 [PubMed - as supplied by publisher]
Am J Med. 2012
Feb;125(2):134-40.
Current
views on diagnostic approach and treatment of lymphedema.
Murdaca G, Cagnati P, Gulli R, Spanò F, Puppo F, Campisi C, Boccardo F.
Source
Department of
Internal Medicine, University of Genova, Genova, Italy.
Abstract
Lymphedema is a
chronic, progressive, and often debilitating condition. Primary lymphedema is a
lymphatic malformation developing during the later stage of lymphangiogenesis.
Secondary lymphedema is the result of obstruction or disruption of the
lymphatic system, which can occur as a consequence of tumors, surgery, trauma,
infection, inflammation, and radiation therapy. In this review, we report an
update upon the diagnostic approach and the medical and surgical therapy for
both primary and secondary lymphedema.
Copyright © 2012
Elsevier Inc. All rights reserved.
PMID:
22269614 [PubMed - in process]
J Miss State Med Assoc. 2011
Oct;52(10):307-9.
Neu-Laxova
syndrome: a prenatal diagnosis.
Dhillon P, Bofill JA.
Source
Division of
Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of
Mississippi Medical Center, Jackson. 39216, USA.
Abstract
Neu-Laxova
syndrome is a rare autosomal recessive congenital disorder. Prenatal diagnosis
is possible via second trimester ultrasonography. Characteristic ultrasound
findings include hydramnios, severe intrauterine growth restriction,
craniofacial and CNS anomalies, limb contractures, skin lymphedema, skin
restrictions, and akinesia. Fewer than 70 cases have been reported, and no
survival beyond six months of age is known with most neonatal deaths occurring
within the first few days of life. Overall, this is a lethal condition after
birth secondary to severe lung hypoplasia and brain anomalies. Herein we report
a recent case from our institution with prenatal diagnosis.
PMID:
22268252 [PubMed - in process]
January
31, 2012
Eur J Vasc Endovasc Surg. 2012
Jan 24. [Epub ahead of print]
Net
Effect of Lymphaticovenous Anastomosis on Volume Reduction of Peripheral
Lymphoedema after Complex Decongestive Physiotherapy.
Maegawa J, Hosono M, Tomoeda H, Tosaki A, Kobayashi S, Iwai T.
Source
Department of
Plastic and Reconstructive Surgery, Yokohama City University Hospital, 3-9
Fukuura Kanazawa-ku, Yokohama 236-0004, Japan.
Abstract
OBJECTIVE:
The results of
reported lymphaticovenous anastomoses include some effects of complex
decongestive physiotherapy (CDP). The present study aimed to determine the net
effect of lymphaticovenous side-to-end anastomosis (LVSEA) in patients with
lower limb lymphoedema treated by preoperative CDP.
DESIGN:
Retrospective
observational study.
MATERIALS:
37 LVSEAs in 31
patients.
METHODS:
Volumes of the
thigh and leg with oedema were compared between the time of initial
examination, and before (application of CDP) and after LVSEA. The patients were
divided into two groups based on the number of anastomoses and
lymphoscintigraphic findings.
RESULTS:
Preoperative CDP
resulted in a reduction of 593 ml (both leg and thigh; p < 0.001). After
CDP, LVSEA (1-8 anastomoses; average of 5) reduced the volume by 109 ml (52 ml
for the thigh (p = 0.01) and 57 ml for the leg (p = 0.002)). There was no
significant difference in volume reduction on lymphoscintigraphy. Volume was
significantly reduced (by 55 ml in the thigh, p = 0.049; 96 ml in the leg, p =
0.006) in the group that underwent 6-8, but not 1-5 LVSEAs.
CONCLUSIONS:
The net effect of
LVSEA on volume reduction was confirmed, but was not particularly large. The
need for CDP decreased in some patients postoperatively, and these patients
should be considered for evaluation.
Copyright © 2012
European Society for Vascular Surgery. Published by Elsevier Ltd. All rights
reserved.
PMID:
22280803 [PubMed - as supplied by publisher]
February
3, 2012,
Indian J Cancer. 2011
Oct;48(4):397-402.
Comprehensive
decongestive therapy in postmastectomy lymphedema: An Indian
perspective.
Randheer S, Kadambari D, Srinivasan K, Bhuvaneswari V, Bhanumathy M, Salaja R.
Source
Department of
Surgery, JIPMER, Puducherry, India.
Abstract
Background:
Lymphedema following breast cancer treatment is one of the most morbid
conditions affecting breast cancer survivors. Currently, no therapy completely
cures this condition. Comprehensive Decongestive Therapy (CDT), a novel
physiotherapeutic method offers promising results in managing this condition.
This therapy is being widely used in the West. Till date, there are no studies
evaluating the effectiveness and feasibility of this therapy in the east.
Materials and Methods: The therapeutic responses of 25 patients with
postmastectomy lymphedema were analyzed prospectively in this study. Each
patient received an intensive phase of therapy for eight days from trained
physiotherapists, which included manual lymphatic drainage, multi layered
compression bandaging, exercises, and skin care. Instruction in self management
techniques were given to the patients on completion of intensive therapy. The
patients were followed up for three months. Changes in the volume of the
edematous limb were assessed with a geometric approximation derived from serial
circumference measurements of the limb and by water displacement volumetry.
Changes in skin and sub cutis thickness were assessed using high frequency
ultrasound. Results: The reduction in limb volume observed after therapy was
32.3% and 42% of the excess, by measurement and volumetry, respectively. The
maximum reduction was obtained after the intensive phase. The reduction in skin
and subcutis thickness of the edematous limb followed the same pattern as
volume reduction. Patients could maintain the reduction obtained by strictly
following the protocols of the maintenance phase. Conclusions: CDT combined
with long-term self management is effective in treating post mastectomy
lymphedema. The tropical climate is a major factor limiting the regular use of
bandages by the patients.
PMID:
22293250 [PubMed - in process]
J Cult Divers. 2011
Winter;18(4):126-8.
Nursing
education on lymphedema self-management and self-monitoring in a South African
oncology clinic.
Dine JL, Austin MK, Armer JM.
Source
Sinclair School
of Nursing, University of Missouri, USA.
Abstract
Breast cancer is
the leading cause of cancer in South African women. Without comprehensive
national and provincial breast health programs, survivorship issues are in need
of being addressed. Lymphedema secondary to breast cancer treatment (BCLE) is
one of the most physically and psychologically devastating outcomes of
treatment. Nurses at a South African oncology clinic educated survivors with
BCLE in cost-effective self-management and self-monitoring techniques. The
purpose of this paper is to describe these techniques and their relevance to
diverse South African survivors. A case study analysis was performed. The need
for cost-effective survivorship programs is discussed.
PMID:
22288209 [PubMed - in process]
Breast Cancer Res Treat. 2012
Jan 29. [Epub ahead of print]
Upper
limb progressive resistance training and stretching exercises following surgery
for early breast cancer: a randomized controlled trial.
Kilbreath SL, Refshauge KM, Beith JM, Ward LC, Lee M, Simpson JM, Hansen R.
Source
Faculty of Health
Sciences, University of Sydney, P.O. Box 170, Lidcombe, Sydney, NSW, 1825,
Australia, [email protected].
Abstract
The aim of this
study was to determine whether an exercise program, commencing 4-6 weeks
post-operatively, reduces upper limb impairments in women treated for early
breast cancer. Women (n = 160) were randomized to either an 8-week exercise
program (n = 81) or to a control group (n = 79) following stratification for
axillary surgery. The exercise program comprised a weekly session and home
program of passive stretching and progressive resistance training for shoulder
muscles. The control group attended fortnightly assessments but no exercises
were provided. The primary outcome was self-reported arm symptoms derived from
the EORTC breast cancer-specific questionnaire (BR23), scored out of 100 with a
low score indicative of fewer symptoms. The secondary outcomes included
physical measures of shoulder range of motion, strength, and swelling (i.e.,
lymphedema). Women were assessed immediately following the intervention and at
6 months post-intervention. The change in symptoms from baseline was not
significantly different between groups immediately following the intervention
or at 6 m post-intervention. The between group difference immediately following
the intervention was 4 (95% CI -1 to 9) and 6 months post-intervention was 4
(-2 to 10). However, the change in range of motion for flexion and abduction
was significantly greater in the exercise group immediately following the
intervention, as was change in shoulder abductor strength. In conclusion, a
supervised exercise program provided some, albeit small, additional benefit at
6 months post-intervention to women who had been provided with written
information and reminders to use their arm. Both the groups reported few
impairments including swelling immediately following the intervention and 6
months post-intervention. Notably, resistance training in the post-operative
period did not precipitate lymphedema.
PMID:
22286332 [PubMed - as supplied by publisher]
Am J Hum Genet. 2012 Jan 24.
[Epub ahead of print]
Mutations
in KIF11 Cause Autosomal-Dominant Microcephaly Variably Associated with
Congenital Lymphedema and Chorioretinopathy.
Ostergaard P, Simpson MA, Mendola A, Vasudevan P, Connell FC, van Impel A, Moore AT, Loeys BL, Ghalamkarpour A, Onoufriadis A, Martinez-Corral I, Devery S, Leroy JG, van Laer L, Singer A, Bialer MG, McEntagart M, Quarrell O, Brice G, Trembath RC, Schulte-Merker S, Makinen T, Vikkula M, Mortimer PS, Mansour S, Jeffery S.
Source
Medical Genetics
Unit, Biomedical Sciences, St. George's University of London, London SW17 0RE,
UK.
Abstract
We have
identified KIF11 mutations in individuals with syndromic autosomal-dominant
microcephaly associated with lymphedema and/or chorioretinopathy. Initial
whole-exome sequencing revealed heterozygous KIF11 mutations in three
individuals with a combination of microcephaly and lymphedema from a
microcephaly-lymphedema-chorioretinal-dysplasia cohort. Subsequent Sanger
sequencing of KIF11 in a further 15 unrelated microcephalic probands with
lymphedema and/or chorioretinopathy identified additional heterozygous
mutations in 12 of them. KIF11 encodes EG5, a homotetramer kinesin motor. The
variety of mutations we have found (two nonsense, two splice site, four
missense, and six indels causing frameshifts) are all predicted to have an
impact on protein function. EG5 has previously been shown to play a role in
spindle assembly and function, and these findings highlight the critical role
of proteins necessary for spindle formation in CNS development. Moreover,
identification of KIF11 mutations in patients with chorioretinopathy and
lymphedema suggests that EG5 is involved in the development and maintenance of
retinal and lymphatic structures.
Copyright © 2012
The American Society of Human Genetics. Published by Elsevier Inc. All rights
reserved.
PMID:
22284827 [PubMed - as supplied by publisher]
Rev Esp Anestesiol Reanim. 2010
Dec;57(10):678.
[Giant
lymphedema-elephantiasis of the right leg].
[Article
in Spanish]
Fernández Jurado MI, Martínez Mezo G, Castilla Moreno M.
Source
Servicio de
Anestesiología y Reanimación, Hospital Regional Universitario Carlos Haya,
Málaga.
PMID:
22283026 [PubMed - in process
MED
NEWS DOCS:
February
1, 2012
UCSB Researchers Discover The
Processes Leading To Acute Myeloid LeukemiaResearchers at UC Santa Barbara have
discovered a molecular pathway that may explain how a particularly deadly form
of cancer develops. The discovery
may lead to new cancer therapies that reprogram cells instead of killing them.
The findings are published in a recent paper in the Journal of Biological
Chemistry.
The UCSB research team described how a certain mutation in
DNA disrupts cellular function in patients with acute myeloid leukemia (AML).
The researchers were prompted to study this process by another research team's
discovery that AML patients have a mutation in a certain enzyme, which was
reported in the New England Journal of Medicine. The enzyme is a protein called
DNMT3A, which leads to changes in how the DNA of AML patients is methylated, or
"tagged." Norbert Reich, professor in the Department of Chemistry and
Biochemistry at UCSB, was already studying that particular enzyme with his
research group, so they began to study the disease process of AML at the
cellular level.
Reich explained that tagging is a way of reading DNA at
the cellular level. This falls within an area of study called epigenetics, a
process that occurs "on top" of genetics. Each person has approximately 200
types of cells, all with the same DNA, and these must be controlled in
different ways. "There is an enzyme - a protein - that tags DNA and controls
which of the genes in your cells, your DNA, gets turned on and off," said
Reich. "So you have 20,000 genes, and you have to control them differently in
your brain than in your liver."
Reich explained that there is current
interest in this broader field of epigenetics as a direction for the treatment
of cancer. "There's definitely the idea that this may be a new way of
developing therapeutics, because you don't have to kill the cancer cell," said
Reich. "Almost every cancer therapy that's out there works on the principle
that a cancer cell needs to be killed."
With epigenetics, instead of
only having DNA sequence coding for certain genes, there is an epigenetic
process, with another layer of information on top of the genetic process. In
this case, that information is the tagging by the methyl groups.
"If
you really think about it, this is part of the answer as to how your cells can
be so different and yet they all have the same DNA," said Reich. "You have the
same genome in every one of your cells, but you do not have the same epigenome,
which is basically the methylation pattern, the tagging pattern. That is
different in every type of your cells. And the way this relates back to cancer,
with leukemia, in those patients, the
tagging is messed up. The patterns are not correct. Our big contribution to
that is we've explained how the mutations in the enzyme could lead to that
disruption of the tagging pattern."
The UCSB group developed a test to
demonstrate that the mutant enzymes in AML can only work on DNA for short
distances. As a result, the precise methylation patterns of a healthy cell are
disturbed, resulting in genes being turned on at the wrong place and time,
which in turn can initiate the growth of cancerous cells.
The team
found that the mutation AML patients have causes a certain complex of four
proteins to be disrupted. "The surprise was that the disruption doesn't stop
the enzyme from being active; it doesn't stop the enzyme from tagging the DNA,"
said Reich. "Instead, it stops the way it can do it. Instead of going to your
DNA and tagging an entire region of chromosome, it goes there, does one thing,
and leaves. That process, that change, is what we see in the AML patients. So
we think we have a molecular explanation for this disease."
Reich said
that the currently prescribed drug Vidaza works by affecting the
same enzyme that is mutated in AML. There is interest in the pharmaceutical
industry in developing other therapeutics to target the enzymes responsible for
tagging the DNA. These epigenetic inhibitors would reprogram rather than kill
the cell.
Traditional cancer therapies use radiation and chemotherapy to
remove or kill cancer cells. "The problem with that is that cancer cells are
often very subtly different from normal cells," said Reich. "So you have one of
the most difficult therapeutic challenges known to man, which is to distinguish
between two human cells - one that's cancerous and one that's not. Instead of
killing the cell, the notion is that if you could just reprogram the cell, then
it goes back to being normal. You intercept the cancer development. This is
still an aspiration; it hasn't been achieved really, but that's what attracts
people to the field of epigenetic-based therapies, because of the prospect of
not having to kill cells."
Celeste Holz-Schietinger and Douglas Matje,
both graduate students working in the Reich lab, are the first and second
authors of the paper.
February 6, 2012
Local groups stepping in after national cancer charity
changes support - Scranton Times-Tribune –by
Erin L. NissleyErin L. Nissley –
After
a national group that helps cancer patients around the country announced it
would be scaling back support of certain programs, local organizations have
been gearing up to fill the gaps.
In
late November, the American Cancer Society sent a letter to local groups
informing them that, as of Jan. 1, it would "no longer provide financial
assistance for wigs, medications, durable medical equipment, lymphedema
supplies or lodging."
Jo-Anne
Sessa, ACS regional vice president, said there are no plans to completely cut
programs, including those that provide cancer patients with wigs and help out
with lodging while they undergo treatment.
She
added, though, that ACS is focusing its resources on areas "where we can make
the most impact," including providing patients with transportation and mileage
reimbursement to and from appointments.
"We've
identified access as the biggest issue across the country," Ms. Sessa said. "In
this economy, it is more challenging (to raise money) and every organization
has to focus their resources."
The
changes to ACS programs will mean cancer patients will depend even more on
local groups for help, said Northeast Regional Cancer Institute President
Robert Durkin. Like many local groups, Northeast Regional Cancer Institute has
suffered deep funding cuts - including the loss of about $1 million a year in
state funding - that makes it difficult to fulfill the needs of cancer patients
in the community, especially when a major resource like ACS makes a decision to
cut support for certain programs.
"We're
local, so we base our resources on what the needs are in the community," Mr.
Durkin said, pointing out that local donations made to ACS do not necessarily
stay in the community.
The
region is lucky to have resources that can help cancer patients, especially a
group like Northeast Regional Cancer Institute, said Dr. Harmar Brereton, a
radiation oncologist at Northeast Radiation Oncology Center.
"The
psychological profundity of having cancer is a really big deal" and cancer
patients need help in a variety of ways, Dr. Brereton said. "It is harder for
all groups to raise funds. We need to get the word out that local groups are
here taking care of these needs, but they need help to do it."
Connecting
cancer patients to resources both local and national is part of the job
description for Kathryn Cramer, an oncology social worker at Northeast
Radiation Oncology Center.
"We
never let anyone do without," she said. "There are programs that can help
patients with medication costs. We can go through churches, the Salvation Army
and the American Cancer Society."
Delta
Medix, which offers treatment for cancer patients, launched a nonprofit
foundation on Oct. 1 that will help cancer patients throughout the region,
regardless of where they obtain treatment. Delta Medix CEO Margo Opsasnick sees
the main focus of the foundation as helping cancer patients with the costs of
genetic testing, which can help with treatment plans for breast cancer patients
and covering co-pays and treatments not covered by insurance. She also hopes
the foundation can focus on helping with smaller needs, like hiring a maid to
help with housework.
"Most
breast cancer patients have to undergo chemotherapy and radiation," she said.
"Wouldn't it be nice for them to come home to a clean house?"
Both
Mrs. Opsasnick and Mr. Durkin said ACS's decision to scale back certain
programs was strange, especially because it came around the same time the group
sent a letter asking a local group to suspend an annual gala fundraiser that
generated tens of thousands of dollars for the charity.
Earlier
this month, ACS officials told The Times-Tribune they made a decision to do
away with Scranton's Ball of Hope after looking at rising costs of the event
and the dip in amount of money raised. October's Ball of Hope cost about
$28,000 and raised about $70,000, according to Erik McGaughney, the American
Cancer Society's income development director for the eastern region of
Pennsylvania.
The
2010 Ball of Hope raised $100,000 and cost about $16,000, he said in previous
interviews. Much of the funds raised went to support a summer camp in Lebanon
County for children with cancer and siblings of children with
cancer.
"It
is certainly puzzling," Mr. Durkin said.
Mrs.
Opsasnick agreed, pointing out that a local group of volunteers organized the
Ball of Hope each year.
"That
group didn't ask for anything from ACS," she said. "Why would you ever turn
down money when you're out there trying to do good things for cancer
patients?"
Contact
the writer: [email protected]
February
7, 2012
SJH RehabCare opens another
location - Vineland Daily Journal –
HARRISON
– South Jersey Healthcare Sports RehabCare, an outpatient orthopedic
rehabilitation provider, recently opened its newest location in Mullica Hill at
201 Tomlin Station Road.
The
facility offers sports and orthopedic physical therapy, occupational therapy,
spine care, worker’s compensation services and lymphedema
services.
The
facility incorporates the Nintendo Wii to enhance participation in therapy
treatment.
“Mullica
Hill ... .is a thriving community, and the staff at SJH Sports RehabCare at
Tomlin Station Park look to continue our commitment to improve the quality of
lives of our patients, and residents in the communities we serve,” said Debbie
Franceschini, director of SJH RehabCare Services.
The
facility has two new staff members:
Kristy
Meade, MSPT, ATC has more than 10 years clinical experience and will oversee
SJH Sports RehabCare. Her special interests include post-surgical patients,
athletic injuries, body mechanics and postural education, with a specialty
focus on trends in ACL rehabilitation.
Victoria
Rink, OTR/L, CHT, is the OT clinical coordinator for all inpatient and
outpatient facilities and SJH Sports RehabCare locations. Rink is a certified
hand therapist with more than 17 years of experience treating upper extremity
disorders.
For more
information, contact SJH Sports RehabCare at (856) 241-2533 or [email protected]. SJH RehabCare
and SJH Sports RehabCare have five convenient locations serving South
Jersey.
February 8,
2012
PolyGel Portable Device for DVT Therapy Helps Patients
Be Compliant After surgery – SBWire –
Tampa, FL
-- (SBWIRE) -- 02/08/2012 -- Major
surgical procedures are events where medical staff must be reminded that
certain patients can be at higher risk for deep vein thrombosis and venous
thromboembolism. Postphlebitic syndrome and pulmonary embolisms can occur in
the hours, days, and weeks after a surgery. An article on Medscape recently
highlighted how prophylaxis with medication and mechanical devices is
critical.
“Each patient must be assessed case-by-case, but the article
‘Deep Venous Thrombosis Prophylaxis in Orthopedic Surgery’ shows that DVT
therapy helped reduce DVT by 60 percent,” said Greg Grambor, president of
Vascular PRN, a company that fills prescriptions for sequential compression devices
and intermittent pneumatic devices for healthcare professionals
nationwide.
The authors of the Medscape article showed that passive
devices such as TED hose and active devices like IPC devices or venous foot
pumps lessened the chance of DVT and did not add the risk of bleeding. Mechanical compression devices
helped to improve blood flow and circulating fibrinolysins. Patient compliance
and efficacy are the most important factors that medical professionals want out
of devices.
“The latest technology is a PolyGel portable device that is
only one pound, the size of a small book, and works off battery power,” said
Grambor. “In the hours after surgery or for at-home care after leaving the
hospital, the PolyGel Ca5 DVTCare System provides the best
compliance.”
The PolyGel portable device lasts for 15 hours when used
for single leg therapy and 8 hours for both legs. Since it is carried over the
shoulder in a compact case, patients can go from their hospital bed, down the
hall to physical therapy, and move about their home when healing in the weeks
after a surgery. The PolyGel’s two segmented cuffs wrap comfortably around the
leg to promote blood flow.
“The PolyGel is super simple to put on the
patient and effortless to keep on the patient,” said Grambor. “You don’t have
to worry about the patient being hooked up to a power source or what happens
when they go to the bathroom.”
And when the PolyGel device needs to be
cleaned, it can be done with mild soap and a washcloth, and it can be charged
in an outlet once the 8 to 15 hours of use is up. It continues to operate while
charging, providing for totally uninterrupted therapy during those critical
post surgery hours.
Vascular PRN has decades of experience helping
nursing homes, surgery centers and hospitals, managed care organizations, and
other institutions with their DVT product needs. To learn more about the
PolyGel portable device, Sequential Compression Devices, IPC devices, or
Lymphedema boots visit http://www.vascularprn.com/ or
call 800.886.4331.
February 8,
2012
ImpediMed L-Dex® U400 device receives expanded U.S.
coverage - Proactive Investors Australia –
ImpediMed’s (ASX:
IPD) L-Dex® U400 device will receive greater coverage in the U.S. as an aid in
the clinical assessment of unilateral lymphoedema of the arm in females,
following the passing of the Patient Protection and Affordable Care
Act.
As a result of the passing of the Act, which makes certain
indigenous tribes and organisations eligible to access the health plans for
federal employees, ImpediMed expects an increase in covered lives for federal
healthcare plans from 1 May 2012.
The estimated number of employees of
indigenous tribes or organisations who are eligible to access federal health
plans is about 350,000.
Direct family members of these employees are
also eligible and include spouse and children up to the age of 26.
As a
result, coverage under federal plans could be expected to increase by an
estimated 700,000 covered lives.
Lymphoedema occurs when the lymphatic
system does not work properly, resulting in the long-term swelling of parts of
the body.
Stanford
Breast Cancer Lymphedema Registry
Meanwhile, the first patient
has been enrolled into the Stanford Breast Cancer Lymphedema
Registry.
Stanford University Medical Center initiated the registry
which will collect and analyse data from breast centres and physicians’ offices
across the U.S.
The registry collects clearly defined health and
demographic information on patients with specific health characteristics, in
this case, breast cancer.
The Stanford Breast Cancer Lymphedema Registry
has been designed to investigate the impact of lymphoedema surveillance upon
breast cancer survivors.
Within a year, researchers expect to have
gained further substantial insights into the value of systematic early
surveillance to prevent and minimise the lymphoedema risk in women treated for
breast cancer.
Patient enrolment will increase in the coming months as
the registry is rolled out to physician sites.
Data generated from
ImpediMed’s L-Dex® U400 device will make-up one arm of the registry.
The
L-Dex® U400 device is the first medical device with a US Food and Drug
Administration clearance to aid health care professionals, clinically assess
secondary unilateral lymphoedema of the arm and leg in women and the leg in
men.
February 13,
2012
High Desert Pharmaceuticals gets boost from export
deal - Northern Nevada Business Weekly – by Rob Sabo –
An
overseas distribution agreement could bring a much-needed financial lift to
High Desert Pharmaceuticals.
The
small Reno company, founded in 2007, recently found a distributor to export the
company’s products to Belgium, Holland, Germany, Switzerland, Poland and
Israel. High Desert Pharmaceuticals has two primary products:
CompressionAssist, used by people who wear heavy compression stockings to
combat lymphedema, which causes painful swelling in the lower legs; and
GloveGlide, used by medical professionals and others who wear surgical gloves.
The products allow easy fitting and donning of compression stockings or of PVC,
nitrile, and latex gloves.
“We
are hoping that is a nice opener for us on a global scale,” says John Wyaux,
High Desert’s executive vice president. The company’s other principal, Dieter
Berndt, is a chemist who created, patented and trademarked the two products.
High Desert Pharmaceuticals won “Product of the Year” for 2009 by Caregiver.com
for CompressionAssist.
The
company’s products are manufactured at a small Carson City facility, while the
small bottles are labeled and boxed in China. Hoping to extend its reach, High
Desert has begun marketing CompressionAssist to schools that train medical
staff about lymphedema. Other potential sources of revenue include medical
offices, hospitals and hospices.
“The
three major lymphedema schools train 400 to 500 students each year, and 200
returning students each year, and those are our potential customers,” Wyaux
says.
For
GloveGlide, High Desert Pharmaceuticals is targeting workers who routinely use
surgical gloves, such doctors, mechanics, law enforcement and security
screeners at airports. Getting the word out about the products, finding the
right channels, and getting potential customers to spend money on a new product
have been major obstacles to widespread use, Wyaux says.
“Given
the state of the economy, we have had to be resourceful,” he says.
Last
year was the first in which High Desert Pharmaceuticals posted a modest profit,
Berdt says. The company has been self-funded since its inception. However, in
order to advance the company’s products, High Desert Pharmaceuticals is seeking
project financing to attract new capital.
Berdt
says he came up the idea to create a donning lubricant after taking his wife to
a doctor’s appointment and watching a nurse struggle to put on latex gloves. He
had extensive experience working with silicone-based products, so he began
experimenting with different types of lubricants. An added side effect he
stumbled across was an 80 to 90 percent reduction in sweat inside the
gloves.
New
products include a long-lasting surface wipe called NanoSept that uses
nanotechnology to counter bacteria, fungi and viruses.
“It
is nearly indefinite,” Berndt says. “It will virtually last forever, unless it
is abraded.”
Berndt
hopes to eventually place the small NanoSept wipes inside the packaging of
electronic devices such as cell phone and tablet computers so consumers can
permanently keep the surfaces of their electronics clean. Hospital settings,
and commercial uses such as keyboards and phones or escalator handrails are
other potential use for the wipes, Wyaux says.
Berndt
says High Desert Pharmaceuticals will commercially introduce the NanoSept wipes
this year, and he plans to establish a pilot program with the product at
several Washoe County schools later this year.
“It
has spectacular potential,” he says.
February 13,
2012
Actress Zina Bethune killed in
hit-and-run - Entertainment Weekly – by Lanford Beard –
Zina
Bethune, a 66-year-old actress and dancer, was fatally struck in a presumed
double hit-and-run when she stopped to help an injured animal, reports the
L.A. Times. Bethune
was a famed ballerina, who taught dance to disabled children for the last 30
years. She herself had overcome diagnoses of scoliosis and lymphedema before
training with George Balanchine and the New York City Ballet at age
14.
Though
she went by Zina Feeley in everyday life, she made her professional name (Zina
Bethune) in 1958 on The
Guiding Light and had roles on Santa
Barbara, Party
of Five, and the 1960s medical drama The
Doctors and the Nurses. She also choreographed for the 1987 TV
series Nutcracker:
Money, Madness & Murder.
Los
Angeles police are investigating the incident, which took place just after
midnight on Sunday. Bethune is believed to have stopped to check on an injured
animal when a car going the opposite direction hit her and threw her across the
intersection, when another car struck her and dragged her 200 yards. The blows
resulted in severe head injuries, and Bethune was pronounced dead at the scene.
Neither of the drivers who struck Bethune have been formally
identified.
February 15,
2012
Health Calendar: Week of Feb. 16,
2012- Daily Breeze – By Sandy
Geretydailybreeze.com
-
Saturday
Lymphedema
A to Z.
Cancer Support Community-Redondo Beach will host Steffy Trousdale, LVN, COF, to
discuss the signs, symptoms and treatment options for Lymphedema from 10 a.m.
to noon Saturday at 109 W. Torrance Blvd., Redondo Beach. Call 310-376-3550, or
visit www.cancersupportredondobeach.org.
February
15, 2012
Complications from breast cancer treatment should be
treated sooner, says UM-Flint researcher
- minbcnews.com - by Kevin Usealman –
FLINT -- A
University of Michigan researcher has concluded 11 years of study
on breast cancer complications. Cindy Pfizer is an associate director of
research in U of M Flint's physical therapy department. The study, which she
began in 2001 while in Washington is in conjunction with researchers at Walter
Reed National Military Medical Center and the National Institutes of Health
Clinical Center.
They say in their conclusion they found that early
diagnosis and treatment of breast cancer-related complications such as
lymphedema, can reduce costs by as much as $2,500 per patient as well as the
need for intensive rehabilitation.
The research team
developed a model for surveillance of complications that result from the
treatment of breast cancer, so they can be identified and treated before the
patient begins to notice problems. The other primary investigator in the study
was Ellen Levy, a researcher from the National Institutes of Health. Pfalzer
continues to aid in data analysis, database updating and manuscript generation
while at her position at UM-Flint.
February
17, 2012
Supporters rally for imprisoned Hash Bash organizer
from Royal Oak - Royal Oak Daily Tribune – By Catherine
Kavanaugh –
Imprisoned last
year following a drug raid at his Royal Oak house, Hash Bash organizer and
medical marijuana proponent Adam Brook has a growing base of supporters trying
to make his time behind bars more comfortable.
Brook, 43, is four months
into a two-year sentence after pleading guilty to two counts of possessing a
firearm while committing a felony.
He suffers from lymphedema, an
incurable condition that causes the legs and arms to swell and is often brought
by on cancer treatment. Brook had thyroid cancer.
“Adam is not a well
man,” said Melissa Griggs, who is selling “Free Adam Brook Now” T-shirts for $10
each to raise money for his prison store account. “His legs are swollen, the
skin is splitting open and he needs special pressurized wraps.”
Griggs
acknowledges Brook has no chance for an early release, parole or probation
because of the mandatory sentence for his firearm pleas.
However, she
said Brook is on a lot of peoples’ minds as plans are made for the 2012 Hash
Bash in Ann Arbor, where she also will sell the T-shirts.
Griggs said
she is among those who people believe Brook was singled out by Oakland County
law enforcement for being a marijuana activist.
“I believe they put him
in prison because of who he is,” Griggs said. “He’s a political prisoner. He
organized the Hash Bash for 20 years and he was the 1994 High Times freedom
fighter of the year.”
Griggs said Brook was at physical therapy when his
home was raided on Jan. 12, 2011.
Undercover police with the Oakland
County Narcotics Enforcement Team (NET) said they seized 600 grams of
marijuana, two handguns, a shotgun, a bullet-proof vest, marijuana candy, a
triple-beam scale, and a tally sheet with names and prices from Brook’s house
on Whitcomb Avenue. Continued...
Brook
was charged with violating drug and weapons laws. He once had a state-approved
medical marijuana card but it had expired and the 1.3 pounds of marijuana he
possessed exceeded the 2.5 ounces allowed to medical marijuana
patients.
Last October, Brook was sentenced to two years in prison after
pleading guilty to two counts of possessing a firearm while committing a
felony. He also pleaded no contest to one count each of delivery and/or
manufacture of marijuana and being a felon in possession of a firearm. His
prior felony conviction was for carrying a concealed weapon in the late
1980s.
Oakland Circuit Judge Rudy Nichols didn’t sentence Brook to any
time for the drug charge or being felon with a firearm. Brook is serving his
two years at the Parnell Correctional Facility, a minimum-security prison in
Jackson.
With the 41st annual Hash Bash set for April 7, a lot of people
are just finding out why Brook doesn’t have a lead role in its organization.
Griggs said she is selling donated T-shirts because people want to help him
until his Oct. 5, 2013, release date.
“Every cent of the money raised
will go to Adam’s commissary account so he can buy decent soap that doesn’t dry
out his skin, shampoo, and T-shirts so he isn’t cold,” Griggs said.
Her
effort is drawing attention to Brook’s case on social media. One Facebook
posting by a supporter says, “He’s in jail for an antique pistol…and a Normandy
Beach flak jacket from an American hero that landed on D-Day to save
Europe.”
Oakland County Prosecutor Jessica Cooper refuted that and
laughed at the notion Brook is a political prisoner.
“I have no idea who
he is,” she said.
Cooper said a black powder six-shot Fillipieta gun
found at Brook’s house was alleged to be antique but three other weapons also
were seized.
“The antique handgun is not an issue,” Cooper said. “They
neglect to talk about the .380 pistol filly loaded in the nightstand, a
Remington 1100 shot gun in the closet and a .357 next to a chair.” Continued...
Brook’s
supporters contend the firearms were legally registered to another person in
the household. However, Brook couldn’t be anywhere there was a gun because of
the prior felony conviction.
His supporters also say the 600 grams of
marijuana at the house were “used up” from a vaporizer process that lets people
inhale active cannabinoids while avoiding harmful smoke toxins.
Cooper
said marijuana was found in jars and bags and there was scale to measure out
quantities. Police also seized Vicodin and THC candy from Brook’s house, she
added.
“If we had prosecuted on all drug counts he could be doing two
years plus two years,” Cooper said.
Griggs said Brook accepted a plea
deal to protect his family from assets being seized. She is selling the “Free
Adam Brook Now” T-shirts for $10 each to people who buy them in person from her
but has to add packaging and shipping costs to mail orders.
February
17, 2012
Grey's Anatomy Doc Speak: What's a
Gliosarcoma? – Wetpaint – by
Dan Clarendon –
Tumors
and lymph nodes and mania, oh my! If all of the medical lingo from last night's
double-header has got your head spinning double-time, have no fear. We've got
you covered. Here's a recap of some of the conditions covered on last night's
episodes of
Grey's Anatomy and
Private
Practice.
Erica suffered from a gliosarcoma,
a rare, malignant, cancerous tumor formed by glial cells in the brain
(basically cells whose job it is to support the neural cells). These cancers
rarely spread outside of the brain, but they have been known to move to the
blood, lungs, liver, and lymph nodes.
Bailey's patient's arm was so
enlarged because she had lymphedema,
a drastic swelling in the arms or the legs caused by a block in
the
lymphatic system. The lymphatic system is responsible for
draining fluid from organs and incorporating that fluid back into the
bloodstream. When there is a blockage, this fluid will build up and create
swelling. The most common cause of lymphedema is the removal or damage of lymph
nodes through cancer treatment.
Sheldon diagnosed Sam's sister Corinne
with hypomania,
a form of bipolar disorder in which affected individuals will often have
intense and unpredictable feelings of euphoria and irritability. Individuals
with hypomania experience no psychotic symptoms associated with mania.
Hypomania usually manifests in a decreased need for sleep and a large amount of
energy, as well as an outgoing and competitive disposition. Individuals with
hypomania often live full-functioning lives because the condition can be
treated by mood-stabilizers and monitored closely by
psychiatrists.
February
19, 2012
Hospital Calendars for the Week of Feb.
19 - PennLive.com –
Tues
- Lymphedema Support Group: 6:30 pm, WellSpan Adams Health Center,
Room 211. Community Multiphasic Blood Screening Program (Inclement weather
make-up date)
February
19, 2012
Breast cancer patients gain strength, mobility,
confidence with better than before program - The
Bridgeton News - NJ.com - By
Lauren T. Taniguchi -
Women
battling breast cancer can regain strength, independence and self-confidence
with the guidance of Better Than Before, a rehabilitative fitness program on
DVD that demonstrates how post-surgery exercises should be performed to support
recovery.
The 50-minute program offers four stages of exercises to help
breast cancer patients safely stretch, achieve mobility and prevent
complications such as lymphedema after undergoing mastectomies, lumpectomies or
reconstructive surgeries.
“Most of what we try to do these days is to
get patients back into society, back into daily living, so they can do normal
activities and get back to their families and jobs,” said Dr. Peter Neumann, a
reconstructive plastic surgeon who gave direction during the program’s
development.
“Another aspect is that after surgery, nobody really deals
with the emotional problems of patients feeling they don’t have the ability to
do what they did before,” Neumann added. “By getting their strength back, they
feel better about themselves, and it prevents depression and family
unrest.”
The program was developed about 15 years ago, when patient Jill
Forrest and her trainer, Lauren Antorino Griffin, worked with Neumann to record
a demonstration of exercises to help women after surgery.
Forrest was a
teacher and outgoing proponent of education, and, though she has since passed
away, her husband, Ed, continues to reach out to breast cancer patients with
Neumann and Griffin in Jill’s memory.
Unfortunately, Neumann said
post-surgery rehabilitation resources in the health care industry are still
lacking, a decade and a half after the program was developed.
“Patients
are stuck, and half the things offered to them in the hospital they don’t
listen to because they’re still so nervous about their treatment,” Neumann
said.
“Most get a rubber ball to squeeze and information from their
friends or the Internet, but not all of that information has been
screened.”
However, Better Than Before has been distributed to fulfill
the great need at medical facilities around the United States and
Europe.
With physician approval, patients can start using Better Than
Before almost immediately following surgery, Neumann said.
“In the
beginning, there are stretching exercises that are safe ways to get mobility in
the arm. The second part is strengthening — using very light weights and/or
resistance to gain strength, especially in the biceps and triceps, as well as
through the pectorals of the chest to get strength back,” Neumann explained.
“The third portion is really for full mobility, all the daily living
activities you’d do as far as picking something off a top shelf or going into a
closet and twisting to pull out a specific shirt. The fourth is
maintenance.”
Neumann, a former member of the board of directors of a
division of the American Cancer Society, said a patient should consult with her
doctor before beginning this or any rehabilitative program. In addition,
patients should listen to their bodies and take care to do only what feels
right.
“We have found this program is completely safe, but if it doesn’t
feel good, maybe you’re not at that point yet. Don’t skip to the end; go
through the program slowly until you get the feeling and strength so you can
move to the next portion,” Neumann said.
Within three to four months of
exercise, most will have regained a significant measure of agility and
strength. Neumann said that by the maintenance stage of the program, most
patients have learned the exercises and begin doing them casually, even during
a morning shower, to stay strong and limber.
Better Than Before is
available for $19.99 online at breastcancerexercises.net, and a
third of all proceeds from DVD sales are donated to the American Cancer Society
to support efforts to find a cure for breast cancer.
“The DVD is all
ages and stages appropriate and is a perfect post-operative gift because better
than flowers, better than sympathy, give her Better Than Before,” wrote Ed
Forrest
February
20, 2012 –
The Week in Sonoma Valley, Feb.
20-26 - Santa Rosa Press Democrat –
Sorry
a one time meeting already passed
February
20, 2012
Lichen Sclerosus Exhibiting Histologic Signs of
Lymphedema: An- Archives of
Dermatology –
We
appreciate the interest of Carlson et al in our article on vulvar VX 1 as well
as their comment about the possible etiologic roles of lymphostasis and
...
You
have to be a member of some group to access this
February
23, 2012
Pinnacle Hand Therapy helps patients with movement,
more - Daily Press – By Phyllis Johnson –
"We take better care of our cars than we do our bodies. We know
that an engine will not last if we do not change the oil, yet we expect to get
years of use from our hands with no preventative care." — Pinnacle Hand
Therapy
The sign outside Pinnacle Hand Therapy LLC doesn't begin to describe
all of the medical services available inside the Middle Ground Boulevard
company
The 8-year-old practice offers hand therapy, lymphedema treatment,
wound care and pediatric therapy. Among the 10 employees, there are three
certified hand therapists and two certified lymphedema therapists who treat
swelling due to a blockage of the lymph passages.
Phyllis Ross, owner and an adjunct professor at Howard University's
Occupational Therapy Department, went into this line of work because she has a
passion for it. She decided to treat lymphedema after seeing breast cancer
survivors who had swelling problems. She gave them complete decongestive
therapy by using compression and massage. Patients use compression wraps and
garments, followed by wrapping at night. It's an ongoing process with measured
successes, something that makes it all worthwhile, she said.
"I love seeing people get better. It's gratifying to see their
progress," said Ross. "We evaluate their physical ability when they come in and
constantly compare it to the baseline to see how far they've
come."
Ross's previous line of work included serving time in the U.S. Navy
during Desert Storm and experience working in hospitals. She migrated back to
the Peninsula to be near family. It's been a good move for her, she said, and
she enjoys her work.
She also enjoys teaching students occupational therapy. "There's a
need for continuing education in the area of hand therapy."
Ross says people often take the things they normally do for granted.
When movement is impaired, there has to be treatment and therapy to bring
normal movement back.
"It's reassuring to a patient to see continued progress. It's a
measurable thing," she said.
A steady stream of people use the practice. There is a room where a
small number of people are getting therapy in a group setting.
"A new patient is able to come in and see someone else further along
in the same treatment and see how well they're doing. That's reassuring for a
new patient," she said.
One patient, Danny Engle of Hampton, showed where he had cut his hand
and later had surgery. Pinnacle Hand Therapy is helping restore motion to his
hand.
"This is the second place I've been for therapy. The staff is very
courteous and patient. They really take care of people here. I've never seen
anyone lose their patience. They're very flexible. Phyllis stayed late for
several hours recently to work with me. It means a lot," said Engle. "The staff
doesn't feel you owe them. They feel they owe you."
Another patient, Robert Raney of Suffolk, has been going to Pinnacle
practice since it opened in 2003. He comes for help with lymphedema and for
therapy for his arms and fingers. He requires special splints for two of his
fingers.
"I was one of her first patients," Raney said. "She gets me to
exercise to effectively help with therapy."
Ross has a good manner with the patients and staff. It's clearly a
place where patients feel right at home. "We often see local high school
athletes come in with injuries, too."
Her staff works with younger students as well when they have problems
with sensory processing, coordination, dyspraxia, motor skills and handwriting.
The practice offers training and hope. Physical activity and using
manipulatives are forms of treatment for motor skills. They use various
techniques for those with autism.
"We see a lot of children sent here from the Children's Hospital of
the King's Daughters who need hand therapy," said Ross. "We're happy to help
them."
Her plans for the future include the development of a continuing
education training course for therapists interested in hand therapy or
lymphedema therapy.
"We stay busy. Even on holidays, we have drop-ins come in for help,"
said Ross. "We're happy to assist people in restoring function so they can
return to whatever job, hobby or other activity they enjoy."
Company details
Pinnacle Hand Therapy
704 Middle Ground Blvd., Suite D, Newport News,
757-595-4880.
Hours: 8 a.m.-5 p.m. Monday through Friday.
The practice is accepting patients from Newport News, Hampton,
Yorktown, Seaford, Grafton, Langley Air Force Base, Fort Monroe and
Gloucester.
February
25, 2012,
Freeze column: Knee surgery -
Salisbury Post –
A
little over three months ago, I started to experience tightness in one of my
knees. On a few of my morning runs, that actually locked up. After a few more
days, I couldn’t climb steps with that left knee, and couldn’t pedal a bike
either. Climbing a ladder was definitely out.
My
two favorite physical therapists offered advice. Drs. Delaine Fowler and Pam
Roseman had some ideas, and we tried a few things.
Delaine,
who owns Fowler Physical Therapy, and Pam, owner of Lymphedema Solutions
Physical Therapy, are both experienced runners. They suggested that I get an
opinion from Dr. Robert Humble, an orthopedic surgeon with a reputation for
getting athletes back on the road quickly.
The
idea of surgery didn’t appeal to me, but something had to happen. Other runners
offered opinions, with most thinking I couldn’t run for a minimum of 14 days
and possibly as much as a month after the surgery.
I
did go to Salisbury Orthopedics Associates and met with Dr. Humble. He and
Physician’s Assistant Ryan Schenk and staff told me what to expect, and were
able to schedule arthroscopic surgery on Feb. 1, just two weeks later.
Arthroscopic
surgery involves two small holes in the knee through which a scope is inserted
and the knee is inflated with a sterile fluid. Dr. Humble would use the scope
to see and repair the damage, saying, “I can fix anything but an ACL, and that
isn’t your issue.” He made me confident of success.
On
the morning before the actual surgery, I had to get my run in. There was even a
fleeting thought of running to Rowan Regional Medical Center’s Outpatient
facility on Julian Road, figuring that no one would have done that before. I
didn’t do that — which later pleased the nurses who took care of me.
My
only previous surgeries were a tonsillectomy and a colonoscopy. Getting your
tonsils out in those days meant plenty of ice cream and some good memories. My
colonoscopy was enjoyable, too, although most people can’t understand why
anybody would think that.
Upon
arriving at the Outpatient Center, I was welcomed quickly, with the paperwork
processed very efficiently. Ameran Hill took care of that. My neighbor Vanessa
Bradley was in that same area, being the first of several staff that I already
knew. My daughters, Ashley and Amber, as well as Laura Kerr were there to make
sure that I didn’t wisecrack to the nurses too much. They also reminded me that
I couldn’t wait for Danica Patrick to show up, even though I was sure that she
was coming.
Dona
Peacock came out and called my name, saying “Aren’t you the guy who writes for
the Salisbury Post?” That immediately opened the door to some interesting
conversation. Dona and Leigh Ann Williams made sure that I was comfortable as
anybody can be while wearing one of those “open rear” gowns.
Next
the nurses who would assist in the surgery came by, and I knew them both. Word
had spread that there might just be a Salisbury Post column about this
experience. Rhonda Smith and Lauren Daniel enjoyed talking with my daughters as
we waited on Dr. Humble and the operating room. The anesthesiologist, Michael
Jones, stopped by and made sure that I would be easy enough to put to sleep.
Dr.
Humble came in, making last preparations. They let me walk to the bathroom one
more time, and then it was “Showtime.” They rolled my bed to the operating room
and put a warm blanket on me since it was much cooler in that room. Kim
Alexander told me that they were going to put something in my IV, and after
what seemed like seconds later, I woke up feeling great with a bandaged knee.
It
took just minutes and I was on my way out of the building, a short three hours
after entering the door. Kay Meilinger, my recovery nurse, must have done a
great job, because I hardly got to know her.
I
spent that afternoon on the couch with a succession of ice packs. The second
day brought a stiff knee and a shower. The swelling began to go down, and I had
no trouble walking by the third day. There was no real pain, just an off and on
ache with stiffness, usually depending on how long I stood.
My
running resumed exactly one week later, meaning that I only missed six days.
Dr. Humble told me that it would take at least a couple of months to recover
full strength in the knee, saying that even pro athletes often aren’t back up
to speed until the next season. With that said, my knee is getting better, now
three weeks after the surgery, and I haven’t ruled out playing major league
baseball next season.
To
the staff at RRMC’s Outpatient Center, you did make a good column, and made
another experience at RRMC very pleasurable. I definitely was cared for by a
group of people who take pride in the work they do. Thank you!
February
24, 2012
Surviving cancer, giving back -
Metrowny.com
Refusing
to accept the statement, ‘You’re just getting old,’ may be the reason
36-year-old Lisa Johnson is alive today.
After beating cervical cancer
in 2004 and celebrating four years of being cancer free, Johnson developed
secondary lymphedema, in 2008. This resulted in a chronic swelling of her left
leg, which developed as a result of lymph nodes that were removed during the
initial surgery she had to remove her cervical cancer years prior.
Initially, Johnson injured herself by rolling off of her sandal and just
assumed her leg was swollen due to the injury, doctors agreed. One doctor even
said her leg was enlarged as a result of old age; however, at age 33, she knew
something else was wrong.
Johnson decided to do her own research. After
dealing with the discomfort of walking around with one leg larger than then
other for three years, she stumbled upon information that indicated how
lymphedema can be caused. Johnson then took her findings to Roswell Park Cancer
Institute in October 2011. There - she was provided with the proper diagnosis
and treatment.
Upon her arrival at Roswell, Johnson’s left leg was 28
percent larger than her right leg.
“You have to just keep doing
research to find out what’s wrong with you,” said Johnson. “You can’t give up.”
As a way of thanking Roswell Park for helping her, Johnson will again is
host the annual “Stick it to Cancer,” event.
“I like helping people and
I wanted to give back for the help that was given to me,” said Johnson.
The event will be held from 2 to 7 p.m. Saturday, April 21 at the Town
of Tonawanda Boys and Girls Club, 54 Riverdale Ave., Town of Tonawanda.
At the event, Johnson will learn to ride a bicycle for the first time in
front of the entire crowd. For safety she will wear knee and elbow pads, a
helmet, and be wrapped head to tow in bubble wrap.
A game called, Boo
Boo Bing-OW, will be played while she rides. Johnson will place baseball cards
in the spokes of her bicycle to make some noise while additional baseball cards
will be sold to raise money for cancer. Johnson will call out players’ names on
the baseball cards while she is riding to give friends and family a chance to
win prizes.
In addition to her ride, a blood drive and basket raffle
will be held throughout the duration of the fund-raiser. Baseball cards will be
sold until 4 p.m., basket raffle drawing will take place at 6 p.m. (winners do
not need to be present), and a 50/50 split drawing that will take place after
the basket raffle.
Admission for the event is $10 per person, $5 for
presenting blood donors and free for children 10 and under. Admission includes
a set of raffle tickets, non-alcoholic beverages and snacks. Raffle tickets
will be sold for $5 per sheet or $20 for five sheets, baseball cards will be
sold for $5 each. For those individuals who wish to just donate blood, there is
no cost.
Proceeds from the event will benefit Roswell and the Town of
Tonawanda Paramedics.
For additional information, contact Johnson at
[email protected], search for “StickItToCancer” on Facebook or visit http://stickittocancer.wordpress.com.
KEYWORD
NEWS – NONE
PUB
MED DOCS:
February
5, 2012
Rev Med Interne. 2012 Jan 30.
[Epub ahead of print]
[Management
of limb lymphedema.]
[Article
in French]
Vignes S.
Source
Unité
de lymphologie, centre national de référence des maladies vasculaires rares,
hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
Abstract
Lymphedema
results from impaired lymphatic transport with increased limb volume.
Cellulitis is the main complication, but psychological or functional discomfort
may occur throughout the course of lymphedema. Lymphedema management is based
on complete decongestive physiotherapy (multilayer low stretch bandage, manual
lymph drainage, skin care, exercises). First phase of treatment leads to a
reduction of lymphedema volume. The second phase stabilizes the volume and is
based on elastic compression. Resection surgery is a useful tool in external
genitalia lymphedema.
Copyright
© 2012 Société nationale française de médecine interne (SNFMI). Published by
Elsevier SAS. All rights reserved.
PMID:
22296831 [PubMed - as supplied by publisher]
February
7, 2012
J Am Acad Orthop Surg. 2012
Feb;20(2):78-85.
Factitious
disorders of the upper extremity.
Birman MV, Lee DH.
Source
Department
of Orthopaedic Surgery, Columbia University, New York, NY, USA.
Abstract
Factitious
disorders of the upper extremity can manifest in many different forms;
therefore, it is critical to recognize warning signs in the history and
examination indicating that the patient may be creating the symptoms and
physical manifestations of the presenting illness. These disorders present in
such predictable patterns as lymphedema, Secretan syndrome, ulcerations and
wound manipulation, clenched fist, subcutaneous emphysema, pachydermodactyly,
nail deformities, and self-mutilation. Management recommendations include
assigning therapeutic responsibility to one person and the involvement of a
multidisciplinary team. Thorough documentation is essential for the protection
of both the patient and the treating physician. Treatment of patients with
factitious disorders of the upper extremity requires patience and insight to
avoid being manipulated into performing unnecessary surgical
procedures
J Radiat Res (Tokyo).
2012;53(1):125-9.
The
Clinical Characteristic Differences between Thrombosis-related Edema and
Lymphedema Following Radiotherapy or Chemoradiotherapy for Patients with
Cervical Cancer.
Wang PL, Cheng YB, Kuerban G.
Source
Center
of Oncology, The Fifth Affiliated Hospital of Xinjiang Medical
University.
Abstract
Thrombosis-related
edema and lymphedema are two principal types of lower extremity edema results
from radiotherapy alone or chemoradiotherapy for patients with cervical cancer.
To characterize differences between them, a retrospective study was performed.
We collected data including age, race, body weight, FIGO stage, histology type,
platelet count, haemoglobin, time of definitely diagnosis, therapeutic regimen,
edema type and which leg edema firstly occurred in. Of 40 patients who were
eligible for this study, 32 were diagnosed as thrombosis-related edema and 8
diagnosed as lymphedema. The differences in patient age (p = 0.004), propotion
of race (p = 0.021), the latent time (p = 0.002) and the mean platelet count (p
= 0.019) were statistically significant. Among 32 patients with
thrombosis-related edema, 34.4% were in stage II and 53.1% in stage III, 78.1%
were squamous cell carcinoma. Among 8 patients with lymphedema, 87.5% were in
stage II and 62.5% were squamous cell carcinoma. The differences were not
statistically significant for weight (p = 0.94), histology type (p = 0.648),
edema site (p = 0.236), haemoglobin (p = 0.088) between the two grouping
patients. Although the small patient cohort is a limitation, the results
suggest that the patients with thrombosis-related edema may have higher
proportion, lower age, shorter latent edema time and more platelet count than
those with lymphedema. Also, thrombosis-related edema was likely inclined to
Uigur and lymphedema to Han race. We did not find statistical differences in
weight, edema site, histology type and haemoglobin between patients with
thrombosis-related edema and lymphedema.
PMID:
22302053 [PubMed - in process]
Rev Med Interne. 2012 Jan 30.
[Epub ahead of print]
[Management
of limb lymphedema.]
[Article
in French]
Vignes S.
Source
Unité
de lymphologie, centre national de référence des maladies vasculaires rares,
hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
Abstract
Lymphedema
results from impaired lymphatic transport with increased limb volume.
Cellulitis is the main complication, but psychological or functional discomfort
may occur throughout the course of lymphedema. Lymphedema management is based
on complete decongestive physiotherapy (multilayer low stretch bandage, manual
lymph drainage, skin care, exercises). First phase of treatment leads to a
reduction of lymphedema volume. The second phase stabilizes the volume and is
based on elastic compression. Resection surgery is a useful tool in external
genitalia lymphedema.
Copyright
© 2012 Société nationale française de médecine interne (SNFMI). Published by
Elsevier SAS. All rights reserved.
PMID:
22296831 [PubMed - as supplied by publisher]
Clin Physiol Funct Imaging. 2012
Mar;32(2):126-32. doi: 10.1111/j.1475-097X.2011.01066.x. Epub 2011 Nov
10.
The
washout rate of a subcutaneous (99m) Tc-HSA depot in lower extremity
lymphoedema.
Jensen MR, Simonsen L, Karlsmark T, Bülow J.
Source
Department
of Clinical Physiology and Nuclear and Medicine Department of Dermatology and
Venereology, Bispebjerg Hospital, University Hospital of Copenhagen,
Copenhagen, Denmark.
Abstract
Purpose:
Lymphoscintigraphy is currently the leading diagnostic modality of lower
extremity lymphoedema but has been criticized for being unreliable. Washout
rate constants have been investigated and proven to be of diagnostic value in
several studies of breast-cancer-related lymphoedema; however, the
applicability in lower extremity lymphoedema needs further evaluation. The aim
of the study was to verify if washout of (99m) Tc-Human Serum Albumin ((99m)
Tc-HSA) is a reliable diagnostic tool in lower extremity lymphoedema. Methods:
Twenty healthy volunteers and eight patients (11 legs) with lymphoscintigraphy
verified lower extremity lymphoedema participated in the study. A depot
consisting of 0·1 ml 10 MBq/ml (99m) Tc-HSA was injected subcutaneously into
the dorsum of each foot. The depot washout rate was measured using a portable
scintillation detector system and time-activity curves were generated. After
30 min of supine rest and 10 min of standardized ergometric exercise,
measurements were recorded for 20 min. Following correction for physical decay
of (99m) Tc, the depot washout rate constant was calculated using linear
regression analysis. Finally depot half-life was calculated from the washout
rate constant. Results: Median half-life for healthy volunteers was 9·4 h
(range 2·5-28·3 h). Median half-life for lymphoedema patients was 10·7 h (range
1·5-35·1 h). No statistical significant difference could be detected between
healthy volunteers and lymphoedema patients (P = 0·78). Conclusions: The
washout rate of a subcutaneous (99m) Tc-HSA depot is not a reliable diagnostic
tool in examination of lower extremity lymphoedema. Additional examinations
revealed in vivo instability of the utilized (99m) Tc-HSA as the likely
reason.
©
2011 The Authors. Clinical Physiology and Functional Imaging © 2011
Scandinavian Society of Clinical Physiology and Nuclear Medicine.
PMID:
22296633 [PubMed - in process]
February
10, 2012
Head Neck. 2012
Mar;34(3):448-53. doi: 10.1002/hed.21538. Epub 2010 Nov 12.
Near-infrared
fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Source
Division
of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The
University of Texas Health Science Center, Houston, Texas; Memorial Hermann
Center for Lymphedema Management, Memorial Hermann - Texas Medical Center,
Houston, Texas. [email protected].
Abstract
BACKGROUND:
Lymphedema
is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions
where treatment options are limited. Although upper and lower extremity
lymphedema may be effectively treated with manual lymphatic drainage (MLD)
therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS
AND RESULTS:
Herein,
we describe the compassionate use of an investigatory technique of
near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy
and function, help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor response to therapy in a patient with head and neck lymphedema after
surgery and radiation treatment.
CONCLUSION:
NIR
fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are
needed to assess the efficacy of MLD therapy when directed by NIR fluorescence
imaging. © 2010 Wiley Periodicals, Inc. Head Neck, 2012.
Copyright
© 2010 Wiley Periodicals, Inc.
PMID:
22311465 [PubMed - in process]
Am J Pathol. 2012 Feb 3. [Epub
ahead of print]
ProxTom
Lymphatic Vessel Reporter Mice Reveal Prox1 Expression in the Adrenal Medulla,
Megakaryocytes, and Platelets.
Truman LA, Bentley KL, Smith EC, Massaro SA, Gonzalez DG, Haberman AM, Hill M, Jones D, Min W, Krause DS, Ruddle NH.
Source
Department
of Epidemiology and Public Health, Yale University School of Medicine, New
Haven, Connecticut.
Abstract
Lymphatic
vessels (LVs) are important structures for antigen presentation, for lipid
metabolism, and as conduits for tumor metastases, but they have been difficult
to visualize in vivo. Prox1 is a transcription factor that is necessary for
lymphangiogenesis in ontogeny and the maintenance of LVs. To visualize LVs in
the lymph node of a living mouse in real time, we made the ProxTom transgenic
mouse in a C57BL/6 background using red fluorescent LVs that are suitable for
in vivo imaging. The ProxTom transgene contained all Prox1 regulatory sequences
and was faithfully expressed in LVs coincident with endogenous Prox1
expression. The progenies of a ProxTom × Hec6stGFP cross were imaged using
two-photon laser scanning microscopy, allowing the simultaneous visualization
of LVs and high endothelial venules in a lymph node of a living mouse for the
first time. We confirmed the expression of Prox1 in the adult liver, lens, and
dentate gyrus. These intensely fluorescent mice revealed the expression of
Prox1 in three novel sites: the neuroendocrine cells of the adrenal medulla,
megakaryocytes, and platelets. The novel sites identified herein suggest
previously unknown roles for Prox. The faithful expression of the fluorescent
reporter in ProxTom LVs indicates that these mice have potential utility in the
study of diseases as diverse as lymphedema, filariasis, transplant rejection,
obesity, and tumor metastasis.
Copyright
© 2012 American Society for Investigative Pathology. Published by Elsevier Inc.
All rights reserved.
PMID:
22310467 [PubMed - as supplied by publisher]
Asia Pac J Public Health. 2012
Feb 15. [Epub ahead of print]
Physical,
Psychological, and Social Aspects of Quality of Life in Filarial Lymphedema
Patients in Colombo, Sri Lanka.
Wijesinghe RS, Wickremasinghe AR.
Source
University
of Queensland, Herston, Australia.
Abstract
Quality
of life (QOL) was assessed in 141 filarial lymphedema patients and 128 healthy
people in the Colombo district, Sri Lanka, by administering modified,
translated, and validated (in Sri Lanka) versions of the Short Form 36 health
survey questionnaire (SF-36) and the 30-item General Health questionnaire
(GHQ-30). The GHQ-30 assesses the current mental health status. The SF-36
measures health on 8 multi-item dimensions covering functional state,
well-being, and overall evaluation of health (physical functioning, role
limitations resulting from physical health problems, role limitations resulting
from emotional problems, energy/fatigue, emotional well-being, social
functioning, pain and general health). By SF-36, patients experienced poorer
physical functioning, more role limitations resulting from physical health
conditions, less emotional well-being, poorer social functioning, and more pain
than healthy individuals. By GHQ-30, mental well-being of healthy controls was
significantly better than that of patients. The significant difference in the
QOL as perceived by filarial lymphedema patients and healthy individuals
reiterates the importance of morbidity control in patients affected by this
disease.
PMID:
22308536 [PubMed - as supplied by publisher]
Breast. 2012 Feb 2. [Epub ahead
of print]
Angiosarcoma
of the breast: A difficult surgical challenge.
Hui A, Henderson M, Speakman D, Skandarajah A.
Source
Department
of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Melbourne
3050, Australia.
Abstract
BACKGROUND
AND OBJECTIVES:
Breast
angiosarcoma presents following radiotherapy after breast conserving surgery,
in the setting of chronic lymphoedema after axillary dissection or as a primary
tumour. The Peter MacCallum Cancer Centre has significant experience due to
large breast and sarcoma units and as a primary radiotherapy centre. Our aims
were to evaluate the management and locoregional and distant outcomes after
breast angiosarcoma.
METHODS:
Retrospective
study of all patients from the prospective breast and sarcoma databases with a
diagnosis of primary or secondary breast angiosarcoma at Peter MacCallum Cancer
Centre was performed between January 2000 and December 2010. Mode of
presentation, management, loco-regional recurrence and survival rates were
reviewed.
RESULTS:
Eight
women developed angiosarcoma in the setting of breast conservation with a
median latency of 7 years post radiotherapy. Six patients had primary breast
angiosarcoma. All breast angiosarcomas were managed with total mastectomy with
5 patients requiring autologous tissue transfer. Four patients had adjuvant
radiotherapy and three patients had adjuvant paclitaxel. The median follow-up
was 2.5 years (6 month-10 years) with 7 episodes of local recurrence in four
patients and 7 patients with distal metastases including two deaths from
distant disease.
CONCLUSIONS:
Primary
angiosarcoma occurs de novo, presenting as a breast mass. Secondary
angiosarcoma presents predominantly as a skin lesion, in the setting
post-operative radiotherapy for breast conserving therapy. Angiosarcoma remains
a rare and difficult management problem with poor loco-regional and distal
control. Secondary AS is an iatrogenic condition that warrants close follow-up
and judicial use of radiotherapy in breast conserving therapy.
Crown
Copyright © 2012. Published by Elsevier Ltd. All rights reserved.
PMID:
22305554 [PubMed - as supplied by publisher]
February
11, 2012
Head Neck. 2012
Mar;34(3):448-53. doi: 10.1002/hed.21538. Epub 2010 Nov 12.
Near-infrared
fluorescence imaging of lymphatics in head and neck lymphedema.
Maus EA, Tan IC, Rasmussen JC, Marshall MV, Fife CE, Smith LA, Guilliod R, Sevick-Muraca EM.
Source
Division
of Cardiology and Hyperbaric Medicine, Department of Internal Medicine at The
University of Texas Health Science Center, Houston, Texas; Memorial Hermann
Center for Lymphedema Management, Memorial Hermann - Texas Medical Center,
Houston, Texas. [email protected].
Abstract
BACKGROUND:
Lymphedema
is a complication that may occur after surgical resection and radiation
treatment in a number of cancer types and is especially debilitating in regions
where treatment options are limited. Although upper and lower extremity
lymphedema may be effectively treated with manual lymphatic drainage (MLD)
therapies and devices that use compression to direct proximal flow of lymph
fluids, head and neck lymphedema is more challenging.
METHODS
AND RESULTS:
Herein,
we describe the compassionate use of an investigatory technique of
near-infrared (NIR) fluorescence imaging to understand the lymphatic anatomy
and function, help direct MLD, and use 3-dimensional (3D) surface profilometry
to monitor response to therapy in a patient with head and neck lymphedema after
surgery and radiation treatment.
CONCLUSION:
NIR
fluorescence imaging provides a mapping of functional lymph vessels for
direction of efficient MLD therapy in the head and neck. Additional studies are
needed to assess the efficacy of MLD therapy when directed by NIR fluorescence
imaging. © 2010 Wiley Periodicals, Inc. Head Neck, 2012.
Copyright
© 2010 Wiley Periodicals, Inc.
PMID:
22311465 [PubMed - in process]
February
17, 2012
Can Respir J. 2012
Jan;19(1):35-6.
Yellow
nails, lymphedema and chronic cough: Yellow nail syndrome in an eight-year-old
girl.
Siddiq I, Hughes DM.
Abstract
Yellow
nail syndrome is a rare disease and reported mainly in adults. A case of yellow
nail syndrome involving an eight-year-old girl with associated discoloured
yellowish nails on the fingers and toes, lymphedema and chronic cough, and
sputum production is reported.
PMID:
22332131 [PubMed - in process]
J Clin Oncol. 2012 Feb 13. [Epub
ahead of print]
Prospective
Study of Factors Predicting Adherence to Surveillance Mammography in Women
Treated for Breast Cancer.
Shelby RA, Scipio CD, Somers TJ, Soo MS, Weinfurt KP, Keefe FJ.
Source
Duke
University Medical Center, Durham, NC.
Abstract
PURPOSEThis
prospective study examined the factors that predicted sustained adherence to
surveillance mammography in women treated for breast cancer. METHODSBreast
cancer survivors (N = 204) who were undergoing surveillance mammography
completed questionnaires assessing mammography-related anticipatory anxiety,
persistent breast pain, mammography pain, and catastrophic thoughts about
mammography pain. Adherence to mammography in the following year was
assessed.ResultsIn the year after study entry, 84.8% of women (n = 173)
returned for a subsequent mammogram. Unadjusted associations showed that
younger age, shorter period of time since surgery, and having upper extremity
lymphedema were associated with lower mammography adherence. Forty percent of
women reported moderate to high levels of mammography pain (score of ≥ 5 on a 0
to 10 scale). Although mammography pain was not associated with adherence,
higher levels of mammography-related anxiety and pain catastrophizing were
associated with not returning for a mammogram (P < .05). The impact of
anxiety on mammography use was mediated by pain catastrophizing (indirect
effect, P < .05). CONCLUSIONFindings suggest that women who are younger,
closer to the time of surgery, or have upper extremity lymphedema may be less
likely to undergo repeated mammograms. It may be important for health
professionals to remind selected patients directly that some women avoid repeat
mammography and to re-emphasize the value of mammography for women with a
history of breast cancer. Teaching women behavioral techniques (eg, redirecting
attention) or providing medication for reducing anxiety could be considered for
women with high levels of anxiety or catastrophic thoughts related to
mammography.
PMID:
22331949 [PubMed - as supplied by publisher]
Phlebology. 2012;27 Suppl
1:139-42.
Lymphatic
complications after varicose veins surgery: risk factors and how to avoid
them.
Pittaluga P, Chastanet S.
Source
Riviera
Vein Institute, 6 Rue Gounod 06000, Nice, France. [email protected];
[email protected].
Abstract
INTRODUCTION:
Lymphatic
complication (LC) after varicose veins (VVs) surgery is an annoying event with
a variable frequency in the literature.
METHOD:
Retrospective
study reviewing all surgeries carried out for VVs from January 2000 to October
2010. Postoperative LC we reported: lymphatic fistula, lymphocele including the
minor ones and lymphoedema.
RESULTS:
During
the period studied, 5407 surgical procedures for VVs were performed in 3407
patients (74.7% women) with a mean age of 53.4 years. A postoperative LC
occurred in 118 cases (2.2%): lymphocele on limb in 1.3%, inguinal LC (fistula
or lymphocele) in 0.7% and a lymphoedema in 0.2%. The population with a LC was
older (59.6 vs. 53.3 years, P < 0.05), had a higher frequency of C4-C6
(22.0% vs. 6.5%, P < 0.05), a higher incidence of obesity (31.4% vs. 5.4%, P
< 0.05) and was more often treated by a redo surgery or a crossectomy
stripping (48.3% vs. 13.4% and 38.1% vs. 21.8%, respectively, P < 0.05). We
have observed a dramatic decrease in incidence of LC after January 2004 (1.3%
vs. 5.3%, P < 0.05) corresponding to a new surgical practice for the
treatment of VVs: stripping, crossectomy and redo surgery at the groin were
less frequent (74.6% vs. 7.7%, 74.6% vs. 0.2% and 11.3% vs. 0.1%, respectively,
P < 0.05), while isolated phlebectomy was more often performed during this
period (78.4% vs. 8.4%, P < 0.05).
CONCLUSION:
LC
after VVs surgery is not rare but frequently limited to lymphocele on limbs.
Older age, more advanced clinical stage and obesity were associated with a
higher frequency of LC. A mini-invasive and selective surgery has significantly
reduced the occurrence of LC.
PMID:
22312081 [PubMed - in process]
February
21, 2012
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Interdisciplinary
Lymphology: The Best Place for Each Discipline in a Team.
Foeldi E, Dimakakos EP.
Source
Foeldi
Clinic for Lymphology, Hinterzarten, Germany.
Abstract
The
term lymphology includes both the physiology and the pathology of the lymphatic
system. Many disciplines are involved in the study of the lymphatic system, to
correctly diagnose lymphatic diseases and to ultimate provide the best
available treatment for the patient. Lymphedema is one of the most common
lymphatic diseases, potentially causing significant problems for the patient
and for the health system in general. The aim of this article is to discuss the
best placement and role for each discipline within an interdisciplinary team in
order to provide an effective management of lymphedema and related lymphatic
diseases.
PMID:
22336902 [PubMed - as supplied by publisher]
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Multidisciplinary
Lymphedema Treatment Program.
Papadopoulou MC, Tsiouri I, Salta-Stankova R, Drakou A, Rousas N, Roussaki-Schulze AV, Giannoukas AD.
Source
University
Hospital of Larissa, Larissa, Greece.
Abstract
Lymphedema
is an underrecognized and undertreated condition that requires a
multidisciplinary approach in an individualized program that will address the
special needs of each patient. In an ideal setting of an outpatient management
program the team should be composed of a vascular surgeon, a dermatologist, a
physiotherapist, a dietician, a psychologist, a social worker, and an office
employee, working together in the assessment and management of all aspects of
lymphedema. All treatment strategies and actions taken should ultimately focus
on the improvement of the quality of life of patients suffering from lymphedema
and on the prevention of lymphedema in high-risk patients.
PMID:
22336900 [PubMed - as supplied by publisher]
Int J Low Extrem Wounds. 2012
Feb 15. [Epub ahead of print]
Wound
Physicians: Lymphedema Is Not a Problem That Will Go Away if
Ignored.
Lazarides MK, Mani R.
Source
Democritus
University Hospital, Alexandropoulis, Greece.
PMID:
22336899 [PubMed - as supplied by publisher]
Eur J Surg Oncol. 2012 Feb 13.
[Epub ahead of print]
Analysis
of direct oil contrast lymphography of upper limb lymphatics traversing the
axilla - A lesson from the past - Contribution to the concept of axillary
reverse mapping.
Pavlista D, Eliska O.
Source
Oncogynecologic
Center, Department of Obstetrics and Gynecology, First Faculty of Medicine,
Charles University in Prague and General University Hospital, Apolinarska 18,
Prague 12801, Czech Republic.
Abstract
INTRODUCTION:
Axillary
reverse mapping (ARM) is a method to preserve upper extremity (UE) lymphatics
during axillary surgery in breast cancer patients. This may reduce the
incidence of lymphedema. Very precise method to demonstrate lymphatic drainage
is direct X-ray lymphography.
MATERIALS
AND METHODS:
The
evaluation of direct lymphography X-ray images of the axilla and proximal part
of the upper extremity was performed in 9 subjects. As contrast was used
Lipiodoil injected on the dorsal side of hand.
RESULTS:
The
lymph from UE is drained by 2-4 main afferent collectors, which in 5 of 9 cases
entered into one node in the lateral axilla (ARM node). This node was
considered to be the sentinel lymph node for the UE. In 4 cases a cranial
collector was shown, which led directly to nodes in the upper part of the
axilla. This collector had numerous anastomoses with other collectors before
entering the axillary nodes. The most important finding is the demonstration of
numerous lymphatic anastomoses that take place between all imaged nodes in the
axilla including the caudal nodes, which is the most frequent localization of
the breast sentinel lymph node.
CONCLUSION:
The
relationship of lymphatic drainage of the UE and breast are closely related and
share numerous connections. These connections represent the main problem of the
ARM concept because they may pose potencional route for metastatic cancer cells
in sentinel node positive breast cancer patients. Further studies are necessary
to improve understanding of this method. Axillary reverse mapping - breast
cancer - lymphedema - sentinel node biopsy.
Copyright
© 2012. Published by Elsevier Ltd.
PMID:
22336143 [PubMed - as supplied by publisher]
February
26, 2012
Int J Low Extrem Wounds. 2012
Feb 21. [Epub ahead of print]
Reporting
an Alliance Using an Integrative Approach to the Management of Lymphedema in
India.
Ryan TJ, Narahari SR.
Source
Oxford
University and Oxford Brookes University, Oxford, Oxfordshire, UK.
Abstract
In
India 553 million persons are estimated to live in areas endemic for LF;
approximately 21 million have symptomatic filariasis. Of the approximately
16.02 million cases of lymphedema caused by LF globally, 7.44 million (46.4%)
are in India. India had seen diethyl carbamizine, and/or albendazole, delivered
to whole populations, beginning the project to eliminate the disease. But new
populations have developed the infection. In 2003 the need in resource-poor
countries for morbidity control of lymphatic filariasis (LF) became clear,
prompting the study by the Institute of Applied Dermatology in Kerala, India.
Under this study,self help and family members assisted in home-based care,
combining compression bandaging, yoga exercises, heat therapy using steaming,
and skin care according to Ayurvedic medicine. Lymphedema presents with
different patterns in the skin with gross changes in the epidermis, dermis, or
subcutaneous tissue. Skilled and time-consuming counselling is important to
give patients support. An almost immediate reduction in inflammatory episodes
from 80.4% to 8.6% shows up within 2 or 3 weeks, and therefore, intake of
antibiotics can be stopped. The second major response is reduction in the size
of the limb. Volume reduction for large-sized limbs at 3 months is 39%, with a
confidence interval of 4.9 to 5.9 L.
PMID:
22354118 [PubMed - as supplied by publisher]
Arch Dermatol. 2012
Feb;148(2):260-2.
Lichen
sclerosus exhibiting histologic signs of lymphedema: an essential factor in the
pathogenesis of verruciform xanthoma.
Carlson JA, Carlson GD, Murphy M, Rohwedder A.
Source
Albany
Medical College, 47 New Scotland Ave, MC-81, Albany, NY 12208.
[email protected].
PMID:
22351836 [PubMed - in process]
Clin Cancer Res. 2012 Feb 20.
[Epub ahead of print]
Connexin
47 mutations increase risk for secondary lymphedema following breast cancer
treatment.
Finegold D, Baty C, Knickelbein K, Perschke S, Noon S, Campbell D, Karlsson J, Huang D, Kimak M, Lawrence E, Feingold E, Meriney S, Brufsky AM, Ferrell R.
Source
pediatrics/human
genetics, university of pittsburgh.
Abstract
PURPOSE:
Secondary
lymphedema is a frequent complication of breast cancer associated with surgery,
chemotherapy, or radiation following breast cancer treatment. The potential
contribution of genetic susceptibility to risk of developing secondary
lymphedema following surgical trauma, radiation, and other tissue insults has
not been studied.
EXPERIMENTAL
DESIGN:
To
determine if women with breast cancer and secondary lymphedema had mutations in
candidate lymphedema genes, we undertook a case - control study of 188 women
diagnosed with breast cancer recruited from the University of Pittsburgh Breast
Cancer Program (http://www.upmccancercenter.com/breast/index.cfm) between
2000-2010.Candidate lymphedema genes, GJC2 (encoding connexin 47 [Cx47]),
FOXC2, HGF, MET, and FLT4 (encoding VEGFR3), were sequenced for mutation.
Bioinformatics analysis and in vitro functional assays were used to confirm
significance of novel mutations.
RESULTS:
Cx47
mutations were identified in individuals having secondary lymphedema following
breast cancer treatment but not in breast cancer controls or normal women
without breast cancer. These novel mutations are dysfunctional as assessed
through in vitro assays and bioinformatics analysis, and provide evidence that
altered gap junction function leads to lymphedema.
CONCLUSIONS:
Our
findings challenge the view that secondary lymphedema is solely due to
mechanical trauma and support the hypothesis that genetic susceptibility is an
important risk factor for secondary lymphedema. A priori recognition of genetic
risk 1) raises the potential for early detection and intervention for a high
risk group, and 2) allows the possibility of altering surgical approach and/or
chemo- and radiation therapy, or direct medical treatment of secondary
lymphedema with novel connexin modifying drugs.
PMID:
22351697 [PubMed - as supplied by publisher]
Gene. 2012 Feb 14. [Epub ahead
of print]
Novel
mutation in the FOXC2 gene in three generations of a family with
lymphoedema-distichiasis syndrome.
Sutkowska E, Gil J, Stembalska A, Hill-Bator A, Szuba A.
Source
Department
and Clinic of Orthopaedic and Traumatologic Surgery-Division of Rehabilitation,
Wroclaw Medical University, Borowska str. 213, 50-556 Wroclaw,
Poland.
Abstract
Lymphoedema-distichiasis
syndrome (LDS, OMIM #153400) is a genetic disorder with an autosomal dominant
pattern of inheritance caused by mutations in the FOXC2 gene. Affected
individuals typically present with lower extremity lymphoedema and
distichiasis. The most common types of mutations in FOXC2 gene include small
deletions and insertions, but duplications, duplications-insertions, missense
and nonsense mutations were also found. Herein, we describe three generations
of a family diagnosed with LDS caused by a new mutation in the FOXC2 gene. This
mutation is a frameshift due to a deletion of two nucleotides (CC) in C repeats
between C586 and C591. This mutation leads to protein truncation as a result of
an earlier insertion of a stop codon. To the best of our knowledge, this is the
first description of this mutation in the literature and could be coupled with
an atypical lymphoscintigram.
Copyright
© 2012 Elsevier B.V. All rights reserved.
PMID:
22349027 [PubMed - as supplied by publisher]
Ann Dermatol. 2011 Dec;23(Suppl
3):S303-5. Epub 2011 Dec 27.
Unilateral
psoriasis in a woman with ipsilateral post-mastectomy lymphedema.
Kim M, Jung JY, Na SY, Na SJ, Lee JH, Cho S.
Source
Department of
Dermatology, Seoul National University College of Medicine, Seoul,
Korea.
Abstract
Psoriasis is a
multi-factorial disease with various clinical manifestations. We present a case
of unilateral psoriasis associated with ipsilateral lymphedema that developed
after mastectomy for breast cancer. A 42-year-old Korean woman was referred to
our clinic with a 1-month history of multiple erythematous scaly patches on the
right arm, back, and breast and was diagnosed with psoriasis by a skin biopsy.
Three years previously, she had been diagnosed with breast cancer (T1N2),
underwent a right quadrantectomy and axillary lymph node dissection, and
completed adjuvant chemotherapy followed by high-dose adjuvant radiotherapy.
She had started rehabilitation therapy on the right arm for secondary
lymphedema 30 months previously. Because of the long interval between radiation
and psoriasis, we speculated that changes in the local milieu caused by the
lymphedema might be a causative factor. We hereby report a rare case of
unilateral psoriasis following post-mastectomy lymphedema.
PMID:
22346263 [PubMed - in process] PMCID: PMC3276782
Breast. 2012 Feb 16. [Epub ahead
of print]
Factors
associated with long-term functional outcomes and psychological sequelae in
women after breast cancer.
Khan F, Amatya B, Pallant JF, Rajapaksa I.
Source
Department
of Medicine, Dentistry & Health Sciences, University of Melbourne, Grattan
Street, Parkville, VIC 3050, Australia; Department of Rehabilitation Medicine,
RoyalMelbourne Hospital, 34-54 Poplar Road Parkville, Melbourne VIC 3052,
Australia.
Abstract
The
objective of this study was to examine factors impacting long-term functional
outcomes and psychological sequelae in survivors of breast cancer (BC). A
clinical assessment and structured interview assessed the impact of BC on
participants' (n = 85) current activity and restriction in participation, using
validated questionnaires: Functional Independence Measure (FIM), Perceived
Impact Problem Profile (PIPP) and Depression Anxiety Stress Scale (DASS).
Participants showed good functional recovery (median motor FIM score = 78).
Three-quarters (74%) reported pain, 32% reported upper limb weakness, 31% pain
limiting shoulder movement and 29% lymphoedema. One third (32%) reported
greatest impact on psychological wellbeing. A substantial number of
participants reported high levels of depression (22%), anxiety and stress (19%
each). Factors associated with poorer current level of functioning and
wellbeing included: younger participants, recent diagnoses, aggressive tumour
types, receiving chemotherapy, shoulder limitation due to pain, and
lymphoedema. BC survivors require long-term management of psychological
sequelae impacting activity and participation.
Copyright
© 2012 Elsevier Ltd. All rights reserved.
PMID:
22342676 [PubMed - as supplied by publisher]
Cancer Radiother. 2012 Feb 17.
[Epub ahead of print]
[Upper
limb lymphedema after breast cancer treatment.]
[Article
in French]
Ben Salah H, Bahri M, Jbali B, Guermazi M, Frikha M, Daoud J.
Source
Service
de radiothérapie carcinologique, CHU Habib-Bourguiba, 3029 Sfax,
Tunisie.
Abstract
PURPOSE:
To
study the frequency and risk factors for upper limb lymphedema through a series
of patients treated for breast cancer.
PATIENTS
AND METHODS:
It
is a retrospective study about 222 patients treated for breast cancer during
the period between February 1993 and December 2003 in Sfax hospitals. Average
age was 51years (27-92years). Tumour was T2 in 59% of cases. All patients had
surgery with lymph node dissection. Infiltrating ductal carcinoma was the most
frequent histological type (80% of cases), with predominant SBR II grade (62%).
The mean number of removed lymph nodes was 12 (2-33). Axillary lymph node
metastasis was detected in 124 patients. Radiotherapy was delivered in 200
patients, including axillary irradiation in 30 cases. The mean follow-up was
68months (12-120).
RESULTS:
Lymphedema
appeared in 23% of cases (51 patients), 14months after surgery (mean period).
Lymphedema affected the brachium in 17% of cases, the forearm in 12% of cases
and all upper limb in 71% of cases. Fifty percent of patients had
rehabilitation. However, improvement of lymphedema was obtained in 18 cases.
Parameters predicting lymphedema were studied. Significant risk factors were
obesity, infection and a number of removed lymph node above 10. The type of
surgery, axillary irradiation and shoulder abduction deficit did not predict
lymphedema.
CONCLUSION:
Lymphedema
of the arm is a frequent consequence of breast cancer treatment. The risk of
lymphedema is correlated with obesity, infection and a number of removed lymph
node above 10.
Copyright
© 2012 Société française de radiothérapie oncologique (SFRO). Published by
Elsevier SAS. All rights reserved.
PMID:
22342349 [PubMed - as supplied by publisher]
MED
NEWS:
February
11, 2012
Highlighting A Rare Subset Of Diseases Involving The
Lymphatic System –
A clinically challenging and under-studied subset of diseases
affecting the lymphatic system and grouped under the disease spectrum
lymphangiomatosis and Gorham's disease is the focus of a special issue of
Lymphatic Research and Biology, a peer-reviewed journal published by
Mary Ann Liebert, Inc.. The issue is available free online.*
Guest
Editor, and Journal Associate Editor Francine Blei MD, MBA, St. Luke's
Roosevelt Hospital, NY, has compiled a collection of articles that highlight
the complex characteristics of these diseases, which can be localized, affect
multiple sites, or be systemic, may be congenital or acquired, and may cause
symptoms that range from mild to severe to life-threatening. The articles focus
on current knowledge, ongoing research, and how these diseases differ from
other lymphatic disorders.
"This disease spectrum affects a patient
population that is small in number, but the effects of the disease(s) are
devastating," says Stanley G. Rockson, MD, Editor-in-Chief of Lymphatic
Research and Biology and Allan and Tina Neill Professor of Lymphatic Research
and Medicine, Stanford University School of Medicine, CA. The collection of
articles in this special issue, "highlights the current state of knowledge (and
ignorance) in this paradoxically neglected area of lymphatic health and
disease."
February 14, 2012
Link Between NSAIDs And Reduced Cancer Metastasis
Strengthened By Study
A new study reveals key factors that promote the spread of cancer to lymph nodes and
provides a mechanism that explains how a common over-the-counter
anti-inflammatory medication can reduce the spread of tumor cells through the
lymphatic system. The research, published by Cell Press in the February 14
issue of the journal Cancer Cell, opens new avenues for the design
of antimetastatic therapies.
The lymphatic system consists of a network
of vessels that carry lymphatic fluid from the body organs back to the general
circulation. Along the way, lymphatic fluid percolates through lymph nodes.
Unfortunately, cancer cells sometimes spread (via a process called metastasis)
through the lymphatic system and can form secondary tumors in the lymph nodes.
The spread of cancer cells to the lymph nodes is an important indicator of
disease progression.
"Some tumors secrete protein growth factors that
can act on the lymphatic vessels to facilitate metastasis. For example,
elevated levels of the growth factor VEGF-D in human tumors correlate with
lymph node metastasis and poor patient prognosis," explains the senior study
author, Steven Stacker, associate professor from the Tumour Angiogenesis
Program, Peter MacCallum Cancer Centre in Melbourne, Australia. "However, thus
far, mechanisms underlying the transit of cancer cells through the larger
lymphatic vessels and into the lymph nodes remain elusive."
In the
current study, Stacker and colleagues investigated how collecting lymphatic
vessels, conduits that drain lymphatic fluid from tissues into lymph nodes, are
altered during VEGF-D-driven metastasis. The researchers discovered that VEGF-D
was linked to prostaglandin pathways, which are important regulators of
lymphatic vessel dilation. Nonsteroidal anti-inflammatory drugs (NSAIDS), which are known
inhibitors of prostaglandin synthesis, reduced lymphatic vessel dilation and,
therefore, inhibited tumor metastasis.
"This key interaction between
lymphatic system growth factors and prostaglandins reveals a mechanism for
physically preparing collecting vessels for tumor cell dissemination and a
mechanism by which NSAIDs can reduce cancer metastases through the lymphatic
system," concludes Dr. Stacker. "These insights may assist with the design of
additional therapeutics for cancer patients and enhance current approaches that
aim to prevent the spread of cancer cells through the lymphatic system and
potentially to distant organs."
February
21, 2012
Two Possible Options Identified For Treating Epstein
Barr Virus-Fueled Lymphomas In Immunosuppressed
Patients
Some 90 percent of people are exposed to the Epstein Barr virus (EBV)
at some point in their life. Even though it is quickly cleared from the body,
the virus can linger silently for years in small numbers of infected B cells.
According to researchers at Children's Hospital Bostonand the Immune Disease
Institute (IDI), the immune system subdues the virus by watching for a single
viral protein called LMP1, knowledge that has already helped suggest two new
treatments for the EBV-fueled cancers seen in some
immunosuppressed patients.
The study team, led by Klaus Rajewksy, MD,
and Baochun Zhang, MD, PhD, of the Program in Cellular and Molecular Medicine
at Children Hospital Boston and the IDI, reported their results online in the
journal Cell.
While the immune system's T cells rapidly
clear most EBV-infected B cells, about one in a million infected cells escapes
destruction. Within these cells, the virus enters a latent phase, kept in check
by the watchful eye of so-called memory T cells. This uneasy relationship
usually holds steady the rest of a person's life, unless something - such as
infection with HIV or use of anti-rejection
drugs following a transplant - suppresses the immune system and breaks the
surveillance. The virus can then reawaken and drive the development of B cell
cancers like AIDS-associated B cell lymphoma and post-transplant
lymphoproliferative disorder.
To better understand how the immune
system maintains its watch and how the virus turns cells cancerous, Rajewsky
and his team had generated a model mimicking latent EBV infection by
engineering mice whose B cells contained an inducible version of viral LMP1.
Researchers have long known that EBV needs LMP1 to turn B cells cancerous, but
modeling this relationship in vivo had proven challenging.
"We had
previously attempted to develop an animal model of LMP1 transformation of B
cells," said Rajewsky, who recently moved to the Max Delbrück Center for
Molecular Medicinein Germany, "but we had never been able to get the mice in
our models to actually produce any mature B cells. The immune response against
the LMP1-producing B cells was so robust that the cells were eliminated very
early on."
Their breakthrough came when Zhang and colleagues
reengineered the model to lack T cells. "The mice were initially fine, but
succumbed within two to three months to aggressive B cell lymphomas," Rajewsky
said. "The profile mimicked very closely what we see in immunosuppressed
lymphoma patients." In additional experiments with Rajewsky's original model,
the team eliminated the mice's T cells before activating the viral protein in B
cells, sparking a similar but even more rapid fatal disease.
The team
also made several observations with possible clinical application. First, they
noted that in the mouse model the LMP1 producing B cells were being attacked by
a specific kind of T cell called a CD4+ T cell. "Transplant patients who
develop B cell lymphomas because they are immunosuppressed by their
anti-rejection drugs are often treated with T cells that carry the CD8 marker,"
Rajewsky noted. "These results would argue for also considering CD4+ T cells
for treatment."
Second, they found that tumors in the LMP1 producing
mice often displayed targets recognized by another kind of immune cell called a
natural killer (NK) cell. Seeing an opportunity, Rajewsky worked with cancer
immunologist Glenn Dranoff, MD and colleagues at Dana-Farber Cancer Institute,
to test a potential therapeutic agent that uses a portion of the NK cell
activating receptor called NKG2D,fused to the stimulatory Fc portion of an
antibody, a combination capable of activating and directing immune attack
against tumor cells. In a transplantation model of LMP1-fueled lymphomas, the
NKG2D-Fc fusion proved quite capable of reducing tumor growth and prolonging
survival of the recipients.
"These preclinical results suggest
administration of the NKG2D-Fc fusion protein, perhaps combined withtreatment
with CD4+ T cells, could benefit some patients with EBV-driven lymphomas,"
Rajewsky said. "What we can say with certainty, though, is that LMP1 is the
immune system's primary surveillance trigger following EBV infection and
clearance, knowledge that we think will open doors to additional treatment
options."
February 25, 2012-02-27
Exploiting A Weakness In Cancer's Defense
System
Researchers at the EPFL have identified an important mechanism that
could lead to the design of more effective cancer vaccines. Their discovery
of a new-found role of the lymphatic system in tumour growth shows how tumours
evade detection by using a patient's own immune system.
Tumour cells
present antigens or protein markers on their surfaces which make them
identifiable to the host immune system. In the last decade, cancer vaccines
have been designed that work by exposing the patient's immune cells to
tumour-associated antigens and so priming them to kill cells that present those
antigens. These have caused much excitement, not least because by acting so
specifically on cancer cells, they could potentially eliminate the unpleasant
side effects of chemo- and radiotherapy.
Like soldiers protecting
a fort
However, clinical trials of such vaccines have had a very
low success rate to date, mainly because tumours have various mechanisms for
evading detection by immune cells, even when those immune cells - called T
cells - have been primed to seek them out. Those mechanisms are, in general,
poorly understood. But in a paper to be published this week in Cell Reports,
the laboratories of Melody Swartz at EPFL and Stéphanie Hugues at UNIGE provide
a key insight into one of them. They describe for the first time how, like
soldiers protecting a fort, lymph vessels surrounding a tumour ward off T cell
attack.
Plenty of research has shown that tumours can induce the growth
of lymph vessels in their vicinity, and that this growth is correlated with
metastasis and poor prognosis. It was assumed that these lymph vessels simply
provided an escape route for cancer cells, transporting them to distant sites.
In the new study, led by postdoc Amanda Lund, the researchers show that lymph
vessels actually suppress the immune response, deleting the attacking T cells
or leaving them "functionally exhausted" by the time they reach the tumour.
They studied a type of tumour that expresses large amounts of VEGF-C, a
molecule that is naturally expressed in humans and that stimulates lymphatic
growth. Having engineered the tumour cells to express a foreign antigen, they
compared the efficacy of a vaccine designed to prime T cells to kill cells
carrying that antigen, either when VEGF-C was present or when its activity was
blocked . With VEGF-C suppressed, the vaccine's efficacy increased and tumour
growth slowed fourfold.
A weakness in cancer's defense system
exploited
The researchers went on to show that the endothelial
cells which line lymph vessels "scavenge" tumour-specific antigens and present
them to the tumour-specific T cells in a suppressive manner. This, in turn,
promotes the local deletion of those T cells. According to Prof Swartz, that
means that first targeting the lymph vessels associated with a tumour could, in
theory, significantly increase the efficacy of existing cancer vaccines. "It
would be like removing the soldiers from around the fort before sending in your
opposing army," she says. "If you disable the lymph vessels' suppressive
functions, our data suggest that tumour-killing T cells would do their job a
lot more effectively." Future clinical trials are needed to put that theory to
the test.
GOOGLE:
January
31, 2012
Advances in Cancer Care: Diagnosis, Treatment and
Survivorship – TribLocal –
Sorry
this is a one-time meeting that has passed
February
6, 2012
Local groups stepping in after national cancer charity
changes support - Scranton Times-Tribune –by
Erin L. NissleyErin L. Nissley –
After
a national group that helps cancer patients around the country announced it
would be scaling back support of certain programs, local organizations have
been gearing up to fill the gaps.
In
late November, the American Cancer Society sent a letter to local groups
informing them that, as of Jan. 1, it would "no longer provide financial
assistance for wigs, medications, durable medical equipment, lymphedema
supplies or lodging."
Jo-Anne
Sessa, ACS regional vice president, said there are no plans to completely cut
programs, including those that provide cancer patients with wigs and help out
with lodging while they undergo treatment.
She
added, though, that ACS is focusing its resources on areas "where we can make
the most impact," including providing patients with transportation and mileage
reimbursement to and from appointments.
"We've
identified access as the biggest issue across the country," Ms. Sessa said. "In
this economy, it is more challenging (to raise money) and every organization
has to focus their resources."
The
changes to ACS programs will mean cancer patients will depend even more on
local groups for help, said Northeast Regional Cancer Institute President
Robert Durkin. Like many local groups, Northeast Regional Cancer Institute has
suffered deep funding cuts - including the loss of about $1 million a year in
state funding - that makes it difficult to fulfill the needs of cancer patients
in the community, especially when a major resource like ACS makes a decision to
cut support for certain programs.
"We're
local, so we base our resources on what the needs are in the community," Mr.
Durkin said, pointing out that local donations made to ACS do not necessarily
stay in the community.
The
region is lucky to have resources that can help cancer patients, especially a
group like Northeast Regional Cancer Institute, said Dr. Harmar Brereton, a
radiation oncologist at Northeast Radiation Oncology Center.
"The
psychological profundity of having cancer is a really big deal" and cancer
patients need help in a variety of ways, Dr. Brereton said. "It is harder for
all groups to raise funds. We need to get the word out that local groups are
here taking care of these needs, but they need help to do it."
Connecting
cancer patients to resources both local and national is part of the job
description for Kathryn Cramer, an oncology social worker at Northeast
Radiation Oncology Center.
"We
never let anyone do without," she said. "There are programs that can help
patients with medication costs. We can go through churches, the Salvation Army
and the American Cancer Society."
Delta
Medix, which offers treatment for cancer patients, launched a nonprofit
foundation on Oct. 1 that will help cancer patients throughout the region,
regardless of where they obtain treatment. Delta Medix CEO Margo Opsasnick sees
the main focus of the foundation as helping cancer patients with the costs of
genetic testing, which can help with treatment plans for breast cancer patients
and covering co-pays and treatments not covered by insurance. She also hopes
the foundation can focus on helping with smaller needs, like hiring a maid to
help with housework.
"Most
breast cancer patients have to undergo chemotherapy and radiation," she said.
"Wouldn't it be nice for them to come home to a clean house?"
Both
Mrs. Opsasnick and Mr. Durkin said ACS's decision to scale back certain
programs was strange, especially because it came around the same time the group
sent a letter asking a local group to suspend an annual gala fundraiser that
generated tens of thousands of dollars for the charity.
Earlier
this month, ACS officials told The Times-Tribune they made a decision to do
away with Scranton's Ball of Hope after looking at rising costs of the event
and the dip in amount of money raised. October's Ball of Hope cost about
$28,000 and raised about $70,000, according to Erik McGaughney, the American
Cancer Society's income development director for the eastern region of
Pennsylvania.
The
2010 Ball of Hope raised $100,000 and cost about $16,000, he said in previous
interviews. Much of the funds raised went to support a summer camp in Lebanon
County for children with cancer and siblings of children with
cancer.
"It
is certainly puzzling," Mr. Durkin said.
Mrs.
Opsasnick agreed, pointing out that a local group of volunteers organized the
Ball of Hope each year.
"That
group didn't ask for anything from ACS," she said. "Why would you ever turn
down money when you're out there trying to do good things for cancer
patients?"
Contact
the writer: [email protected]
February
7, 2012
SJH RehabCare opens another
location - Vineland Daily Journal –
HARRISON
– South Jersey Healthcare Sports RehabCare, an outpatient orthopedic
rehabilitation provider, recently opened its newest location in Mullica Hill at
201 Tomlin Station Road.
The
facility offers sports and orthopedic physical therapy, occupational therapy,
spine care, worker’s compensation services and lymphedema
services.
The
facility incorporates the Nintendo Wii to enhance participation in therapy
treatment.
“Mullica
Hill ... .is a thriving community, and the staff at SJH Sports RehabCare at
Tomlin Station Park look to continue our commitment to improve the quality of
lives of our patients, and residents in the communities we serve,” said Debbie
Franceschini, director of SJH RehabCare Services.
The
facility has two new staff members:
Kristy
Meade, MSPT, ATC has more than 10 years clinical experience and will oversee
SJH Sports RehabCare. Her special interests include post-surgical patients,
athletic injuries, body mechanics and postural education, with a specialty
focus on trends in ACL rehabilitation.
Victoria
Rink, OTR/L, CHT, is the OT clinical coordinator for all inpatient and
outpatient facilities and SJH Sports RehabCare locations. Rink is a certified
hand therapist with more than 17 years of experience treating upper extremity
disorders.
For more
information, contact SJH Sports RehabCare at (856) 241-2533 or [email protected]. SJH RehabCare
and SJH Sports RehabCare have five convenient locations serving South
Jersey.
February 8,
2012
PolyGel Portable Device for DVT Therapy Helps Patients
Be Compliant After surgery – SBWire –
Tampa, FL
-- (SBWIRE) -- 02/08/2012 -- Major
surgical procedures are events where medical staff must be reminded that
certain patients can be at higher risk for deep vein thrombosis and venous
thromboembolism. Postphlebitic syndrome and pulmonary embolisms can occur in
the hours, days, and weeks after a surgery. An article on Medscape recently
highlighted how prophylaxis with medication and mechanical devices is
critical.
“Each patient must be assessed case-by-case, but the article
‘Deep Venous Thrombosis Prophylaxis in Orthopedic Surgery’ shows that DVT
therapy helped reduce DVT by 60 percent,” said Greg Grambor, president of
Vascular PRN, a company that fills prescriptions for sequential compression devices
and intermittent pneumatic devices for healthcare professionals
nationwide.
The authors of the Medscape article showed that passive
devices such as TED hose and active devices like IPC devices or venous foot
pumps lessened the chance of DVT and did not add the risk of bleeding. Mechanical compression devices
helped to improve blood flow and circulating fibrinolysins. Patient compliance
and efficacy are the most important factors that medical professionals want out
of devices.
“The latest technology is a PolyGel portable device that is
only one pound, the size of a small book, and works off battery power,” said
Grambor. “In the hours after surgery or for at-home care after leaving the
hospital, the PolyGel Ca5 DVTCare System provides the best
compliance.”
The PolyGel portable device lasts for 15 hours when used
for single leg therapy and 8 hours for both legs. Since it is carried over the
shoulder in a compact case, patients can go from their hospital bed, down the
hall to physical therapy, and move about their home when healing in the weeks
after a surgery. The PolyGel’s two segmented cuffs wrap comfortably around the
leg to promote blood flow.
“The PolyGel is super simple to put on the
patient and effortless to keep on the patient,” said Grambor. “You don’t have
to worry about the patient being hooked up to a power source or what happens
when they go to the bathroom.”
And when the PolyGel device needs to be
cleaned, it can be done with mild soap and a washcloth, and it can be charged
in an outlet once the 8 to 15 hours of use is up. It continues to operate while
charging, providing for totally uninterrupted therapy during those critical
post surgery hours.
Vascular PRN has decades of experience helping
nursing homes, surgery centers and hospitals, managed care organizations, and
other institutions with their DVT product needs. To learn more about the
PolyGel portable device, Sequential Compression Devices, IPC devices, or
Lymphedema boots visit http://www.vascularprn.com/ or
call 800.886.4331.
February 8,
2012
ImpediMed L-Dex® U400 device receives expanded U.S.
coverage - Proactive Investors Australia –
ImpediMed’s (ASX:
IPD) L-Dex® U400 device will receive greater coverage in the U.S. as an aid in
the clinical assessment of unilateral lymphoedema of the arm in females,
following the passing of the Patient Protection and Affordable Care
Act.
As a result of the passing of the Act, which makes certain
indigenous tribes and organisations eligible to access the health plans for
federal employees, ImpediMed expects an increase in covered lives for federal
healthcare plans from 1 May 2012.
The estimated number of employees of
indigenous tribes or organisations who are eligible to access federal health
plans is about 350,000.
Direct family members of these employees are
also eligible and include spouse and children up to the age of 26.
As a
result, coverage under federal plans could be expected to increase by an
estimated 700,000 covered lives.
Lymphoedema occurs when the lymphatic
system does not work properly, resulting in the long-term swelling of parts of
the body.
Stanford
Breast Cancer Lymphedema Registry
Meanwhile, the first patient
has been enrolled into the Stanford Breast Cancer Lymphedema
Registry.
Stanford University Medical Center initiated the registry
which will collect and analyse data from breast centres and physicians’ offices
across the U.S.
The registry collects clearly defined health and
demographic information on patients with specific health characteristics, in
this case, breast cancer.
The Stanford Breast Cancer Lymphedema Registry
has been designed to investigate the impact of lymphoedema surveillance upon
breast cancer survivors.
Within a year, researchers expect to have
gained further substantial insights into the value of systematic early
surveillance to prevent and minimise the lymphoedema risk in women treated for
breast cancer.
Patient enrolment will increase in the coming months as
the registry is rolled out to physician sites.
Data generated from
ImpediMed’s L-Dex® U400 device will make-up one arm of the registry.
The
L-Dex® U400 device is the first medical device with a US Food and Drug
Administration clearance to aid health care professionals, clinically assess
secondary unilateral lymphoedema of the arm and leg in women and the leg in
men.
February 13,
2012
High Desert Pharmaceuticals gets boost from export
deal - Northern Nevada Business Weekly – by Rob Sabo –
An
overseas distribution agreement could bring a much-needed financial lift to
High Desert Pharmaceuticals.
The
small Reno company, founded in 2007, recently found a distributor to export the
company’s products to Belgium, Holland, Germany, Switzerland, Poland and
Israel. High Desert Pharmaceuticals has two primary products:
CompressionAssist, used by people who wear heavy compression stockings to
combat lymphedema, which causes painful swelling in the lower legs; and
GloveGlide, used by medical professionals and others who wear surgical gloves.
The products allow easy fitting and donning of compression stockings or of PVC,
nitrile, and latex gloves.
“We
are hoping that is a nice opener for us on a global scale,” says John Wyaux,
High Desert’s executive vice president. The company’s other principal, Dieter
Berndt, is a chemist who created, patented and trademarked the two products.
High Desert Pharmaceuticals won “Product of the Year” for 2009 by Caregiver.com
for CompressionAssist.
The
company’s products are manufactured at a small Carson City facility, while the
small bottles are labeled and boxed in China. Hoping to extend its reach, High
Desert has begun marketing CompressionAssist to schools that train medical
staff about lymphedema. Other potential sources of revenue include medical
offices, hospitals and hospices.
“The
three major lymphedema schools train 400 to 500 students each year, and 200
returning students each year, and those are our potential customers,” Wyaux
says.
For
GloveGlide, High Desert Pharmaceuticals is targeting workers who routinely use
surgical gloves, such doctors, mechanics, law enforcement and security
screeners at airports. Getting the word out about the products, finding the
right channels, and getting potential customers to spend money on a new product
have been major obstacles to widespread use, Wyaux says.
“Given
the state of the economy, we have had to be resourceful,” he says.
Last
year was the first in which High Desert Pharmaceuticals posted a modest profit,
Berdt says. The company has been self-funded since its inception. However, in
order to advance the company’s products, High Desert Pharmaceuticals is seeking
project financing to attract new capital.
Berdt
says he came up the idea to create a donning lubricant after taking his wife to
a doctor’s appointment and watching a nurse struggle to put on latex gloves. He
had extensive experience working with silicone-based products, so he began
experimenting with different types of lubricants. An added side effect he
stumbled across was an 80 to 90 percent reduction in sweat inside the
gloves.
New
products include a long-lasting surface wipe called NanoSept that uses
nanotechnology to counter bacteria, fungi and viruses.
“It
is nearly indefinite,” Berndt says. “It will virtually last forever, unless it
is abraded.”
Berndt
hopes to eventually place the small NanoSept wipes inside the packaging of
electronic devices such as cell phone and tablet computers so consumers can
permanently keep the surfaces of their electronics clean. Hospital settings,
and commercial uses such as keyboards and phones or escalator handrails are
other potential use for the wipes, Wyaux says.
Berndt
says High Desert Pharmaceuticals will commercially introduce the NanoSept wipes
this year, and he plans to establish a pilot program with the product at
several Washoe County schools later this year.
“It
has spectacular potential,” he says.
February 13,
2012
Actress Zina Bethune killed in
hit-and-run - Entertainment Weekly – by Lanford Beard –
Zina
Bethune, a 66-year-old actress and dancer, was fatally struck in a presumed
double hit-and-run when she stopped to help an injured animal, reports the
L.A. Times. Bethune
was a famed ballerina, who taught dance to disabled children for the last 30
years. She herself had overcome diagnoses of scoliosis and lymphedema before
training with George Balanchine and the New York City Ballet at age
14.
Though
she went by Zina Feeley in everyday life, she made her professional name (Zina
Bethune) in 1958 on The
Guiding Light and had roles on Santa
Barbara, Party
of Five, and the 1960s medical drama The
Doctors and the Nurses. She also choreographed for the 1987 TV
series Nutcracker:
Money, Madness & Murder.
Los
Angeles police are investigating the incident, which took place just after
midnight on Sunday. Bethune is believed to have stopped to check on an injured
animal when a car going the opposite direction hit her and threw her across the
intersection, when another car struck her and dragged her 200 yards. The blows
resulted in severe head injuries, and Bethune was pronounced dead at the scene.
Neither of the drivers who struck Bethune have been formally
identified.
February 15,
2012
Health Calendar: Week of Feb. 16,
2012- Daily Breeze – By Sandy
Geretydailybreeze.com
-
Saturday
Lymphedema
A to Z.
Cancer Support Community-Redondo Beach will host Steffy Trousdale, LVN, COF, to
discuss the signs, symptoms and treatment options for Lymphedema from 10 a.m.
to noon Saturday at 109 W. Torrance Blvd., Redondo Beach. Call 310-376-3550, or
visit www.cancersupportredondobeach.org.
February
15, 2012
Complications from breast cancer treatment should be
treated sooner, says UM-Flint researcher
- minbcnews.com - by Kevin Usealman –
FLINT -- A
University of Michigan researcher has concluded 11 years of study
on breast cancer complications. Cindy Pfizer is an associate director of
research in U of M Flint's physical therapy department. The study, which she
began in 2001 while in Washington is in conjunction with researchers at Walter
Reed National Military Medical Center and the National Institutes of Health
Clinical Center.
They say in their conclusion they found that early
diagnosis and treatment of breast cancer-related complications such as
lymphedema, can reduce costs by as much as $2,500 per patient as well as the
need for intensive rehabilitation.
The research team
developed a model for surveillance of complications that result from the
treatment of breast cancer, so they can be identified and treated before the
patient begins to notice problems. The other primary investigator in the study
was Ellen Levy, a researcher from the National Institutes of Health. Pfalzer
continues to aid in data analysis, database updating and manuscript generation
while at her position at UM-Flint.
February
17, 2012
Supporters rally for imprisoned Hash Bash organizer
from Royal Oak - Royal Oak Daily Tribune – By Catherine
Kavanaugh –
Imprisoned last
year following a drug raid at his Royal Oak house, Hash Bash organizer and
medical marijuana proponent Adam Brook has a growing base of supporters trying
to make his time behind bars more comfortable.
Brook, 43, is four months
into a two-year sentence after pleading guilty to two counts of possessing a
firearm while committing a felony.
He suffers from lymphedema, an
incurable condition that causes the legs and arms to swell and is often brought
by on cancer treatment. Brook had thyroid cancer.
“Adam is not a well
man,” said Melissa Griggs, who is selling “Free Adam Brook Now” T-shirts for $10
each to raise money for his prison store account. “His legs are swollen, the
skin is splitting open and he needs special pressurized wraps.”
Griggs
acknowledges Brook has no chance for an early release, parole or probation
because of the mandatory sentence for his firearm pleas.
However, she
said Brook is on a lot of peoples’ minds as plans are made for the 2012 Hash
Bash in Ann Arbor, where she also will sell the T-shirts.
Griggs said
she is among those who people believe Brook was singled out by Oakland County
law enforcement for being a marijuana activist.
“I believe they put him
in prison because of who he is,” Griggs said. “He’s a political prisoner. He
organized the Hash Bash for 20 years and he was the 1994 High Times freedom
fighter of the year.”
Griggs said Brook was at physical therapy when his
home was raided on Jan. 12, 2011.
Undercover police with the Oakland
County Narcotics Enforcement Team (NET) said they seized 600 grams of
marijuana, two handguns, a shotgun, a bullet-proof vest, marijuana candy, a
triple-beam scale, and a tally sheet with names and prices from Brook’s house
on Whitcomb Avenue. Continued...
Brook
was charged with violating drug and weapons laws. He once had a state-approved
medical marijuana card but it had expired and the 1.3 pounds of marijuana he
possessed exceeded the 2.5 ounces allowed to medical marijuana
patients.
Last October, Brook was sentenced to two years in prison after
pleading guilty to two counts of possessing a firearm while committing a
felony. He also pleaded no contest to one count each of delivery and/or
manufacture of marijuana and being a felon in possession of a firearm. His
prior felony conviction was for carrying a concealed weapon in the late
1980s.
Oakland Circuit Judge Rudy Nichols didn’t sentence Brook to any
time for the drug charge or being felon with a firearm. Brook is serving his
two years at the Parnell Correctional Facility, a minimum-security prison in
Jackson.
With the 41st annual Hash Bash set for April 7, a lot of people
are just finding out why Brook doesn’t have a lead role in its organization.
Griggs said she is selling donated T-shirts because people want to help him
until his Oct. 5, 2013, release date.
“Every cent of the money raised
will go to Adam’s commissary account so he can buy decent soap that doesn’t dry
out his skin, shampoo, and T-shirts so he isn’t cold,” Griggs said.
Her
effort is drawing attention to Brook’s case on social media. One Facebook
posting by a supporter says, “He’s in jail for an antique pistol…and a Normandy
Beach flak jacket from an American hero that landed on D-Day to save
Europe.”
Oakland County Prosecutor Jessica Cooper refuted that and
laughed at the notion Brook is a political prisoner.
“I have no idea who
he is,” she said.
Cooper said a black powder six-shot Fillipieta gun
found at Brook’s house was alleged to be antique but three other weapons also
were seized.
“The antique handgun is not an issue,” Cooper said. “They
neglect to talk about the .380 pistol filly loaded in the nightstand, a
Remington 1100 shot gun in the closet and a .357 next to a chair.” Continued...
Brook’s
supporters contend the firearms were legally registered to another person in
the household. However, Brook couldn’t be anywhere there was a gun because of
the prior felony conviction.
His supporters also say the 600 grams of
marijuana at the house were “used up” from a vaporizer process that lets people
inhale active cannabinoids while avoiding harmful smoke toxins.
Cooper
said marijuana was found in jars and bags and there was scale to measure out
quantities. Police also seized Vicodin and THC candy from Brook’s house, she
added.
“If we had prosecuted on all drug counts he could be doing two
years plus two years,” Cooper said.
Griggs said Brook accepted a plea
deal to protect his family from assets being seized. She is selling the “Free
Adam Brook Now” T-shirts for $10 each to people who buy them in person from her
but has to add packaging and shipping costs to mail orders.
February
17, 2012
Grey's Anatomy Doc Speak: What's a
Gliosarcoma? – Wetpaint – by
Dan Clarendon –
Tumors
and lymph nodes and mania, oh my! If all of the medical lingo from last night's
double-header has got your head spinning double-time, have no fear. We've got
you covered. Here's a recap of some of the conditions covered on last night's
episodes of
Grey's Anatomy and
Private
Practice.
Erica suffered from a gliosarcoma,
a rare, malignant, cancerous tumor formed by glial cells in the brain
(basically cells whose job it is to support the neural cells). These cancers
rarely spread outside of the brain, but they have been known to move to the
blood, lungs, liver, and lymph nodes.
Bailey's patient's arm was so
enlarged because she had lymphedema,
a drastic swelling in the arms or the legs caused by a block in
the
lymphatic system. The lymphatic system is responsible for
draining fluid from organs and incorporating that fluid back into the
bloodstream. When there is a blockage, this fluid will build up and create
swelling. The most common cause of lymphedema is the removal or damage of lymph
nodes through cancer treatment.
Sheldon diagnosed Sam's sister Corinne
with hypomania,
a form of bipolar disorder in which affected individuals will often have
intense and unpredictable feelings of euphoria and irritability. Individuals
with hypomania experience no psychotic symptoms associated with mania.
Hypomania usually manifests in a decreased need for sleep and a large amount of
energy, as well as an outgoing and competitive disposition. Individuals with
hypomania often live full-functioning lives because the condition can be
treated by mood-stabilizers and monitored closely by
psychiatrists.
February
19, 2012
Hospital Calendars for the Week of Feb.
19 - PennLive.com –
Tues
- Lymphedema Support Group: 6:30 pm, WellSpan Adams Health Center,
Room 211. Community Multiphasic Blood Screening Program (Inclement weather
make-up date)
February
19, 2012
Breast cancer patients gain strength, mobility,
confidence with better than before program - The
Bridgeton News - NJ.com - By
Lauren T. Taniguchi -
Women
battling breast cancer can regain strength, independence and self-confidence
with the guidance of Better Than Before, a rehabilitative fitness program on
DVD that demonstrates how post-surgery exercises should be performed to support
recovery.
The 50-minute program offers four stages of exercises to help
breast cancer patients safely stretch, achieve mobility and prevent
complications such as lymphedema after undergoing mastectomies, lumpectomies or
reconstructive surgeries.
“Most of what we try to do these days is to
get patients back into society, back into daily living, so they can do normal
activities and get back to their families and jobs,” said Dr. Peter Neumann, a
reconstructive plastic surgeon who gave direction during the program’s
development.
“Another aspect is that after surgery, nobody really deals
with the emotional problems of patients feeling they don’t have the ability to
do what they did before,” Neumann added. “By getting their strength back, they
feel better about themselves, and it prevents depression and family
unrest.”
The program was developed about 15 years ago, when patient Jill
Forrest and her trainer, Lauren Antorino Griffin, worked with Neumann to record
a demonstration of exercises to help women after surgery.
Forrest was a
teacher and outgoing proponent of education, and, though she has since passed
away, her husband, Ed, continues to reach out to breast cancer patients with
Neumann and Griffin in Jill’s memory.
Unfortunately, Neumann said
post-surgery rehabilitation resources in the health care industry are still
lacking, a decade and a half after the program was developed.
“Patients
are stuck, and half the things offered to them in the hospital they don’t
listen to because they’re still so nervous about their treatment,” Neumann
said.
“Most get a rubber ball to squeeze and information from their
friends or the Internet, but not all of that information has been
screened.”
However, Better Than Before has been distributed to fulfill
the great need at medical facilities around the United States and
Europe.
With physician approval, patients can start using Better Than
Before almost immediately following surgery, Neumann said.
“In the
beginning, there are stretching exercises that are safe ways to get mobility in
the arm. The second part is strengthening — using very light weights and/or
resistance to gain strength, especially in the biceps and triceps, as well as
through the pectorals of the chest to get strength back,” Neumann explained.
“The third portion is really for full mobility, all the daily living
activities you’d do as far as picking something off a top shelf or going into a
closet and twisting to pull out a specific shirt. The fourth is
maintenance.”
Neumann, a former member of the board of directors of a
division of the American Cancer Society, said a patient should consult with her
doctor before beginning this or any rehabilitative program. In addition,
patients should listen to their bodies and take care to do only what feels
right.
“We have found this program is completely safe, but if it doesn’t
feel good, maybe you’re not at that point yet. Don’t skip to the end; go
through the program slowly until you get the feeling and strength so you can
move to the next portion,” Neumann said.
Within three to four months of
exercise, most will have regained a significant measure of agility and
strength. Neumann said that by the maintenance stage of the program, most
patients have learned the exercises and begin doing them casually, even during
a morning shower, to stay strong and limber.
Better Than Before is
available for $19.99 online at breastcancerexercises.net, and a
third of all proceeds from DVD sales are donated to the American Cancer Society
to support efforts to find a cure for breast cancer.
“The DVD is all
ages and stages appropriate and is a perfect post-operative gift because better
than flowers, better than sympathy, give her Better Than Before,” wrote Ed
Forrest
February
20, 2012 –
The Week in Sonoma Valley, Feb.
20-26 - Santa Rosa Press Democrat –
Sorry
a one time meeting already passed
February
20, 2012
Lichen Sclerosus Exhibiting Histologic Signs of
Lymphedema: An- Archives of
Dermatology –
We
appreciate the interest of Carlson et al in our article on vulvar VX 1 as well
as their comment about the possible etiologic roles of lymphostasis and
...
You
have to be a member of some group to access this
February
23, 2012
Pinnacle Hand Therapy helps patients with movement,
more - Daily Press – By Phyllis Johnson –
"We take better care of our cars than we do our bodies. We know
that an engine will not last if we do not change the oil, yet we expect to get
years of use from our hands with no preventative care." — Pinnacle Hand
Therapy
The sign outside Pinnacle Hand Therapy LLC doesn't begin to describe
all of the medical services available inside the Middle Ground Boulevard
company
The 8-year-old practice offers hand therapy, lymphedema treatment,
wound care and pediatric therapy. Among the 10 employees, there are three
certified hand therapists and two certified lymphedema therapists who treat
swelling due to a blockage of the lymph passages.
Phyllis Ross, owner and an adjunct professor at Howard University's
Occupational Therapy Department, went into this line of work because she has a
passion for it. She decided to treat lymphedema after seeing breast cancer
survivors who had swelling problems. She gave them complete decongestive
therapy by using compression and massage. Patients use compression wraps and
garments, followed by wrapping at night. It's an ongoing process with measured
successes, something that makes it all worthwhile, she said.
"I love seeing people get better. It's gratifying to see their
progress," said Ross. "We evaluate their physical ability when they come in and
constantly compare it to the baseline to see how far they've
come."
Ross's previous line of work included serving time in the U.S. Navy
during Desert Storm and experience working in hospitals. She migrated back to
the Peninsula to be near family. It's been a good move for her, she said, and
she enjoys her work.
She also enjoys teaching students occupational therapy. "There's a
need for continuing education in the area of hand therapy."
Ross says people often take the things they normally do for granted.
When movement is impaired, there has to be treatment and therapy to bring
normal movement back.
"It's reassuring to a patient to see continued progress. It's a
measurable thing," she said.
A steady stream of people use the practice. There is a room where a
small number of people are getting therapy in a group setting.
"A new patient is able to come in and see someone else further along
in the same treatment and see how well they're doing. That's reassuring for a
new patient," she said.
One patient, Danny Engle of Hampton, showed where he had cut his hand
and later had surgery. Pinnacle Hand Therapy is helping restore motion to his
hand.
"This is the second place I've been for therapy. The staff is very
courteous and patient. They really take care of people here. I've never seen
anyone lose their patience. They're very flexible. Phyllis stayed late for
several hours recently to work with me. It means a lot," said Engle. "The staff
doesn't feel you owe them. They feel they owe you."
Another patient, Robert Raney of Suffolk, has been going to Pinnacle
practice since it opened in 2003. He comes for help with lymphedema and for
therapy for his arms and fingers. He requires special splints for two of his
fingers.
"I was one of her first patients," Raney said. "She gets me to
exercise to effectively help with therapy."
Ross has a good manner with the patients and staff. It's clearly a
place where patients feel right at home. "We often see local high school
athletes come in with injuries, too."
Her staff works with younger students as well when they have problems
with sensory processing, coordination, dyspraxia, motor skills and handwriting.
The practice offers training and hope. Physical activity and using
manipulatives are forms of treatment for motor skills. They use various
techniques for those with autism.
"We see a lot of children sent here from the Children's Hospital of
the King's Daughters who need hand therapy," said Ross. "We're happy to help
them."
Her plans for the future include the development of a continuing
education training course for therapists interested in hand therapy or
lymphedema therapy.
"We stay busy. Even on holidays, we have drop-ins come in for help,"
said Ross. "We're happy to assist people in restoring function so they can
return to whatever job, hobby or other activity they enjoy."
Company details
Pinnacle Hand Therapy
704 Middle Ground Blvd., Suite D, Newport News,
757-595-4880.
Hours: 8 a.m.-5 p.m. Monday through Friday.
The practice is accepting patients from Newport News, Hampton,
Yorktown, Seaford, Grafton, Langley Air Force Base, Fort Monroe and
Gloucester.
February
25, 2012,
Freeze column: Knee surgery -
Salisbury Post –
A
little over three months ago, I started to experience tightness in one of my
knees. On a few of my morning runs, that actually locked up. After a few more
days, I couldn’t climb steps with that left knee, and couldn’t pedal a bike
either. Climbing a ladder was definitely out.
My
two favorite physical therapists offered advice. Drs. Delaine Fowler and Pam
Roseman had some ideas, and we tried a few things.
Delaine,
who owns Fowler Physical Therapy, and Pam, owner of Lymphedema Solutions
Physical Therapy, are both experienced runners. They suggested that I get an
opinion from Dr. Robert Humble, an orthopedic surgeon with a reputation for
getting athletes back on the road quickly.
The
idea of surgery didn’t appeal to me, but something had to happen. Other runners
offered opinions, with most thinking I couldn’t run for a minimum of 14 days
and possibly as much as a month after the surgery.
I
did go to Salisbury Orthopedics Associates and met with Dr. Humble. He and
Physician’s Assistant Ryan Schenk and staff told me what to expect, and were
able to schedule arthroscopic surgery on Feb. 1, just two weeks later.
Arthroscopic
surgery involves two small holes in the knee through which a scope is inserted
and the knee is inflated with a sterile fluid. Dr. Humble would use the scope
to see and repair the damage, saying, “I can fix anything but an ACL, and that
isn’t your issue.” He made me confident of success.
On
the morning before the actual surgery, I had to get my run in. There was even a
fleeting thought of running to Rowan Regional Medical Center’s Outpatient
facility on Julian Road, figuring that no one would have done that before. I
didn’t do that — which later pleased the nurses who took care of me.
My
only previous surgeries were a tonsillectomy and a colonoscopy. Getting your
tonsils out in those days meant plenty of ice cream and some good memories. My
colonoscopy was enjoyable, too, although most people can’t understand why
anybody would think that.
Upon
arriving at the Outpatient Center, I was welcomed quickly, with the paperwork
processed very efficiently. Ameran Hill took care of that. My neighbor Vanessa
Bradley was in that same area, being the first of several staff that I already
knew. My daughters, Ashley and Amber, as well as Laura Kerr were there to make
sure that I didn’t wisecrack to the nurses too much. They also reminded me that
I couldn’t wait for Danica Patrick to show up, even though I was sure that she
was coming.
Dona
Peacock came out and called my name, saying “Aren’t you the guy who writes for
the Salisbury Post?” That immediately opened the door to some interesting
conversation. Dona and Leigh Ann Williams made sure that I was comfortable as
anybody can be while wearing one of those “open rear” gowns.
Next
the nurses who would assist in the surgery came by, and I knew them both. Word
had spread that there might just be a Salisbury Post column about this
experience. Rhonda Smith and Lauren Daniel enjoyed talking with my daughters as
we waited on Dr. Humble and the operating room. The anesthesiologist, Michael
Jones, stopped by and made sure that I would be easy enough to put to sleep.
Dr.
Humble came in, making last preparations. They let me walk to the bathroom one
more time, and then it was “Showtime.” They rolled my bed to the operating room
and put a warm blanket on me since it was much cooler in that room. Kim
Alexander told me that they were going to put something in my IV, and after
what seemed like seconds later, I woke up feeling great with a bandaged knee.
It
took just minutes and I was on my way out of the building, a short three hours
after entering the door. Kay Meilinger, my recovery nurse, must have done a
great job, because I hardly got to know her.
I
spent that afternoon on the couch with a succession of ice packs. The second
day brought a stiff knee and a shower. The swelling began to go down, and I had
no trouble walking by the third day. There was no real pain, just an off and on
ache with stiffness, usually depending on how long I stood.
My
running resumed exactly one week later, meaning that I only missed six days.
Dr. Humble told me that it would take at least a couple of months to recover
full strength in the knee, saying that even pro athletes often aren’t back up
to speed until the next season. With that said, my knee is getting better, now
three weeks after the surgery, and I haven’t ruled out playing major league
baseball next season.
To
the staff at RRMC’s Outpatient Center, you did make a good column, and made
another experience at RRMC very pleasurable. I definitely was cared for by a
group of people who take pride in the work they do. Thank you!
February
24, 2012
Surviving cancer, giving back -
Metrowny.com
Refusing to accept the statement, ‘You’re
just getting old,’ may be the reason 36-year-old Lisa Johnson is alive today.
After beating cervical cancer in 2004 and celebrating four years of
being cancer free, Johnson developed secondary lymphedema, in 2008. This
resulted in a chronic swelling of her left leg, which developed as a result of
lymph nodes that were removed during the initial surgery she had to remove her
cervical cancer years prior.
Initially, Johnson injured herself by
rolling off of her sandal and just assumed her leg was swollen due to the
injury, doctors agreed. One doctor even said her leg was enlarged as a result
of old age; however, at age 33, she knew something else was wrong.
Johnson decided to do her own research. After dealing with the
discomfort of walking around with one leg larger than then other for three
years, she stumbled upon information that indicated how lymphedema can be
caused. Johnson then took her findings to Roswell Park Cancer Institute in
October 2011. There - she was provided with the proper diagnosis and treatment.
Upon her arrival at Roswell, Johnson’s left leg was 28 percent larger
than her right leg.
“You have to just keep doing research to find out
what’s wrong with you,” said Johnson. “You can’t give up.”
As a way of
thanking Roswell Park for helping her, Johnson will again is host the annual
“Stick it to Cancer,” event.
“I like helping people and I wanted to give
back for the help that was given to me,” said Johnson.
The event will
be held from 2 to 7 p.m. Saturday, April 21 at the Town of Tonawanda Boys and
Girls Club, 54 Riverdale Ave., Town of Tonawanda.
At the event, Johnson
will learn to ride a bicycle for the first time in front of the entire crowd.
For safety she will wear knee and elbow pads, a helmet, and be wrapped head to
tow in bubble wrap.
A game called, Boo Boo Bing-OW, will be played
while she rides. Johnson will place baseball cards in the spokes of her bicycle
to make some noise while additional baseball cards will be sold to raise money
for cancer. Johnson will call out players’ names on the baseball cards while
she is riding to give friends and family a chance to win prizes.
In
addition to her ride, a blood drive and basket raffle will be held throughout
the duration of the fund-raiser. Baseball cards will be sold until 4 p.m.,
basket raffle drawing will take place at 6 p.m. (winners do not need to be
present), and a 50/50 split drawing that will take place after the basket
raffle.
Admission for the event is $10 per person, $5 for presenting
blood donors and free for children 10 and under. Admission includes a set of
raffle tickets, non-alcoholic beverages and snacks. Raffle tickets will be sold
for $5 per sheet or $20 for five sheets, baseball cards will be sold for $5
each. For those individuals who wish to just donate blood, there is no cost.
Proceeds from the event will benefit Roswell and the Town of Tonawanda
Paramedics.
For additional information, contact Johnson at
[email protected], search for “StickItToCancer” on Facebook or visit http://stickittocancer.wordpress.com.
March 1, 2012
Waterside will alter seats for big
customers - Bucks Herald –
Published on Thursday 1 March 2012 14:24
A TOWN centre theatre has reassured guests after a woman avoided
the venue for fear she could not fit into a seat.
The Aylesbury mother, who has asked to remain anonymous, has had to
refuse her 17-year-old special needs son a trip to the Waterside Theatre for
fear that the seats were too small, given her health.
The 39 year old of Walton Court suffers from lymphedema, a gland
condition meaning her legs and hips retain fluid, making her too large for a
normal seat.
“My friends have all been and told me I probably wouldn’t fit in
any of the seats,” she said.
“Because of the arms I just wouldn’t fit into the chairs, because
they don’t lift up at all.
“This means each time I see something I would like to go and watch
at the theatre I don’t even bother looking into getting tickets and have had to
put off taking my son when he’s asked me.
“Not all disabled people use wheelchairs.”
But the Waterside Theatre has responded saying it is happy to
accommodate anyone with such a condition.
John Coughlan, creative learning manager at the venue, said:
“Seating in the auditorium is designed to be removable in order for us to meet
the needs of our customers with access requirements.
“In line with our policies, if a customer makes us aware on booking
a ticket that they are unable to use the seating provided due to a medical
condition or access requirement, we would endeavour to provide alternative,
suitable seating at no additional cost, to ensure they are able to enjoy the
performance comfortably.”
Training
like an athlete is tough work, but worth it - Montreal
Gazette –
A
regimen designed for football players can be effective for everyone
The
idea that there's no such thing as being "too big" to play football is
changing. So is the belief that football players need to spend their off-season
in the weight room pushing more and more weight. Instead, studies exploring the
relationship between football performance and fitness testing have shown that
explosive power and maximal running speed are better markers of on field
playing ability.
Liam
Mahoney, a former Concordia Stinger and now a receiver for the Hamilton
Tiger-Cats, used to live by the bigger-is-better philosophy. But he found the
added size made him slower and less reactive than he was at a lighter
weight.
"I
don't need to get stronger or lift more weight," said 6-foot-1, 200-pound
Mahoney. "What I need is more core strength and more explosive speed off the
line."
Mahoney's
role on the field is to run routes, find open space and catch the ball. So
while he still spends time in the weight room, his main focus is on building
the kind of strength and quickness that allows him to outrun and outmanoeuvre
the competition.
"When
I run a route, I always have guys pushing me and hanging on me," said Mahoney.
"So I need a strong core to do my job on the field."
To
help achieve his goals, Mahoney went looking for a trainer who could design a
sport-specific, position-specific and fitness-specific program. He needed
someone who understood football and had the knowledge and creativity to design
a program that would improve his athletic skills on the field.
He
found what he was looking for closer to home than he thought he would. Trainer
Michael Alfonso played football with Mahoney at Vanier College. Unlike Mahoney,
however, Alfonso hung up his cleats. He didn't abandon the sport, though. He
became a certified strength and conditioning specialist whose main focus is
training football players to stay healthy and perform better on the
field.
"I
help bridge the gap from the weight room to the field by building a training
program that simulates their playing style," Alfonso said of the Speed Science
Training System.
In
football, that means lots of short, high-intensity bursts of power punctuated
by periods of rest, which is exactly the type of workout Alfonso's clients can
expect.
In
the case of Mahoney, testing revealed that he needed to increase the power
output of his first two steps off the line. So with Alfonso's help, he's been
building explosive strength in his lower body. After three months of hard work,
Mahoney has mastered an impressive 51-inch standing box jump (a jump from the
floor to the top of a box) and makes it look easy (see video).
It's
not just pro football players who can benefit from this type of conditioning.
Charles Héroux is a 38-year-old account manager who coaches football in his
spare time. Not happy with the extra pounds he put on over the years, Héroux
knew he needed to change things up.
His
workout routine meant running when he wanted to lose weight and hitting the gym
when he wanted to bulk up. But that routine had grown old. What he wanted was a
workout similar to what his players were doing. So Héroux sat down with Alfonso
and put together a plan, not just to lose 40 pounds but to improve his overall
fitness. He started the plan in January, and so far, it seems to be
working.
"I've
never trained like that before," said Héroux. "I almost puke my guts out, but
I'm happy."
While
his first few weeks were tough, he's pleased with his progress. He's even
happier that he gets it all done in 40 minutes, three times a
week.
"I've
lost 15 pounds," he said. "My body is changing; I'm standing straighter and my
energy level is up."
Before
you get inspired and sign up for the nearest training program that promises to
build athletic speed and power, keep in mind that you have to be prepared to
work hard - probably harder than you have ever worked before.
"If
you want to get in better shape and you want to be lean, you need to train like
an athlete," said Alfonso.
And
you have to make sure you have a trainer who knows what he or she is doing.
These aren't cookiecutter programs prescribed for any Joe or Jill. They're
high-intensity workouts that need to be tailored to individual strengths and
weaknesses and consistently rejigged as you progress.
Alfonso
uses lots of specialized equipment to build the kind of fitness and athleticism
his clients want. And he keeps the workouts challenging, changing them up often
so that both mind and body stay stimulated.
In
addition to the impressive physical results, the challenge, intensity and
diversity of an athletic based program will recharge your batteries and make
you love going to the gym.
"Put
a big guy on a treadmill for 45 minutes, and he will hate his life," said
Alfonso. "But 45 minutes of this kind of training really gets the guys
going."
FOOTBALL
TRAINING
Click
on this column on the Health page to watch John Mahoney's video of Montreal
Alouettes Marc-Olivier Brouillette and Hamilton Tiger-Cats receiver Liam
Mahoney (above) working out at Speed Science Training System gym with trainer
Michael Alfonso: montrealgazette.com/health
LACE
UP FOR LOCAL EVENTS
April
29: 5K Walk for Lymphedema, 8 to 11 a.m. at Jean Drapeau Park. Visit
infolympho.ca.
May
27: The Kidney Walk for the Kidney Foundation of Canada. 5K, 10 a.m. at
Lafontaine Park, École Le Plateau. Call 514-938-4515, Local 228 or visit
kidney.ca/quebec.
Ongoing:
One Million Kilometres, One Million Dollars. Choose an activity, like walking,
running, skating or skiing, count your kilometres and ask friends and family to
sponsor you. No minimum contribution. Benefits the Montreal Children's
Hospital's Family Resource Centre.
1millionkm.com;
514-934-4846.
If
your organization is planning a walk or run in the Montreal region, fax the
details (registration, date, time, location, distance, website, phone number)
to Race Calendar at 514-987-2638, email artslife@ montrealgazette.com or write
to Race Calendar, Arts & Life, The Gazette, 1010 Ste. Catherine St. W.,
Suite 200, Montreal H3B 5L1.
[email protected]
©
Copyright (c) The Montreal Gazette
March
12, 2012
Lymphedema: Separating Fact From
Fiction - Cancer Network – By Sarah A. McLaughlin,
MD
ABSTRACT:
Lymphedema is a feared complication of cancer treatment and one that negatively
impacts survivorship. The incidence of breast cancer–related lymphedema ranges
from 6% to 70%, but lymphedema may be a common and under-reported morbidity. No
standard guidelines for its diagnosis and assessment exist. Although the true
etiology of lymphedema remains unknown, radiation, chemotherapy, type of breast
surgery, and extent of axillary surgery are commonly cited risk factors.
However, the relationship between the number of nodes removed and the risk of
lymphedema is not clearly correlated. Clinical trials are focusing on ways to
reduce the need for axillary dissection even in the setting of a positive
sentinel node, to help minimize axillary morbidity. Risk-reduction practices,
including avoidance of skin puncture and blood pressures in the ipsilateral
upper extremity, and precautionary behaviors such as wearing compression
garments during air travel continue to be advocated by the medical and survivor
communities, despite a lack of rigorous evidence supporting their benefit.
Emerging data support exercise in at-risk and affected women with lymphedema
when started gradually and increased cautiously.
Introduction
The
most recent survivorship data from the Surveillance, Epidemiology, and End
Results (SEER) database demonstrate a significant increase in the number of US
cancer survivors over the last 30 years, from roughly 3 million in 1973 to
nearly 12 million in 2008.[1] As a result, issues of survivorship have
stimulated new focus for clinical trials, not only to determine the most
effective therapeutic regimen (surgery, drug, or radiation) but also to
identify the one with the least influence on future quality of life. Lymphedema
has long been a feared complication of surgical cancer treatment, and notably
one that negatively impacts survivorship. Fear of lymphedema stems from patient
concerns regarding the chronic, progressive nature of the condition and the
clinician’s relative inability to predict or prevent its development.
Furthermore, decades of physician and allied health teachings based on opinion
and theory have perpetuated the myths shrouding lymphedema risk, prevention,
and
A
vast body of literature documents the occurrence of breast cancer–related
lymphedema, with more than 1400 articles indexed in PubMed-MEDLINE databases
alone. Importantly, lymphedema also exists after surgery for
non–breast-cancer-related malignancies, but data documenting this occurrence
are rare in comparison. Recently, Cormier et al found only 47 studies between
1972 and 2008 with more than 10 patients that prospectively evaluated
lymphedema as a primary or secondary outcome after treatment for melanoma,
bladder, sarcoma, penile, prostate, vulvar, cervical, endometrial, or head and
neck cancers.[2] The authors’ analysis of these studies demonstrated the
overall incidence of lymphedema to be 16.3% after melanoma, 10.1% after
genitourinary cancers, and 19.6% after gynecologic malignancies, and notes that
lymphedema rates are higher when the lower rather than upper extremity is
affected. Given the abundance of breast cancer data, this review will focus on
breast cancer–related lymphedema. However, the principles and controversies
discussed are relevant regardless of the type of malignancy to which the
lymphedema is attributed.
Incidence
and Diagnosis
The
incidence of breast cancer–related lymphedema has been difficult to quantify
due to delayed onset of symptoms and the lack of standardized diagnostic
criteria. A recent meta-analysis reports the incidence of breast cancer–related
lymphedema to range from 0 to 3% after lumpectomy alone to as high as 65% to
70% after modified radical mastectomy (removal of breast and axillary lymph
nodes) with regional nodal radiation.[3] Overall, 80% to 90% of women who will
develop lymphedema do so within 3 years of treatment,[4,5] but the risk
persists years later as the remaining 10% to 20% will develop lymphedema at a
rate of 1% per year.[5] Petrek et al followed 263 patients and found that
nearly 50% developed lymphedema by 20 years.[5] These data suggest that
lymphedema is probably more common than generally reported, and clearly the
length of follow-up in a given study influences the reported incidence. A
uniform definition of lymphedema does not exist. Although volume displacement
methods are considered the gold standard for diagnosis, these methods are
cumbersome and unable to identify subclinical lymphedema. Thus, displacement
methods are rarely used in clinical settings. Circumferential arm measurements
performed with a nonelastic tape measure are commonly used to determine upper
extremity size differences. It is essential to obtain baseline preoperative
measurements of the ipsilateral and contralateral extremities, as differences
of up to 2 cm may naturally exist between the dominant and nondominant arms at
baseline.[6] Published literature demonstrates significant heterogeneity, as
studies lack agreement on the location and minimal number of measurements
performed. Furthermore, they use multiple definitions of what constitutes
lymphedema, including measurement changes greater than 2 cm, volume increase of
more than 200 mL, or percentage increases in volume (> 10% or > 20%)
compared with baseline when controlled for changes in the contralateral
arm.[7,8] Aside from objective measurements, some studies define lymphedema by
patient subjective symptoms or patient perceptions of swelling.
Controversy
remains as to whether a measurement change or a patient’s perception of
swelling should be considered diagnostic. While a measurement change is
objective, measurements may be affected by inter-rater and even intra-rater
variability affecting reproducibility. Perhaps more importantly, a defined
measurement change may be asymptomatic in an obese patient, while a thin woman
may be bothered by more subtle measurement changes not meeting measured
criteria for lymphedema. Alternatively, a patient’s perception of swelling may
more accurately diagnose symptomatic lymphedema, but this perception may be
influenced by sensory changes from the surgery and additional adjuvant
therapies. Further, women with surgery in their dominant arm may perceive
functional issues to a greater degree than if it were the nondominant arm that
was affected.[9] In fact, one study found only 41% of women with perceived
swelling had circumferential arm measurement changes greater than 2 cm, the
objective threshold used in the study to define lymphedema.[9] Several
contemporary studies have evaluated the differences between measured and
perceived lymphedema and have validated patient perceptions against physical
therapist–directed measurements.[4,10] These studies conclude that each
evaluation method is valid but not interchangeable, and they do not endorse one
method over another.
The
clinical introduction of a single-frequency bioelectrical impedance device
manufactured by Impedimed (Mansfield, Australia) can minimize both inter-rater
and intra-rater variability seen with other measurement techniques. The device
produces easily interpretable values measuring the changes in extracellular
fluid when compared with the unaffected contralateral upper extremity. A score
increase of 10 or more or one that registers outside the normal range should
prompt intervention with a compression garment or a referral for physical
therapy. Some investigators report that measurement of bioimpedance has
improved sensitivity in detecting subclinical lymphedema up to 4 months prior
to standard measurement changes.[11] For these reasons, the current National
Lymphedema Network (NLN) breast cancer–related lymphedema guidelines recommend
that all breast cancer patients receive pre- and post-treatment measurements
(of any type) on both arms and encourage the use of bioimpedance spectroscopy
or infrared perometry as alternatives to tape measures, to limit measurement
variations.[12]
Is
It All About the Nodes?
Over
the years, many retrospective studies have reported risk factors for
lymphedema. Axillary node dissection (ALND), mastectomy, obesity, radiation,
infection, and ipsilateral upper extremity injury consistently rank as the most
influential causes of damage or disruption to the lymphatic system and thus
lymphedema. However, the magnitude of association between breast cancer
treatment factors and lymphedema is inconsistent across studies.[8] Tsai et al
reviewed 98 studies conducted in the United States and Canada through January
2008 for lymphedema risk factors.[8] The authors report a significantly
increased risk for lymphedema in women undergoing mastectomy compared with
lumpectomy (risk ratio [RR], 1.42; 95% confidence interval [CI], 1.15–1.76),
ALND compared with no dissection (RR, 3.47; CI, 2.34–5.15), ALND compared with
sentinel lymph node biopsy (SLNB) (RR, 3.07; CI, 2.20–4.29), radiation therapy
vs no radiation therapy (RR, 1.92; CI, 1.61–2.28), and positive vs negative
axillary lymph nodes (RR, 1.54; CI, 1.32–1.80). While this meta-analysis
demonstrates a comprehensive, contemporary review of lymphedema risk factors,
the heterogeneity of the data must be considered, as 11 different definitions
for lymphedema were used and follow-up ranged between 1 month and 30
years.
Though
the most intuitively obvious risk factor for lymphedema is the number of nodes
removed, the relationship between the number of lymph nodes removed and the
risk of lymphedema remains unresolved. Several retrospective studies have shown
that the number of nodes removed and the risk of lymphedema do not
correlate.[13,14] Others find an increasing risk of lymphedema as more nodes
are removed.[15-17] Despite various lengths of follow-up, from 6 to 60 months,
the prospective trials vetting SLNB as the standard of care for axillary
staging demonstrate significantly reduced rates of lymphedema after SLNB (0 to
7%) compared with ALND (12% to 16%).[18-21] These studies certainly support the
concept that the risk of lymphedema is proportional to the extent of axillary
surgery. Importantly, though, they also confirm that even with SLNB a small but
clear risk of lymphedema remains. A recent study by Goldberg et al suggests
that it is not the number of lymph nodes removed but instead the degree of
dissection and disruption of the lymphatic system that results in
lymphedema.[22] The authors reviewed 600 women having SLNB with a median
follow-up of 5 years and found an overall incidence of lymphedema of 5%. When
stratifying the data according to the number of nodes removed, they found no
significant association between the mean, median, or range of number of nodes
excised and lymphedema (P = .93). Furthermore,
the authors completed a subset analysis of the women having more than 10 lymph
nodes removed at SLNB. None of these women developed lymphedema. Interestingly,
when these SLNB patients having > 10 nodes removed were compared with a
separate group of women having 10 to 17 nodes removed at ALND, 11% of the ALND
patients had measured lymphedema (P
= .04). The fact that women having more than 10 nodes removed during SLNB did
not develop lymphedema but women with the same number of nodes removed after
ALND did reaffirms that the relationship between the nodes removed and
lymphedema is complex. Perhaps it is the relative magnitude of lymphatic
destruction and individual patient ability to form collateral lymphatic
channels, rather than the number of nodes removed, that influences lymphedema
risk. For example, a patient with many nodes removed at SLNB and no finding of
lymphedema may have more lymphatic collaterals and therefore will have suffered
relatively less lymphatic disruption despite a larger than “normal” number of
SLNs removed. On the other hand, women having ALND and a relatively small
number of total nodes excised may have suffered an overall greater degree of
lymphatic disruption and therefore develop lymphedema. Unfortunately, the
number of nodes within each patient’s nodal basin and the patient’s ability to
protect or form new lymphatic collaterals during or after treatments is
unknown. Therefore, simply the number of nodes removed may be insufficient to
determine lymphedema risk.
If,
however, the degree of lymphatic disruption or damage is the key driver of
lymphedema risk, then it is plausible that radiation can also act primarily or
synergistically to influence lymphedema risk. Axillary radiation alone is not
without complications, as these patients can have a 2- to 4.5-fold increase in
the risk of lymphedema. A recent meta-analysis by Shah and Vicini finds
lymphedema in 9% to 65% of patients after lumpectomy alone (no nodal surgery)
and regional nodal radiation and in 58% to 65% of women after mastectomy alone
and regional nodal radiation.[3] Additionally, the synergistic effect of
surgery and radiation is well documented to result in a 3.5- to 10-fold higher
risk of lymphedema when compared with surgery alone.[3,23,24]
Finally,
accumulating data suggest that chemotherapy may also affect lymphatic
destruction. Norman et al found anthracycline-based chemotherapy regimens
increase the risk of lymphedema.[25] Their prospective review of 631 breast
cancer survivors followed for 5 years found an elevated hazard ratio (HR) of
1.46 (95% CI, 1.04–2.04) for lymphedema among breast cancer patients receiving
anthracycline-based chemotherapy vs no chemotherapy. This risk persisted after
stratifying for stage at diagnosis or number of positive nodes. Furthermore,
the authors concluded that treatment combinations involving ALND or
chemotherapy resulted in approximately four- to five-fold increases in the HRs
for lymphedema (HR, 4.16 [95% CI, 1.32–12.45]for SLNB/chemotherapy/no
radiation)compared with no treatment. While further validation of this finding
is needed, the concept that chemotherapy independently influences lymphedema
risk demonstrates that this risk can be affected not only by locally directed
therapies but also by systemic ones.[25]
Changes
in Surgical Management
Changes in the surgical management of the
axilla have been instrumental in reducing axillary morbidity, especially
lymphedema. SLNB is now the standard of care for axillary staging, as its
accuracy, low false-negative rate, and low rate of axillary recurrence have
been documented in more than 70 studies. Current research to further minimize
morbidity from axillary surgery focuses on reducing the need for completion
axillary dissection in the setting of a positive axillary node. The American
College of Surgeons (ACOSOG) Z0011 trial published in early 2011 documents the
first prospective randomized data showing that at a median of 6 years
follow-up, SLNB alone does not result in inferior survival in women with T1 or
T2 tumors and one or two positive sentinel nodes who received breast
conservation surgery, chemotherapy and/or hormonal therapy, and whole breast
radiation therapy.[26] In the study, more than 70% of the women with a positive
SLNB had no additional positive nodes, suggesting that in select cases SLNB can
be both diagnostic and therapeutic. While this trial is viewed as
practice-changing, it is important to note that the trial called for standard
whole breast radiation but did not standardize the radiation tangents other
than to say that third field–directed axillary radiation was forbidden. As a
result it is possible that radiation tangents were adjusted higher in
node-positive women who were randomized to the SLNB-only arm. If standard
radiation tangents cover approximately 30% to 50% of the level I and 25% of the
level II axillary nodes,[27] then adjusting the tangents “higher” has the
intention of covering more nodes than standard. These data are important from
the perspective of morbidity, as an adjustment in the tangents may result in
increased rates of axillary morbidity above what is seen with standard whole
breast tangents and SLNB alone. The radiation ports are currently being
evaluated retrospectively. An additional prospective trial, ACOSOG Z1071, is
evaluating the validity, accuracy, and false-negative rate of SLNB after
neoadjuvant chemotherapy in women who present with node-positive disease at
diagnosis. The investigators hypothesize that SLNB after neoadjuvant
chemotherapy will appropriately and reliably stage the axilla and therefore
allow elimination of ALND in women converted by neoadjuvant chemotherapy from
node-positive to node-negative status. The trial accrued quickly and results
are pending. Remaining questions to be answered include that of which women may
be able to forgo axillary surgery (SLNB or ALND)
altogether.
Lymphedema Prevention and Early
Intervention: A Worthy Goal - Cancer Network –
By
Atilla Soran, MD, MPH, David N. Finegold, MD, Adam Brufsky, MD,
PhD
The etiology and
risk factors of breast cancer–related lymphedema (BCRL) are multifactorial and
not fully understood. BCRL risk factors are divided into three main categories.
There are treatment-related factors, including surgery, radiotherapy,
chemotherapy, and combined treatments. Secondly, there are disease-related
factors, including tumor stage at time of diagnosis, pathologic nodal status,
number of removed lymph nodes, and the location of the tumor in the breast.
Finally, there are patient-related factors, including age at diagnosis, high
body mass index (BMI), comorbidities, history of infection or inflammation,
hand dominance, sedentary lifestyle, and excessive use of the affected
limb.
BMI is one of the
patient-related factors affecting BCRL. Several studies showed that a majority
of the patients with BCRL were overweight or obese. BMI is a risk factor for
increased severity of BCRL, infection, and wound healing. Advanced age also
appears to be a risk factor that contributes to the severity of BCRL and
quality of life. Further validation studies must be conducted to obtain more
information about the effects of the patient’s age on BCRL.[1,2]
Level of hand use
is another significant factor for BCRL, notwithstanding controversy in the
literature. Two studies from our group confirmed that patient occupation is a
risk factor for BCRL.[3,4] We modified the previous classification system of
the level of hand use by three objective criteria, according to the status of
occupational workload. Group I included working continuously less than 30
minutes at a time and 8 hours or less per day. Group II included working
continuously between 30 and 60 minutes at a time, and 8 hours or less per day.
Group III included working continuously for more than 1 hour and at least 8
hours per day. Based on this new classification, we confirmed that occupation
is an important risk factor for increased severity of BRCL, and patients with
occupations requiring more upper extremity activity and long periods of work
had an independent risk for more severe disease outcome. Therefore, patients
with BCRL should be advised to adjust their daily use of upper extremities to
prevent increased severity of BRCL. As the study authors stated, a uniform
definition of lymphedema does not exist and the diagnosis of BCRL remains a
challenge. Nevertheless, the new techniques for diagnosis of lymphedema,
including DEXA (dual emission x-ray absorptiometry) and BIS (broadband
impedence spectroscopy), are promising. Such technologies represent significant
improvements over traditional ones, by providing standardized cutoffs, limiting
observer variability, increasing sensitivity with the potential for subclinical
detection, and accurately measuring the extracellular fluid space.
Early diagnosis of
lymphedema translates to more treatment options; less edema, smaller limbs,
improvement in joint aches, and reduced muscle pain and tightness; a decreased
infection rate; increased patient desire to continue treatment; decreased
medical costs; and an improved quality of life. Diagnosis of subclinical
lymphedema facilitates early interventions such as education and preventive
recommendations such as the use of over-the-counter compression sleeves,
physical therapy consultation, daily exercise, and avoiding overuse of the
affected arm.
Surgical prevention
of BCRL with axillary reverse mapping (ARM) marks the drainage of the arm with
blue dye to determine the anatomical variation in the lymphatics and thus
provides a roadmap for their preservation. However, the preservation of ARM
nodes and lymphatics is not always possible. Several problems remain to be
resolved in the practical use of this technique, including insufficient
identification rates of the ARM nodes and lymphatics, persistent blue dye
retention at the site of injection, and involvement of the ARM nodes with
metastatic foci in patients with axial lymph node metastases. In a minority of
patients, the sentinel lymph node draining the breast may also be the same as
the ARM node draining the upper extremity.
For severe BCRL,
excisional operations and debulking procedures have been reported as effective
me-thods to alleviate symptoms by removing fibrosclerotic connective tissue,
excess adipose tissue, and excess skin. Liposuction was introduced as an
excisional technique to remove subcutaneous fat, to reduce the limb’s overall
size. Preventive surgical strategies to avoid a diagnosis of BCRL include
pedicled omentoplasty and lymphovenous anastomosis in high-risk patients.
Contemporary advances have resulted in the development of microsurgical
reconstruction, enabling the creation of fine connections between distal
lymphatics and subdermal venules (lymphaticovenular anastomosis [LVA]). The
advantage of LVA is that the subdermal location of the smaller vessels
eliminates the pressure imbalance be-tween the lymphatic and venular
anastomosis, potentially eliminating the potential for thrombosis and
back-flow. In addition, the subdermal location of the anastomosis permits the
use of small incisions with minimal dissection and morbidity, allowing the
procedures to be performed with local anesthesia and requiring only short-term
hospitalization. Early reports of LVA for the treatment of lymphedema have been
promising. Other surgical techniques such as lympho-lymphatic anastomosis and
lymphatic grafting have been proposed as reconstructive techniques that are
associated with im-proved patency over time.[5]
Low-level laser
therapy (LLLT) is a new modality that has been evaluated in the management of
various musculoskeletal disorders. It is presumed that by increasing lymphatic
flow, LLLT reduces the surplus of both tissue protein and fluid, and thereby
improves limb performance. LLLT is believed to encourage lymphangiogenesis and
stimulate lymphatic motoricity. Thus the greatest benefit from LLLT is achieved
over a long period of time, and it has been suggested that patients with
early-stage lymphedema might respond better to LLLT than those at advanced
stages. Patients with BCRL gained additional benefits from LLLT, such as
reduction in limb circumference and pain, increase in extremity range of
motion, and an improvement in scar mobility when LLLT was used in conjunction
with conventional treatment modalities.[6]
Pneumatic
compression devices (PCD) have been developed during the last 25 years as both
alternatives to manual lymphatic drainage (MLD) and as complementary treatments
to be used along with MLD. More recently developed lower-pressure devices, when
used with appropriate training and education, are believed to be safer than
their older counterparts and have been cleared by the US Food and Drug
Administration (FDA) for home use.[7] A prospective study suggests that the
devices may provide better maintenance edema control than self-administered
massage in BCRL.[8] In another study, participants’ use of professional MLD
therapy, self-MLD, and bandaging declined after they initiated use of the newer
PCD.[9] Truncal/chest/arm advanced pneumatic compression therapy vs arm-only
pneumatic compression in self-care for arm lymphedema without truncal
involvement has been studied. Findings revealed a statistically significant
reduction in both the number of symptoms and overall symptom burden within each
group, and reduction in BIS and arm circumference was achieved in both groups;
however, there was no statistically significant difference in reduction between
groups.[10] These findings indicate that both configurations are effective;
however, there may be no added benefit to advanced pneumatic treatment of the
truncal lymphatics prior to arm massage when the trunk is not also
affected.
Treatments for
lymphedema (LE) should only be ordered after qualified practitioners have
completed a thorough diagnostic evaluation. Use of PCD is the current
international standard of care for managing BCRL. A number of other promising
treatments have been reported, but they have not yet been subjected to
sufficient rigorous research for them to be recommended as the standard of
care. Our lack of understanding of the cellular and molecular mechanisms in the
development of LE has complicated effective preventive strategies. As the
author states, many of the current recommendations for prevention of LE are
anecdotal, with scant scientific evidence. Research priorities in this area
should focus more on how to prevent patients from developing BCRL, and on how
to accurately diagnose it in the subclinical phase to enable early intervention
with the goal of preventing the occurrence of severe lymphedema.
Financial
Disclosure: The
authors have no significant financial interest or other relationship with the
manufacturers of any products or providers of any service mentioned in this
article.
LympheDIVAs for Lymphedema
sufferers - Edmonton Journal (blog) –
If
you’ve never heard of Lymphedema (and I hadn’t until today), you
probably don’t know that, not only is it an unpleasant side effect of breast
cancer treatment that causes permanent swelling in the arms, it poses both
comfort and fashion challenges.
Since
March is Lymphedema Awareness Month, it’s a good time to do a fashionable
favour for sufferers from this condition, which is treated with massage and
compression sleeves.
The
bandage-like sleeves are usually hot, heavy and made from rough fabric. But a
US company called LympheDIVAs has created stylish versions in comfy, breathable
materials in everything from nude shades to bright colours to crazy
patterns.
March
13, 2012
Lymphedema: Still a Problem Without an
Answer - Cancer Network - By
Rosemarie Hardin, MD, Lisa K. Jacobs, M
It is ironic that
we were asked to comment on the article by Dr. McLaughlin in this issue of
ONCOLOGY. A few months ago, one of us (LKJ) was attending a patient in the
breast clinic who had recovered well from a lumpectomy with sentinel node
biopsy followed by completion axillary lymph node dissection (ALND). She handed
me an educational packet for me, my fellow, and the support staff. She was
extremely appreciative of her surgical and medical care, but she had one
complaint. She had developed lymphedema after her ALND. She sought the
appropriate therapy approximately 4 months after the start of swelling in her
upper extremity and with the aid of compression garments had significant
symptomatic improvement in a matter of a few weeks, improving her functional
status and quality of life. She became her own advocate and made several copies
of the literature she had reviewed, to distribute to all of her providers. This
patient identified a need for heightened awareness of this
complication.
Early detection of
breast cancer at a “curable” stage, combined with remarkable advancements in
multidisciplinary care, has resulted in a precipitous rise in the number of
survivors. The increased number of women living with the long-term effects of
breast cancer treatment is a driving force in the development of survivorship
clinics.
Lymphedema, the
most significant complication of surgical therapy, will be a prominent focus in
those clinics. With early diagnosis and therefore fewer axillary node
dissections, we may see this complication less frequently than we did in the
days of the radical mastectomy. Despite the less aggressive surgical approach
of sentinel lymph node biopsy now commonly taken, there is still a risk of
lymphedema; the article by Dr. McLaughlin quotes an incidence of up to 7%. For
all patients who develop lymphedema, it is a complication that has a
significant impact on their quality of life.
Much of the
challenge in managing lymphedema is the inconsistency in diagnostic standards.
If it is impossible to reach a consensus on diagnosis, it is also impossible to
reach consensus on treatment recommendations. In Dr. McLaughlin’s article, the
incidence is quoted as being between 6% and 70%. Our lack of understanding of
the disease results in this tremendous variability and indicates that we are
likely grossly underestimating the incidence in our practices. The diagnostic
method known to most of us clinically is the inter-arm circumference
discrepancy, in which the arm is measured every 4 cm from the wrist to the
shoulder. A 2-cm difference between the arms has been adopted as diagnostic of
lymphedema. However, this does not account for women with earlier stages of
lymphedema who might not have progressed to this degree of swelling yet or who
have intermittent swelling. This 2-cm cutoff certainly helps to confirm
lymphedema but it should not rule out lymphedema if it is clinically
suspected.
As physicians
caring for breast cancer patients, can we recite the staging system of
lymphedema as readily as the staging system of breast cancer? Do we recognize
that symptoms such as pain, aching, or tightness in the extremity may precede
the actual onset of the swelling? There must be heightened awareness of
lymphedema signs and symptoms in order for the appropriate action to be taken.
Careful physical examination may reveal subtle changes in the extremity without
gross swelling. Lymphedema may also affect areas other than the extremity,
including the chest wall or truncal area and breast. When initiated in the
early stages of lymphedema, treatment is most successful and results in better
long-term outcomes. That leads to the next question: What are the appropriate
therapeutic interventions? Unfortunately, lymphedema specialists are not widely
available and compression garments are not always covered by insurance
companies. These are areas that will have to be addressed in survivorship
clinics. The lack of progress in lymphedema research and treatment can be
attributed to the lack of standard diagnostic criteria, limited awareness of
and evaluation for lymphedema in follow-up visits, and findings that can be
subtle. Educating patients about risk and management without clear
evidence-based data is a significant obstacle to improving treatment. For
example, resistance exercise, which is now deemed beneficial, was previously
believed to increase the risk of lymphedema, so patients were routinely
cautioned to restrict these activities. With the trend toward personalized
care, we have been able to select some populations of patients that can be
spared aggressive surgical approaches in the axilla, but we are still limited
in our ability to inform patients about risks and treatments of lymphedema. The
next steps to improved lymphedema managment will involve awareness, education,
and research. We compliment Dr. McLaughlin on having the insight to shed light
on this topic. It is likely that, as we continue to develop survivorship
clinics, we will hear more about lymphedema in our practices. As Dr. McLaughlin
poignantly stated in her article, “as long as axillary surgery and radiation
remain pillars of breast cancer treatment, lymphedema will remain a potential
complication.”
March
9, 2012
How to treat
lymphedema - Clinical Advisor –
A
man aged 56 years underwent a liver transplant five years ago. He recently
presented with bilateral leg swelling that has progressively worsened. He has
no deep venous thrombosis or venous insufficiency. A diagnosis of lymphedema
has been made. What are the most effective therapies available to treat this
condition? — Jeannie Brennan, ANP-C, ACNP-C, Phoenix
Complete decongestive therapy (CDT) (also called combined, complex, or
comprehensive decongestive therapy) is the gold standard of treatment for
lymphedema. The goals of therapy are to decrease swelling, increase lymph
drainage from the congested area, reduce skin fibrosis and improve the
condition of the skin, enhance the patient's functional status and quality of
life, relieve pain and discomfort and decrease the risk of cellulitis.
Components of CDT include manual lymph drainage, compression
bandaging, lymphatic exercise, skin care and patient education. Lymphedema is a
chronic condition, so the patient must be educated in the important areas of
risk reduction; self-lymph drainage; skin care; signs and symptoms of
infections; proper fit and care of garments; and the importance of a healthy
diet, exercise and weight management. There are lymphedema treatment centers
(including one in Scottsdale, Ariz.) that provide expertise in lymphedema
management. — Eileen F. Campbell, MSN, CRNP (161-4)
March
8, 2012
Initial trials show promising results in stem cell
treatment - Zee News –
Havana:
About 1700 patients were treated until December, 2011, with stem cells, a
treatment with promising results, according to official sources quoted by
media.
Results are similar to those reached in developed countries,
avoiding important amputations to patients, told to Gramma newspaper Doctor
Porfirio Hernandez, coordinator of the National Group for Regenerative Medicine
at the Ministry of Public Health.
According to Hernandez, the treatment
is still trial phase under strict selection criteria, although 10 of the 15
Cuban provinces already receive that service.
Hernandez said that Cuba
has contributed significantly to the international scientific literature in the
sphere, as in the case of improvements experienced by those patients suffering
from chronic Lymphedema in lower limbs.
Hernandez also mentioned the
case of a minor suffering from Idiopathic pulmonary fibrosis (IPF), who was
treated with a procedure based on stem cells, avoiding a lung
transplant.
With the capacity of splitting without limits, stem cells
can regenerate tissues damaged by diseases, trauma or aging.
It is
mainly obtained by bone marrow, peripheral blood, cornea, brain, lung and
endometrium.
600 lbs Cedar Rapids woman pleas for help with weight
loss - The Gazette: Eastern Iowa Breaking News and
Headlines (blog)
Pierce says a
string of medical conditions have brought her to a debilitating
weight
CEDAR
RAPIDS — A 36-year-old woman who says health problems have caused her to weigh
more than 600 pounds is looking for help as she tries to lose enough of the
extra weight to qualify for gastric bypass surgery.
Charity
Pierce of Cedar Rapids hasn’t left her home since November. She said she’s
always been heavy, but a string of medical conditions have brought her to a
debilitating weight.
“Anyone
can see I have lymphedema in my left leg, from the very bottom ankle all the
way up my whole entire left side,” she said. “It’s like carrying another person
around, and it’s really hard to exercise that way.”
Also
known as lymphatic obstruction, the condition causes fluid to build up in the
body after lymph nodes have been damaged. Pierce said that in her case, the
swelling in her leg began after a fall down a flight of stairs in
2001.
She said
her health history includes another complication as well: She once spent eight
months in a hospital fighting the effects of a flesh-eating bacteria
infection.
So now,
Pierce said, she stays inside her apartment to hide.
“This
side of my stomach has lymphedema. This side has been cut away (from the
infection). This leg has lymphedema and this leg doesn’t,” she
said.
Pierce
said she has to lose weight to help the swelling go down and improve her
health. And she knows some people will criticize her for having been obese
before the lymphedema struck.
“‘You
need to just do it on your own,’” is how she characterized others’ advice.
“Well, that’s easier said than done.”
Her
refrigerator isn’t full of junk, but she’s living on food stamps, so eating
healthfully is a challenge.
Pierce
estimates her weight between 610 and 630 pounds; she needs to get down to 500
to be eligible for the weight loss surgery she hopes will give her a fresh
start. So she turned to the Internet, posting a video about her plight on
KCRG-TV9’s Facebook page.
“As long
as I stay hidden in the house, nobody is going to know my story,” she
said.
She’s
hoping for drastic measures to save her life so she can see her 16-year-old
daughter, Charly, grow up.
“She’s
my life. She’s my rock. She’s my world,” Pierce said.
March 7,
2012
Cedar Rapids Woman Pleas for Help with Weight
Loss – KCRG –
Same article as
previous one
March 7,
2012
Lymphedema and the role of physical
therapy - Coeur d'Alene Press – By SHEREE DiBIASE,
PT
Lymphedema
affects approximately two million people in the United States. Its incidence is
on the rise because each year approximately 500,000 Americans will be treated
for some type of cancer that will be treated for some removal or the
destruction of their lymph nodes. One out of every five of those people will
then develop lymphedema.
Lymphedema
occurs when the normal drainage of fluid in our body is disrupted. As the fluid
accumulates, the area will become red, hot, swollen and painful. Often the arm
or leg will double in size. In a normal lymph system, the body utilizes a
network of nodes and ducts. Those nodes and ducts maintain the balance of the
body's fluid, they filter our waste products and fight bacteria.
However,
when lymph nodes have been removed or destroyed by radiation this lymphatic
system loses its ability to maintain this delicate fluid balance. As a result,
there is an accumulation of protein-rich fluid that becomes a breeding ground
for bacteria. If this swelling in the tissue is left untreated, it can lead to
permanent tissue damage, scarring and long-term disability.
Presently,
it is seen most often in women who have had breast cancer surgery where lymph
nodes have been removed and radiation therapy has been done. This swelling in
their arms can occur weeks, months or even years later after
surgery.
That
is exactly what happened for Sarah Micheals. She had decided to take an
airplane trip to New York City to visit her daughter. Five years earlier she
had breast cancer surgery and had been doing just fine since then. However, the
next morning after she woke up at her daughter's home, something just didn't
seem right. She felt like she was getting the flu. Her body ached and her right
arm had a strange red streak on it. Throughout the day the pain in her arm
became worse and her arm started to swell. She got so swollen she could barely
hold her coffee cup and she had to remove her rings. Finally her daughter took
her to the ER, where it was discovered she was suffering from an infection in
that arm resulting from lymphedema. She was given antibiotics, which cured the
infection, however, the swelling in her arm remained. She then was referred to
physical therapy for treatment of the swelling.
Physical
therapy care for lymphedema consists of Manual Lymph Drainage Massage (MLDM),
Medical Compressions Bandaging (MCB), special exercises that milk the lymph
system and supplement the massage, skin care and treatment of any
infections.
The
physical therapy care will help decongest the swollen body part, eliminate
fiber tissue and improve the immune system function. Once the body part has
reduced in size a protective garment needs to be worn on that extremity to
avoid re-accumulation of that lymph fluid. This protective garment helps to
maintain the natural fluid balance of the affected body part.
If
you are a cancer patient who has had any lymph nodes removed or radiated here
are some guidelines you should follow in order to prevent this chronic,
progressive disease.
•
Wear a protective garment for flying of when doing any new actives you are not
accustomed to.
•
Wear gloves during household chores or gardening to avoid minor cuts, animal
scratches, bug bites and puncture wounds. Use antibacterial ointment right away
if you do get a wound and consult your physician immediately.
•
Avoid injections and blood pressure monitoring on the body part.
•
Exercise at a moderate pace and keep "muscle pump" active. (Swimming in 75 to 85
degree F water is one of the best forms of exercise due to the natural pressure
gradient in the water).
•
Avoid hot baths such as Jacuzzi tubs, whirlpools, heat from hair dryer and sun
exposure.
•
Avoid any deep tissue massage.
•
Wear clothing that is not restrictive to allow appropriate lymph flow. Wear your
rings and watch on other extremity.
•
Eat a diet low in sodium and saturated fats. Discontinue use of alcohol and
nicotine.
•
Keep skin clean and well moisturized. Use electric razors only.
If
you have further questions regarding Lymphedema or you are wondering whether
you have this disease, you can go online to the National Lymphedema Network at
www.lymphnet.org or call them at
(800) 541-3259.
Sheree
DiBiase, PT, is a licensed physical therapist and the owner of Lake City
Physical Therapy in Coeur d'Alene and the Spokane Valley. She has been
practicing outpatient physical therapy for more than 20 years and was an
Adjunct Professor at Loma Linda University, School of Physical Therapy for
seven years, she instructed in Applied Kinesiology, Biomechanics and Gait
Analysis. Both of her offices provide care for cancer related fatigue, weakness
and lymphedema. She can be reached at (208) 667-1988.
At Last - Possible Therapy for
Lymphedema - dailyRx – By:
Laurie
Stoneham
Lymphedema may have new treatment in Lymfactin
(dailyRx)
About one in five women has painful swelling following breast cancer
surgery. There are currently only limited options for dealing with this
condition - lymphedema - but that may be about to change.
A new medication - Lymfactin - is currently being tested to treat
breast cancer related lymphedema. The drug will be used in combination with
surgery.
Pre-clinical data has been presented on Lymfactin, which is being used
at the Gordon Research Conference for Molecular Mechanisms in Lymphatic
Function & Disease.
“Currently there is no advanced pharmacologically-based therapeutic
for lymphedema,” said principal investigator of the upcoming "first in human"
trial for Lymfactin, Stanley G. Rockson, M.D., director of the Center for
Lymphatic and Venous Disorders at Stanford University School of
Medicine.
“Although the research Is still early, the preliminary data show a
remarkable improvement in the ability to successfully conduct lymph node
transplant surgery with the benefit of Lymfactin.”
Lymphedema occurs from damage or trauma to the lymph nodes that can
cause blockages in the lymphatic system and result in fluid build-up. About 20
percent of patients with breast cancer suffer from the condition that can cause
painful inflammation and swelling in the limbs - usually the arm closest to the
breast that was treated for cancer.
The therapy with this medication involves removing a lymph node flap
from the patient's lower abdomen. The lymph node is injected with Lymfactin and
placed into the axillary (underarm) region.
A number of previous laboratory and animal studies have been conducted
to test the effectiveness of transferring lymph nodes. One such study showed
that the transfer alone resulted in a 20 percent improvement in
mice.
When the lymph node was injected with a medicine containing a gene
known as vascular endothelial growth factor C (VEGF-C), overall improvement
jumped to about 80 percent. Lymfactin is a VEGF-C gene therapy.
"I think this is extremely exciting," David N. Finegold, M.D.,
professor of pediatrics and human genetics at the University of Pittsburgh,
told dailyRx.
"The current therapies for secondary lymphedema are extremely limited
largely involving compression and bandaging," said Dr. Finegold, who has not
been involved with these studies.
He continued, "With the significant advances in treatment of breast
cancer, there may be as many as 400,000 to 600,000 women suffering from
secondary lymphedema. The possibility of alleviating this concerning
complication of treatment will provide hope for significant improvement in
quality of life for women suffering from this condition," Dr. Finegold
said.
Wendy Chaite, founder of the Lymphatic Research Foundation, a national
organization devoted to advancing lymphatic research, calls this treatment
"very promising," adding, “Lymphedema is one of those seldom discussed but far
too common conditions that biotech and pharmaceutical companies have yet to
explore."
Lymfactin is an investigational therapy being developed by Laurantis
Pharma Oy in Finland. The company plans to begin a phase I/II study in early
2013.
March 6,
2012
Gift From Cancer? A New Look -
New York Times –
ONE
Friday afternoon early this year, in a limestone town house on the Upper East
Side, the topic of conversation was “cancer things, like lymphedema,” said
Sherry Kreek, who is undergoing chemotherapy for breast cancer.
The
conversation wasn’t happening in an oncologist’s waiting room or at a luncheon,
but at Sharon
Dorram Color at Sally Hershberger, a homey six-chair
salon where Ms. Kreek, 62, is the manager.
Three
women with microshort hair, strangers before they sat down, had all gone to Ms.
Dorram, whose clients include Christie Brinkley and Linda Evangelista, to have
their hair dyed for the first time since it had grown back after cancer
treatment. They weren’t shy about talking about their new hair and what to do
with it, whether they liked their wigs, or much else about the disease they
shared.
“This
was a more upbeat, happy place to talk than a treatment center,” Ms. Kreek
said.
A
decade ago, the women who came to see Ms. Dorram, then at John Frieda, after
chemo or radiation therapy did so furtively. They removed their wigs in the
bathroom or booked early morning appointments so they didn’t have to be in a
room with healthy clients.
“You
feel vulnerable,” said Ms. Kreek, who met Ms. Dorram at John Frieda, when she
returned to blond after her first round of chemotherapy in 2003. “You don’t
want to come into a room with ladies with tons of hair, going, ‘I liked it when
you did that last time.’ It’s like, ‘Shut up.’ ”
Now,
for many women who have lost hair during cancer treatments, dyeing is
empowering — and doing it in an open, chatty session makes it all the better.
“They’re feeling good again,” said Alexis Antonellis, a colorist at Oscar
Blandi who often sees clients who want hair colored after chemotherapy. “They
want to go back to who they were. They’re so excited to sit back in the chair
and get their life back. It’s really nice. You’ve got to see the smiles.”
Even
Ms. Kreek, who wears a stunning blond shoulder-length wig because her hair is
not yet long enough to color, has become less guarded. “I used to make them
wash my wig on my head,” she said. “Now I just hand it off.”
She’s
planning to have Ms. Dorram dye her hair in the next week or so, in time for a
vacation to Palm Beach, Fla. “I haven’t been anything but a blonde since I was
a kid,” she said. “A lot of that was not natural, but to have this ash-colored
hair is not me. I am definitely a blonde. I’m not a gray-haired person, no
matter what my body says.”
One
might expect cancer patients to be leery of chemical processes, especially
those that have been explored for possible carcinogenicity, as hair color has.
The International
Agency for Research on Cancer, part of the World Health
Organization and dedicated to identifying cancer causes, said personal hair dye
is “not classifiable as to its carcinogenicity to humans,” based on a lack of
evidence from studies in people. On its Web site, the
National Cancer Institute writes that while “some studies
have indicated that people who began using hair dyes before 1980 have an
increased risk of developing non-Hodgkin’s lymphoma, the evidence for increased
risks of other cancers from hair-dye use is limited and conflicting.”
“Nothing
is off the table,” Ms. Antonellis said of the dyes she uses. “But I’m
constantly thinking about respecting the integrity of what they have and where
they are in treatment.”
Dr.
James Speyer, medical director at the Cancer Institute at NYU Langone Medical
Center, who is also Ms. Kreek’s oncologist, said he encouraged women to dye
their hair if it made them feel better. “It is my understanding that there is
no risk,” he said. “It is perfectly fine for women to color their hair. It’s
obviously important to them, and there’s no risk of the normal hair dye causing
additional cancers.”
And
it’s not just a female issue. “How people look is a very important part of
their whole approach to the diagnosis of cancer and to the treatment of cancer,
and anything we can do to help them work through that period is so important to
their overall sense of well-being.”
Amy
Katz, 48, of Westport, Conn., whose breast cancer was diagnosed in June 2008,
noticed her hair growing in gray after treatment. “You start looking like Jamie
Lee Curtis,” she said. The first person she called was her oncologist. “You’re
eating perfectly and doing everything right,” she said. “You’re walking on
eggshells, so I asked, ‘Do you think I can color my hair?’ ”
“Blondie,”
her oncologist told her, “I want you to color your hair any color you want.”
John
Barrett, who has a namesake salon at Bergdorf Goodman, said hair usually grows
back curlier and slightly grayer. “Generally when the hair grows back, it grows
back quite differently, but it goes back to its normal texture within a year,”
he said. “I tend to recommend that people wait a little while before deciding on
a color, but then I usually suggest that they go lighter and try having a few
highlights.”
After
her oncologist’s O.K., Ms. Katz returned to blond. “People made me feel like I
looked like Sharon Stone, whether I did or didn’t,” she said.
The
most important thing for her was that she began to look as she did before
cancer. “You want to prove that you can climb Mount Kilimanjaro and get over to
the other side and get your life back to where it was,” she said. “You want to
know that you can do it, and having the same hair color is part of that.”
Some
survivors celebrate the newest phase of their lives with a radically different
style. Kate King, an actress in her 40s who also had cancer, had her post-chemo
hair dyed blonder than it had been. “Before cancer, I looked like the girl next
door, like Jennifer Aniston,” she said. “Now I feel like I have Annie Lennox
inside me. It empowered me to bring out that aspect of my personality.
“Of all of the changes that did occur, my
hair has made the biggest difference,” said Ms. King, from the Upper West Side.
“I was so afraid to lose it and frightened by what I saw in the mirror, and then
I realized it was such a gift. The last thing I expected was to get a whole new
look out of cancer.”
March 6, 2012
K.
Alitalo wins Lymphatic Research Leadership Award for VEGF-C lymph node
transplant research -
EurekAlert
-
Lymphatic
Research Foundation marks National Lymphedema Awareness Day by presenting the
2012 Lymphatic Research Leadership Award to Kari Alitalo, M.D. Ph.D.,
University of Helsinki for 'advancing lymphatic science'
(Ventura,
Calif. March 6, 2012) The Lymphatic Research Foundation (LRF) today presented
the 2012 Lymphatic Research Leadership Award to Professor Kari Alitalo, MD,
from the Hartman Institute at the University of Helsinki.
The
award is presented in recognition of Dr. Alitalo's outstanding dedication and
contributions to the field of lymphatic research.
"Dr.
Alitalo research continues to have significant impact on advancing lymphatic
science and of helping to put the lymphatic system 'on the map' of biomedical
research worldwide," said Wendy Chaite, Founder, Lymphatic Research Foundation.
"We are enormously proud to include Dr. Alitalo in our distinguished list of
award winners and hope to incentivize more groundbreaking research in to this
field for which we currently understand far too little."
The
LRF-Lymphatic Research Leadership Award recognizes individuals who have made a
significant contribution toward promoting and supporting the growing field of
lymphatic research and/or to find improved treatments and a cure for lymphatic
disease, lymphedema and related disorders. Past recipients have included
Stephen Goldman, PhD and Henry Chang, MD (2002); Stanley Rockson, MD (2004),
Waldemar Olszewski, MD (2006); Guillermo Oliver, PhD (2008); and David Zawieja,
PhD (2010).
The
award was presented on Lymphedema Awareness Day during a special meeting of the
LRF held near the Gordon Research Conference on Molecular Mechanisms in
Lymphatic Function & Disease, Ventura, California.
About
Dr. Alitalo
Dr.
Alitalo is Director, Academy of Finland Center of Excellence in Cancer Biology,
University of Helsinki and Academy Professor, Research Council for Health,
Academy of Finland.
Dr.
Alitalo's work is widely cited; and he is credited with being the first to
isolate and characterize lymphangiogenic growth factor (VEGF-C), its receptor
(VEGFR-3) and isolate lymphatic endothelial cells for molecular analysis. He
has devised molecular therapies that hold promise for new treatments of
lymphedema and lymphatic metastasis.
Professor
Alitalo made the discovery that the growth factor VEGF-C regulates the growth
and development of the lymphatic system in humans and other mammals.
Together
with his colleagues Dr. Tuomas Tammela and Dr. Anne Saaristo, they identified
that if VEGF-C is injected into tissues in mice and subsequently in pigs,
growth of new lymphatic vessels and the restoration of the lymphatic
architecture is catalyzed. Previous studies have shown that transferring lymph
nodes from the inguinal region to the axillary region in patients with
secondary lymphedema following their treatment for breast cancer was found to
offer a slight improvement in their condition.
Removal
of old scar tissue from the axilla is considered an important step of this
procedure.
Professor
Alitalo and his team then showed that by combining VEGF-C injections with lymph
node transfer in animal models using mice and then pigs, the response seen was
even better than lymph node transfer alone. The results in mice indicated that
lymphedema treated with lymph node transfer alone resulted in about 20%
improvement. However, when combined with the administration of VEGF-C, the
overall response was increased to around 80%.
###
About
Disorders of the Lymphatic System, Lymphatic Disease, Lymphedema and Related
Disorders
The
most prevalent lymphatic disorder is lymphatic insufficiency, or lymphedema.
This is an accumulation of lymphatic fluid in the interstitial tissue causing
swelling, most often in the arm(s) and/or leg(s), and occasionally in other
parts of the body. The severity of this disease varies from very mild
complications to a disfiguring, painful and disabling condition. In addition,
patients are often susceptible to serious life-threatening cellulite infections
(deep skin), and if untreated, can spread systemically or require surgical
intervention. It remains a lifelong functional problem requiring daily
treatment for maintenance. Eventually the skin becomes fibrotic (thickening of
the skin and subcutaneous tissues) with loss of normal architecture, function
and mobility.
Primary
Lymphedema is an inherited condition in approximately 0.6% of live births. The
lymphatic vessels are either missing or impaired and can affect from one to as
many as four limbs and/or other parts of the body, including internal organs.
It can be present at birth, develop at the onset of puberty or present in
adulthood, with no apparent causes. Other lymphatic diseases include lipedema,
cystic hygromas, lymphangiomas, lymphangiectasias, lymphangiomatosis and other
mixed vascular/lymphatic malformation syndromes and conditions, such as
Turner-Weber and Klippel Trenauney Syndrome.
Secondary
Lymphedema (acquired regional lymphatic insufficiency) is a common problem
among adults and children in the United States. It can occur following any
trauma, infection or surgery that disrupts the lymphatic channels or results in
the loss of lymph nodes. Among the more than 3 million breast cancer survivors
alone, acquired or secondary lymphedema is believed to be present in
approximately 30% of these individuals, predisposing them to the same long-term
problems as described above. Lymphedema also results from prostate, uterine,
cervical, abdominal, orthopedic cosmetic (liposuction) and other surgeries,
malignant melanoma, and treatments used for both Hodgkin's and non-Hodgkin's
lymphoma. Radiation, sports injuries, tattooing, and any physical insult to the
lymphatic pathways can also cause lymphedema. Even though lymphatic
insufficiency may not immediately present at the time any of the events occur,
these individuals are at life-long risk for the onset of lymphedema.
About
Lymphatic Research Foundation
LRF
is a 501(c)(3) not-for profit organization whose mission is to advance research
of the lymphatic system and to find the cause of and cure for lymphatic
diseases, lymphedema, and related disorders.
The
lymphatic system is vital to the health of every individual. Scientific
investigation of the lymphatic system will provide preventive and therapeutic
benefits for a broad array of diseases. As an integral part of the immune
system, it is both critical to the body's surveillance against cancer, and it
can provide pathways for cancer to metastasize.
Unraveling
the mysteries of the lymphatic system is vital to understanding many other
disease processes. It plays a role in inflammatory and auto-immune disorders
such as arthritis and systemic lupus, and is key to understanding the spread of
AIDS and many infections. The Lymphatic Research Foundation fosters and
supports research to discover the links between lymphatic function, diseases,
and levels of wellness.
LRF's
immediate goals are to increase public and private funding for lymphatic
research and to increase public awareness. More information is available at www.lymphaticresearch.org.
March
3, 2012
Homegrown beef with no hormones, antibiotics on
sale - Salisbury Post –
SALISBURY
— Burleson Farms offers all-natural beef for sale in Rowan County.
Lanny
Burleson started raising cattle naturally three years ago after retiring from
East Rowan High School, where he taught agriculture for 24 years.
While
his family has raised cattle on a Stanly County farm since the 1950s, Burleson
said he decided to try raising all-natural cattle with no hormones or
antibiotics.
He
sells the beef at Variety Produce in Rockwell, as well as online at
www.burlesonbeef.com.
Burleson
cattle eat grasses and hay grown on the family farm, and all beef is homegrown
from birth to harvest.
“Our
cattle are well cared for as they grow, free from the growth-enhancing
antibiotics, added hormones, preservatives and animal by-products commonly used
in commercial feed lots,” Burleson said.
Their
diet is supplemented with small amounts of grain prior to processing to enhance
the beef’s marbling and flavor, he said.
Burleson
Farms cattle are guaranteed to be at least 50 percent Angus, crossbred with
European breeds to gain hybrid vigor and efficiency while maintaining the
tenderness and flavor of Angus beef, Burleson said.
Beef
is sold in eighths, quarters or half sides. An eighth side of beef weighs
between 50 and 60 pounds ($5.75 per pound), a quarter side between 100 and 125
pounds ($5.50 per pound) and a half side about 250 pounds ($5 per pound). Two
adults typically eat a quarter side of beef per year. The beef is packaged,
vacuum sealed, weighed and labeled according to the type of cut.
To
learn more, email [email protected] or call 704-239-3841.
Roseman
opens Lymphedema Solutions Physical Therapy
SALISBURY
— Pam Roseman has opened Lymphedema Solutions Physical Therapy Inc. at 322
Mocksville Ave.
Roseman
has an advanced master’s of health science and a doctorate of physical therapy.
She is also certified in manual therapy and as a lymphedema therapist. Roseman
has 21 years of physical therapy experience.
Lymphedema
is defined as an abnormal accumulation of fluid in the tissues. Lymphedema can
also be defined as swelling, which can manifest in the arms, legs, face or
trunk.
The
office is open Monday through Friday from 8 a.m. to 5 p.m. The phone number is
704-213-4952.
Saving
Grace horses getting a free dewormer shipment
As
a part of its platinum level sponsorship of the Professional Association of
Therapeutic Horsemanship International, Bimeda will ship boxes of Equimax
dewormer to Saving Grace Farm in Salisbury.
All
shipments will be sent in time for spring deworming. Generally, horses should
be dewormed twice a year, usually in the spring and fall.
Saving
Grace Farm serves the community by providing Equine Facilitated Learning and
Therapeutic Horsemanship activities, serving people with special needs and
at-risk youth.
The
PATH Intl. Premier Accredited Center Program uses accreditation and licensing
systems to improve equine-assisted activities and therapies.
For
information on Saving Grace Farm, visit http://savinggracefarm.com or call
704-638-2339. For more information on the program, visit
www.pathintl.org.
Sloop
Heating & Air Conditioning honored for training hours
Trane’s
Charlotte/Greensboro District Sales Office presented S.A. Sloop Heating &
Air Conditioning Inc. with an award for 342 Technical/Business Training Hours
in 2011.
This
award goes annually to the Trane dealer with the most training hours within the
district.
Terry
Clendenin with Trane presented this award to Stanley and Brenda Sloop, owners
of the business at 705 West Ryder Ave. in Landis on March 1.
S.A.
Sloop is a Trane Comfort Specialist dealer, a distinction held by few Trane
dealers nationwide. Only dealers that meet Trane standards and who demonstrate
a commitment to customer satisfaction earn the designation.
Bank
of the Carolinas no longer listed on Nasdaq exchange
MOCKSVILLE
— Bank of the Carolinas Corp., the parent company of Bank of the Carolinas,
announced its common stock will no longer be traded on the Nasdaq Stock
Market.
Trading
of the company's common stock is expected to be available for quotation on the
OTC Pink market, commonly referred to as the “Pink Sheets.” The company also
plans to pursue the quotation of its common stock on the OTC Bulletin
Board.
Nasdaq
rules require a minimum market value of $5 million.
The
company chose not to appeal Nasdaq’s decision to suspend trading.
“Clearly
we are disappointed that trading in our stock on Nasdaq has been suspended,”
Stephen R. Talbert, president and chief executive officer of the company, said
in a news release. “Due to market conditions, we are not in a position to
satisfy Nasdaq’s continued listing requirements at this time. However, we
remain committed to strengthening our company and focusing on the needs of our
customers.”
The
move is not expected to have any effect on the company’s operations or
customers.
Bank
of the Carolinas Corp. operates 10 banking offices, including ones in
Cleveland,
Food
Lion to pick up Energy Star award March 15 in Washington
SALISBURY
— The U.S. Environmental Protection Agency has awarded Food Lion, Harveys and
Reid’s with its 11th consecutive Energy Star award.
The
2012 Sustained Excellence Awards are given to a select group of organizations
that have exhibited outstanding leadership year after year. Winners have
reduced greenhouse gas emissions by setting and achieving aggressive goals,
employing innovative approaches, and showing others what can be achieved
through energy efficiency.
“We
are honored to receive this ENERGY STAR Sustained Excellence award and are
committed to being strong corporate citizens in the communities in which we
operate,” said Susan Sollenberger, director of energy, maintenance and
equipment purchasing at Delhaize America.
Award
winners are selected from about 20,000 organizations that participate in the
Energy Star program.
Company
representatives will receive the award on March 15 in Washington,
D.C.
Concord,
Landis, Lexington and Mocksville.
Reid-Hairston
earns Biltmore Who’s Who honor for social work
SALISBURY
— Velveeta Reid-Hairston, president and owner of Family Training and Assessment
Services LLC, has been selected as a member of the Biltmore Who’s Who Executive
and Professional Registry for community social work and
networking.
Reid-Hairston,
who received her undergraduate degree from Livingstone College and a master’s
degree in clinical social work from Norfolk State University, is a certified
clinical sexual offender treatment specialist.
She
is a contract trainer specialist and has experience in child welfare/foster
care and adoption services. She founded the nonprofit The Shepherd’s Heart
Ministry, which provides financial resource assistance to seniors, as well as
empowerment opportunities/strategies to meet basic daily needs for
survival.
She
is employed with the Department of Health and Human Services-Division of
Services for the Blind in Greensboro and is a member of Alpha Alpha Zeta
Chapter of Zeta Phi Beta Sorority Inc. of Salisbury. She attends Jerusalem
Baptist Church in East Spencer.
Reid-Hairston
is also the administrative assistant to her husband, Tommy H. Hairston Sr., of
Hairston Funeral Home Inc. She and her husband have four adult children and six
grandchildren.
Kannapolis
Gentiva Home Health office recognized for sales success
The
Kannapolis Gentiva Home Health office, 297 East 22nd St., was selected as the
national crew of the week for its sales success.
Employees
were recognized on the national ring the bell call.
The
week’s admissions were 132 percent of the weekly goal, tying a record weekly
admissions set earlier in the month.
The
office billed a record for revenue in the week, with a 52 percent gross margin
year to date so far.
Submit
information about new businesses, honors and management promotions to
[email protected]. Include a daytime phone number.
March
1, 2012
Rep. Floyd: Capitol Hill Wrapup
- The Chattanoogan –
The
House of Representatives Thursday moved legislation to provide small business
entrepreneurs with a “one stop opportunity” webpage to help incentivize and
encourage small business activity throughout Tennessee.
Countless
studies have shown small businesses are the backbone of Tennessee’s
economy.
House lawmakers
have consistently shown they are committed to removing regulatory roadblocks
and refashioning government to be a resource for job creators in Tennessee.
Today’s legislation provided more evidence of this long-standing
commitment.
Under
House Bill 2612, the General Assembly directs the Department of Economic and
Community Development, in conjunction with the Office of the Comptroller’s
Small Business Advocate, to develop a web page to aid job creators desiring to
form a small business in obtaining information concerning state laws,
regulations, and requirements that apply to the specific type of small business
the user desires to form. The web page must contain hyperlinks to relevant
laws, regulations and requirements, including:
(1)
Forms or documents which a state department or agency requires to be filed for
that type of business to operate in the state;
(2) Contact information and
web sites for boards and commissions which regulate the specific type of entity
to be formed; and
(3) Notices regarding potential and pending rule making
hearings for the various boards and commissions.
The
main sponsor brought the bill to the House Floor and stated, “This is one of a
number of items that is designed to encourage and grow small business
opportunities in the State of Tennessee.” The bill, which is consistent with
the Governor’s calls to help Tennessee’s job creators, now goes to the Senate
for action.
House
Punishes Sex Promoters
With
a vote of 90-0, the House of Representatives passed tough new legislation
targeting individuals who promote sex as a profession, also known as “pimps.”
The bill, House Bill 2853, adds the names of individuals convicted of promoting
prostitution to the sex offender registry. First time offenders will be listed
for ten years. Individuals with second offenses would be there for
life.
The
legislation was inspired by findings from Tennessee Bureau of Investigation
(TBI) 2011 report on human trafficking in Tennessee and the detrimental effects
that activity has on individuals throughout the State. The study can be
accessed here.
Asked
why she decided to carry this bill, the Representative leading it stated,
“These offenders exploit adults and children for profit and that is a bad
thing. I believe the public has a right to know who these individuals
are.”
The
bill is a portion of a legislative package to combat human trafficking in
Tennessee being ushered through the General Assembly by the House Majority. “We
are going to do everything we can to stop this heinous activity. This is one
more piece of trying to make sure Tennessee is no longer a magnet for human
trafficking,” concluded the Representative.
Comptroller
Wilson Provides In-Depth Report on Tennessee’s Financial Condition to House
Majority
Tennessee
is in a historically strong financial position according to a review of the
State’s fiscal affairs. In the middle of the week, the Tennessee Comptroller
gave an in-depth report on this subject to Members of the
Majority.
During
his presentation, the Comptroller outlined several positive indicators of
Tennessee’s current status, among them:
-
The State budget is balanced on a recurring basis;
-
the current State debt is not excessive and Tennessee has one of the lowest debt
ratios in the nation;
-
the State’s retirement plan is sound; and,
-
the Tennessee unemployment trust fund is solvent.
Though
the report was encouraging about current financial positions, the Comptroller
discussed challenges that lie ahead for the State to remain on such sure
footing. He stated that, without proper fiscal leadership, the State will have
limited reserves and be haunted by past goals instead of present priorities. He
also talked about a reduced opportunity for tax reductions and capital
projects, both major priorities of the Majority Party for the future well being
of the State.
Lawmakers
Honor Inspirational Tennessee Hero
During
a recent session of the General Assembly, one Representative took some time to
share the inspirational story of Blake McMeans with his colleagues in
the House.
McMeans
was once a rising tennis star, ranked as high as fourth in the nation at one
point, who saw his dreams dashed on a cold winter’s night in 1994 because he
made the decision to drive home under the influence. McMeans crashed into a
tree and was airlifted to a hospital where he would spend nearly four months in
a coma. Doctors were convinced he would never recover, but McMeans had other
plans.
Today,
he runs the Blake McMeans Promise Tour which is designed to educate and
motivate students to make the right choices with their lives. The tour has
touched thousands of lives across Tennessee.
To
honor McMeans’ service, lawmakers authored House Joint Resolution 542. The
resolution unanimously passed both Chambers of the General
Assembly.
One
Representative remarked, “Blake McMeans’ touching story has launched numerous
collaborative efforts throughout our great State and has empowered thousands of
young people to be become responsible, mature leaders dedicated to living life
to the fullest.” He continued, “I believe the least we could do is recognize
his service to Tennessee and lift him up as an example of how to make a
difference in society.”
In
Brief
Lawmakers
Move Local Redevelopment Bill to Encourage Job Growth--At
the conclusion of the week, the House advanced legislation to provide
transparency and accountability in tax increment financing (TIF) law.
Additionally, House Bill 2231, streamlines the Tennessee Code to place all TIF
references into one section of the Code. TIF is an economic development tool
that local governments use to redevelop areas. Without TIF, some of the
redevelopment projects may never occur, costing areas potential economic growth
and jobs.
Teachers
First Amendment Rights Protected by Legislation--On
Thursday, House Members took a strong step to protect the First Amendment
rights of school personnel, including teachers and administrators.
Representatives sought to ensure educators can participate in programs that
take place either before or after school hours and do not interfere with their
school duties. The legislation passed 93-0. The companion version of the bill
is currently in the Senate Education Committee.
Ford
Raises Awareness About Lymphedema--In
an effort to show support for National Lymphedema Day, House Members are urging
individuals to wear turquoise on National Lymphedema Day, Tuesday, March
6th, to raise awareness about the debilitating condition. Lymphedema
refers to swelling that generally occurs in one of your arms or legs. It
affects thousands of individuals a year. “This is a very special cause and one
worthy of the support of our community,” said a supportive Representative. “It
is incumbent upon all of us to support those affected by this
disorder.”
Tennesseans
Strongly Support Voter ID—Eighty
two percent of Tennesseans consider the new voter identification law “a good
idea that should be kept in place,” according to a new Middle Tennessee State
University (MTSU) poll. About four in five Tennesseans (83 percent) say they
have heard that voters will be asked to show a photo ID at the polls starting
this year, up significantly from last fall’s 71 percent.
Secretary
of State Unveils New Tennessee Business Spotlight—With
nearly 900 companies and more than 100,000 employees, auto manufacturers,
suppliers and parts retailers make up a large segment of Tennessee’s economy.
In March, the Secretary of State’s office is highlighting five of these
businesses in its Tennessee Business Spotlight. The Tennessee Business
Spotlight is a new program featured on the Secretary of State’s web site that
highlights selected companies with overviews of their products and operations
including employment figures, photos, and links to their Internet and social
media sites. March’s theme is “Tennessee - Wheels in Motion.” To view the
Tennessee Business Spotlight, go to www.spotlight.tnsos.net.
*
* *
I
want to thank Rep. Richard Floyd for his work and keeping everyone updated.
Fine job.
Joe Blevins
Guild, Tn.
March
1, 2012
LACE UP FOR LOCAL EVENTS -
Montreal Gazette –
April
29: 5K Walk for Lymphedema, 8 to 11 am at Jean Drapeau Park. Visit infolympho.ca. May 27: The
Kidney Walk for the Kidney Foundation of Canada.
March
14, 2012
Lymph system, what? - Coeur
d'Alene Press – By
SHEREE DiBIASE, PTThe
Coeur d' Alene Press
The
Lymph system is a major system in our body that probably is the least
understood and one of the systems that is barely talked about in health care
today. However, really it is of vital importance on a daily basis for our
health and overall well-being. The lymph systems primary function is to protect
the body from infection and disease via the immune response system according to
the National Lymphedema Network. It does this by the production, maintenance
and distribution of lymphocytes. The lymphocytes are the "infection fighting
cells."
The
spleen and thymus gland produce the lymphocytes. These cells then fight the
unhealthy cells and they are transported by little watersheds and vessels to
the bloodstream and ultimately flushed out of the body. The Lymph system could
be called the body's own "garbage disposal system," it gets rid of all the
junk.
The
lymph system is made up of more than 700-800 lymph nodes throughout the
body.
There
are chains of nodes and then clusters of nodes in strategic areas. The clusters
are located in a specific area to protect that area from invasion. For example,
when you get a sore throat often you will often have enlarged lymph nodes on
either side of your neck. These nodes collect and filter the waste, and
regulate the protein levels, so we know we are "fighting off something" when
they are enlarged.
The
lymph system has lymph fluid that is clear and colorless. It is made up of
protein, water, cellular debris and fatty acids. Now imagine the lymph vessels
as a stream, which runs in one direction. They have a one-way value only and
this pushes the lymph in that direction. All streams run back toward the heart.
So the bloodstream needs to be able to handle the load each day of the lymph
cleaning system. The lymph fluid can be mobilized by massage, compression; the
"muscle pump" which is why exercising is so important, external pressure,
breathing patterns, etc.
If
the lymph fluid builds up in the tissue and is not flushed each day, as it
should be it could harden the surrounding tissue. It also loves to bind to the
fatty tissue and then it is especially hard to mobilize. The skin integrity is
then compromised due to too much fluid and breakdown of the tissues can occur
and then the efficiency of the muscle pump decreases. The lymph vessels will
dilate and the one-way values cease to function and the area becomes swollen.
This can happen anytime there is any accumulation of swelling, whether from an
injury, a bruise, a localized tendonitis or post-surgically. You do not want
fluid that is ever stagnant, because that is where infection can
brew.
When
the body is functioning efficiently the lymph system will activate itself no
problem. However, if nodes have been damaged or destroyed as with radiation or
surgical lines that interrupt the lymph streams flow pattern, then the lymph
system cannot handle the load and will shut down. We see fluid get backed up
behind C-sections scar lines, and even edema from a total joint.
If
this happens to you do not be dismayed. There are things you can do to mobilize
the flow of protein rich fluid. The first thing to do some very basic things
like drinking more water, up to eight glasses a day. Decreasing your sodium
intake to below 1,800mg a day (the average American consumes 3,500mmg a day).
Stop smoking because this slows the lymph system down and decreases tissue
healing.
Make
sure you are sleeping at least eight hours a night to ensure the body's healing
mechanisms. Then increase your leafy greens veggies, fruits and decrease all
processed foods to a minimum.
Next
seek the assistance of your physical therapist, which has been specifically
educated in the care of the lymph system. Remember, the lymph system can be
trained how to move fluid around areas of scarring. We also teach the system
how to transport edema around an area that there is restriction with four
specific steps.
The
four steps include specific muscle pump strategies, compression techniques or
kinsiotex taping, manual lymph drainage massage and meticulous skin care. The
therapists who are trained in edema reduction know and use these steps to
assist the lymph system in re-booting itself whether it is from an orthopedic,
cancer or immune system related problem. Please know your therapists can get
your lymph system back on track.
Sheree
DiBiase is a licensed physical therapist and the owner of Lake City Orthopedic
and Sports Physical Therapy in Coeur d'Alene and the Spokane Valley. She has
been practicing outpatient physical therapy for more than 20 years and was an
Adjunct Professor at Loma Linda University, School of Physical Therapy for
seven years, she instructed in Applied Kinesiology, Biomechanics and Gait
Analysis. Both of her offices provide care for cancer related fatigue, weakness
and lymphedema. She can be reached at (208) 667-1988.
March
17, 2012
After almost 10 years, man finds relief from
misunderstood disease - Salisbury Post - By
David Freeze –
Lymphedema
has plagued Alvin Merritt for many years, but because it went undiagnosed until
recently, he didn’t know there was help available.
Now,
Merritt has regained the quality of life he thought was gone for
good.
Lymphedema
is the most common cause of disability in the world, says Dr. Pam Roseman, a
physical therapist who specializes in lymphedema. In this country, 3-5 million
people are living with it.
Lymphedema,
according to the Mayo Clinic website, refers to swelling that generally occurs
in an arm or leg. Although lymphedema tends to affect just one arm or leg,
sometimes both arms or both legs may be affected.
The
condition is caused by a blockage in the lymphatic system, which prevents lymph
fluid from draining well, and as the fluid builds up, the swelling
continues.
Most
lymphedema sufferers don’t know they have the condition, and Alvin Merritt was
one of these. Merritt was severely injured in a motorcycle accident near his
home in Cleveland, Ohio in October 2002. Though he doesn’t remember much about
the accident, Merritt thinks it started when a car in front of him skidded out
of control.
Following
the accident, Merritt had multiple medical issues that included a minor stroke,
memory loss, impaired vision, and inability to swallow. To improve his chance
of survival and recovery, doctors induced a coma that continued for 45 days.
Merritt did survive, but the most lingering issue was a badly swollen left leg.
Doctors told him that he might never walk again, and that blood clots had
caused the leg to swell. The possibility of amputation was
discussed.
For
more than 9 years, Merritt fought to cope with his disability. He looked for
work that he was physically capable of doing. Long term movement or even
standing made the condition worse. With many pleasant memories of the south,
Merritt eventually moved to the China Grove area, hoping to find work and to be
near family members. Merritt had family in Mocksville and found China Grove to
be an easy commute back to Cleveland or to still more family members in
Augusta, Ga.
Merritt
had served in the Marines from 1994-1998, so he visited the Hefner VA Medical
Center in Salisbury for treatment. Doctors tried to find the cause of the
swelling and prescribed water pills, elevated legs, and compression socks,
though these had been recommended to Merritt for years. He knew they wouldn’t
work, and he asked for more help. He was referred to Rowan Regional Medical
Center shortly after another VA doctor mentioned lymphedema. A doctor at Rowan
Regional referred Merritt to Pam Roseman, owner of Lymphedema Solutions on
Mocksville Avenue.
Merritt
credits Roseman for an almost complete recovery after only a month of
treatment. “She gave me my life back,” he said. “The leg is back to near normal
size for the first time since the accident nine and a half years ago. Previous
to meeting her, I would spend my days like this. Up for breakfast, then watch
TV till lunch, and sit on the porch till supper time. I didn’t have much going
on.”
Roseman,
who has a doctorate in physical therapy, said, “There are no diagnostic tests
for lymphedema. I look for swelling with no pain, with the arm or leg feeling
heavy or tight, and often the inability to wear shoes. Early treatment is
essential, but even in Alvin’s case we were able to make quick
progress.”
Lymphedema
is a lifelong progressive condition. Without treatment, limbs can become
infected or deformed. Skin can become hardened. Lymphedema can be present even
if it is not visible. Women who have had breast cancer treatment are
susceptible, with 26 percent developing lymphedema after treatment, and 45
percent developing the condition 5 or more years later.
Roseman
pointed out that the lymphatic system is responsible for removing extra fluid
from the body and is part of the body’s immune system. She treats Merritt’s
condition with skin care, manual massage, exercise and compression. The manual
massage promotes flow of the lymphatic fluid from the limbs toward the lymph
nodes. Lymph nodes are in the neck area, armpits, and the groin
area.
“We
have to get the lymph flow moving,” Roseman said. “I teach Alvin how to manage
it, and his self-treatment only takes about 30 minutes a day. Part of his work
is to massage the affected area, and he has to keep lotion on the skin.
Lymphedema dries out the skin. I want him to exercise and he now has a
hip-length compression stocking. At night, he will sleep in a Reid Sleeve,
which is full-leg, foam covered version of a compression
stocking.”
Merritt,
who turned 41 this past Friday, knows that he will always have lymphedema, but
now it is manageable.
“I’m
so glad I met Pam,” he says. “My sleeping has returned to normal. I am just so
much happier. I can now walk straighter and without a limp. I plan on walking
more and eventually starting running.
“That
is a long way from using a walker and being treated for anxiety and depression.
I thought I would have to use a motorized wheelchair for the rest of my life.
My mom, Genevieve, only checks on me once a day now, so we know that I am
getting better.”
“Alvin
does have his life back,” said Roseman, who is a certified lymphedema
therapist. “He is now looking for work after being disabled for so long.
Lymphedema remains misunderstood by most doctors, but their awareness and that
of the general public is slowly increasing. Lymphedema can be managed with
complete decongestive therapy, so our goal is to help others like
Alvin.”
Lymphedema
Solutions Physical Therapy is located at 322 Mocksville Avenue in Salisbury.
The office number is 704-213-4952. Roseman also offers home care through
Gentiva Health Services.
March
20, 2012
Child's health battle - Fraser
Coast Chronicle –
TWO Hervey Bay parents unable to meet treatment costs for their sick
one-year-old daughter have pleaded for changes to the medical benefits
scheme.
Glenn and Amy Rivera said they were left to feel helpless as their
child, Brianna, struggled with the rare medical condition,
Lymphedema.
The illness caused Brianna's legs and feet to fill with fluid and she
suffered arthritis-like pain unless medically designed compression garments
were worn.
Two of the socks are needed for each leg and cost the family $300 and
$150 respectively.
"She gets cramps in her ankles and knees and at night time she will
wake up screaming," Amy said.
"It is very difficult on us as parents - we can't really afford $900
every couple of months."
Glenn and Amy moved to the region recently from New South Wales and
said the compression garments Brianna needed had been covered under the medical
benefits scheme there.
Amy said they were struggling to comprehend how products used to treat
a child's illness could be subsidised in one state, but not
another.
"Because she is only 22-months-old and she grows so fast, we need to
replace the socks every couple of months," Amy said.
"Nobody has been able to explain to us why the benefits scheme is not
the same all around Australia - it makes no sense."
Glenn said he was forced to move his young family to the area and
accept a new job as caretaker of a local charity organisation.
He said his wage was minimal which, combined with rising living costs,
made financing treatment for his daughter's illness difficult.
Brianna will visit The Royal Brisbane Children's Hospital for further
treatment next week.
The Chronicle contacted Queensland Health in relation to the Rivera
family's complaint.
They were unable to provide a response by the time The Chronicle went
to print.
March
19, 2012
Health happenings calendar: March
20 - Bradenton Herald –
Lymphedema
Support: meets by appointment. Information: Marsha Shuford,
941-798-2141.
March 19, 2012
Massage Therapist Develops Unique Lymphatic Drainage
System - The Epoch
Times
You know there’s lymph somewhere inside you, but what, exactly, is it
doing for you?
A
less-talked-about but no-less-crucial constituent of the vascular system, lymph
is a light oily substance that floats in the layer of fat just below the skin,
moving around in its own system of vessels.
Lymph is
essentially plasma that transports hormones and fat to cells. It’s responsible
for moving large particles and everything fat-soluble. It also transports
waste, debris, bacteria, toxins, and other unwanted material from cells for
elimination.
One of
the crucial functions of lymph is to deal with toxins—to “take out the
trash.”
And
here’s the kicker—the lymphatic system has no pump. The motion of lymph depends
upon exercise. Our sedentary lifestyles combined with the sheer volume of
toxins our bodies are bombarded daily with make it easier for the tiny vessels
lymph travels through to become clogged.
When
lymph drainage is sluggish or impaired, the waste and toxins that should be
eliminated can be stored in our fat. There they stay, causing symptoms from
stiffness and puffiness to skin irritation, fatigue, severe swelling, physical
pain, and weight gain.
Mild and
severe symptoms can be relieved with lymphatic drainage.
Manual
lymphatic drainage was pioneered by Emil Voder in the 1930s to help lymphedema
patients. Voder’s technique of gentle massage has been the mainstay for
lymphedema patients until now.
Canadian
Innovator
Registered Massage Therapist Marie Graff has created a unique method
of manual lymphatic drainage. The results have pleasantly surprised patients at
the downtown health and wellness clinic Bodyone where Graff is the proprietor,
heading a team of massage therapists, acupuncturists, and
aestheticians.
Graff
Lymphatic Recovery (GLR) uses a combination of all-natural fat-splitting
ingredients that are absorbed by the skin, in combination with aggressive
lymphatic drainage massage to help unclog parts of the lymphatic system that
are not circulating properly.
“The
primary problem,” says Graff, “is that when the lymph gets backed up and
stagnant, it gets thick like lard. The [lymph] vessels are microscopic. You are
not going to get lard into a microscopic vessel.”
Graff’s
method of splitting the fatty molecules uses ingredients you might find in your
refrigerator, which break up the congestion below the skin. The aggressive
massage flushes waste and toxins through the lymph vessels and into the
elimination channels of the spleen and liver.
“Many
of the things that weight the body down come from toxicity,” explains Graff.
“Toxicity is corrosive and aggressive to tissue. Getting it out is important
and in modern life we accumulate toxins like never before.”
Purposeful stimulation of the lymphatic system has a surprising
number of uses.
Pre- and
Post-Operative
A number
of Graff’s clients have found GLR treatments helpful in recovering after
liposuction, breast enhancement, and other kinds or surgery where the lymphatic
system had been damaged.
“Some
plastic surgeons in France and the United States will not do elective surgery
without a regime of lymphatic drainage before and after surgery,” says Graff,
“the results of healing are so much greater.”
Forty-three-year-old IT professional Irina experienced serious
complications after cosmetic surgery.
“There
was no movement in the tissue in my cheeks, chin, and sides. The tissue was
swollen and very tight. Touching and moving the skin on my face would result in
needles-picking sensation with a shooting pain. I would get very strong
headaches and severe pain in my temples area in the evenings.”
In
essence Irina had lost the use of her face.
After
seven GLR treatments, Irina reported that her condition improved
significantly.
“I was
able to start feeling my face again. I stopped to feel as if I had a hockey
mask on top of my face.”
Swollen?
For other
patients, like Margaret, the lack of proper lymph circulation created serious
problems.
“I had
severe total body swelling … pain greatly inhibiting my ability to walk, climb
stairs, or sit without pain,” recalls Margaret.
“Prior to
the treatment my feet and legs were so swollen I could not get boots
on.”
After
seven days of intensive GLR treatments, Margaret wrote in a letter of
thanks.
“I can
walk now with no pain except in one localized area [where a previous injury had
occurred]. … At the end of my last day of treatment, my body congestion [and]
inflammation were reduced by over, in my estimation, 85 percent. …You provided
a solution that was drug-free, effective, and not available anywhere
else.”
GLR has also helped patients with recurring skin problems. Ana, 42,
works in IT as a business analyst.
“I
had severe acne mainly on the chin area and a lot of scarring. The area looked
inflamed and I used to get pimples, [which were] very painful.”
Before
her GLR treatments, Ana had been prescribed antibiotics. “It helped for a few
months, then the problem reoccurred.”
After
10 sessions of GLR, Ana reported a lasting change. “I didn’t have the chin acne
problem since the treatment last year in June.”
Lorena,
a 39-year-old educator at University of Toronto had been diagnosed with adult
acne that covered her chest and back. She was offered a
prescription.
“There
were a lot of potential side effects, and I was not prepared to risk
it.”
“GLR
did improve my symptoms by eventually taking away the acne altogether. … My
skin felt completely renewed and nourished.”
March
19, 2012
Your
vote for the North
Penn YMCA can help local cancer patients - The Reporter - By BRADLEY
SCHLEGEL
Sorry
this has passed
March
23, 2012
NCCN Breast Cancer Guidelines Have 'Major'
Changes – Medscape –
Lymphedema
of the arm occurs in a "significant" number of patients and can become a
"serious quality-of-life issue" with this more extensive lymph node
...
You
have to be a member to access this article sorry
March
24, 2012
Mother & Daughter Beat Cancer -
KFYR-TV –
Last
March, a Mandan woman was diagnosed with breast cancer. Seven months later her
mother was given the same grim news. Coni Couch and Roxi Polzin are now happily
cancer free but have been left with mounting medical bills.
On Saturday
afternoon, friends organized a benefit for them to help with their medical
costs since neither has insurance. Couch is a proud breast cancer survivor but
admits it took her a while to accept the news.
"It just never really
hit me until the day I looked in the mirror, I got out of the shower and looked
in the mirror and I was totally bald, I had lost all my hair and it`s like I
don`t know why but that day it`s like you really have cancer. You really lived
through this," she said.
Shortly after having the cancer removed, Couch
discovered she had Lymphedema. She says the money raised at Saturday`s benefit
will also cover the costs associated with that.
If you`d like to donate
money, you can go to Dakota Community Bank and Trust. An account has been set
up under Coni Couch and Roxi Polzin.
March
25, 2012
Ex-chief secretary Malathi loses last stand against
cancer - Times of India –
CHENNAI:
Former Tamil Nadu chief secretary S Malathi died in a private hospital on
Sunday morning after a prolonged battle with cancer. She was 57.
An
IAS officer from the 1977 batch, Malathi opted for voluntary retirement in
August 2011. She was known as an honest and forthright government servant who
expected the best from those who worked with her.
"Her work
ethic was inspiring. She was meticulous, organised and straightforward. Every
government order, every bit of information was at her fingertips," said
additional chief secretary Sheela Chunkath, who knew Malathi since 1980 when
they were posted together in Trichy.
Malathi
started her career as a sub-collector in Trichy in 1979 and held various
positions including collector of North Arcot district (1987-89) and secretary
of the municipal administration and water supply department
(1996-2001).
"She was
someone who young officers could look up to. She guided us, was supportive,
planned her work and meetings carefully, and never wasted her time or ours,"
said J Radhakrishnan, who worked under her for close to four years. Malathi was
diagnosed with breast cancer in July 2003 when she headed the statistics
department. She underwent treatment while continuing to work, and in seven
months her condition improved. She continued to rise in the ranks and became
home secretary in 2006. A scarf to cover hair thinned by chemotherapy and a
swollen left hand due to lymphedema were the only signs of her
illness.
In May
2010, as home secretary, she was diagnosed with recurrent breast cancer in the
liver. Malathi was expected to take over from K S Sripathi as chief secretary
but she was moved to the vigilance department to give her time to
recuperate.
In August
2010, Malathi wrote a series of moving pieces on her experience for The Times
of India. "I want people to understand that you can fight cancer. Taken with
the right mindset, coming to terms with this illness is not that difficult. The
trick is to be positive but prepared for the worst," she told TOI during a
meeting to edit the pieces.
She
wrote: "After seven years you do get a feeling of having been cured... [so
hearing the diagnosis] was truly shattering... From the totally despondent
thought that I would die in a few days to the dread of therapy to how it will
affect my daughter to how expensive the treatment will be, my mind was
travelling in several directions but getting nowhere... The immediate desire
was to sit in a corner and cry, but then the need to look dignified gets the
better of you and stone-faced I left the hospital."
Malathi
became chief secretary in September 2010 in the DMK regime, only the second
woman to hold the top bureaucrat's post. In May 2011 when the AIADMK took over,
she was transferred to the statistics department. Though she had three more
years of service, she resigned in August.
At her
farewell party when colleagues wished her health and happiness, Malathi told
them that she didn't have much time left. "It was hard to hear that from
someone who was always a fighter," said Chunkath. "But she said it with such
strength and grace," she said.
Malathi wrote for TOI: "I am not sure what the future holds for me: Will I get over this
instalment of cancer and if so, for how long? In the time I have left, I shall
live every day to the full, and be a good human being, treasuring
relationships. Cancer has reinforced my effort to realize myself. If you are
unfortunate enough to be diagnosed with cancer, things are not that bleak,
there is hope. But cancer or no cancer, eat healthy, do not abuse the body and
learn to treasure every day."
March
27, 2012
Tickets now on-sale for 2012 Stylin' Against Breast
Cancer - Quad-Cities Online –
Press
release submitted by Trinity Regional Health System
Dueling
pianos return for wine and cheese party
The Trinity Health Foundation is
now accepting reservations for the 2012 Stylin' Against Breast Cancer. Trinity
Health Foundation, in partnership with Always a Woman, Midwest Hope and
Healing, The American Cancer Society, the Trinity Cancer Center and women who
do not represent an organization but who are advocates of breast health and
survivors, organize the events each year to raise funds for projects that
benefit local breast cancer survivors and promote education about breast cancer
and breast health.
On Wednesday, April 25, the group will host a wine
and cheese party from 6-9:30 p.m., at the Quad-Cities Waterfront Convention
Center, 2021 State St., Bettendorf. Penguins Entertainment will once again
provide "dueling pianos" during the event. The party will also include a raffle
as well as light hors d'oeuvres and wine served by area men who have a personal
connection to someone diagnosed with breast cancer. Tickets for the wine and
cheese party are $25 per person with a reservation or $30 at the
door.
The third winner of the Roxanne Kramer Award will be honored
during the seventh annual Stylin' against Breast Cancer luncheon and fashion
show that features local breast cancer survivors modeling clothing from area
stores on Thursday, April 26, also at the Quad-Cities Waterfront Convention
Center. Doors open at 11 a.m. with the luncheon beginning at 11:30 a.m. Tickets
are $30 per person.
One hundred percent of the proceeds from both events
benefit stay in the Quad-Cities area to fund projects that help local breast
cancer patients and promote education about breast cancer and breast health. To
reserve tickets, call the Trinity Health Foundation at (309) 764-7610, email
[email protected] or visit www.trinityhealthfoundation.com.
About the
Roxanne Kramer Award
The Roxanne Kramer Award is an annual honor to be
given to an outstanding individual(s), organization or business that has
tirelessly contributed to the quality of life of breast cancer survivors and
which through deed, word and ongoing advocacy, has helped educate the community
about breast cancer and breast health.
Kramer, a breast cancer survivor
herself, owns "Always a Woman" boutique in Moline and co-founded the Quad City
Breast Cancer & Lymphedema Support Group.
March
28, 2012
Researchers identify genetic basis of tropical foot
and leg lymphedema – EurekAlert –
Researchers
identify genetic basis of tropical foot and leg lymphedema
Wearing
shoes and genomics are tied together in strategy to eliminate
podoconiosis
Farmers
in the highlands of southern Ethiopia scratch out a subsistence living from the
region's volcanic red clay. The soil supports the farms, but fine-grained,
volcanic rock particles in the dirt threaten the farmers and their families.
Continual exposure of bare feet to the volcanic soil causes 1 in 20 people to
develop a painful inflammation of the lower extremities that, over time, leads
to foot disfigurement. Doctors call it podoconiosis. The locals call it mossy
foot. And those affected suffer social stigma as well as debilitating
discomfort.
Now,
researchers think they know why some 4 million people in at least 10 countries
worldwide develop this incapacitating condition. One-fifth carry genetic
variants that cause their immune system to react to the volcanic dust. This
disease-producing response, triggered by exposure from the lack of shoes,
provides a dramatic example of the interaction between genes and the
environment.
Writing
in the March 29, 2012 New England Journal of Medicine, an international
team that includes researchers from the National Human Genome Research
Institute (NHGRI), part of the National Institutes of Health, describes the
genetic link that turns dirt into a toxin.
"This
study draws attention to a neglected tropical disease with a devastating impact
on poor people and their communities," said NHGRI Scientific Director Dan
Kastner, M.D., Ph.D. "It demonstrates the global reach of genomics research
into the lives of people in parts of the world where endemic diseases very
often go unchecked."
Doctors
have known for a long time that podoconiosis runs in families and that
continual exposure to volcanic soil triggers it. Wearing shoes and socks, or
even washing off the dirt, prevents the condition. But doctors have been
perplexed that only some people develop the disease, while others with the same
environmental exposure are spared.
To
sort this out, the international collaborators conducted a genome-wide
association study—or GWAS—analyzing DNA from 194 volunteers from the Ethiopian
highlands affected by podoconiosis, along with DNA from another 203 unaffected
individuals from the same region. The researchers collaborated with field
workers from the non-profit Mossy Foot Treatment and Prevention Association in
southern Ethiopia to collect the data and samples.
The
researchers generated a dataset from study-participant DNA, screening more than
550,000 single-nucleotide polymorphisms (SNPs), which are sites in an
individual's DNA that contain a different chemical base when compared to a
standard reference human genome sequence. They found significant podoconiosis
association for eight SNPs within or nearby a stretch of DNA on chromosome 6,
called the HLA class II locus.
The
researchers performed a second validation step, called a family-based
association study, using DNA samples from 202 sets of child-parent trios from
affected families. The researchers detected six SNPs that showed significant
association—those that mapped to HLA class II region genes and most strongly
associated with podoconiosis in the GWAS, validating the GWAS results.
Further
analysis of direct HLA tests of 94 affected persons and 94 controls confirmed
that podoconiosis susceptibility is increased by inheriting altered DNA in the
HLA class II locus from one or both parents. The researchers estimated that the
SNPs found through the GWAS—which alone comprise a portion of the genetic
factors in podoconiosis—¬¬ explained about 16 percent of the variance in the
disease occurrence. They also found that individuals with those gene variants
were 2 to 3 times as likely to become affected if exposed to the volcanic rock
soil.
"This
is the first study of a non-communicable disease to have used genome-wide
association for any African population, and it is the first study that has
attempted to use a systematic genomic approach to shed light on the genetic
basis of podoconiosis," said Charles Rotimi, Ph.D., co-author and senior
investigator in NHGRI's Inherited Disease Research Branch and director of the
trans-NIH Center for Research on Genomics and Global Health (CRGGH).
The
HLA class II locus is also particularly associated with T cell-mediated
immunity, according to co-author Adebowale Adeyemo, M.D., NHGRI staff scientist
and CRGGH deputy director. The research findings point to the fact that
podoconiosis is likely to be a T cell-mediated inflammatory disease. Mineral
particles are absorbed through the skin of the foot and build up in the
lymphatic system, causing inflammation and scarring that can obstruct blood
vessels in an affected individual's feet.
"We
found a result that is consistent with the clinical observations of
inflammation and provides a way forward for scientific study of the disease,"
Adeyemo said. "Our hope is that other studies will follow, including a gene
expression and immunology study, and a study of the soil."
Fasil
Tekola Ayele, Ph.D., the study's lead author and a CRGGH post-doctoral fellow,
coordinated the field work in the Ethiopian villages, where he said it is very
common to see people with podoconiosis. "It may even be more prevalent than
other diseases, like HIV, tuberculosis and malaria," he said.
"One
aspect that makes podoconiosis disturbing is that it is almost 100 percent
preventable by wearing shoes. So it is a disease of poverty to a very large
extent," Dr. Rotimi said. Public health campaigns are underway to encourage use
of footwear in endemic areas. Philanthropic groups distribute free shoes for
children in impacted communities and make shoes to fit affected
adults.
Depending
on the stage, podoconiosis can be reversible to a large extent with basic foot
hygiene that includes regularly washing off the dirt and wearing shoes and
socks. "At the later stage, surgery may be the only remedy," Dr. Adeyemo said.
"In time, it becomes a very hopeless situation." Doctors can surgically remove
prominent skin nodules, but ongoing exposure to the soil can lead to recurrence
that is sometimes worse for the person with podoconiosis.
Researchers
in NHGRI's Social and Behavioral Research Branch (SBRB) are among groups
engaged in research to learn about the social and behavioral factors that
perpetuate the disease. SBRB and its collaborators are launching a study of
public health interventions, including measuring the effectiveness of
intervention strategies and messages that promote foot health, including foot
hygiene and shoe use.
In
addition to the NIH researchers who conducted the GWAS, the study team included
members from the Brighton and Sussex Medical School and the Clinical
Transplantation Laboratory in the United Kingdom and the Armauer Hansen
Research Institute in Addis Ababa, Ethiopia. Part of the team led by senior
authors Gail Davey, M.D., and Melanie Newport, M.D, Ph.D., of the Brighton and
Sussex Medical School, conducted preliminary epidemiology work in the Ethiopian
highlands and also had developed a clinical staging system for people with the
condition—from early to late stages.
In
addition to his role at CRGGH, Dr. Rotimi is president of the African Society
of Human Genetics. He considers this study of podoconiosis to be a step toward
addressing health disparities. "So far, 95 percent of what has been done in
GWAS research has been on European populations and some Asian populations," Dr.
Rotimi said. "This study is a wonderful example of the mission of CRGGH,
including training African scientists, applying state-of-the-art science and
answering questions about diseases that would otherwise not be dealt
with."
March
27, 2012
Henry Ford Wyandotte Physical Rehabilitation Center
Hosts Friday Open House at Former Blockbuster Site -
Patch.com – ByJason Alley
While
the business relocated just across the street, officials are excited about the
possibilities of their new location.
After
a few months of work, the Henry Ford Wyandotte Physical Rehabilitation Center
is ready to open at
the former Blockbuster site at Biddle and
Eureka.
Formerly
known as Wyandotte Hospital Rehabilitation and Orthopedic Center, it used to
operate out of the third floor of the Chase
Bank building, which is mere yards away from the new
spot.
“The
new facility is a great improvement and much easier to find,” said Denise
Dailing, administrator for rehabilitation services. “The building’s large
windows let in a huge amount of natural light and that, combined with the
bright wall and accent colors, give our patients a beautiful, energizing
environment for their rehabilitation.”
A
grand opening for the new outpatient rehabilitation facility, 3323 Biddle, is
set for 5 to 9 p.m. Friday. Visitors will be able to take a self-guided tour of
the facility and learn about the outpatient rehabilitation services offered.
Everyone who stops in can receive a free five-minute chair massage and enter to
win a 30-minute massage. (Wyandotte
Patch readers have an
additional opportunity to win a half-hour
massage.)
Services
offered through the outpatient rehabilitation program have not changed with the
relocation. Professional therapists continue to offer physical, occupational,
speech and massage therapy services, as well as a variety of specialized
programs that focus on specific areas of the rehabilitation
process.
These
programs include:
·Driver
Assessment. This program helps people regain the ability to drive after an
injury or illness.
·Hand
Therapy. Therapists with advanced training treat hand and arm injuries. It is
available to acute post-operative patients on a walk-in basis.
·Industrial
Rehabilitation. The Return to Work Center facilitates the process of rebuilding
job skills after an illness or injury.
·Joint
Replacement. Therapists meet with patients about upcoming elective surgeries
and make recommendations about post surgical care.
·Lymphedema.
In order to drain accumulated protein-rich fluid, this conservative approach
consists of four parts: skin care, lymphatic drainage, bandaging and
exercise.
·Sports
medicine. Efforts are focused on treating chronic athletic-type injuries, acute
post-surgical conditions and injuries caused from overuse or repetitive
motions.
·Vestibular
rehabilitation. Therapists help patients retrain balance and decrease feelings
of dizziness.
Therapy
programs are individualized and are established through consultations with the
patient’s physician. Walk-in service and appointments are available. For more
information, call 734-284-4499.
March
28, 2012
Genetic Variants Explain
Podoconiosis - Doctors Lounge –
Genetic
variants in the HLA class II region are associated with podoconiosis, a
neglected tropical disease, according to a study published in the March 29
issue of the New England Journal of Medicine.
WEDNESDAY,
March 28 (HealthDay News) -- Genetic variants in the HLA class II region are
associated with podoconiosis, a tropical lymphedema resulting from long-term
barefoot exposure to soil derived from volcanic rock, according to a study
published in the March 29 issue of the New England Journal of
Medicine.
Fasil
Tekola Ayele, Ph.D., M.P.H., of the National Human Genome Research Institute in
Bethesda, Md., and colleagues conducted a genome-wide association study of 194
case patients and 203 controls from southern Ethiopia. Findings were validated
by family-based association testing in 202 family trios and HLA typing in 94
case patients and 94 controls.
The
researchers found that there was a significant genome-wide association between
podoconiosis with the single nucleotide polymorphism (SNP) rs17612858, located
5.8 kb from the HLA-DQA1 locus (in the allelic model: odds ratio [OR],
2.44; in the additive model: OR, 2.19) and suggestive significant associations
with seven other SNPs in or near HLA-DQB1, HLA-DQA1, and
HLA-DRB1. These associations were confirmed using family-based
association testing. HLA typing showed that the alleles HLA-DRB1*0701
(OR, 2.00), DQA1*0201 (OR, 1.91), and DQB1*0202 (OR, 1.79) and
the HLA-DRB1*07017-DQB1*0202 haplotype (OR, 1.92) were risk variants for
podoconiosis.
"Association
between variants in HLA class II loci with podoconiosis (a noncommunicable
disease) suggests that the condition may be a T-cell-mediated inflammatory
disease and is a model for gene-environment interactions that may be relevant
to other complex genetic disorders," the authors write.
March
29, 2012
Pat Burns Award: Twelve caregivers
honoured - Canada NewsWire –
MONTREAL, March 29, 2012 /CNW Telbec/ - In conjunction with the 4th
National Conference to Defeat Cancer, the jury of the Pat Burns Award has
announced the recipient of the annual Pat Burns Award and the names of the
award finalists. Inspired by Jason Burns, son of the late head coach of the
Montreal Canadiens and president of the Pat Burns Foundation, this award was
created by the Coalition Priorité Cancer au Québec to honour a caregiver who
has particularly stood out in providing support to a person living with
cancer.
"Six months ago, at the start of the nomination period for the Pat
Burns Award, I could hardly imagine the immense generosity that the
participants would demonstrate in sharing with us such a significant part of
their lives," Mr. Burns, president of the Pat Burns Award, said at the awards
presentation.
A gift of $10,000 is shared by the 2011 Pat Burns Award recipient and
the two finalists. The award is graciously offered by the Fédération québécoise
des massothérapeutes (FQM) and the Fondation québécoise de la
massothérapie.
Pat Burns Award recipient
Ms Julie Chapdelaine
At age 27, Julie's husband, Marc-André Benoît, was diagnosed with
a form of leukemia called granulocytic sarcoma. His legs almost totally
paralysed, Marc-André had to undergo major back surgery, followed by physical
rehabilitation and multiple chemotherapy treatments. In addition to quitting
her job and spending five days a week at her husband's side in hospital, Julie,
then aged 30, was able to see to his comfort, as well as that of their two
children, handle daily tasks and look after herself, too. Today, as the family
slowly gets back to a normal life, Marc-André declares that Julie's presence at
his side has made all the difference and that she "deserves all the honours in
the world."
Finalists (tie)
Ms Pauline Guilbault-Corbeil
"A true 'love catalyst', a woman of courage with an enormous
heart, Pauline unfailingly supported her son. Confident and reassuring, she was
both mom and confidant. Throughout Charles' illness, Pauline was an equally
generous mother to her two other sons, both of whom also suffer from a
handicapping disease. Her entire life has involved, and will continue to
involve, providing support to her loved ones. Pauline has ably balanced family,
outings with friends and sports activities."
- Chantal Charron, Charles' spouse
Ms Natacha Berger
"Natacha Berger is the mother of three: Thomas, Nicolas and Joanna
Comtois. Joanna died in February 2011 at age 14 from bone cancer. Diagnosed in
June 2004 with Ewing's sarcoma, after a full year of treatments, she was in
remission for three years. Sadly, she relapsed in 2008. Soon after, in the fall
of that year, her father committed suicide. We could go on at great length
about Joanna and the path she followed. But it's imperative to emphasize that
none of that would have been possible without the exemplary support, the
devoted care and the attention that her mother gave her while fully respecting
her daughter's needs and wishes."
- Louise Geoffrion, Leucan Montréal
The Pat Burns Award recipient receives $5000 and the two finalists,
$2500 each.
Coalition Priorité Cancer au Québec president Dr. Pierre
Audet-Lapointe thanked everyone who proposed a candidate for the Pat Burns
Award, as well as the jury members.
"We are proud that this initiative spotlights in a new way the key
role played by caregivers," Dr. Audet-Lapointe said. "Without them, the lives
of people living with cancer would often be unbearable."
The application period for the second edition of the Pat Burns Award
will open officially this fall.
Nine honourable mentions
The jury members also decided to give honourable mentions to nine
caregivers to salute their altruism and in acknowledgement of the testimonials
to their humane nature that accompanied their nominations.
About the Coalition
Coalition Priorité Cancer au Québec was founded in 2001 to protect and give a voice to people affected by
cancer (patients, survivors, informal caregivers, their families and their
loved ones) to help support cancer-related community organizations and health
professionals) and to help organize the fight against cancer.
The Coalition's members represent more than 1.5 million
people
Alliance des Communautés Culturelles pour l'Égalité dans la Santé et
les Services Sociaux (ACCÉSSS), Alliance du personnel professionnel et
technique de la santé et des services sociaux (APTS), Association des
radio-oncologues du Québec (AROQ), Association du cancer de l'Est du Québec,
Association des laryngectomisés de Montréal Inc, Care-Ring-Voice Network,
Canadian Breast Cancer Network (CBCN), Colorectal Cancer Association of Canada
(CCAC), Association québécoise des registraires en oncologie (AQRO),
Association des retraitées et retraités de l'éducation et des autres services
publics du Québec (AREQ), Centrale des syndicats du Québec (CSQ), Chaire de
recherche en environnement cancer Guzzo de l'université de Montréal, Chaire de
recherche et de traitement du cancer de l'UQAM, Quebec Clinical Research
Organization in Cancer (Q-CROC), Fédération des travailleurs et travailleuses
du Québec (FTQ), la Fédération québécoise des massothérapeutes, la Fondation
québécoise de la massothérapie FQM, Fondation Monique Fitz-Back, Fondation
québécoise du cancer (FQC), Fondation Rêvez la vie, Foundation of Stars, Hope
and Cope / L'espoir c'est la vie, HPV Awareness Corporation, Institut de
l'anémie - Recherche et éducation (IARE), Lymphoma Foundation Canada,
Lymphedema Association of Quebec, Libera Mutatio, Leukemia & Lymphoma
Society of Canada, Mains de l'espoir de Charlevoix, Myeloma Canada, Nova
Montréal, Ordre des technologues en imagerie médicale et en radio-oncologie du
Québec, Ordre professionnel des technologistes médicaux du Québec (OPTMQ),
Organisation multiressources pour les personnes atteintes de cancer (OMPAC),
Organisation québécoise pour les personnes atteintes de cancer (OQPAC),
Organisme gaspésien pour les personnes atteintes de cancer (OGPAC), Ovaire
espoir Québec, Ovarian Cancer Canada (OCC), Palliative Home-care Society of
Greater Montreal, ProCure-The Force Against Prostate Cancer, Professionnals
Networking for Caregivers, Quebec Lung Association (QLA), Regroupement des
onco-psychologues du Québec (ROPQ), Réseau des femmes en environnement, Réseau
FADOQ.
For further information:
Source : Coalition Priorité Cancer au Québec
For information and/or interview requests:
Sylvie Piché
Cell : (514) 296-0694
Michel Racette
Cell :
(514) 576-9327
April
2, 2012
They love Lou C's: Boutique changing lives of women
with cancer - News Courier – By Lora Scripps
—
Cassandra Johnson is the type of person many work a lifetime to
become.
A warrior. A mother of three who is chock-full of spirit, rooted
in love and grounded in faith.
It hasn’t been an easy road.
In
2009, at age 38, she had a stroke.
“I had always dealt with high blood
pressure,” she said. “I had the stroke and it took out my left
side.”
She was in the hospital for months. During her stay, doctors
discovered she had breast cancer.
“They ended up having to do a
mastectomy, which took it to a whole other level,” she said. “It had seeped
into my bones. Of course, I didn’t know what was going on.”
She was also
diagnosed with lymphedema — blockage of the lymph nodes — and had to have her
lymph nodes removed.
After being released and able to go home, Cassandra
heard about a lady named Lou Covington from a friend. She told her about Lou
C’s Boutique, a special boutique that’s aim is to help women look and feel
better during their journey with cancer.
Lou C’s
Boutique
Lou C’s Boutique first opened in 2004. Lou and her husband
transformed a house into a unique boutique. It is located at 207 Coman
St.
Lou said her mother gave her the inspiration.
“My mother had
colon cancer,” she said. “But, you know cancer is cancer.”
Her mother
would tell her about friends who would have to travel outside Athens to get the
necessities they needed while working to overcome different forms of
cancer.
Lou thought to herself, “I love people and I try to make people
feel better about themselves, ” why not open a place where she could help
someone else.
“To me mental health is just as important as bone health
or breast care or anything else,” Lou said. “Without your mental health and
strength in God, you can’t get through this.”
At first, Cassandra didn’t
have insurance or Medicaid for the items she needed. So, she didn’t have the
chance to meet Lou right away.
“I had to go through the ropes to get
that in order and working,” she said.
During that time she would travel
to the Athens-Limestone Hospital Wellness Center. There she met another woman
who wanted to introduce her to Lou. Cassandra took her up on the
offer.
It’s no wonder Cassandra and Lou became fast friends. In truth,
the two, simply, share the same attributes.
“When I found her I found a
great lady,” Cassandra said.
She visited the boutique. Lou fit Cassandra
with a compression sleeve. The sleeve would be used to help with blood flow and
circulation in her arm.
Unfortunately, Cassandra’s insurance didn’t
cover the sleeve she needed.
“She helped me anyway,” Cassandra said.
“She was willing to work with me.”
Other items had to
wait.
“Finally, things started coming around for Cassandra,” Lou said,
adding she offered to pay out-of-pocket.
Lou let Cassandra pay what she
could. The rest came from Lou’s Angel Closet.
The Angel Closet, created
by Lou, contains items for women that insurance won’t cover. It is available to
women who are willing to do all they can to pay for their services, but who may
be struggling financially.
Cassandra said her first meeting with Lou
opened up a whole new world to her.
Cassandra has three children, now
ages, 22, 17 and 9. Her health problems brought change for
everyone.
“For me, my whole household, my family — we all came together
in times when we needed to,” a teary-eyed Cassandra said. “We pulled together
and by the grace of God we made it through.”
She admitted she honestly
didn’t know if she was going to make it. “I keep on looking towards Heaven,”
she said. “That gets me through a lot.”
It is a story of faith that
touches Lou’s heart.
Cassandra offered to pay when she couldn’t, said
Lou. “That’s what makes giving so awesome,” she said. “You can tell when
someone is deserving. She said she would save up and do without. That’s not
acceptable to me.
“People say ‘Lou isn’t your job depressing?’ and I say
‘No’ because I meet the most awesome women,” Lou said. “She (Cassandra) is not
in here saying, ‘Poor, pitiful me.’”
Cassandra, a choir and youth
director at Peace Missionary Baptist Church hasn’t let her situation slow her
down.
“I’m determined I’m going to do everything to the best of my
ability,” Cassandra said. “I might operate from a wheelchair, but I’m going to
get there some kind of way. Things are going great for me now.”
Lou said
that attitude and the attitude of so many women she comes in contact with has,
at times, made her feel ashamed of herself.
However, Lou has nothing to
be ashamed of. Like Cassandra, she too, is a warrior — a warrior for other
women who are in the midst of the most trying times in their
lives.
“Cancer is a terrible thing, but it also draws a lot of
miracles,” Lou said. “It pulls people together.
“I want this to be the
best part of their experience that it can be,” she said. “I want to make it a
good time instead of dreading it. A lot of ladies go without.”
The women
Lou helps believe she is special.
“She is such a unique and fabulous
lady who is always willing to help out,” Cassandra said.
Not only does
Lou have the boutique, but she also organizes The Pink Ribbon Hope Chest
survivor group. The group meets at 6 p.m. the third Tuesday of each month at
Athens-Limestone Hospital.
Coming
together
Alice Cosco said when the
Athens Ladies Civitan group heard about Lou C’s they wanted to do all they
could to help.
As a member of a group whose main focus is community, she
suggested helping Lou to the Ladies Civitan board. “I felt this was a really
good cause to give back to women in the community,” Alice said.
She told
the group about Lou helping others out of her own pocket.
The group
recently gave Lou $700 to help purchase supplies — supplies so important to
breast cancer patients in the recovery process.
The donation came from
the club’s newly formed Helen Hammond Cancer Fund. Hammond was a member of the
club who just last week lost her three-year battle with lung cancer.
“We
really felt strongly about giving back to deserving women in this community,”
Alice said.
“The Ladies Civitan have many options to give and they chose
this one,” Lou said.
“I am just overwhelmed and
speechless.”
Others in the community have helped as well including the
East Limestone Fire Department, Walk Awhile in my Shoes, and a number of
personal donors.
The donations go directly to the shop and on to people
who Stephanie Mitchell said “deserve to have these types of
services.”
“Lou C’s Boutique is a place where women can go to look and
feel better on their journey with cancer,” Stephanie said.
Stephanie, a
certified Zumba instructor, is organizing a Zumba Party to help support breast
cancer fighters. The event will take place from 5:30-7:30 p.m. April 17, at the
Valley Event Center. Tickets are $5. Donations will be given to Lou C’s
Boutique. Participants don’t have to participate in Zumba fitness to
attend.
“People pulling together make it all worthwhile,” Lou said. “In
one way or another we are all in this together and no one should go through
this alone. We need to be aware all the time.
“I will do all I can to
help those fighting cancer and with the help of the community — they should not
be alone or be without.”