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Lymphland International Lymphedema Online
1. Int J Med Sci. 2010 Apr 15;7(2):68-71.
Godoy & Godoy technique in the treatment of lymphedema for under-privileged populations.
de Godoy JM, de Godoy Mde F.
Stricto-Sensu and Lato-Sensu of Course in Medicine of Medical School in São José do Rio Preto-
SP (FAMERP), Brazil. godoyjmp@riopreto.com.br
Abstract
The aim of this paper is to report new options in the treatment of lymphedema for under-privileged
populations. Several articles and books have been published reporting recent advances and
contributions. A new technique of manual lymph drainage, mechanisms of compression, development
of active and passive exercising apparatuses and the adaptation of myolymphokinetic activities have
been developed for the treatment of lymphedema. This novel approach can be adapted for the
treatment of lymphedema in mass.
PMID: 20428336 [PubMed - in process]PMCID: PMC2860639
2. Contrib Nephrol. 2010;164:227-36. Epub 2010 Apr 20.
Fluid assessment and management in the emergency department.
Di Somma S, Gori CS, Grandi T, Risicato MG, Salvatori E.
Sant'Andrea Hospital, Second Faculty Medical School, "La Sapienza" University of Rome, Rome,
Italy.
Abstract
Evaluation of hydration state or water homeostasis is an important component in the assessment and
treatment of critically ill patients in the emergency department (ED). The main purpose of ED
physicians is to immediately distinguish between normal hydrated, dehydrated and hyperhydrated
states. Fluid depletion may result from renal losses and extrarenal losses (from the GI tract,
respiratory system, skin, fever, sepsis, third space accumulations). Total body fluid increase can
result from heart failure, kidney disease, liver disease, malignant lymphoedema or thyroid disease. In
patients with fluid overload due to acute heart failure, diuretics should be given when there is
evidence of systemic volume overload, in a dose up-titrated according to renal function, systolic
blood pressure, and history of chronic diuretic use. The bioelectrical impedance vector analysis
(BIVA) is a noninvasive technique to estimate body mass and water composition by bioelectrical
impedance measurements, resistance and reactance. In patients with hyperhydration state due to
heart failure, some authors showed that reactance is strongly related to BNP values and the NYHA
functional classes. Other authors found a correlation between impedance and central venous pressure
in critically ill patients. We have been analyzing the hydration state at admission to the ED, 24, 72 h
after admission and at discharge, and found a significant and indirectly proportional correlation
between BIVA hydration and the Caval index at the time of presentation to the ED and 24 and 72 h
after hospital admission. Moreover, at admission we found an inverse relationship between BIVA
hydration and reduced urine output that became directly proportional at 72 h. This confirms the good
response to diuretic therapy with the shift of fluids from interstitial spaces.
Copyright (c) 64\C S. Karger AG, Basel.
PMID: 20428007 [PubMed - in process]
3. Womens Health (Lond Engl). 2010 May;6(3):399-406.
Breast cancer and lymphedema: a current overview for the healthcare provider.
Rourke LL, Hunt KK, Cormier JN.
University of Texas, MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX
77030, USA. lrourke@mdanderson.org
Abstract
Lymphedema is a troublesome condition faced by many breast cancer survivors today. Since
lymphedema represents a debilitating and progressive problem that is feared by most breast cancer
patients and their providers, an up-to-date understanding is necessary in order to better diagnose,
treat and manage these patients. The etiology of lymphedema is multifactorial and poorly understood.
Although lymphedema is not clearly defined within the medical community, there are several
diagnostic tools available to the clinician, of which the most widely accepted in the clinical setting are
the arm circumference measurements. Misinformation has recently been conveyed regarding activity
recommendations for those patients afflicted with lymphedema. These recent events highlight the
critical importance of education, heightened awareness and dedicated future cooperative research in
order to favorably impact on lymphedema care and the quality of life for those living with
lymphedema.
PMID: 20426606 [PubMed - in process]
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 Mar;26(2):103-6.
[The pathological characteristics and clinical significances of maturational change of port-wine stain]
[Article in Chinese]
Wang W, Lin XX, Ma G, Li W, Hu XJ, Jin YB, Chen H, Yang C, Wang W.
Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiaotong
University, Shanghai 200011, China. docwang001@gmail.com
Abstract
OBJECTIVE: In this study histologic observations were presented to elucidate the possible
mechanism of maturational change of port-wine stain(PWS).
METHODS: Normal PWS(3 cases) , thicken PWS (11 cases) and nodular PWS (9 cases) were
included to present histologic observations.
RESULTS: Normal PWS, only shows mild dilated, thin-walled vessels within superficial dermis.
Thicken PWS, shows further dilated vessels and sebaceous gland throughout dermis and superficial
subcutaneous fat. Nodular PWS can be divided into three groups. I Similar to thicken PWS, shows
further dilated vessels and sebaceous gland throughout dermis and superficial subcutaneous fat. II
Shows Large number of dilated vessels, honeycombin and less vascular mesenchymall. III Tenacious
texture shows mild dilated vessels, diffused collagen, mesenchymal rarefactin, lymphocyte infiltration
and lymphedema change.
CONCLUSIONS: Histologic examination revealed not only the expected vascular abnormalities, but
also a number of widely distributed hamartomatous changes in thicken and nodular PWS. The
complex hamartomatous changes suggest a genetically determined, multilineage developmental field
defect in the pathogenesis of PWS.
PMID: 20540312 [PubMed - in process]
1. J Vector Borne Dis. 2010 Jun;47(2):91-6.
Bancroftian filariasis among the Mbembe people of Cross River state, Nigeria.
Okon OE, Iboh CI, Opara KN.
Department of Zoology & Environmental Biology, University of Calabar, Calabar, Nigeria.
Abstract
BACKGROUND & OBJECTIVE: Bancroftian filariasis is a major public health and socioeconomic
problems in the humid tropical and subtropical regions of the world. A study was undertaken to
investigate the status of the disease in some rural communities of Cross River State, Nigeria, with a
view to enriching the epidemiological baseline data of the disease in Nigeria.
METHODS: A total of 897 Mbembe people living in six major villages of Obubra Local
Government Area of Cross River State, Nigeria were examined between December 2008 and June
2009 for lymphatic filariasis due to Wuchereria bancrofti.
RESULTS: Out of the 897 persons examined, 139 (15.5%) were positive for microfilariae in their
blood smear. Infection varied significantly among villages (p <0.05) but was not sex-specific (p >0.
05). The overall mean microfilarial density among the total population was 9.9 mf/50 microl. The
occurrence of microfilaria in the peripheral blood of the infected persons was neither age nor sex
specific (p >0.05). The most important clinical manifestations were hydrocele (9.7%) and
lymphoedema (2.3%). Overall disease prevalence was (6.8%).
CONCLUSION: Government effort on the Community Directed Treatment with Ivermectin (CDTI)
project should be complimented with albendazole distribution to the endemic communities.
Environmental sanitation should also be intensified to eliminate the breeding sites of the mosquito
vectors.
PMID: 20539046 [PubMed - in process]
2. J Surg Res. 2010 Apr 18. [Epub ahead of print]
Treatment of Post-Mastectomy Lymphedema with Laser Therapy: Double Blind Placebo Control
Randomized Study.
Ahmed Omar MT, El Morsy AM, Abd-El-Gayed Ebid A.
Faculty of Physical Therapy, Cairo, Egypt. Member of International Panel of Advisory Board for
Indian Journal of Physiotherapy and Occupational Therapy.
Abstract
BACKGROUND: In post-mastectomy patients, lymphedema has the potential to become a
permanent progressive condition and become extremely resistant to treatment. Thus, it can results in
function impairment and decrease quality of life. The aim of this study was to evaluate the effect of
low level laser therapy (LLLT) on limb volume, shoulder mobility, and hand grip strength.
MATERIAL AND METHODS: Fifty women with breast cancer-related lymphedema were enrolled
in a double-blind, placebo controlled trial. Patients were randomly assigned to active laser (n = 25)
and placebo (n = 25) groups and received irradiation with Ga-As laser device that had wavelength of
904 nm, power of 5 mW, and spot size of 0.2 cm(2) over the axillary and arm areas, three times a
week for 12 wk. The total energy applied at each point was 300 mjoules over seven points, giving a
dosage of 1.5 joules/cm(2) in the active group. The placebo group received placebo therapy in
which the laser had been disabled without affecting its apparent function. Limb circumference,
shoulder mobility, and grip strength were measured before treatment and at 4, 8, and 12 wk.
RESULTS: The two groups had similar parameters at baseline. The reduction of limb volume tended
to decline in both groups. The trend being more significantly pronounced in active LLLT group than
placebo at 8 and 12 wk, respectively (P < 0.05). Goniometric data for shoulder mobility and hand
grip strength were statistically significance for LLLT group than for placebo.
CONCLUSION: Laser treatment was found to be effective in reducing the limb volume, increase
shoulder mobility, and hand grip strength in approximately 93% of patients with postmastectomy
lymphedema. Copyright © 2010 Elsevier Inc. All rights reserved.
PMID: 20538293 [PubMed - as supplied by publisher]
3. Lancet Oncol. 2010 May 25. [Epub ahead of print]
Angiosarcoma.
Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ.
Academic Unit of Surgical Oncology, School of Medicine and Biomedical Sciences, University of
Sheffield, Sheffield, UK.
Abstract
Angiosarcomas are rare soft-tissue sarcomas of endothelial cell origin that have a poor prognosis.
They can arise anywhere in the body, most commonly presenting as cutaneous disease in elderly
white men, involving the head and neck and particularly the scalp. They can be caused by therapeutic
radiation or chronic lymphoedema and hence secondary breast angiosarcomas are an important
subgroup. Recent work has sought to establish the molecular biology of angiosarcomas and identify
specific targets for treatment. Interest is now focused on trials of vascular-targeted drugs, which are
showing promise in the control of angiosarcomas. In this review we discuss angiosarcoma and its
current management, with a focus on clinical trials investigating the treatment of advanced disease.
Copyright © 2010 Elsevier Ltd. All rights reserved.
PMID: 20537949 [PubMed - as supplied by publisher]
4. Am J Hum Genet. 2010 Jun 11;86(6):943-8. Epub 2010 May 27.
GJC2 missense mutations cause human lymphedema.
Ferrell RE, Baty CJ, Kimak MA, Karlsson JM, Lawrence EC, Franke-Snyder M, Meriney SD,
Feingold E, Finegold DN.
Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh,
Pittsburgh, PA 15261, USA.
Abstract
Lymphedema is the clinical manifestation of defects in lymphatic structure or function. Mutations
identified in genes regulating lymphatic development result in inherited lymphedema. No mutations
have yet been identified in genes mediating lymphatic function that result in inherited lymphedema.
Survey microarray studies comparing lymphatic and blood endothelial cells identified expression of
several connexins in lymphatic endothelial cells. Additionally, gap junctions are implicated in
maintaining lymphatic flow. By sequencing GJA1, GJA4, and GJC2 in a group of families with
dominantly inherited lymphedema, we identified six probands with unique missense mutations in
GJC2 (encoding connexin [Cx] 47). Two larger families cosegregate lymphedema and GJC2
mutation (LOD score = 6.5). We hypothesize that missense mutations in GJC2 alter gap junction
function and disrupt lymphatic flow. Until now, GJC2 mutations were only thought to cause
dysmyelination, with primary expression of Cx47 limited to the central nervous system. The
identification of GJC2 mutations as a cause of primary lymphedema raises the possibility of novel
gap-junction-modifying agents as potential therapy for some forms of lymphedema. Copyright 2010
The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.
PMID: 20537300 [PubMed - in process]
5. Microcirculation. 2010 May;17(4):281-96.
Lymphatic dysfunction, not aplasia, underlies milroy disease.
Mellor RH, Hubert CE, Stanton AW, Tate N, Akhras V, Smith A, Burnand KG, Jeffery S, Mäkinen
T, Levick JR, Mortimer PS.
Cardiac & Vascular Sciences (Dermatology), St George's Hospital Medical School, University of
London, London, UK.
Abstract
OBJECTIVE: Milroy disease is an inherited autosomal dominant lymphoedema caused by mutations
in the gene for vascular endothelial growth factor receptor-3 (VEGFR-3, also known as FLT4). The
phenotype has to date been ascribed to lymphatic aplasia. We further investigated the structural and
functional defects underlying the phenotype in humans.
METHODS: The skin of the swollen foot and the non-swollen forearm was examined by (i)
fluorescence microlymphangiography, to quantify functional initial lymphatic density in vivo; and (ii)
podoplanin and LYVE-1 immunohistochemistry of biopsies, to quantify structural lymphatic density.
Leg vein function was assessed by colour Doppler duplex ultrasound.
RESULTS: Milroy patients exhibited profound (86-91%) functional failure of the initial lymphatics in
the foot; the forearm was unimpaired. Dermal lymphatics were present in biopsies but density was
reduced by 51-61% (foot) and 26-33% (forearm). Saphenous venous reflux was present in 9/10
individuals with VEGFR3 mutations, including two carriers.
CONCLUSION: We propose that VEGFR3 mutations in humans cause lymphoedema through a
failure of tissue protein and fluid absorption. This is due to a profound functional failure of initial
lymphatics and is not explained by microlymphatic hypoplasia alone. The superficial venous valve
reflux indicates the dual role of VEGFR-3 in lymphatic and venous development.
PMID: 20536741 [PubMed - in process]
6. Genet Med. 2010 Jun 8. [Epub ahead of print]
Spinal extradural arachnoid cysts in lymphedema-distichiasis syndrome.
Sánchez-Carpintero R, Dominguez P, Núñez MT, Patiño-García A.
From the 1Department of Pediatrics, Pediatric Neurology Unit; 2Department of Radiology,
Neuroradiology Unit; and 3Department of Pediatrics, Laboratory of Pediatrics, University Clinic of
Navarra, Pamplona, Spain.
Abstract
PURPOSE:: Lymphedema-distichiasis syndrome is characterized by the presence of lower limb
lymphedema and supernumerary eyelashes arising from the Meibomian glands. Spinal extradural
arachnoid cysts have been observed in some families but their true frequency is unknown. The aim of
this study is to determine the frequency of spinal extradural arachnoid cysts in lymphedema
distichiasis syndrome.
METHODS:: We collected clinical information from all 45 living members of a complete family of 48
members and performed molecular analysis of the FOXC2 gene in 30 individuals. We obtained
spinal magnetic resonance imaging from all family members with a FOXC2 gene mutation.
RESULTS:: Twelve family members carried a mutation in the FOXC2 gene and had clinical features
of lymphedema-distichiasis syndrome. Of these, 58% (seven individuals) had extradural arachnoid
cysts.
DISCUSSION:: We suggest that a follow-up protocol for lymphedema-distichiasis syndrome
families should include spinal magnetic resonance imaging for all affected members so that the timing
of surgery for removal of these cysts can be optimized.
PMID: 20535019 [PubMed - as supplied by publisher]
7. Ugeskr Laeger. 2010 Jun 7;172(23):1765-6.
[Recurrent post surgical cellulitis of the breast][Article in Danish]
Thoning JM, Thormann H.
Svendborg Sygehus, Medicinsk Afdeling, Odense Universitetshospital, 5230 Odense, Denmark.
jthon04@gmail.com
Abstract
Differentiation between infectious and non-infectious cellulitis is a frequent clinical issue. Often, there
is no proven portal of entry for infection and it is difficult to obtain a positive culture. Two case
stories with recurrence of postoperative cellulitis are presented. Lymphoedema, often seen post
surgery, is itself inflammatory and may cause inflammatory cellulitis. In recurrent cases of cellulitis
without any effect of antibiotic treatment, inflammatory cellulitis should be considered.
PMID: 20534207 [PubMed - in process]
June 6, 1010 - This is Now Considered a Critical Piece of Cancer Treatment -
The research of Dr. Kathryn Schmitz, which had already research reversed decades of cautionary
exercise advice given to breast cancer patients with lymphedema, led an expert panel to developed
the new recommendations.
According to Eurekalert:
"Cancer patients and survivors should strive to get the same 150 minutes per week of moderate-
intensity aerobic exercise that is recommended for the general public ... Though the evidence
indicates that most types of physical activity -- from swimming to yoga to strength training -- are
beneficial for cancer patients, clinicians should tailor exercise recommendations to individual patients".
Sources: Science Daily June 1, 2010
Dr. Mercola's Comments:
As little as a decade ago, it was common for physicians to advise their heart attack patients to avoid
exercise for fear that they could stress out their heart and trigger a second attack.
Now, it's common knowledge that exercise is a phenomenal way to strengthen your heart after a
heart attack as well as lessen your risk of further problems, and regular exercise is routinely
recommended to heart patients.
For cancer patients, this trend is still in the beginning stages, with many practitioners advising their
patients to avoid exercise during and after cancer treatment. But increasing evidence is showing that
this outdated advice is actually causing cancer patients harm, as regular exercise can lead to a
number of health improvements for cancer patients, including:
· Better aerobic fitness
· Increased muscular strength
· Improved quality of life
· Less fatigue
Exercise Improves Cancer Survival
I've written a lot about how exercise can help to reduce your risk of cancer in the first place, but
does it do any good if you're already fighting cancer? Yes … a lot.
Harvard Medical School researchers found patients who exercise moderately -- 3-5 hours a week
-- reduce their odds of dying from breast cancer by about half as compared to sedentary women. In
fact, any amount of weekly exercise increased a patient's odds of surviving breast cancer. This
benefit also remained constant regardless of whether women were diagnosed early on or after their
cancer had spread.
Patients receiving the biggest boost from exercise were those most sensitive to estrogen, the most
common form of breast cancer. (Previous research has shown exercise lowers estrogen levels, which
can fuel the growth of breast cancer cells.)
Think about it. If just three to five hours of walking per week can so drastically improve your
chances of surviving a hormone-responsive breast cancer tumor, imagine what a few more hours a
week of exercise could do for you.
If you're male, be aware that athletes have lower levels of circulating testosterone than non-athletes,
and similar to the association between estrogen levels and breast cancer in women, testosterone is
known to influence the development of prostate cancer in men.
Physical activity can reduce your risk and boost your chances of recovery if you have cancer.
Exercise is a Potent Cancer Fighter
Cancer thrives on sugar, but regular exercise reduces your insulin levels, which creates a low sugar
environment that discourages the growth and spread of cancer cells. Controlling your insulin levels is
one of the most powerful steps you can take to reduce your cancer risk and help keep it from
returning.
Physically active adults experience about half the incidence of colon cancer as their sedentary
counterparts. Exercise has a beneficial influence on insulin, prostaglandins and bile acids, all of which
are thought to encourage the growth and spread of cancer cells in your colon. Exercise also improves
bowel transit time, which means your body's waste is spending less time in contact with the mucosal
lining of your colon.
Exercise also improves the circulation of immune cells in your blood. The job of these cells is to
neutralize pathogens throughout your body.
The better these cells circulate, the more efficient your immune system is at locating and defending
against viruses and diseases, including cancer, trying to attack your body.
It's also been suggested that apoptosis (programmed cell death) is triggered by exercise, causing
cancer cells to die. So you can see why a regular exercise program is important not only during any
treatment you're receiving but also afterward as well.
Exercise Tips for Cancer Patients
I would also strongly recommend that you read the lead article in today's newsletter that reviews
some of the newest insights on how to optimize your exercise program and actually reduce your
exercise time and improve your benefits.
You will need to tailor your exercise routine to your individual scenario, taking into account your
stamina and current health. Often, you will be able to take part in a regular exercise program -- one
that involves a variety of exercises like strength training, core-building, stretching, aerobic and
anaerobic -- with very little changes necessary.
However, you may find that you need to exercise at a lower intensity or for shorter durations at
times. Always listen to your body and if you feel you need a break, take time to rest. Even exercising
for a few minutes a day is better than not exercising at all, and you'll likely find that your stamina
increases and you're able to complete more challenging workouts with each passing day.
In the event you are suffering from a very weakened immune system, you may want to exercise in
your home instead of visiting a public gym. But remember that exercise will ultimately help to boost
your immune system, so it's very important to continue with your program.
June 21, 2010 - Indian River County health notes for June 22 -
VNA screenings
The Visiting Nurse Association of the Treasure Coast is offering the following no-cost blood
pressure and blood glucose screenings in June
June 22, (BP/BS) 9-11 a.m. Staples, 1191 U.S. 1, Vero Beach.
June 28, (BP/BS) 8:30-10 a.m. Sebastian Gym & Fitness, 345 Sebastian Blvd., Sebastian.
For morning blood sugar tests, you should fast after midnight on the evening before the screening.
For more information about health screenings or other VNA services, call (772) 567-5551 or visit
www.vnatc.com.
Balancing hormones
A free workshop, “Balancing Hormones Safely and Naturally,” will be presented 6 p.m. Tuesday,
June 22, at Alternative Medicine Family Care Center, 3408 Aviation Blvd., Vero Beach.
The workshop addresses non-drug solutions to the hormone-related concerns of women 0f all ages
including thyroid problems, hot flashes, fatigue, night sweats, irregular cycle, headaches, trouble
sleeping, abnormal cramping, depression and anxiety.
To R.S.V.P., call (772) 778-8877. Visit www.amfcc.info for more information on alternative
medicine.
Digestive disorders
A free workshop on digestive disorders will be presented 6-7 p.m. Thursday, June 24, at Alternative
Medicine Family Care Center, 3408 Aviation Blvd., Vero Beach.
This workshop will teach alternative approaches to preventing and relieving common digestive
disorders including acid reflux, hiatal hernia, gas, bloating, irritable bowel, diarrhea, stomach cramps,
Crohn’s Disease and constipation.
Call (772) 778-8877 to R.S.V.P. For more info, visit www.amfcc.info.
Balance screenings
Sunshine Physical Therapy Clinic will be at the Walgreens on 17th Avenue and U.S. 1 in Vero
Beach 10 a.m.-noon Wednesday, June 30, to do balance screenings. For more information, call the
clinic at (772) 562-6877.
Blood pressure screenings
Blood pressure screenings are offered 10-11:30 a.m. the third Tuesday of every month as Oxygen
Plus, 2360 U.S. 1, Vero Beach. For more information, call (772) 569-0232 or write oxygen-
plus@mail.com.
Wellness program
A free wellness presentation to raise antioxidant levels, improve immune system functions and reduce
DNA damage will be offered at the Institute of Colorectal Health & Wellness, 1255 37th St., Suite
B, Vero Beach, 7 p.m. Thursdays.
R.S.V.P. at (772) 778-4773 or christyicrhw@gmail.com.
Walkers, wheelchairs
Veterans of Foreign Wars Post 3918, Vero Beach, has walkers, wheelchairs, crutches, portable
commodes and motor scooters, available free for anybody who needs them. For information, call the
Post 3918 office at (772) 567-8487 and leave your name and number.
Quit smoking
Free quit smoking now classes (all forms of tobacco) are offered to all county residents 18 and older
at the Indian River County Health Department, 1900 27th St., Vero Beach.
Call (561) 640-3620 for dates and times. This is a community health promotion program offered by
Everglades Area Health Education Center.
Mental health
The Mental Health Association has opened a walk-in center to provide people in crisis immediate
access to help. Death in the family, domestic abuse, depression, anxiety, parenting issues —
whatever the difficulty, MHA’s therapists stand ready to assist. If you are interested in donating to
the MHA or if you need help for yourself or your loved ones, call (772) 569-9788.
Health talk show
If you have missed any of Indian River Medical Center’s Health Talk TV segments that air on
WWCI-TV Channel 10, you can now go to the hospital’s Web site, www.irmc.cc. Under “Health
Resources” at the top of the home page, choose to watch any or all segments from the first four
shows.
To view on YouTube, go to www.youtube.com and type “Indian River Medical Center” in the
search box.
The show, hosted by Kim Beckett, wife of Dr. Clark W. Beckett, IRMC vascular surgeon, features
the latest in health news and medical advances. The series airs on Channel 10 on alternate Mondays
and Wednesdays at 4, 7 and 11 p.m.
E-mail questions, comments and suggested topics to healthtalk@irmc.cc.
Fitness camp
In partnership with the Club at Spine & Sport Institute, CityFit Outdoor Fitness Camp is hosting
Brown Bag boot camps from noon to 12:50 p.m. Tuesdays and Thursdays on 36th Street in Vero
Beach.
The camps are designed with a holistic approach to health and include workouts, workshops and
field trips focused on smarter shopping and menu planning..
The cost is $250 for six weeks. Call Jill at (772) 713-7938 or e-mail cityfitflorida@gmail.com to
reserve a spot.
Macular Degeneration
Free initial eye screenings are available at Diabetes Eye and Macular Degeneration Institute for
patients who are diabetic or age 50 and older. Call (772) 770-1577 to schedule an appointment at
93 Royal Palm Pointe, Vero Beach.
Florida Eye Institute
Florida Eye Institute will begin free initial vision and glaucoma screenings from 9 to 11 a.m. Fridays
at 2750 Indian River Blvd. in Vero Beach. Call (772) 569-9500 or visit www.fleye.com for more
information.
Monnett Eye Center
Monnett Eye Center provides free vision, glaucoma and hearing screenings from 9 a.m. to 2 p.m.
Tuesdays at the clinic, 14410 U.S. 1 in Sebastian. Monnett Eye Center also provides local
businesses with free vision, glaucoma and hearing screenings for their employees. For more
information and appointments, call (772) 589-8111.
Aesthetic medicine
Find out what’s new in aesthetic medicine at a free informational seminar presented by Ferdinand
Becker M.D., F.A.C.S. and Barry Boyd, M.D. 10-11 a.m. Friday, June 25, at Advanced Facial
Cosmetic and Laser Surgery Center, 5070 N. State Road A1A, Vero Beach. Topics include
surgical and nonsurgical cosmetic procedures such as dermal fillers, Zerona, fractional laser
resurfacing and photorejuvenation, as well as aesthetic surgery for the face and body, including
facelifts and eyelid surgery, breast surgery, tummy tucks and liposuction. The seminar is free, but
reservations are required. Call (772) 234-3700.
Lymphedema therapy
Sunshine Physical Therapy Clinic, 1705 17th Ave., Vero Beach, now offers lymphedema therapy
among its regular services. Michelle Dorfman is certified in treating anyone with lymphedema of the
upper extremity. If you have had a mastectomy, lumpectomy radiation treatment, lymph node
removal, other surgeries or infections to the limbs, you may be at risk for developing lymphedema.
For information, call (772) 562-6877.
June 22, 2010 - Dragonboat gets grant –
Prince George Northbreast Passage Dragon Boat team has received a grant for $2,000 for the
upcoming season. The grant was part of a $50,000 Canadian Breast Cancer Foundation grant
allotted to 22 B.C. Dragon Boat breast cancer survivor teams for 2010.
The grant was created to celebrate the fact women can lead healthy and active lives after breast
cancer. This region has supported the teams since 1997. The Dragon Boat movement for breast
cancer survivors began in 1996 as the result of a ground breaking study led by Dr. Don McKenzie ,
professor of sports medicine at the University of British Columbia. He set out to investigate the link
between upper body exercise and the development of lymphedema in women with breast cancer.
Lymphedema is the swelling some women experience due to accumulation of fluid in the arm and
chest after removal of lymph nodes for the treatment of breast cancer.
In his study, 24 women, all with a history of breast cancer, volunteered for the research project and
began training as dragon boaters. McKenzie found that despite rigorous repetitive upper-body
exercises – which dragon boating requires – no new cases of lymphemdema occurred and none of
the existing cases progressed.
Women who participated showed a marked improvement in both physical and mental health. From
this initial project in Vancouver, an international movement of breast cancer survivor Dragon boat
teams has evolved.
Balance a touch away - Jerrilyn Zavada - 06/24/2010
An oasis of peace sits relatively untapped in downtown Streator.
Body/Mind/Spirit, owned by Amy Ryan of Streator, offers massage and lymphedema therapy and
Reiki, among other services to provide a balance between body and spirit.
Ryan is a graduate of the Illinois Valley Community College massage therapy program. She practiced
locally for seven years, before going into private practice.
"I love what I do and I love helping people," Ryan said. "I believe I have a gift and I want to share it."
Ryan's philosophy in providing the services is simple. She provides massage techniques tailored to
individual needs.
"A few simple changes can bring more balance into a busy lifestyle and you can enjoy a higher, more
vibrant state of health," she said. "Blending the wise ways of the East with dynamic ways of the West
is the necessary step that would bring us closer to manifesting health and inner peace."
Ryan offers competitive prices for 30-minute, one-hour and 90-minute massage sessions. She offers
discounts to senior citizens.
"A lot of them are on fixed incomes and it's so wonderful for them," she said.
June 25, 2010 - Pulling together - Joey Coleman -
They paddle the west harbour every Saturday morning. Forty women in two boats, determined to
paddle the fastest dragon boat in the world. Like all athletes, they're focused on the next race -- the
next big challenge.
What makes these athletes different is their biggest challenge is behind them. They're breast cancer
survivors.
The team formed 13 years ago after an article in Chatelaine about the debate over upper body
exercise for women with breast cancer. Two decades ago, it was believed this activity increased the
risk of lymphedema.
But a study by Dr. Don McKenzie of the University of British Columbia proved conventional
wisdom was wrong.
Dragon boating is physically demanding and a challenge for even the most healthy person.
"A lot of people believe it's canoeing and canoeing is a nice easy stroke," said Kathy Levy, a
founding member and now a coach with the team.
"A lot of our ladies, including me, did not do a lot of physical activity. Now, all of the sudden, we
have triceps, biceps and calf muscles," said coach Ann Fowbes Arndt.
They practise at Macassa Bay Yacht Club two days a week and on other days do water aerobics,
marathon training, spinning, cross-training and even boxing.
Two weekends ago, they won an international breast cancer survivors dragon boat festival, beating
72 other international teams.
Husbands get involved, too, sometimes treating team members to breakfast when they come off the
water.
"A couple years back, they had a race and they had to pull off a good time," said Jim Martin, whose
wife, Loraine, is on the team.
"I said if you can do this, I'll cook breakfast ... waffles and ice cream with shaved chocolate,
strawberries cut into hearts."
Since then, he has been part of the shore team preparing breakfast following each victory.
Racing, and the mental preparation involved, helps the paddlers think about something other than
cancer, but it's never far from their thoughts.
"It's always in the back of your head that one day it may come back to bite you," said Levy. "We
have lost three members already this year. It's hard."
Team member Rae Puttock listened by cellphone from her bed as the team won in Peterborough.
She died the next day.
"She was always a part of everything we were doing right up to the day before she died," said Levy.
"You don't leave the team because you've retired or you've been traded."
Levy and Fowbes Arndt say the losses increase their determination.
"We gather strength from the girls we've lost. It makes us paddle harder for each of them. They're
with us on the boat."
June 24, 2010 - Decongestive Physiotherapy Helps Patients with Painful Leg Swelling -
Source: Wolters Kluwer Health: Lippincott Williams & Wilkins
Combination Approach Benefits Patients with Chronic Venous Insufficiency or Lymphedema,
Reports Topics in Geriatric Rehabilitation
Newswise — For patients with painful swelling of the legs caused by chronic venous insufficiency
(CVI), a combination treatment approach called "complete decongestive physiotherapy" improves
symptoms, walking ability, and quality of life, reports a study in Topics in Geriatric Rehabilitation.
The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a
leading provider of information and business intelligence for students, professionals, and institutions in
medicine, nursing, allied health, and pharmacy.
Complete (or "complex") decongestive physiotherapy (CDP) can greatly reduce leg swelling and
pain in patients with CVI, according to the new study, led by Yesim Bakar, Ph.D., P.T., of Abant
Izzet Baysal University in Bolu, Turkey. Another paper in the same issue of TGR shows similar
benefits of CDP in a patient with lymphatic obstruction (lymphedema) related to the skin condition
psoriasis.
Complete Decongestive Physiotherapy Brings Good Results
Dr Bakar and coauthors evaluated the effects of CDP in 62 older adults (average age 65 years) with
CVI. Patients with CVI have poor blood flow in the veins of the leg, leading to fluid buildup. This
results in painful swelling, making it difficult for patients to walk and perform other activities. Usually
only one leg is affected.
All patients were treated using the CDP approach, which combines four types of physical therapy
treatments:
• Manual lymph drainage—massage to promote drainage of the lymph nodes.
• Skin care—moisturizers and other treatments for skin changes caused by poor circulation.
• Compression—bandages are applied to prevent fluid from reaccumulating.
• Exercise—simple leg exercises to improve blood flow and leg motion.
For the first month, patients met with a physical therapist five days a week for treatment. They also
received education in performing each of the four types of therapy for themselves. The goal was to
keep fluid buildup under control through lifelong, daily self-care.
The CDP treatment program dramatically reduced leg swelling—on average, fluid buildup in the
affected leg decreased by the equivalent of nearly half a liter. Pain was also decreased, from an
average score of 67 to 18 on a 100-point scale. Patients had improved walking ability, less pain
when walking, and improved ability to perform daily activities. The authors believe that including
exercise in the treatment program was a key factor in improving walking ability.
Dr. Bakar is also a co-author of the other paper, which reports on the use of CDP in a woman with
lymphedema related to the chronic skin condition psoriasis. In patients with lymphedema, obstruction
of the lymph nodes causes similar symptoms of leg pain and swelling. In both the short and long term,
CDP brought significant improvement in pain, swelling, and activity.
In recent years, CDP has become an accepted approach to treatment for lymphedema. Although not
a cure, CDP incorporates several physical therapy techniques that can help keep fluid buildup, leg
swelling, and pain under control.
The new studies are the first to evaluate the fully integrated CDP approach—including daily home
maintenance therapy—in patients with CVI and psoriasis-related lymphedema. "CDP is a time-
consuming process for patients and physiotherapists," Dr. Bakar and colleagues write. "However, it
is widely used and an effective treatment for patients with lymphedema." The new results suggest that
this combination physical therapy approach could also be very helpful for patients with leg pain and
swelling caused by CVI.
About Topics in Geriatric Rehabilitation
Topics in Geriatric Rehabilitation is a peer-reviewed quarterly publication that presents clinical, basic,
and applied research, as well as theoretic information, consolidated into a clinically relevant form.
TGR is a leading resource for the healthcare professional practicing in the area of geriatric
rehabilitation. TGR provides useful treatment information written by and for specialists in all aspects
of geriatric care. Each issue focuses on a specific topic, providing best practices and dependable
hands-on tips and techniques.
Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals
and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing
under the LWW brand, as well as content-based sites and online corporate and customer services.
LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence
for students, professionals and institutions in medicine, nursing, allied health and pharmacy. Major
brands include traditional publishers of medical and drug reference tools and textbooks, such as
Lippincott Williams & Wilkins and Facts & Comparisons®; and electronic information providers,
such as Ovid®, UpToDate®, Medi-Span® and ProVation® Medical.
Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services
company. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk,
compliance, and healthcare rely on Wolters Kluwer’s leading, information-enabled tools and
solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever
more dynamic world.
Wolters Kluwer has 2009 annual revenues of €3.4 billion ($4.8 billion), employs approximately
19,300 people worldwide, and maintains operations in over 40 countries across Europe, North
America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Alphen aan den Rijn,
the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX
and Euronext 100 indices.
June 19, 2010 - Post-surgery lymphedema often goes untreated -
Massage technique can help reduce hand swelling
Lymphedema is a physical and emotional problem for many post-surgery cancer patients, "and all
too often not diagnosed," says Canadian lymphedema expert Dr. Anna Towers.
"People go to emergency with a skin infection or ulcer and they are treated for that, but not for the
underlying cause, which is severe swelling lymphedema," says the McGill University professor.
She visited Victoria recently to talk about lymphedema, a fluid-retention condition that can affect
anyone who has had radiation or surgery involving lymph nodes.
Towers is founding chairwoman of the newly formed Canadian Lymphedema Framework, which
seeks to raise the profile and treatment of this condition.
Lymph is a fluid, found between the body's cells, that is carried by the lymphatic system through
nodes. Unlike blood, it has no central pump, but moves due to muscle action. Under ideal conditions,
the fluid feeds cells and carries away excess waste and cancer cells, says the palliative care physician.
But when damaged, the system doesn't drain well and any inflammation causes even more to build
up. "We're doing a large Canadian study now following women who've had breast cancer. We're
only halfway through; the study goes from 2005 to 2015, and already we're showing 17 per cent
have lymphedema. "It can appear immediately after treatment or years later, after an injury - a
suntan, an infection from an insect sting, even air travel," Towers says. "Inflammation exacerbates the
problem."
Untreated, lymphedema can lead to disability, loss of function, job loss and early death.
Forty per cent of patients with the condition develop complications ranging from infection to blood
clots, says Towers, associate professor in McGill's oncology department and former director of its
palliative care division. She is advocating across the country for better research, care and medical
coverage.
About 25,000 new cases occur in B.C. every year, mostly following surgeries for breast, prostate,
colorectal, gynecological or melanoma cancers. (The condition can also be genetic.)
Once lymphedema develops, the preferred treatment is hands-on, decongestive massage to softly
guide lymph in the right direction, to reduce swelling and improve function. A compression garment
or bandage is worn for maintenance.
Robert Harris operates the Dr. Vodder clinic here, which trains therapists in the massage. "It's very
light, gentle, rhythmic, and stimulates the lymph vessels to pump," he says. "Patients love it," and
frequent massage can bring a limb down 40 to 50 per cent in a month, which also lowers infection
risk.
"The therapy is life-changing but its success depends on how soon it happens." One hour costs about
$85. The medical services plan picks up $23, while some extended-health plans pay more.
A 60-year-old woman, who asked not to be identified, had a recent lumpectomy and developed
swelling in her hand, arm and breast. "It was like an overfilled balloon. I couldn't close my fist, get
my rings off. But after about six treatments the therapist got my breast draining and my hand
working.
"I tried to get physio at the cancer clinic, but was told it would be up to six week. I didn't want to
wait because it was getting bigger and bigger. This therapy is wonderful."
Combined decongestive therapist Beth Atkinson took the Dr. Vodder lymph drainage course and
works at Vitality Treatment Centre in Oak Bay, with others trained in the specialty. There are eight in
the city. "We cover seven days a week, because when a person comes in with a severe problem,
there's an intense phase before maintenance can begin. We might see them three, four times a week,
for three weeks. "A patient might have a leg that weighs twice what's normal. Even after massage,
there's tremendous difference. People get off the table and say: Wow, I can bend my knee.' (Excess
water is eliminated through waste.)" She adds lymph drainage is useful for other inflammatory
conditions, too, and patients can learn to do it themselves.
Towers says the therapy should be covered by provincial medical plans, but blamed lack of
leadership. Health policy favours prevention and treatment - "as it should" - but that leaves less for
followup care, she says. Because the treatment is not pharmacological, "we don't have the benefit of
pharmaceutical firms' resources to help advocate." In addition, many problems appear years after the
cancer management ends.
The B.C. Cancer Agency recommends patients contact the Dr. Vodder school - www.vodderschool.
com or at 250-598-9862 for combined decongestive therapy. It's not available in hospitals, which
use compression pumps instead.
June 25, 2010 - Cancer centers revitalize survivors - By Helena Oliviero -
For almost five months, Priscilla Tomlinson’s life revolved around regular trips to the basement of
Piedmont Hospital. There, on every third Tuesday, she underwent chemotherapy sessions lasting
almost eight hours to battle ovarian cancer.
After each session, she went into her backyard and lit a bouquet of dried sage, letting it waft over her
like incense. Two days later, a flu-like wave would smash her to her core. Slowly, she would begin
to feel better. And then it was time for the next Tuesday chemo date at Piedmont.
Then suddenly, in January 2007, her cancer treatments were done. She would require checkups and
medication, but she was no longer a cancer patient.
Yet, moving forward was difficult, and she found herself returning to Piedmont, again and again. But
no longer to the basement. Now she takes the elevator to the 7th floor, to Piedmont’s Cancer
Wellness Center.
There, Tomlinson takes African drumming classes. She molds clay into pinch pots. She jots down
her thoughts in an “expressive arts room.” She participates in food demonstrations. She meditates
and meets with therapists.
Tomlinson is among a growing number of cancer patients who are looking to cancer centers for help
in making the transition to life as a survivor. And more cancer centers are offering post-treatment
options.
Yoga, massage therapy and mind-body studios are becoming mainstream as medical facilities extend
the traditional boundaries of health care. It allows them to maintain relationships with the patients, as
well as meet patient demands for more complementary and alternative approaches to wellness.
“It helps me deal with the anxiety of scans and helps me stay in the present,” said Tomlinson, 70,
who lives in Decatur. “It helps me from not running stories in my mind thinking of all of the bad things
that can happen. This helps me live my life.”
Seeking help
Cancer survivors are living longer and healthier lives. The chance of surviving most cancer has been
steadily rising. For example, the 5-year survival rate for breast cancer is now 90 percent, up from 75
percent in the mid-to-late 1970s, according to the National Cancer Institute.
Still, fighting a deadly disease can leave survivors feeling battered and confused, and struggling to find
their way. From soreness and scars to being emotionally shaken, survivors often need help grappling
with everything from depression and fatigue to body image concerns and relationship woes.
At the same time, Americans overall are increasingly looking outside traditional medicine for their
health care needs.
About a third of Americans are using at least one form of what’s referred to as “complementary or
alternative medicine.”
When megavitamins and prayer are included in this definition, the percentage rises to 62 percent,
according to the National Institutes of Health. Americans spend $34 billion annually in out-of-pocket
expenses on complementary and alternative approaches, according to a 2009 analysis by the
Centers for Disease Control and Prevention.
Several smaller studies of cancer patients suggest many of them are seeking alternative care. A study
published in the 2000 issue of the Journal of Oncology found 69 percent of 453 cancer patients
turned to some aspect of alternative care as part of their cancer treatment. A more recent study
published in a December 2004 issue of the Journal found 88 percent of 102 cancer patients enrolled
in a research study turned to CAM therapy, which can include vitamins or minerals and acupuncture.
Filling a void
Dr. Perry Ballard, an oncologist at Piedmont since 1987, said he used to be skeptical of
nontraditional care but now embraces its role in helping a person get better.
“Life is never the same after you have cancer, and it goes beyond having the most cutting-edge
therapies,” said Ballard. “You have to heal yourself psychologically and spiritually. We are learning
more and more about the mind-body connection.”
As a doctor seeing as many as 25 patients a day, Ballard said he hears a wide range of emotional
aches and pains: a young woman who’s been prematurely thrust into menopause because of a
mastectomy; a man losing sexual function; young singles wondering if they will ever get married.
Complementary care, he said, helps fill the void of what traditional medicine can do. And patients
addressing emotional and physical needs are better patients — they are more likely to keep
appointments and stay on top of their treatments.
Erika Baube, a licensed social worker at Georgia Cancer Specialists, said the majority of her clients
seek counseling after they complete treatment.
During the treatment stage, patients are intently focused on doctors’ appointments, chemotherapy
and other all-consuming medical needs. Once that intense routine ends, many emotions bubble up.
“There’s this emotional letdown at the end of treatment,” said Baube. “They have been so focused
on getting through the treatment, and then it’s, ‘Now what?’ They are finally allowing themselves to
feel the fear.”
Feeling up to par
After surgery and undergoing several rounds of radiation in 2007, Alice Stubblefield turned to
Turning Point in Alpharetta, a nonprofit resource for women with breast cancer offering physical
therapy, massage, counseling and other services.
Stubblefield couldn’t shake lingering soreness and lymphedema, an accumulation of fluid that
sometimes builds up and causes swelling after cancer treatment. She also worried about her body
image, concerned about her husband’s reaction to the mastectomy.
“I know my husband is here for me and still loves me, but the women there helped me work through
the process and really accept myself,” said Stubblefield.
Going to Turning Point also encouraged her to set goals. Among them: To play golf with her husband
again.
For the longest time after her cancer, she had no interest in picking up a set of clubs. Over time, her
outlook on life brightened. She and her husband are golfing together again.
“Not only do you want to do more things, but it’s not the end of the world,” she said. ‘What do I do
now?’
For Ned Crystal, who is 36, launching a new support group helped re-energize him after his cancer
treatments. “We have been going through this ritual of doctors and restrictive diet and you have this
moment of clarity that gets clouded again.
What is a normal life and what do I do now? How do I go through a transition of getting back to the
grindstone of work?” said Crystal, who was diagnosed with sarcoma, a rare form of cancer
developing in the soft tissues of the body, after suffering a knee injury three years ago. “They are
calling me a survivor and saying I am in the clear now. ... It’s frightening and it’s unnerving” said
Crystal, who lives in Smyrna with his wife.
Crystal, who underwent treatment at Emory University’s Winship Cancer Center, joined a steering
committee to help design a new program for cancer survivors, including a peer-to-peer program
matching newly diagnosed cancer patients with survivors. He’s also founded a new sarcoma support
group, believed to be the first in Atlanta.
“According to the statistics, there is a 95 percent chance I’m not going to make it five years. You can
fold up the tent and go home or make a difference. ... For me, getting involved has renewed my
passion.” ‘I really needed this’
On a recent afternoon, Priscilla Tomlinson closes her eyes and taps on an African drum. Then her
eyes spring open and she begins pounding the instrument — boom, boom, boom! She releases
nervous energy. She releases anxiety.
All of the participants in this class are cancer survivors. The chemotherapy, the radiation, the surgery
is behind them. Yet, they all wrestle with the fear it may one day return.
Harriet Sims, 40, is among those in this class. Dripping in sweat and tearful, she smiles. Sims was
diagnosed two years ago with multiple myeloma, a blood cancer. She underwent a stem-cell
treatment a year and a half ago. She will get a follow-up biopsy during the coming days to see if the
cancer has been kept at bay, “I can’t tell you how much I needed this,” said Sims. “I come here
and it makes me feel good.”
Tomlinson gives her a hug.
As the class comes to a close, they sing together: “I’m a tower of strength within and without, I am a
tower of strength within. All my fears slip away, slip away, all my fears slip away.”
June 25, 2010 - CDP treatment can reduce pain and swelling in CVI patients -
For patients with painful swelling of the legs caused by chronic venous insufficiency (CVI), a
combination treatment approach called "complete decongestive physiotherapy" improves symptoms,
walking ability, and quality of life, reports a study in Topics in Geriatric Rehabilitation. The journal is
published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of
information and business intelligence for students, professionals, and institutions in medicine, nursing,
allied health, and pharmacy.
Complete (or "complex") decongestive physiotherapy (CDP) can greatly reduce leg swelling and
pain in patients with CVI, according to the new study, led by Yesim Bakar, Ph.D., P.T., of Abant
Izzet Baysal University in Bolu, Turkey. Another paper in the same issue of TGR shows similar
benefits of CDP in a patient with lymphatic obstruction (lymphedema) related to the skin condition
psoriasis.
Complete Decongestive Physiotherapy Brings Good Results
Dr Bakar and coauthors evaluated the effects of CDP in 62 older adults (average age 65 years) with
CVI. Patients with CVI have poor blood flow in the veins of the leg, leading to fluid buildup. This
results in painful swelling, making it difficult for patients to walk and perform other activities. Usually
only one leg is affected.
All patients were treated using the CDP approach, which combines four types of physical therapy
treatments:
•Manual lymph drainage—massage to promote drainage of the lymph nodes.
•Skin care—moisturizers and other treatments for skin changes caused by poor circulation.
•Compression—bandages are applied to prevent fluid from reaccumulating.
•Exercise—simple leg exercises to improve blood flow and leg motion.
For the first month, patients met with a physical therapist five days a week for treatment. They also
received education in performing each of the four types of therapy for themselves. The goal was to
keep fluid buildup under control through lifelong, daily self-care.
The CDP treatment program dramatically reduced leg swelling—on average, fluid buildup in the
affected leg decreased by the equivalent of nearly half a liter. Pain was also decreased, from an
average score of 67 to 18 on a 100-point scale. Patients had improved walking ability, less pain
when walking, and improved ability to perform daily activities. The authors believe that including
exercise in the treatment program was a key factor in improving walking ability.
Dr. Bakar is also a co-author of the other paper, which reports on the use of CDP in a woman with
lymphedema related to the chronic skin condition psoriasis. In patients with lymphedema, obstruction
of the lymph nodes causes similar symptoms of leg pain and swelling. In both the short and long term,
CDP brought significant improvement in pain, swelling, and activity.
In recent years, CDP has become an accepted approach to treatment for lymphedema. Although not
a cure, CDP incorporates several physical therapy techniques that can help keep fluid buildup, leg
swelling, and pain under control.
The new studies are the first to evaluate the fully integrated CDP approach—including daily home
maintenance therapy—in patients with CVI and psoriasis-related lymphedema. "CDP is a time-
consuming process for patients and physiotherapists," Dr. Bakar and colleagues write. "However, it
is widely used and an effective treatment for patients with lymphedema." The new results suggest that
this combination physical therapy approach could also be very helpful for patients with leg pain and
swelling caused by CVI.
June 26, 2010 - This is Now Considered a Critical Piece of Cancer Treatment…-
The research of Dr. Kathryn Schmitz, which had already research reversed decades of cautionary
exercise advice given to breast cancer patients with lymphedema, led an expert panel to developed
the new recommendations.
According to Eurekalert:
"Cancer patients and survivors should strive to get the same 150 minutes per week of moderate-
intensity aerobic exercise that is recommended for the general public ... Though the evidence
indicates that most types of physical activity -- from swimming to yoga to strength training -- are
beneficial for cancer patients, clinicians should tailor exercise recommendations to individual patients".
Sources: Science Daily June 1, 2010
Dr. Mercola's Comments:
As little as a decade ago, it was common for physicians to advise their heart attack patients to avoid
exercise for fear that they could stress out their heart and trigger a second attack.
Now, it's common knowledge that exercise is a phenomenal way to strengthen your heart after a
heart attack as well as lessen your risk of further problems, and regular exercise is routinely
recommended to heart patients.
For cancer patients, this trend is still in the beginning stages, with many practitioners advising their
patients to avoid exercise during and after cancer treatment. But increasing evidence is showing that
this outdated advice is actually causing cancer patients harm, as regular exercise can lead to a
number of health improvements for cancer patients, including:
· Better aerobic fitness
· Increased muscular strength
· Improved quality of life
· Less fatigue
Exercise Improves Cancer Survival
I've written a lot about how exercise can help to reduce your risk of cancer in the first place, but
does it do any good if you're already fighting cancer? Yes … a lot.
Harvard Medical School researchers found patients who exercise moderately -- 3-5 hours a week
-- reduce their odds of dying from breast cancer by about half as compared to sedentary women. In
fact, any amount of weekly exercise increased a patient's odds of surviving breast cancer. This
benefit also remained constant regardless of whether women were diagnosed early on or after their
cancer had spread.
Patients receiving the biggest boost from exercise were those most sensitive to estrogen, the most
common form of breast cancer. (Previous research has shown exercise lowers estrogen levels, which
can fuel the growth of breast cancer cells.)
Think about it. If just three to five hours of walking per week can so drastically improve your
chances of surviving a hormone-responsive breast cancer tumor, imagine what a few more hours a
week of exercise could do for you.
If you're male, be aware that athletes have lower levels of circulating testosterone than non-athletes,
and similar to the association between estrogen levels and breast cancer in women, testosterone is
known to influence the development of prostate cancer in men.
Physical activity can reduce your risk and boost your chances of recovery if you have cancer.
Exercise is a Potent Cancer Fighter
Cancer thrives on sugar, but regular exercise reduces your insulin levels, which creates a low sugar
environment that discourages the growth and spread of cancer cells. Controlling your insulin levels is
one of the most powerful steps you can take to reduce your cancer risk and help keep it from
returning.
Physically active adults experience about half the incidence of colon cancer as their sedentary
counterparts. Exercise has a beneficial influence on insulin, prostaglandins and bile acids, all of which
are thought to encourage the growth and spread of cancer cells in your colon. Exercise also improves
bowel transit time, which means your body's waste is spending less time in contact with the mucosal
lining of your colon.
Exercise also improves the circulation of immune cells in your blood. The job of these cells is to
neutralize pathogens throughout your body.
The better these cells circulate, the more efficient your immune system is at locating and defending
against viruses and diseases, including cancer, trying to attack your body.
It's also been suggested that apoptosis (programmed cell death) is triggered by exercise, causing
cancer cells to die. So you can see why a regular exercise program is important not only during any
treatment you're receiving but also afterward as well.
Exercise Tips for Cancer Patients
I would also strongly recommend that you read the lead article in today's newsletter that reviews
some of the newest insights on how to optimize your exercise program and actually reduce your
exercise time and improve your benefits.
You will need to tailor your exercise routine to your individual scenario, taking into account your
stamina and current health. Often, you will be able to take part in a regular exercise program -- one
that involves a variety of exercises like strength training, core-building, stretching, aerobic and
anaerobic -- with very little changes necessary.
However, you may find that you need to exercise at a lower intensity or for shorter durations at
times. Always listen to your body and if you feel you need a break, take time to rest. Even exercising
for a few minutes a day is better than not exercising at all, and you'll likely find that your stamina
increases and you're able to complete more challenging workouts with each passing day.
In the event you are suffering from a very weakened immune system, you may want to exercise in
your home instead of visiting a public gym. But remember that exercise will ultimately help to boost
your immune system, so it's very important to continue with your program.
June 28, 2010 - HFM offers programming for cancer patients - Lakeshore health briefs -
MANITOWOC — The Holy Family Memorial Wellness Center is offering individual programming
for cancer patients.
Among the benefits: reduced pain and fatigue associated with cancer and treatments; prevention,
identification and management of lymphedema; increased treatment tolerance; and return to pre-
treatment levels of strength and fitness.
Wellness Center coordinator Melissa Sperbeck, recently certified as a cancer exercise specialist, will
meet with patients for a free consultation and discuss individual programming unique to each client
and illness. Funding for program participation is available through the Carol Rose Wester Fund.
For information, or to schedule a free consultation, call Sperbeck at (920) 320-4620.
Personal yoga instruction offered
MANITOWOC — The Holy Family Memorial Wellness Center is offering personal yoga instruction.
Wellness Center yoga instructor Corinne Knab has more than 30 years of yoga experience, and will
be studying this summer to earn certification as a yoga therapist.
Each session will begin with an assessment of how the individual is feeling, both physically and
emotionally. Based on the assessment, Knab will determine which breathing practices, poses and
meditation techniques to lead the participant through.
For information, call (920) 320-4600.
HFM Laboratory receives reaccreditation
MANITOWOC — Holy Family Memorial Laboratory has been awarded reaccreditation by the
Accreditation Committee of the College of American Pathologists (CAP), based on the results of a
recent onsite inspection. The reaccreditation includes the laboratories at Holy Family Memorial
Medical Center, Woodland Clinic and Harbor Town Campus.
The CAP Laboratory Accreditation Program, started in the early 1960s, is recognized by the federal
government as being equal to, or more strict than the government's own inspection program, an
HFM news release said.
During the CAP accreditation process, inspectors examine the laboratory's records and quality of
procedures for the previous two years. Inspectors also examine laboratory staff qualifications, as well
as the laboratory's equipment, facilities, safety program and record, in addition to the overall
management of the lab.
HFM offers free classes, screenings
MANITOWOC — Holy Family Memorial's Health Resource Center, 2300 Western Ave., offers
the following:
A free, one-hour class on the basics of how to search the Internet for health information is open to
the public on a one-on-one basis by appointment between 8 a.m. to 4 p.m. Monday through Friday.
To make an appointment, call (920) 320-2519.
A variety of health related books, videos and DVDs , a computer with Internet access,
knowledgeable staff and information on HFM physicians, programs and services is available to the
public during the above hours.
Free blood pressure screenings will be offered from 1 to 3 p.m. July 6 and 20 and from 9 to 11 a.m.
July 8 and 22. Walk-ins are welcome.
A cholesterol and blood sugar screening will be offered from 6:30 to 10 a.m. July 15. To schedule an
appointment, call (920) 320-6777.
June 28th, 2010 - More exercise prescribed for cancer survivors, even before they finish therapy –
WASHINGTON - New guidelines urge cancer survivors to exercise more, even, difficult as it may
sound, those who have not yet finished their treatment.
There Is growing evidence that physical activity improves quality of life and eases some cancer-
related fatigue. More, it can help fend off a serious decline in physical function that can last long after
therapy is finished.
Consider: In one year, women who needed chemotherapy for their breast cancer can see a swapping
of muscle for fat that is equivalent to 10 years of normal aging, says Dr. Wendy Demark-Wahnefried
of the University of Alabama at Birmingham.
In other words, a 45-year-old may find herself with the fatter, weaker body type of a 55-year-old.
Scientists have long advised that being overweight and sedentary increases the risk for various
cancers. Among the nearly 12 million U.S. cancer survivors, there are hints — although not yet proof
— that people who are more active may lower risk of a recurrence. Like everyone who ages, the
longer cancer survivors live, the higher their risk for heart disease that exercise definitely fights.
The American College of Sports Medicine convened a panel of cancer and exercise specialists to
evaluate the evidence. Guidelines issued this month advise cancer survivors to aim for the same
amount of exercise as recommended for the average person: about 2½ hours a week.
Patients still in treatment may not feel up to that much, the guidelines acknowledge, but should avoid
inactivity on their good days.
"You don't have to be Lance Armstrong," stresses Dr. Julia Rowland of the National Cancer
Institute, speaking from a survivorship meeting this month that highlighted exercise research. "Walk
the dog, play a little golf."
But how much exercise is needed? And what kind? Innovative new studies are under way to start
answering those questions, including:
—Oregon Health and Science University is training prostate cancer survivors to exercise with their
wives. The study will enrol 66 couples, comparing those given twice-a-week muscle-strengthening
exercises with pairs who do not get active.
Researchers think exercising together may help both partners stick with it. They also are testing
whether the shared activity improves both physical functioning and eases the strain that cancer puts
on the caregiver and the marriage.
"It has the potential to have not just physical benefits but emotional benefits, too," says lead
researcher Dr. Kerri Winters-Stone.
—Demark-Wahnefried led a recent study of 641 overweight breast cancer survivors that found at-
home exercises with some muscle-strengthening, plus a better diet, could slow physical decline.
—Duke University is recruiting 160 lung cancer patients to test whether three-times-a-week aerobic
exercise, strength training or both could improve their fitness after surgery. Lung cancer has long
been thought beyond the reach of exercise benefits because it so often is diagnosed at late stages.
Duke's Dr. Lee Jones notes that thousands who are caught in time to remove the lung tumour do
survive about five years, and he suspects that fitness, measured by how well their bodies use oxygen,
plays a role.
People with cancer usually get less active as symptoms or treatments make them feel lousy. Plus,
certain therapies can weaken muscles, bones, even the heart. Not that long ago, doctors advised
taking it easy.
Not anymore: Be as active as you are able, says Dr. Kathryn Schmitz of the University of
Pennsylvania, lead author of the new guidelines. "Absolutely it's as simple as getting up off the couch
and walking," she says.
Exercise programs are beginning to target cancer survivors, like Livestrong at the YMCA, a
partnership with cycling great and cancer survivor Armstrong's foundation. The American College of
Sports Medicine now certifies fitness trainers who specialize in cancer survivors.
Still, anyone starting more vigorous activity for the first time or who has particular risks, like the
painful arm swelling called lymphedema that some breast cancer survivors experience, may need
more specialized exercise advice, Schmitz says. They should discuss physical therapy with their
oncologist, she advises. For example, Schmitz led a major study that found careful weight training
can protect against lymphedema, reversing years of advice to coddle the at-risk arm. But the
average fitness trainer does not know how to offer that special training safely, she cautions.
Mary Lou Galantino of Wilmington, Delaware, is a physical therapist who specializes in cancer care
and kept exercising when her own breast cancer was diagnosed at the University of Pennsylvania in
2003. Then 42, she says she was on the treadmill within 24 hours of each chemo session, to stay fit
enough to care for her two preschoolers. "You can feel more energy" with the right exercise, says
Galantino, a physical therapy professor at the Richard Stockton College of New Jersey. "I was
giving my body up to the surgeons and chemo, but I could take my body back through yoga and
aerobic exercise."
June 29, 2010 - Recurrent furunculosis as a cause of isolated penile lymphedema: a case report - Ali
AlshahamSuneet Sood -
IntroductionIsolated lymphedema of the penis is extremely rare: combined involvement of the
scrotum and penis is the norm. Furunculosis as a cause is not, to our knowledge, previously reported.
We present a case of isolated penile lymphedema that responded to excision of lymphedematous
tissue and reconstruction with flaps.Case presentationA 32-year-old Arab man presented with a
three-year history of a gradually increasing, painless penile swelling. Our patient's main complaint was
non-erectile sexual dysfunction.
The swelling was preceded by at least three prior episodes of severe furunculosis at the penile root.
He had no other contributory past medical or family history.
On examination there was gross penile enlargement, maximally at the mid shaft, associated with
thickened skin at the sites of prior furunculosis. The glans and scrotum were normal.
Both testes were palpable. Serology for filariasis, and urinary tract ultrasound and computed
tomography scan were normal.
The clinical diagnosis was lymphedema following recurrent penile furunculosis. At operation the
lymphedematous tissues were removed.
Closure of the penile shaft was accomplished by bilateral advancement of flaps from both ends of the
penis. He resumed normal sexual activity one month after surgery.
At 12 months, he had a good cosmetic result, with no signs of recurrence.
Conclusions: Furunculosis at the penile root may result in lymphedema confined to the penile shaft,
sparing the scrotum. Excision of abnormal tissue and cover with a skin flap gave excellent cosmetic
results, and allowed satisfactory sexual activity.
June 29, 2010 - What's the Big Idea? Inaugural Conference Aims to Find out - By Joan Delaney -
Just as the G8 and G20 summits have wound up in Ontario, a conference of a very different kind is
being planned on the other side of the country in Victoria.
Called IdeaWave, the aim of conference is to bring innovative thinkers together to brainstorm a wide
range of issues, from sewage treatment and drug prohibition to health and public transit.
The two-day conference will feature 50 short talks on any topic the speaker desires, giving critical
thinkers from the Pacific Northwest a forum to explore issues that affect both their immediate region
and further afield.
“There’s a lot of critical thinkers out there who are meeting regularly, talking about ideas informally,
and so I just thought, ‘What would it take to get all of those people together in a room?’ To me,
having 200 critical thinkers in a room is quite exciting,” says event organizer Kris Constable.
Constable believes his conference is the first ever to keep the talks to 10 minutes with no limit on the
subject matter. Established ideas conferences that take place annually in Vancouver and California
cost between $3,000 and $7,000 to participate, he adds.
“I, like most North Americans, can’t afford to attend such a thing. So this is kind of my answer to
that. I'm going to make this the first approachable ideas conference ever. We've got both speakers
and attendees coming from Washington State and all over B.C.”
Limiting the talks to 10 minutes keeps them from becoming boring and “cuts right to the meat” of the
topic, he says.
“It separates the wheat from the chaff essentially. You've got 10 minutes to make sure that you’ve
clearly articulated your idea in the best way that you can. With 10 minutes you're concentrating your
talk to be as effective as possible.”
Frank Heidt, a chief executive officer with a company in Seattle, will talk about expanding on the
idea of transforming abandoned shipping containers into housing. There are about three million
unused shipping containers in the Pacific Rim because it’s cheaper for companies to leave them there
than return them to their country of origin empty or partially filled, according to Heidt.
His talk will be about using these shipping containers as lending libraries of hand tools, enabling
people in developing countries to “build their own future.”
Margaret Pulton, a nurse from B.C., will explore using technology to create clothing as a treatment
for Lymphedema, while Clem Persaud, a professor of biotechnology, will devote his 10 minutes to
how we can positively impact our lives by influencing the expression of our genes.
As well as airing their ideas, there will also be a chance for both speakers and attendees to mingle
and network.
“If your idea’s good enough that other people are excited, they're going to go ahead and talk to you
and hopefully get a few people helping you make your idea happen,” says Constable.
“These are the people who are kind of the thinkers and the doers in one.”
Being still a few shy of the required 50 speakers, Constable is looking for more people to submit
their proposals. The conference will take place July 10 and 11 at the Ambrosia Centre in downtown
Victoria.
June 29, 2010 - Community-based education strengthens campaign for elimination of lymphatic
filariasis - Joseph Quimby
Community-based lymphatic filariasis education in Orissa State, India, increased treatment
compliance from around 50% to up to 90%, according to a study published June 29 in the open-
access journal PLoS Neglected Tropical Diseases. In their study, researchers from the U.S. Centers
for Disease Control and Prevention, in partnership with the Church's Auxiliary for Social Action, an
India-based non-governmental organization, and IMA World Health, a US-based non-governmental
organization, identified barriers to compliance with India's MDA program for LF, and suggest that
timely educational and lymphedema management programs can reverse this trend.
Nearly 1.3 billion people worldwide live at risk of infection with the parasite that causes lymphatic
filariasis. Infected individuals may develop long-term complications, such as grossly swollen limbs
from lymphedema. Elimination of this disease of poverty requires giving drugs at least once per year
to people who are at risk; of that population, 80% or more need to continue receiving medication on
an annual basis for 5 or more years to stop transmission.
The authors evaluated a community-based education campaign, noted deficiencies, and designed
interventions to correct them. An evaluation of the revised education program, covering over 8,000
people in ninety villages, showed markedly improved drug compliance and, for the first time, showed
that lymphedema management programs, which teach leg care to patients with swollen legs, may also
increase compliance with lymphatic filariasis mass drug administration programs. The increase was
greatest in areas that had implemented U.S. Agency for International Development-supported
programs to teach people how to care for legs swollen from infection.
This evaluation was confined to rural areas in Orissa State, so the findings do not necessarily apply to
urban areas or areas outside the state. Nonetheless, lymphatic filariasis elimination programs facing
difficulties in achieving the necessary level of drug compliance should consider evaluating their
education campaigns using similar methods and integrating lymphedema management with lymphatic
filariasis elimination efforts, the authors say.
FINANCIAL DISCLOSURE: Funding for this work was provided by USAID (GHA-G-00-03-
0005-00) to IMA World Health and by CDC (IAA GHH99-006). The funders had no role in study
design, data collection and analysis, decision to publish, or preparation of the manucript.
COMPETING INTERESTS: The authors have declared that no competing interests exist
PLEASE ADD THIS LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF
YOUR REPORT: http://dx.plos.org/10.1371/journal.pntd.0000728
CITATION: Cantey PT, Rout J, Rao G, Williamson J, Fox LM (2010) Increasing Compliance with
Mass Drug Administration Programs for Lymphatic Filariasis in India through Education and
Lymphedema Management Programs. PLoS Negl Trop Dis 4(6): e728. doi:10.1371/journal.pntd.
0000728
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June 29, 2010 - Lymphedema treatment options -
Chronic lymphedema often turns into cellulitis in patients with diabetes. What is the preferred
treatment?—PAULA JAUERING, ARNP, Leavenworth, Kan.
The diagnosis of lymphedema is usually made based on clinical presentation and history. Imaging
studies may also be used for diagnosis and evaluation of treatment; lymphoscintigraphy is considered
the gold standard. Duplex ultrasound, CT, and MRI may also be used. Conservative physiotherapy
treatments include complex or complete decongestive therapy (which incorporates manual lymphatic
drainage, compression bandages, myolymphokinetic exercises, skin care, and precautions during
daily activities) and pneumatic compression, also referred to as pressure therapy. Pneumatic
compression utilizes a segmental air pump to fill air chambers (gloves or boots) that provide pressure
to the edematous limb. Newer techniques include high-voltage electrical stimulation (which reduces
lymphedema by producing muscle contractions and relaxation that increase venous and lymphatic
flow) and laser therapy (which reduces fibosis and stimulates lymphangiogenesis, lymph activity,
lymphatic movement, macrophages, and the immune system). Surgical therapies for patients in whom
conservative therapy was not effective may include resection procedures, microsurgical interventions,
and liposuction.
For more information, see Rev Lat Am Enfermagem. 2009;17:730-736 and Ann Plast Surg. 2007;
59:464-472.—Philip R. Cohen, MD
June 30, 2010 - People and Places: Carroll Hospital foundation disperses funds to nonprofits -
The Carroll Hospital Center Foundation released more than $2.5 million to support programs and
services at Carroll Hospital Center and Carroll Hospice.
Jack Tevis, chairman of the Foundation’s Board of Trustees, presented checks to Mark Blacksten,
chairman of Carroll Hospice’s Board of Directors, and John Sernulka, FACHE, president and CEO
of Carroll Hospital Center.
The donation represents proceeds accumulated from the foundation’s various fundraising efforts for
the hospital and Carroll Hospice throughout the year. The funds will be used to support a variety of
capital programs including adding a new cardiovascular lab, renovating the emergency department’s
triage area as well as the waiting room in The Family Birthplace and creating a dedicated orthopaedic
unit on the third floor of the hospital.
In addition, the gifts will enhance many programs provided by the hospital including the navigation
and lymphedema services at The Women’s Place and Breast Center. It also will provide educational
support to staff such as those offered through the Libman Nursing Scholarship and the College
Scholarship for Dependants of Associates.
People and Places and New Business briefs offer information about Carroll County-based
companies, employees and their operations, and news of awards, promotions, new business
openings, new hires, etc. To have your information included, send your typed, double-spaced press
release to Business Briefs, Carroll County Times, P.O. Box 346, Westminster, MD 21158..
Information must reach this office within four weeks after an event.
Pub Med doc 1 (3):
Am J Med. 2010 Jun;123(6):489-95.
Caring for the breast cancer survivor: a guide for primary care physicians.
Chalasani P, Downey L, Stopeck AT.
Arizona Cancer Center, University of Arizona, Tucson, AZ 85724-5024, USA. pchalasani@azcc.
arizona.edu
Abstract
Breast cancer accounts for more than 25% of cancers in women. Because of improved screening
and treatment modalities, mortality has decreased significantly. Currently, over 2.5 million breast
cancer survivors live in the US and receive care from a primary care provider. Providers need to be
aware of common and serious complications of breast cancer treatment. In this review we discuss
complications of local and systemic treatment for breast cancer, including lymphedema, osteoporosis,
cardiovascular disease, and vasomotor symptoms. Current strategies for screening, monitoring, and
treating these complications also are outlined. Copyright 2010. Published by Elsevier Inc.
PMID: 20569749 [PubMed - in process]
Cancer. 2010 Apr 29. [Epub ahead of print]
A prospective cohort study defining utilities using time trade-offs and the Euroqol-5D to assess the
impact of cancer-related lymphedema.
Cheville AL, Almoza M, Courmier JN, Basford JR.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND:: The devastating impact of lymphedema on cancer survivors' quality of life has
prompted consideration of several changes in medical and surgical care. Unfortunately, our
understanding of the benefits gained from these approaches relative to their cost remains limited. This
study was designed to estimate utilities for lymphedema and characterize how utilities differ between
subgroups defined by lymphedema etiology and distribution.
METHODS:: A consecutive sample of 236 subjects with lymphedema seen at a lymphedema clinic
completed both a time trade-off (TTO) exercise and the Euroqol 5D. Responses were adjusted in
multivariate regression models for demographic factors, comorbidities, and lymphedema
severity/location.
RESULTS:: Most participants (167 of 236, 71%) had lymphedema as a consequence of cancer
treatment; 123 with breast cancer and upper extremity involvement. Mean TTO utility estimates were
consistently higher than Euroqol 5D estimates. Unadjusted TTO (0.85; standard deviation [SD],
0.21) and Euroqol 5D (0.76; SD, 0.18) scores diminished with increasing lymphedema stage and
patient body mass index (BMI). Adjusted utility scores were lowest in patients with cancer-related
lower extremity lymphedema (TTO = 0.82; SD, 0.04 and Euroqol 5D = 0.80; SD, 0.03). Breast
cancer patients also had lower adjusted Euroqol 5D scores (0.80; SD, 0.02).
CONCLUSIONS:: Lymphedema-associated utilities are in the range of 0.80. Lower utilities are
observed for patients with higher lymphedema stages, elevated BMI, and cancer-related
lymphedema. Greater expenditures for the prevention and treatment of cancer-related lymphedema
are warranted. Cancer, 2010. (c) 2010 American Cancer Society.
PMID: 20564063 [PubMed - as supplied by publisher]
Breast. 2010 Jun 17. [Epub ahead of print]
Self-reported arm-lymphedema and functional impairment after breast cancer treatment - A
nationwide study of prevalence and associated factors.
Gärtner R, Jensen MB, Kronborg L, Ewertz M, Kehlet H, Kroman N.
Department of Breast Surgery, Rigshospitalet 3103, Copenhagen University, 2100 Copenhagen,
Denmark.
Abstract
Lymphedema and impairment of function are well-established sequelae to breast cancer treatment
and affect an increasing number of women due to continually improved survival. The aim of the
present nationwide questionnaire study was to examine the impact of breast cancer treatment on
perceived swelling/sensation of heaviness (lymphedema) and on function, reporting prevalence in 12
subgroups of modern treatment and offering estimates for treatment-related associated factors. 3253
Women (87%) returned the study questionnaire. Depending on treatment group prevalence of
perceived swelling/heaviness varied from 13 to 65%. Associated factors were young age, axillary
lymph node dissection (ALND) and radiotherapy but not type of breast surgery or use of
chemotherapy. Depending on treatment group 11-44% had to give up activities. Giving up activities
was associated with pain and swelling/heaviness, younger age, ALND, chemotherapy, time elapsed
since surgery, and surgery on the dominant side. Radiotherapy and type of breast surgery were of no
importance. Copyright © 2010 Elsevier Ltd. All rights reserved.
PMID: 20561790 [PubMed - as supplied by publisher]
PUB MED DOC 2 (2)
Br J Community Nurs. 2010 Apr;15(4):S18-24.
Manual lymphatic drainage: exploring the history and evidence base.
Williams A.
Edinburgh Napier University. A.Williams@napier.ac.uk
Abstract
Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but there is limited
evidence to guide clinical practice. This paper outlines the historical background to MLD and
provides insights into the evidence relating to the effect and efficacy of manual lymph drainage,
highlighting considerations for lymphoedema practitioners.
PMID: 20559172 [PubMed - in process]
Jpn J Clin Oncol. 2010 Jun 17. [Epub ahead of print]
Evaluation of the Clinical Effectiveness of Physiotherapeutic Management of Lymphoedema in
Palliative Care Patients.
Clemens KE, Jaspers B, Klaschik E, Nieland P.
1Department of Science and Research, Centre for Palliative Medicine, University of Bonn.
Abstract
OBJECTIVE: Lymphoedema is a common sequela of cancer or its treatment that affects lymph node
drainage. The physiotherapist, as member of the multiprofessional team in palliative care, is one of the
keys to successful rehabilitation and management of patients with cancer and non-malignant
motoneuron disease such as amyotrophic lateral sclerosis and palliative care needs. The aim of the
study was to evaluate the frequency and effect of manual lymphatic drainage in palliative care patients
with lymphoedema in a far advanced stage of their disease.
METHODS: Retrospective study (reflexive control design) of data of the 208 patients admitted to
our palliative care unit from January 2007 to December 2007. Demographic and disease-related
data (diagnosis, symptoms, Karnofsky performance status and effect of manual lymphatic drainage
interventions) were documented and compared. Statistics: mean +/- SD, median; Wilcoxon's test.
RESULTS: Of the 208 patients, 90 who reported symptom load due to lymphoedema were
included; 67 (74.4%) had pain, 23 (25.6%) dyspnoea due to progredient trunk oedema. Mean age
65.5 +/- 13.0 years; 33 (36.7%) male; Karnofsky index 50% (30-80%), mean length of stay 15.6
+/- 8.0 days. The mean number of physiotherapeutic treatment interventions was 7.0 +/- 5.8.
Manual lymphatic drainage was well tolerated in 83 (92.2%) patients; 63 of 67 (94.0%) patients
showed a clinically relevant improvement in pain, and 17 of 23 (73.9%) in dyspnoea.
CONCLUSIONS: The majority of the patients showed a clinical improvement in the intensity of
symptoms after manual lymphatic drainage.
PMID: 20558463 [PubMed - as supplied by publisher]
Pub med doc 3 (1)
Ann Surg Oncol. 2010 Jun 24. [Epub ahead of print]
Morbidity of Sentinel Node Biopsy in Breast Cancer: The Relationship Between the Number of
Excised Lymph Nodes and Lymphedema.
Goldberg JI, Wiechmann LI, Riedel ER, Morrow M, Van Zee KJ.
Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY,
USA.
Abstract
BACKGROUND: Despite the reduced morbidity associated with sentinel lymph node biopsy
(SLNB), lymphedema remains a clinically relevant complication. We hypothesized that a higher
number of lymph nodes (LNs) removed during SLNB is associated with a higher risk of lymphedema.
METHODS: Six hundred patients with clinically node-negative breast cancer who underwent SLNB
were prospectively studied. Circumferential bilateral upper extremity measurements were performed
preoperatively and at 3-8 years after surgery. Association of lymphedema with total number of LNs
excised and other clinicopathologic variables was analyzed by the Spearman rank correlation
coefficient, Fisher's exact test, Wilcoxon rank sum test, and logistic regression.
RESULTS: At a median follow-up of 5 years, 5% of patients had developed lymphedema. Factors
associated with lymphedema included weight and body mass index. There was no association
between the number of LNs removed and the change in upper extremity measurements or in the
incidence of lymphedema. Among patients with lymphedema (n = 31) compared to those without,
the mean (3.9 vs. 4.2), median (4 vs. 3), and range (1-9 vs. 1-17) of number of LNs removed were
similar (P = 0.93). Among the 33 women with >/=10 LNs removed, none developed lymphedema.
CONCLUSIONS: In this population of 600 women who underwent SLNB, there is no correlation
between number of LNs removed and change in upper extremity circumference or incidence of
lymphedema. These data suggest that other factors, such as the global disruption of the lymphatic
channels during axillary lymph node dissection, play a larger role in development of lymphedema than
does the number of LNs removed.
PMID: 20574774 [PubMed - as supplied by publisher]
PUB MED DOC 4 (11)
Br J Community Nurs. 2010 Apr;15(4):S28-30.
Massage: a helping hand for people with chronic oedema and lymphoedema.
Pyke C.
British Lymphology Society. Cheryl.Pyke@abm-tr.wales.nhs.uk
Abstract
Skin care is fundamental in maintaining the integrity of one's skin and it has become modern practice
to wash and dry ourselves on a daily basis to eliminate odour and rejuvenate the skin. What is
becoming more apparent is that as health professionals we are not transferring this basic act to our
patient's care and this simple form of neglect can be detrimental to your patient's recovery.
Moreover, when washing with the soapy products that are available to us, and then drying ourselves
rigorously, we remove our skin's natural oils thus the skin appears drier and is more susceptible to
damage. This is where the simple application of a moisturising agent will not only replace the lost oils,
but it will in fact stimulate the initial lymphatics lying under your skin. The action of rubbing a cream or
emollient into the skin is a form of massage, and this simple action will go a very long way towards
the recovery of skin integrity and in the prevention of harm and infection. Make this part of your
practice when looking after your patient's wounds and swollen limbs.
PMID: 20559174 [PubMed - in process]
Br J Community Nurs. 2010 Apr;15(4):S18-24.
Manual lymphatic drainage: exploring the history and evidence base.
Williams A.
Edinburgh Napier University. A.Williams@napier.ac.uk
Abstract
Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but there is limited
evidence to guide clinical practice. This paper outlines the historical background to MLD and
provides insights into the evidence relating to the effect and efficacy of manual lymph drainage,
highlighting considerations for lymphoedema practitioners.
PMID: 20559172 [PubMed - in process]
Br J Community Nurs. 2010 Apr;15(4):S10-6.
Lipoedema: presentation and management.
Todd M.
Specialist Lymphoedema Service, Greater Glasgow & Clyde NHS Trust. marie.todd@ggc.scot.nhs.
uk
Abstract
Lipoedema is a distinct clinical condition characterized by bilateral, symmetrical enlargement of the
buttocks and lower limbs owing to excess deposition of subcutaneous fat. It is found almost
exclusively in women. The common features associated with this condition are 'column- shaped' legs
with sparing of the feet, bruising, sensitivity to pressure, and orthostatic oedema. The progression to
lipo-lymphoedema or morbid obesity is possible. Conservative measures used in the management of
lymphoedema can prevent progression/limit the orthostatic oedema. Surgical procedures may also
play a part in the management of lipoedema.
PMID: 20559170 [PubMed - in process]
Jpn J Clin Oncol. 2010 Jun 17. [Epub ahead of print]
Evaluation of the Clinical Effectiveness of Physiotherapeutic Management of Lymphoedema in
Palliative Care Patients.
Clemens KE, Jaspers B, Klaschik E, Nieland P.
1Department of Science and Research, Centre for Palliative Medicine, University of Bonn.
Abstract
OBJECTIVE: Lymphoedema is a common sequela of cancer or its treatment that affects lymph node
drainage. The physiotherapist, as member of the multiprofessional team in palliative care, is one of the
keys to successful rehabilitation and management of patients with cancer and non-malignant
motoneuron disease such as amyotrophic lateral sclerosis and palliative care needs. The aim of the
study was to evaluate the frequency and effect of manual lymphatic drainage in palliative care patients
with lymphoedema in a far advanced stage of their disease.
METHODS: Retrospective study (reflexive control design) of data of the 208 patients admitted to
our palliative care unit from January 2007 to December 2007. Demographic and disease-related
data (diagnosis, symptoms, Karnofsky performance status and effect of manual lymphatic drainage
interventions) were documented and compared. Statistics: mean +/- SD, median; Wilcoxon's test.
RESULTS: Of the 208 patients, 90 who reported symptom load due to lymphoedema were
included; 67 (74.4%) had pain, 23 (25.6%) dyspnoea due to progredient trunk oedema. Mean age
65.5 +/- 13.0 years; 33 (36.7%) male; Karnofsky index 50% (30-80%), mean length of stay 15.6
+/- 8.0 days. The mean number of physiotherapeutic treatment interventions was 7.0 +/- 5.8.
Manual lymphatic drainage was well tolerated in 83 (92.2%) patients; 63 of 67 (94.0%) patients
showed a clinically relevant improvement in pain, and 17 of 23 (73.9%) in dyspnoea.
CONCLUSIONS: The majority of the patients showed a clinical improvement in the intensity of
symptoms after manual lymphatic drainage.
PMID: 20558463 [PubMed - as supplied by publisher]
Cochrane Database Syst Rev. 2010 Jun 16;6:CD005211.
Exercise interventions for upper-limb dysfunction due to breast cancer treatment.
McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, Mackey J, Courneya K.
Department of Physical Therapy, University of Alberta, 2-50, Corbett Hall, Edmonton, Alberta,
Canada, T6G 2G4.
Abstract
BACKGROUND: Upper-limb dysfunction is a commonly reported side effect of treatment for
breast cancer and may include decreased shoulder range of motion (the range through which a joint
can be moved) (ROM) and strength, pain and lymphedema.
OBJECTIVES: To review randomized controlled trials (RCTs) evaluating the effectiveness of
exercise interventions in preventing, minimi sing, or improving upper-limb dysfunction due to breast
cancer treatment.
SEARCH STRATEGY: We searched the Specialised Register of the Cochrane Breast Cancer
Group, MEDLINE, EMBASE, CINAHL, and LILACS (to August 2008); contacted experts,
handsearched reference lists, conference proceedings, clinical practice guidelines and other
unpublished literature sources.
SELECTION CRITERIA: RCTs evaluating the effectiveness and safety of exercise for upper-limb
dysfunction.
DATA COLLECTION AND ANALYSIS: Two authors independently performed the data
abstraction. Investigators were contacted for missing data.
MAIN RESULTS: We included 24 studies involving 2132 participants. Ten of the 24 were
considered of adequate methodological quality.Ten studies examined the effect of early versus
delayed implementation of post-operative exercise. Implementing early exercise was more effective
than delayed exercise in the short term recovery of shoulder flexion ROM (Weighted Mean
Difference (WMD): 10.6 degrees; 95% Confidence Interval (CI): 4.51 to 16.6); however, early
exercise also resulted in a statistically significant increase in wound drainage volume (Standardized
Mean Difference (SMD) 0.31; 95% CI: 0.13 to 0.49) and duration (WMD: 1.15 days; 95% CI:
0.65 to 1.65).Fourteen studies examined the effect of structured exercise compared to usual
care/comparison. Of these, six were post-operative, three during adjuvant treatment and five
following cancer treatment. Structured exercise programs in the post-operative period significantly
improved shoulder flexion ROM in the short-term (WMD: 12.92 degrees; 95% CI: 0.69 to 25.16).
Physical therapy treatment yielded additional benefit for shoulder function post-intervention (SMD:
0.77; 95% CI: 0.33 to 1.21) and at six-month follow-up (SMD: 0.75; 95% CI: 0.32 to 1.19). There
was no evidence of increased risk of lymphedema from exercise at any time point.
AUTHORS' CONCLUSIONS: Exercise can result in a significant and clinically meaningful
improvement in shoulder ROM in women with breast cancer. In the post-operative period,
consideration should be given to early implementation of exercises, although this approach may need
to be carefully weighed against the potential for increases in wound drainage volume and duration.
High quality research studies that closely monitor exercise prescription factors (e.g. intensity), and
address persistent upper-limb dysfunction are needed.
PMID: 20556760 [PubMed - in process]
In Vivo. 2010 May-Jun;24(3):309-14.
Milroy's Primary Congenital Lymphedema in a Male Infant and Review of the Literature.
Kitsiou-Tzeli S, Vrettou C, Leze E, Makrythanasis P, Kanavakis E, Willems P.
"Choremeio" Research Laboratory of Medical Genetics, Children's Hospital "Aghia Sophia", Thivon
and Levadeias, 11527, Greece. skitsiou@med.uoa.gr.
Abstract
BACKGROUND: Milroy's primary congenital lymphedema is a non-syndromic primary
lymphedema caused mainly by autosomal dominant mutations in the FLT4 (VEGFR3) gene. Here,
we report on a 6-month-old boy with congenital non-syndromic bilateral lymphedema at both feet
and tibias, who underwent molecular investigation, consisted of PCR amplification and DHPLC
analysis of exons 17-26 of the FLT4 gene. The clinical diagnosis of Milroy disease was confirmed by
molecular analysis showing the c.3109G>C mutation in the FLT4 gene, inherited from the
asymptomatic father. This is a known missense mutation, which substitutes an aspartic acid into a
histidine on amino acid position 1037 of the resulting protein (p.D1037H), described in two other
families with Milroy disease. A thorough genetic molecular investigation and clinical evaluation
contributes to the provision of proper genetic counseling for parents of an affected child with Milroy
disease. The herein described case, which is the third reported so far with c.3109G>C mutation,
adds data on genotypic-phenotypic correlation of Milroy disease. The relative literature regarding the
pathophysiology, molecular basis, clinical spectrum and treatment of Milroy disease is reviewed.
PMID: 20555004 [PubMed - in process]
Lymphology. 2010 Mar;43(1):42-4.
Primary lymphedema and acute leukemia--is there a link?
Todd M, Welsh J, Drummond MW.
Specialist Lymphoedema Clinic, NHS Greater Glasgow and Clyde, Scotland, UK. Marie.todd@ggc.
scot.nhs.uk
Abstract
The lymphedema service in Glasgow has been treating patients with lymphedema of all causes since
1991. In the past five years 3 patients with primary lymphedema have been diagnosed with
myelodysplasia (leading to acute leukemia) or acute leukemia. These are relatively unusual
malignancies given the ages of the patients and all three of these patients died within an average of 12
months of diagnosis. A connection between the presence of primary lymphedema and the subsequent
development of the hematological disorder is postulated. Standard marrow cytogenetics failed to
identify a common abnormality but the authors feel that further study is warranted.
PMID: 20552819 [PubMed - in process]
Lymphology. 2010 Mar;43(1):25-33.
Comparing two treatment methods for post mastectomy lymphedema: complex decongestive therapy
alone and in combination with intermittent pneumatic compression.
Haghighat S, Lotfi-Tokaldany M, Yunesian M, Akbari ME, Nazemi F, Weiss J.
Breast Research Department, Iranian Center for Breast Cancer, Tehran, Iran. Sh_haghighat@yahoo.
com
Abstract
There is no cure for breast cancer related lymphedema. This study was conducted to compare two
treatment methods for postmastectomy lymphedema: Complex Decongestive Therapy (CDT) and
Modified CDT (MCDT) combined with Intermittent Pneumatic Compression (IPC). One hundred
and twelve patients referred to the Lymphedema Clinic of the Iranian Center for Breast Cancer in
2008, were included in a randomized clinical trial. They were randomly allocated into two equal
groups receiving daily CDT alone or in combination with IPC. The volume reduction of the upper
limb was measured by water displacement volumetry. No statistically significant differences in
demographic and clinical variables between the two groups were observed. During the intensive
phase (phase I) of treatment, CDT alone yielded a significantly higher mean volume reduction than
the combination modality (43.1% vs. 37.5%; p = 0.036). Limb volume measured three months
following treatment, showed 16.9% volume reduction by CDT alone, and 7.5% reduction by MCDT
plus IPC. This study demonstrated that the use of CDT alone, or in combination with IPC
significantly reduced limb volume in patients with post mastectomy lymphedema. CDT alone
provided better results in both treatment phases. Further studies will help to define the role of
multidisciplinary approaches in the management of postmastectomy lymphedema.
PMID: 20552817 [PubMed - in process]
Lymphology. 2010 Mar;43(1):19-24.
Cutaneous metastasis of pancreatic carcinoma as an initial symptom in the lower extremity with
obstructive lymphedema treated by physiotherapy and lymphaticovenous shunt: a case report,
review, and pathophysiological implications.
Shimizu H, Maegawa J, Ho T, Yamamoto Y, Mikami T, Nagahama K.
Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama,
Japan. shimizu-ykh@umin.ac.jp
Abstract
Cutaneous metastasis from pancreatic cancer is relatively rare as an initial symptom, and it is
generally localized on the periumbilical area that is known as Sister Mary Joseph's nodule. We report
a rare case of a 49-year-old female who developed cutaneous metastasis of pancreatic cancer as an
initial symptom. The patient was referred to our department for treatment of lymphedema due to
surgical treatment of cervical cancer and underwent combined physiotherapy and, 2 months later, a
lymph venous anastomosis (LVA) for treatment of the lymphedema. Two months after the operation,
she developed erythema on her right leg which spread from the leg to the groin in series. This pattern
corresponded to the direction of lymph drainage, which may have been enhanced by the
conservative physiotherapy and LVA treatments. These facts suggest a possible relationship between
cutaneous metastasis of carcinoma and treatment for lymphedema. Alternatively, the
lymphedematous limb may be a privileged site for cancer growth, and metastatic seeding could have
taken place from pre-existing hematogenous spread at the time of operation.
PMID: 20552816 [PubMed - in process]
Lymphology. 2010 Mar;43(1):14-8.
A novel missense mutation and two microrearrangements in the FOXC2 gene of three families with
lymphedema-distichiasis syndrome.
Fauret AL, Tuleja E, Jeunemaitre X, Vignes S.
Département de Génétique et Centre de Référence des Maladies Vasculaires Rares, AP-HP,
Hôpital Européen Georges Pompidou Paris, France.
Abstract
Lymphedema-distichiasis (LD) syndrome is a rare autosomal dominant disorder of the FOXC2
gene, which codes for a forkhead transcription factor. Most of the mutations described in this gene to
date are deletions or insertions, suggesting a mechanism of haploinsufficiency. We studied three
independent families with LD presenting with both lymphedema and distichiasis. Two
microrearrangements (one 8-bp deletion and one 7-bp duplication) occurring in a GC-rich genomic
region (c.893-930) known to be prone to mutations were identified. A new missense mutation (p.
Lys132Glu) located in a highly conserved sequence, the forkhead domain, was also identified.
Mutations in this domain have been previously shown to impair FOXC2 transactivation ability. At a
genetic level, this study confirms the heterogeneity of mutations responsible for LD and is consistent
with a mechanism of haploinsufficiency. At a clinical level, it reinforces the importance of genetic
testing in subjects with familial lymphedema or distichiasis, since measures can be taken at an early
stage to prevent complications and to reduce the progression of lymphedema or delay its occurrence.
PMID: 20552815 [PubMed - in process]
Lymphology. 2010 Mar;43(1):1-13.
Impact of lymphedema and arm symptoms on quality of life in breast cancer survivors.
Hormes JM, Bryan C, Lytle LA, Gross CR, Ahmed RL, Troxel AB, Schmitz KH.
Department of Psychology, University of Pennsylvania , Philadelphia, Pennsylvania 19104-6021,
USA.
Abstract
Lymphedema is one of many arm problems reported by breast cancer survivors. Understanding the
impact of lymphedema on quality of life requires consideration that arm symptoms may occur with or
without lymphedema. It was hypothesized that specific arm symptoms and pain, related or unrelated
to lymphedema, would be more associated with quality of life outcomes than arm swelling. The
relation of arm swelling and of arm symptoms and associated severity with a range of quality of life
outcomes following breast cancer treatment was assessed in a diverse sample of 295 women, 141 of
whom had a clinical diagnosis of lymphedema. Arm swelling (as defined by interlimb volume or
circumference differences) and lymphedema severity (defined by Common Toxicity Criteria) were
less correlated with quality of life than total number of arm symptoms and specific individual
symptoms. Pain in the affected arm correlated with poor quality of life outcomes, regardless of arm
swelling. When evaluating the impact of lymphedema on quality of life, arm swelling may not be as
important as the total number and specific types of arm symptoms present, as these may be more
informative about quality of life outcomes in survivors of breast cancer with and without lymphedema.
PMID: 20552814 [PubMed - in process]
This one I don’t know where it goes, but you said “goes in news for July O/T and you never
answered me when I question it, so Im putting it here though it was sent to the group by Robert
Weiss but it isn’t about Medicare:
July 10, 2010 (1 doc)
FDA Warns of Risks With Unapproved Use of Quinine Sulfate
ROCKVILLE, Md -- July 8, 2010 -- The US Food and Drug Administration (FDA) today warned
that the unapproved use of the malaria drug quinine sulfate (Qualaquin) to treat night time leg cramps
has resulted in serious side effects and prompted the manufacturer to develop a risk management
plan aimed at educating healthcare professionals and patients about the potential risks.
Quinine is not FDA-approved to treat or prevent night time leg cramps.
A review of reports submitted to the FDA's Adverse Event Reporting System (AERS) between
April 2005 and October 1, 2008, found 38 US cases of serious side effects associated with the use
of quinine.
Quinine use resulted in serious and life-threatening reactions in 24 cases, including thrombocytopenia
and hemolytic uremic syndrome/thrombotic thrombocytopenic purpura.
In some patients, these side effects resulted in permanent kidney impairment and hospitalisation. Two
patients died. Most of those reporting serious side effects took the drug to prevent or treat leg
cramps or restless leg syndrome.
The risk management plan, called a Risk Evaluation and Mitigation Strategy (REMS), requires that
patients be given a Medication Guide explaining what quinine is and is not approved for, as well as
the potential side effects of the drug. The company is also required to issue a Dear Health Care
Provider Letter warning of the potential risk of serious and life-threatening haematologic reactions.
SOURCE: US Food and Drug Administration
Godoy & Godoy technique in the treatment of lymphedema for under-privileged populations.
de Godoy JM, de Godoy Mde F.
Stricto-Sensu and Lato-Sensu of Course in Medicine of Medical School in São José do Rio Preto-
SP (FAMERP), Brazil. godoyjmp@riopreto.com.br
Abstract
The aim of this paper is to report new options in the treatment of lymphedema for under-privileged
populations. Several articles and books have been published reporting recent advances and
contributions. A new technique of manual lymph drainage, mechanisms of compression, development
of active and passive exercising apparatuses and the adaptation of myolymphokinetic activities have
been developed for the treatment of lymphedema. This novel approach can be adapted for the
treatment of lymphedema in mass.
PMID: 20428336 [PubMed - in process]PMCID: PMC2860639
2. Contrib Nephrol. 2010;164:227-36. Epub 2010 Apr 20.
Fluid assessment and management in the emergency department.
Di Somma S, Gori CS, Grandi T, Risicato MG, Salvatori E.
Sant'Andrea Hospital, Second Faculty Medical School, "La Sapienza" University of Rome, Rome,
Italy.
Abstract
Evaluation of hydration state or water homeostasis is an important component in the assessment and
treatment of critically ill patients in the emergency department (ED). The main purpose of ED
physicians is to immediately distinguish between normal hydrated, dehydrated and hyperhydrated
states. Fluid depletion may result from renal losses and extrarenal losses (from the GI tract,
respiratory system, skin, fever, sepsis, third space accumulations). Total body fluid increase can
result from heart failure, kidney disease, liver disease, malignant lymphoedema or thyroid disease. In
patients with fluid overload due to acute heart failure, diuretics should be given when there is
evidence of systemic volume overload, in a dose up-titrated according to renal function, systolic
blood pressure, and history of chronic diuretic use. The bioelectrical impedance vector analysis
(BIVA) is a noninvasive technique to estimate body mass and water composition by bioelectrical
impedance measurements, resistance and reactance. In patients with hyperhydration state due to
heart failure, some authors showed that reactance is strongly related to BNP values and the NYHA
functional classes. Other authors found a correlation between impedance and central venous pressure
in critically ill patients. We have been analyzing the hydration state at admission to the ED, 24, 72 h
after admission and at discharge, and found a significant and indirectly proportional correlation
between BIVA hydration and the Caval index at the time of presentation to the ED and 24 and 72 h
after hospital admission. Moreover, at admission we found an inverse relationship between BIVA
hydration and reduced urine output that became directly proportional at 72 h. This confirms the good
response to diuretic therapy with the shift of fluids from interstitial spaces.
Copyright (c) 64\C S. Karger AG, Basel.
PMID: 20428007 [PubMed - in process]
3. Womens Health (Lond Engl). 2010 May;6(3):399-406.
Breast cancer and lymphedema: a current overview for the healthcare provider.
Rourke LL, Hunt KK, Cormier JN.
University of Texas, MD Anderson Cancer Center, Department of Surgical Oncology, Houston, TX
77030, USA. lrourke@mdanderson.org
Abstract
Lymphedema is a troublesome condition faced by many breast cancer survivors today. Since
lymphedema represents a debilitating and progressive problem that is feared by most breast cancer
patients and their providers, an up-to-date understanding is necessary in order to better diagnose,
treat and manage these patients. The etiology of lymphedema is multifactorial and poorly understood.
Although lymphedema is not clearly defined within the medical community, there are several
diagnostic tools available to the clinician, of which the most widely accepted in the clinical setting are
the arm circumference measurements. Misinformation has recently been conveyed regarding activity
recommendations for those patients afflicted with lymphedema. These recent events highlight the
critical importance of education, heightened awareness and dedicated future cooperative research in
order to favorably impact on lymphedema care and the quality of life for those living with
lymphedema.
PMID: 20426606 [PubMed - in process]
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 Mar;26(2):103-6.
[The pathological characteristics and clinical significances of maturational change of port-wine stain]
[Article in Chinese]
Wang W, Lin XX, Ma G, Li W, Hu XJ, Jin YB, Chen H, Yang C, Wang W.
Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiaotong
University, Shanghai 200011, China. docwang001@gmail.com
Abstract
OBJECTIVE: In this study histologic observations were presented to elucidate the possible
mechanism of maturational change of port-wine stain(PWS).
METHODS: Normal PWS(3 cases) , thicken PWS (11 cases) and nodular PWS (9 cases) were
included to present histologic observations.
RESULTS: Normal PWS, only shows mild dilated, thin-walled vessels within superficial dermis.
Thicken PWS, shows further dilated vessels and sebaceous gland throughout dermis and superficial
subcutaneous fat. Nodular PWS can be divided into three groups. I Similar to thicken PWS, shows
further dilated vessels and sebaceous gland throughout dermis and superficial subcutaneous fat. II
Shows Large number of dilated vessels, honeycombin and less vascular mesenchymall. III Tenacious
texture shows mild dilated vessels, diffused collagen, mesenchymal rarefactin, lymphocyte infiltration
and lymphedema change.
CONCLUSIONS: Histologic examination revealed not only the expected vascular abnormalities, but
also a number of widely distributed hamartomatous changes in thicken and nodular PWS. The
complex hamartomatous changes suggest a genetically determined, multilineage developmental field
defect in the pathogenesis of PWS.
PMID: 20540312 [PubMed - in process]
1. J Vector Borne Dis. 2010 Jun;47(2):91-6.
Bancroftian filariasis among the Mbembe people of Cross River state, Nigeria.
Okon OE, Iboh CI, Opara KN.
Department of Zoology & Environmental Biology, University of Calabar, Calabar, Nigeria.
Abstract
BACKGROUND & OBJECTIVE: Bancroftian filariasis is a major public health and socioeconomic
problems in the humid tropical and subtropical regions of the world. A study was undertaken to
investigate the status of the disease in some rural communities of Cross River State, Nigeria, with a
view to enriching the epidemiological baseline data of the disease in Nigeria.
METHODS: A total of 897 Mbembe people living in six major villages of Obubra Local
Government Area of Cross River State, Nigeria were examined between December 2008 and June
2009 for lymphatic filariasis due to Wuchereria bancrofti.
RESULTS: Out of the 897 persons examined, 139 (15.5%) were positive for microfilariae in their
blood smear. Infection varied significantly among villages (p <0.05) but was not sex-specific (p >0.
05). The overall mean microfilarial density among the total population was 9.9 mf/50 microl. The
occurrence of microfilaria in the peripheral blood of the infected persons was neither age nor sex
specific (p >0.05). The most important clinical manifestations were hydrocele (9.7%) and
lymphoedema (2.3%). Overall disease prevalence was (6.8%).
CONCLUSION: Government effort on the Community Directed Treatment with Ivermectin (CDTI)
project should be complimented with albendazole distribution to the endemic communities.
Environmental sanitation should also be intensified to eliminate the breeding sites of the mosquito
vectors.
PMID: 20539046 [PubMed - in process]
2. J Surg Res. 2010 Apr 18. [Epub ahead of print]
Treatment of Post-Mastectomy Lymphedema with Laser Therapy: Double Blind Placebo Control
Randomized Study.
Ahmed Omar MT, El Morsy AM, Abd-El-Gayed Ebid A.
Faculty of Physical Therapy, Cairo, Egypt. Member of International Panel of Advisory Board for
Indian Journal of Physiotherapy and Occupational Therapy.
Abstract
BACKGROUND: In post-mastectomy patients, lymphedema has the potential to become a
permanent progressive condition and become extremely resistant to treatment. Thus, it can results in
function impairment and decrease quality of life. The aim of this study was to evaluate the effect of
low level laser therapy (LLLT) on limb volume, shoulder mobility, and hand grip strength.
MATERIAL AND METHODS: Fifty women with breast cancer-related lymphedema were enrolled
in a double-blind, placebo controlled trial. Patients were randomly assigned to active laser (n = 25)
and placebo (n = 25) groups and received irradiation with Ga-As laser device that had wavelength of
904 nm, power of 5 mW, and spot size of 0.2 cm(2) over the axillary and arm areas, three times a
week for 12 wk. The total energy applied at each point was 300 mjoules over seven points, giving a
dosage of 1.5 joules/cm(2) in the active group. The placebo group received placebo therapy in
which the laser had been disabled without affecting its apparent function. Limb circumference,
shoulder mobility, and grip strength were measured before treatment and at 4, 8, and 12 wk.
RESULTS: The two groups had similar parameters at baseline. The reduction of limb volume tended
to decline in both groups. The trend being more significantly pronounced in active LLLT group than
placebo at 8 and 12 wk, respectively (P < 0.05). Goniometric data for shoulder mobility and hand
grip strength were statistically significance for LLLT group than for placebo.
CONCLUSION: Laser treatment was found to be effective in reducing the limb volume, increase
shoulder mobility, and hand grip strength in approximately 93% of patients with postmastectomy
lymphedema. Copyright © 2010 Elsevier Inc. All rights reserved.
PMID: 20538293 [PubMed - as supplied by publisher]
3. Lancet Oncol. 2010 May 25. [Epub ahead of print]
Angiosarcoma.
Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ.
Academic Unit of Surgical Oncology, School of Medicine and Biomedical Sciences, University of
Sheffield, Sheffield, UK.
Abstract
Angiosarcomas are rare soft-tissue sarcomas of endothelial cell origin that have a poor prognosis.
They can arise anywhere in the body, most commonly presenting as cutaneous disease in elderly
white men, involving the head and neck and particularly the scalp. They can be caused by therapeutic
radiation or chronic lymphoedema and hence secondary breast angiosarcomas are an important
subgroup. Recent work has sought to establish the molecular biology of angiosarcomas and identify
specific targets for treatment. Interest is now focused on trials of vascular-targeted drugs, which are
showing promise in the control of angiosarcomas. In this review we discuss angiosarcoma and its
current management, with a focus on clinical trials investigating the treatment of advanced disease.
Copyright © 2010 Elsevier Ltd. All rights reserved.
PMID: 20537949 [PubMed - as supplied by publisher]
4. Am J Hum Genet. 2010 Jun 11;86(6):943-8. Epub 2010 May 27.
GJC2 missense mutations cause human lymphedema.
Ferrell RE, Baty CJ, Kimak MA, Karlsson JM, Lawrence EC, Franke-Snyder M, Meriney SD,
Feingold E, Finegold DN.
Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh,
Pittsburgh, PA 15261, USA.
Abstract
Lymphedema is the clinical manifestation of defects in lymphatic structure or function. Mutations
identified in genes regulating lymphatic development result in inherited lymphedema. No mutations
have yet been identified in genes mediating lymphatic function that result in inherited lymphedema.
Survey microarray studies comparing lymphatic and blood endothelial cells identified expression of
several connexins in lymphatic endothelial cells. Additionally, gap junctions are implicated in
maintaining lymphatic flow. By sequencing GJA1, GJA4, and GJC2 in a group of families with
dominantly inherited lymphedema, we identified six probands with unique missense mutations in
GJC2 (encoding connexin [Cx] 47). Two larger families cosegregate lymphedema and GJC2
mutation (LOD score = 6.5). We hypothesize that missense mutations in GJC2 alter gap junction
function and disrupt lymphatic flow. Until now, GJC2 mutations were only thought to cause
dysmyelination, with primary expression of Cx47 limited to the central nervous system. The
identification of GJC2 mutations as a cause of primary lymphedema raises the possibility of novel
gap-junction-modifying agents as potential therapy for some forms of lymphedema. Copyright 2010
The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.
PMID: 20537300 [PubMed - in process]
5. Microcirculation. 2010 May;17(4):281-96.
Lymphatic dysfunction, not aplasia, underlies milroy disease.
Mellor RH, Hubert CE, Stanton AW, Tate N, Akhras V, Smith A, Burnand KG, Jeffery S, Mäkinen
T, Levick JR, Mortimer PS.
Cardiac & Vascular Sciences (Dermatology), St George's Hospital Medical School, University of
London, London, UK.
Abstract
OBJECTIVE: Milroy disease is an inherited autosomal dominant lymphoedema caused by mutations
in the gene for vascular endothelial growth factor receptor-3 (VEGFR-3, also known as FLT4). The
phenotype has to date been ascribed to lymphatic aplasia. We further investigated the structural and
functional defects underlying the phenotype in humans.
METHODS: The skin of the swollen foot and the non-swollen forearm was examined by (i)
fluorescence microlymphangiography, to quantify functional initial lymphatic density in vivo; and (ii)
podoplanin and LYVE-1 immunohistochemistry of biopsies, to quantify structural lymphatic density.
Leg vein function was assessed by colour Doppler duplex ultrasound.
RESULTS: Milroy patients exhibited profound (86-91%) functional failure of the initial lymphatics in
the foot; the forearm was unimpaired. Dermal lymphatics were present in biopsies but density was
reduced by 51-61% (foot) and 26-33% (forearm). Saphenous venous reflux was present in 9/10
individuals with VEGFR3 mutations, including two carriers.
CONCLUSION: We propose that VEGFR3 mutations in humans cause lymphoedema through a
failure of tissue protein and fluid absorption. This is due to a profound functional failure of initial
lymphatics and is not explained by microlymphatic hypoplasia alone. The superficial venous valve
reflux indicates the dual role of VEGFR-3 in lymphatic and venous development.
PMID: 20536741 [PubMed - in process]
6. Genet Med. 2010 Jun 8. [Epub ahead of print]
Spinal extradural arachnoid cysts in lymphedema-distichiasis syndrome.
Sánchez-Carpintero R, Dominguez P, Núñez MT, Patiño-García A.
From the 1Department of Pediatrics, Pediatric Neurology Unit; 2Department of Radiology,
Neuroradiology Unit; and 3Department of Pediatrics, Laboratory of Pediatrics, University Clinic of
Navarra, Pamplona, Spain.
Abstract
PURPOSE:: Lymphedema-distichiasis syndrome is characterized by the presence of lower limb
lymphedema and supernumerary eyelashes arising from the Meibomian glands. Spinal extradural
arachnoid cysts have been observed in some families but their true frequency is unknown. The aim of
this study is to determine the frequency of spinal extradural arachnoid cysts in lymphedema
distichiasis syndrome.
METHODS:: We collected clinical information from all 45 living members of a complete family of 48
members and performed molecular analysis of the FOXC2 gene in 30 individuals. We obtained
spinal magnetic resonance imaging from all family members with a FOXC2 gene mutation.
RESULTS:: Twelve family members carried a mutation in the FOXC2 gene and had clinical features
of lymphedema-distichiasis syndrome. Of these, 58% (seven individuals) had extradural arachnoid
cysts.
DISCUSSION:: We suggest that a follow-up protocol for lymphedema-distichiasis syndrome
families should include spinal magnetic resonance imaging for all affected members so that the timing
of surgery for removal of these cysts can be optimized.
PMID: 20535019 [PubMed - as supplied by publisher]
7. Ugeskr Laeger. 2010 Jun 7;172(23):1765-6.
[Recurrent post surgical cellulitis of the breast][Article in Danish]
Thoning JM, Thormann H.
Svendborg Sygehus, Medicinsk Afdeling, Odense Universitetshospital, 5230 Odense, Denmark.
jthon04@gmail.com
Abstract
Differentiation between infectious and non-infectious cellulitis is a frequent clinical issue. Often, there
is no proven portal of entry for infection and it is difficult to obtain a positive culture. Two case
stories with recurrence of postoperative cellulitis are presented. Lymphoedema, often seen post
surgery, is itself inflammatory and may cause inflammatory cellulitis. In recurrent cases of cellulitis
without any effect of antibiotic treatment, inflammatory cellulitis should be considered.
PMID: 20534207 [PubMed - in process]
June 6, 1010 - This is Now Considered a Critical Piece of Cancer Treatment -
The research of Dr. Kathryn Schmitz, which had already research reversed decades of cautionary
exercise advice given to breast cancer patients with lymphedema, led an expert panel to developed
the new recommendations.
According to Eurekalert:
"Cancer patients and survivors should strive to get the same 150 minutes per week of moderate-
intensity aerobic exercise that is recommended for the general public ... Though the evidence
indicates that most types of physical activity -- from swimming to yoga to strength training -- are
beneficial for cancer patients, clinicians should tailor exercise recommendations to individual patients".
Sources: Science Daily June 1, 2010
Dr. Mercola's Comments:
As little as a decade ago, it was common for physicians to advise their heart attack patients to avoid
exercise for fear that they could stress out their heart and trigger a second attack.
Now, it's common knowledge that exercise is a phenomenal way to strengthen your heart after a
heart attack as well as lessen your risk of further problems, and regular exercise is routinely
recommended to heart patients.
For cancer patients, this trend is still in the beginning stages, with many practitioners advising their
patients to avoid exercise during and after cancer treatment. But increasing evidence is showing that
this outdated advice is actually causing cancer patients harm, as regular exercise can lead to a
number of health improvements for cancer patients, including:
· Better aerobic fitness
· Increased muscular strength
· Improved quality of life
· Less fatigue
Exercise Improves Cancer Survival
I've written a lot about how exercise can help to reduce your risk of cancer in the first place, but
does it do any good if you're already fighting cancer? Yes … a lot.
Harvard Medical School researchers found patients who exercise moderately -- 3-5 hours a week
-- reduce their odds of dying from breast cancer by about half as compared to sedentary women. In
fact, any amount of weekly exercise increased a patient's odds of surviving breast cancer. This
benefit also remained constant regardless of whether women were diagnosed early on or after their
cancer had spread.
Patients receiving the biggest boost from exercise were those most sensitive to estrogen, the most
common form of breast cancer. (Previous research has shown exercise lowers estrogen levels, which
can fuel the growth of breast cancer cells.)
Think about it. If just three to five hours of walking per week can so drastically improve your
chances of surviving a hormone-responsive breast cancer tumor, imagine what a few more hours a
week of exercise could do for you.
If you're male, be aware that athletes have lower levels of circulating testosterone than non-athletes,
and similar to the association between estrogen levels and breast cancer in women, testosterone is
known to influence the development of prostate cancer in men.
Physical activity can reduce your risk and boost your chances of recovery if you have cancer.
Exercise is a Potent Cancer Fighter
Cancer thrives on sugar, but regular exercise reduces your insulin levels, which creates a low sugar
environment that discourages the growth and spread of cancer cells. Controlling your insulin levels is
one of the most powerful steps you can take to reduce your cancer risk and help keep it from
returning.
Physically active adults experience about half the incidence of colon cancer as their sedentary
counterparts. Exercise has a beneficial influence on insulin, prostaglandins and bile acids, all of which
are thought to encourage the growth and spread of cancer cells in your colon. Exercise also improves
bowel transit time, which means your body's waste is spending less time in contact with the mucosal
lining of your colon.
Exercise also improves the circulation of immune cells in your blood. The job of these cells is to
neutralize pathogens throughout your body.
The better these cells circulate, the more efficient your immune system is at locating and defending
against viruses and diseases, including cancer, trying to attack your body.
It's also been suggested that apoptosis (programmed cell death) is triggered by exercise, causing
cancer cells to die. So you can see why a regular exercise program is important not only during any
treatment you're receiving but also afterward as well.
Exercise Tips for Cancer Patients
I would also strongly recommend that you read the lead article in today's newsletter that reviews
some of the newest insights on how to optimize your exercise program and actually reduce your
exercise time and improve your benefits.
You will need to tailor your exercise routine to your individual scenario, taking into account your
stamina and current health. Often, you will be able to take part in a regular exercise program -- one
that involves a variety of exercises like strength training, core-building, stretching, aerobic and
anaerobic -- with very little changes necessary.
However, you may find that you need to exercise at a lower intensity or for shorter durations at
times. Always listen to your body and if you feel you need a break, take time to rest. Even exercising
for a few minutes a day is better than not exercising at all, and you'll likely find that your stamina
increases and you're able to complete more challenging workouts with each passing day.
In the event you are suffering from a very weakened immune system, you may want to exercise in
your home instead of visiting a public gym. But remember that exercise will ultimately help to boost
your immune system, so it's very important to continue with your program.
June 21, 2010 - Indian River County health notes for June 22 -
VNA screenings
The Visiting Nurse Association of the Treasure Coast is offering the following no-cost blood
pressure and blood glucose screenings in June
June 22, (BP/BS) 9-11 a.m. Staples, 1191 U.S. 1, Vero Beach.
June 28, (BP/BS) 8:30-10 a.m. Sebastian Gym & Fitness, 345 Sebastian Blvd., Sebastian.
For morning blood sugar tests, you should fast after midnight on the evening before the screening.
For more information about health screenings or other VNA services, call (772) 567-5551 or visit
www.vnatc.com.
Balancing hormones
A free workshop, “Balancing Hormones Safely and Naturally,” will be presented 6 p.m. Tuesday,
June 22, at Alternative Medicine Family Care Center, 3408 Aviation Blvd., Vero Beach.
The workshop addresses non-drug solutions to the hormone-related concerns of women 0f all ages
including thyroid problems, hot flashes, fatigue, night sweats, irregular cycle, headaches, trouble
sleeping, abnormal cramping, depression and anxiety.
To R.S.V.P., call (772) 778-8877. Visit www.amfcc.info for more information on alternative
medicine.
Digestive disorders
A free workshop on digestive disorders will be presented 6-7 p.m. Thursday, June 24, at Alternative
Medicine Family Care Center, 3408 Aviation Blvd., Vero Beach.
This workshop will teach alternative approaches to preventing and relieving common digestive
disorders including acid reflux, hiatal hernia, gas, bloating, irritable bowel, diarrhea, stomach cramps,
Crohn’s Disease and constipation.
Call (772) 778-8877 to R.S.V.P. For more info, visit www.amfcc.info.
Balance screenings
Sunshine Physical Therapy Clinic will be at the Walgreens on 17th Avenue and U.S. 1 in Vero
Beach 10 a.m.-noon Wednesday, June 30, to do balance screenings. For more information, call the
clinic at (772) 562-6877.
Blood pressure screenings
Blood pressure screenings are offered 10-11:30 a.m. the third Tuesday of every month as Oxygen
Plus, 2360 U.S. 1, Vero Beach. For more information, call (772) 569-0232 or write oxygen-
plus@mail.com.
Wellness program
A free wellness presentation to raise antioxidant levels, improve immune system functions and reduce
DNA damage will be offered at the Institute of Colorectal Health & Wellness, 1255 37th St., Suite
B, Vero Beach, 7 p.m. Thursdays.
R.S.V.P. at (772) 778-4773 or christyicrhw@gmail.com.
Walkers, wheelchairs
Veterans of Foreign Wars Post 3918, Vero Beach, has walkers, wheelchairs, crutches, portable
commodes and motor scooters, available free for anybody who needs them. For information, call the
Post 3918 office at (772) 567-8487 and leave your name and number.
Quit smoking
Free quit smoking now classes (all forms of tobacco) are offered to all county residents 18 and older
at the Indian River County Health Department, 1900 27th St., Vero Beach.
Call (561) 640-3620 for dates and times. This is a community health promotion program offered by
Everglades Area Health Education Center.
Mental health
The Mental Health Association has opened a walk-in center to provide people in crisis immediate
access to help. Death in the family, domestic abuse, depression, anxiety, parenting issues —
whatever the difficulty, MHA’s therapists stand ready to assist. If you are interested in donating to
the MHA or if you need help for yourself or your loved ones, call (772) 569-9788.
Health talk show
If you have missed any of Indian River Medical Center’s Health Talk TV segments that air on
WWCI-TV Channel 10, you can now go to the hospital’s Web site, www.irmc.cc. Under “Health
Resources” at the top of the home page, choose to watch any or all segments from the first four
shows.
To view on YouTube, go to www.youtube.com and type “Indian River Medical Center” in the
search box.
The show, hosted by Kim Beckett, wife of Dr. Clark W. Beckett, IRMC vascular surgeon, features
the latest in health news and medical advances. The series airs on Channel 10 on alternate Mondays
and Wednesdays at 4, 7 and 11 p.m.
E-mail questions, comments and suggested topics to healthtalk@irmc.cc.
Fitness camp
In partnership with the Club at Spine & Sport Institute, CityFit Outdoor Fitness Camp is hosting
Brown Bag boot camps from noon to 12:50 p.m. Tuesdays and Thursdays on 36th Street in Vero
Beach.
The camps are designed with a holistic approach to health and include workouts, workshops and
field trips focused on smarter shopping and menu planning..
The cost is $250 for six weeks. Call Jill at (772) 713-7938 or e-mail cityfitflorida@gmail.com to
reserve a spot.
Macular Degeneration
Free initial eye screenings are available at Diabetes Eye and Macular Degeneration Institute for
patients who are diabetic or age 50 and older. Call (772) 770-1577 to schedule an appointment at
93 Royal Palm Pointe, Vero Beach.
Florida Eye Institute
Florida Eye Institute will begin free initial vision and glaucoma screenings from 9 to 11 a.m. Fridays
at 2750 Indian River Blvd. in Vero Beach. Call (772) 569-9500 or visit www.fleye.com for more
information.
Monnett Eye Center
Monnett Eye Center provides free vision, glaucoma and hearing screenings from 9 a.m. to 2 p.m.
Tuesdays at the clinic, 14410 U.S. 1 in Sebastian. Monnett Eye Center also provides local
businesses with free vision, glaucoma and hearing screenings for their employees. For more
information and appointments, call (772) 589-8111.
Aesthetic medicine
Find out what’s new in aesthetic medicine at a free informational seminar presented by Ferdinand
Becker M.D., F.A.C.S. and Barry Boyd, M.D. 10-11 a.m. Friday, June 25, at Advanced Facial
Cosmetic and Laser Surgery Center, 5070 N. State Road A1A, Vero Beach. Topics include
surgical and nonsurgical cosmetic procedures such as dermal fillers, Zerona, fractional laser
resurfacing and photorejuvenation, as well as aesthetic surgery for the face and body, including
facelifts and eyelid surgery, breast surgery, tummy tucks and liposuction. The seminar is free, but
reservations are required. Call (772) 234-3700.
Lymphedema therapy
Sunshine Physical Therapy Clinic, 1705 17th Ave., Vero Beach, now offers lymphedema therapy
among its regular services. Michelle Dorfman is certified in treating anyone with lymphedema of the
upper extremity. If you have had a mastectomy, lumpectomy radiation treatment, lymph node
removal, other surgeries or infections to the limbs, you may be at risk for developing lymphedema.
For information, call (772) 562-6877.
June 22, 2010 - Dragonboat gets grant –
Prince George Northbreast Passage Dragon Boat team has received a grant for $2,000 for the
upcoming season. The grant was part of a $50,000 Canadian Breast Cancer Foundation grant
allotted to 22 B.C. Dragon Boat breast cancer survivor teams for 2010.
The grant was created to celebrate the fact women can lead healthy and active lives after breast
cancer. This region has supported the teams since 1997. The Dragon Boat movement for breast
cancer survivors began in 1996 as the result of a ground breaking study led by Dr. Don McKenzie ,
professor of sports medicine at the University of British Columbia. He set out to investigate the link
between upper body exercise and the development of lymphedema in women with breast cancer.
Lymphedema is the swelling some women experience due to accumulation of fluid in the arm and
chest after removal of lymph nodes for the treatment of breast cancer.
In his study, 24 women, all with a history of breast cancer, volunteered for the research project and
began training as dragon boaters. McKenzie found that despite rigorous repetitive upper-body
exercises – which dragon boating requires – no new cases of lymphemdema occurred and none of
the existing cases progressed.
Women who participated showed a marked improvement in both physical and mental health. From
this initial project in Vancouver, an international movement of breast cancer survivor Dragon boat
teams has evolved.
Balance a touch away - Jerrilyn Zavada - 06/24/2010
An oasis of peace sits relatively untapped in downtown Streator.
Body/Mind/Spirit, owned by Amy Ryan of Streator, offers massage and lymphedema therapy and
Reiki, among other services to provide a balance between body and spirit.
Ryan is a graduate of the Illinois Valley Community College massage therapy program. She practiced
locally for seven years, before going into private practice.
"I love what I do and I love helping people," Ryan said. "I believe I have a gift and I want to share it."
Ryan's philosophy in providing the services is simple. She provides massage techniques tailored to
individual needs.
"A few simple changes can bring more balance into a busy lifestyle and you can enjoy a higher, more
vibrant state of health," she said. "Blending the wise ways of the East with dynamic ways of the West
is the necessary step that would bring us closer to manifesting health and inner peace."
Ryan offers competitive prices for 30-minute, one-hour and 90-minute massage sessions. She offers
discounts to senior citizens.
"A lot of them are on fixed incomes and it's so wonderful for them," she said.
June 25, 2010 - Pulling together - Joey Coleman -
They paddle the west harbour every Saturday morning. Forty women in two boats, determined to
paddle the fastest dragon boat in the world. Like all athletes, they're focused on the next race -- the
next big challenge.
What makes these athletes different is their biggest challenge is behind them. They're breast cancer
survivors.
The team formed 13 years ago after an article in Chatelaine about the debate over upper body
exercise for women with breast cancer. Two decades ago, it was believed this activity increased the
risk of lymphedema.
But a study by Dr. Don McKenzie of the University of British Columbia proved conventional
wisdom was wrong.
Dragon boating is physically demanding and a challenge for even the most healthy person.
"A lot of people believe it's canoeing and canoeing is a nice easy stroke," said Kathy Levy, a
founding member and now a coach with the team.
"A lot of our ladies, including me, did not do a lot of physical activity. Now, all of the sudden, we
have triceps, biceps and calf muscles," said coach Ann Fowbes Arndt.
They practise at Macassa Bay Yacht Club two days a week and on other days do water aerobics,
marathon training, spinning, cross-training and even boxing.
Two weekends ago, they won an international breast cancer survivors dragon boat festival, beating
72 other international teams.
Husbands get involved, too, sometimes treating team members to breakfast when they come off the
water.
"A couple years back, they had a race and they had to pull off a good time," said Jim Martin, whose
wife, Loraine, is on the team.
"I said if you can do this, I'll cook breakfast ... waffles and ice cream with shaved chocolate,
strawberries cut into hearts."
Since then, he has been part of the shore team preparing breakfast following each victory.
Racing, and the mental preparation involved, helps the paddlers think about something other than
cancer, but it's never far from their thoughts.
"It's always in the back of your head that one day it may come back to bite you," said Levy. "We
have lost three members already this year. It's hard."
Team member Rae Puttock listened by cellphone from her bed as the team won in Peterborough.
She died the next day.
"She was always a part of everything we were doing right up to the day before she died," said Levy.
"You don't leave the team because you've retired or you've been traded."
Levy and Fowbes Arndt say the losses increase their determination.
"We gather strength from the girls we've lost. It makes us paddle harder for each of them. They're
with us on the boat."
June 24, 2010 - Decongestive Physiotherapy Helps Patients with Painful Leg Swelling -
Source: Wolters Kluwer Health: Lippincott Williams & Wilkins
Combination Approach Benefits Patients with Chronic Venous Insufficiency or Lymphedema,
Reports Topics in Geriatric Rehabilitation
Newswise — For patients with painful swelling of the legs caused by chronic venous insufficiency
(CVI), a combination treatment approach called "complete decongestive physiotherapy" improves
symptoms, walking ability, and quality of life, reports a study in Topics in Geriatric Rehabilitation.
The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a
leading provider of information and business intelligence for students, professionals, and institutions in
medicine, nursing, allied health, and pharmacy.
Complete (or "complex") decongestive physiotherapy (CDP) can greatly reduce leg swelling and
pain in patients with CVI, according to the new study, led by Yesim Bakar, Ph.D., P.T., of Abant
Izzet Baysal University in Bolu, Turkey. Another paper in the same issue of TGR shows similar
benefits of CDP in a patient with lymphatic obstruction (lymphedema) related to the skin condition
psoriasis.
Complete Decongestive Physiotherapy Brings Good Results
Dr Bakar and coauthors evaluated the effects of CDP in 62 older adults (average age 65 years) with
CVI. Patients with CVI have poor blood flow in the veins of the leg, leading to fluid buildup. This
results in painful swelling, making it difficult for patients to walk and perform other activities. Usually
only one leg is affected.
All patients were treated using the CDP approach, which combines four types of physical therapy
treatments:
• Manual lymph drainage—massage to promote drainage of the lymph nodes.
• Skin care—moisturizers and other treatments for skin changes caused by poor circulation.
• Compression—bandages are applied to prevent fluid from reaccumulating.
• Exercise—simple leg exercises to improve blood flow and leg motion.
For the first month, patients met with a physical therapist five days a week for treatment. They also
received education in performing each of the four types of therapy for themselves. The goal was to
keep fluid buildup under control through lifelong, daily self-care.
The CDP treatment program dramatically reduced leg swelling—on average, fluid buildup in the
affected leg decreased by the equivalent of nearly half a liter. Pain was also decreased, from an
average score of 67 to 18 on a 100-point scale. Patients had improved walking ability, less pain
when walking, and improved ability to perform daily activities. The authors believe that including
exercise in the treatment program was a key factor in improving walking ability.
Dr. Bakar is also a co-author of the other paper, which reports on the use of CDP in a woman with
lymphedema related to the chronic skin condition psoriasis. In patients with lymphedema, obstruction
of the lymph nodes causes similar symptoms of leg pain and swelling. In both the short and long term,
CDP brought significant improvement in pain, swelling, and activity.
In recent years, CDP has become an accepted approach to treatment for lymphedema. Although not
a cure, CDP incorporates several physical therapy techniques that can help keep fluid buildup, leg
swelling, and pain under control.
The new studies are the first to evaluate the fully integrated CDP approach—including daily home
maintenance therapy—in patients with CVI and psoriasis-related lymphedema. "CDP is a time-
consuming process for patients and physiotherapists," Dr. Bakar and colleagues write. "However, it
is widely used and an effective treatment for patients with lymphedema." The new results suggest that
this combination physical therapy approach could also be very helpful for patients with leg pain and
swelling caused by CVI.
About Topics in Geriatric Rehabilitation
Topics in Geriatric Rehabilitation is a peer-reviewed quarterly publication that presents clinical, basic,
and applied research, as well as theoretic information, consolidated into a clinically relevant form.
TGR is a leading resource for the healthcare professional practicing in the area of geriatric
rehabilitation. TGR provides useful treatment information written by and for specialists in all aspects
of geriatric care. Each issue focuses on a specific topic, providing best practices and dependable
hands-on tips and techniques.
Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals
and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing
under the LWW brand, as well as content-based sites and online corporate and customer services.
LWW is part of Wolters Kluwer Health, a leading provider of information and business intelligence
for students, professionals and institutions in medicine, nursing, allied health and pharmacy. Major
brands include traditional publishers of medical and drug reference tools and textbooks, such as
Lippincott Williams & Wilkins and Facts & Comparisons®; and electronic information providers,
such as Ovid®, UpToDate®, Medi-Span® and ProVation® Medical.
Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services
company. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk,
compliance, and healthcare rely on Wolters Kluwer’s leading, information-enabled tools and
solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever
more dynamic world.
Wolters Kluwer has 2009 annual revenues of €3.4 billion ($4.8 billion), employs approximately
19,300 people worldwide, and maintains operations in over 40 countries across Europe, North
America, Asia Pacific, and Latin America. Wolters Kluwer is headquartered in Alphen aan den Rijn,
the Netherlands. Its shares are quoted on Euronext Amsterdam (WKL) and are included in the AEX
and Euronext 100 indices.
June 19, 2010 - Post-surgery lymphedema often goes untreated -
Massage technique can help reduce hand swelling
Lymphedema is a physical and emotional problem for many post-surgery cancer patients, "and all
too often not diagnosed," says Canadian lymphedema expert Dr. Anna Towers.
"People go to emergency with a skin infection or ulcer and they are treated for that, but not for the
underlying cause, which is severe swelling lymphedema," says the McGill University professor.
She visited Victoria recently to talk about lymphedema, a fluid-retention condition that can affect
anyone who has had radiation or surgery involving lymph nodes.
Towers is founding chairwoman of the newly formed Canadian Lymphedema Framework, which
seeks to raise the profile and treatment of this condition.
Lymph is a fluid, found between the body's cells, that is carried by the lymphatic system through
nodes. Unlike blood, it has no central pump, but moves due to muscle action. Under ideal conditions,
the fluid feeds cells and carries away excess waste and cancer cells, says the palliative care physician.
But when damaged, the system doesn't drain well and any inflammation causes even more to build
up. "We're doing a large Canadian study now following women who've had breast cancer. We're
only halfway through; the study goes from 2005 to 2015, and already we're showing 17 per cent
have lymphedema. "It can appear immediately after treatment or years later, after an injury - a
suntan, an infection from an insect sting, even air travel," Towers says. "Inflammation exacerbates the
problem."
Untreated, lymphedema can lead to disability, loss of function, job loss and early death.
Forty per cent of patients with the condition develop complications ranging from infection to blood
clots, says Towers, associate professor in McGill's oncology department and former director of its
palliative care division. She is advocating across the country for better research, care and medical
coverage.
About 25,000 new cases occur in B.C. every year, mostly following surgeries for breast, prostate,
colorectal, gynecological or melanoma cancers. (The condition can also be genetic.)
Once lymphedema develops, the preferred treatment is hands-on, decongestive massage to softly
guide lymph in the right direction, to reduce swelling and improve function. A compression garment
or bandage is worn for maintenance.
Robert Harris operates the Dr. Vodder clinic here, which trains therapists in the massage. "It's very
light, gentle, rhythmic, and stimulates the lymph vessels to pump," he says. "Patients love it," and
frequent massage can bring a limb down 40 to 50 per cent in a month, which also lowers infection
risk.
"The therapy is life-changing but its success depends on how soon it happens." One hour costs about
$85. The medical services plan picks up $23, while some extended-health plans pay more.
A 60-year-old woman, who asked not to be identified, had a recent lumpectomy and developed
swelling in her hand, arm and breast. "It was like an overfilled balloon. I couldn't close my fist, get
my rings off. But after about six treatments the therapist got my breast draining and my hand
working.
"I tried to get physio at the cancer clinic, but was told it would be up to six week. I didn't want to
wait because it was getting bigger and bigger. This therapy is wonderful."
Combined decongestive therapist Beth Atkinson took the Dr. Vodder lymph drainage course and
works at Vitality Treatment Centre in Oak Bay, with others trained in the specialty. There are eight in
the city. "We cover seven days a week, because when a person comes in with a severe problem,
there's an intense phase before maintenance can begin. We might see them three, four times a week,
for three weeks. "A patient might have a leg that weighs twice what's normal. Even after massage,
there's tremendous difference. People get off the table and say: Wow, I can bend my knee.' (Excess
water is eliminated through waste.)" She adds lymph drainage is useful for other inflammatory
conditions, too, and patients can learn to do it themselves.
Towers says the therapy should be covered by provincial medical plans, but blamed lack of
leadership. Health policy favours prevention and treatment - "as it should" - but that leaves less for
followup care, she says. Because the treatment is not pharmacological, "we don't have the benefit of
pharmaceutical firms' resources to help advocate." In addition, many problems appear years after the
cancer management ends.
The B.C. Cancer Agency recommends patients contact the Dr. Vodder school - www.vodderschool.
com or at 250-598-9862 for combined decongestive therapy. It's not available in hospitals, which
use compression pumps instead.
June 25, 2010 - Cancer centers revitalize survivors - By Helena Oliviero -
For almost five months, Priscilla Tomlinson’s life revolved around regular trips to the basement of
Piedmont Hospital. There, on every third Tuesday, she underwent chemotherapy sessions lasting
almost eight hours to battle ovarian cancer.
After each session, she went into her backyard and lit a bouquet of dried sage, letting it waft over her
like incense. Two days later, a flu-like wave would smash her to her core. Slowly, she would begin
to feel better. And then it was time for the next Tuesday chemo date at Piedmont.
Then suddenly, in January 2007, her cancer treatments were done. She would require checkups and
medication, but she was no longer a cancer patient.
Yet, moving forward was difficult, and she found herself returning to Piedmont, again and again. But
no longer to the basement. Now she takes the elevator to the 7th floor, to Piedmont’s Cancer
Wellness Center.
There, Tomlinson takes African drumming classes. She molds clay into pinch pots. She jots down
her thoughts in an “expressive arts room.” She participates in food demonstrations. She meditates
and meets with therapists.
Tomlinson is among a growing number of cancer patients who are looking to cancer centers for help
in making the transition to life as a survivor. And more cancer centers are offering post-treatment
options.
Yoga, massage therapy and mind-body studios are becoming mainstream as medical facilities extend
the traditional boundaries of health care. It allows them to maintain relationships with the patients, as
well as meet patient demands for more complementary and alternative approaches to wellness.
“It helps me deal with the anxiety of scans and helps me stay in the present,” said Tomlinson, 70,
who lives in Decatur. “It helps me from not running stories in my mind thinking of all of the bad things
that can happen. This helps me live my life.”
Seeking help
Cancer survivors are living longer and healthier lives. The chance of surviving most cancer has been
steadily rising. For example, the 5-year survival rate for breast cancer is now 90 percent, up from 75
percent in the mid-to-late 1970s, according to the National Cancer Institute.
Still, fighting a deadly disease can leave survivors feeling battered and confused, and struggling to find
their way. From soreness and scars to being emotionally shaken, survivors often need help grappling
with everything from depression and fatigue to body image concerns and relationship woes.
At the same time, Americans overall are increasingly looking outside traditional medicine for their
health care needs.
About a third of Americans are using at least one form of what’s referred to as “complementary or
alternative medicine.”
When megavitamins and prayer are included in this definition, the percentage rises to 62 percent,
according to the National Institutes of Health. Americans spend $34 billion annually in out-of-pocket
expenses on complementary and alternative approaches, according to a 2009 analysis by the
Centers for Disease Control and Prevention.
Several smaller studies of cancer patients suggest many of them are seeking alternative care. A study
published in the 2000 issue of the Journal of Oncology found 69 percent of 453 cancer patients
turned to some aspect of alternative care as part of their cancer treatment. A more recent study
published in a December 2004 issue of the Journal found 88 percent of 102 cancer patients enrolled
in a research study turned to CAM therapy, which can include vitamins or minerals and acupuncture.
Filling a void
Dr. Perry Ballard, an oncologist at Piedmont since 1987, said he used to be skeptical of
nontraditional care but now embraces its role in helping a person get better.
“Life is never the same after you have cancer, and it goes beyond having the most cutting-edge
therapies,” said Ballard. “You have to heal yourself psychologically and spiritually. We are learning
more and more about the mind-body connection.”
As a doctor seeing as many as 25 patients a day, Ballard said he hears a wide range of emotional
aches and pains: a young woman who’s been prematurely thrust into menopause because of a
mastectomy; a man losing sexual function; young singles wondering if they will ever get married.
Complementary care, he said, helps fill the void of what traditional medicine can do. And patients
addressing emotional and physical needs are better patients — they are more likely to keep
appointments and stay on top of their treatments.
Erika Baube, a licensed social worker at Georgia Cancer Specialists, said the majority of her clients
seek counseling after they complete treatment.
During the treatment stage, patients are intently focused on doctors’ appointments, chemotherapy
and other all-consuming medical needs. Once that intense routine ends, many emotions bubble up.
“There’s this emotional letdown at the end of treatment,” said Baube. “They have been so focused
on getting through the treatment, and then it’s, ‘Now what?’ They are finally allowing themselves to
feel the fear.”
Feeling up to par
After surgery and undergoing several rounds of radiation in 2007, Alice Stubblefield turned to
Turning Point in Alpharetta, a nonprofit resource for women with breast cancer offering physical
therapy, massage, counseling and other services.
Stubblefield couldn’t shake lingering soreness and lymphedema, an accumulation of fluid that
sometimes builds up and causes swelling after cancer treatment. She also worried about her body
image, concerned about her husband’s reaction to the mastectomy.
“I know my husband is here for me and still loves me, but the women there helped me work through
the process and really accept myself,” said Stubblefield.
Going to Turning Point also encouraged her to set goals. Among them: To play golf with her husband
again.
For the longest time after her cancer, she had no interest in picking up a set of clubs. Over time, her
outlook on life brightened. She and her husband are golfing together again.
“Not only do you want to do more things, but it’s not the end of the world,” she said. ‘What do I do
now?’
For Ned Crystal, who is 36, launching a new support group helped re-energize him after his cancer
treatments. “We have been going through this ritual of doctors and restrictive diet and you have this
moment of clarity that gets clouded again.
What is a normal life and what do I do now? How do I go through a transition of getting back to the
grindstone of work?” said Crystal, who was diagnosed with sarcoma, a rare form of cancer
developing in the soft tissues of the body, after suffering a knee injury three years ago. “They are
calling me a survivor and saying I am in the clear now. ... It’s frightening and it’s unnerving” said
Crystal, who lives in Smyrna with his wife.
Crystal, who underwent treatment at Emory University’s Winship Cancer Center, joined a steering
committee to help design a new program for cancer survivors, including a peer-to-peer program
matching newly diagnosed cancer patients with survivors. He’s also founded a new sarcoma support
group, believed to be the first in Atlanta.
“According to the statistics, there is a 95 percent chance I’m not going to make it five years. You can
fold up the tent and go home or make a difference. ... For me, getting involved has renewed my
passion.” ‘I really needed this’
On a recent afternoon, Priscilla Tomlinson closes her eyes and taps on an African drum. Then her
eyes spring open and she begins pounding the instrument — boom, boom, boom! She releases
nervous energy. She releases anxiety.
All of the participants in this class are cancer survivors. The chemotherapy, the radiation, the surgery
is behind them. Yet, they all wrestle with the fear it may one day return.
Harriet Sims, 40, is among those in this class. Dripping in sweat and tearful, she smiles. Sims was
diagnosed two years ago with multiple myeloma, a blood cancer. She underwent a stem-cell
treatment a year and a half ago. She will get a follow-up biopsy during the coming days to see if the
cancer has been kept at bay, “I can’t tell you how much I needed this,” said Sims. “I come here
and it makes me feel good.”
Tomlinson gives her a hug.
As the class comes to a close, they sing together: “I’m a tower of strength within and without, I am a
tower of strength within. All my fears slip away, slip away, all my fears slip away.”
June 25, 2010 - CDP treatment can reduce pain and swelling in CVI patients -
For patients with painful swelling of the legs caused by chronic venous insufficiency (CVI), a
combination treatment approach called "complete decongestive physiotherapy" improves symptoms,
walking ability, and quality of life, reports a study in Topics in Geriatric Rehabilitation. The journal is
published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of
information and business intelligence for students, professionals, and institutions in medicine, nursing,
allied health, and pharmacy.
Complete (or "complex") decongestive physiotherapy (CDP) can greatly reduce leg swelling and
pain in patients with CVI, according to the new study, led by Yesim Bakar, Ph.D., P.T., of Abant
Izzet Baysal University in Bolu, Turkey. Another paper in the same issue of TGR shows similar
benefits of CDP in a patient with lymphatic obstruction (lymphedema) related to the skin condition
psoriasis.
Complete Decongestive Physiotherapy Brings Good Results
Dr Bakar and coauthors evaluated the effects of CDP in 62 older adults (average age 65 years) with
CVI. Patients with CVI have poor blood flow in the veins of the leg, leading to fluid buildup. This
results in painful swelling, making it difficult for patients to walk and perform other activities. Usually
only one leg is affected.
All patients were treated using the CDP approach, which combines four types of physical therapy
treatments:
•Manual lymph drainage—massage to promote drainage of the lymph nodes.
•Skin care—moisturizers and other treatments for skin changes caused by poor circulation.
•Compression—bandages are applied to prevent fluid from reaccumulating.
•Exercise—simple leg exercises to improve blood flow and leg motion.
For the first month, patients met with a physical therapist five days a week for treatment. They also
received education in performing each of the four types of therapy for themselves. The goal was to
keep fluid buildup under control through lifelong, daily self-care.
The CDP treatment program dramatically reduced leg swelling—on average, fluid buildup in the
affected leg decreased by the equivalent of nearly half a liter. Pain was also decreased, from an
average score of 67 to 18 on a 100-point scale. Patients had improved walking ability, less pain
when walking, and improved ability to perform daily activities. The authors believe that including
exercise in the treatment program was a key factor in improving walking ability.
Dr. Bakar is also a co-author of the other paper, which reports on the use of CDP in a woman with
lymphedema related to the chronic skin condition psoriasis. In patients with lymphedema, obstruction
of the lymph nodes causes similar symptoms of leg pain and swelling. In both the short and long term,
CDP brought significant improvement in pain, swelling, and activity.
In recent years, CDP has become an accepted approach to treatment for lymphedema. Although not
a cure, CDP incorporates several physical therapy techniques that can help keep fluid buildup, leg
swelling, and pain under control.
The new studies are the first to evaluate the fully integrated CDP approach—including daily home
maintenance therapy—in patients with CVI and psoriasis-related lymphedema. "CDP is a time-
consuming process for patients and physiotherapists," Dr. Bakar and colleagues write. "However, it
is widely used and an effective treatment for patients with lymphedema." The new results suggest that
this combination physical therapy approach could also be very helpful for patients with leg pain and
swelling caused by CVI.
June 26, 2010 - This is Now Considered a Critical Piece of Cancer Treatment…-
The research of Dr. Kathryn Schmitz, which had already research reversed decades of cautionary
exercise advice given to breast cancer patients with lymphedema, led an expert panel to developed
the new recommendations.
According to Eurekalert:
"Cancer patients and survivors should strive to get the same 150 minutes per week of moderate-
intensity aerobic exercise that is recommended for the general public ... Though the evidence
indicates that most types of physical activity -- from swimming to yoga to strength training -- are
beneficial for cancer patients, clinicians should tailor exercise recommendations to individual patients".
Sources: Science Daily June 1, 2010
Dr. Mercola's Comments:
As little as a decade ago, it was common for physicians to advise their heart attack patients to avoid
exercise for fear that they could stress out their heart and trigger a second attack.
Now, it's common knowledge that exercise is a phenomenal way to strengthen your heart after a
heart attack as well as lessen your risk of further problems, and regular exercise is routinely
recommended to heart patients.
For cancer patients, this trend is still in the beginning stages, with many practitioners advising their
patients to avoid exercise during and after cancer treatment. But increasing evidence is showing that
this outdated advice is actually causing cancer patients harm, as regular exercise can lead to a
number of health improvements for cancer patients, including:
· Better aerobic fitness
· Increased muscular strength
· Improved quality of life
· Less fatigue
Exercise Improves Cancer Survival
I've written a lot about how exercise can help to reduce your risk of cancer in the first place, but
does it do any good if you're already fighting cancer? Yes … a lot.
Harvard Medical School researchers found patients who exercise moderately -- 3-5 hours a week
-- reduce their odds of dying from breast cancer by about half as compared to sedentary women. In
fact, any amount of weekly exercise increased a patient's odds of surviving breast cancer. This
benefit also remained constant regardless of whether women were diagnosed early on or after their
cancer had spread.
Patients receiving the biggest boost from exercise were those most sensitive to estrogen, the most
common form of breast cancer. (Previous research has shown exercise lowers estrogen levels, which
can fuel the growth of breast cancer cells.)
Think about it. If just three to five hours of walking per week can so drastically improve your
chances of surviving a hormone-responsive breast cancer tumor, imagine what a few more hours a
week of exercise could do for you.
If you're male, be aware that athletes have lower levels of circulating testosterone than non-athletes,
and similar to the association between estrogen levels and breast cancer in women, testosterone is
known to influence the development of prostate cancer in men.
Physical activity can reduce your risk and boost your chances of recovery if you have cancer.
Exercise is a Potent Cancer Fighter
Cancer thrives on sugar, but regular exercise reduces your insulin levels, which creates a low sugar
environment that discourages the growth and spread of cancer cells. Controlling your insulin levels is
one of the most powerful steps you can take to reduce your cancer risk and help keep it from
returning.
Physically active adults experience about half the incidence of colon cancer as their sedentary
counterparts. Exercise has a beneficial influence on insulin, prostaglandins and bile acids, all of which
are thought to encourage the growth and spread of cancer cells in your colon. Exercise also improves
bowel transit time, which means your body's waste is spending less time in contact with the mucosal
lining of your colon.
Exercise also improves the circulation of immune cells in your blood. The job of these cells is to
neutralize pathogens throughout your body.
The better these cells circulate, the more efficient your immune system is at locating and defending
against viruses and diseases, including cancer, trying to attack your body.
It's also been suggested that apoptosis (programmed cell death) is triggered by exercise, causing
cancer cells to die. So you can see why a regular exercise program is important not only during any
treatment you're receiving but also afterward as well.
Exercise Tips for Cancer Patients
I would also strongly recommend that you read the lead article in today's newsletter that reviews
some of the newest insights on how to optimize your exercise program and actually reduce your
exercise time and improve your benefits.
You will need to tailor your exercise routine to your individual scenario, taking into account your
stamina and current health. Often, you will be able to take part in a regular exercise program -- one
that involves a variety of exercises like strength training, core-building, stretching, aerobic and
anaerobic -- with very little changes necessary.
However, you may find that you need to exercise at a lower intensity or for shorter durations at
times. Always listen to your body and if you feel you need a break, take time to rest. Even exercising
for a few minutes a day is better than not exercising at all, and you'll likely find that your stamina
increases and you're able to complete more challenging workouts with each passing day.
In the event you are suffering from a very weakened immune system, you may want to exercise in
your home instead of visiting a public gym. But remember that exercise will ultimately help to boost
your immune system, so it's very important to continue with your program.
June 28, 2010 - HFM offers programming for cancer patients - Lakeshore health briefs -
MANITOWOC — The Holy Family Memorial Wellness Center is offering individual programming
for cancer patients.
Among the benefits: reduced pain and fatigue associated with cancer and treatments; prevention,
identification and management of lymphedema; increased treatment tolerance; and return to pre-
treatment levels of strength and fitness.
Wellness Center coordinator Melissa Sperbeck, recently certified as a cancer exercise specialist, will
meet with patients for a free consultation and discuss individual programming unique to each client
and illness. Funding for program participation is available through the Carol Rose Wester Fund.
For information, or to schedule a free consultation, call Sperbeck at (920) 320-4620.
Personal yoga instruction offered
MANITOWOC — The Holy Family Memorial Wellness Center is offering personal yoga instruction.
Wellness Center yoga instructor Corinne Knab has more than 30 years of yoga experience, and will
be studying this summer to earn certification as a yoga therapist.
Each session will begin with an assessment of how the individual is feeling, both physically and
emotionally. Based on the assessment, Knab will determine which breathing practices, poses and
meditation techniques to lead the participant through.
For information, call (920) 320-4600.
HFM Laboratory receives reaccreditation
MANITOWOC — Holy Family Memorial Laboratory has been awarded reaccreditation by the
Accreditation Committee of the College of American Pathologists (CAP), based on the results of a
recent onsite inspection. The reaccreditation includes the laboratories at Holy Family Memorial
Medical Center, Woodland Clinic and Harbor Town Campus.
The CAP Laboratory Accreditation Program, started in the early 1960s, is recognized by the federal
government as being equal to, or more strict than the government's own inspection program, an
HFM news release said.
During the CAP accreditation process, inspectors examine the laboratory's records and quality of
procedures for the previous two years. Inspectors also examine laboratory staff qualifications, as well
as the laboratory's equipment, facilities, safety program and record, in addition to the overall
management of the lab.
HFM offers free classes, screenings
MANITOWOC — Holy Family Memorial's Health Resource Center, 2300 Western Ave., offers
the following:
A free, one-hour class on the basics of how to search the Internet for health information is open to
the public on a one-on-one basis by appointment between 8 a.m. to 4 p.m. Monday through Friday.
To make an appointment, call (920) 320-2519.
A variety of health related books, videos and DVDs , a computer with Internet access,
knowledgeable staff and information on HFM physicians, programs and services is available to the
public during the above hours.
Free blood pressure screenings will be offered from 1 to 3 p.m. July 6 and 20 and from 9 to 11 a.m.
July 8 and 22. Walk-ins are welcome.
A cholesterol and blood sugar screening will be offered from 6:30 to 10 a.m. July 15. To schedule an
appointment, call (920) 320-6777.
June 28th, 2010 - More exercise prescribed for cancer survivors, even before they finish therapy –
WASHINGTON - New guidelines urge cancer survivors to exercise more, even, difficult as it may
sound, those who have not yet finished their treatment.
There Is growing evidence that physical activity improves quality of life and eases some cancer-
related fatigue. More, it can help fend off a serious decline in physical function that can last long after
therapy is finished.
Consider: In one year, women who needed chemotherapy for their breast cancer can see a swapping
of muscle for fat that is equivalent to 10 years of normal aging, says Dr. Wendy Demark-Wahnefried
of the University of Alabama at Birmingham.
In other words, a 45-year-old may find herself with the fatter, weaker body type of a 55-year-old.
Scientists have long advised that being overweight and sedentary increases the risk for various
cancers. Among the nearly 12 million U.S. cancer survivors, there are hints — although not yet proof
— that people who are more active may lower risk of a recurrence. Like everyone who ages, the
longer cancer survivors live, the higher their risk for heart disease that exercise definitely fights.
The American College of Sports Medicine convened a panel of cancer and exercise specialists to
evaluate the evidence. Guidelines issued this month advise cancer survivors to aim for the same
amount of exercise as recommended for the average person: about 2½ hours a week.
Patients still in treatment may not feel up to that much, the guidelines acknowledge, but should avoid
inactivity on their good days.
"You don't have to be Lance Armstrong," stresses Dr. Julia Rowland of the National Cancer
Institute, speaking from a survivorship meeting this month that highlighted exercise research. "Walk
the dog, play a little golf."
But how much exercise is needed? And what kind? Innovative new studies are under way to start
answering those questions, including:
—Oregon Health and Science University is training prostate cancer survivors to exercise with their
wives. The study will enrol 66 couples, comparing those given twice-a-week muscle-strengthening
exercises with pairs who do not get active.
Researchers think exercising together may help both partners stick with it. They also are testing
whether the shared activity improves both physical functioning and eases the strain that cancer puts
on the caregiver and the marriage.
"It has the potential to have not just physical benefits but emotional benefits, too," says lead
researcher Dr. Kerri Winters-Stone.
—Demark-Wahnefried led a recent study of 641 overweight breast cancer survivors that found at-
home exercises with some muscle-strengthening, plus a better diet, could slow physical decline.
—Duke University is recruiting 160 lung cancer patients to test whether three-times-a-week aerobic
exercise, strength training or both could improve their fitness after surgery. Lung cancer has long
been thought beyond the reach of exercise benefits because it so often is diagnosed at late stages.
Duke's Dr. Lee Jones notes that thousands who are caught in time to remove the lung tumour do
survive about five years, and he suspects that fitness, measured by how well their bodies use oxygen,
plays a role.
People with cancer usually get less active as symptoms or treatments make them feel lousy. Plus,
certain therapies can weaken muscles, bones, even the heart. Not that long ago, doctors advised
taking it easy.
Not anymore: Be as active as you are able, says Dr. Kathryn Schmitz of the University of
Pennsylvania, lead author of the new guidelines. "Absolutely it's as simple as getting up off the couch
and walking," she says.
Exercise programs are beginning to target cancer survivors, like Livestrong at the YMCA, a
partnership with cycling great and cancer survivor Armstrong's foundation. The American College of
Sports Medicine now certifies fitness trainers who specialize in cancer survivors.
Still, anyone starting more vigorous activity for the first time or who has particular risks, like the
painful arm swelling called lymphedema that some breast cancer survivors experience, may need
more specialized exercise advice, Schmitz says. They should discuss physical therapy with their
oncologist, she advises. For example, Schmitz led a major study that found careful weight training
can protect against lymphedema, reversing years of advice to coddle the at-risk arm. But the
average fitness trainer does not know how to offer that special training safely, she cautions.
Mary Lou Galantino of Wilmington, Delaware, is a physical therapist who specializes in cancer care
and kept exercising when her own breast cancer was diagnosed at the University of Pennsylvania in
2003. Then 42, she says she was on the treadmill within 24 hours of each chemo session, to stay fit
enough to care for her two preschoolers. "You can feel more energy" with the right exercise, says
Galantino, a physical therapy professor at the Richard Stockton College of New Jersey. "I was
giving my body up to the surgeons and chemo, but I could take my body back through yoga and
aerobic exercise."
June 29, 2010 - Recurrent furunculosis as a cause of isolated penile lymphedema: a case report - Ali
AlshahamSuneet Sood -
IntroductionIsolated lymphedema of the penis is extremely rare: combined involvement of the
scrotum and penis is the norm. Furunculosis as a cause is not, to our knowledge, previously reported.
We present a case of isolated penile lymphedema that responded to excision of lymphedematous
tissue and reconstruction with flaps.Case presentationA 32-year-old Arab man presented with a
three-year history of a gradually increasing, painless penile swelling. Our patient's main complaint was
non-erectile sexual dysfunction.
The swelling was preceded by at least three prior episodes of severe furunculosis at the penile root.
He had no other contributory past medical or family history.
On examination there was gross penile enlargement, maximally at the mid shaft, associated with
thickened skin at the sites of prior furunculosis. The glans and scrotum were normal.
Both testes were palpable. Serology for filariasis, and urinary tract ultrasound and computed
tomography scan were normal.
The clinical diagnosis was lymphedema following recurrent penile furunculosis. At operation the
lymphedematous tissues were removed.
Closure of the penile shaft was accomplished by bilateral advancement of flaps from both ends of the
penis. He resumed normal sexual activity one month after surgery.
At 12 months, he had a good cosmetic result, with no signs of recurrence.
Conclusions: Furunculosis at the penile root may result in lymphedema confined to the penile shaft,
sparing the scrotum. Excision of abnormal tissue and cover with a skin flap gave excellent cosmetic
results, and allowed satisfactory sexual activity.
June 29, 2010 - What's the Big Idea? Inaugural Conference Aims to Find out - By Joan Delaney -
Just as the G8 and G20 summits have wound up in Ontario, a conference of a very different kind is
being planned on the other side of the country in Victoria.
Called IdeaWave, the aim of conference is to bring innovative thinkers together to brainstorm a wide
range of issues, from sewage treatment and drug prohibition to health and public transit.
The two-day conference will feature 50 short talks on any topic the speaker desires, giving critical
thinkers from the Pacific Northwest a forum to explore issues that affect both their immediate region
and further afield.
“There’s a lot of critical thinkers out there who are meeting regularly, talking about ideas informally,
and so I just thought, ‘What would it take to get all of those people together in a room?’ To me,
having 200 critical thinkers in a room is quite exciting,” says event organizer Kris Constable.
Constable believes his conference is the first ever to keep the talks to 10 minutes with no limit on the
subject matter. Established ideas conferences that take place annually in Vancouver and California
cost between $3,000 and $7,000 to participate, he adds.
“I, like most North Americans, can’t afford to attend such a thing. So this is kind of my answer to
that. I'm going to make this the first approachable ideas conference ever. We've got both speakers
and attendees coming from Washington State and all over B.C.”
Limiting the talks to 10 minutes keeps them from becoming boring and “cuts right to the meat” of the
topic, he says.
“It separates the wheat from the chaff essentially. You've got 10 minutes to make sure that you’ve
clearly articulated your idea in the best way that you can. With 10 minutes you're concentrating your
talk to be as effective as possible.”
Frank Heidt, a chief executive officer with a company in Seattle, will talk about expanding on the
idea of transforming abandoned shipping containers into housing. There are about three million
unused shipping containers in the Pacific Rim because it’s cheaper for companies to leave them there
than return them to their country of origin empty or partially filled, according to Heidt.
His talk will be about using these shipping containers as lending libraries of hand tools, enabling
people in developing countries to “build their own future.”
Margaret Pulton, a nurse from B.C., will explore using technology to create clothing as a treatment
for Lymphedema, while Clem Persaud, a professor of biotechnology, will devote his 10 minutes to
how we can positively impact our lives by influencing the expression of our genes.
As well as airing their ideas, there will also be a chance for both speakers and attendees to mingle
and network.
“If your idea’s good enough that other people are excited, they're going to go ahead and talk to you
and hopefully get a few people helping you make your idea happen,” says Constable.
“These are the people who are kind of the thinkers and the doers in one.”
Being still a few shy of the required 50 speakers, Constable is looking for more people to submit
their proposals. The conference will take place July 10 and 11 at the Ambrosia Centre in downtown
Victoria.
June 29, 2010 - Community-based education strengthens campaign for elimination of lymphatic
filariasis - Joseph Quimby
Community-based lymphatic filariasis education in Orissa State, India, increased treatment
compliance from around 50% to up to 90%, according to a study published June 29 in the open-
access journal PLoS Neglected Tropical Diseases. In their study, researchers from the U.S. Centers
for Disease Control and Prevention, in partnership with the Church's Auxiliary for Social Action, an
India-based non-governmental organization, and IMA World Health, a US-based non-governmental
organization, identified barriers to compliance with India's MDA program for LF, and suggest that
timely educational and lymphedema management programs can reverse this trend.
Nearly 1.3 billion people worldwide live at risk of infection with the parasite that causes lymphatic
filariasis. Infected individuals may develop long-term complications, such as grossly swollen limbs
from lymphedema. Elimination of this disease of poverty requires giving drugs at least once per year
to people who are at risk; of that population, 80% or more need to continue receiving medication on
an annual basis for 5 or more years to stop transmission.
The authors evaluated a community-based education campaign, noted deficiencies, and designed
interventions to correct them. An evaluation of the revised education program, covering over 8,000
people in ninety villages, showed markedly improved drug compliance and, for the first time, showed
that lymphedema management programs, which teach leg care to patients with swollen legs, may also
increase compliance with lymphatic filariasis mass drug administration programs. The increase was
greatest in areas that had implemented U.S. Agency for International Development-supported
programs to teach people how to care for legs swollen from infection.
This evaluation was confined to rural areas in Orissa State, so the findings do not necessarily apply to
urban areas or areas outside the state. Nonetheless, lymphatic filariasis elimination programs facing
difficulties in achieving the necessary level of drug compliance should consider evaluating their
education campaigns using similar methods and integrating lymphedema management with lymphatic
filariasis elimination efforts, the authors say.
FINANCIAL DISCLOSURE: Funding for this work was provided by USAID (GHA-G-00-03-
0005-00) to IMA World Health and by CDC (IAA GHH99-006). The funders had no role in study
design, data collection and analysis, decision to publish, or preparation of the manucript.
COMPETING INTERESTS: The authors have declared that no competing interests exist
PLEASE ADD THIS LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF
YOUR REPORT: http://dx.plos.org/10.1371/journal.pntd.0000728
CITATION: Cantey PT, Rout J, Rao G, Williamson J, Fox LM (2010) Increasing Compliance with
Mass Drug Administration Programs for Lymphatic Filariasis in India through Education and
Lymphedema Management Programs. PLoS Negl Trop Dis 4(6): e728. doi:10.1371/journal.pntd.
0000728
Disclaimer
This press release refers to an upcoming article in PLoS Neglected Tropical Diseases. The release is
provided by the article authors and Centers for Disease Control and Prevention (CDC). Any
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and articles and your use of such information.
About PLoS Neglected Tropical Diseases
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tropical diseases, as well as public policy relevant to this group of diseases. All works published in
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For more information, visit http://www.plos.org.
June 29, 2010 - Lymphedema treatment options -
Chronic lymphedema often turns into cellulitis in patients with diabetes. What is the preferred
treatment?—PAULA JAUERING, ARNP, Leavenworth, Kan.
The diagnosis of lymphedema is usually made based on clinical presentation and history. Imaging
studies may also be used for diagnosis and evaluation of treatment; lymphoscintigraphy is considered
the gold standard. Duplex ultrasound, CT, and MRI may also be used. Conservative physiotherapy
treatments include complex or complete decongestive therapy (which incorporates manual lymphatic
drainage, compression bandages, myolymphokinetic exercises, skin care, and precautions during
daily activities) and pneumatic compression, also referred to as pressure therapy. Pneumatic
compression utilizes a segmental air pump to fill air chambers (gloves or boots) that provide pressure
to the edematous limb. Newer techniques include high-voltage electrical stimulation (which reduces
lymphedema by producing muscle contractions and relaxation that increase venous and lymphatic
flow) and laser therapy (which reduces fibosis and stimulates lymphangiogenesis, lymph activity,
lymphatic movement, macrophages, and the immune system). Surgical therapies for patients in whom
conservative therapy was not effective may include resection procedures, microsurgical interventions,
and liposuction.
For more information, see Rev Lat Am Enfermagem. 2009;17:730-736 and Ann Plast Surg. 2007;
59:464-472.—Philip R. Cohen, MD
June 30, 2010 - People and Places: Carroll Hospital foundation disperses funds to nonprofits -
The Carroll Hospital Center Foundation released more than $2.5 million to support programs and
services at Carroll Hospital Center and Carroll Hospice.
Jack Tevis, chairman of the Foundation’s Board of Trustees, presented checks to Mark Blacksten,
chairman of Carroll Hospice’s Board of Directors, and John Sernulka, FACHE, president and CEO
of Carroll Hospital Center.
The donation represents proceeds accumulated from the foundation’s various fundraising efforts for
the hospital and Carroll Hospice throughout the year. The funds will be used to support a variety of
capital programs including adding a new cardiovascular lab, renovating the emergency department’s
triage area as well as the waiting room in The Family Birthplace and creating a dedicated orthopaedic
unit on the third floor of the hospital.
In addition, the gifts will enhance many programs provided by the hospital including the navigation
and lymphedema services at The Women’s Place and Breast Center. It also will provide educational
support to staff such as those offered through the Libman Nursing Scholarship and the College
Scholarship for Dependants of Associates.
People and Places and New Business briefs offer information about Carroll County-based
companies, employees and their operations, and news of awards, promotions, new business
openings, new hires, etc. To have your information included, send your typed, double-spaced press
release to Business Briefs, Carroll County Times, P.O. Box 346, Westminster, MD 21158..
Information must reach this office within four weeks after an event.
Pub Med doc 1 (3):
Am J Med. 2010 Jun;123(6):489-95.
Caring for the breast cancer survivor: a guide for primary care physicians.
Chalasani P, Downey L, Stopeck AT.
Arizona Cancer Center, University of Arizona, Tucson, AZ 85724-5024, USA. pchalasani@azcc.
arizona.edu
Abstract
Breast cancer accounts for more than 25% of cancers in women. Because of improved screening
and treatment modalities, mortality has decreased significantly. Currently, over 2.5 million breast
cancer survivors live in the US and receive care from a primary care provider. Providers need to be
aware of common and serious complications of breast cancer treatment. In this review we discuss
complications of local and systemic treatment for breast cancer, including lymphedema, osteoporosis,
cardiovascular disease, and vasomotor symptoms. Current strategies for screening, monitoring, and
treating these complications also are outlined. Copyright 2010. Published by Elsevier Inc.
PMID: 20569749 [PubMed - in process]
Cancer. 2010 Apr 29. [Epub ahead of print]
A prospective cohort study defining utilities using time trade-offs and the Euroqol-5D to assess the
impact of cancer-related lymphedema.
Cheville AL, Almoza M, Courmier JN, Basford JR.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND:: The devastating impact of lymphedema on cancer survivors' quality of life has
prompted consideration of several changes in medical and surgical care. Unfortunately, our
understanding of the benefits gained from these approaches relative to their cost remains limited. This
study was designed to estimate utilities for lymphedema and characterize how utilities differ between
subgroups defined by lymphedema etiology and distribution.
METHODS:: A consecutive sample of 236 subjects with lymphedema seen at a lymphedema clinic
completed both a time trade-off (TTO) exercise and the Euroqol 5D. Responses were adjusted in
multivariate regression models for demographic factors, comorbidities, and lymphedema
severity/location.
RESULTS:: Most participants (167 of 236, 71%) had lymphedema as a consequence of cancer
treatment; 123 with breast cancer and upper extremity involvement. Mean TTO utility estimates were
consistently higher than Euroqol 5D estimates. Unadjusted TTO (0.85; standard deviation [SD],
0.21) and Euroqol 5D (0.76; SD, 0.18) scores diminished with increasing lymphedema stage and
patient body mass index (BMI). Adjusted utility scores were lowest in patients with cancer-related
lower extremity lymphedema (TTO = 0.82; SD, 0.04 and Euroqol 5D = 0.80; SD, 0.03). Breast
cancer patients also had lower adjusted Euroqol 5D scores (0.80; SD, 0.02).
CONCLUSIONS:: Lymphedema-associated utilities are in the range of 0.80. Lower utilities are
observed for patients with higher lymphedema stages, elevated BMI, and cancer-related
lymphedema. Greater expenditures for the prevention and treatment of cancer-related lymphedema
are warranted. Cancer, 2010. (c) 2010 American Cancer Society.
PMID: 20564063 [PubMed - as supplied by publisher]
Breast. 2010 Jun 17. [Epub ahead of print]
Self-reported arm-lymphedema and functional impairment after breast cancer treatment - A
nationwide study of prevalence and associated factors.
Gärtner R, Jensen MB, Kronborg L, Ewertz M, Kehlet H, Kroman N.
Department of Breast Surgery, Rigshospitalet 3103, Copenhagen University, 2100 Copenhagen,
Denmark.
Abstract
Lymphedema and impairment of function are well-established sequelae to breast cancer treatment
and affect an increasing number of women due to continually improved survival. The aim of the
present nationwide questionnaire study was to examine the impact of breast cancer treatment on
perceived swelling/sensation of heaviness (lymphedema) and on function, reporting prevalence in 12
subgroups of modern treatment and offering estimates for treatment-related associated factors. 3253
Women (87%) returned the study questionnaire. Depending on treatment group prevalence of
perceived swelling/heaviness varied from 13 to 65%. Associated factors were young age, axillary
lymph node dissection (ALND) and radiotherapy but not type of breast surgery or use of
chemotherapy. Depending on treatment group 11-44% had to give up activities. Giving up activities
was associated with pain and swelling/heaviness, younger age, ALND, chemotherapy, time elapsed
since surgery, and surgery on the dominant side. Radiotherapy and type of breast surgery were of no
importance. Copyright © 2010 Elsevier Ltd. All rights reserved.
PMID: 20561790 [PubMed - as supplied by publisher]
PUB MED DOC 2 (2)
Br J Community Nurs. 2010 Apr;15(4):S18-24.
Manual lymphatic drainage: exploring the history and evidence base.
Williams A.
Edinburgh Napier University. A.Williams@napier.ac.uk
Abstract
Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but there is limited
evidence to guide clinical practice. This paper outlines the historical background to MLD and
provides insights into the evidence relating to the effect and efficacy of manual lymph drainage,
highlighting considerations for lymphoedema practitioners.
PMID: 20559172 [PubMed - in process]
Jpn J Clin Oncol. 2010 Jun 17. [Epub ahead of print]
Evaluation of the Clinical Effectiveness of Physiotherapeutic Management of Lymphoedema in
Palliative Care Patients.
Clemens KE, Jaspers B, Klaschik E, Nieland P.
1Department of Science and Research, Centre for Palliative Medicine, University of Bonn.
Abstract
OBJECTIVE: Lymphoedema is a common sequela of cancer or its treatment that affects lymph node
drainage. The physiotherapist, as member of the multiprofessional team in palliative care, is one of the
keys to successful rehabilitation and management of patients with cancer and non-malignant
motoneuron disease such as amyotrophic lateral sclerosis and palliative care needs. The aim of the
study was to evaluate the frequency and effect of manual lymphatic drainage in palliative care patients
with lymphoedema in a far advanced stage of their disease.
METHODS: Retrospective study (reflexive control design) of data of the 208 patients admitted to
our palliative care unit from January 2007 to December 2007. Demographic and disease-related
data (diagnosis, symptoms, Karnofsky performance status and effect of manual lymphatic drainage
interventions) were documented and compared. Statistics: mean +/- SD, median; Wilcoxon's test.
RESULTS: Of the 208 patients, 90 who reported symptom load due to lymphoedema were
included; 67 (74.4%) had pain, 23 (25.6%) dyspnoea due to progredient trunk oedema. Mean age
65.5 +/- 13.0 years; 33 (36.7%) male; Karnofsky index 50% (30-80%), mean length of stay 15.6
+/- 8.0 days. The mean number of physiotherapeutic treatment interventions was 7.0 +/- 5.8.
Manual lymphatic drainage was well tolerated in 83 (92.2%) patients; 63 of 67 (94.0%) patients
showed a clinically relevant improvement in pain, and 17 of 23 (73.9%) in dyspnoea.
CONCLUSIONS: The majority of the patients showed a clinical improvement in the intensity of
symptoms after manual lymphatic drainage.
PMID: 20558463 [PubMed - as supplied by publisher]
Pub med doc 3 (1)
Ann Surg Oncol. 2010 Jun 24. [Epub ahead of print]
Morbidity of Sentinel Node Biopsy in Breast Cancer: The Relationship Between the Number of
Excised Lymph Nodes and Lymphedema.
Goldberg JI, Wiechmann LI, Riedel ER, Morrow M, Van Zee KJ.
Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY,
USA.
Abstract
BACKGROUND: Despite the reduced morbidity associated with sentinel lymph node biopsy
(SLNB), lymphedema remains a clinically relevant complication. We hypothesized that a higher
number of lymph nodes (LNs) removed during SLNB is associated with a higher risk of lymphedema.
METHODS: Six hundred patients with clinically node-negative breast cancer who underwent SLNB
were prospectively studied. Circumferential bilateral upper extremity measurements were performed
preoperatively and at 3-8 years after surgery. Association of lymphedema with total number of LNs
excised and other clinicopathologic variables was analyzed by the Spearman rank correlation
coefficient, Fisher's exact test, Wilcoxon rank sum test, and logistic regression.
RESULTS: At a median follow-up of 5 years, 5% of patients had developed lymphedema. Factors
associated with lymphedema included weight and body mass index. There was no association
between the number of LNs removed and the change in upper extremity measurements or in the
incidence of lymphedema. Among patients with lymphedema (n = 31) compared to those without,
the mean (3.9 vs. 4.2), median (4 vs. 3), and range (1-9 vs. 1-17) of number of LNs removed were
similar (P = 0.93). Among the 33 women with >/=10 LNs removed, none developed lymphedema.
CONCLUSIONS: In this population of 600 women who underwent SLNB, there is no correlation
between number of LNs removed and change in upper extremity circumference or incidence of
lymphedema. These data suggest that other factors, such as the global disruption of the lymphatic
channels during axillary lymph node dissection, play a larger role in development of lymphedema than
does the number of LNs removed.
PMID: 20574774 [PubMed - as supplied by publisher]
PUB MED DOC 4 (11)
Br J Community Nurs. 2010 Apr;15(4):S28-30.
Massage: a helping hand for people with chronic oedema and lymphoedema.
Pyke C.
British Lymphology Society. Cheryl.Pyke@abm-tr.wales.nhs.uk
Abstract
Skin care is fundamental in maintaining the integrity of one's skin and it has become modern practice
to wash and dry ourselves on a daily basis to eliminate odour and rejuvenate the skin. What is
becoming more apparent is that as health professionals we are not transferring this basic act to our
patient's care and this simple form of neglect can be detrimental to your patient's recovery.
Moreover, when washing with the soapy products that are available to us, and then drying ourselves
rigorously, we remove our skin's natural oils thus the skin appears drier and is more susceptible to
damage. This is where the simple application of a moisturising agent will not only replace the lost oils,
but it will in fact stimulate the initial lymphatics lying under your skin. The action of rubbing a cream or
emollient into the skin is a form of massage, and this simple action will go a very long way towards
the recovery of skin integrity and in the prevention of harm and infection. Make this part of your
practice when looking after your patient's wounds and swollen limbs.
PMID: 20559174 [PubMed - in process]
Br J Community Nurs. 2010 Apr;15(4):S18-24.
Manual lymphatic drainage: exploring the history and evidence base.
Williams A.
Edinburgh Napier University. A.Williams@napier.ac.uk
Abstract
Manual lymph drainage (MLD) is an integral part of lymphoedema treatment but there is limited
evidence to guide clinical practice. This paper outlines the historical background to MLD and
provides insights into the evidence relating to the effect and efficacy of manual lymph drainage,
highlighting considerations for lymphoedema practitioners.
PMID: 20559172 [PubMed - in process]
Br J Community Nurs. 2010 Apr;15(4):S10-6.
Lipoedema: presentation and management.
Todd M.
Specialist Lymphoedema Service, Greater Glasgow & Clyde NHS Trust. marie.todd@ggc.scot.nhs.
uk
Abstract
Lipoedema is a distinct clinical condition characterized by bilateral, symmetrical enlargement of the
buttocks and lower limbs owing to excess deposition of subcutaneous fat. It is found almost
exclusively in women. The common features associated with this condition are 'column- shaped' legs
with sparing of the feet, bruising, sensitivity to pressure, and orthostatic oedema. The progression to
lipo-lymphoedema or morbid obesity is possible. Conservative measures used in the management of
lymphoedema can prevent progression/limit the orthostatic oedema. Surgical procedures may also
play a part in the management of lipoedema.
PMID: 20559170 [PubMed - in process]
Jpn J Clin Oncol. 2010 Jun 17. [Epub ahead of print]
Evaluation of the Clinical Effectiveness of Physiotherapeutic Management of Lymphoedema in
Palliative Care Patients.
Clemens KE, Jaspers B, Klaschik E, Nieland P.
1Department of Science and Research, Centre for Palliative Medicine, University of Bonn.
Abstract
OBJECTIVE: Lymphoedema is a common sequela of cancer or its treatment that affects lymph node
drainage. The physiotherapist, as member of the multiprofessional team in palliative care, is one of the
keys to successful rehabilitation and management of patients with cancer and non-malignant
motoneuron disease such as amyotrophic lateral sclerosis and palliative care needs. The aim of the
study was to evaluate the frequency and effect of manual lymphatic drainage in palliative care patients
with lymphoedema in a far advanced stage of their disease.
METHODS: Retrospective study (reflexive control design) of data of the 208 patients admitted to
our palliative care unit from January 2007 to December 2007. Demographic and disease-related
data (diagnosis, symptoms, Karnofsky performance status and effect of manual lymphatic drainage
interventions) were documented and compared. Statistics: mean +/- SD, median; Wilcoxon's test.
RESULTS: Of the 208 patients, 90 who reported symptom load due to lymphoedema were
included; 67 (74.4%) had pain, 23 (25.6%) dyspnoea due to progredient trunk oedema. Mean age
65.5 +/- 13.0 years; 33 (36.7%) male; Karnofsky index 50% (30-80%), mean length of stay 15.6
+/- 8.0 days. The mean number of physiotherapeutic treatment interventions was 7.0 +/- 5.8.
Manual lymphatic drainage was well tolerated in 83 (92.2%) patients; 63 of 67 (94.0%) patients
showed a clinically relevant improvement in pain, and 17 of 23 (73.9%) in dyspnoea.
CONCLUSIONS: The majority of the patients showed a clinical improvement in the intensity of
symptoms after manual lymphatic drainage.
PMID: 20558463 [PubMed - as supplied by publisher]
Cochrane Database Syst Rev. 2010 Jun 16;6:CD005211.
Exercise interventions for upper-limb dysfunction due to breast cancer treatment.
McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, Mackey J, Courneya K.
Department of Physical Therapy, University of Alberta, 2-50, Corbett Hall, Edmonton, Alberta,
Canada, T6G 2G4.
Abstract
BACKGROUND: Upper-limb dysfunction is a commonly reported side effect of treatment for
breast cancer and may include decreased shoulder range of motion (the range through which a joint
can be moved) (ROM) and strength, pain and lymphedema.
OBJECTIVES: To review randomized controlled trials (RCTs) evaluating the effectiveness of
exercise interventions in preventing, minimi sing, or improving upper-limb dysfunction due to breast
cancer treatment.
SEARCH STRATEGY: We searched the Specialised Register of the Cochrane Breast Cancer
Group, MEDLINE, EMBASE, CINAHL, and LILACS (to August 2008); contacted experts,
handsearched reference lists, conference proceedings, clinical practice guidelines and other
unpublished literature sources.
SELECTION CRITERIA: RCTs evaluating the effectiveness and safety of exercise for upper-limb
dysfunction.
DATA COLLECTION AND ANALYSIS: Two authors independently performed the data
abstraction. Investigators were contacted for missing data.
MAIN RESULTS: We included 24 studies involving 2132 participants. Ten of the 24 were
considered of adequate methodological quality.Ten studies examined the effect of early versus
delayed implementation of post-operative exercise. Implementing early exercise was more effective
than delayed exercise in the short term recovery of shoulder flexion ROM (Weighted Mean
Difference (WMD): 10.6 degrees; 95% Confidence Interval (CI): 4.51 to 16.6); however, early
exercise also resulted in a statistically significant increase in wound drainage volume (Standardized
Mean Difference (SMD) 0.31; 95% CI: 0.13 to 0.49) and duration (WMD: 1.15 days; 95% CI:
0.65 to 1.65).Fourteen studies examined the effect of structured exercise compared to usual
care/comparison. Of these, six were post-operative, three during adjuvant treatment and five
following cancer treatment. Structured exercise programs in the post-operative period significantly
improved shoulder flexion ROM in the short-term (WMD: 12.92 degrees; 95% CI: 0.69 to 25.16).
Physical therapy treatment yielded additional benefit for shoulder function post-intervention (SMD:
0.77; 95% CI: 0.33 to 1.21) and at six-month follow-up (SMD: 0.75; 95% CI: 0.32 to 1.19). There
was no evidence of increased risk of lymphedema from exercise at any time point.
AUTHORS' CONCLUSIONS: Exercise can result in a significant and clinically meaningful
improvement in shoulder ROM in women with breast cancer. In the post-operative period,
consideration should be given to early implementation of exercises, although this approach may need
to be carefully weighed against the potential for increases in wound drainage volume and duration.
High quality research studies that closely monitor exercise prescription factors (e.g. intensity), and
address persistent upper-limb dysfunction are needed.
PMID: 20556760 [PubMed - in process]
In Vivo. 2010 May-Jun;24(3):309-14.
Milroy's Primary Congenital Lymphedema in a Male Infant and Review of the Literature.
Kitsiou-Tzeli S, Vrettou C, Leze E, Makrythanasis P, Kanavakis E, Willems P.
"Choremeio" Research Laboratory of Medical Genetics, Children's Hospital "Aghia Sophia", Thivon
and Levadeias, 11527, Greece. skitsiou@med.uoa.gr.
Abstract
BACKGROUND: Milroy's primary congenital lymphedema is a non-syndromic primary
lymphedema caused mainly by autosomal dominant mutations in the FLT4 (VEGFR3) gene. Here,
we report on a 6-month-old boy with congenital non-syndromic bilateral lymphedema at both feet
and tibias, who underwent molecular investigation, consisted of PCR amplification and DHPLC
analysis of exons 17-26 of the FLT4 gene. The clinical diagnosis of Milroy disease was confirmed by
molecular analysis showing the c.3109G>C mutation in the FLT4 gene, inherited from the
asymptomatic father. This is a known missense mutation, which substitutes an aspartic acid into a
histidine on amino acid position 1037 of the resulting protein (p.D1037H), described in two other
families with Milroy disease. A thorough genetic molecular investigation and clinical evaluation
contributes to the provision of proper genetic counseling for parents of an affected child with Milroy
disease. The herein described case, which is the third reported so far with c.3109G>C mutation,
adds data on genotypic-phenotypic correlation of Milroy disease. The relative literature regarding the
pathophysiology, molecular basis, clinical spectrum and treatment of Milroy disease is reviewed.
PMID: 20555004 [PubMed - in process]
Lymphology. 2010 Mar;43(1):42-4.
Primary lymphedema and acute leukemia--is there a link?
Todd M, Welsh J, Drummond MW.
Specialist Lymphoedema Clinic, NHS Greater Glasgow and Clyde, Scotland, UK. Marie.todd@ggc.
scot.nhs.uk
Abstract
The lymphedema service in Glasgow has been treating patients with lymphedema of all causes since
1991. In the past five years 3 patients with primary lymphedema have been diagnosed with
myelodysplasia (leading to acute leukemia) or acute leukemia. These are relatively unusual
malignancies given the ages of the patients and all three of these patients died within an average of 12
months of diagnosis. A connection between the presence of primary lymphedema and the subsequent
development of the hematological disorder is postulated. Standard marrow cytogenetics failed to
identify a common abnormality but the authors feel that further study is warranted.
PMID: 20552819 [PubMed - in process]
Lymphology. 2010 Mar;43(1):25-33.
Comparing two treatment methods for post mastectomy lymphedema: complex decongestive therapy
alone and in combination with intermittent pneumatic compression.
Haghighat S, Lotfi-Tokaldany M, Yunesian M, Akbari ME, Nazemi F, Weiss J.
Breast Research Department, Iranian Center for Breast Cancer, Tehran, Iran. Sh_haghighat@yahoo.
com
Abstract
There is no cure for breast cancer related lymphedema. This study was conducted to compare two
treatment methods for postmastectomy lymphedema: Complex Decongestive Therapy (CDT) and
Modified CDT (MCDT) combined with Intermittent Pneumatic Compression (IPC). One hundred
and twelve patients referred to the Lymphedema Clinic of the Iranian Center for Breast Cancer in
2008, were included in a randomized clinical trial. They were randomly allocated into two equal
groups receiving daily CDT alone or in combination with IPC. The volume reduction of the upper
limb was measured by water displacement volumetry. No statistically significant differences in
demographic and clinical variables between the two groups were observed. During the intensive
phase (phase I) of treatment, CDT alone yielded a significantly higher mean volume reduction than
the combination modality (43.1% vs. 37.5%; p = 0.036). Limb volume measured three months
following treatment, showed 16.9% volume reduction by CDT alone, and 7.5% reduction by MCDT
plus IPC. This study demonstrated that the use of CDT alone, or in combination with IPC
significantly reduced limb volume in patients with post mastectomy lymphedema. CDT alone
provided better results in both treatment phases. Further studies will help to define the role of
multidisciplinary approaches in the management of postmastectomy lymphedema.
PMID: 20552817 [PubMed - in process]
Lymphology. 2010 Mar;43(1):19-24.
Cutaneous metastasis of pancreatic carcinoma as an initial symptom in the lower extremity with
obstructive lymphedema treated by physiotherapy and lymphaticovenous shunt: a case report,
review, and pathophysiological implications.
Shimizu H, Maegawa J, Ho T, Yamamoto Y, Mikami T, Nagahama K.
Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama,
Japan. shimizu-ykh@umin.ac.jp
Abstract
Cutaneous metastasis from pancreatic cancer is relatively rare as an initial symptom, and it is
generally localized on the periumbilical area that is known as Sister Mary Joseph's nodule. We report
a rare case of a 49-year-old female who developed cutaneous metastasis of pancreatic cancer as an
initial symptom. The patient was referred to our department for treatment of lymphedema due to
surgical treatment of cervical cancer and underwent combined physiotherapy and, 2 months later, a
lymph venous anastomosis (LVA) for treatment of the lymphedema. Two months after the operation,
she developed erythema on her right leg which spread from the leg to the groin in series. This pattern
corresponded to the direction of lymph drainage, which may have been enhanced by the
conservative physiotherapy and LVA treatments. These facts suggest a possible relationship between
cutaneous metastasis of carcinoma and treatment for lymphedema. Alternatively, the
lymphedematous limb may be a privileged site for cancer growth, and metastatic seeding could have
taken place from pre-existing hematogenous spread at the time of operation.
PMID: 20552816 [PubMed - in process]
Lymphology. 2010 Mar;43(1):14-8.
A novel missense mutation and two microrearrangements in the FOXC2 gene of three families with
lymphedema-distichiasis syndrome.
Fauret AL, Tuleja E, Jeunemaitre X, Vignes S.
Département de Génétique et Centre de Référence des Maladies Vasculaires Rares, AP-HP,
Hôpital Européen Georges Pompidou Paris, France.
Abstract
Lymphedema-distichiasis (LD) syndrome is a rare autosomal dominant disorder of the FOXC2
gene, which codes for a forkhead transcription factor. Most of the mutations described in this gene to
date are deletions or insertions, suggesting a mechanism of haploinsufficiency. We studied three
independent families with LD presenting with both lymphedema and distichiasis. Two
microrearrangements (one 8-bp deletion and one 7-bp duplication) occurring in a GC-rich genomic
region (c.893-930) known to be prone to mutations were identified. A new missense mutation (p.
Lys132Glu) located in a highly conserved sequence, the forkhead domain, was also identified.
Mutations in this domain have been previously shown to impair FOXC2 transactivation ability. At a
genetic level, this study confirms the heterogeneity of mutations responsible for LD and is consistent
with a mechanism of haploinsufficiency. At a clinical level, it reinforces the importance of genetic
testing in subjects with familial lymphedema or distichiasis, since measures can be taken at an early
stage to prevent complications and to reduce the progression of lymphedema or delay its occurrence.
PMID: 20552815 [PubMed - in process]
Lymphology. 2010 Mar;43(1):1-13.
Impact of lymphedema and arm symptoms on quality of life in breast cancer survivors.
Hormes JM, Bryan C, Lytle LA, Gross CR, Ahmed RL, Troxel AB, Schmitz KH.
Department of Psychology, University of Pennsylvania , Philadelphia, Pennsylvania 19104-6021,
USA.
Abstract
Lymphedema is one of many arm problems reported by breast cancer survivors. Understanding the
impact of lymphedema on quality of life requires consideration that arm symptoms may occur with or
without lymphedema. It was hypothesized that specific arm symptoms and pain, related or unrelated
to lymphedema, would be more associated with quality of life outcomes than arm swelling. The
relation of arm swelling and of arm symptoms and associated severity with a range of quality of life
outcomes following breast cancer treatment was assessed in a diverse sample of 295 women, 141 of
whom had a clinical diagnosis of lymphedema. Arm swelling (as defined by interlimb volume or
circumference differences) and lymphedema severity (defined by Common Toxicity Criteria) were
less correlated with quality of life than total number of arm symptoms and specific individual
symptoms. Pain in the affected arm correlated with poor quality of life outcomes, regardless of arm
swelling. When evaluating the impact of lymphedema on quality of life, arm swelling may not be as
important as the total number and specific types of arm symptoms present, as these may be more
informative about quality of life outcomes in survivors of breast cancer with and without lymphedema.
PMID: 20552814 [PubMed - in process]
This one I don’t know where it goes, but you said “goes in news for July O/T and you never
answered me when I question it, so Im putting it here though it was sent to the group by Robert
Weiss but it isn’t about Medicare:
July 10, 2010 (1 doc)
FDA Warns of Risks With Unapproved Use of Quinine Sulfate
ROCKVILLE, Md -- July 8, 2010 -- The US Food and Drug Administration (FDA) today warned
that the unapproved use of the malaria drug quinine sulfate (Qualaquin) to treat night time leg cramps
has resulted in serious side effects and prompted the manufacturer to develop a risk management
plan aimed at educating healthcare professionals and patients about the potential risks.
Quinine is not FDA-approved to treat or prevent night time leg cramps.
A review of reports submitted to the FDA's Adverse Event Reporting System (AERS) between
April 2005 and October 1, 2008, found 38 US cases of serious side effects associated with the use
of quinine.
Quinine use resulted in serious and life-threatening reactions in 24 cases, including thrombocytopenia
and hemolytic uremic syndrome/thrombotic thrombocytopenic purpura.
In some patients, these side effects resulted in permanent kidney impairment and hospitalisation. Two
patients died. Most of those reporting serious side effects took the drug to prevent or treat leg
cramps or restless leg syndrome.
The risk management plan, called a Risk Evaluation and Mitigation Strategy (REMS), requires that
patients be given a Medication Guide explaining what quinine is and is not approved for, as well as
the potential side effects of the drug. The company is also required to issue a Dear Health Care
Provider Letter warning of the potential risk of serious and life-threatening haematologic reactions.
SOURCE: US Food and Drug Administration